Concurrent chemoradiotherapy (CCRT) refers to the simultaneous treatment of chemotherapy and radiotherapy, and the effect of radiotherapy is enhanced with low-dose chemotherapy, which can reduce tumor recurrence and metastasis and improve clinical prognosis of patients. At present, the main factors for the increase of radiosensitivity of concurrent chemotherapy is that concurrent chemotherapy prevents the repair of tumor cells, and chemotherapy and radiotherapy act on different cell cycles and have synergistic effects. However, even for patients with locally advanced cervical cancer (LACC) who have undergone CCRT, the 5-year survival rate is only 60%, which is still not ideal. In order to improve the efficacy, researchers have conducted a series of exploratory studies, which consist of the combination of targeted drugs and immunodrugs, and neoadjuvant regimens before CCRT, etc. Although targeted or immunologic drugs are effective treatment of LACC, in view of the lack of large-scale evidence-based medical evidence, multi-center prospective and randomized phase III clinical trials and high-level articles are needed to improve the level of evidence-based medicine. This consensus summarizes several key evidence-based medical studies published recently, especially the clinical research progress in targeted and immunological therapies, providing reference for domestic peers.

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668

Background: Several risk factors have been identified that compromise the treatment outcome in patients with early-to-mid-stage cervical cancer (CC) who are primarily treated with radical surgery. However, there is no report on the impact of intraoperative frozen pathology examination of vaginal margins on the prognosis of patients with CC. This study aimed to conduct a randomized controlled trial (RCT) to determine whether selective vaginal resection can reduce the incidence of operative complications and the risk of postoperative radiotherapy. The impact of the length of the vagina removed in radical hysterectomy (RH) on prognosis and quality of life (QoL) for IB2–IIA2 CC patients will be investigated. Methods A multicenter, non-inferiority, RCT at 7 institutions in China is designed to investigate the effect of intraoperative frozen pathology exam of vaginal margin in RH on the survival outcomes for patients with IB2–IIA2 CC. Eligible patients aged 18–70 years will be randomly assigned online by one-to-one random allocation to receive intraoperative frozen pathology exam of vaginal margin or not. If frozen pathology indicates positive margin, continue resection of 1 centimeter of vaginal tissue until negative margin is achieved. The primary end point is 2-year disease-free survival (DFS). Adverse events (AEs) caused by further vagina resection, 5-year DFS, 2-year overall survival (OS), 5-year OS and AEs caused by radiotherapy and QoL are secondary end points. A total of 310 patients will be enrolled from 7 tertiary hospitals in China within 3-year period and followed up for 5 years.Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000035668

Objective:To determine the direction of traction that has the least influence on temporomandibular joint (TMJ) during mandibular distraction osteogenesis(MDO).Methods:(1) The three-dimensional finite element model was established after the mandible data were obtained by cone beam computed tomography (CBCT) scanning, and the validity of the model was verified. (2) Based on the verified three-dimensional finite element model, the distraction osteogenesis of mandible was carried out with six different directions. (3) The effects of different traction directions on disc pressure, osteotomy displacement, temporal bone pressure and condylar pressure were measured.Results:(1)In the thinnest area of the articular disc, the direction of the minimum stress on the upper and lower surfaces of the disc was "along the direction of the mandible, parallel to the surface of the mandible" . (2) Under the same load, the displacement of each osteotomy surface along the traction direction was different, but the difference was not big, and the effect was basically the same. (3) "Along the direction of the mandible, parallel to the surface of the mandible" and "along the direction of the mandible and parallel to the sagittal plane" had less pressure on the temporal bone than other situations, and the two directions of traction were parallel to the mandible. After the force decomposition, the direction of the condyle was the smallest, so the pressure on the condyle was smaller.Conclusions:A satisfactory TMJ model can be obtained by DICOM. The traction force of "along the direction of the mandible body, parallel to the surface of the mandible body" and "along the direction of the mandible body and parallel to the sagittal plane" had the least effect on the TMJ. When designing the traction direction of MDO, we should not only consider the influence of surgery on the shape of jaw and upper respiratory tract, but also weigh in the influence of traction direction on the TMJ, and determine the direction of traction which has the least influence on the TMJ.

Objective:To determine the direction of traction that has the least influence on temporomandibular joint (TMJ) during mandibular distraction osteogenesis(MDO).Methods:(1) The three-dimensional finite element model was established after the mandible data were obtained by cone beam computed tomography (CBCT) scanning, and the validity of the model was verified. (2) Based on the verified three-dimensional finite element model, the distraction osteogenesis of mandible was carried out with six different directions. (3) The effects of different traction directions on disc pressure, osteotomy displacement, temporal bone pressure and condylar pressure were measured.Results:(1)In the thinnest area of the articular disc, the direction of the minimum stress on the upper and lower surfaces of the disc was "along the direction of the mandible, parallel to the surface of the mandible" . (2) Under the same load, the displacement of each osteotomy surface along the traction direction was different, but the difference was not big, and the effect was basically the same. (3) "Along the direction of the mandible, parallel to the surface of the mandible" and "along the direction of the mandible and parallel to the sagittal plane" had less pressure on the temporal bone than other situations, and the two directions of traction were parallel to the mandible. After the force decomposition, the direction of the condyle was the smallest, so the pressure on the condyle was smaller.Conclusions:A satisfactory TMJ model can be obtained by DICOM. The traction force of "along the direction of the mandible body, parallel to the surface of the mandible body" and "along the direction of the mandible body and parallel to the sagittal plane" had the least effect on the TMJ. When designing the traction direction of MDO, we should not only consider the influence of surgery on the shape of jaw and upper respiratory tract, but also weigh in the influence of traction direction on the TMJ, and determine the direction of traction which has the least influence on the TMJ.

Objective To investigate the health status of centenarian hospitalized patients and analyze the risk factors for in-hospital death in Nanjing district.Methods All centenarians hospitalized patients who were discharged from wards of 10 upper first-class general hospitals in Nanjing district during the past five years were retrieved from their hospital information systems.Then,a retrospective study was performed on centenarians' data of general information,laboratory test results,Charlson comorbidity index (CCI),neutrophil to lymphocyte ratio (NLR) and shock index(SI),etc.were calculated and collected.Relevant risk factors for in-hospital death were analyzed by multivariate logistic regression analysis.Results A total of 156 patients aged 100 years and over,with an average age of (101.0±2.1)years,were enrolled during the past 5 years.The top 3 admitting diagnosis for the patients were pulmonary infection(30.1％,47/156 cases),coronary heart disease(10.9％,17/156 cases)and cerebrovascular disease(7.1％,11/156 cases).Fifty patients died during hospitalization,with a mortality of 32.1％ (50/156).Pneumonia was the most common admitting diagnosis(40.0％,20/50 case).Among causes of death,the combined admitting diagnosis with dementia,chronic renal insufficiency,one or more basic disease were significantly associated with death.There were statistically significant differences between bad vs.good vs.indifferent prognosis in heart rate,shock index,leukocyte count,neutrophil count,NLR,hemoglobin,albumin,albumin/globulin,fasting blood glucose,blood urea nitrogen,serum creatinine,C-reactive protein(CRP)and CCI levels.Multivariate logistic regression analysis suggested that NLR≥13.18,fasting blood glucose ≥7.56 mmol/L,blood urea nitrogen ≥20.74 mmol/L,CRP≥65 mg/L and CCI≥3 might be predictors for in-hospital death in the cohort(OR =48.91、3.43、1.22、6.55、1.55,all P＜0.05).Conclusions Pulmonary infection is the most common reason for admission and the cause of death in centenarian inpatients.Comorbidities increase the risk of death.To lower in-hospital mortality,CCI and other assessment indicators should be used to strengthen the comprehensive assessment and chronic disease management of hospitalized centenarians.Infectious diseases should be prevented beforehand.

By now,the clinical methods of cancer treatment are mainly surgery,radiotherapy,chemotherapy,and traditional Chinese medicine methods. However,some tumors are concealed due to onset,initial diagnosis and treatment,which have entered the middle and late stage,lost the operation opportunity and impossible to pass accurate surgical staging by assessment of prognosis. Radi-cal concurrent chemoradiotherapy can be used for tumors that are inoperable and sensitive to radiation therapy. Therefore,it has be-come a hot spot to explore accurate and economic indicators to evaluate the prognosis of radiotherapy and chemotherapy. Neutrophil to lymphocyte ratio(NLR)refers to the ratio of neutrophils to lymphocytes in peripheral blood before treatment. As a general indicator of systemic inflammatory response,many studies have confirmed that the relationship between the efficacy of radiotherapy and chemother-apy for tumors provides a new way to evaluate the prognosis of tumors. This article briefly reviews the relationship between NLR and the prognosis of tumor-controlled radiotherapy and chemotherapy.

Objective To create multi-parameter analysis model by conventional two-dimensional echorcardiography( 2DE) and three-dimensional speckle tracking imaging( 3D-STI) in order to improve the early diagnosis in MYH7G + P- mutation carriers of familiar hypertrophic cardiomyopathy( HCM ) . Methods Twenty-eight MYH7 mutation carriers without left ventricular hypertrophy ( MYH7G + P- ) were enrolled as the research group , while 27 MYBPC3 mutation carriers without left ventricular hypertrophy ( MYBPC3G + P- ) were selected as the control group . The clinical data ,conventional 2DE and tissue Doppler imaging ( TDI) parameters of the two groups were acquired ,including the maximum of the thickness of interventricular septum( IVS) and left ventricular posterior ventricular wall thickness( LVPWT ) in end of diastole ,mitral flow E and A velocities ,E peak deceleration time( EDT ) ,atrioventricular filling time ,mitral annulus velocity of interventricular septum IVS-e' and lateral wall L-e' ,interventricular septum IVS-a' and lateral wall L-a' peak in diastole ,calculate mean value e' and a' ,and calculate E/ e' ,E/A ,left atrial volume index( LAVI) ,left ventricular mass index( LVMI) ,left ventricular ejection fraction( LVEF) and isovolumic relaxation time( IVRT ) ,isovolumic contraction time( IVCT ) . The global longitudinal peak strain( GLS) , global radial peak strain( GRS) ,global circumferential peak strain( GCS) and global area peak strain( GAS) were acquired by 3D-STI . All parameters were compared between research group and control group . Results Compared with the control group ,research group significantly increased in LAVI , maximum IVS and LVPWT ,LVMI and GAS( P < 0 .01) . There were no significant difference in TDI parameters( P > 0 .05) . For single parameter ,the area under ROC curve( AUC) were successively LVPWT > LAVI > IVS > LVMI >GAS( 0 .772 ,0 .738 ,0 .733 ,0 .719 ,0 .714 ,respectively) . AUC of multi-parameters was 0 .912 ,the sensitivity and specificity were 85 .2％ and 96 .3％ ,respectively . Conclusions Multi-parameter analysis model by conventional 2DE and 3D-STI can significantly improve the recognition efficiency of early diagnosis MYH7G + P- of familiar HCM . With further ,maximum LVPWT is an independent predictor of distinction MYH7G + P- and MYBPC3G + P- .

Objective To study the association between blood glucose control and mild cognitive impairment (MCI) in patients with diabetes mellitus and small-artery occlusion (SAO).Methods A screening study of cognitive impairment was conducted in the 676 patients diagnosed with SAO who had been treated at Department of Neurology,Huanhu Hospital from January 2010 through June 2017.They were divided into a normal cognition group (n=629) and an MCI group (n=47) according to the screening results.They were also divided into 4 groups according to their history of diabetes and levels of hemoglobin Alc:normal blood glucose group (n=398),stringent goals group (n=59),general goals group (n=46) and goals-not-met group (n=173).The differences were compared in terms of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) scores between the normal blood glucose,stringent goals,general goals and goals-not-met groups.We also analyzed the general clinical data and risk factors between the normal cognition and MCI groups.Variables of confounders that were identified as significant were entered into logistic regression.Results There were significant differences in MMSE and MoCA scores between the 4 groups (P＜0.05).Between the normal cognition and MCI groups,significant differences were found in proportion of smokers,blood glucose level and severity of stroke (P＜0.05).Logistic regression analysis showed that compared with the normal blood glucose group the incidence of MCI was 2.707-fold higher in the stringent goals group (OR=2.707,95％ CI:1.035～7.083,P=0.042),2.963-fold higher in the general goals group (OR=2.963,95％ CI:1.064～8.277,P=0.038) and 2.604-fold higher in the goals-not-met group (OR=2.604,95％ CI:1.269～5.341,P=0.009).Conclusions MCI is more likely to occur in acute phase in patients with diabetes and SAO stroke.The patients can benefit from joint managements of diabetes,stroke and cognitive dysfunction in clinical practice.