Objective:To explore the predictors of upper tract urothelial carcinoma (UTUC) invading muscle.Methods:The preoperative clinical data of 169 patients with UTUC who underwent radical nephroureterectomy (RNU) in the Department of Urology, Second Hospital of Tianjin Medical University from August 2019 to September 2021 were retrospectively collected. The average age of the patients was (67.7±8.3)years. There were 95 male cases (56.2%).15 cases (15.8%) were with diabetes, 46 cases (48.4%) with hypertension, 68 cases (71.6%) with hematuria, 44 cases (46.3%) with renal pelvis tumor, 74 cases (77.9%) with hydronephrosis and 8 cases (8.4%) with multifocality. There were 15 (20.3%), with diabetes, 40(54.1%) with hypertension, 58(78.4%)with hematuria, 32(43.2%) with renal pelvis tumor, 60(81.1%) with hydronephrosis and 2(2.7%) with multifocality among 74 female patients(43.8%), respectively. Patients’ body mass index (BMI) was (24.2±3.2) kg/m 2.The tumor diameter was (3.4±1.8) cm. The average count of neutrophil (NEU) was (4.2±1.7) ×10 9/L, with monocyte (MON) (0.4±0.2) ×10 9/L, platelet (PLT) (237.8±75.3) ×10 9/L and lymphocyte (LYM) (1.7±0.5) ×10 9/L. Neutrophil-to-lymphocyte ratio (NLR) was 2.7±1.4. Mmonocyte-to-lymphocyte ratio (MLR) was 0.3±0.1 and platelet-to-lymphocyte ratio (PLR) was 151.1±59.6. The concentrations of hemoglobin (Hb) and fibrinogen (FIB) were (127.1±18.3) g/L and(3.5±1.0) g/L. Univariate logistic regression analysis was performed on all preoperative data, and a nomogram was established to predict UTUC invading muscle by stepwise regression combined with multivariate logistic analysis. Concordance index (C-index) was used to evaluate the accuracy of the model, and Hosmer-Lemeshow test was used to check the fit. Using 1000 bootstrap resampling to validate the model and draw calibration plot. Receiver operating characteristics (ROC) curves were used to determine the most appropriate cut-off point of the model to predict tumor invasion and evaluate its sensitivity and specificity. Results:In this study, there were 169 cases. Postoperative pathological results showed that 18 cases (10.6%) were of low grade and 151 cases (89.4%) were of high grade. There were 2 patients (1.2%) with pT a stage, 44 patients (26.0%) with pT 1 stage, 37 patients (21.9%) with pT 2 stage, 81 patients (47.9%) with pT 3 stage and 5 patients (3.0%) with pT 4 stage. According to tumor stage, 46 patients were included into non-muscle invasive disease (NMID, pT a/T is/T 1) group and 123 patients were included into muscle invasive disease (MID, pT 2/T 3/T 4) group. Univariate analysis showed that hydronephrosis ( OR=2.919, 95% CI 1.332-6.387, P=0.007) was significantly correlated with MID. Tumor location in ureter ( OR=1.898, 95% CI 0.960-3.800, P=0.067), higher NLR value ( OR=1.313, 95% CI 0.9901.832, P=0.082) and FIB concentration ( OR=1.436, 95% CI 1.008-2.125, P=0.056) might have potential association with MID. Stepwise regression method was used to screen out PLT, FIB and hydronefrosis as the optimal combination for MID prediction. multivariate analysis suggested that PLT decreasing ( OR=0.727, 95% CI 0.548-0.955, P=0.023), FIB increasing ( OR=1.629, 95% CI 1.084-2.552, P=0.025) and hydronephrosis ( OR=2.500, 95% CI 1.111-5.601, P=0.026) were independent predictors of MID.The C-index of the model constructed by the three factors was 0.682, and the P-value of the goodness of fit was 0.778. The ROC curve showed that the optimal cut-off point for the prediction of high-risk MID by the nomogram was 0.627, achieving 39.1% specificity, 88.6% sensitivity and 0.682 area under the curve (AUC). Conclusions:Preoperative decrease of PLT, increase of FIB and hydronephrosis were independent factors for predicting UTUC invading muscle.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Objective:To retrospectively analyze the failure patterns and outcomes of patients with locally advanced hypopharyngeal squamous cell carcinoma (HPSCC) after undergoing induction chemotherapy (IC) followed by definitive radiotherapy.Methods:For patients with locally advanced HPSCC who were treated with IC and definitive radiotherapy from August 2008 to December 2019, their data were collected from the medical records system, and their clinical characteristics, failure patterns, and survival were retrospectively analyzed.Results:A total of 116 eligible patient with squamous cell carcinoma were included in this study. with a median age of 59 (39-79), and 3, 3, 60, and 50 of them had stage Ⅱ, Ⅲ, Ⅳ A, and Ⅳ B HPSCC, respectively. Among these patients, 81 received 1~2 cycles of IC, and 35 received 3-4 cycles of IC. After treatment with IC, 54, 13, and 49 patients received concurrent chemoradiotherapy, radiotherapy combined with targeted therapy, and radiotherapy alone, respectively. The median follow-up was 34.6 months (95% CI: 28.7-40.5 months). The 3-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), metastasis-free survival (MFS), progression-free survival (PFS), and overall survival (OS) of all the patients were 63.5%, 82.8%, 75.2%, 47.3%, and 43.1%, respectively. Median PFS and OS were 26.1 and 28.0 months, respectively. Treatment failure was reported in 59 patients, of whom 22, 5, 12, 10, 3, 6 and 1 experienced local, regional, distant only, local-regional, regional-distant, local-distant, and local-regional-distant failure, respectively. The objective response rate (CR+ PR) of patients after IC was 55.2% (64/116). The LRFS, RRFS, PFS, and OS of IC responders (CR+ PR) were better than those of IC non-responders (SD+ PD) ( χ2 = 12.52, 5.16, 13.19, 11.72, all P< 0.05). Conclusions:IC combined with radical radiotherapy has efficacy to a certain extent in the treatment of locally advanced HPSCC, and locoregional recurrence predominates the failure patterns. The prognosis of IC responders is significantly better than that of IC non-responders.

Objective:To evaluate the efficacy of endovascular stenting of various types of venous sinus stenosis in idiopathic intracranial hypertension (IIH).Method:Clinical, radiological, and manometric data before and after stenting in venous sinus stenosis were retrospectively analyzed in 99 IIH patients who were refractory to medical therapy or rapidly progressed between July 2004 to July 2019. The follow-up period was between 2.3 months to 11 years.Results:Our study enrolled 21 men (21.2%)and 78 women (78.8%) with average body mass index (BMI) 19.2-40.6(27.0±4.4) kg/m2 and median age 37 years. Before stent placement, the mean transverse sinus stenosis gradient was 1-59(26±8) mmHg. Patients with extrinsic stenosis were younger than those with intrinsic and mixed stenosis. In all cases, stenting was effective for papilledema. Fifty patients complained of headaches. Pulsatile tinnitus in twenty-eight patients completely alleviated after stenting. In one patient, replacement of stent did not improve symptoms, and a subsequent CSF diversion procedure was performed and effective.Conclusion:Irrespective of the type of stenosis, stenting of venous sinus stenosis is an effective treatment for IIH. Patients with persistent papilledema post-stenting and elevated transverse pressure pre-stenting should be followed closely as high risk of stenting failure may occur and further diversion procedure is needed.

Objective:To observe the changes of nutrition impact symptoms (NIS) and fat-free mass and analyze the relationship between them in patients with head and neck cancer (HNC) during radiotherapy.Methods:A convenient sampling method was adopted to select HNC patients who received radiotherapy in the outpatient clinic of department of radiotherapy for head and neck cancer in a cancer hospital in Beijing from March 2017 to January 2020. The nutrition impact symptoms (NIS) were assessed by a nutrition impact symptoms checklist and the fat free mass was assessed by bioelectrical impedance analysis at three time points: before radiotherapy (T1), during radiotherapy (T2) and at the end of radiotherapy (T3). The Generalized Estimating Equations (GEE) was used to analyze the relationship between them.Results:A total of 542 HNC patients were included in the analysis. During radiotherapy, the patients' NIS number and score presented an increasing trend, reaching the highest level and peaked at the end of radiotherapy. The change of fat-free mass showed a decreasing trend and reached the minimum at the end of radiotherapy. Patients with higher NIS scores had more percentage loss of fat-free mass.Conclusions:During radiotherapy, patients with HNC showed an increase in NIS score and lost fat-free mass. Patients with higher NIS score lost more percentage of fat-free mass, which suggested that clinical medical staff should pay attention to NIS management and take comprehensive intervention measures in time to reduce the loss of fat-free mass.

Objective:To investigate the effect of nursing intervention based on stress system theory on posttraumatic growth (PTG) and social support in patients with stroke.Methods:120 stroke patients who were hospitalized in Department of Neurology, Tangshan People's Hospital from January to August 2018 were selected as the research subjects by convenient sampling. A total of 120 stroke patients were divided into intervention group and control group according to the random number table method with 60 patients in each group. The control group was given routine care, and the intervention group was given stress system intervention on this basis. The Post-traumatic Growth Assessment Inventory (PTGI) and the Perceived Social Support Scale (PSSS) were used to compare the PTG and social support levels of the two groups.Results:After 2 months of intervention, the total score of PTGI in the intervention group was (69.67±9.10) , and that in the control group was (48.62±7.94) , the difference between the two groups was statistically significant ( P<0.05) . After the intervention, the PSSS score of the intervention group was (59.15±13.47) , which was higher than that in the control group (50.87±20.09) , the difference between the two groups was statistically significant ( P<0.05) . Conclusions:Stress system intervention can improve PTG and social support in patients with stroke.

Objective To describe the characteristics of radiation induced mucositis in patients withhead and neck cancer ( HNC) during radiotherapy, and analyze the effect of radiation induced mucositis on diet patterns and weight change and the influencing factors for radiation induced mucositis. Methods Patients with HNC treated with radiotherapy in one cancer hospital were recruited. Data were collected before, during and at the end of the radiotherapy, which included radiation induced oral and pharyngeal mucositis, pain during eat-ing, diet patterns and weight. Results Two hundred and two patients were completely investigated and 43.5％and 34. 2％ of the patients suffered from moderate to severe (≥grade 2) oral mucositis and pharyngeal mucosi-tis, respectively during the radiotherapy. At the end of radiotherapy, 53. 5％ and 51. 5％ of the patients suffered from moderate to severe oral mucositis and pharyngeal mucositis (≥grade 2 ) , respectively. Oral and pharyngeal mucositis were significantly correlated with pain during eating, diet patterns and weight ( P<0. 05) . Tumor site was the main reason that affected the severity of mucositis ( Wald χ2 =26. 033, 14. 216;P<0.001). Conclusion Radiation induced mucositis was gradually aggravated with radiotherapy progress, which is closely related to pain during eating, change of diet patterns and weight loss. The severity of mucositis is re-lated to the tumor site. Measures should be taken to strengthen the management of adverse reactions and nutri-tional status of patients.

Objective To evaluate the differences of the malignant rate of thyroid nodules between primary hyperparathyroidism (PHPT) patients and health examination population, and analyze the clinical characteristics of PHPT combined with papillary thyroid carcinoma (PTC). Methods The clinical data of 158 PHPT patients who had underwent parathyroidectomy and 468 thyroid nodule patients who had underwent fine-needle aspiration (FNA) from 2009 to 2014 were retrospectively analyzed, and the detection rate of PTC in patients with thyroid nodule was recorded. Results Of the 158 patients with PHPT, 61 patients had thyroid nodules, the incidence of PHPT with thyroid nodule was 38.6% (61/158), and postoperative pathologically proved PTC was in 12 cases (19.7%). Of the 468 thyroid nodule patients who had underwent FNA, postoperative pathologically proved PTC was in 19 patients (4.1% ). The malignant rate of thyroid nodules in PHPT patients was significantly higher than that in health examination population (P＜0.01). The adjusted serum calcium in patients with PHPT combined with PCT was significantly lower than that in patients with PHPT combined with benign thyroid nodules and patients with PHPT without thyroid nodules: (2.63 ± 0.26) mmol/L vs. (2.92 ± 0.32) and (2.93 ± 0.47) mmol/L, and there was statistical difference (P＜0.05). Conclusions The malignant rate of thyroid nodules in PHPT patients is significantly higher than that in patients from health examination population, which suggests that PHPT might be a risk factor for the malignancy of thyroid nodules. A lower level of serum calcium may predict the existence of PCT in PHPT patients with thyroid nodules.

Vorapaxar,a novel antagonist of the protease-activated receptor 1 (PAR-1 ),can inhibit the clotting process. Deuterium-labeled vorapaxar was required for the analysis of clinical sample as an internal stand-ard. Starting for unlabeled vorapaxar,four-step reactions including hydrolysis,condensation,transesterification and hydrogen-deuterium exchange were carried out to synthesize [D8]vorapaxar effectively for the first time. All intermediates and final products were confirmed by NMR and high resolution mass spectrometry (HRMS).Impor-tantly,the prepared [D8]vorapaxar could meet the requirements of sample analysis as the internal standard.

Objective To study the relationship between hypertensive cerebral hemorrhage and microbleeds by analyzing the characteristics of magetic susceptibility-weighted imaging.Methods Fifty-one patients with mild hypertensive cerebral hemorrhage admitted to Shenzhen Nanshan District No.6 People's Hospital for MRI (T1WI,T2WI and T2FLAIR),susceptibility-weighted imaging,and magnetic resonance angiography from June 2016 to June 2017 were included in this study.Their MRI data were analyzed.Results Multiple foci of microbleeds and small vessel hyperplasia were detected in hemorrhage regions of the 51 patients included in this study,including ＞2 foci of microbleeds in intracranial basal area,thalamus,brain stem and cerebellar area of 40 patients (78.4％),and cerebral small vessel hyperplasia and VR space enlargement in 11 patients (21.6 ％).Magnetic resonance angiography showed cerebral middle artery and basal artery atheroclerosis in 15 patients but no vascular dissection,stenosis,aneurysm and vascular malformation in the other patients.Conclusion MRI can show the pathological changes in cerebral blood vessels of hypertensive hemorrhage patients,including cerebral microbleeds,cerebral small vessel hyperplasia and VR space enlargement.