Entinostat plus exemestane in hormone receptor-positive (HR+) advanced breast cancer (ABC) previously showed encouraging outcomes. This multicenter phase 3 trial evaluated the efficacy and safety of entinostat plus exemestane in Chinese patients with HR + ABC that relapsed/progressed after ≥1 endocrine therapy. Patients were randomized (2:1) to oral exemestane 25 mg/day plus entinostat (n = 235) or placebo (n = 119) 5 mg/week in 28-day cycles. The primary endpoint was the independent radiographic committee (IRC)-assessed progression-free survival (PFS). The median age was 52 (range, 28-75) years and 222 (62.7%) patients were postmenopausal. CDK4/6 inhibitors and fulvestrant were previously used in 23 (6.5%) and 92 (26.0%) patients, respectively. The baseline characteristics were comparable between the entinostat and placebo groups. The median PFS was 6.32 (95% CI, 5.30-9.11) and 3.72 (95% CI, 1.91-5.49) months in the entinostat and placebo groups (HR, 0.76; 95% CI, 0.58-0.98; P = 0.046), respectively. Grade ≥3 adverse events (AEs) occurred in 154 (65.5%) patients in the entinostat group versus 23 (19.3%) in the placebo group, and the most common grade ≥3 treatment-related AEs were neutropenia [103 (43.8%)], thrombocytopenia [20 (8.5%)], and leucopenia [15 (6.4%)]. Entinostat plus exemestane significantly improved PFS compared with exemestane, with generally manageable toxicities in HR + ABC (ClinicalTrials.gov #NCT03538171).

Objective:To develop a prototype artificial intelligence immunofluorescence image recognition system for classification of antinuclear antibodies in order to meet the growing clinical requirements for an automatic readout and classification of immunof luorescence patterns for antinuclear antibody (ANA) images.Methods:Immunofluorescence images with positive results of ANA in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 2020 to December 2021 were collected. Three senior technicians independently and in parallel interpreted the Immunofluorescence images to determine the ANA results. Then the images were labeled according to the ANA International Consensus on Fluorescence Patterns (ICAP) classification criteria. There were 7 labeled groups: Fine speckled, Coarse speckled, Homogeneous, nucleolar, Centromere, Nuclear dots and Nuclear envelope. Each group was randomly divided into training dataset and validation dataset at a ratio of 9∶1 by using random number table. On the deep learning framework PyTORCH 1.7, the convolutional neural network (CNN) training platform was constructed based on ResNet-34 image classification network, and the automatic ANA recognition system was established. After the model was established, the test set was set up separately, the judgment results of the model were output by ranking the prediction probability, with the results of the 2 senior technicians was taken as "golden standard". Parameters such as accuracy, precision, recall and F1-score were used as indicators to evaluate the performance of the model.Results:A total of 23138 immunofluorescence images were obtained after segmentation and annotation. A total of 7 models were trained, and the effects of different algorithms, image processing and enhancement methods on the model were compared. The ResNet-34 model with the highest accuracy andswas selected as the final model, with the classification accuracy of 93.31%, precision rate of 91%, and recall rate of 90% and F1-score of 91% in the test set. The overall coincidence rate between the model and manual interpretation was 90.05%, and the accuracy of recognition of nucleolus was the highest, with the coincidence rate reaching 100% in the test set.Conclusion:The current AI system developed based on deep learning of the ANA immunofluorescence images in the present study showed the ability to recognize ANA pattern, especially in the common, typical, simple pattern.

Objective:To analyze the clinical effect of navigation-assisted cosmetic incision for reduction and internal fixation in treating unilateral B-type zygomatic fracture.Methods:A retrospective cohort study was performed on clinical data of 35 patients with unilateral type B zygomatic fracture treated from January 2018 to December 2019 in First Affiliated Hospital of Fujian Medical University. There were 20 males and 15 females at age range of 5-62 years [(38.7±11.3)years]. Navigation-assisted cosmetic incision for reduction and internal fixation was performed for 17 patients (navigation group), and empirical incision to reduction and internal fixation was performed for 18 patients (convention group). The length of bony zygomatic process (zygomatic process) and width of zygomatic temporal point (frontal width) of the bilateral zygomatic bone were measured on the horizontal axis of CT at 1 week after operation. The absolute values of the difference of bony zygomatic process degree and frontal bony width between affected side and the healthy side were compared between the two groups. The patients′ satisfaction and occurrence of complications such as lower eyelid ectropion, incision infection and facial nerve injury were compared between the two groups at half a year after operation.Results:All patients were followed up for 6-24 months [(9.3±1.2)months]. The absolute difference of bony zygomatic process was 0.60(0.25, 0.85) mm in navigation group, and was 0.75 (0.20, 1.98)mm in convention group ( P>0.05). The absolute difference of frontal bony width was (0.37±0.11)mm in navigation group, and was (2.47±0.63)mm in convention group ( P<0.01). Satisfaction rates by both objective evaluation and subjective evaluation in navigation group were better than that in convention group at half a year after operation (both P<0.05). Navigation group showed lower eyelid ectropion in 1 patient and incision infection in 1 patient. Convention group showed facial nerve injury in 1 patient and incision infection in 2 patients. There was no significant difference in the incidence of complications between navigation group [12%(2/17)] and conventional group [17%(3/18)] ( P>0.05). Conclusion:For unilateral type B zygomatic fracture, navigation-assisted cosmetic incision for reduction and internal fixation can more accurately restore the frontal width, and improve satisfaction rate as compared with empirical reduction and internal fixation.

The coronal process of ulna is an important stable structure in front of the elbow joint, which is composed of the tip of the coronal process, towering tubercle and anterior medial face. The fracture of the coronal process is often accompanied by the fracture and dislocation of the elbow joint, which leads to the instability of the elbow joint. The coronoid process has the advantages of small size, special shape, complex surrounding soft tissue structure, and plays an important role in the stability of the elbow joint. The selection of safe, minimally invasive and well exposed surgical approach is a necessary condition for safe and effective internal fixation. The choice of surgical approach must comprehensively consider the concomitant injury and choose the best surgical approach. This article mainly describes the normal anatomical structure of the coronal process and around the elbow joint, analyzes the biomechanics and stability of the coronal process in the elbow joint, and reviews the latest progress in surgical treatment.

Objective:To assess the clinical characteristics and grafts status by coronary angiography(CAG) in symptomatic patients with prior coronary artery bypass graft(CABG).Methods:A retrospective descriptive study of symptomatic patients with prior CABG who underwent CAG was performed, 1 136 patients were included and analyzed. The mean age was(62.5±8.7) years, 76.4% were male. There was a high prevalence of risk factors like hypertension(75.0%), dyslipidemia(48.2%), diabetes(46.1%) and smoking history(62.8%).Results:The mean duration after CABG was (4.65±3.39) years. 94.5% of patients had chest pain. 12.9% of patients had all diseased grafts and 28.7% had all patent grafts. The proportion of diseased SVG was higher than that of diseased arterial grafts. The proportion of diseased grafts anastomosed to RCA territory was higher than that of grafts anastomosed to LCX territory or LAD territory. 52.5% of patients received percutaneous coronary intervention(PCI) revascularization, and 88.3% of PCI was performed in native vessels.Conclusion:The most common symptom recurring to patients with prior CABG was chest pain. Graft status in symptomatic patients with prior CABG was worse than we expected. Patients received repeated revascularization mostly by PCI and PCI was mainly performed in native vessels.

Objective:To explore the perioperative effect of coronary artery bypass grafting(CABG) or CABG+ mitral valve repair(MVP) in patients with coronary heart disease(CAD) and moderate ischemic mitral regurgitation(IMR).Methods:The clinical data and perioperative complications of 210 patients with CAD and moderate IMR, who underwent CABG from January 2018 to December 2019, were included into this study, with 155 males and mean age of(62.3±8.5) years old. According to the operation mode, patients were divided into CABG group(138 cases) and CABG+ MVP group(72 cases).Results:There were no significant differences in age, gender, comorbidities(diabetes, hypertension, hyperlipidemia, peripheral vascular disease, cerebrovascular events, previous history of myocardial infarction and PCI), LVEF and of coronary artery lesions between the two groups(all P>0.05). Sequential anastomosis was the main method, and most patients underwent internal mammary artery graft in both groups, there was no significant difference between the two groups( P>0.05). CABG group was higher than CABG+ MVP group in all-cause death, heart failure, cerebrovascular events, secondary thoracotomy, CRRT and IABP support events, but there were no significant differences between the two groups( P>0.05). Echocardiographic reexamination showed that the indexes of cardiac function in CABG+ MVP group were higher than those in CABG group, but there was no significant difference between the two groups( P>0.05). The mean area of mitral regurgitation in CABG + MVP group was 1.3 cm 2, significantly lower than that in CABG group(2.5 cm 2), P<0.05. Conclusion:CABG+ MVP has low perioperative risk in patients with CAD and moderate IMR, and the area of mitral regurgitation is lower.

Objective:To analyze the administration of rabies immunoglobulin (RIG) in populations who had rabies virus exposure, and to investigate the safety of RIG and related factors affecting its administration.Methods:This cross-sectional study included the rabies virus exposed victims who were treated at the sixth medical center of the People’s Liberation Army (PLA) General Hospital from April to November 2019. The clinical characteristics of the patients who accepted RIG injection and those who refused RIG were analyzed and compared, and the determinant factors of the RIG injection were studied by stepwise multiple logistic regression analysis.Results:There were 1 395 cases of category III exposure, of whom 662 (47%) were males, 733 (52.5%) were females. The median age was 29 (9-49) years. Among them, 1 049 cases were injected with RIG, while 346 were not injected with RIG. Side effects associated with RIG injection included pain (97.6%), dizziness (7.0%), nausea (6.5%), chest tightness (2.1%), and syncope (0.3%). Stepwise multiple logistic regression analysis showed that adults ( OR=17.14, 95% CI: 9.69-30.32), middle-aged and elderly ( OR=12.92, 95% CI: 6.83-24.43), and those whose injury was caused by cats ( OR=3.18, 95% CI: 2.09-4.84), scratches ( OR=7.66, 95% CI: 4.27-13.75), those with minor injuries ( OR=21.75, 95% CI: 11.70-40.42) more likely to choose not to inject RIG. Conclusions:It is safe and effective to inject RIG for patients with grade III exposure to rabies virus. Exposed persons who are not injured by dogs, slightly injured and elderly people tend not to inject RIG.

Objective To analyze clinicopathological characteristics and the potential risk-related factors of female breast hyperplasia in different age groups.Method From Jan 2015 to Dec 2016,patients diagnosed with breast hyperplasia in 12 hospitals were evaluated.All patients completed the self-designed questionnaires on women'health,including basic demographic information,clinic examination information,radiologic information and pathologic results.The patients were divided into a young group (＜ 45 years old) and an elderly group (from 45 to 75 years old).Results There were 3 684 cases of breast hyperplasia,including 2 291 cases in young group and 1 393 cases in elder group,respectively Clinically breast pain type were most commonly observed in both young and older groups (50.3％ vs.42.7％,P ＜ 0.001).While pathological research based on biopsy showed that breast adenopathy were the most common changes in both groups (67.9％ vs.61.7％,P ＜0.001).More breast cancer cases were identified in elder group than that in young group,especially in clinically lump type patients (9.4％ vs.4.2％,P ＜ 0.001).Compared with elder group,patients in young group have different distribution characteristics regarding to fertility factors,lifestyle factors and psychology scale including anxiety and depression.Conclusion Distributions of clinicopathological characteristics and risk factors of female breast hyperplasia differ across different age groups.

Objective: To evaluate the influence of oral hygiene on risk of oral cancer in non-smoking and non-drinking women. Methods: From September 2010 to February 2016, 242 non-smoking and non-drinking female patients with pathologically confirmed oral cancer were recruited in a hospital of Fuzhou, and another 856 non-smoking and non-drinking healthy women from health examination center in the same hospital were selected as control group. Five oral hygiene related variables including the frequency of teeth brushing, number of teeth lost, poor prosthesis, regular dental visits and recurrent dental ulceration were used to develop oral hygiene index model. Unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95%CI). The area under the receiver operating characteristic curve (AUROC) was used to evaluate the predictability of the oral hygiene index model. Multivariate logistic regression model was used to analyze the association between oral hygiene index and the incidence of oral cancer. Results: Teeth brushing <2 twice daily, teeth lost ≥5, poor prosthesis, no regular dental visits, recurrent dental ulceration were risk factors for the incidence of oral cancer in non-smoking and non-drinking women, the corresponding OR (95%CI) were 1.50 (1.08-2.09), 1.81 (1.15-2.85), 1.51 (1.03-2.23), 1.73 (1.15-2.59), 7.30 (4.00-13.30), respectively. The AUROC of the oral hygiene index model was 0.705 9, indicating a high predictability. Multivariate logistic regression showed that the oral hygiene index was associated with risk of oral cancer. The higher the score, the higher risk was observed. The corresponding OR (95%CI) of oral hygiene index scores (score 1, score 2, score 3, score 4-5) were 2.51 (0.84-7.53), 4.68 (1.59-13.71), 6.47 (2.18-19.25), 15.29 (5.08-45.99), respectively. Conclusion Oral hygiene could influence the incidence of oral cancer in non-smoking and non-drinking women, and oral hygiene index has a certain significance in assessing the combined effects of oral hygiene.

Objective: To investigate the effects between fish, seafood and pickled food intakes on oral squamous cell carcinoma (OSCC). Methods: A case-control study was carried out in Fujian area during September 2010 to December 2016, in which 604 newly diagnosed primary OSCC cases confirmed by pathological diagnosis were collected from hospital and 1 343 control subjects were enrolled from community and healthy hospital population. Demographic data, history of smoking drinking and tea drinking, oral hygiene status and dietary behaviors (fish, seafood and pickled food intakes) were collected by in-person interviews using a standard questionnaire.Using unconditional logistic regression to estimate adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) to assess the effects of fish, seafood and pickled food intakes on OSCC. Analysis stratified by smoking, alcohol drinking and bad prosthesis to explore the possible difference in association between subgroups. Multiplicative interactions and additive interactions between fish and bad prosthesis, seafood and alcohol drinking, pickled food and bad prosthesis were assessed by unconditional logistic regression, relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). Results: The average age of case group and control group were separately (58.69±13.92) years old and (59.27±11.37) years old (χ²=4.75, P=0.191). The people whose fish and seafood intakes ≥3 times/week had the lower risk of OSCC, the adjusted OR (95%CI) values were 0.63 (0.52-0.77) and 0.51 (0.41-0.64); The stratified analysis indicated that the people having bad prosthesis had the lower risk of OSCC if they eating fish ≥3 times/week, and the adjusted OR (95%CI) values was 0.53 (0.39-0.71); the people having bad prosthesis had the higher risk of OSCC if they eating pickled food ≥3 times/week, the adjusted OR (95%CI) values was 1.37 (1.02-1.88). Regularly eating seafood can decrease the risk of OSCC for non-smokers, smokers, non-drinkers, drinkers, people without bad prosthesis and had bad prosthesis, the adjusted OR (95%CI) values were 0.49 (0.36-0.68), 0.52 (0.37-0.73), 0.41 (0.31-0.55), 0.77 (0.51-0.96), 0.49 (0.36-0.67), 0.59 (0.42-0.83). Crossover analysis showed fish and bad prosthesis exist multiplication interaction relationship (adjusted OR=0.66, 95%CI: 0.44-0.97) and additional interaction relationship (RERI=-0.81, 95%CI:-1.43--0.19; AP=-0.76, 95%CI:-1.35--0.17; S=0.08, 95%CI: 0.01-0.98); pickled food and bad prosthesis exist multiplication interaction relationship (adjusted OR=1.63, 95%CI: 1.06-2.51) and addition interaction relationship (RERI=0.65, 95%CI:0.08-1.22; AP=0.36, 95%CI:0.10-0.62; S=5.19, 95%CI:1.32-54.49). Conclusion Reducing the consumption of pickled food, quitting smoking and limiting alcohol consumption, and regularly eating fish and seafood can prevent the occurrence of OSCC.