BACKGROUND: The effect of intra-operative chemotherapy (IOC) on the long-term survival of patients with colorectal cancer (CRC) remains unclear. In this study, we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection. METHODS: 1820 patients were recruited, and 1263 received IOC and 557 did not. Clinical and demographic data were collected, including overall survival (OS), clinicopathological features, and treatment strategies. Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models. A regression model was developed to analyze the independent effects of IOC. RESULTS: Proportional hazard regression analysis showed that IOC (hazard ratio [HR]=0.53, 95% confidence intervals [CI] [0.43, 0.65], P  < 0.001) was a protective factor for the survival of patients. The mean overall survival time in IOC group was 82.50 (95% CI [80.52, 84.49]) months, and 71.21 (95% CI [67.92, 74.50]) months in non-IOC group. The OS in IOC-treated patients were significantly higher than non-IOC-treated patients ( P  < 0.001, log-rank test). Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model (HR=0.53, 95% CI [0.43, 0.65], P  < 0.001), model 2 (adjusted for age and gender, HR=0.52, 95% CI [0.43, 0.64], P  < 0.001), and model 3 (adjusted for all factors, 95% CI 0.71 [0.55, 0.90], P  = 0.006). The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II (HR = 0.46, 95% CI [0.31, 0.67]) or III disease (HR=0.59, 95% CI [0.45, 0.76]), regardless of pre-operative radiotherapy (HR=0.55, 95% CI [0.45, 0.68]) or pre-operative chemotherapy (HR=0.54, 95% CI [0.44, 0.66]). CONCLUSIONS: IOC is an independent factor that influences the survival of CRC patients. It improved the OS of patients with stages II and III CRC after radical surgery. TRIAL REGISTRATION chictr.org.cn, ChiCTR 2100043775.
Humans ; Fluorouracil/therapeutic use* ; Leucovorin/therapeutic use* ; Colorectal Neoplasms/pathology* ; Retrospective Studies ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Proportional Hazards Models ; Prognosis

Objective To revise the qualitative and quantitative determination methods of Xuanxi Rongjin powder. Methods TLC was used to qualitatively identify Chuanxiong and Chuanshanlong. The content of cinnamaldehyde in the preparation was determined by HPLC with KR100-5C₁₈ column (250 mm×4.6 mm, 5μm). The mobile phase was acetonitrile-water (35:65) and the detection wavelength was 290 nm. Results TLC can qualitatively identify Chuanxiong and Chuanshanlong. Cinnamaldehyde has a good linear relationship in the range of 0.0489~0.3260 µg/ml (r=1.00), The average recovery was 95.71% (RSD=1.78%). Conclusion The method has high sensitivity, good specificity, simple operation and good reproducibility.

COVID-19, caused by SARS-COV-2, has the characteristics of world epidemic, highly infectious and large base of death. In China, transmission route of SARS-COV-2 has been contained so effectively that COVID-19 has been well controlled due to the proactive national prevention and control strategy. However, not only does it bring a huge impact on the existing medical structure model, but also an objective impact on the treatment of patients with chronic diseases such as malignant tumors. Based on the progress reported in the domestic and international literatures and the actual management experience of our team, this paper reflects on the treatment strategies for patients with gastrointestinal stromal tumor (GIST) during the epidemic period of COVID-19. We focus on risk stratification for primary GIST and forming treatment strategies accordingly. Major considerations include the impact of delayed operation, the burden of medical resources, the waiting time for elective operation, and the principle of emergency operation. In addition, we focus on the level of evidence for non-surgical approaches with a view to developing a holistic strategy of "priority management principles" to guide clinical treatment in the context of limited resources and different GIST priorities.
COVID-19 ; China ; Gastrointestinal Stromal Tumors ; Humans ; SARS-CoV-2

Objective:To evaluate the performance of Hybribio human papillomavirus (HPV) typing test kit for high risk HPV-DNA typing detection in screening of cervical precancer lesions.Methods:A total of 9 914 women were recruited in Henan, Shanxi, and Guangdong provinces from June to July 2017. All women underwent HPV DNA test. The women who diagnosed as HPV positive and cytological examination ≥ atypical squamous cells of undetermined significance (ASCUS) or HPV negative and cytological examination≥low-grade squamous intraepithelial lesions (LSIL) underwent colposcopy biopsy and pathological examination. Using the pathological diagnosis as the gold standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and 95% confidence interval ( CI) of high-risk HPV and HPV16/18 tests were calculated. Results:The mean age of 9 914 subjects was (45.0±9.3) years old. Among them, 1 302 subjects were detected as high risk HPV positive, including 211 of HPV16 positive and 64 of HPV18 positive. According to the pathological gold standard of cervical intraepithelial neoplasia grade 2 (CIN2) or worse, the sensitivity and specificity of high risk-HPV and HPV 16/18 for triaging ASCUS women were 90.6% (95% CI: 75.8%-96.8%) and 78.0% (95% CI: 74.5%-81.2%) as well as 56.3% (95% CI: 39.3%-71.8%) and 95.7% (95% CI: 93.8%-97.1%), respectively. The sensitivity and specificity of high risk-HPV and HPV 16/18 for cervical precancer lesions screening were 95.1% (95% CI: 88.1%-98.1%) and 87.6% (95% CI: 86.9%-88.2%) as well as 65.9% (95% CI: 55.1%-75.2%) and 97.8% (95% CI: 97.5%-98.1%), respectively. Conclusions:The Hybribio HPV test kit has a relative high sensitivity and specificity for cervical precancer lesions screening and ASCUS triaging. It is reliable for HPV DNA detection and cervical cancer screening.

Objective:To evaluate the performance of Hybribio human papillomavirus (HPV) typing test kit for high risk HPV-DNA typing detection in screening of cervical precancer lesions.Methods:A total of 9 914 women were recruited in Henan, Shanxi, and Guangdong provinces from June to July 2017. All women underwent HPV DNA test. The women who diagnosed as HPV positive and cytological examination ≥ atypical squamous cells of undetermined significance (ASCUS) or HPV negative and cytological examination≥low-grade squamous intraepithelial lesions (LSIL) underwent colposcopy biopsy and pathological examination. Using the pathological diagnosis as the gold standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and 95% confidence interval ( CI) of high-risk HPV and HPV16/18 tests were calculated. Results:The mean age of 9 914 subjects was (45.0±9.3) years old. Among them, 1 302 subjects were detected as high risk HPV positive, including 211 of HPV16 positive and 64 of HPV18 positive. According to the pathological gold standard of cervical intraepithelial neoplasia grade 2 (CIN2) or worse, the sensitivity and specificity of high risk-HPV and HPV 16/18 for triaging ASCUS women were 90.6% (95% CI: 75.8%-96.8%) and 78.0% (95% CI: 74.5%-81.2%) as well as 56.3% (95% CI: 39.3%-71.8%) and 95.7% (95% CI: 93.8%-97.1%), respectively. The sensitivity and specificity of high risk-HPV and HPV 16/18 for cervical precancer lesions screening were 95.1% (95% CI: 88.1%-98.1%) and 87.6% (95% CI: 86.9%-88.2%) as well as 65.9% (95% CI: 55.1%-75.2%) and 97.8% (95% CI: 97.5%-98.1%), respectively. Conclusions:The Hybribio HPV test kit has a relative high sensitivity and specificity for cervical precancer lesions screening and ASCUS triaging. It is reliable for HPV DNA detection and cervical cancer screening.

Objective:To investigate the clinical features of placental thrombosis complicated with fetal growth restriction(FGR),and to analyze its diagnosis and treatment methods. Methods:Combined with reviewing the relevant literatures, the clinical data of a case of placental thrombosis complicated with FGR was retrospectively analyzed. The patient with 32 1/7 weeks of gestation was hospitalized due to placental blood sinus found one month ago;at the same time FGR was found by ultrasound examination. The patient was intravenously given nutritional support treatment such as amino acid and glucose.At the same time, the patient was continuously given low-flow oxygen. Results:The patient received cesarean section at 35 2/7 weeks of gestation and a baby girl with 1 280 g weight and 32 cm length was gained;many blood sinus in the maternal surface of placenta were seen with the largest diameter of 3-4cm;the placenta was hypertrophic, weighted 540 g .After operation,the newborn was transferred to Department of Neonatology and followed up for 1 month.1 month later, the infant could eat by herself, other physical examinations were finished without any obvious abnormal findings and the newbron discharged from hospital after recovery. Conclusion:Placental thrombosis complicated with FGR is very common in clinic and this disease severely endangers the neonatal health. Early diagnosis and reasonable treatment can improve the pregnancy outcomes.

Objective To explore the effects of continuing nursing on quality of life ( QOL) in patients with urology stoma. Methods Totally 61 patients from January 2014 to June 2015 with muscle invasive bladder cancer who underwent radical cystectomy and urinary colostomy surgery were selected randomly and divided into the experimental group ( n=30) and the control group ( n=31). Patients in the control group were given conventional urinary colostomy perioperative health education, while patients in the experimental group received continuing nursing on the basis of conventional urinary colostomy perioperative health education. The QOL of patients in two groups were compared by the rating scale of QOL, and the occurrence rate of complications in urinary colostomy surgery was compared in two groups. Results 3 months after surgery, the score of factors in QOL in the experimental group was higher than the control group:the score of sleep quality was (71.5±10.68);activities and feelings was (73.4±11.94);cognitive ability of disease was (71.33±13.52);work and adapt to the society was (68.00±16.83);life and entertainment was (68.3±13.42). The differences were significant (t=2.37, 2.02,2.06,2.88,2.04;P<0.05). 12 months after surgery, in the control group, there was 1 case of uric acid crystal, 5 cases of parastomal hernia, 3 cases of colostomy dermatitis, and the incidence rate of complications was higher than the experimental group (χ2=3.968,4.322,5.985;P<0.05).Conclusions Continuing nursing applied to the patients with urinary stoma can significantly improve the QOL and social sense of belonging, meet the needs of nursing, and decrease the readmission rate and the nursing stress of families.

Objective To observe the expression level of inhibitor of differentiation 2 (Id‐2) and matrix metalloproteinases‐9 (MMP‐9) in rectal cancer ,analysis the correlation of the expression level of them ,to study the relationship between the expression level of them and the clinical pathology indicators of rectal cancer .Methods Rectal cancer tissues and normal tissue adjacent to rec‐tal cancer were obtained from the rectal cancer resection of 56 patients with rectal cancer ,using immunohistochemical method to ob‐serve the expression level of Id‐2 and MMP‐9 in normal tissue adjacent to rectal cancer and rectal cancer and Spearman correlation test to detect the correlation between the expression level of Id‐2 and MMP‐9 ;then we analyzed the relationships between the ex‐pression level of Id‐2 and MMP‐9 and the index of rectal cancer clinical pathology .Results The positive expression rate of Id‐2 in the in rectal cancer tissues is more higher than that of normal tissue of adjacent to rectal cancer (73 .21% vs .48 .21% ,P<0 .05) . The positive expression rate of MMP‐9 in the in rectal cancer tissues is higher than that of normal tissue of adjacent to rectal cancer (71 .43% vs .44 .64% ,P<0 .05) .Spearman correlation test showed that there is the positive correlation between the expression level of Id‐2 and MMP‐9 (r=0 .393 ,P=0 .003) .The expression levels of Id‐2 and MMP‐9 in rectal cancer were correlated with the degree of tumor differentiation ,TNM stage and lymph node metastasis (P<0 .05) ,but had no differences between the elements of age and sex (P>0 .05) .Conclusion There is a close relationship between the expression levels of Id‐2 and MMP‐9 in rectal cancer and the occurrence and development of rectal cancer .Rectal cancer with the higher Id‐2 expression level may be the ways to achieve tumor invasion and metastasis through MMP‐9 as a facilitator .

Objective To report two cases of Candida parapsilosis-caused candidiasis characterized by verrucous nodules and masses,and to assess their clinical features,diagnosis and treatment.Methods A medical history including medication history and therapeutic response was carefully collected from two male patients.Physical examination was carried out with a focus on skin lesions.Diagnosis was made according to medical history as well as physical,mycological and histopathological examination findings.Antifungal agents were given at a high enough dose in time.After lesions improved,the doses of antifungal agents were tapered gradually,and drugs were withdrawn until patients completely healed.Compound preparations containing both antifungal agents and glucocorticoids were also topically applied in the early period of treatment.Results Both patients were diagnosed as Candida parapsilosis-caused candidiasis characterized by verrucous nodules and masses,and cured after 100-day supporting treatment and antifungal treatment with oral itraconazole,etc.Conclusions Candida parapsilosis-caused candidiasis should be managed with combination therapy mainly including antifungal agents.To achieve a satisfying efficacy,antifungal agents should be given early at a high enough dose for a long enough period.

Objective To determine the value of MR in the diagnosis of the medial and lateral meniscal posterior root tears.Methods One hundred and twenty one patients underwent arthroscopy and MR of knee examinations were retrospectively reviewed,and all of them did not have the history of knee surgery before the MR examination.MR images were double-blinded,independently,retrospectively scored by radiology residency (doctor 1) and attending radiologist (doctor 2).The likelihood of the meniscus posterior root tear was scored on basis of arthroscopic findings constituted the gold standard.Sensitivity,specificity and accuracy of MR diagnosis of the lateral and medial meniscus posterior root tear by two physicians were calculated,and the consistency of diagnosis results by two physicians was evaluated using the Kappa statistics.Reasons leading to misdiagnosis or missed diagnosis were discussed.Results Thirty three of the 121 patients were diagnosed with meniscus posterior root tears by arthroscopy,including 14 cases of lateral tears and 19 cases of medial tears.The sensitivity,specificity and accuracy in the diagnosis of posterior lateral meniscus root tears (PLMRT) for doctor 1 were 71.4％ (10/14),82.2％ (88/107) and 81.0％ (98/121),respectively,and for doctor 2 were 71.4％ (10/14),86.0％ (92/107) and 84.3％ (102/121).The sensitivity,specificity and accuracy in the diagnosis of posterior medial meniscus root tears (PMMRT) for doctor 1 were 100.0％ (19/19),88.2％ (90/102) and 90.1％ (109/121),respectively,and for doctor 2 were 100.0％ (19/19),95.1％ (97/102) and 95.9％ (116/121),respectively.The Kappa statistics for PLMRT and PMMRT were 0.67 and 0.81,respectively,demonstrating a good interobserver agreement (P＜0.05).The misdiagnosed cases of the PMMRT were 12 for doctor 1 and 5 for doctor 2.There were 4 cases being commonly misdiagnosed by the two doctors,and there were no any missed cases in this study.For the PLMRT,the misdiagnosed cases were 19 for doctor 1 and 15 for doctor 2.Eleven cases were misdiagnosed and 4 were missed by the two physicians.Conclusion MR is a reliable diagnostic tool for detecting posterior root tears of the medial and lateral meniscus.