Objective To investigate the value of quantitative CT(QCT)parameters related to abdominal and dorsal fat content for predicting early postoperative complications of esophageal cancer.Methods A total of 184 patients who underwent radical esophageal cancer surgery were retrospectively collected and divided into complication group(n=76)and control group(n=108)according to whether early postoperation complication(within 30 days after surgery)occurred or not.QCT was used to obtain parameters related to abdominal and dorsal fat content,including visceral fat area(VFA),subcutaneous fat area(SFA),VFA/SFA and the degree of muscle fat infiltration(MFI)of posterior vertebral muscles based on L3 central-level CT images.Univariate analysis and multivariate logistic regression were used to analyze clinical and pathological data as well as QCT parameters related to abdominal and dorsal fat content to screen independent risk factors for early postoperative complications of esophageal cancer.Then receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of each independent risk factor alone and their combination for predicting early postoperative complications of esophageal cancer.Results VFA/SFA and MFI degree of posterior vertebral muscles were both independent risk factors for early postoperative complications of esophageal cancer(OR=5.121,1.110,both P＜0.05).The AUC of VFA/SFA and MFI degree of posterior vertebral muscle was 0.81 and 0.77,respectively,while of their combination was 0.84.Conclusion QCT parameters related to abdominal and dorsal fat content could be used to effectively predict early complications of esophageal cancer after surgery.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma. Despite the scarcity of reported BIA-ALCL cases in Asia, it is imperative to research early diagnosis. The crucial diagnostic criteria for BIA-ALCL include the presence of ALK - and CD30 + T cells exceeding 10% in the delayed seroma fluid. Furthermore, laboratory tests, such as histological examination of capsulectomies and analysis of clonal T-cell receptor (TCR) gene rearrangements, serve as important auxiliary diagnostic indicators. This article reported the case of a 56-year-old female patient who underwent bilateral breast augmentation with implants over 20 years ago. She presented with hardness, enlargement, and mild discomfort in her left breast. She was admitted to Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in January 2023. MRI suggested implant rupture. Therefore, bilateral implant removal surgery was performed on February 2, 2023. Pathological examination of the fluid within the capsule of the left implant revealed a small number of ALK - and CD30 + T cells, with monoclonality observed in TCRγ gene rearrangement, indicating early changes suggestive of BIA-ALCL. Long-term follow-up is needed. The authors suggest that patients suspected of BIA-ALCL should undergo TCR gene rearrangement testing in addition to cytological and immunological examinations, which can provide guidance for the diagnosis, treatment, and necessary long-term follow-up of these patients.

Objective:To explore the challenges in the implementation of drug centralized volume-based procurement policies in hospitals and propose corresponding optimization suggestions.Methods:From August to December 2023, a purposive sampling was conducted to select 11 pharmaceutical experts from tertiary hospitals in China for Delphi method. The survey content included " policy recommendations for promoting the acceleration and expansion of national drug centralized procurement and retaining surplus medical insurance funds for centralized procurement" .Results:Survey participants gave feedback on a set of existing problems found in the implementation of drug centralized procurement policies and proposed corresponding optimization methods. Kendall′s W coefficient of the specialist consultation was 0.332( P<0.05), demonstrating good consistency and concentration of the expert opinions. Among the problems, the score of drug supply guarantee was the highest(mean value of importance was 4.45). At the same time, the recommendation of strengthening monitoring and early warning, coordination and dispatch, and effectively ensuring the supply of centralized drug procurement had the highest score and concentration(mean value of importance was 4.91, coefficient of variation was 0.06). Conclusions:Through Delphi method, this study revealed issues and optimization methods in the implementation of drug centralized procurement policies in hospitals. The findings could provide valuable insights for improvements in the pharmaceutical sector and future policy adjustments.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma. Despite the scarcity of reported BIA-ALCL cases in Asia, it is imperative to research early diagnosis. The crucial diagnostic criteria for BIA-ALCL include the presence of ALK - and CD30 + T cells exceeding 10% in the delayed seroma fluid. Furthermore, laboratory tests, such as histological examination of capsulectomies and analysis of clonal T-cell receptor (TCR) gene rearrangements, serve as important auxiliary diagnostic indicators. This article reported the case of a 56-year-old female patient who underwent bilateral breast augmentation with implants over 20 years ago. She presented with hardness, enlargement, and mild discomfort in her left breast. She was admitted to Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in January 2023. MRI suggested implant rupture. Therefore, bilateral implant removal surgery was performed on February 2, 2023. Pathological examination of the fluid within the capsule of the left implant revealed a small number of ALK - and CD30 + T cells, with monoclonality observed in TCRγ gene rearrangement, indicating early changes suggestive of BIA-ALCL. Long-term follow-up is needed. The authors suggest that patients suspected of BIA-ALCL should undergo TCR gene rearrangement testing in addition to cytological and immunological examinations, which can provide guidance for the diagnosis, treatment, and necessary long-term follow-up of these patients.

The electronic nursing clinical pathway was fully applied, and the evidence-based practice achievements of cancer patient symptom management was integrated into the electronic nursing clinical pathway in Fudan University Shanghai Cancer Center. Taking " comprehensive evaluation before chemotherapy" , " chemotherapy-related nausea and vomiting" , " chemotherapy-related diarrhea" as examples, the authors introduced the application of evidence-based practice project in nursing clinical pathway. Through the implementation of the project, a standardized operation flow of electronic nursing clinical pathway was formed; The nurses introduced new nursing tools, new processes and new technologies in the process of project implementation; Meanwhile, the project reduced the incidence of adverse symptoms and shortened the hospitalization time of patients. The project achieved the goal of " win-win" to reduce the burden of patients′ disease and improve the efficiency of tumor care.

Purpose: Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature. Methods: Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently. Results: In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant. Conclusion In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.

Objective To assess the efficacy and safety of mizoribine (MZR) in initial immunosuppression in living-related renal transplant recipients.Methods From October 2015 to October 2017,twenty-two patients undergoing initial living-related renal transplantation received MZR (3-4 mg/kg/d) plus tacrolimus and corticosteroid.During a follow-up period of 12 months,patient/graft survival,incidence of acute rejection and adverse events were observed.Results There was no onset of graft loss and death and acute rejection rate was 22.7％.Renal allograft function remained stable.The incidence rate of cytomegaloviral infection was 4.5％ and no CMV disease occurred.The incidence of BKV viruria was 36.4％ and the infection rate was 18.2％.Digestive symptoms occurred (n =3,13.6％).The major side effect of hyperuricemia could be controlled without reduction or withdrawal of MZR.Conclusions Excellent graft survival can be achieved when using MZR as initial immunosuppression in living-donor renal transplant recipients,yet the incidence of acute rejection remains high.Further study is required for determining the effect of MZR in the prevention of BK viral infection during renal transplantation.

Objective: To analyze the CT and MRI manifestations of undifferentiated hepatic embryonal sarcoma in adults with an aim to improve the preoperative diagnosis of this disease. Methods: A retrospective analysis was carried out on the clinical data of 11 patients with undifferentiated hepatic embryonal sarcoma treated in Wenzhou People’s Hospital of Zhejiang and Wenzhou Central Hospital of Zhejiang between January 2008 and December 2018. There were 5 males and 6 females. The age ranged from 46 to 76 years (median 64 years). The site, size, morphology, margin, and pattern and degree of enhancement of the tumors were analyzed. Results: Among the 11 patients, 10 patients had a single tumor, only 1 patient had multiple tumors. A total of seven patients' tumors were located in the right liver, 2 in the left liver, and 2 involved both the left and right livers. The maximum diameter of the tumors ranged from 5.5 cm to 21.2 cm, the maximum diameter (10.2±4.8 cm). The edge of tumors was clear in 9 patients and unclear in 2 patients. The tumors were elliptical in 4 patients or irregular in 7 patients. Plain CT scan showed 4 patients' tumors had mainly a cystic component, while 5 patients had both cystic and solid components. Plain MRI scan showed that five tumors were cystic and solid, with mixed internal signals. T₁ weighted imaging (T₁WI) showed slightly lower and lower signals; T₂ weighted imaging (T₂WI) showed slightly higher and higher signals. There was a low signal stripe separating inside; Diffusion-weighted imaging showed a high signal and apparent diffusion coefficient showed a low signal. The enhancement was characterized by "fast in and fast out" (marked enhancement in the arterial phase and fast clearance in the venous phase), and "delayed enhancement" (mild to moderate enhancement in the arterial phase and even more obvious enhancement in the venous or delayed phase). Conclusion Adult undifferentiated embryonic sarcoma has certain CT and MRI features. Its shape is elliptical or irregular, and mostly with a clear boundary. There were intratumoral cystic or cystic solid components, with mixed density/signal on CT and MRI, being characterized by "fast in and fast out" and "delayed enhancement" on intravenous contrast enhanced scans.