Objective:To investigate the pathogen distribution and influencing factors for pulmonary infection after radical resection of esophageal cancer.Methods:The retrospective case-control study was conducted. The clinical data of 555 patients who underwent radical resection of esophageal cancer in Heping Hospital Affiliated to Changzhi Medical College from January 2021 to December 2022 were collected. There were 344 males and 211 females, aged (64±8)years. Obser-vation indicators: (1) incidence of postoperative pulmonary infection and pathogen distribution; (2) analysis of influencing factors for postoperative pulmonary infection. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. The comparisons of ordinal data were analyzed using the nonparametric test. Univariate analysis was performed using the corresponding statistical methods based on data type. Multivariate analysis was performed using the Logistic stepwise regre-ssion model advance method. Results:(1) Incidence of postoperative pulmonary infection and pathogen distribution. Among 555 patients, 91 cases had postoperative pulmonary infection, with the incidence as 16.40%(91/555). In 91 patients with postoperative pulmonary infection, 59 strains of bacteria were isolated and cultured. There were 53 strains of gram-negative bacteria, 3 strains of gram-positive bacteria and 3 strains of fungi, including 20 multidrug-resistant bacteria. Among the 53 strains of gram-negative bacteria, there were 18 strains of Acinetobacter baumannii (12 strains were multidrug resistant), 18 strains of Klebsiella pneumoniae (3 strains were multidrug resistant), 6 strains of Pseudomonas aeruginosa (2 strains were multidrug resistant), 2 strains of Escherichia coli, 2 strains of Enterobacter cloacae, and 2 strains of Haemophilus influenzae (2 strains of Escherichia coli and 1 strain of Enterobacter cloacae were multidrug resistant strains), 1 strain of Serratia marcescens, 1 strain of Citrobacter keri, 1 strain of Corynebacterium striatum, 1 strain of Proteus mirabilis and 1 strain of Klebsiella acidogenes. Among the 3 strains of Gram-positive bacteria, there were 2 strains of Staphylococcus aureus and 1 strain of Streptococcus pneumoniae. All the three strains of fungi were Candida albicans. Among the 18 strains of Acinetobacter baumannii, there were 12, 12, 11, 9, 8, 6 and 5 strains resistant to imipenem, ceftriaxone, ceftazidme, cefoperazone or sulbactam, ciprofloxacin, amicacin and levofloxacin, respectively. The above indexes of 18 strains of Klebsiella pneumoniae were 0, 1, 1, 1, 2, 0 and 2, respectively. (2) Analysis of influencing factors for postoperative pulmonary infection. Results of multivariate analysis showed that tumor pathological staging as stage Ⅱ and Ⅲ, duration of preoperative hospital stay ≥6 days, operation time ≥240 minutes, mode of operation as thoracotomy, type of antibiotics used in peri-operative period ≥3, and postoperative antibiotic use time ≥5 days were independent risk factors for postoperative pulmonary infection ( P<0.05). Conclusions:The main pathogenic bacteria of pulmonary infection after radical resection of esophageal cancer are Acinetobacter baumannii and Klebsiella pneumoniae. Tumor pathological staging as stage Ⅱ and Ⅲ, duration of preoperative hospital stay ≥6 days, operation time ≥240 minutes, mode of operation as thoracotomy, type of antibiotics used in perioperative period ≥3, and postoperative antibiotic use time ≥5 days are independent risk factors for pulmonary infection in patients with esophageal cancer after radical surgery.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

OBJECTIVES: To reduce the dimension of characteristic information extracted from pelvic CT images by using principal component analysis (PCA) and partial least squares (PLS) methods. To establish a support vector machine (SVM) classification and identification model to identify if there is pelvic injury by the reduced dimension data and evaluate the feasibility of its application. METHODS: Eighty percent of 146 normal and injured pelvic CT images were randomly selected as training set for model fitting, and the remaining 20% was used as testing set to verify the accuracy of the test, respectively. Through CT image input, preprocessing, feature extraction, feature information dimension reduction, feature selection, parameter selection, model establishment and model comparison, a discriminative model of pelvic injury was established. RESULTS: The PLS dimension reduction method was better than the PCA method and the SVM model was better than the naive Bayesian classifier (NBC) model. The accuracy of the modeling set, leave-one-out cross validation and testing set of the SVM classification model based on 12 PLS factors was 100%, 100% and 93.33%, respectively. CONCLUSIONS In the evaluation of pelvic injury, the pelvic injury data mining model based on CT images reaches high accuracy, which lays a foundation for automatic and rapid identification of pelvic injuries.
Algorithms ; Bayes Theorem ; Data Mining ; Least-Squares Analysis ; Support Vector Machine

Objective: The primary aim was to evaluate the influence of depressive and anxiety symptoms on the 1-year recurrence rate of non-muscle invasive bladder cancer (NMIBC) patients. The secondary aim was to examine the risk factors leading to psychological distress. Methods: A total of 104 NMIBC patients were enrolled for interviews, and the Hospital Anxiety and Depression Scale (HADS) questionnaire survey was administered 1 month after their operation. Their cystoscopy results were followed up. The risk factors affecting their 1-year recurrence rate were evaluated through univariate analysis, Cox regression and Kaplan-Meier analysis. The risk factors causing depressive and anxiety symptoms were evaluated through univariate analysis and logistic regression. Results: In addition to American Urological Association risk stratification, depressive symptoms were another independent risk factor for recurrence in NMIBC patients (HR: 2.493, 95% CI: 1.048–5.930, p=0.039), and the increase in the recurrence rate was highly significant in intermediate-risk patients (HR: 8.496, 95% CI: 2.178–33.138, p=0.019). Anxiety symptoms were not an independent risk factor for recurrence (HR: 1.655, 95% CI: 0.714–3.837, p=0.240). We also observed that the burden of medical expenses of NMIBC on the family was an independent risk factor for depressive symptoms (p=0.029) and anxiety symptoms (p=0.048); chronic pain was an independent risk factor for anxiety symptoms (OR: 3.447, 95% CI: 1.182–10.052, p=0.023). Conclusion Depression symptoms are an independent risk factor for recurrence in NMIBC patients. Moreover, the burden of medical expenses on the family is an independent risk factor for depressive and anxiety symptoms in NMIBC patients. Additionally, chronic pain is a risk factor for anxiety symptoms in NMIBC patients. This study provided a theoretical foundation for clinical oncologists to pay more attention to the mental health of NMIBC patients.

Objective: The primary aim was to evaluate the influence of depressive and anxiety symptoms on the 1-year recurrence rate of non-muscle invasive bladder cancer (NMIBC) patients. The secondary aim was to examine the risk factors leading to psychological distress. Methods: A total of 104 NMIBC patients were enrolled for interviews, and the Hospital Anxiety and Depression Scale (HADS) questionnaire survey was administered 1 month after their operation. Their cystoscopy results were followed up. The risk factors affecting their 1-year recurrence rate were evaluated through univariate analysis, Cox regression and Kaplan-Meier analysis. The risk factors causing depressive and anxiety symptoms were evaluated through univariate analysis and logistic regression. Results: In addition to American Urological Association risk stratification, depressive symptoms were another independent risk factor for recurrence in NMIBC patients (HR: 2.493, 95% CI: 1.048–5.930, p=0.039), and the increase in the recurrence rate was highly significant in intermediate-risk patients (HR: 8.496, 95% CI: 2.178–33.138, p=0.019). Anxiety symptoms were not an independent risk factor for recurrence (HR: 1.655, 95% CI: 0.714–3.837, p=0.240). We also observed that the burden of medical expenses of NMIBC on the family was an independent risk factor for depressive symptoms (p=0.029) and anxiety symptoms (p=0.048); chronic pain was an independent risk factor for anxiety symptoms (OR: 3.447, 95% CI: 1.182–10.052, p=0.023). Conclusion Depression symptoms are an independent risk factor for recurrence in NMIBC patients. Moreover, the burden of medical expenses on the family is an independent risk factor for depressive and anxiety symptoms in NMIBC patients. Additionally, chronic pain is a risk factor for anxiety symptoms in NMIBC patients. This study provided a theoretical foundation for clinical oncologists to pay more attention to the mental health of NMIBC patients.

Objective To explore the value of multiple non-gaussian distribution models DWI in evaluating hepatic ischemia reperfusion injury (HIRI) model in rats.Methods Forty-two SD rats were divided into 7 groups by random numeric table method.Each group had 6 rats.The 7 groups were 6 h,12 h,1 d,3 d,7 d,14 d group after HIRI and control group,respectively.The experimental groups underwent right hepatic portal vein and hepatic artery ligation,and received reperfusion 3 h after operation.MRI scanning (T1WI,T2WI,single b-values DWI and 15 b-values DWI) was performed at 6 h,12 h,1 d,3 d,7 d and 14 d after reperfusion.The control group underwent sham operation and MRI scanning.According to monoexponential model,biexponential model,threxponential model,stretched-exponential model DWI and diffusion kurtosis imaging,many parametres were obtained and their dynamic changes at each time point were observed.The parameters included standard apparent diffusion coefficient (ADCs),pure diffusion coefficients (D),pseudodiffusion coefficients (D*),perfusion fraction (f),ultra-high apparent diffusion coefficient (ADCu),distributed diffusion coefficient (DDC),water diffusion heterogeneity index (or),mean diffusion coefficient (MD) and mean diffusion kurtosis (MK).One way ANOVA was used to compare the differences of parameters among different groups.Results MRI examination and pathological examination were successfully completed in all rats.The right hepatic lobe in the experimental groups appeared hypointense on T1WI and hyperintense on T2WI relative to control group from 6 h after operation.The infarcted liver lobe in the experimental groups became significantly smaller at 1 week after HIRI and almost disappeared at 2 weeks after HIRI.The findings of DWI at different b-values were consistent with those at T2WI.There were significant differences in parameters among 6 h,12 h,1 d,3 d,7 d,14 d groups after HIRI and control group (P＜0.05).There were significant differences among 12 h after HIRI,1 d after HIRI,3 d after HIRI and 6 h after HIRI,7 d after HIRI,14 d after HIRI,control group concerning ADCs values respectively (P＜0.05).There were significant differences among 6 h after HIRI,12 h after HIRI,1 d after HIRI,3 d after HIRI,7 d after HIRI and 14 d after HIRI,control group concerning D,D*,f,ADCu,α,DDC,MK values respectively (P＜0.05).In addition,there were significant differences among 1 d after HIRI,3 d after HIRI and 6 h after HIRI,12 h after HIRI,7 d after HIRI and 14 d after HIRI,control group concerning D values respectively (P＜0.05).There were significant differences among 6 h after HIRI,12 h after HIRI,1 d after HIRI,3 d after HIRI and 7 d after HIRI,14 d after HIRI,control group concerning f values respectively (P＜0.05).There were significant differences among 12 h after HIRI and 14 d after HIRI,control group concerning MD values respectively (P＜0.05).There were significant differences between 1 d after HIRI and 14 d after HIRI concerning MD values (P＜0.05).Conclusion Multiple non-gaussian distribution models DWI is superior to conventional DWI in evaluating HIRI model in rats.

Objective: To investigate the efficacy and the prognostic factors in pediatric hepatoblastoma according to the standard diagnostic and therapeutic regimen. Method: Eighty-four consecutive patients were enrolled in this study between June 2000 and June 2015. Diagnosis and staging was decided by the multi-disciplinary team including oncologists, surgeons, pathologists and sub-specialized radiologists refering to protocol of Children′s Oncology Group(COG) and International Society of Pediatric Oncology Liver Tumor Study Group (SIOPEL) in a case observational study. Univariate analysis was tested by the log-rank and multivariate analysis by COX regression. All consecutive cases were divided into low risk group and high risk group according to grouping criteria. Complete remission was defined as both imaging negative and α fetoprotein (AFP) normalization. Retrospective analysis was performed in clinical features, long-term outcomes and prognostic factors. Result: Ten patients were excluded because of giving up after less than or equal to three cycles of treatment. A total of 74 cases were included in this study; 45 males and 29 females. The median age at diagnosis was 1.7 years(range 0.2-14.8 years). Untill August 30, 2016, the median follow-up time was 24.2 months (range 4.1-135.3 months); 59 cases achieved complete remission.The estimated five years overall survival (OS) and event free survival(EFS) were 90%(68/74)and 72%(58/74). AFP could be normalized after 5 circles of treatment or 2 circles of postoperation.In univariate analysis , the five years OS and EFS in low risk group were both 100%(18/18), and those in high risk group were 88%(50/56)and 68%(40/56), respectively. The five years OS rates were 75%(15/19) and 95%(53/55) in patients with or without distant metastasis (P=0.016). After 3 cycles of chemotherapy post tumor resection, we divided these patients into 2 groups according to AFP recover or not, the five years OS were 100%(43/43)and 81%(22/26), respectively (P=0.011). Conclusion The result of this protocol is reasonable when comparing with other worldwide research. Except for staging, metastasis, pathological subtypes, postoperative AFP recover or not is a prognostic factor after 3 cycles of chemotherapy.

Objective: To investigate the long-term efficacy and prognostic factors of pediatric relapsed Wilms tumor (WT) after retreatment. Method: Sixteen children in Shanghai Children′s Medical Center with relapsed Wilms tumor were enrolled consecutively in this study between April 2006 and June 2016. All patients were diagnosed according to pathology, imaging and medical and surgical oncologist′s assistance. Relapse treatment included surgical excision, chemotherapy and selective radiation therapy. The clinical features, long-term outcomes and prognostic factors of patients were analyzed retrospectively.Survival data were analyzed by Kaplan-Meier.Log-Rank analysis was used for univariate analysis. Result: One case was excluded because of giving up the therapy even though no disease progress was identified. A total of 15 cases (5 males and 10 females) were included in this study. The median age at diagnosis was 3.8 years (range 0.5-9.1 years). The tumor staging at diagnosis included one case of stageⅠ, 7 cases of stageⅡand 7 cases of stage Ⅲ. Among cases of stage Ⅲ, 6 cases had radiation therapy history. The pathology of all patients′ recurrent tumor was favorable histology (FH). The median follow-up time was 34.6 months (range 12.5-132.7 months) until March 21, 2017. The time from initial diagnosis to relapse was 7.9 months (range 3.1-17.9 months). Four cases experienced local recurrence, 9 cases relapsed with metastases (6 cases in lungs, 2 in livers, 1 in mediastinum) and 2 cases relapsed in both local site and with metastases. Except to 2 cases received irregular retreatment, 13 cases received regimen I (doxorubicin, vincristine, epoposide and cyclophosphamide for 25 weeks) as relapsed chemotherapy. Five cases received autologous bone marrow transplantation (ABMT). Until the last follow-up, 8 cases achieved continuous complete remission (range 6.7-104.3 months), 3 cases had relapse again or progressing and 4 cases died. The estimated 5-year overall survival (OS) rate and event free survival (EFS) rate were (70±15)% and (52±15)%. According to whether received ABMT or not, the 5-year EFS rate were 51% and 53%. According to whether relapsed within 6 months after diagnosis or not, the 5-year EFS rate were 38% and 56% respectively. Conclusion The 5-year EFS rate of pediatric relapsed FH WT have reached above 50% by multi-disciplinary treatment in our experience and we encourage patients and doctors to receive retreatment.

Objective To evaluate the outcomes of children with stage Ⅳ malignant extracranial germ cell tumors. Methods Twenty-five patients were enrolled in the retrospective analysis. Event-free survival (EFS) and overall survival (OS) rates were estimated by Kaplan-Meier method with SPSS 13.0. Results Of the 25 children, there were 13 males and 12 females. The mean age at diagnosis was 2 years old (ranged 1 to 11). Five patients receiving chemotherapy in another hospital before (n=1), or giving up treatment after confirmed diagnosis (n=1), or giving up effective treatment after received less than 2 cycles (n=3) were excluded from this analysis. Of the 20 patients, 90.0% (18/20) achieved complete remission and 5.0% (1/20) achieved partial remission after treatment. The 5-year EFS rate and 5-year OS rate were 70.0%±10.2% and 82.4%±9.2% respectively. There was no death occurred due to complications. Conclusions The effect of this treatment program is positive. The cumulative dose of the drugs is not high, compared with other schemes such as PEB, but there are more drugs involved. Whether these drugs may cause long-term adverse reactions needs further research.

Glucocorticoid receptor (GR),a member of the steroid receptor superfamily,can mediate the signal pathway of ligands like glucocorticoids,regulate the transcription of target genes,and exert biological activity.GR is expressed in different degrees in three major kinds of urological malignant tumors including renal cancer,bladder cancer and prostate cancer.It also affects the metabolism of tumor cells,and is closely related to the occurrence,development and prognosis of tumors.GR provides an important clue for targeted therapy and endocrine therapy of urological malignant tumors.