Objective To investigate the efficacy and safety of Linaclotide combined with Simethicone oil and compound polyethylene glycol electrolyte(PEG)for cleansing effect of bowel in patients with constipation.Methods A prospective randomized controlled trial was designed and implemented by single blind method.383 patients with constipation who underwent colonoscopy from April 2023 to August 2024 were enrolled and randomly divided into routine group(128 cases),experimental group A(128 cases)and experimental group B(127 cases).Routine group treated with 3 L PEG,experimental group A treated with 290 μg Linaclotide+2 L PEG and experimental group B treated with 290 μg Linaclotide+30 mL Simethicone+2 L PEG.Bowel preparation effect[Boston bowel preparation scale(BBPS)scores and foaming removal effect],lesion detection rate,first defecation interval,frequency of defecation,the success rate of cecal intubation,the insertion time of colonoscopy,the withdrawal time of colonoscopy,incidence of adverse reactions and willingness to repeat examination of the three groups were compared.Results No statistically significant differences were observed in the BBPS scores among the three groups(P>0.05);The foaming removal effect score in experimental group B was significantly lower than that in routine group and experimental group A,the difference was statistically significant(P<0.05);The total lesion detection rate and polyps detection rate of experimental group B were significantly higher than those of routine group and experimental group A,the differences were statistically significant(P<0.05).The first defecation interval of the routine group was significantly longer than that of experimental group A and experimental group B,the difference was statistically significant(P<0.05);The frequency of defecation was compared among the three groups,and the difference was no statistically significant(P>0.05).The success rate of cecal intubation in the three groups was 100.0%,and the insertion time of colonoscopy was similar,the differences were not statistically significant(P>0.05);The withdrawal time of colonoscopy in experimental group B was significantly shorter than that in routine group and experimental group A,the difference was statistically significant(P<0.05).The incidence of abdominal distension and total adverse reactions in the routine group were higher than those in experimental group A and experimental group B,the differences were statistically significant(P<0.05);The willingness to repeat examination rate of the routine group was significantly lower than that of experimental group A and experimental group B,the differences were statistically significant(P<0.05).Conclusion 290 μg Linaclotide combined with 30 mL Simethicone and 2 L PEG solution regimen has advantages in intestinal preparation for patients with constipation,and can achieve better intestinal cleaning effect than 3 L PEG solution and 290 μg linalopeptide+2 L PEG solution regimen,with higher safety and willingness to repeat examination.It can be recommended for bowel preparation for patients with constipation.

Objective To investigate the efficacy and safety of Linaclotide combined with Simethicone oil and compound polyethylene glycol electrolyte(PEG)for cleansing effect of bowel in patients with constipation.Methods A prospective randomized controlled trial was designed and implemented by single blind method.383 patients with constipation who underwent colonoscopy from April 2023 to August 2024 were enrolled and randomly divided into routine group(128 cases),experimental group A(128 cases)and experimental group B(127 cases).Routine group treated with 3 L PEG,experimental group A treated with 290 μg Linaclotide+2 L PEG and experimental group B treated with 290 μg Linaclotide+30 mL Simethicone+2 L PEG.Bowel preparation effect[Boston bowel preparation scale(BBPS)scores and foaming removal effect],lesion detection rate,first defecation interval,frequency of defecation,the success rate of cecal intubation,the insertion time of colonoscopy,the withdrawal time of colonoscopy,incidence of adverse reactions and willingness to repeat examination of the three groups were compared.Results No statistically significant differences were observed in the BBPS scores among the three groups(P>0.05);The foaming removal effect score in experimental group B was significantly lower than that in routine group and experimental group A,the difference was statistically significant(P<0.05);The total lesion detection rate and polyps detection rate of experimental group B were significantly higher than those of routine group and experimental group A,the differences were statistically significant(P<0.05).The first defecation interval of the routine group was significantly longer than that of experimental group A and experimental group B,the difference was statistically significant(P<0.05);The frequency of defecation was compared among the three groups,and the difference was no statistically significant(P>0.05).The success rate of cecal intubation in the three groups was 100.0%,and the insertion time of colonoscopy was similar,the differences were not statistically significant(P>0.05);The withdrawal time of colonoscopy in experimental group B was significantly shorter than that in routine group and experimental group A,the difference was statistically significant(P<0.05).The incidence of abdominal distension and total adverse reactions in the routine group were higher than those in experimental group A and experimental group B,the differences were statistically significant(P<0.05);The willingness to repeat examination rate of the routine group was significantly lower than that of experimental group A and experimental group B,the differences were statistically significant(P<0.05).Conclusion 290 μg Linaclotide combined with 30 mL Simethicone and 2 L PEG solution regimen has advantages in intestinal preparation for patients with constipation,and can achieve better intestinal cleaning effect than 3 L PEG solution and 290 μg linalopeptide+2 L PEG solution regimen,with higher safety and willingness to repeat examination.It can be recommended for bowel preparation for patients with constipation.

Objective:To investigate the effect of preoperative patellar tilt angle on postoperative outcome of total knee arthroplasty (TKA).Methods:A total of 277 patients with knee osteoarthritis who underwent TKA without patellar replacement in the First Affiliated Hospital of Nanjing Medical University from October 2020 to September 2022 were retrospectively analyzed. There were 72 males and 205 females, aged 69.16±6.77 years (range, 52-87 years), body mass index 27.01±3.81 kg/m 2 (range 18.14-39.01 kg/m 2). The patients were divided into three groups according to the preoperative tilt angle of the patella: tilt angle<5° for mild tilt group, 5°≤tilt angle<10° for moderate tilt group, and tilt angle≥10° for severe tilt group. There were 103 cases in the mild group, 137 cases in the moderate group, and 37 cases in the severe group. The preoperative and postoperative visual analogue scale (VAS), Hospital for Special Surgery (HSS) score and Feller's score of patella were compared. Results:All patients were followed up for 15.73±3.06 months (range, 12-22 months). The patellar tilt angle was 6.86°±3.55° preoperatively and 3.63°±2.61° postoperatively ( t=19.086, P<0.001). The patellar tilt angle of mild group, moderate group and severe group decreased after operation, and the difference was statistically significant compared with that before operation ( P<0.05). The anterior knee VAS of the three groups decreased after operation, and the differences were statistically significant compared with those before operation. The anterior knee VAS at 3, 6, and 12 months after operation were lower than those before operation. The differences between groups at 6 and 12 months postoperatively were statistically significant ( P<0.05), with anterior knee VAS scores of 2.59±0.55 and 2.03±0.55 in the severe group being greater than those of 2.15±0.38 and 1.57±0.50 in the mild group and 2.19±0.49 and 1.67± 0.61 in the moderate group. The HSS score of the three groups was increased after operation, and the difference was statistically significant compared with that before operation ( P<0.05), and the HSS scores at 3, 6 and 12 months after operation were higher than those before operation. There were significant differences at 6 and 12 months after operation ( P<0.05), the HSS scores of the severe group were 86.27±2.04 and 87.73±2.28, which were lower than those of the mild group 89.02±2.33 and 89.83±1.48, and the moderate group 88.77±2.83 and 89.52±1.95. Postoperative patellar Feller score increased in all three groups, and the difference was statistically significant compared with that before operation ( P<0.05), the patellar Feller score at 3, 6 and 12 months after operation was higher than that before operation. There were significant differences at 6 and 12 months after operation ( P<0.05), the patellar Feller scores in the severe group were 18.32±1.99 and 20.32±1.60, which were lower than those in the mild group 20.92±1.01 and 23.07±1.39 and the moderate group 20.91±1.95 and 22.69±1.59. Conclusion:In TKA patients without patella replacement, the increase of patellar tilt angle before operation can lead to anterior knee pain and reduced knee function.

Objective:To analyze the differences in clinical outcomes and toxicities between postoperative radiotherapy alone and postoperative radiochemotherapy for soft tissue sarcoma (STS), as well as the related factors affecting clinical prognosis of STS patients.Methods:Retrospective analysis of patients diagnosed with primary STS admitted to Zhejiang Cancer Hospital from May 2012 to May 2019 was performed, who received adjuvant radiotherapy after surgery, combined with or without postoperative chemotherapy. A total of 100 patients were enrolled and divided into postoperative radiotherapy group ( n=52) and postoperative radiochemotherapy group ( n=48). The median follow-up time was 65 months (24-124 months). The local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-related toxicities were recorded in two groups. The survival rate was calculated by Kaplan-Meier analysis. Log-rank test was used for univariate analysis, and Cox model was used for multivariate analysis. Results:In multivariate analysis, the maximum tumor diameter was an independent predictor of local tumor recurrence ( HR=4.80, 95% CI=1.16-19.85, P=0.031), distant metastasis ( HR=4.67, 95% CI=1.53-14.26, P=0.007) and OS ( HR=4.10, 95% CI=1.35-12.48, P=0.013). In addition, the degree of myelosuppression in patients in postoperative radiochemotherapy was significantly higher than that in their counterparts in postoperative radiotherapy group ( P<0.001). Conclusions:In the limited number of patients, radiochemotherapy has no advantages over radiotherapy alone in distant metastasis or survival rate. Besides, it increases toxicities, but the overall tolerability is favorable. It is necessary to conduct prospective randomized studies in a large population and subgroup analysis of histological subtypes, aiming to obtain results with better reference value.

The existing doctor-patient communication pattern often falls prey to insufficient informed consent and even medical disputes. In the patient centered perspective, Zhejiang Provincial People′s Hospital explored a new communication mode centering on patients. Based on diagnosis-related groups catalogues and high-frequency surgeries catalogues of the departments, multimedia technology was called into play to produce dubbed PPTs and videos that were easy to understand, standardized and homogeneous, which were embedded into medical records system. Following observation of the PPT or video, patients could directly sign an informed consent on the computer. This practice not only deepens patient′s understanding and achieves homogeneous level of the communication, but also elevates doctor′s work efficiency, contributing to building a harmonious doctor-patient relationship.

Currently, the epidemic of 2019 coronavirus disease (COVID-19) is still ongoing. The characteristics including high contagiousness, herd susceptibility and clinical phenotype diversity, made a serious influence on people’s daily life and rountine therapy for other diseases. Breast dieases are clinical common diseases. In the central epidemic area of COVID-19, Hubei province, especially Wuhan, the clinical specialists of breast diseases should consider all of the following factors comprehensively: the prevention of COVID-19, the diagnosis and treatment of breast diseases and the accessibility of medical resources. Besides, we should select the appropriate therapy and optimize treatment process so as to prevent the propagation and cross infection of COVID-19 as well as manage the breast diseases without delay. Therefore, we carried out some management proposals of the patients with breast diseases in the central epidemic area during the epidemic of COVID-19 on the basis of conventional treatment guidelines and clinical experiences. The suggestions and corrections from colleagues will be welcomed.

Objective:To analyze the correlation between nutritional status and acute toxicity induced by concurrent chemoradiotherapy in patients with rectal cancer.Methods:A total of 115 patients with rectal cancer who underwent concurrent chemoradiotherapy in Zhejiang Cancer Hospital from March 2018 to August 2019 were prospectively selected. Nutritional risk was assessed by NRS 2002 and PG-SGA nutritional screening tools before, during and after radiotherapy. The acute toxicity was assessed by RTOG and CTCAE 3.0 scoring criteria. The correlation between nutritional status and the acute toxicity of chemoradiotherapy was analyzed by Spearman′ s correlation analysis. Results:The nutritional risk of the cohort was gradually increased from the beginning of chemoradiotherapy to the fourth week of chemoradiotherapy, and then decreased gradually. Spearman′ s correlation analysis showed that NRS 2002 and PG-SGA scores were positively correlated with acute hematological toxicity ( r=0.26, P<0.05; r=0.31, P<0.01), upper gastrointestinal toxicity ( r=0.51, P<0.01; r=0.63, P<0.01), proctitis ( r=0.23, P<0.05; r=0.45, P<0.01) and fatigue ( r=0.47, P<0.01; r=0.64, P<0.01) in patients with rectal cancer undergoing chemoradiotherapy. The correlation coefficients between PG-SGA and various toxicities were higher than those of NRS 2002. Stratified analysis showed that patients with stage Ⅱ-Ⅲ B, age<65 years and postoperative adjuvant chemoradiotherapy, nutritional status was significantly associated with the severity of toxicity (all P<0.05). Conclusions:Patients with rectal cancer has a high risk of malnutrition during concurrent chemoradiotherapy. The higher the risk of malnutrition, the greater the acute toxicity of chemoradiotherapy. Therefore, dynamic nutrition assessment and nutritional support should be strengthened for rectal cancer patients during chemoradiotherapy.

Much progress has been made in the diagnosis and treatment of Hodgkin's lymphoma, which has become a highly curable malignancy.However, prolonged survival makes clinicians pay more attention to long-term toxicities of treatment.Consequently, individualized treatment based on disease stage and risk factors is a research hotspot at present.This article reviews recent advances in the individualized treatment of early-stage classical Hodgkin's lymphoma.

Objective: In comparison with thrombus aspiration, to study the safety and effcacy of precise intracoronary retrograde thrombolysis during primary percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).
Methods: A total of 123 consecutive patients with acute STEMI received primary PCI in our hospital from 2014-01 to 2015-12 were enrolled.The patients were randomly divided into 2 groups: RT group, the patients received precise intracoronary retrograde thrombolysis (RT),n=60 and TA group, the patients received thrombus aspiration (TA),n=63, among them, 3 patients with failed TA were excluded. Primary end points included occurrence rates of no-lfow after PCI and ST-segment resolution (STR)≥50% at (60-90) min after PCI; primary safety end points included occurrence rates of in-hospital stroke and TIMI-hemorrhage events.
Results:①Compared with TA group, RT group showed decreased no-lfow rate after PCI (1.7% vs 15.0%),P=0.008 and increased rate of STR≥50% after PCI (65.0% vs 45.0%),P=0.028, improved LVEF by echocardiography (50.7±8.6) % vs (46.7±8.3)%,P=0.011. The in-hospital MACE occurrence rate was similar between 2 groups,P>0.05.②No in-hospital stroke or TIMI-hemorrhage events occurred in neither group.
Conclusion: Intracoronary retrograde precise thrombolysis had the similar safety to thrombus aspiration during primary PCI in patients with acute STEMI, it may reduce no-relfow rate and improve left ventricular function after PCI.

Objective To investigate the effect and mechanism of combined therapy using anti-CTLA-4 antibody and doxoru-bicin on mice bearing breast cancer.Methods Balb/c mice inoculated with 4T-1 mouse breast cancer cell were used as tumor mod-els,which were randomly divided into blank group,solvent control group,anti-CTLA-4 antibody only group,doxorubicin only group and combined therapy group.Tumor growth of mice was observed.The ratio of spleen and bone marrow cell subgroup were evaluated.Tumor microenvironment apoptosis and microvessel density (MVD)were evaluated.Results The tumor volume of an-ti-CTLA-4 antibody only group,doxorubicin only group and combined therapy group were lower than those in the rest groups(P <0.05).The tumor volume and mass of combined therapy group was significantly higher than those of anti-CTLA-4 antibody only group,doxorubicin only group (P <0.05).Compared with blank group,solvent control group,CD8 + Tand CD4 + T ratio in anti-CTLA-4 antibody only group,doxorubicin only group,combined therapy group increased with significant difference (P <0.05). The positive cell apoptosis rate of combined therapy group was significantly higher than those of other groups(P < 0.05 ).The MVD of combined therapy group was significantly lower than those of other groups(P <0.05).The positive cell apoptosis rate and MVD of anti-CTLA-4 antibody only group,doxorubicin only group were better than those of blank group,solvent control group. Conclusion Combined therapy using anti-CTLA-4 antibody and doxorubicin could improve the immune,significantly inhibit the growth of tumor,promote cancer cell apoptosis and decrease MVD.