OBJECTIVE: To investigate the safety and prognostic factors influencing the treatment of upper urinary tract urothelial carcinoma (UTUC) combined with bladder cancer (BCa) by laparoscopic simultaneous radical cystectomy and nephroureterectomy (RCNU). METHODS: The clinical data of patients admitted to Peking University Third Hospital for laparoscopic RCNU surgery from January 2009 to September 2023 were analyzed retrospectively. Based on the same gender, age (±5 years), history of uroepithelial tumors, underlying diseases, T-stage, N-stage, M-stage, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, and body mass index (BMI) (±5), 34 patients with RCNU were matched 1 ∶1 with patients with bladder cancer who underwent laparoscopic radical cystectomy (RC) alone. Kaplan-Meier survival analysis was used to calculate patient survival, and Cox proportional regression risk model was used to analyze clinical factors affecting prognosis. RESULTS: Of the 68 patients enrolled, the follow-up rate was 100% with a median follow-up time of 27.0 (11.7, 60.2) months. Comparison of intraoperative conditions (including operation time, estimated intraoperative bleeding, intra-operative blood transfusion, etc.) between the two groups of patients showed no significant difference (P>0.05). Comparison of preoperative creatinine and postoperative creatinine between the two groups of patients showed significant differences (P < 0.05). The perioperative Clavien grade Ⅲ-Ⅳ complication rates were 2.9% (1/34) in the RC group and 5.9% (2/34) in the RCNU group. There was no significant difference in terms of perioperative complications between the two groups. Overall survival was significantly lower in the patients receiving RCNU compared with the matched group receiving RC alone (P < 0.05). Cox regression analysis suggested that two factors, high N stage and high postoperative creatinine, were independent risk factors affecting the prognosis of patients in the 2 groups (P < 0.05). CONCLUSION The overall survival prognosis of patients undergoing RCNU surgery was worse compared with laparoscopic RC surgery alone during the same period. There was no clinically significant difference between the two groups in terms of operation time, intraoperative bleeding, and perioperative complications, and there were clinically significant differences in preoperative renal function and post-operative renal function.
Humans ; Laparoscopy/methods* ; Nephroureterectomy/methods* ; Cystectomy/methods* ; Prognosis ; Male ; Retrospective Studies ; Female ; Urinary Bladder Neoplasms/mortality* ; Middle Aged ; Aged

Purpose BRCA1/2 gene germline variants of the uncertain significance(VUS)are categorized into five clas-ses based on their risk levels,and three classes require regular periodic analysis due to their unclear clinical significance.The aim of this study was to investigate the influence of updating var-iation evidences on the VUS sites and guide clinical diagnosis and treatment.Methods The VUS sites in BRCA1/2 gene were analyzed.971 samples(breast or ovarian cancer)that un-derwent BRCA1/2 germline testing were stored.The VUS sites in BRCA1/2 gene were further reinterpreted by integrating the following evidences,including population frequency database,disease database,computer software prediction,co-segregation evidence,allelic evidence and population cohort evidence to determine whether the variation classification was changed.Results The number of the patients with VUS sites was 142,accounting for 14.6％(142/971).The total number of VUS sites was 128,among which the proportions of missense muta-tion,synonymous mutation,in-frame non-shifted mutation and non-coding region mutation were 70.3％,4.7％,3.1％and 21.9％,respectively.Reinterpretation of VUS sites discovered that 11.7％(15/128)of VUS sites could be downgraded to Class 2,likely benign.Conclusion With the continuous in-creasing evidences of germline variation,the variation classifica-tion of VUS sites will be changed after periodic analysis.

As a kind of immunosuppressive cells, myeloid-derived suppressor cells (MDSCs) are an important component of the immune microenvironment. MDSCs play a significant role in promoting tumor immune escape. In addition, non-immunological functions such as promoting angiogenesis can also promote tumor development with the deepening of research. MDSCs can promote tumor angiogenesis directly through vascular endothelial growth factor signaling pathway, or promote tumor growth and angiogenesis by secreting cytokines such as matrix metalloprotein-9, basic fibroblast growth factor, angiogenic peptide Bv8, platelet derived growth factor, exosomes, or interacting with other cells. Exploring the expansion, activation, recruitment and angiogenesis mechanism of MDSCs will provide new ideas for regulating the individualized diagnosis and treatment based on targeted MDSCs.

MET exon14 (METex14) skipping mutation is an independent driver gene in non-small cell lung cancer (NSCLC) . About 3%-4% of NSCLC patients carry METex14 skipping mutation. These patients have poor prognoses and poor responses to traditional chemotherapy and immunotherapy. Highly selective MET inhibitors such as capmatinib, tepotinib, savolitinib have shown good efficacy and safety data in clinical trials, which bring new treatment options for patients with METex14 skipping mutations.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

ObjectiveTo investigate the efficacy and safety of CalliSpheres microsphere-transcatheter arterial chemoembolization (CSM-TACE) versus conventional transcatheter arterial chemoembolization (cTACE) in the treatment of hepatocellular carcinoma (HCC) through a meta-analysis. MethodsPubMed, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP were searched for all Chinese and English articles on the application of CSM-TACE and cTACE in HCC published up to the end of October, 2020. After quality assessment was performed for the articles included, RevMan 5.3 software provided by Cochrane Library was used for analysis. ResultsA total of 15 studies were included, with 1535 patients in total. This meta-analysis showed that compared with the patients receiving cTACE, the patients receiving CSM-TACE had significantly higher 1-year overall survival rate (odds ratio ［OR］=2.26, 95% confidence interval ［CI］: 1.63-3.13, P＜0.000 01), 2-year overall survival rate (OR=1.73, 95%CI: 1.20-2.50, P=0.003), and 2-year progression-free survival rate (OR=1.60, 95%CI: 1.05-2.43, P=0.03). In terms of safety, compared with the patients receiving cTACE, the patients receiving CSM-TACE had significantly lower incidence rates of postoperative vomiting (OR=0.65, 95%CI: 0.46-0.92, P=0.01), bone marrow suppression (OR=0.17, 95%CI: 0.05-0.54, P=0.003), and neutropenia (OR=0.18, 95%CI: 0.07-045, P=0.000 3), while there were no significant differences between the two groups of patients in postoperative pyrexia, abdominal pain, and ascites (all P＞0.05). ConclusionCSM-TACE has significant advantages in improving 1- and 2-year overall survival rates and 2-year progression-free survival rates and can significantly reduce the incidence rates of postoperative vomiting, bone marrow suppression, and neutropenia. Therefore, CSM-TACE is a safe and effective treatment method.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Objective: To explore the costs and other information of two different treatment plans for pediatric acute promyelocytic leukemia (APL): one is the traditional intravenous drip arsenic (arsenic trioxide) combined with chemotherapy treatment, and the other is a medication family treatment program based on oral arsenic (Realgar-Indigo naturalis formula), in order to provide a reference for the promotion of pediatric APL family treatment mode and the formulation of medical insurance policies. Methods: The medical record homepage data and drug using of pediatric APL from 2010 to 2018 in Institute of Hematology & Blood Diseases Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College were retrospectively analyzed, and the newly diagnosed pediatric patients (≤14 years old) with APL were included. The hospitalization expenses and hospitalization time of two treatment options were compared. One treatment option was Chinese children APL treatment plan 2010 (CCAPL 2010), which was based on intravenous drip arsenic trioxide. The other was Chinese Children Cancer Group APL treatment plan 2017 (CCCG-APL 2017), which was based on oral Realgar-Indigo naturalis formula. Results: A total of 79 pediatric APL patients were included and grouped according to the treatment plans, 56 patients were treated with CCAPL 2010 plan, and 23 patients were treated with CCCG-APL 2017 plan. The median costs of one single pediatric APL patient in CCAPL 2010 plan was 167 700 yuan (95 800-386 600 yuan), and the median hospital stay time of one single pediatric APL patient was 102 days (14-157 days). The median costs of one single pediatric APL patient in CCCG-APL 2017 plan group was 118 700 yuan(50 800-270 600 yuan), and the median hospital stay time of one single pediatric APL patient was 37 days(5-96 days). The costs and hospital stay time of one single pediatric APL patient with CCCG-APL 2017 plan were remarkably less than those of one single pediatric APL patient with CCAPL 2010 plan (U = 178, P < 0.01; U = 66, P < 0.01). Conclusions The CCCG-APL 2017 plan simplifies the treatment plan compared with the CCAPL 2010 plan and significantly reduces the patient's medical expenses and shortens the hospitalization days. The CCCG-APL 2017 plan is suitable for family therapy and has good social and economic benefits, which is worthy of clinical promotion.

BACKGROUND:Digital three-dimensional model which can reflect the fine structure of the chambers inside heart not only enhances the understanding of cardiac physiology, but also provides basic medical data for the study of cardiac electrophysiology simulation and endocardial electrophysiological mapping navigation. OBJECTIVE:To construct the digital three-dimensional model of cardiac cavity from sectional data and in conformity with the actual anatomical structure. METHODS:Image segmentation was accomplished in MATLAB environment. Firstly, registration of human cardiac cavity slice dataset was realized. Secondly, classifying each composition was achieved by clustering method according to color characteristics of the image. Then, both cardiac cavity and related connected region was distinguished by region growing method. At last, the processed image was reconstructed through dedicated medical processing software into three-dimensional model of the cardiac cavity. RESULTS AND CONCLUSION:The proposed method could reconstruct quite exquisite three-dimensional model of the cardiac cavity. In models, left and right atrial and ventricular structure was clear. Aorta and superior vena cava were visible. Three tricuspid and mitral valve were also observed. Results indicated that reconstructed model can reflect the anatomical characteristics of cardiac cavity accurately, and provide basic medical data for the study on electrophysiological simulation and endocardial electric mapping.

ObjectiveTo study the effect on humoral immunity with combination of CsA and IL-2 fusion protein. MethodsForty C57/B6 mice were evenly divided into four groups,after receiving skin graft from DBA mouse.Mice in the experimental group was given CsA(30 mg/kg,ip) plus IL-2/Fc (1μg,ip) while the control group was only given CsA,each group was given HBV vaccine after skin graft surgery (2 μg,im),while blank group was only given vaccine after skin transplantation.The fourth group were left intact.Fourteen days later,the level of HBSAb,IL-4,IL-10,IFN-γ,IL-2 were measured with ELISA and IL-21and FoxP3 expression level and Tfh percentage of mixed lymphocytes detected. ResultsThe HBSAb level in experimental group is significantly higher than that in the control group and the survival time of skin graft is longer than that in the control group ( F =29.886,P =0.010 ; F =29.772,P =0.011).IL-2,IFN-γ are significantly higher than that in the control group( F =18.156,P =0.0020;F =90.042,P =0.003 ),but the Th2 cytokines such as IL-4,IL-10 are lower ( F =42.102,P =0.009 ; F =23.734,P =0.015 ).The expression level of both IL-21and FoxP3 are significantly higher than control group( F =9.784,P =0.048 ;F =27.883,P =0.012). ConclusionsCombination of CsA and IL-2 fusion protein can significantly enhance the immunogenicity of HBV vaccine and prolong graft survival time.It may be related to the higher expression level of IL-21and FoxP3.