Objective:To analyze the clinical characteristics and prognostic factors of high-risk neuroblastoma (HR-NB) patients with skeletal metastasis.Methods:The clinical features of 336 newly treated HR-NB patients with skeletal metastases admitted to the Department of Medical Oncology of Beijing Children′s Hospital, Capital Medical University from January 2007 to December 2018 were analyzed retrospectively.Kaplan-Meier method was used for the survival analysis, and Log- Rank test was used for univariate prognosis analysis.The Cox model was used to analyze the multifactorial prognostic analysis. Results:A total of 336 HR-NB patients were recruited, involving 188 males and 148 females with the median age of onset of at 43 (4-148) months.Skeletal metastases affected the viscerocranium (89 cases, 26.5%), neurocranium (193 cases, 57.4%), vertebrae (298 cases, 88.7%), sternum and ribs (183 cases, 54.5%), pelvis (270 cases, 80.4%), upper limbs (182 cases, 54.2%) and lower limbs (240 cases, 71.4%). The 5-year event-free survival (EFS) rate and overall survival (OS) rate were (30.4±2.7)% and (41.3±2.9)%, respectively.Univariate analysis showed a significantly lower 5-year OS rate in skeletal metastatic HR-NB patients with poor prognostic classification, the morphology of neuroblastoma (stroma-poor) and ganglioneuroblastoma (intermixed), high index of mitosis-karyorrhexis index, lactate dehydrogenase≥587 U/L, serum ferritin≥92 μg/L, MYCN amplification and 1p loss of heterozygosity, and metastases in the viscerocranium, neurocranium, vertebrae, sternum and ribs, pelvis, upper limbs and lower limbs (all P<0.05). The 5-year OS rate of HR-NB patients with all 7 regions of skeletal metastases was only (14.2±5.9)%, which was significantly lower than that in patients with a single region metastasis or multi-region metastases[(66.0±10.2)% vs.(43.6±3.4)%, χ2=45.722, P<0.05]. Cox multifactorial analysis showed that MYCN amplification ( HR=4.165, 95% CI: 2.356-7.363) and the viscerocranium metastasis ( HR=2.560, 95% CI: 1.519-4.315) were the independent risk factors affecting the prognosis of HR-NB patients with skeletal metastases (all P<0.05). Conclusions:The prognosis is extremely poor in HR-NB patients with multiple skeletal metastases at the initial diagnosis.The amplification of MYCN and the viscerocranium metastasis are the poor prognostic factors for HR-NB patients with skeletal metastases.

Objective: To analyze the clinical characteristics of newly treated high-risk group neuroblastoma (NB) patients with bone marrow metastasis and to explore the prognostic factors. Methods: The clinical features (sex, age, stage, risk group, pathological type, metastatic site, etc.) of 203 newly treated high-risk NB patients with bone marrow metastasis admitted to Hematology Oncology Center, Beijing Children′s Hospital from January 2007 to December 2016 were analyzed retrospectively. There were 118 males (58.1%) and 85 females (41.9%). Kaplan-Meier method was used for survival analysis and Cox regression was used to analyze the prognostic factors. Results: The age at onset of the 203 patients was 41 months (9-147 months). The metastatic sites at diagnosis were as follows: bone in 195 cases (96.1%), distant lymph nodes in 104 cases (51.2%), skull and endomeninx in 61 cases (30.0%), orbit in 30 cases (14.8%), pleura in 16 cases (7.9%), liver in 13 cases(6.4%), canalis spinalis in 13 cases (6.4%), other sites in 11 cases (5.4%) and skin and soft tissue in 10 cases (4.9%). In all, 194 cases were enrolled for prognostic analysis. The follow-up time was 36 months (1 day-138 months) , and the 5-years event free survival (EFS) and overall survival (OS) were 36.1% and 39.7%, respectively. A total of 118 patients (60.8%) had events (first relapse or death) with the time to event occurrence was 15 months (1 day-72 months), whereas 112 patients (57.7%) died with the event occurrence to death time was 3 months (1 day-21 months). There was no significant difference in 5-years OS between radiotherapy group and non-radiotherapy group (42.3% vs. 38.3%, χ²=3.671, P=0.055). The 5-years OS in transplantation group was significantly better than the non-transplantation group (44.3% vs. 35.5%, χ²=8.878, P=0.003), and the radiotherapy combined transplantation group also had a better 5-years OS rate than the non-radiotherapy combined transplantation group (45.8% vs. 37.3%, χ²=5.945, P=0.015). Univariate survival analysis showed lactate dehydrogenase ≥ 1 500 U/L, the amplification of MYCN, the metastatic sites of orbit, canalis spinalis and pleura were associated with poor prognosis of newly diagnosed high-risk NB patients (χ²=21.064, 13.601, 3.998, 6.183, 15.307, all P<0.05). The amplification of MYCN and the metastatic sites of pleura were risk factors for prognosis of newly diagnosed high-risk NB patients by Cox regression models (HR=1.896,1.100, 95%CI: 1.113-3.231, 1.020-1.187, both P<0.05). Conclusions The prognosis is unfavorable in high-risk group NB patients with BM metastasis. Radiotherapy combined with transplantation can further improve the prognosis of these patients. The amplification of MYCN and the metastatic sites of pleura were the poor prognostic factors for high-risk NB patients with bone marrow metastasis.

To analyze the clinical characteristics of newly treated high?risk group neuroblastoma (NB) patients with bone marrow metastasis and to explore the prognostic factors. Methods The clinical features (sex, age, stage, risk group, pathological type, metastatic site, etc.) of 203 newly treated high?risk NB patients with bone marrow metastasis admitted to Hematology Oncology Center, Beijing Children's Hospital from January 2007 to December 2016 were analyzed retrospectively. There were 118 males (58.1%) and 85 females (41.9%). Kaplan?Meier method was used for survival analysis and Cox regression was used to analyze the prognostic factors. Results The age at onset of the 203 patients was 41 months (9-147 months). The metastatic sites at diagnosis were as follows: bone in 195 cases (96.1%), distant lymph nodes in 104 cases (51.2%), skull and endomeninx in 61 cases (30.0%), orbit in 30 cases (14.8%), pleura in 16 cases (7.9%), liver in 13 cases(6.4%), canalis spinalis in 13 cases (6.4%), other sites in 11 cases (5.4%) and skin and soft tissue in 10 cases (4.9%). In all, 194 cases were enrolled for prognostic analysis. The follow?up time was 36 months (1 day-138 months), and the 5?years event free survival (EFS) and overall survival (OS) were 36.1% and 39.7%, respectively. A total of 118 patients (60.8%) had events (first relapse or death) with the time to event occurrence was 15 months (1 day-72 months), whereas 112 patients (57.7%) died with the event occurrence to death time was 3 months (1 day-21 months). There was no significant difference in 5?years OS between radiotherapy group and non?radiotherapy group (42.3% vs. 38.3%, χ2=3.671, P=0.055). The 5?years OS in transplantation group was significantly better than the non?transplantation group (44.3% vs. 35.5%, χ2=8.878, P=0.003), and the radiotherapy combined transplantation group also had a better 5?years OS rate than the non?radiotherapy combined transplantation group (45.8% vs. 37.3%, χ2=5.945, P=0.015). Univariate survival analysis showed lactate dehydrogenase ≥1 500 U/L, the amplification of MYCN, the metastatic sites of orbit, canalis spinalis and pleura were associated with poor prognosis of newly diagnosed high?risk NB patients (χ2=21.064, 13.601, 3.998, 6.183, 15.307, all P<0.05). The amplification of MYCN and the metastatic sites of pleura were risk factors for prognosis of newly diagnosed high?risk NB patients by Cox regression models ( HR=1.896, 1.100, 95%CI :1.113-3.231, 1.020-1.187, both P<0.05). Conclusions The prognosis is unfavorable in high?risk group NB patients with BM metastasis. Radiotherapy combined with transplantation can further improve the prognosis of these patients. The amplification of MYCN and the metastatic sites of pleura were the poor prognostic factors for high?risk NB patients with bone marrow metastasis.

Objective:To analyze the trend relevant factors leading to death and their patterns over a 10-year period in inpatients with connective tissue diseases (CTDs).Methods:All clinical data about death in inpatients with CTDs were retrospectively reviewed between 2005 and 2014 at the Department of Rheumatology and Immunology in Xiangya Hospital of Central South University.Results:In the 10-year time period,the overall hospital mortality was 15.689‰.The disease itself accounted for 44.71% of the total causes of death,infection accounted for 42.94%,and comorbidities accounted for 12.35%.The constituent ratio of deaths and the average hospital mortality caused by the disease itself declined gradually year by year,and the constituent ratio of deaths caused by infection and comorbidities increased gradually year by year (P<0.05).In 2013-2014,infection was the leading cause of death,which accounted for 51.06%.The survival time for CTDs inpatients with interstitial lung disease (ILD) was shorter than that of CTDs inpatients without ILD,and even the risk of death was 1.722 times of the latter.The proportion of deaths caused by the disease itself was the highest in systemic sclerosis and systemic lupus erythematosus,that by infection was the highest in idiopathic inflammatory myopathy (IIM),and that by comorbidities was the highest in rheumatoid arthritis.Conclusion:The proportion of deaths and the hospital mortality in CTDs inpatients caused by the disease itself show a declining trend,while the proportion of deaths caused by infection and comorbidities increase.CTDs patients with ILD have shorter survival time and an increase in risk of death.

Objective To study the clinical characteristic of non puerperal mastitis and estimate the effect of anti-mycobacterial agents for non puerperal mastitis .Methods 22 cases of periductal mastitis and gran-ulomatous mastitis receiving anti-mycobacteria drugs therapy from Mar .2012 to Mar.2014 were retrospectively analyzed.Results All patients were female.The mean age was 30 years(ranging from 24 to 46 years).The main clinical manifestation of the 22 patients were 18 patients(81.8%)with mass, 20 patients(90.9%)with abscess, 15 patients(68.2%)with fistula and 9 patients(40.9%)with all of the above 3 symptoms.6 patients had incision and drainage of abscess and 2 patients had tumor resection before anti-mycobacterial therapy .All of the 8 patients had postoperative recurrence .All patients underwent anti-mycobacterial therapy with 3 to 16 months.11 cases (50.0%)patients were cured without recurrence until now .7 cases(31.8%) patients were improved markedly and they still received drug treatment .2 cases(9.0%)patients with tumor size reduced to 2 cm were ready to sur-gical resection.2 cases(9.0%)were lost to follow-up.Conclusion Patients with refractory non puerperal masti-tis can be treated with anti-mycobacterial agents with relatively long treatment time and can also avoid mastecto-my.

Objective To explore the expression of BCSG 1 in the triple negative breast cancer and the non-triple-negative breast cancer and its significance .Methods The clinical data from 170 patients were retrospectively analyzed,which including 160 breast cancer and 10 benign breast disease .We checked the expression of BCSG 1 in the specimens by the immunohistochemistry to analysis the similarities and differences the BCSG 1 between the triple negative breast cancer and the non-triple negative breast cancer .Results The expression rate of the BCSG 1 was 41.0%in the non-triple negative breast cancer , which was lower than 57.5% in the triple negative breast cancer (χ2 =4.2,P=0.04).Conclusion The expression rate of the BCSG1 in the triple-negative breast cancer is higher than that in the non-triple-negative breast cancer.and it was statistically significant (P<0.05),so the expression of BCSG1 in triple negative breast cancer is unique .It prompt that BCSG1 can be a new treatment target in the triple negative breast cancer .

Objective To evaluate the safety of intrvenous balanced propofol sedation with fentanyl in elderly patients during combined gastroscopy and colonoscopy procedures.Methods Totally 877 elderly patients aged (76.4 ± 8.5) years received intravenous propofol and fentanyl sedation during gastroscopy or/and colonoscopy procedures were assigned to groups:294 cases with only gastroscopy,257 cases with only colonoscopy and 326 cases with combined gastroscopy and colonoscopy.50 g Fentanyl and 0.5-1.0 mg/kg propofol were intravenously administered in the patients.The peripheral oxygen saturation,arterial pressure and heart rate were monitored and recorded during procedures.Results There were no procedure-related perforations and sedationassociated severe complications and mortalities,and no one need stop endoscopy procedures in all the patients.The average dosage of propofol in combined,gastroscopy and colonoscopy groups were (100.4±38.5) mg,(130.4±50.5)mg and (170.3± 60.3)mg,respectively.There were no significant differences in heart rate,arterial pressure and rate of cardiovascular events among groups (P＞0.05).The rate of respiration events in the above groups were 9 cases(3.1％),6 cases(2.3％)and 13 cases(4.0％),respectively (P＞0.05).Decrease of peripheral oxygen saturation was mainly induced by the aspiration of oral secretions and snoring.Conclusions Intravenous balanced propofol sedation provides safe and effective sedation in the elderly undergoing combined gastroscopy and colonoscopy.

Objective To summarize the clinical experience in treatment of the Lisfranc joint injury with open reduction and internal fixation at early stage. Methods Twelve patients ( including ten males and two females at average age of 34 years) with early stage Lisfranc joint injury received open reduction and screw/wire fixation from 2005 to 2010. According to the Myerson classification, there were two patients with type A, eight with type B and two with type C. All the patients received open reduction and internal fixation with screw or Kirschner wire within 17 days after injury. The post-operative function was estimated by mid-foot scoring scale of AOFAS. X-ray and CT scan were used in radiography estimation. Results All the patients were followed up for average 33 months ( range, 6-60 months). The mean score of post-operative mid-foot scoring scale of AOFAS was 74.5 points ( range, 53-96 points), with excellent result in eight patients, good in two and fair in two. The anatomical reduction was observed in eight patients and all the patients obtained bony union according to the results of X-ray and CT scan.There was no any complication found.Conclusions Open reduction and internal fixation is a good choice for the treatment of Lisfranc joint injury at early stage. A preoperative comprehensive analysis combined with clinical X-ray and CT scan is necessary.

Objective To compare the efficacy of laryngeal mask airway Guardian (GLMA) and laryngeal mask airway Supreme (SLMA) in patients undergoing gynecological surgery. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients aged 19-80 yr weighing 50-70 kg undergoing gynecological surgery were randomly divided into 2 groups: SLMA group (group S, n = 59) and GLMA group (group G, n =61). LMA was inserted after induction of anesthesia with propofol 2.0-2.5 mg/kg, sufentanil 0.2 μg/kg and rocuronium 0.6 mg/kg. All the patients were mechanically ventilated. BP, HR, SpO2, PETCO2 and Ppeak were monitored during operation. The rate of successful placement, placement time, fiberoptic bronchoscope grade, airway sealing pressure, airway pressure during normal ventilation with tidal volume of 8 ml/kg, airway pressure and air leakage during ventilation with large tidal volume of 20 ml/kg, air leakage during opertion, complications, anesthesia time, duration of surgery, extubation time and emergence time were recorded. Results There was no significant difference in the rate of successful placement, placement time, airway pressure during normal ventilation and during ventilation with large tidal volume, blood stain at LMA removal, incidence of sore throat, choking hoarseness and dysphagia, anesthesia time, duration of surgery, extubation time, and emergence time between the two groups (P ＜ 0.05). The BP,HR, SpO2, Ppeak and PETCO2 were within the normal range during operation in both groups. The fiberoptic bronchoscope grade and airway sealing pressure were significantly higher, and the incidence of air leakage during ventilation with large tidal volume and during operation was significantly lower in group G than in group S (P ＜ 0.01).Conclusion GLMA and SLMA can provide adequate ventilation during operation with fewer complications and can be used effectively for gynecological surgery. The efficacy of GLMA is better.