Objective:To investigate the risk factors for recurrence of benign vocal cord lesions after microsurgery.Methods:The clinical data of 2 214 patients with benign vocal cord lesions who underwent laryngeal microsurgery at the Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Yangzhou University from April 2013 to April 2022 were collected. The data, including sex, age, drinking history, smoking history, unilateral and bilateral lesions, and diagnosis, were recorded. These patients were divided into six groups according to admission diagnosis: polyps, Reinke's edema, leukoplakia, granulomas, cysts, and other benign lesions. All patients were followed up for 0-115 months, with a median follow-up time of 55 months. The Kaplan-Meier curve was used to determine whether there was any difference in the recurrence rate of benign vocal cord lesions among groups after surgical treatment. The Cox regression model was used to analyze the risk factors for the recurrence of benign vocal cord lesions after surgical treatment.Results:Out of the 2 214 patients, there were 1 953 cases of polyps (88.21%), 41 cases of granulomas (1.85%), 67 cases of cysts (3.03%), 87 cases of leukoplakia (3.93%), 34 cases of Reinke's edema (1.54%), and 32 cases of other benign lesions (1.45%). The recurrence rate for benign vocal cord lesions was 4.86% (95/1 953) in the polyp group, 31.70% (13/41) in the granuloma group, 14.94% (13/87) in the leukoplakia group, 2.98% (2/67) in the cysts group, 8.82% (3/34) in the Reinke's edema group, and 9.37% (3/32) in the other benign lesions group. Univariate analysis showed that bilateral lesions (95% CI 6.899-17.289, P < 0.001), smoking history (95% CI 1.282-2.564, P = 0.001), and alcohol consumption (95% CI 1.173-2.346, P = 0.001) were significantly associated with the recurrence of benign vocal cord lesions. The recurrence rate for benign vocal cord lesions in the leukoplakia group (95% CI 1.375-27.011, P = 0.017) and granuloma group (95% CI 3.053-60.980, P = 0.001) was significantly higher than that in the cysts group. Multivariate analysis of the risk factors for postoperative recurrence of benign vocal cord lesions showed that patients who had bilateral lesions (95% CI 6.680-16.900, P < 0.001) and a history of smoking (95% CI 1.572-16.157, P = 0.007) had a higher risk of recurrence of benign vocal cord lesions compared with those without bilateral lesions and a history of smoking. Granulomas were found to be significantly associated with postoperative recurrence of benign vocal cord lesions (95% CI 4.691-97.667, P < 0.05). Conclusion:Bilateral lesions and smoking are independent risk factors for the recurrence of benign vocal cord lesions after microsurgery. Granuloma is strongly associated with the postoperative recurrence of benign vocal cord lesions.

Objective To assess whether pregnancy affects the survival of pregnancy-associated breast cancer (PABC), compared with non-PABC. Methods We retrospectively analyzed the data of PABC patients.PABC cases and non-PABC cases were matched with 1:2 according to T stage, molecular classification, age of onset and year of diagnosis.The Kaplan-Meier method was used to estimate DFS and OS, and Log rank test was used for comparison.Cox regression analysis was used to evaluate the risk factors that affect the prognosis of PABC. Results We enrolled 35 patients in the PABC group (pregnancy: 10;postpartum: 25), and 70 patients in the non-PABC group.The median follow-up time was 68.5 and 70.7 months, respectively.The 5-year DFS was 51.6% in the PABC group, and that of the non-PABC group was 72.8%(χ²=4.72, P=0.029);the 5-year OS of the PABC group and the non-PABC group were similar (χ²=1.769, P=0.183).Cox regression analysis showed that pregnancy was an independent risk factor for DFS of PABC patients (P=0.011). Conclusion Patients with breast cancer during pregnancy have a higher risk of recurrence.Further research is necessary to diagnose pregnancy-associated breast cancer earlier and adopt measures to improve the curative effect.

Objective:To propose a method of image similarity measurement based on structure information and intuitionistic fuzzy set and measure the similarity between CT image and CBCT image of radiotherapy plan positioning, aiming to objectively measure the setup errors.Methods:A total of four pre-registration images of a nasopharyngeal carcinoma patient on the cross-sectional and sagittal planes and a pelvic tumor patient on the cross-sectional and coronal planes were randomly selected. Five methods were used to quantify the setup errors, including correlation coefficient, mean square error, image joint entropy, mutual information and similarity measure method.Results:All five methods could describe the deviation to a certain extent. Compared with other methods, the similarity measure method showed a stronger upward trend with the increase of errors. After normalization, the results of five types of error increase on the cross-sectional plane of the nasopharyngeal carcinoma patient were 0.553, 0.683, 1.055, 1.995, 5.151, and 1.171, 1.618, 1.962, 1.790, 3.572 on the sagittal plane, respectively. The results of other methods were between 0 and 2 after normalization, and the results of different errors of the same method slightly changed. In addition, the method was more sensitive to the soft tissue errors.Conclusions:The image similarity measurement method based on structure information and intuitionistic fuzzy set is more consistent with human eye perception than the existing evaluation methods. The errors between bone markers and soft tissues can be objectively quantified to certain extent. The soft tissue deviation reflected by the setup errors is of significance for individualized precision radiotherapy.

ObjectiveTo investigate the clinical value of indocyanine green retention rate at 15 minutes (ICG-R15), Child-Turcotte-Pugh (CTP) class, and Model for End-Stage Liver Disease (MELD) score in predicting post-transjugular intrahepatic portosystemic shunt (TIPS) hepatic encephalopathy (HE) in liver cancer patients with portal hypertension. MethodsA retrospective analysis was performed for the clinical data of 95 liver cancer patients with portal hypertension who underwent TIPS in Department of Interventional Therapy in Beijing Shijitan Hospital from January 2015 to June 2017, and according to the presence or absence of HE after TIPS, they were divided into HE group with 24 patients and non-HE group with 71 patients. ICG-R15, CTP class, and MELD score were determined for all patients before surgery. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher’s exact test were used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for HE after TIPS, and the receiver operating characteristic (ROC) curve was used to analyze the value of ICG-R15, CTP class, and MELD score in predicting HE. ResultsThe incidence rate of HE was 25.2% (24/95) within 12 months after TIPS. The univariate analysis showed that stent location (P=0.021), ICG-R15 (P=0.005), and CTP class (P=0.040) were associated with HE after TIPS. The multivariate analysis showed that stent located in the right portal vein (OR=3.373, 95% CI: 2.346~5.103, P=0.010) and ICG-R15＞30% (OR=2.107, 95% CI: 1.331~3.212, P=0.036) were independent risk factors for HE after TIPS in liver cancer patients with portal hypertension. The ROC curve analysis showed that ICG-R15, MELD score, and CTP class had an area under the ROC curve of 0.659, 0.638, and 0.621, respectively, in predicting HE after TIPS. ConclusionICG-R15 has a certain clinical value in predicting HE after TIPS in liver cancer patients with portal hypertension.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective: To quantitatively evaluate dose accuracy of radiotherapy for cervical cancer. Methods: A CT image correction algorithm based on image transformation was proposed. Referring to CBCT images, CT images of radiotherapy plan for cervical cancer were corrected to obtain the corrected images which could reflect the actual body position of treatment. The clinical plan was transplanted to the corrected images for dose recalculation as a test plan, and the dosimetry parameters were statistically compared to evaluate the dose accuracy. Results: Both of the target coverage of contrast plans could meet the clinical requirements (>98%), and there was no significant difference in the homogeneity index (P=0.150). The conformability of the test plan was significantly worse than that of the clinical plan (P<0.05). The maximum dose of each organ at risk in the test plan was approximately 30 cGy higher than that of the clinical plan (P<0.05), V₅₀ was slightly higher than that of the clinical plan, whereas the average dose (D_mean) did not significantly differ. Conclusion The CT image correction algorithm based on image transformation can quantitatively evaluate the dose accuracy of radiotherapy for cervical cancer, which provides reference for resolving similar problems in clinical practice.

OBJECTIVE To investigate the clinical features and therapeutic methods of ameloblastoma in nasal cavity and paranasal sinuses. METHODS The clinical data of 6 cases of ameloblastoma in nasal cavity and paranasal sinuses diagnosed by pathology were analyzed retrospectively, and the relevant literature were reviewed. RESULTS All of the 6 cases received surgical treatment. The follow-up period was 15 months to 10 years after operation.3 patients recurred until the last follow up. Among them, 2 cases recurred once, 1 case recurred 2 times, no patient died of this tumor. CONCLUSION The incidence of ameloblastoma in nasal cavity and paranasal sinuses is low and the symptoms are nonspecific, the diagnosis mainly depends on pathology and immunohistochemistry. CT and MRI examinations of ameloblastoma are helpful in diagnosis and differential diagnosis of the lesion. The main treatment is surgical resection of the lesion, the recurrence rate is higher. It has malignant tendency, and long-term follow-up is needed.

OBJECTIVE:To establish a method for the content determination of 8 metal elements in Propylgaclate and sodium chloride injection. METHODS:Microwave digestion-inductively coupled plasma mass spectrometry(ICP-MS) was adopted. Radiofrequency power was 1 530 W;cooling temperature was 4 ℃;collision gas was He gas;carrier gas was argon;flow rate of carrier gas was 1.08 L/min;integration time was 0.3 s;plasma gas flow rate was 15 L/min;the vacuum degree of quadrupole was 3.04×10－4 Pa;sampling cone aperture was 1.0 mm;interception cone aperture was 0.4 mm;the speed of sampling was 0.3 rps;data collection was repeated for 3 times. The microwave digestion power is 1 600 W,and the heating process is heated to 160℃at room temperature for 30 min,and maintained at 5 min,and then heated to 190 ℃ at a temperature of 5 ℃/min and maintained 45 min. RESULTS:The linear range of Mg and Al were 1-250 ng/mL;the linear range of Cr,Mn,Fe,Cu,Zn,Cd were 1-100 ng/ mL(all r≥0.999 0). The limits of detection were 0.063 6-1.785 0 ng/mL. RSDs of precision,stability and reproducibility tests were all lower than 4%. The recoveries were 89.65%-105.60%(RSD were 1.57%-3.98%,n＝9). RSDs of durablity were all lower than 12%. CONCLUSIONS:The method is simple,accurate,precise,stable,reproducible and durable. It can be used for content determination of 8 metal elements in Propylgaclate and sodium chloride injection.

Objective To examine the application of On-Board Imaging (OBI) system-based image-guided radiotherapy (IGRT) in the improvement of the precision of intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma.Methods Ten patients with nasopharyngeal carcinoma were treated with IMRT using the OBI system. The IGRT images after positioning, position adjustment, and treatment were observed and recorded to investigate the image difference between CT simulation and IGRT. Results The deviations in the x (lateral), y (cranial-caudal), and z (ventral-dorsal) directions between CT simulation and IGRT images were 0.22±1.00 mm,-0.37±1.28 mm, and 0.04±1.36 mm, respectively, after positioning, 0.29±0.76 mm,-0.04±0.78 mm, and -0.01±0.92 mm, respectively, after position adjustment, and 0.20±0.78 mm, 0.16±0.80 mm, and 0.05±0.92 mm, respectively, after treatment. The probabilities of a ≤1 mm deviation in the x, y, and z directions were 81.0%, 77.6%, and 88.2%, respectively, after positioning, 92.5%, 96.4%, and 96.4%, respectively, after position adjustment, and 91.7%, 94.9%, and 96.8%, respectively, after treatment. Conclusions The application of OBI system-based IGRT is very important in the improvement of the precision of fractionated IMRT for patients with nasopharyngeal carcinoma. The position of the patient should be adjusted based on the IGRT image after positioning in order to correct set-up error and effectively increase the precision of fractionated IMRT.

Objective: To establish a method for the determination of eucalyptol, camphor and menthol in compound menthol camphor eucalyptus oil solution by GC.Methods: An HP-INNOWAX 19091N-216 capillary column(60 m× 0.32 mm , 0.50 μm)was used.The carrier gas was nitrogen with the flow rate of 30 ml·min-1 , the gas was hydrogen with the flow rate of 40 ml·min-1 and the oxidant gas was air with the flow rate of 400 ml· min-1.The detector was FID and the inlet temperature was 250℃.The temperature program was as follows: the initial column temperature was 50℃, and then risen to 160℃ with a rate of 10℃·min-1 and kept for 5 min, and finally risen to 220℃ with a rate of 20℃·min-1 and kept for 3 min.The split ratio was 15∶1 and the injection volume was 1 μl.Results: The linear range of eucalyptol, camphor and menthol was 0.031 9-2.550 0 mg·ml-1 (r=1.000 0), 0.041 3-3.305 0 mg·ml-1 (r=1.000 0) and 0.053 7-4.294 0 mg·ml-1 (r=1.000 0), respectively.The average recovery was 98.24% (RSD=0.3% , n =9), 98.97% (RSD=0.4% , n =9) and 98.98% (RSD=0.5% , n =9), respectively.Conclusion: The method is sensitive and accurate with good stability, which can be used to determine the contents of eucalyptol, camphor and menthol in compound menthol camphor eucalyptus oil solution.