Objective:To evaluate the effects of sequential immunotherapy with radiotherapy on survival time and immune function in patients with unresectable stage III non-small cell lung cancer (NSCLC) in a real-world study.Methods:Data of 84 patients with unresectable stage III NSCLC who were treated at the Affiliated Hospital of Inner Mongolia Medical University from January 2021 to December 2022 (retrospective cohort) and from January 2023 to December 2023 (prospective cohort) were collected. The patients were divided into the combination group ( n=40) and radiotherapy group ( n=44) based on whether they received sequential immunotherapy or not. The progression-free survival (PFS) and overall survival (OS) between two groups were compared using standardized mortality ratio weighting (SMRW). Univariate Cox proportional hazards model, multivariate regression analysis, multi-model comparison of propensity score matching and subgroup analysis were emploed to analyze the robustness of clinical efficacy between two groups. E-value analysis was used to analyze the sensitivity of unmeasured confounding factors in observational studies. Additionally, the percentage of CD4 +T cells, CD8 +T cells and natural killer (NK) cells, and CD4 +/CD8 + T cell ratio before and after treatment between two groups were compared using analysis of covariance. Results:Among 84 patients, 77 (92%) cases were male and 7 (8%) were female. Among them, 42 (50%) were aged 65 years or older. The variables showed high homogeneity after SMRW, with a standardized mean difference of less than 0.1. In the combination group, the median PFS [17.0 months vs. 7.0 months, HR=0.260, 95% CI: 0.130-0.490, P<0.001] and OS [not reached vs. 24.0 months, HR=0.210, 95% CI: 0.070-0.590, P=0.002] were significantly longer compared to that in the radiotherapy group, with statistically significant differences. The study results were confirmed by robustness and sensitivity analyses. After treatment, patients in the combination group showed a statistically significant increase in the percentage of CD4 + T cells and NK cells, and CD4 +/CD8 + T cell ratio, as well as a decrease in the percentage of CD8 + T cells compared to those in the radiotherapy group (all P<0.05). Conclusions:Sequential immunotherapy following radiotherapy can significantly improve survival and prognosis of unresectable stage III NSCLC patients. The survival benefit is even greater when combined with chemotherapy. The main mechanism of the survival benefit may be the improvement of anti-tumor immune function.

Objective To evaluate the efficacy and safety of magnetic resonance-guided modified ligation of the intersphincteric fistula tract in the treatment of deep anorectal abscess.Methods A retrospective study was conducted on 148 patients with deep anorectal abscess treated at our hospital from September 2019 to June 2023,who met the inclusion criteria.Of these,51 patients in the observation group underwent modified LIFT,while 97 patients in the control group received incision and drainage.Using propensity score matching,47 patients from each group with balanced baseline characteristics were selected,resulting in a total of 94 patients being included in the analysis.The study compared operation time,hospital stay,pain index,postoperative complications,anal function,and healing rate between the two groups.Results Primary lesions originating in the sphincter space were identified through preoperative magnetic resonance imaging in all 94 patients.The mean operation time for the observation group was(43.75±11.77)minutes,significantly longer than that of the control group at(28.90±8.67)minutes(P<0.05).At three months post-surgery,the healing rate in the observation group was 80.9%,which was signifi-cantly higher than the 57.4%observed in the control group(P<0.05).Among patients with fistulas in the observation group,the healing rate was 73.1%,although this difference was not statistically significant in the univariate analysis of clinical characteristics(P>0.05).No significant differences were found between the two groups regarding the length of hospital stay,pain index,postoperative complications,or anal function(all P>0.05).Conclusions Modified LIFT guided by MRI can be conditionally applied in the treatment of deep anorectal abscesses.This approach can enhance the initial surgical healing rate without significantly increasing the incidence of postoperative complications,thereby avoiding potential damage to anal function.

Objective To evaluate the efficacy and safety of magnetic resonance-guided modified ligation of the intersphincteric fistula tract in the treatment of deep anorectal abscess.Methods A retrospective study was conducted on 148 patients with deep anorectal abscess treated at our hospital from September 2019 to June 2023,who met the inclusion criteria.Of these,51 patients in the observation group underwent modified LIFT,while 97 patients in the control group received incision and drainage.Using propensity score matching,47 patients from each group with balanced baseline characteristics were selected,resulting in a total of 94 patients being included in the analysis.The study compared operation time,hospital stay,pain index,postoperative complications,anal function,and healing rate between the two groups.Results Primary lesions originating in the sphincter space were identified through preoperative magnetic resonance imaging in all 94 patients.The mean operation time for the observation group was(43.75±11.77)minutes,significantly longer than that of the control group at(28.90±8.67)minutes(P<0.05).At three months post-surgery,the healing rate in the observation group was 80.9%,which was signifi-cantly higher than the 57.4%observed in the control group(P<0.05).Among patients with fistulas in the observation group,the healing rate was 73.1%,although this difference was not statistically significant in the univariate analysis of clinical characteristics(P>0.05).No significant differences were found between the two groups regarding the length of hospital stay,pain index,postoperative complications,or anal function(all P>0.05).Conclusions Modified LIFT guided by MRI can be conditionally applied in the treatment of deep anorectal abscesses.This approach can enhance the initial surgical healing rate without significantly increasing the incidence of postoperative complications,thereby avoiding potential damage to anal function.

Objective:To evaluate the effects of sequential immunotherapy with radiotherapy on survival time and immune function in patients with unresectable stage III non-small cell lung cancer (NSCLC) in a real-world study.Methods:Data of 84 patients with unresectable stage III NSCLC who were treated at the Affiliated Hospital of Inner Mongolia Medical University from January 2021 to December 2022 (retrospective cohort) and from January 2023 to December 2023 (prospective cohort) were collected. The patients were divided into the combination group ( n=40) and radiotherapy group ( n=44) based on whether they received sequential immunotherapy or not. The progression-free survival (PFS) and overall survival (OS) between two groups were compared using standardized mortality ratio weighting (SMRW). Univariate Cox proportional hazards model, multivariate regression analysis, multi-model comparison of propensity score matching and subgroup analysis were emploed to analyze the robustness of clinical efficacy between two groups. E-value analysis was used to analyze the sensitivity of unmeasured confounding factors in observational studies. Additionally, the percentage of CD4 +T cells, CD8 +T cells and natural killer (NK) cells, and CD4 +/CD8 + T cell ratio before and after treatment between two groups were compared using analysis of covariance. Results:Among 84 patients, 77 (92%) cases were male and 7 (8%) were female. Among them, 42 (50%) were aged 65 years or older. The variables showed high homogeneity after SMRW, with a standardized mean difference of less than 0.1. In the combination group, the median PFS [17.0 months vs. 7.0 months, HR=0.260, 95% CI: 0.130-0.490, P<0.001] and OS [not reached vs. 24.0 months, HR=0.210, 95% CI: 0.070-0.590, P=0.002] were significantly longer compared to that in the radiotherapy group, with statistically significant differences. The study results were confirmed by robustness and sensitivity analyses. After treatment, patients in the combination group showed a statistically significant increase in the percentage of CD4 + T cells and NK cells, and CD4 +/CD8 + T cell ratio, as well as a decrease in the percentage of CD8 + T cells compared to those in the radiotherapy group (all P<0.05). Conclusions:Sequential immunotherapy following radiotherapy can significantly improve survival and prognosis of unresectable stage III NSCLC patients. The survival benefit is even greater when combined with chemotherapy. The main mechanism of the survival benefit may be the improvement of anti-tumor immune function.

Objective To compare the efficacy, safety, and survivability of TCbHP versus AC-THP in the neoadjuvant therapy of HER2-positive breast cancer in real-world. Methods Clinical data of patients with HER2 positive breast cancer, who have received TCbHP or AC-THP as neoadjuvant therapy and completed surgery in 11 third-class hospitals in various cities of Hebei Province, were retrospectively collected.The total pathological complete remission (tpCR) rate, the incidence of grade 3 or higher adverse reactions and the completion rate of the given approaches were compared. Results A total of 110 cases were collected, including 78 cases in the TCbHP group and 32 cases in the AC-THP group.The tpCR rate of the TCbHP group was higher than that of the AC-THP group, but the difference was not statistically significant (64.10% vs. 56.25%, P=0.441).No significant difference was found in the breast pathologic complete response (bpCR) and axillary pathologic complete response (apCR) rates between the TCbHP group and the AC-THP group (70.51% vs. 56.25%, P=0.150;78.21% vs. 84.38%, P=0.462).Exploratory analysis revealed that the tpCR rate of the TCbHP group was significantly higher than that of the AC-THP group in patients with HR-positive breast cancer (51.11% vs. 22.22%, P=0.036).As for the patients with HR-negative breast cancer, the tpCR rate of the AC-THP group tended to be higher than that of the TCbHP group (100% vs. 81.82%, P=0.088).The incidence of grade 3 or higher adverse reactions in the TCbHP group was slightly higher than that in the AC-THP group (12.82% vs. 9.38%, P=0.753).No deaths occurred in the whole group.Moreover, no significant difference was observed in the completion rate of the given approaches between the TCbHP group and the AC-THP group (92.31% vs. 90.63%, P=0.718). Conclusion In real-world clinical practice, the neoadjuvant therapy of TCbHP and AC-THP are effective, safe, and well tolerated among patients with HER2-positive breast cancer.The tpCR rate between the two approaches was not significantly different.The AC-THP regimen could also be considered as one of the optimal regimens for HER2-positive breast cancer in neoadjuvant therapy.

Objective:To investigate the risk factors for nonunion after surgery for femoral shaft fractures in order to reduce them.Methods:The clinical data were retrospectively analyzed of the 804 patients with femoral shaft fracture who had been treated from January 2014 to December 2020 at Department of Orthopaedics, Xijing Hospital. There were 575 males and 229 females, aged from 18 to 96 years (average, 43.7 years). The patients were divided into 2 groups according to whether nonunion had occurred after surgery: a nonunion group of 112 cases and a fracture healing group of 692 cases. The preoperative general data, such as age, gender and fracture type, as well as intraoperative and postoperative data, such as operation time, internal fixation method, reduction method and internal fixation failure, were compared between the 2 groups. Items with P<0.05 were included in the multivariate logistic regression analysis to identify the risk factors for nonunion. Results:There were statistically significant differences between the nonunion group and the fracture healing group in smoking history, drinking history, injury mechanism, injury type, multiple injuries, fracture AO classification, fixation method, internal fixation failure, postoperative infection and use of non-steroid anti-inflammtory drugs ( P<0.05). Multivariate logistic regression analysis showed that smoking ( OR=3.261, 95% CI: 2.072 to 5.133, P<0.001), high energy injury ( OR=2.010, 95% CI: 1.085 to 3.722, P=0.026), multiple injuries ( OR=3.354, 95% CI: 1.985 to 5.669, P<0.001), AO type 32-C fracture (type 32-C fracture used as a reference, P=0.034), internal fixation failure ( OR=3.517, 95% CI: 1.806 to 6.849, P<0.001), external stent fixation (external stent fixation used as a reference, P=0.009) were the risk factors for nonunion after femoral shaft fractures. Conclusions:After surgery for patients with femoral shaft fracture, special attention should be paid to those with a smoking habit, high-energy injury, multiple injuries, AO type 32-C fracture, external stent fixation or a failed internal fixation, because they are high-risk groups prone to postoperative nonunion.

ObjectiveTo investigate the accuracy of three laparoscopic liver resection (LLR) difficulty score systems (DSSs) in evaluating surgical difficulty and predicting short-term postoperative outcome. MethodsThe retrospective cohort study was conducted for 142 patients who underwent LLR in The First Hospital of Lanzhou University from June 2015 to May 2020, and their preoperative, intraoperative, and postoperative clinical data were collected. According to preoperative clinical data, DSS-B score, Hasegawa score, and Halls score were used to determine the difficulty score of surgery for each patient, and then the patients were divided into low, medium, and high difficulty groups. Intraoperative data were compared between the three groups to verify the accuracy of the three DSSs, and postoperative clinical data were used to evaluate the ability of DSSs to predict short-term postoperative outcome. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple or two groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups, and the Bonferroni method was used for correction of P values between two groups. The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated to evaluate the efficiency of each DSS in predicting postoperative complications. ResultsAmong the 142 patients, there were 37 patients in the low difficulty group, 56 in the medium difficulty group, and 49 in the high difficulty group based on DSS-B score; there were 70 patients in the low difficulty group, 47 in the medium difficulty group, and 25 in the high difficulty group based on Hasegawa score; there were 46 patients in the low difficulty group, 62 in the medium difficulty group, and 34 in the high difficulty group based on Halls score. For the low, medium, and high difficulty groups based on DSS-B score, Hasegawa score, or Halls score, time of operation, intraoperative blood loss, and rate of hepatic portal occlusion increased with the increase in difficulty score (all P＜0.001); there was a significant difference in intraoperative blood transfusion rate between the medium and high difficulty groups based on DSS-B score (P＜0.017), between the low and high difficulty groups based on Halls score (P＜0.017), and between the low, medium, and high difficulty groups based on Hasegawa score (P＜0.017). There was a significant difference in the rate of conversion to laparotomy between the medium and high difficulty groups based on DSS-B score (P＜0.017), and Hasegawa score and Halls score identified the difference between the low and high difficulty groups (P＜0.017). For the length of postoperative hospital stay, DSS-B score and Halls score only identified the difference between the low and high difficulty groups (P＜0.05), while Hasegawa score identified the difference between the low difficulty group and the medium/high difficulty groups (P＜0.05); for the incidence rate of postoperative complications, only Hasegawa score effectively identified the difference between the high difficulty group and the low/medium difficulty groups (P＜0.017). DSS-B score, Halls score, and Hasegawa score had an AUC of 0.636 (95% confidence interval ［CI］: 0.515-0.758), 0.557 (95% CI: 0.442-0.673), and 0.760 (95% CI: 0.654-0.866), respectively, in predicting postoperative complications, among which Hasegawa score had the highest predictive efficiency. ConclusionDSS-B score and Hasegawa score can better assess the difficulty of LLR, and Hasegawa score has an advantage in predicting short-term postoperative outcome.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To explore the value of medical three-dimensional visualization technology in preoperative precise assessment for hepatocellular carcinoma (HCC).Methods The clinical data of 24 HCC patients were analyzed retrospectively from Jan 2015 to Dec 2016 in our department.Thin-layer 320-slice CT scaning was performed and data stored in the form of DICOM.Three dimensional reconstruction and simulated hepatectomy were conducted,and correlation test analysis was performed.Results The volume of simulated resected liver was (565 ± 296)ml,while the actual liver resection volume was(523 ± 252)ml.There was no significant difference between the predicted and the actual values (t =1.734,P ＞ 0.05).The actual liver resection volume was positively correlated with the predicted liver resection volume (r =0.920,P ＜ 0.05).The stimulated resection margin was (1.2 ± 0.6)cm,while the actual resected tumor margin was (1.0 ± 0.5) cm.There was no significant difference between the predicted and the actual values (t =1.853,P ＞0.05).The actual margin was positively correlated with the predicted one (r =0.956,P ＜ 0.05).Conclusion The three-dimensional visualization technology has a certain degree of clinical value in the preoperative evaluation of HCC.

Objective:To prepare lansoprazole enteric-coated pellets and compress them into orally disintegrating tablets , and e-valuate the acid resistance in the acid stage and the in vitro dissolution in the buffer stage .Methods:Lansoprazole enteric-coated pel-lets were prepared by fluid bed coating technology , and the effects of the ratio of methacrylic acid copolymer dispersion to ethyl acrylate–methyl methacrylate copolymer dispersion , the concentration of triethyl citrate and the main pressure on the acid resistance in the acid stage and the in vitro dissolution in the buffer stage were evaluated .The similarity of the self-prepared orally disintegrating tablets and the reference preparation was evaluated by using f 2 similarity factor method .Results:The average particle size of microcrystalline cellulose core was 150-180 μm, the ratio of methacrylic acid copolymer dispersion to ethyl acrylate –methyl methacrylate copolymer dispersion was adjusted to 8:2, the enteric-coated weight was 30％, 20％triethyl citrate was used and the main pressure was controlled within the range of 10-16 kN.Lansoprazole enteric-coated pellets had sufficiently flexibility and stability against the compression force . The enteric coating did not break , showing good acid resistance .The dissolution similarity factor of the self-prepared orally disintegra-ting tablets and the reference preparation was greater than 50.Conclusion: Lansoprazole enteric-coated pellets orally disintegrating tablets have good acid resistance and high similarity for the in vitro dissolution, which can be further amplified .