Molecularly defined renal carcinoma is a pathologic subtype of renal cell cancer (RCC) with a definite driver gene, which was first proposed in the 2022 WHO classification of tumors of the urinary system and male reproductive organs. The fumarate hydratase-deficient renal cell carcinoma and SMARCB1-deficient renal medullary carcinoma are highly aggressive and lethal subtypes. Due to the low incidence and lack of research on the mechanism, there is almost no effective treatment for these aggressive RCC subtypes. Cytoreductive nephrectomy or metastasectomy are important methods to improve the survival and quality of life of metastatic RCC patients under effective systemic therapy. However, for the highly aggressive RCC, the clinical value of the above surgical strategies is still unclear. In this review, we will discuss these problems in order to provide reference for the improvement of prognosis for patients with highly aggressive RCC subtypes.

Calibration ; Humans ; Radiometry ; Radiosurgery ; Radiotherapy Dosage

Radiotherapy is the most common treatment for nasopharyngeal carcinoma, and the radiotherapy technique is essential for the prognosis of nasopharyngeal carcinoma. Due to the complexity of the structure of the intensity-modulated device and the accuracy of the clinical requirements of radiotherapy, it is inevitable that higher requirements will be imposed on the process of intensity-modulated radiotherapy. Currently, gaps exist in the radiotherapy equipment and personnel qualification among radiotherapy units, and thus the homogenization in the radiotherapy remains to be strengthened in China. With the application of radiotherapy information management system, digital medicine and artificial intelligence technologies in the field of radiotherapy, the original process fails to meet the application needs of the new precise radiotherapy technology. Therefore, this process is designed based on the existing radiotherapy procedures for nasopharyngeal carcinoma in combination with the latest developments in the field of radiotherapy, aiming to establish a novel standard process recommendation, ensuring the standardization and homogenization of radiotherapy and achieve the individualized intensity-modulated radiotherapy for nasopharyngeal carcinoma patients.

Dysregulation of the gut microbiota/gut hormone axis contributes to the pathogenesis of irritable bowel syndrome (IBS). Melatonin plays a beneficial role in gut motility and immunity. However, altered expression of local mucosal melatonin in IBS and its relationship with the gut microbiota remain unclear. Therefore, we aimed to detect the colonic melatonin levels and microbiota profiles in patients with diarrhea-predominant IBS (IBS-D) and explore their relationship in germ-free (GF) rats and BON-1 cel s. Thirty-two IBS-D patients and twenty-eight healthy controls (HCs) were recruited. Fecal specimens from IBS-D patients and HCs were separately transplanted into GF rats by gavage. The levels of colon mucosal melatonin were assessed by immunohistochemical methods, and fecal microbiota communities were ana-lyzed using 16S rDNA sequencing. The effect of butyrate on melatonin synthesis in BON-1 cel s was eval-uated by ELISA. Melatonin levels were significantly increased and negatively correlated with visceral hypersensitivity in IBS-D patients. GF rats inoculated with fecal microbiota from IBS-D patients had high colonic melatonin levels. Butyrate-producing Clostridium cluster XIVa species, such as Roseburia species and Lachnospira species, were positively related to colonic mucosal melatonin expression. Butyrate signif-icantly increased melatonin secretion in BON-1 cel s. Increased melatonin expression may be an adaptive protective mechanism in the development of IBS-D. Moreover, some Clostridium cluster XIVa species could increase melatonin expression via butyrate production. Modulation of the gut hormone/gut micro-biota axis offers a promising target of interest for IBS in the future.

Objective: To summarize experience and result in surgical treatment of Stanford type A intramural hematoma. Methods: 60 patients with Stanford type A intramural hematoma were operated from February 2015 to August 2017. Surgery was indicated in complicated cases with penetrating ulcer or ulcer-like projection in ascending aorta, maximum aorta diameter≥50 mm, progressive maximum aortic wall thickness≥10 mm, pericardial or pleural effusion, persistent or recurrent pain. Aortic valve regurgitation. In our group, 46 patients recieved ascending aorta replacement+ Sun' s procedure. 6 patients recieved Bentall+ Sun' s procedure. 4 patients recieved asceding aorta+ hemiarch replacement. 2 patients recieved Bentall+ hemiarch replacement. 2 patients recieved asceding aorta replacement. Results: In the whole group, there was 1(1.7%)operative death because of multiple organ failure after operation. Hyoxemiaoccured in 5(8.3%) patients, 2(3.3%) patients occurred new renal failure and required CRRT treatment, cerebrovascular complication occurred in 1 (1.7%)patient, re-sternotomy due to bleeeding occured in 1 (1.7%)patient and paraplegia occured in 1(1.7%) patient after operation. but they recoved quickly after proper treatment. During follow up period, there were 4 cases need reintervention, including TEVAR for type B dissection at 3 months and distal stent-graft new entry at 1 year. Two other reinterventions were performed for endoleak by interventional occlusion. During the follow-up, hematoma absorption rates after treatment 1、3 and 6 months were 68.6%, 84.7% and 94.8%. Conclusion Given the dynamic evolution of acute type A IMH pre-operative accurate indications and the proper surgical strategy maybe the keys for success.

Objective: To investigate the application of Symptom Checklist-90 (SCL-90) in Chinese nurses. Methods: We performed a literature search for articles in Chinese on the mental health of nurses investigated using the SCL-90 that were published from January 2007 to December 2016. A total of 129 articles were included, involving 178 groups of valid samples as well as 36316 subjects in 27 provinces or cities in China. The metafor package of R 3.2.1 software and Excel were used for meta-analysis and data statistics. Results: Heterogeneity was identified for the nine factors included in the literature data (Q test: P<0.05; I² test >40%) , so a random effects model was used. For all factors except interpersonal relationship factor, the 95% confidence intervals of the pooled effect sizes did not include 0. For all factors except interpersonal relationship factor (Egger test: P<0.05) , no significant asymmetry or incompleteness appeared in the funnel plots. The fail-safe number of each factor was much larger than 5k+10. The merger scores and mean values of nine factors were higher than the national norm. Conclusion The SCL-90 is widely used in the study of mental status of Chinese nurses, but the SCL-90 norm for nurses is lacking.

Objective: To investigate the status of abnormal menstruation in female nurses in a comprehensive hospital in Beijing, China and related influencing factors. Methods: In July 2016, a cross-sectional survey was performed, and a self-administered questionnaire was used to investigate the status of menstruation and occupation in female nurses in a comprehensive hospital in Beijing. The chi-square test and a multivariate logistic regression analysis were used for statistical analysis. Results: A total of 892 female nurses were investigated, and among them, 485 experienced abnormal menstruation within the past three months, resulting in an abnormal menstruation rate of 54.37%. The female nurses who were exposed to harmful factors during work, negative life events, or high workload had a significantly higher abnormal menstruation rate than those who were not exposed to such factors (χ²=5.199, 16.186, and 10.227, P<0.05 or P<0.01) . Negative life events (odds ratio [OR]=1.813, 95% confidence interval[CI]: 1.317-2.496) and high workload (OR=1.461, 95%CI: 1.112-1.918) were risk factors for abnormal menstruation. Conclusion Nurses have an abnormal menstruation rate as high as 54.37%, and high workload and negative life events were risk factors for abnormal menstruation in nurses.

Objective: To observe the effect of ticagrelor for non-ST-segment elevation acute coronary syndrome after percutaneous coronary intervention (PCI). Methods: A total of 200 patients with non-ST-segment elevation acute coronary syndrome after PCI were enrolled in this study.And the patients were randomly divided into the observation group (18 months treatment group, 100 cases) and control group (12 months treatment group, 100 cases) according to the digital table.The control group was given dual antiplatelet therapy (DAPT) for 12 months, and then, suspended the usage of ticagrelor.The observation group was treated by DAPT for 18 months.The major adverse cardiovascular events (MACCE) and the secondary end point events were observed. Results: The incidence rate of MACCE between the two groups had no statistically significant difference (χ²=0.298, P=0.862). And there was no statisticallysignificant difference in the incidence of the secondary end point events between the two groups (χ²=1.963, P=0.375). Conclusion The usage of DAPT beyond or equal 12 months doesn't reduce the incidence of MACC and it will not increase the blooding rate.The use of DAPT (aspirin and ticagrelor) should be used less than 12 months.

Objective: To observe the clinical effect of self-made Jiuxin decoction in the treatment of end-stage hypertrophic non-obstructive cardiomyopathy. Methods: From July 2016 to October 2017, 60 patients with end-stage hypertrophic non-obstructive cardiomyopathy in the First People′s Hospital of Yuhang District were randomly divided into two groups according to digital table, with 30 cases in each group.The control group was treated with conventional western medicine, and the observation group was treated with self-made Jiuxin soup for a week.The changes of body weight, degree of edema, NYHA class, Lee score, B-type natriuretic peptide, blood angiotensin Ⅱ, blood potassium, sodium, chlorine content and other indicators before and after treatment were observed in the two groups. Results: After one-week treatment, the cardiac function and heart failure indicators of the two groups were all significantly improved(the observation group: t=10.527, 15.358, all P<0.01; the control group: t=7.504, 12.417, all P<0.01), and the indicators of the observation group were better than those of the control group, and the differences between the two groups were statistically significant(t=3.772, 4.446, all P<0.01). After treatment, the levels of B-type natriuretic peptide of the two groups were significantly lower than those before treatment (the observation group: t=5.628, the control group: t=11.423, all P<0.05). The angiotensin and renin levels in the observation group were all significantly lower than those before treatment(t=4.355, 6.418, all P<0.05), and the indicators of the observation group were all significantly lower than those of the control group(t=3.521, 4.275, all P<0.05). The incidence rate of adverse reaction of the observation group was significantly lower than that of the control group(3.3% vs.23.3%, χ²=5.192, P=0.023). Conclusion Self-made Jiuxin decoction can significantly improve the cardiac function in patients with end-stage hypertrophic non-obstructive cardiomyopathy and it is a safe way of treatment.

BACKGROUND:Failure rate is higher in patients with osteonecrosis of femoral head than in osteoarthritis patients after primary total hip arthroplasty, especial y acetabular prosthesis. Bone mineral density around the prosthesis is a key factor for quality of life of the prosthesis. OBJECTIVE:To observe the difference in periprosthetic bone mineral density between patients with osteonecrosis of the femoral head and osteoarthritis patients and the exact location of differences after primary total hip arthroplasty. METHODS:Fifty patients with osteonecrosis of femoral head and fifty osteoarthritis patients were enrol ed in this study. Dual energy X-ray absorptiometry examination was used to compare bone mineral density 5 years after total hip arthroplasty. In accordance with De Lee’s and Charnley’s methods, images of acetabulum were divided. The bone mineral density of different areas of the acetabulum was compared between the two groups. RESULTS AND CONCLUSION:(1) Periprosthetic bone mineral density:Bone mineral density in the lower part and upper part of the acetabulum was significantly lower in the osteonecrosis group than in the osteoarthritis group (P<0.05). No significant difference in bone mineral density in the middle of the acetabulum was detected between the two groups. (2) Results confirmed that the bone mineral density in the lower and the upper parts of the acetabular component was significantly lower in patients with osteonecrosis of femoral head than in patients with osteoarthritis.