Objective By comparison with the surgical resection,to evaluate the relapse-free survival(RFS),overall survival(OS),and clinical safety of transcatheter hepatic arterial chemoembolization(TACE)combined with microwave ablation(MWA)in the treatment of early primary hepatocellular carcinoma(HCC).Methods From January 2013 to January 2018 at authors'hospital,51 HCC patients received TACE combined with MWA(TACE+MWA group)and 58 HCC patients received surgical resection(RES group).The HCC lesions were single tumor with diameter ≤7 cm or multiple tumors with stage Ⅰ a-Ⅱ a meeting the"up-to-7"criteria.The postoperative RFS,OS,and clinical safety were compared between the two groups.Results The one-,3-and 5-year RFS in the TACE+MWA group were 84.3％,37.3％and 13.7％respectively,which in the RES group were 67.2％,27.6％and 13.8％respectively.The difference in the one-year RFS between the two groups was statistically significant(P=0.039),and the differences in the 3-and 5-year RFS between the two groups were not statistically significant(P=0.281 and P=0.992,respectively).The one-,3-and 5-year survival rates in the TACE+MWA group were 98％,62.7％and 45.1％respectively,which in the RES group were 94.8％,75.9％and 44.8％respectively,and the differences between the two groups were not statistically significant(P=0.704,P=0.137 and P=0.977 respectively).No treatment-related death occurred in both groups.In the TACE+MWA group,the main complications included transient embolism syndrome,abdominal pain during ablation procedure,and mild to moderate transient elevation of transaminase after treatment.In the RES group,the main postoperative complications included fever,pleural effusion,abdominal effusion,and intraoperative bleeding;and in one patient the postoperative liver function impairment worsened to Child grade C.The average cost of hospitalization in the TACE+MWA group was(39 834.98±6 717.38)Chinese yuan,which in the RES group was(49 042.59±11 810.69)Chinese yuan,the difference between the two groups was statistically significant(P=0.017).The hospitalization length in the TACE+MWA group was 23 days(19-28 days),which in the RES group was 21 days(17-25 days),and the difference between the two groups was not statistically significant(P=0.196).Conclusion For the treatment of early HCC,TACE combined with MWA has reliable curative effect,and also has the advantages of being safe and economical.Therefore,this therapy can be used as a preferred option of non-surgical treatment for single tumor with ≤7 cm diameter or multiple tumors with stage Ⅰ a-Ⅱa meeting"up-to-7"criteria.(J Intervent Radiol,2024,33:488-494)

Objective:To explore the effect and safety of endoscopic tubular musculoskeletal tumor surgery (ETMS) technology in spinal tumors.Methods:Clinical data were retrospectively collected from 18 spinal tumor patients who were treated with ETMS technology at Tianjin Medical University Cancer Institute and Hospital ( n=16) or the Affiliated Hospital of Qingdao University ( n=2) from November 2022 to December 2023. The total cohort included 11 males and 7 females, with the age at 60.3±8.6 years (range of 41-76). Two cases were diagnosed with benign tumors, four patients were diagnosed with spinal hematologic malignancies while other 12 cases were patients with spinal metastases. After localization under the C-arm X-ray machine, the spinal endoscopic channel is established using dilators. Soft tissue is dissected under endoscopic guidance to create an artificial cavity. Subsequently, the saline medium relied upon by the spinal endoscopic technique is removed, and posterior decompression and tumor curettage are performed using tubular techniques. Frankel grade classification and paraplegia index were used to evaluate the improvement of postoperative function and the VAS score was performed in pain scoring. The surgical complications and tumor evaluation were observed by postoperative outpatient and telephone follow-up. Results:The ETMS technology was successfully completed in all 18 patients with the mean operation time of 240.3±80.2 min. The median of intraoperative bleeding was 200.0(172.5, 350.0) ml and the mean postoperative drainage was 131.4±69.5 ml. The median value of postoperative hospitalization days was 6.0(4.0, 10.25) d. The paraplegia index decreased from 1.5(0, 3.0) preoperatively to 0(0, 1.25) postoperatively ( Z=-2.599, P=0.009). All the patients presented an improvement in Frankel grading after surgery except for one patient (downgrading from grade E to grade D). There was significantly difference in Frankel grading between preoperative and postoperative groups ( Z=2.812, P=0.005). The median value of preoperative VAS score was up to 5.5(4.0, 7.0) while the median value at postoperative, one month after surgery and three months after surgery were 1.5(1.0, 2.25), 1.0(0, 1.0) and 0(0, 1.0), respectively (χ 2=44.641, P<0.001). The 3-month postoperative VAS improvement rate was 91.2% (range 75%-100%). During a mean follow-up period of 7.6±6.2 months, none of the 18 patients presented surgical complications or tumor recurrence at surgical region. Only one patient died at 3.2 months after surgery until the last follow-up due to respiratory failure after lung tumor progression. The mean survival of the total cohort was up to 13.3 [95% CI (11.5, 15.0)] months. The 16 cases with spinal metastases or spinal hematological malignancies had a mean survival of 13.2 [95% CI (11.3, 15.0)] months. Conclusion:The ETMS technology presented good efficacy and safety in treatment of spinal tumors with low blood supply and with diameter less than 5cm.

OBJECTIVE To observe the efficacy and safety of ceftazidime and avibactam sodium （CAZ/AVI） in the treatment of carbapenem-resistant organism （CRO） infection. METHODS The information of patients with CRO infection admitted to the Second Affiliated Hospital of Soochow University from September 2019 to March 2022 was collected， and the patients were retrospectively divided into observation group （48 cases） and control group （48 cases） according to the treatment plan. The control group was given Polycolistin B sulfate for injection intravenously at a dose of 500 000 U every 12 hours； no dose adjustment was performed in patients with renal insufficiency or receiving continuous renal replacement therapy （CRRT）. The observation group was given continuous micropump of CAZ/AVI for injection intravenously at a dose of 2.5 g every 8 hours for 2 continous hours； among them， the patients with renal insufficiency received an adjusted dose based on creatinine clearance， and no dose adjustment was performed in patients receiving CRRT. The clinical efficacy and microbiological efficacy as well as body temperature， white blood cell （WBC）， C-reactive protein （CRP） and procalcitonin （PCT） before and after treatment were compared between 2 groups. The prognosis and the occurrence of adverse drug reactions were recorded. The factors influencing the clinical efficacy were screened by Logistic regression analysis. RESULTS The effective rate and microbial clearance rate of the observation group were significantly higher than the control group （P＜0.05）. After treatment， body temperature， PCT and CRP of 2 groups were significantly lower than before treatment， and CRP of the observation group was significantly lower than the control （No.SDFEYJLC2105） group （P＜0.05）. There was no statistically significant differencebetween the two groups in terms of rehabilitation discharge rate， the proportion of patients transferred to general wards，the proportion of dead patients， and the total incidence ofadverse drug reactions （P＞0.05）. CAZ/AVI and prolonging therapy duration were more likely to achieve clinical benefits （odds ratios of 1.146， 7.707，P＜0.05）， while lung infection and CRRT may be independent risk factors for treatment failure （odds ratios of 0.182， 0.236， P＜0.05）. CONCLUSIONS CAZ/AVI has good efficacy and safety in the treatment of CRO infection， the appropriate extension of antibacterial treatment time can achieve a higher clinical response rate， while lung infection or CRRT may lead to treatment failure.

OBJECTIVES: This study investigate the clinical and imaging features of Ewing sarcoma (ES) of the jaw. METHODS: Eight cases of pathologically diagnosed ES of the jaw from January 2010 to June 2022 were included in the study. Clinical and radiological features were retrospectively analyzed. RESULTS: Among the eight cases, the mean age at onset was 29.4 years, and the male to female ratio was 7∶1. The predilecting site was the posterior part of mandible, accounting for 75% of the cases. The lesions often exhibited early numbness of the lower lip and lymphadenopathy. The main radiographic manifestation of mandibular lesions was ill-defined radiolucency, mixed with fibrous or brush-like tumor matrix, and soft tissue mass. The maxillary ES lesions mainly presented as lytic bone destruction accompanied by adjacent soft tissue mass. Periosteal ossification was rarely seen. CONCLUSIONS The clinical and imaging characteristics of ES in the jaw are helpful for its diagnosis.
Male ; Humans ; Female ; Sarcoma, Ewing/pathology* ; Retrospective Studies ; Radiography ; Mandible/pathology* ; Lip ; Bone Neoplasms

Objective To establish a high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method for simultaneous determination of sodium valproate and vancomycin in human serum. Methods Valproic acid-d₆ and kanamycin B were used as the internal standard of sodium valproate and vancomycin, the serum samples were treated by acetonitrile precipitation protein method. The mobile phase was 0.1% formic acid aqueous solution-acetonitrile for gradient elution. The flow rate was 0.5 ml/min, with column temperature at 25 ℃. The sample volume was 4 μl and total analysis time was 12 min. The positive and negative ion mode was monitored by electrospray ion source and the multiple reaction monitoring mode was used for quantitative analysis. The specificity, standard curve, lower limit of quantification, precision, recovery, matrix effect, and stability of the method were examined. Results Sodium valproate and vancomycin had good linear relationships in the range of 1 - 200 μg/ml and 0.5 - 100 μg/ml, respectively. The quantitative lower limits were 1 μg/ml and 0.5 μg/ml, respectively. The extraction recoveries were above 70%. The inter- and intra-batch precision RSD values were less than 10%. The stability was good and there was no obvious matrix effect. Conclusion This method is simple, quick, sensitive, specific and accurate, which could be used to simultaneously determine the concentration of sodium valproate and vancomycin in human serum.

Objective:To analyze the mediating effect of work-occupation fit between occupational stress and anxiety symptoms in medical staff.Methods:Convenience sampling method was adopted to select participants of one general hospital and three specialized hospitals as respondents for a questionnaire survey in Henan Province from October 2020 to January 2021. A total of 2050 medical staff were investigated, and 1988 valid questionnaires were collected, and the effective rate of the questionnaire was 97.0% (1988/2050) . The "Depression-Anxiety-Stress Scale" and "Worker-Occupation Fit Inventory" were used to evaluate the occupational stress, anxiety symptoms and worker-occupation fit level of medical staff, and the mediation effect of work-occupation fit on the relationship between occupational stress and anxiety symptoms was analyzed using a mediating effect model.Results:The average age of the 1988 medical staff was (32.7±7.8) years old, the positive detection rates of occupational stress and anxiety symptoms were 42.5% (845/1988) and 56.7% (1127/1988) , respectively. Anxiety symptoms of medical staff were positively correlated with occupational stress, negatively correlated with worker-occupation fit ( r=0.831, -0.364, P<0.001) , work-occupation fit was negatively correlated with occupational stress ( r=-0.259, P<0.001) . The results of the mediation effect analysis showed that occupational stress had a direct effect on anxiety symptoms ( β=0.677, BCa 95% CI: 0.648-0.707) , and worker-occupation fit ( β=0.047, BCa 95% CI: 0.039-0.056) , characteristic fit ( β=0.089, BCa 95% CI: 0.074-0.104) , need-supply fit ( β=0.075, BCa 95% CI: 0.062-0.089) , and ability-demand fit ( β=0.035, BCa 95% CI: 0.026-0.044) mediated the association between occupational stress and anxiety symptoms in medical staff, with the mediating effect as a percentage of 6.5%, 12.3%, 10.3%, and 4.8%, respectively. Conclusion:Worker-occupation fit has a mediating effect between occupational stress and anxiety symptoms in medical staff, but mainly direct effect.

Objective:To analyze the mediating effect of work-occupation fit between occupational stress and anxiety symptoms in medical staff.Methods:Convenience sampling method was adopted to select participants of one general hospital and three specialized hospitals as respondents for a questionnaire survey in Henan Province from October 2020 to January 2021. A total of 2050 medical staff were investigated, and 1988 valid questionnaires were collected, and the effective rate of the questionnaire was 97.0% (1988/2050) . The "Depression-Anxiety-Stress Scale" and "Worker-Occupation Fit Inventory" were used to evaluate the occupational stress, anxiety symptoms and worker-occupation fit level of medical staff, and the mediation effect of work-occupation fit on the relationship between occupational stress and anxiety symptoms was analyzed using a mediating effect model.Results:The average age of the 1988 medical staff was (32.7±7.8) years old, the positive detection rates of occupational stress and anxiety symptoms were 42.5% (845/1988) and 56.7% (1127/1988) , respectively. Anxiety symptoms of medical staff were positively correlated with occupational stress, negatively correlated with worker-occupation fit ( r=0.831, -0.364, P<0.001) , work-occupation fit was negatively correlated with occupational stress ( r=-0.259, P<0.001) . The results of the mediation effect analysis showed that occupational stress had a direct effect on anxiety symptoms ( β=0.677, BCa 95% CI: 0.648-0.707) , and worker-occupation fit ( β=0.047, BCa 95% CI: 0.039-0.056) , characteristic fit ( β=0.089, BCa 95% CI: 0.074-0.104) , need-supply fit ( β=0.075, BCa 95% CI: 0.062-0.089) , and ability-demand fit ( β=0.035, BCa 95% CI: 0.026-0.044) mediated the association between occupational stress and anxiety symptoms in medical staff, with the mediating effect as a percentage of 6.5%, 12.3%, 10.3%, and 4.8%, respectively. Conclusion:Worker-occupation fit has a mediating effect between occupational stress and anxiety symptoms in medical staff, but mainly direct effect.

Objective:To preliminarily discuss the difference of ovary anti-miillerian hormone ( AMH) when cyclophosphamide is used in different time during menstrual cycle .Methods:Totally 30 young female patients with average age of (36 ±6.39) diagnosed as glomerular disease were treated with cyclophosphamide .According to the medication time , the patients were divided into follicular phase group and secretory phase group based on the property of menstrual cycle .Follicular phase group was treated with cyclophospha-mide during the first day and the eighth day of menstrual cycle .Secretory phase group was treated with cyclophosphamide after ovulato-ry time, namely the 14th day-the 16th day of menstrual cycle.AMH was detected before the drug treatment and 1st, 3rd, 6th and 10th cycles after cyclophosphamide treatment in the two groups .Results: AMH in the five periods had no statistic difference between the groups (P>0.05).There was significant difference in AMH before the treatment and after one-month treatment in the same group(P<0.05).AMH in different age groups showed statistic difference (P<0.05).Conclusion:There is no significant difference in AMH when cyclophosphamide is administrated in different time of menstrual cycle .However , ovarian function is impaired just by low dose cyclophosphamide (0.8g) with the first administration and will be recovered slowly at least half a year after the drug withdrawal .

Objective: To evaluate the effects of application of vancomycin in the early stage of patients with extremely severe burn, in order to provide reference to drug for anti-infection treatment in the early stage of patients with extremely severe burn. Methods: Data of 15 patients of Kunshan explosion on August 2nd, 2014, admitted to the Department of Intensive Care in our hospital were retrospectively analyzed. The clinical efficacy of continuously intravenous dripping of vancomycin (combined with imipenem) in the early stage of burns (before and on post burn day 14) was analyzed. (1) The steady state plasma concentration of vancomycin was monitored respectively 30 min before the third, sixth, and tenth medication with direct chemiluminescent imaging method. (2) The distribution of Gram-positive bacteria of patients during hospitalization and their drug resistance to 14 antibiotics commonly used in clinic were analyzed. (3) Serum level of procalcitonin (PCT), white blood cell count, percentage of neutrophils before and after treatment, and efficacy grade of anti-infection treatment in the early stage of burns were analyzed. (4) Serum levels of aspartate transaminase (AST), alanine aminotransferase (ALT), creatinine before and after treatment, and the adverse effects during medication were analyzed. The WHONET 5.5 statistical software was used to analyze the distribution of Gram-positive bacteria in all the pathogens, and the status of drug resistance of Gram-positive bacteria to 14 antibiotics. Data were processed with Wilcoxon rank sum test. Results: (1) Twenty-nine times of steady state plasma concentration monitoring were performed in the patients in total, with the steady state plasma concentration of vancomycin from 4.3 to 42.1 μg/mL. In the monitoring before third, sixth, and tenth medication, the percentages of result reaching the standard were respectively 1, 3/14, and 2/7. (2) A total of 79 Gram-positive bacteria were isolated, including 49 (62.03%) strains of Staphylococcus aureus, 9 (11.39%) strains of Staphylococcus haemolyticus, 7 (8.86%) strains of Staphylococcus epidermidis, 12 (15.19%) strains of Enterococcus faecium, and 2 (2.53%) strains of Enterococcus faecalis. The above-mentioned Staphylococcus strains were with high drug resistance to antibiotics including penicillins, erythromycin, ciprofloxacin, and low drug resistance to linezolid, teicoplanin, and nitrofurantoin. The above-mentioned Enterococcus strains were with high drug resistance to antibiotics including erythromycin, ciprofloxacin, gentamicin, and low drug resistance to linezolid and teicoplanin. The above-mentioned Staphylococcus strains were all sensitive to vancomycin. Two strains of vancomycin-resistant Enterococcus were detected in the above-mentioned Enterococcus strains. (3) Serum level of PCT, white blood cell count, percentage of neutrophils of patients were (8.1±7.5) ng/mL, (24±10)×10⁹/L, and 0.898±0.029 before treatment, which were significantly higher than (3.0±2.8) ng/mL, (12±5)×10⁹/L, and 0.867±0.016 after treatment (with Z values respectively -2.103, -3.237, and -3.068, P<0.05 or P<0.01). After the early treatment, excellence, progess, and invalid results were achieved in 7, 5, and 3 patients, with the effective percentage of 4/5 in clinic. (4) There were no statistically significant differences in serum levels of AST, ALT, and creatinine of patients between before and after treatment (with Z values respectively-0.057, -1.508, and -1.363, P values above 0.05). Only one patient had liver and renal dysfunction during treatment. Conclusions The positive and reasonable use of vancomycin can remove most of the Gram-positive bacteria, and control the development of sepsis combined with imipenem in the early stage of patients with extremely severe burn. However, the dose of vancomycin should be individualized and the steady state plasma concentration should be monitored to maintain the blood concentration within the safe and effective range, so as to improve the rational use of vancomycin.