Objectives:To investigate the clinical and genetic features of young Chinese patients with myeloproliferative neoplasms (MPN) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to patients with MPN patients nationwide. The respondents were divided into 3 groups based on their age at diagnosis: young (≤40 years) , middle-aged (41-60 years) , and elderly (>60 years) . We compared the clinical and genetic characteristics of three groups of MPN patients.Results:1727 assessable questionnaires were collected. There were 453 (26.2%) young respondents with MPNs, including 274 with essential thrombocythemia (ET) , 80 with polycythemia vera (PV) , and 99 with myelofibrosis. Among the young group, 178 (39.3%) were male, and the median age was 31 (18-40) years. In comparison to middle-aged and elderly respondents, young respondents with MPN were more likely to present with a higher proportion of unmarried status (all P<0.001) , a higher education level (all P<0.001) , less comorbidity (ies) , fewer medications (all P<0.001) , and low-risk stratification (all P<0.001) . Younger respondents experienced headache (ET, P<0.001; PV, P=0.007; MF, P=0.001) at diagnosis, had splenomegaly at diagnosis (PV, P<0.001) , and survey (ET, P=0.052; PV, P=0.063) . Younger respondents had fewer thrombotic events at diagnosis (ET, P<0.001; PV, P=0.011) and during the survey (ET, P<0.001; PV, P=0.003) . JAK2 mutations were found in fewer young people (ET, P<0.001; PV, P<0.001; MF, P=0.013) ; however, CALR mutations were found in more young people (ET, P<0.001; MF, P=0.015) . Furthermore, mutations in non-driver genes (ET, P=0.042; PV, P=0.043; MF, P=0.004) and high-molecular risk mutations (ET, P=0.024; PV, P=0.023; MF, P=0.001) were found in fewer young respondents. Conclusion:Compared with middle-aged and elderly patients, young patients with MPN had unique clinical and genetic characteristics.

Objectives:To explore health-related quality of life (HRQoL) and identify its associated variables in Chinese patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to adult patients with MPNs to assess symptom burden measured by MPN-10 and HRQoL measured by Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) .Results:The data from 1405 respondents with MPNs, including 645 (45.9%) with essential thrombocythemia (ET) , 297 (21.1%) with polycythemia vera (PV) , and 463 (33.0%) with myelofibrosis (MF) , were analyzed. 646 (46.0%) respondents were male. The median age was 56 (range, 18-99) years. The mean MPN-10 scores were 13.0±12.7, 15.0±14.7, and 21.0±16.6 ( P<0.001) , and the physical component summary (PCS) and mental component summary (MCS) scores were 48.0±8.5, 47.0±9.0, and 42.0±10.0 ( P<0.001) and 51.0±11.0, 50.0±10.8, and 49.0±11.1 ( P=0.002) for respondents with ET, PV, and MF, respectively. Respondents with MF reported the lowest score of physical functioning, role functioning, emotional functioning, cognitive functioning, social function, and global health status (all P<0.01) and the highest score of fatigue, pain, dyspnea, appetite loss, diarrhea, and financial problems (all P<0.05) in EORTC QLQ-C30. Multivariate analyses revealed that higher MPN-10 scores were significantly associated with lower PCS (-0.220 to -0.277, P<0.001) and MCS (-0.244 to -0.329, P<0.001) scores; increasing age (-1.923 to -4.869; all P<0.05) , lower PCS score. Additionally, comorbidity (ies) , symptom at diagnosis, splenomegaly, anemia, unknown driver gene, and higher annual out-of-pocket cost were significantly associated with lower PCS and/or MCS scores. However, age ≥ 60 years, urban household registration, concomitant medication, and receiving ruxolitinib therapy in respondents with MF were associated with higher MCS scores. Weak correlations were found between MPN-10 score (except the subscale of appetite loss and constipation) and EORTC QLQ-C30 score in majority of subscales in respondents with ET (| r| = 0.193-0.457, all P<0.001) , PV (| r| = 0.192-0.529, all P<0.01) , and MF (| r| = 0.180-0.488, all P<0.001) , respectively. Conclusions:HRQoL in patients with MPN was significantly reduced, especially in patients with MF. Sociodemographic and clinical variables were significantly associated with the HRQoL in patients with MPNs.

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 assess the associations of indoor fine particulate matter (PM_2.5) from outdoor and indoor sources with heart rate (HR) and heart rate variability (HRV) in patients with chronic obstructive pulmonary disease (COPD) of Beijing. Methods: A total of 40 male patients in a stable stage of COPD were recruited from a hospital in a panel study in Beijing with 5 consecutive days of measurement for each subject. General information and disease history of the participants from questionnaires were obtained prior to the study. HR and HRV were repeatedly examined using dynamic electrocardiograph. HRV included standard deviation of all NN intervals (SDNN), root mean square of successive differences between adjacent NN intervals (rMSSD), total power (TP) power in the low-frequency band (LF) and the high-frequency band (HF). Iron was used as tracer element to separate indoor-originated PM_2.5 and outdoor-originated PM_2.5. Mixed-effect models were applied to assess the associations of outdoor-originated PM_2.5 or indoor-originated PM_2.5 and health effects. Results: The P₅₀ (P₂₅, P₇₅) values of daily indoor PM_2.5, indoor-originated PM_2.5 and outdoor-originated PM_2.5 were 50.9 (26.8, 122.7), 16.0 (1.9, 43.7) and 27.3 (13.5, 61.8) μg/m³, respectively. The mean±SD of concentrations of real-time indoor PM_2.5, indoor-originated PM_2.5 and outdoor-originated PM₂.5 were (61.5±58.8), (25.3±39.1) and (36.2±42.7) μg/m³, respectively. Compared with outdoor-originated PM_2.5, indoor-originated PM_2.5 had significant associations with HRV and HR. Each 10 μg/m³ increase at 4 h indoor-originated PM_2.5 and outdoor-originated PM_2.5 moving average was associated with 3.4% (95%CI: -4.7%, -2.1%) and 0.6% (95%CI: -2.0%, -0.8%) reduction in TP (P<0.001). Each 10 μg/m³ increase at 12 h indoor-originated PM_2.5 moving average was associated with 7.6% (95%CI: -10.1%, -5.1%), 4.7% (95%CI: -6.7%, -2.7%), 3.3% (95%CI: -4.2%,-2.4%) and 3.0% (95%CI: -4.5%, -1.5%) reduction in HF, LF, SDNN and rMSSD, respectively. Each 10 μg/m³ increase at 12 h outdoor-originated PM_2.5 moving average was associated with 0.7% (95%CI: -2.7%, -1.4%), 0.2% (95%CI: -1.9%, 1.4%), 0.7% (95%CI: -1.4%, -0.1%) and 0.2% (95%CI: -1.3%, 0.9%) reduction in HF, LF, SDNN and rMSSD, respectively (P<0.001). Each 10 μg/m³ increase at 8 h indoor-originated PM_2.5 and outdoor-originated PM_2.5 moving average was associated with 0.7% (95%CI: 0.4%, 1.0%) and 0.4% (95%CI: 0.2%, 0.6%) increase in HR. Conclusion Exposure to indoor-originated PM_2.5 was more strongly associations with HRV indices and HR compared with outdoor-originated PM_2.5 in male COPD patients.

Objective To investigate the use of parenteral nutrition preparations in Jiangsu Province,and to provide reference for the standardized management of parenteral nutrition preparations.Methods 720 cases using parenteral nutrition preparations from January 2017 to June 2017 in the department of general surgery of 12 hospitals in Jiangsu province were selected.The rate of nutritional risk screening,the indications of parenteral nutrition,the way of infusion,the rationality and economy of the prescriptions were retrospectively evaluated.The calorie,amino acid content,non-protein calorie/nitrogen ratio,glycolipid ratio and cation concentration of the patients received total parenteral nutrition were calculated.Results The total costs of parenteral nutrition preparations of 720 cases were 1.614 1 millions,and 346 cases did not have the indications for parenteral nutrition.The results of prescription comment showed that only 16 patients were screened for nutritional risk by Nutritional Risk Screening 2002 tool at admission.544 cases were intravenous dripped with amino acid and fat emulsion from peripheral vein.In the 176 total parenteral nutrition prescriptions,there were 39 non-protein calorie/nitrogen ratio cases,15 glycolipid ratio cases,69 cation concentration cases,61 calorie cases and 32 amino acid content cases failing to comply with the recommendation of the guidelines.Only 31 total parenteral nutrition prescriptions were completely reasonable.Conclusion The costs of parenteral nutrition preparations used in hospitals of Jiangsu are high but the rate of rationality is low.Nutrition support team should be established to regulate the use of parenteral nutrition preparations and save medical resources.

Objective To find out the relationship between lymph node metastasis and clinical pathological specificity, the prognostic factors for the purpose of improving survival of early gastric cancer (EGC) and quality of life. Methods The clinical data of the 338 EGC patients from July 1999 to June 2009 was analyzed retrospectively, includirg the possible relationship of lymph node metastasis, the size of tumor,types of histopathology,depth of infiltration. Using Kaplan-Meier method to process suvival rate,immunohistochemistry method to detect the micrometastasis. Results Lymphnode metastasis was relative to the size of tumor, depth of infiltration (P < 0.05 or < 0.01). Total 5-year survival rate was 92.1%, intramucosa 5-year survival rate 97.1%, submucosa 5-year survival rate was 85.7% in 63 followed up patients, the survival rate of EGC was related with depth of infiltration and size of tumor (P = 0.043,0.004). Conclusion By precisely estimating depth of infiltration, the size of tumor and correct estimating the state of lymph node metastasis, choosing right 5-year surgical protocol can improve EGC survival rate and prognosis.

Objective To discuss the effect of pylorus-preserving gastrectomy for early gastric cancer(EGC). Methods Between August 1995 and December 2005, 52 cases of EGC underwent pyloruspreserving gastrectomy(PPG) and 159 cases of EGC underwent distal gastrectomy(DG), Clinicopathlogic data and follow-up results of the two groups were analyzed retrospectively, and gastric emptying and gallbladder function of 15 cases PPG and 17 cases DG were compared at the same time.Results Compared with DG group, patients in PPG group maintain the body weight, gastric emptying and gallbladder function. There was no significant difference between PPG group (92. 3% ) and DG group (93.1% ) in overall 5-year survival rate ( P = 0. 881 ). The 5-year survival rate of the the PPG group with lymph node dissection was D1 100%, D1+α 92. 3%, D1+β 88.9%, D2 87. 5% respectively.Conclusions For early gastric cancer, the pylorus-preserving gastrectomy is effective for maintaining the postoperative function with similar long term survival as that of distal gastrectomy.

Objective To explore the characteristics of lymph node metastasis in gastric stump cancer and the efficacy of surgical treatment. Methods The clinical data of 42 patients with gastric stump cancer (test group) and 56 patients with primary cancer in the upper stomach (control group) who were admitted to The First Affiliated Hospital of Dalian Medical University from January 1994 to January 2008 were retrospectively analyzed. All data were analyzed by t test and chi-square test. The survival of the patients and lymph node metastasis rate were analyzed using the Kaplan-Meier method and Log-rank test, respectively. Results The metastasis rates of lymph nodes 1-3 of the test group and control group were similar (43%-61%), with no significant difference between the 2 groups (χ2 = 0.752, 0. 833, 0. 678, P > 0. 05). The metastasis rates of lymph nodes 7-9 of the test group and control group were 22% , 18% , 25% and 46% , 25% , 30% , respectively, and this was signifi-cantly different between the 2 groups (χ2 = 2. 168, 3. 263, 5. 761, P < 0. 05). The metastasis rates of lymph nodes 10-14 were 47% , 36% , 31% , 20% and 25% in the test group, which were significantly higher than 33% , 34% , 19% , 6% and zero in the control group, respectively (χ2 =3.225, 1.883, 3.945, 4.137, 6.823, P <0.05). The metastasis rate of lymph node no. 16 was zero in the test group and 23% in the control group. The metastasis rate of jejunal mesenteric lymph nodes was 27% in the test group and zero in the control group. The accumulative 5-year survival rate of patients was 38% in the test group and 48% in the control group, and this was significantly different (χ2 =4. 165, P<0.05). The overall 5-year survival rate of patients with radical resection was not significantly different between degree A (54%) and B (57%) (χ2 = 0. 622, P > 0. 05). Conclusions Gastric stump cancer has a unique pattern in lymph node metastasis. Surgical resection is effective in improving the prognosis of patients with gastric stump cancer.

In this study, the time-dependent changes on dynamic computed tomograph (CT) of radiation-induced liver injury in gastric cancer patients was examined. The CT images of 52 gastric cancer patients who had received chemoradiotherapies were reviewed on the PACS system. Dynamic CT scan was performed in all the subjects. Our results showed that 18 patients were found to have radiation-induced liver injury. The CT findings of radiation-induced liver injury in gastric cancer patients tend to show up one month after radiation treatment. The damaged area was of low density on all three phases, and then it was enhanced on portal vein phase or delay phase. The focal radiation reaction of liver without basic disease vanished 9-11 months later after treatment. We are led to conclude that dynamic CT is of help in the diagnosis of CRT-induced liver injury, and it may be the method of choice for following up the whole course of the CRT-induced liver injury, i.e., form hepatic damage to healing. The classification of CT findings we recommend can avoid the influence of technological factors, and thereby serve as a better guide for treatment of CRT-induced liver injury.

In this study, the time-dependent changes on dynamic computed tomograph (CT) of radiation-induced liver injury in gastric cancer patients was examined. The CT images of 52 gastric cancer patients who had received chemoradiotherapies were reviewed on the PACS system. Dynamic CT scan was performed in all the subjects. Our results showed that 18 patients were found to have radiation-induced liver injury. The CT findings of radiation-induced liver injury in gastric cancer patients tend to show up one month after radiation treatment. The damaged area was of low density on all three phases, and then it was enhanced on portal vein phase or delay phase. The focal radiation reaction of liver without basic disease vanished 9-11 months later after treatment. We are led to conclude that dynamic CT is of help in the diagnosis of CRT-induced liver injury, and it may be the method of choice for following up the whole course of the CRT-induced liver injury, i.e., form hepatic damage to healing. The classification of CT findings we recommend can avoid the influence of technological factors, and thereby serve as a better guide for treatment of CRT-induced liver injury.