Objective: To investigate the incidence of adverse event following immunization (AEFI) with 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) in Jiaxing City, Zhejiang Province, so as to provide insights into safety monitoring and evaluation of PCV13. Methods: Surveillance data of AEFI with PCV13 in Jiaxing City from 2020 to 2022 were collected from the AEFI Monitoring Information Management System of the Immunization Planning System of Chinese Disease Prevention and Control Information System, including demographic information, vaccination time, time of AEFI occurrence and clinical symptoms, and the reported incidence, population and district distribution, and clinical symptoms of AEFI with PCV13 were descriptively analyzed. Results: Totally 455 cases of AEFI with PCV13 were reported in Jiaxing City from 2020 to 2022, with a reported incidence rate of 232.33/105 doses. There were 431, 21 and 3 cases of general, abnormal, coincidence and psychogenic reactions, with reported incidence rates of 220.07/105 doses, 10.72/105 doses and 1.53/105 doses, respectively, and no reports of causal reaction, vaccine quality accident and vaccination accident. The AEFI cases included 258 boys and 197 girls, with a boy/girl ratio of 1.31∶1, and 288 children at ages of less than a year (63.30%). The largest number of AEFI was reported in Haining City (87 cases, 19.12%), and there were 349 AEFI cases (76.70%) within 24 hours following vaccination. The clinical symptoms mainly included redness and swelling, fever and induration, with reported incidence rates of 132.76/105 doses (260 cases), 109.27/105 doses (214 cases), and 55.66/105 doses (109 cases), respectively. There were 450 cases cured and 5 cases improved in 455 cases of AEFI. Conclusions General reaction is the predominant AEFI in Jiaxing City from 2020 to 2022, with mild symptoms. Most AEFI occurs within 24 hours following vaccination, and has a good prognosis.

OBJECTIVES: Peripheral whole blood cell counts have been used as prognostic indicators for various cancers, but their predictive value in nasopharyngeal carcinoma remain unclear. This study aims to evaluate the prognostic significance of the pretreatment hemoglobin×lymphocyte/monocyte ratio (HLMR) in non-recurrent, non-metastatic NPC patients undergoing definitive radiotherapy. METHODS: Clinical and follow-up data from 805 NPC patients who completed definitive radiotherapy or chemoradiotherapy were retrospectively analyzed. Pretreatment hemoglobin, lymphocyte count, and monocyte count were collected to calculate HLMR. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off value of HLMR. Patients were then classified into high and low HLMR groups. The association between HLMR and clinicopathological characteristic was assessed using chi-square tests. Independent prognostic factors for overall survival (OS) and progression-free survival (PFS) were identified using Cox proportional hazards models. A nomogram was constructed based on the independent predictors to estimate patient survival rates, and internal validation was performed using a validation cohort. RESULTS: The ROC curve identified 605.5 as the optimal HLMR cut-off value for predicting 5-year survival. Multivariate Cox regression analysis revealed that T stage (HR=1.886, 95% CI 1.331 to 2.673, P<0.001), N stage (HR=2.021, 95% CI 1.267 to 3.225, P=0.003), Eastern Cooperative Oncology Group (ECOG) score (HR=3.991, 95% CI 1.257 to 12.677, P=0.019), concurrent chemoradiotherapy regimen (HR=0.338, 95% CI 0.156 to 0.731, P=0.006), and HLMR (HR=0.648, 95% CI 0.460 to 0.912, P=0.013) were independent prognostic factors for OS. A nomogram including T stage, N stage, and HLMR in the training cohort was constructed to predict 3-, 5-, and 7-year OS, with a C-index of 0.713. The area under the curves for predicting 3-, 5-, and 7-year OS were 0.744, 0.665, and 0.682, respectively. Calibration curves showed good agreement between predicted and observed survival rates. The above results were further confirmed in the validation cohort. CONCLUSIONS Pretreatment HLMR may serve as a promising prognostic biomarker for patients with nasopharyngeal carcinoma.
Humans ; Nasopharyngeal Carcinoma/mortality* ; Prognosis ; Hemoglobins/analysis* ; Nasopharyngeal Neoplasms/pathology* ; Monocytes/cytology* ; Female ; Male ; Retrospective Studies ; Middle Aged ; Adult ; Aged ; Nomograms ; Chemoradiotherapy ; ROC Curve

Objective:To summarize the surgical treatment experience of extended thymectomy for myasthenia gravis(MG), and to explore the surgical treatment of MG.Methods:Retrospectively analyzed the clinical data of 527 MG patients undergoing extended thymectomy in our hospital from June 1996 to October 2017, including 242 males and 285 females, aged 5 to 77 years, with a mean age of(52.6±13.7) years old. The course of illness was 12 days to 18 years. There were 22 cases of hyperthyroidism, 7 cases of pure red blood cell aplastic anemia, 1 case each of hypothyroidism, irritable bowel disease, rheumatoid arthritis, ankylosing spondylitis and thrombocytopenia syndrome. There were 272 cases of MG in Osserman Ⅰ, 72 cases inⅡa, 78 cases inⅡb, 81 cases in Ⅲ, and 24 cases in Ⅳ, respectively. The muscle fatigue test and neostigmine test of all patients were positive, and the diagnosis was confirmed by chest CT examination. Meanwhile, summarize the perioperative data and postoperative follow-up.Results:3 cases died during the postoperative period, all of which were thymoma with MG, including 2 cases of Osserman Ⅲ MG and 1 case of Ⅳ MG; 15 cases of postoperative myasthenia crisis, including 2 OssermanⅡb cases, 11 Osserman Ⅲ cases and 2 Osserman Ⅳ cases, also including 7 cases of tracheotomy; 70 cases of plasma exchange, of whom 2 cases of hypotonic syndrome and 2 cases of lower extremity venous thrombosis. The postoperative pathological types were followed by thymic hyperplasia 293 cases(55.60%), thymoma 207 cases(39.28%), thymic cyst 24 cases(4.55%) and thymic atrophy 3 cases(0.57%) in descending order. 378 cases were followed up with an average follow-up of(85.9±58.5)months; MG with complete remission, partial remission, no change and deterioration accounted for 135(35.71%), 192(50.79%), 41(10.85%) and 10(2.65%)cases, respectively. Complete remission rate ranked as Osserman typeⅠ>Ⅱa>Ⅳ>Ⅱb>Ⅲ, the deterioration rate from high to low was Osserman type Ⅲ>Ⅳ>Ⅰ. 18 OssermanⅠcases showed no effects, whose preoperative course of disease> 5-10 years; 1 OssermanⅠcase was worsening who initially was diagnosed with ophthalmic MG and underwent video-assisted thoracoscopic thymectomy. The left thymus lobe was left unresected and developed 6 years later. Another operation was performed to remove the left lobe thymus, confirming the compensatory hypertrophy of the left lobe thymus. Among the worsening patients, 6 died, all of them were thymoma with MG, including 5 cases of type Ⅲ and one case of type Ⅳ. The cause of death was omyasthenia crisis(3 cases), sudden respiratory arrest after 3 months of rapid stopping of brompistigmine(2 cases)and cholinergic crisis(1 case).Conclusion:Standardized extended thymectomy is an effective method for the treatment of MG. Earlier surgery for ocular muscle type MG can effectively reduce the risk of generalization. MG with Osserman Ⅱb or higher is prone to myasthenia crisis. Comprehensive treatments should be taken to reduce MG-related risks. Myasthenia crisis can occur repeatedly in severe patients in the long term after surgery, requiring regular medication and comprehensive MG treatments.

To investigate the clinical efficacy of extended thymectomy by subxiphoid approach video-assisted thoracoscopic surgery(VATS) for myasthenia gravis. Methods We retrospectively analyzed the clinical date of 64 cases of myasthenia gravis treated by subxiphoid approach VATS in the same surgical team from September 2015 to April 2018. The patients were equally divided into 4 groups(A, B, C and D) according to the date of operation. Comparisons were made among the four groups in operation time, blood loss during operation, rate of conversion to thoracotomy, postoperative complications, postoperative hospital stay, duration and amount of postoperative chest tube drainage, frequenlly of surgery. The operative effect of different stage was analyzed. Results There were no intraoperative deaths. 1 patient(group A) was converted to thoracotomy. 3 patients(2 cases of group A; 1 case of group D) had lung infection. 1 patient(group B) developed myasthenia crisis after surgery, and the rest patients showed obvious improvement in postoperative myasthenia symptoms. No significant differences were found in postoperative complications, rate of conversion to thoracotomy, postoperative hospital stay, duration and amount of postoperative chest tube drainage among the 4 groups(P >0. 05). The operation time was significantly longer in group A(186. 25 ± 25. 79) min than the other 3 groups [B(128. 75 ± 16. 28) min, C(135. 00 ± 21. 29) min, D(128. 75 ± 19. 62)min], P <0. 05. The blood loss in surgery was significsntly more in group A(110. 00 ±38. 82)ml than that in the other 3 groups[B(63. 75 ±28. 26)ml, C(58. 13 ±27. 86)ml, D(58. 75 ±25. 00)ml], P <0. 05, while no statistical difference was found among group B, C and D. The frequency of surgery was increased from 1. 6 cases in group A to 2. 3, 2. 7 and 2. 7 cases one month in B, C and D, respectively. Conclusion The results of the present study have shown that subxiphoid approach VATS thymectomy is safe and feasible for the treatment of MG patients. For thoracic surgeons with certain experience in thoracoscopic technique, a plateau of the surgical skill of the subxiphoid opproach can be reached after learning curve procedures.

Objective: To observe the effect of moxibustion on the expressions of tumor necrosis factor-α (TNF-α) and nuclear transcription factor kappa B (NF-κB) proteins in ankle joints of rats with rheumatoid arthritis (RA), and to explore the anti-inflammatory mechanism of moxibustion in the treatment of RA.Methods: Adjuvant arthritis (AA) rat models were induced and used as rat models of RA. Rats were randomly divided into a normal group, a model group, a moxibustion group and a saline group. Rats in the normal and model groups were not treated; rats in the moxibustion group accepted treatment by moxibustion at Zusanli (ST 36) and Shenshu (BL 23) after modeling; rats in the saline group were injected with 0.15 mL saline to the bottom of the left hind paw and had no other treatments. Hematoxylin-eosin (HE) staining was used to observe the histopathological changes of rats' ankle joints under light microscope. Immunohistochemistry was used to observe the expressions of TNF-α and NF-κB in ankle joints of rats.Results: Compared with the normal group, the rats' ankle joints in the model group showed disorganization, joint surface defect, and significantly increased mean optical density (MOD) of TNF-α and NF-κB (allP<0.05). After moxibustion treatment, rats in the moxibustion group showed repaired ankle tissues, smooth joint surface without defects, decreased MOD of TNF-α and NF-κB than those in the model group (allP<0.05). Rats in the saline group had no damage to ankle joints, while TNF-α and NF-κB were significantly different from those in the model group (P<0.05).Conclusion: Moxibustion could down-regulate the expressions of NF-κB and TNF-α protein in ankle joints of RA rats, and produce an anti-inflammatory effect to promote tissue repair.

Objective Based on the different physiological characteristics of the mastoid skin and soft tissue in congenital microtia malformation ,the different ear reconstructivemethod were respectively applied for the individuals with microtia .And the feasibility of personalized treatment to microtia patients was explored in this study .Method Considering different thickness and tightness in mastoid hairless skin and soft tissue,2129 microtia patients were received the skin expansionmethod of ear reconstruction surgery , while 1321 cases were treated with Nagata ' s technique, and 330 cases with skin and fascia expansionmethod . Result With average 10-month follow-up,1944 ( 91.31％) cases using the mastoid skin expansionmethod were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance.305(92.42％)cases using the skin and fascia expansionmethod were satisfied with theresult .1264 (95.69％) cases using Nagata ' s two—stagemethod received satisfactory outcomes .49 ( 3.71％) cases showed partial exposure of the cartilage framework .There were no postoperative complications , such as chest wall deformity or affected normal physical function .Conclusion Based on the different physiological characteristics of the mastoid skin and soft tissue ,it's beneficial to select individualized operationalmethod in ear reconstruction for congenital microtia among Chinese patients .

Objective Based on the different physiological characteristics of the mastoid skin and soft tissue in congenital microtia malformation ,the different ear reconstructivemethod were respectively applied for the individuals with microtia .And the feasibility of personalized treatment to microtia patients was explored in this study .Method Considering different thickness and tightness in mastoid hairless skin and soft tissue,2129 microtia patients were received the skin expansionmethod of ear reconstruction surgery , while 1321 cases were treated with Nagata ' s technique, and 330 cases with skin and fascia expansionmethod . Result With average 10-month follow-up,1944 ( 91.31％) cases using the mastoid skin expansionmethod were satisfied with the outcome of the reconstructed ear including three dimensional position and subunit appearance.305(92.42％)cases using the skin and fascia expansionmethod were satisfied with theresult .1264 (95.69％) cases using Nagata ' s two—stagemethod received satisfactory outcomes .49 ( 3.71％) cases showed partial exposure of the cartilage framework .There were no postoperative complications , such as chest wall deformity or affected normal physical function .Conclusion Based on the different physiological characteristics of the mastoid skin and soft tissue ,it's beneficial to select individualized operationalmethod in ear reconstruction for congenital microtia among Chinese patients .

OBJECTIVE: To analyze the impact of β-tubulin-III (TUBB3), thymidylate synthase (TS) and excision repair cross complementation group 1 (ERCC1) mRNA expression on chemoresponse and clinical outcome of patients with advanced gastric cancer treated with TXT/CDDP/FU (DCF) regimen chemotherapy. METHODS: The study population consisted of 48 patients with advanced gastric cancer. All patients were treated with DCF regimen palliative chemotherapy. The mRNA expressions of TUBB3, TS and ERCC1 of primary tumors were examined by multiplex branched-DNA liquid chip technology. RESULTS: The patients with low TUBB3 mRNA expression had higher response rate to chemotherapy than patients with high TUBB3 expression (P=0.011). There were no significant differences between response rate and TS or ERCC1 expression pattern. Median overall survival (OS) and median time to progression (TTP) were significantly longer in patients with low TUBB3 mRNA expression (P=0.002, P<0.001). TS or ERCC1 expression was not correlated with TTP and OS. In the combined analysis including TUBB3, TS and ERCC1, the patients with 0 or 1 high expression gene had better response rate, TTP and OS than the remaining patients (all P<0.001). Multivariate analysis revealed that ECOG (Eastern Cooperative Oncology Group)≥2 (HR=2.42, P=0.009) and TUBB3 (HR=2.34, P=0.036) mRNA expression significantly impacted on OS. CONCLUSION High TUBB3 mRNA expression is correlated with resistance to DCF regimen chemotherapy. TUBB3 might be a predictive and prognostic factor in patients with advanced gastric cancer treated with TXT-based chemotherapy. The combined evaluation of TUBB3, TS and ERCC1 expression can promote the individual treatment in advanced gastric cancer.
Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Biomarkers, Tumor ; metabolism ; DNA-Binding Proteins ; genetics ; metabolism ; Drug Resistance, Neoplasm ; Endonucleases ; genetics ; metabolism ; Humans ; RNA, Messenger ; genetics ; metabolism ; Stomach Neoplasms ; drug therapy ; genetics ; Thymidylate Synthase ; genetics ; metabolism ; Treatment Outcome ; Tubulin ; genetics ; metabolism

Objective To identify the main etiologies of emergency room (ER) patients with chest pain or equivalent syndrome.Methods This was a prospective and cross-sectinal survey of ER patinets with chest pain or equivalent syndrome in 17 medical centre in Beijing,China from July to August 2009.Data was collected by structured interviews and medical record reviews.The mean follow up period was 30 days.Results A total of 5666 patients were enrolled in the study (2663 males and 3303 females) and the mean age was 58.1 ± 18.4years.Their final diagnoses were:coronary heart disease 1506 ( 27.4％ ),acute heart failure 149 ( 2.6％ ),pericarditis 4 ( 0.1％ ),pulmonary embolism 11 ( 0.2％ ),aortic dissection 8 ( 0.1％ ),acute cerebrovascular disease 431 ( 7.6％ ) and non-cardic chest pain 2538 ( 44.9％ ).Thirty-seven cased died and 275 cases hospitalized again 30 days later,4.9％ patients with cornary heart disease had symptoms at their presentation.Conclusion Special vigilance and thorough coronary artery evaluation are needed for all patients with chest discomfort or respiratory distress in the ER,even for patients without chest pain.

Objective To analyze the clinical features of rectal and perianal inflammatory myofibroblastic tumor and evaluate its diagnosis and treatment.Method Clinicopathological data of 3 cases diagnosed as inflammatory myofibroblastic tumor from January,2005 to June,2011 were retrospectively reviewed.Results Inflammatory myofibroblastic tumor presents as infiltrative growth mass with rich vascularization on CT or MRI,and is difficult to distinguish from hemangioma and other rectal tumors.Preoperative biopsy usually fails to ascertain the entity of mass,and pathological examination of the whole resected specimen with immunohistochemical staining is needed to make final diagnosis.All 3 cases underwent sphincter preserving surgery.One case received a second radical operation 16 months after primary resection because of local recurrence.All patients are followed up to now,with a survival time of 67 months,55 months,and 35 months respectively.Conclusions Rectal and perianal inflammatory myofibroblastic tumor is difficult to diagnose on preoperative imaging examinations or biopsy.Immunohistochemical staining is needed to make final diagnosis.Sphincter preserving surgery with complete tumor removal could achieve long term survival.