Objective To evaluate the efficacy of endovascular treatment for ruptured descending thoracic aortic aneurysm(rDTAA),and to summarize the treatment experience.Methods The clinical data of 8 patients with rDTAA,who were admitted to the Department of Vascular Interventional Surgery,Zhangjiajie Municipal People's Hospital of China to receive treatment between January 2016 and June 2023,were retrospectively analyzed.The patients included 4 males and 4 females,with a median age of 70.5 years(61-78 years).Preoperative computed tomography angiography(CTA)was performed in all the 8 patients,and the diagnosis of rDTAA complicated by hematoma in the thoracic cavity and/or mediastinum was confirmed.Emergency thoracic endovascular aortic repair(TEVAR)was carried out in all the 8 patients.Results Complete isolation of the thoracic descending aortic aneurysm was achieved in 6 patients,and 2 of them received reconstruction of left subclavian artery by using chimney stent technique.The remaining two patients had a small amount of type Ⅰa endoleak,which disappeared after implantation of a cuff stent at the proximal site.During hospitalization,one patient died of septic shock caused by thoracic aortic-esophageal fistula,and 3 patients developed respiratory failure after operation,which was recovered after thoracic drainage,anti-infection medication and ventilator-assisted breathing therapy.Two patients developed postoperative ischemic stroke,one of them presented as grade Ⅲ motor muscle weakness on the affected side accompanied by speech impairment,and the another patient presented as grade Ⅳ motor muscle weakness on the affected side accompanied by speech impairment.During the follow-up period,one patient died of sudden chest pain 7 months after surgery,and another patient who had not received chimney stent implantation developed type Ⅰa endoleak 18 months after operation,which disappeared after implantation of a cuff stent at the proximal site.The remaining 5 patients showed good clinical condition during the follow-up period.Conclusion For the treatment of rDTAA,TEVAR is clinically safe and effective.

We aimed to evaluate the effectiveness and safety of single-course initial regimens in patients with low-risk gestational trophoblastic neoplasia (GTN). In this trial (NCT01823315), 276 patients were analyzed. Patients were allocated to three initiated regimens: single-course methotrexate (MTX), single-course MTX + dactinomycin (ACTD), and multi-course MTX (control arm). The primary endpoint was the complete remission (CR) rate by initial drug(s). The primary CR rate was 64.4% with multi-course MTX in the control arm. For the single-course MTX arm, the CR rate was 35.8% by one course; it increased to 59.3% after subsequent multi-course MTX, with non-inferiority to the control (difference -5.1%,95% confidence interval (CI) -19.4% to 9.2%, P = 0.014). After further treatment with multi-course ACTD, the CR rate (93.3%) was similar to that of the control (95.2%, P = 0.577). For the single-course MTX + ACTD arm, the CR rate was 46.7% by one course, which increased to 89.1% after subsequent multi-course, with non-inferiority (difference 24.7%, 95% CI 12.8%-36.6%, P < 0.001) to the control. It was similar to the CR rate by MTX and further ACTD in the control arm (89.1% vs. 95.2%, P =0.135). Four patients experienced recurrence, with no death, during the 2-year follow-up. We demonstrated that chemotherapy initiation with single-course MTX may be an alternative regimen for patients with low-risk GTN.
Antineoplastic Combined Chemotherapy Protocols/adverse effects* ; Dactinomycin/adverse effects* ; Female ; Gestational Trophoblastic Disease/drug therapy* ; Humans ; Methotrexate/therapeutic use* ; Pregnancy ; Retrospective Studies

Objective:To explore the effect of enhanced recovery after surgery(ERAS)-based multidisciplinary collaboration model on shortening the time of forbidden eating before receiving surgery, provide the basis for the selection of the preoperative diet prohibition scheme.Methods:From January 2017 to February 2019, a total of 384 patients who received the operation in Qingdao Municipal Hospital were analyzed retrospectively. The patients who under the traditional preoperative diet prohibition scheme were taken as the control group(156 cases) while those who under the multidisciplinary cooperation mode nursing under the concept of eras were taken as the experimental group(228 cases). The experimental group formulated the perioperative diet prohibition process according to the guidelines of eras, and the experimental group carried out the perioperative diet management for the patients according to the procedure. The difference between the two groups in the time of fasting, hunger, thirst incidence, insulin resistance, temporary stop will be observed and compared.Results:The time of fasting was (4.01±1.55) h in the experimental group and (10.12±1.57) h in the control group,there was significant difference between the two groups( t value was -1.65, P < 0.01). The incidences of thirst,hunger were 13.2%(30/228), 11.8%(27/228) in the experimental group and 89.7%(140/156), 87.2%(136/156) in the control group, there were significant differences between the two groups(χ 2 values were 220.20, 215.20, P < 0.01). The levels of insulin resistance on the first and third day after operation were 1.85 ± 0.43,1.52±0.61 in the experimental group and 1.99±0.51, 1.67±0.49 in the control group, the differences were statistically significant ( t values were -2.90, -2.56, P < 0.05).The temporary stop rate was 1.75%(4/228) in the experimental group and 7.69%(12/156) in the control group, the difference was statistically significant( χ2 value was 8.19, P<0.01). Conclusions:The ERAS-based multidisciplinary collaboration model can effectively shorten the preoperative fasting time, reduce the level of insulin resistance, reduce the incidence of hunger and thirst, and improve the rate of temporary stop and adjustment.

Objective:To investigate the effect of body mass index (BMI) on clinical pregnancy and neonatal outcomes in patients with polycystic ovary syndrome (PCOS) during frozen-thawed embryo transfer.Methods:A total of 650 patients with PCOS who received routine in vitro fertilization or intracytoplasmic sperm injection treatment for frozen-thawed embryo transfer from June 2014 to June 2019 in Tianjin Central Hospital of Gynecology Obstetrics were retrospectively analyzed. According to BMI, PCOS patients were divided into group A (18.5≤BMI<23 kg/m 2, n=253), group B (23≤BMI<25 kg/m 2, n=167), and group C (BMI≥25 kg/m 2, n=230). The general information, clinical pregnancy outcomes, pregnancy complications, the incidence of macrosomia and low-birth-weight infants were compared in the three groups, and the influencing factors of neonatal birth weight were analyzed. Results:The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate all showed downward trend with the increase of BMI, but the differences were not statistically significant (all P>0.05). The live birth rate in group C [47.0% (108/230)] was significantly lower than those in groups A and B, with statistical significance ( χ2 =7.43, P=0.024). The late miscarriage rate was higher in group C [9.4% (13/139)] than in groups A and B ( χ2 =7.66, P=0.022). The birth rates of macrosomia in groups B [22.2% (16/72)] and group C [21.1% (16/76)] were significantly higher than that in group A, and the difference was statistically significant ( χ2 =14.15, P=0.001). There was no statistically significant difference in the incidence of gestational diabetes between the three groups ( χ2 =3.81, P=0.149). The incidence of hypertension disorders complicating pregnancy increased with the increase of BMI, and the difference was not statistically significant ( P>0.05). Regression analysis showed that macrosomia was significantly associated with maternal pre-pregnancy BMI and gestational weeks, and the risk of macrosomia increased by 15% (95% CI: 3%-28%) for every increase in maternal BMI. Conclusions:The embryo implantation rate, clinical pregnancy rate, and ongoing pregnancy rate of PCOS patients in frozen-thawed embryo transfer cycles show downward trend with the increase of BMI. Obese patients with PCOS have a significant increase in late miscarriage rate and a significant decrease in live birth rate. The incidence of hypertension disorders complicating pregnancy in PCOS patients in the obese group has an increasing trend, and the birth rate of macrosomia has increased significantly. Therefore, it is recommended that obese women with PCOS lose weight scientifically before pregnancy to improve pregnancy and neonatal outcomes.

Brachytherapy is an integral part of radiotherapy treatment for cervical cancer. With the rapid development of medical imaging technology, three-dimensional (3D) imaging modality has been applied in the brachytherapy for cervical cancer. After computed tomography (CT) and magnetic resonance imaging (MRI), 3D ultrasound has been gradually applied to guide the brachytherapy for cervical cancer due to its superior soft tissue imaging characteristics, economy, high efficiency and convenience. In this article, the research progress on the application of ultrasonography in brachytherapy was summarized according to literature review, aiming to provide reference for subsequent research.

Objective Investigate the relationship between gross tumor volume (GTV)-related factors including GTV-T volume,the maximum thickness of the esophageal lesion plane and GTV-T volume/length(GTV-T volume divided by the length of the lesion calculated by the number of GTV-T layers) and the locoregional failure of radical intensity-modulated radiation therapy (IMRT) for esophageal carcinoma.Methods A total of 133 patients with esophageal cancer undergoing radical IMRT were enrolled.The factors related to GTV-T including GTV-T volume,the maximum thickness of the esophageal lesions,GTV-T volume/length were calculated.The relationship between GTV-T related factors and local recurrence of tumors was retrospectively analyzed.Results There was positively linear association between the locoregional failure rate of GTV-T and the volume of GTV-T.The volume of GTV-T tumor was 36 cm3,the maximum wall thickness was 2.5 cm,and the GTV-T volume/length was calculated as 5.3 cm2.These critical values could be utilized to predict the risk of locoregional failure of IMRT for esophageal carcinoma.Conclusions The GTV-T factors can be adopted to predict the local control and the risk of locoregional failure of radical IMRT for esophageal carcinoma to certain extent.

Objective To retrospectively analyze the treatment outcomes and prognostic factors for primary bone lymphomas ( PBL) . Methods Forty patients with PBL who were admitted to our center from 1964 to 2014 were enrolled as subjects. In those patients, 10 were treated with chemotherapy alone, 10 with radiochemotherapy, 10 with postoperative chemotherapy, 9 with postoperative radiochemotherapy, and 1 with surgery alone. The median radiation dose was 36 Gy. The Kaplan?Meier method was used to calculate survival rates . The log?rank test was used for survival difference analysis and univariate prognostic analysis . Results The follow?up rate was 100%. The 3?year sample size was 36. In all patients, the 1?and 3?year overall survival rates were 60% and 42%, respectively, while the 1?and 3?year disease?free survival rates were 45%and 34%, respectively. The univariate analysis showed that no pathological fracture at diagnosis, normal lactate dehydrogenase level, an International Prognostic Index score of ≤1, early clinical stage ( stageⅠE ) , complete response after initial treatment, no less than 6 cycles of chemotherapy, a radiation dose of≥40 Gy, no progression outside radiation field after radiotherapy, and grade<3 bone marrow suppression during the treatment were prognostic factors for survival ( P=0. 027, 0. 037, 0. 000, 0. 016, 0. 000, 0. 000, 0. 022, 0. 014, and 0. 030). Conclusions The incidence of PBL is low. Comprehensive treatment can achieve satisfactory outcomes. As a PBL staging system, Ann Arbor has limitations. The staging of PBL should be based on local bone destruction and metastasis.

Objective To analyze the differences of positive detection rate and copy number of human papillomavirus (HPV) DNA and E6/E7 mRNA between different grades of cervical lesions, and evaluate their clinical values in early screen?ing of cervical cancer. Methods The cervical exfoliated cell samples from 154 women undergoing biopsy examination and 32 objects undergoing hysterectomy (control group) were collected in Tianjin Central Hospital of Gynecology Obstetrics in 2014. According to the pathological results of cervical biopsy, 154 samples were divided into low-grade squamous intraepi?thelial lesion group (LSIL, n=51), high-grade squamous intraepithelial lesion group (HSIL, n=71), and squamous cell carci?noma group (SCC, n=32). HPV DNA was tested with hybrid capture technology, and E6/E7 mRNA was detected with fluores?cence quantitative hybridization. Immunohistochemistry was performed by detecting E6/E7 protein in all patients after sur?gery or cervical biopsy. Results Combined results of HPV DNA and E6/E7 mRNA demonstrated that the positive detection rate was significantly lower in control group than that of all levels of lesion groups (P<0.05). The copy number of high risk HPV E6/E7 mRNA was significantly increased with the aggravation of lesions (P<0.05), whereas no difference was found in that of HPV DNA. Compared with the normal control and low-grade squamous intraepithelial lesion group, cervical cancer patients with mRNA copies > 10 000 E6/E7 were significantly increased in high-grade squamous intraepithelial lesion group. Immunohistochemical results showed that the positive detection rate of E6/E7 was significantly lower in control group than that of all levels of lesion groups (P<0.05). The positive rate of E6/E7 was significantly higher in the high-grade squa?mous intraepithelial lesion group than that of low-grade group (P<0.05). Conclusion HPV infection is closely related to cervical abnormalities, which is one of effective measures for early screening of cervical cancer. The negative result of HPV DNA is very helpful to exclude the cervical abnormality, whereas the positive detection of mRNA has great value in predict?ing the disease. Combined results of positive detection and copy number make a comprehensive evaluation for the risk of cer?vical lesions.

Objective To investigate the incidence and risk factors of human papillomavirus type 16 (HPV16) infec?tion among women through health screenings in Tianjin urban area. Methods A total of 2 000 women from Tianjin urban area were recruited for this study, and potential risk factors were investigated by questionnaire as well as by collecting cervi?cal exfoliated cells from the participants. HPV type was examined using polymerase chain reaction and pyrosequencing tech?nology, then the risk factors of HPV16 infection were examined by chi square test and the multiple factor logistic regression analysis. Results Among those 2 000 women who received health screenings, a total of 271 cases were HPV positive (13.55%). HPV16 accounts for the most common human papillomavirus types (39.5%, 107/271) while HPV58 account for 15.13%(41/271)and HPV18 account for 9.59% (26/271). Factors related to HPV16 infection were investigated include smoking history, initial age of sex (>25 years old or not) , number of pregnancies (≥2 or not), number of sexual partners (≥2 or not) and contraception measures (condom or other ways) with χ2=6.268,8.540,4.951,7.123,6.053,5.019, respectively. (P < 0.05). Age, alcohol intake, education level and previous gynecologial examination did not differ significantly among HPV16 positive patients compared to those with negative HPV. Multiple factor Logistic regression model analysis showed that the independent factors were smoking history and initial age for sex(≤25 years old)(P<0.05). Conclusion HPV16 is the most common type of cervical infection among women in Tianjin urban area. Changing inappropriate sexual behavior and smoking cessation are effective measures to prevent HPV16 infection and reduce incidence of cervical cancer.

Objective To investigate the cervical human papillomavirus (HPV) infection, genotypes and related high risk factors in 459 women of annual health examination. Methods A total of 459 cervical cytology specimens were de-tected with nest PCR and pyrosequencing methods. Questionnaires were collected simultaneously and the risk factors of HPV infection were analyzed. Results The detection rate of HPV-positive samples was 17.9%. Seven kinds of high-risk genotypes of HPV were found. The detection of HPV 16 was the most common (9.8%), followed by HPV58 (7.0%) and HPV18 (5.2%). The detection rates of simplex infection, dual infections and multiple infections were 9.6%, 4.8%and 1.5%respectively. The risk factors for HPV infection included alcohol consumption,income <3 000 yuan/ month, sexual part-ners>1, frequency of sexual activity>4 times/month and cervical erosion (P<0.05). Conclusion HPV DNA genotyping can provide important reference for HPV screening at early time and the application of HPV vaccines, which also provide sig-nificant evidence for the prevention, diagnosis and treatment of cervical cancer at early stage for the high risk population.