1.Molecular subtype-driven surgical concepts and clinical application in gliomas
Haihui JIANG ; Shouzan ZHANG ; Song LIN
Chinese Journal of Surgery 2026;64(1):70-78
Objective:To compare the prognostic impact of different extents of resection among patients with molecularly defined glioma subtypes.Methods:This retrospective cohort study included 1191 glioma patients who underwent surgical treatment at Beijing Tiantan Hospital, Capital Medical University, between January 2011 and January 2021. The cohort comprised 692 males and 499 females, with an age of (44.5±11.9) years (range: 18 to 75 years). Tumors were classified according to the 2021 WHO Classification of Tumors of the Central Nervous System (5th edition), and the extent of resection was assessed using postoperative MRI. Kaplan-Meier survival analyses and log-rank tests were used to evaluate the effects of resection extent on progression-free survival (PFS) and overall survival (OS) within each molecular subtype. Cox proportional hazards models were applied to identify independent prognostic factors for PFS and OS. Follow-up was completed in January 2024.Results:Among the 1 191 patients, 291 (24.43%) had isocitrate dehydrogenase( IDH)-mutant, 1p/19q-codeleted oligodendroglioma (OG), 338 (28.37%) had IDH-mutant astrocytoma, and 562 (47.19%) had IDH-wild-type glioblastoma (GBM). Patients with IDH-mutant, 1p/19q-codeleted OG had the best prognosis, with median PFS and OS not reached. In IDH-wild type GBM, the median PFS and OS were 12.0 and 24.0 months, respectively; in IDH-mutant astrocytoma, the median PFS and OS were 61.0 and 102.0 months. Differences in PFS and OS among the three groups were statistically significant ( P<0.01). In patients with IDH-wild type GBM, supratotal resection yielded better PFS and OS than gross total resection ( P<0.05). In IDH-mutant astrocytoma, PFS and OS did not differ between supratotal and gross total resection ( P>0.05), while gross total resection was superior to subtotal resection ( P<0.05). In IDH-mutant, 1p/19q-codeleted OG, PFS and OS did not differ significantly across resection categories ( P>0.05). Multivariate analyses identified age, Karnofsky Performance Status, extent of resection, tumor grade, and O 6-methylguanine-DNA methyltransferase promoter methylation status as independent predictors of both PFS and OS ( P<0.05). Conclusions:For IDH-wild type GBM, maximal efforts should be made to achieve supratotal resection. For IDH-mutant astrocytoma, maximal safe resection is recommended with preservation of neurological function. For IDH-mutant, 1p/19q-codeleted oligodendroglioma, a relatively conservative approach may be appropriate to protect neurological function.
2.Molecular subtype-driven surgical concepts and clinical application in gliomas
Haihui JIANG ; Shouzan ZHANG ; Song LIN
Chinese Journal of Surgery 2026;64(1):70-78
Objective:To compare the prognostic impact of different extents of resection among patients with molecularly defined glioma subtypes.Methods:This retrospective cohort study included 1191 glioma patients who underwent surgical treatment at Beijing Tiantan Hospital, Capital Medical University, between January 2011 and January 2021. The cohort comprised 692 males and 499 females, with an age of (44.5±11.9) years (range: 18 to 75 years). Tumors were classified according to the 2021 WHO Classification of Tumors of the Central Nervous System (5th edition), and the extent of resection was assessed using postoperative MRI. Kaplan-Meier survival analyses and log-rank tests were used to evaluate the effects of resection extent on progression-free survival (PFS) and overall survival (OS) within each molecular subtype. Cox proportional hazards models were applied to identify independent prognostic factors for PFS and OS. Follow-up was completed in January 2024.Results:Among the 1 191 patients, 291 (24.43%) had isocitrate dehydrogenase( IDH)-mutant, 1p/19q-codeleted oligodendroglioma (OG), 338 (28.37%) had IDH-mutant astrocytoma, and 562 (47.19%) had IDH-wild-type glioblastoma (GBM). Patients with IDH-mutant, 1p/19q-codeleted OG had the best prognosis, with median PFS and OS not reached. In IDH-wild type GBM, the median PFS and OS were 12.0 and 24.0 months, respectively; in IDH-mutant astrocytoma, the median PFS and OS were 61.0 and 102.0 months. Differences in PFS and OS among the three groups were statistically significant ( P<0.01). In patients with IDH-wild type GBM, supratotal resection yielded better PFS and OS than gross total resection ( P<0.05). In IDH-mutant astrocytoma, PFS and OS did not differ between supratotal and gross total resection ( P>0.05), while gross total resection was superior to subtotal resection ( P<0.05). In IDH-mutant, 1p/19q-codeleted OG, PFS and OS did not differ significantly across resection categories ( P>0.05). Multivariate analyses identified age, Karnofsky Performance Status, extent of resection, tumor grade, and O 6-methylguanine-DNA methyltransferase promoter methylation status as independent predictors of both PFS and OS ( P<0.05). Conclusions:For IDH-wild type GBM, maximal efforts should be made to achieve supratotal resection. For IDH-mutant astrocytoma, maximal safe resection is recommended with preservation of neurological function. For IDH-mutant, 1p/19q-codeleted oligodendroglioma, a relatively conservative approach may be appropriate to protect neurological function.
3.Clinical characteristics analysis of patients with granulomatous mastitis and erythema nodosum
Haihui GAO ; Lei ZHAO ; Lin PAN ; Liqin WANG ; Jing DONG
Chinese Journal of Rheumatology 2025;29(1):48-51
Objective:To describe the clinical characteristics of a possible rare syndrome, the granulomatous mastitis(GM), erythema nodosum and arthritis syndrome (GMENA syndrome), by retrospective analyzing patients with both GM and erythema nodosum, with or without arthritis, and provide clinical evidence for further researchstudy.Methods:This study analyzed the demographic general information, clinical manifestations, laboratory tests results, medications, operations, and the first visits of cases collected from the Affiliated Hospital of Qingdao University between January 2015 and February 2024. All patients were diagnosed with both GM and erythema nodosum, with or without arthritis. The frequency, means and standard deviation were used to perform descriptive analysis.Results:Among the 22 cases, all of the GM were unilateral, and nodular erythema mainly appeared in both lower limbs 17 (77%). Eight (67%) patients had arthritis. Sixteen cases (80%) were reported forwith elevated white blood cells count, and 16 (84%) with elevated C-reactive protein level, 12(86%) patients were with elevated erythrocyte sedimentation rate. Two cases were associated with hyperprolactinemia. In the bacterial tests of the breast abscess, C orynebacterium kroppenstedtii, and one Staphylococcus epidermidis were detected in 1 case respectively. The department of breast surgery was the most frequently first visit (86%) medical service, and 14 cases (64%) visited the department of rheumatology and immunology. Four cases (18%) underwent abscess incision and drainage after ineffective medication and none of them were treated with glucocorticoids. Five cases with glucocorticoids and followed-up by the department of rheumatology and immunology were not operated and four in of them without recurrenc. Conclusion:GMENA syndrome may be a syndrome characterized by high inflammatory activity, cytokine activation, and often involves the breast, skin, and joint. The pathogenesis and treatment of this syndrome need to be investigated further.
4.Clinical characteristics analysis of patients with granulomatous mastitis and erythema nodosum
Haihui GAO ; Lei ZHAO ; Lin PAN ; Liqin WANG ; Jing DONG
Chinese Journal of Rheumatology 2025;29(1):48-51
Objective:To describe the clinical characteristics of a possible rare syndrome, the granulomatous mastitis(GM), erythema nodosum and arthritis syndrome (GMENA syndrome), by retrospective analyzing patients with both GM and erythema nodosum, with or without arthritis, and provide clinical evidence for further researchstudy.Methods:This study analyzed the demographic general information, clinical manifestations, laboratory tests results, medications, operations, and the first visits of cases collected from the Affiliated Hospital of Qingdao University between January 2015 and February 2024. All patients were diagnosed with both GM and erythema nodosum, with or without arthritis. The frequency, means and standard deviation were used to perform descriptive analysis.Results:Among the 22 cases, all of the GM were unilateral, and nodular erythema mainly appeared in both lower limbs 17 (77%). Eight (67%) patients had arthritis. Sixteen cases (80%) were reported forwith elevated white blood cells count, and 16 (84%) with elevated C-reactive protein level, 12(86%) patients were with elevated erythrocyte sedimentation rate. Two cases were associated with hyperprolactinemia. In the bacterial tests of the breast abscess, C orynebacterium kroppenstedtii, and one Staphylococcus epidermidis were detected in 1 case respectively. The department of breast surgery was the most frequently first visit (86%) medical service, and 14 cases (64%) visited the department of rheumatology and immunology. Four cases (18%) underwent abscess incision and drainage after ineffective medication and none of them were treated with glucocorticoids. Five cases with glucocorticoids and followed-up by the department of rheumatology and immunology were not operated and four in of them without recurrenc. Conclusion:GMENA syndrome may be a syndrome characterized by high inflammatory activity, cytokine activation, and often involves the breast, skin, and joint. The pathogenesis and treatment of this syndrome need to be investigated further.
5.Research progress on the effects of low dose radiation on DNA damage repair
Xiang LI ; Ming LIU ; Haihui LIN ; Yinghong WEI ; Shibiao SU
China Occupational Medicine 2024;51(6):700-706
Low dose radiation (LDR) is a relatively low dose, but it is important in the fields of occupational health, medical radiation protection and environmental protection. Therefore, the effects of LDR on DNA damage repair and its potential mechanisms have attracted increasing attention. LDR mainly acts on DNA molecules in direct or indirect ways, leading to DNA double strand breaks (DSBs), which then triggers DNA damage, forms cluster damage, and induces DNA damage repair, which has a potential impact on organisms. However, long-term LDR exposure may lead to dysfunction of the DNA repair system and increase the risk of accumulating DNA damage. LDR-induced DNA damage response is an adaptive response, with DNA damage repair being one of its main mechanisms. The repair of DSBs is particularly important, with the main repair methods including homologous recombination and non-homologous end joining. LDR may also trigger adaptive responses by activating immune cells, enhancing cellular antioxidant capacities, and through varies of specific biological mechanisms such as immune/inflammatory response and antioxidant responses. The biological effects of LDR mainly include cell stress response, cell cycle regulation and bystander effect. In the future, it is necessary to further explore the molecular mechanism of LDR's impact on organism health and evaluate its impact on radiation risk assessment and individualized protective measures, to better understand the basic principles of radiation biology and provide scientific basis for radiation protection, risk assessment and injury treatment.
6.Analysis of immunological indicators in patients with unexplained recurrent pregnancy failure
Jing DONG ; Haihui GAO ; Liqin WANG ; Lin PAN ; Lei ZHAO
Chinese Journal of Reproduction and Contraception 2024;44(11):1175-1179
Objective:To classify and analyze the immunological indicators of patients with unexplained recurrent pregnancy failure, and explore whether the immunological indicators of these patients were related to pregnancy failure.Methods:We retrospectively studied 91 patients who visited the Rheumatology and Immunology Department of the Affiliated Hospital of Qingdao University from January 2022 to June 2022 due to recurrent pregnancy failures, including recurrent spontaneous abortion and recurrent implantation failures (RIF). We adopted case-control study method. Analysis was conducted from two different perspectives: antinuclear antibody (ANA) positivity and natural killer (NK) cell elevation. Among them, there were 34 ANA positive patients and 57 ANA negative patients; 32 patients had normal NK cells and 59 had elevated NK cell. Clinical data, duration of infertility, number of miscarriages, number of biochemical pregnancies, number of recurrent implant failures, and other information from patients were collected. Immunological indicators included ANA, anti-extractable nuclear antigen antibody, antiphospholipid antibodies, peripheral blood lymphocyte subsets, complement, immunoglobulin, rheumatism, etc. Routine laboratory tests included blood routine, urine routine, liver and kidney function, etc. The results were statistically analyzed.Results:There were no statistically significant differences between the ANA-positive and negative groups in terms of the number of spontaneous abortion, the number of post-transplantation abortions, the total number of pregnancy failures, and previous gynecological and chronic diseases (all P>0.05). The number of no-implanting after transplantation in the ANA-positive group was 3.20±2.04, which was significantly higher than that in the ANA-negative group (1.47±0.96, P=0.004). The proportion of CD19 +B cells [(12.96±4.26)%] and CD3 -HLA -DR + activated B/NK cells [(14.58±5.45)%] in the ANA negative group were significantly higher than those in the ANA positive group [(10.23±3.54)%, P=0.007; (11.34±4.11)%, P=0.009]. There were no significant differences in the number of spontaneous abortion, the number of fetal abortion after transplantation and the total number of pregnancy failure between the normal NK cell group and the increased NK cell group (all P>0.05). Conclusion:The number of RIF in ANA positive patients is significantly increased. The relationship between NK cells and pregnancy failure is not clear yet.
7.Analysis of immunological indicators in patients with unexplained recurrent pregnancy failure
Jing DONG ; Haihui GAO ; Liqin WANG ; Lin PAN ; Lei ZHAO
Chinese Journal of Reproduction and Contraception 2024;44(11):1175-1179
Objective:To classify and analyze the immunological indicators of patients with unexplained recurrent pregnancy failure, and explore whether the immunological indicators of these patients were related to pregnancy failure.Methods:We retrospectively studied 91 patients who visited the Rheumatology and Immunology Department of the Affiliated Hospital of Qingdao University from January 2022 to June 2022 due to recurrent pregnancy failures, including recurrent spontaneous abortion and recurrent implantation failures (RIF). We adopted case-control study method. Analysis was conducted from two different perspectives: antinuclear antibody (ANA) positivity and natural killer (NK) cell elevation. Among them, there were 34 ANA positive patients and 57 ANA negative patients; 32 patients had normal NK cells and 59 had elevated NK cell. Clinical data, duration of infertility, number of miscarriages, number of biochemical pregnancies, number of recurrent implant failures, and other information from patients were collected. Immunological indicators included ANA, anti-extractable nuclear antigen antibody, antiphospholipid antibodies, peripheral blood lymphocyte subsets, complement, immunoglobulin, rheumatism, etc. Routine laboratory tests included blood routine, urine routine, liver and kidney function, etc. The results were statistically analyzed.Results:There were no statistically significant differences between the ANA-positive and negative groups in terms of the number of spontaneous abortion, the number of post-transplantation abortions, the total number of pregnancy failures, and previous gynecological and chronic diseases (all P>0.05). The number of no-implanting after transplantation in the ANA-positive group was 3.20±2.04, which was significantly higher than that in the ANA-negative group (1.47±0.96, P=0.004). The proportion of CD19 +B cells [(12.96±4.26)%] and CD3 -HLA -DR + activated B/NK cells [(14.58±5.45)%] in the ANA negative group were significantly higher than those in the ANA positive group [(10.23±3.54)%, P=0.007; (11.34±4.11)%, P=0.009]. There were no significant differences in the number of spontaneous abortion, the number of fetal abortion after transplantation and the total number of pregnancy failure between the normal NK cell group and the increased NK cell group (all P>0.05). Conclusion:The number of RIF in ANA positive patients is significantly increased. The relationship between NK cells and pregnancy failure is not clear yet.
8.Estimation of the effective radiation dose for tunnel construction workers
Ming LIU ; Haihui LIN ; Yanbing LIU ; Yinhong WEI ; Xiang LI ; Shibiao SU
China Occupational Medicine 2023;50(3):345-348
Objective To analyze and set up the effective dose of different ionizing radiation for tunnel construction workers. Methods A total of five tunnels constructed using drilling and blasting methods were selected as the research subjects using the convenient sampling method. The workplace γ radiation effective dose, radon concentrations, and radioactive activity concentrations were detected, and on-site surveys were conducted to estimate the internal and external irradiation doses and total effective doses for workers in different work sites. Results Radiological hazards in tunnels constructed using drilling and blasting methods included radon and its progeny, γ radiation, radioactive dust (uranium-238, radium-226, thorium-232, and potassium-40) and others. The average total effective dose of ionizing radiation exposure for tunnel construction workers was (6.730 1±1.541 1) mSv. The average dose of radon and its progeny was (6.163 0±1.512 8) mSv, radioactive dust was (0.014 6±0.009 1) mSv, γ radiation was (0.552 6±0.138 7) mSv. The dose of radioactive dust of radon and its progeny was 0.24%. Radon and its progeny contributed more to the radioactive dose than radioactive dust and γ radiation (all P<0.05). Among all the radioactive dusts, the dose contribution ranked from highest to lowest was thorium-232, uranium-238, and radium-226. Conclusion For tunnel construction workers, the largest contribution to the effective dose of ionizing radiation exposure is from radon and its progeny for internal irradiation, followed by γ radiation for external irradiation. The contribution of radioactive dust to internal irradiation dose can be considered negligible.
9.Different treatment regimens for primary central nervous system lymphoma:based on SEER database
Chuanwei YANG ; Xiaohui REN ; Haihui JIANG ; Mingxiao LI ; Xuzhe ZHAO ; Qinghui ZHU ; Yong CUI ; Song LIN
Chinese Journal of Surgery 2021;59(1):52-58
Objectives:To explore the prognostic factors of primary central nervous system lymphoma(PCNSL) and to analyze the efficacy of different treatment methods.Methods:Clinical data of 4 812 patients with PCNSL in SEER database from January 1975 to December 2016 were retrospectively analyzed.Among them, 2 831 were male and 1 981 were female, the ratio of male to female was 1.4∶1.0.There were 2 236 cases(46.47%) under 60 years old, 1 718 cases(35.70%) aged 60 to 74 years old, and 858 cases(17.83%) aged 75 years old or above. Two thousand four hundred and seventeen cases(50.23%) had supratentorial tumors, 299 cases (6.21%) had infratentorial tumors, and 554 cases(11.51%) had multiple brain tumors, 1 542 cases (32.04%) were other or unspecified location.Three thousand five hundred and thirteen cases(73.00%) had diffuse large B-cell lymphoma (DLBCL), 234 cases(4.86%) had non DLBCL, 1 065 cases (22.13%) had other or unspecified types of tumor.The treatment included 2 011 cases (41.77%) of biopsy, 61 cases (1.27%) of subtotal resection(STR), 54 cases (1.12%) of gross total resection(GTR), 2 384 cases (49.54%) of biopsy and chemotherapy, 159 cases (3.30%) of STR and chemotherapy, 144 cases (3.00%) of GTR and chemotherapy.Univariate and multivariate Cox regression models were used to analyze the prognostic factors affecting the overall survival of the patients.Fine-Gray test and competitive risk model were used to analyze the prognostic factors affecting cancer-specific survival.Kaplan-Meier method and Log-rank test was used for survival analysis.Results:Univariate and multivariate Cox regression analyses showed that age, race, marital status, tumor site, pathological subtype, surgery, chemotherapy, combined with other malignant tumors, and HIV infection were the independent prognostic factors affecting the overall survival of PCNSL patients.The results of Fine-Gray test and competitive risk model analyses showed that age, race, marital status, tumor location, pathological subtype, surgical method, chemotherapy, combined with other malignant tumors, and HIV infection were independent prognostic factors affecting cancer-specific survival, while gender and radiotherapy had no significant correlation with cancer-specific survival.Compared with biopsy, PCNSL patients may benefit from surgical resection (STR: HR=0.805, 95% CI:0.656?0.989, P=0.04; GTR: HR=0.521, 95% CI:0.414?0.656, P<0.01).Kaplan-Meier survival analysis showed that the median survival time of biopsy+chemotherapy group was 28 months (95% CI:24.497?31.503), 2 months (95% CI:1.756?2.244) in the biopsy group, 2 months (95% CI:1.410-2.590) in the STR group, 19 months ( 95%CI:0?39.311) in the biopsy+chemotherapy group, 67 months (95% CI:46.187-87.813) in the STR+chemotherapy group, 84 months (95% CI:57.448?110.552) in the GTR+chemotherapy group.The median survival time of patients with different treatment methods was statistically significant ( P<0.01). Conclusions:Surgical resection may improve the prognosis of some PCNSL patients.Patients who have access to receive GTR or STR combined with chemotherapy may have prolonged Cancer-specific survival.
10.Different treatment regimens for primary central nervous system lymphoma:based on SEER database
Chuanwei YANG ; Xiaohui REN ; Haihui JIANG ; Mingxiao LI ; Xuzhe ZHAO ; Qinghui ZHU ; Yong CUI ; Song LIN
Chinese Journal of Surgery 2021;59(1):52-58
Objectives:To explore the prognostic factors of primary central nervous system lymphoma(PCNSL) and to analyze the efficacy of different treatment methods.Methods:Clinical data of 4 812 patients with PCNSL in SEER database from January 1975 to December 2016 were retrospectively analyzed.Among them, 2 831 were male and 1 981 were female, the ratio of male to female was 1.4∶1.0.There were 2 236 cases(46.47%) under 60 years old, 1 718 cases(35.70%) aged 60 to 74 years old, and 858 cases(17.83%) aged 75 years old or above. Two thousand four hundred and seventeen cases(50.23%) had supratentorial tumors, 299 cases (6.21%) had infratentorial tumors, and 554 cases(11.51%) had multiple brain tumors, 1 542 cases (32.04%) were other or unspecified location.Three thousand five hundred and thirteen cases(73.00%) had diffuse large B-cell lymphoma (DLBCL), 234 cases(4.86%) had non DLBCL, 1 065 cases (22.13%) had other or unspecified types of tumor.The treatment included 2 011 cases (41.77%) of biopsy, 61 cases (1.27%) of subtotal resection(STR), 54 cases (1.12%) of gross total resection(GTR), 2 384 cases (49.54%) of biopsy and chemotherapy, 159 cases (3.30%) of STR and chemotherapy, 144 cases (3.00%) of GTR and chemotherapy.Univariate and multivariate Cox regression models were used to analyze the prognostic factors affecting the overall survival of the patients.Fine-Gray test and competitive risk model were used to analyze the prognostic factors affecting cancer-specific survival.Kaplan-Meier method and Log-rank test was used for survival analysis.Results:Univariate and multivariate Cox regression analyses showed that age, race, marital status, tumor site, pathological subtype, surgery, chemotherapy, combined with other malignant tumors, and HIV infection were the independent prognostic factors affecting the overall survival of PCNSL patients.The results of Fine-Gray test and competitive risk model analyses showed that age, race, marital status, tumor location, pathological subtype, surgical method, chemotherapy, combined with other malignant tumors, and HIV infection were independent prognostic factors affecting cancer-specific survival, while gender and radiotherapy had no significant correlation with cancer-specific survival.Compared with biopsy, PCNSL patients may benefit from surgical resection (STR: HR=0.805, 95% CI:0.656?0.989, P=0.04; GTR: HR=0.521, 95% CI:0.414?0.656, P<0.01).Kaplan-Meier survival analysis showed that the median survival time of biopsy+chemotherapy group was 28 months (95% CI:24.497?31.503), 2 months (95% CI:1.756?2.244) in the biopsy group, 2 months (95% CI:1.410-2.590) in the STR group, 19 months ( 95%CI:0?39.311) in the biopsy+chemotherapy group, 67 months (95% CI:46.187-87.813) in the STR+chemotherapy group, 84 months (95% CI:57.448?110.552) in the GTR+chemotherapy group.The median survival time of patients with different treatment methods was statistically significant ( P<0.01). Conclusions:Surgical resection may improve the prognosis of some PCNSL patients.Patients who have access to receive GTR or STR combined with chemotherapy may have prolonged Cancer-specific survival.

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