Objective:To evaluate the surgery combined chemotherapy and radiation in locally advanced neuroendocrine carcinoma of the cervix (NECC) .Methods:This is a single-center retrospective cohort study. Locally advanced NECC patients admitted to Peking Union Medical College Hospital, Chinese Acadmy of Medical Sciences from January 2011 to April 2022 were enrolled. They were divided into concurrent chemoradiotherapy group, and surgery combined with chemotherapy and radiation group. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate.Results:(1) Forty-six cases were included, 22 in concurrent chemoradiotherapy group, 24 in surgery combined chemotherapy and radiation group. With 16 patients (35%, 16/46) received neoadjuvant chemotherapy (NACT), the NACT effective rate was 15/16. (2) The median follow-up time was 27.5 months (range: 10-106 months), with 26 (57%, 26/46) experienced recurrences. There were 4 (9%, 4/46) pelvic recurrences and 25 (54%, 25/46) distant recurrences, and 3 (7%, 3/46) both pelvic and distant recurrences. Compared with concurrent chemoradiotherapy group, surgery combined chemotherapy and radiation group had lower pelvic recurrence rate [14% (3/22) vs 4% (1/24); χ2=1.296, P=0.255] but without statistic difference. Both groups had similar distant recurrence rate [55% (12/22) vs 54% (13/24); χ2=0.001, P=0.979] and overall recurrence rate [59% (13/22) vs 54% (13/24); χ2=0.113, P=0.736]. (3) During the follow-up period, 22 cases (48%, 22/46) died, with 11 cases (50%, 11/22) in concurrent chemoradiotherapy group and 11 cases (46%, 11/24) in surgery combined chemotherapy and radiation group, without significant difference ( χ2=0.080, P=0.777). The postoperative 3-year and 5-year OS rates were 62.3% and 36.9%. Compared with concurrent chemoradiotherapy group, the patients in surgery combined chemotherapy and radiation group showed an extended trend in PFS (17.0 vs 32.0 months) and OS (37.0 vs 50.0 months) but without statistic differences ( P=0.287, P=0.125). Both groups had similar 3-year OS rate (54.2% vs 69.9%; P=0.138) and 5-year OS rate (36.1% vs 38.8%; P=0.217). Conclusions:Our study supports the multi-modality treatment strategy (including surgery, chemotherapy and radiation) as an important component in the treatment of locally advanced NECC. The combination of surgery, chemotherapy and radiation seems to have advantages in the treatment of locally advanced NECC, but needs to be confirmed by further multicenter studies.

This review comprehensively summarizes clinical assessment tools which have been developed and validated for cholinergic urticaria (CholU) , involving diagnosis and severity assessment of CholU, assessment of patients′ quality of life, and assessment of disease control. The application methods and status of relevant tools in clinical practice are introduced in detail.

Objective:To construct "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " based on the Delphi method, and to provide a methodological basis for consensus construction.Methods:After systematic search and evaluation of the literature related to chronic inducible urticaria, the first draft of "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " was written, and a questionnaire was designed for expert consultation. A representative sample of 25 experts was selected to conduct two rounds of correspondence consultation via electronic questionnaire in strict accordance with the Delphi method, and the content of the consensus was revised and improved according to the consultation results.Results:The response rates in the two rounds of questionnaire consultation were both 100%, and the expert authority coefficient was 0.92 ± 0.09. In the first round of consultation, the coefficients of variation (CV values) of 9 items were greater than 20%, and the mean agreement degree of 3 items was less than 7 points; in the second round of consultation, the CV values of all items were less than 15%, the agreement degree of the above 3 items whose mean agreement degree was less than 7 points in the first round of consultation all rose to over 7 points, and the median agreement degree of all items was greater than or equal to 8 points. Reliability analysis of the two rounds of questionnaire results showed that the Cronbach α coefficient and standardized Cronbach α coefficient were both greater than 0.9; the P values in the agreement tests by using Kendall′s coefficient of concordance for the two rounds of questionnaire results were both less than 0.001, and the Kendall′s coefficients of concordance were 0.170 and 0.219 in the first and second rounds of questionnaire consultation, respectively. Conclusion:The Delphi method-based "Expert consensus on diagnosis and treatment of chronic inducible urticaria in China (2023) " is highly representative, authoritative and reliable; this study also provides a methodological reference for the formulation and research of consensus.

Objective:To analyze the relationship between allergen reactivity, atopic disease history and clinical features in patients with chronic inducible urticaria (CIndU) .Methods:A retrospective analysis was conducted on clinical data and follow-up results from 168 patients with CIndU in the Department of Dermatology, Southwest Hospital of Army Medical University from June 2014 to June 2015. Associations were analyzed between allergen reactivity, atopic disease history and clinical characteristics (including patient global assessment [PGA] scores, pruritus intensity, dermatology life quality index [DLQI], proportions of cases with complicated angioedema, natural course, etc.) in patients with different CIndU subtypes. Chi-square test, Mann-Whitney U test and Kaplan-Meier survival analysis were used for statistical analysis. Results:Among the 168 patients with CIndU, 117 were diagnosed with symptomatic dermographism (SD) , 32 with cold contact urticaria (CCU) , 5 with heat contact urticaria (HCU) , and 14 with cholinergic urticaria (CholU) ; there were 46 (39.3%) , 14 (43.8%) , 3, and 9 patients with positive skin prick test (SPT) among the patients with SD, CCU, HCU and CholU respectively, and no significant difference was observed in the positive rate of SPT among patients with different CIndU subtypes ( χ2 = 3.86, P = 0.283) . The SPT-positive CIndU patients showed significantly increased PGA scores, pruritus scores, DLQI scores and proportions of cases with complicated angioedema compared with the SPT-negative patients (all P<0.05) ; the CIndU patients with a personal or family history of atopic diseases also showed significantly increased PGA and DLQI scores compared with those without (both P < 0.05) . For different CIndU subtypes, the pruritus scores, PGA scores, DLQI scores, and proportions of cases with complicated angioedema were significantly higher in the SPT-positive SD patients than in the SPT-negative SD patients (all P < 0.05) ; the DLQI scores were significantly higher in the SPT-positive CholU patients than in the SPT-negative CholU patients ( Z = -2.28, P = 0.019) ; the pruritus scores were significantly higher in the CCU patients with a personal or family history of atopic diseases than in those without ( Z =-2.41, P = 0.022) . Conclusion:The allergen reactivity and atopic disease history of CIndU patients were associated with disease severity, pruritus intensity, quality of life, and the proportion of cases with complicated angioedema, but their relationship with the natural course of CIndU needs to be confirmed by further studies.

With the common occurrence of knee osteoarthritis, total knee arthroplasty has become an effective method for the treatment of middle and late knee osteoarthritis. Continuous passive movement is an effective auxiliary method for rehabilitation after total knee arthroplasty, but it also has some limitations. This article reviews the research progress of continuous passive movement after total knee arthroplasty.

Bone infection is a serious infectious disease in clinical practice due to its difficult treatment and poor prognosis. Therefore, early accurate diagnosis of bone infection is the key for successful treatment. The traditional detection methods is time consuming with lower positive rate. Therefore, it is urgent to find better detection techniques to identify the pathogenic microorganisms of bone infection. In recent years, metagenomic second-generation sequencing technology has been widely used in the diagnosis of clinical infectious diseases because of its advantages of accurate, rapid, efficient and comprehensive diagnosis of pathogenic microorganisms, and can be used as an effective tool for the diagnosis of bone infections. This paper mainly reviews the advantages, disadvantages and development direction of metagenomics next-generation sequencing technology in the diagnosis of bone infection.

Objective:To explore the immune infiltration cells in rheumatoid arthritis (RA) synovial lesions, and to provide new research directions and therapeutic targets for the pathogenesis and treatment of RA.Methods:The three gene expression data sets GSE77298, GSE55457 and GSE1919 were downloaded from gene expression omnibus (GEO) (http://www.ncbi.nlm.nih.gov/geo), and the data were merged with Perl. The "limma" package was used to adjust batch differences. In R, "CIBERSORT" software was used to obtain the expression matrix of 22 kinds of immune cells corresponding to RA synovial tissue samples and normal synovial tissue samples were analyzed with the three packages of "e1071", "parallel" and "preprocessCore". Perl was used to screen samples with P<0.05 in the immune cell matrix. R's "barplot" function was analyzed by the percentage of 22 immune cells in samples with P<0.05. The "pheatmap" package of R was used to visualize heatmaps, and "corrplot" package was used to draw correlation heatmaps. The "vioplot" package of R was used to draw violin plots of differences via the wilcox test. Results:The results of immune cell infiltration analysis showed that in RA synovial tissue samples and normal synovial tissue samples at P<0.05, B cells naive and natural killer cells resting were under-expressed in RA synovial tissue, and plasma cells, mast cells resting, macrophages M1, B cells memory and T cells regulatory were highly expressed in RA synovial tissue. This study also found that in the same sample, the correlation coefficient between natural killer cells resting and neutrophils ( r=0.91) was the highest, indicating synergistic effect between the two. In the same sample, the correlation coefficient between macrophages M0 and plasma cells ( r=-0.88) was the lowest, indicating antagonistic effect between the two. Conclusion:The immune infiltrating cells in RA synovial lesions discovered in this study provide a certain theoretical basis and research direction for the research on the disease mechanism and treatment of RA.

Objective:To assess the efficacy and intervention time of sequential laser treatments for early stage of facial post-traumatic scars which were managed by plastic surgeons.Methods:212 patients in our department with facial post-traumatic scar which were managed by plastic surgeons within 2-12 weeks received 3-session of sequential 595 nm and CO 2 ablative fractional lasertreatments at 8 weeks intervals. They were divided into four groups in this retrospective study. Traumatic scars were first treated by 595 nm pulsed dye laser at 2 weeks (group A), 4 weeks (group B), 8 weeks (group C), 12 weeks (group D) post-operation respectively. Until the vascularity scores of Vancouver scar scale (VSS) fell below 2 points, then scars were treated with CO 2 ablative fractional laser. During the study, all cases were treated with standard silicone gel. Photographs taken before and after each treatment session were independently evaluated and scored by two uninvolved doctors with Vancouver scar rating scale (VSS). Friedman test and Mann-Whitney U test were used for intragroup and intergroup comparison of the difference before and after each session treatment. Patients, self-satisfactory (on 0-100%) and adverse effects were recorded and Chi-square and Fisher’s exact test were used to compare the differences between groups. Results:All 4 groups of patients completed 3-session laser treatments. The VSS score of A/B/C/D group was 3.0 (3.00-5.00) /4.0(3.00-4.00) /6.0 (5.00-6.00) /6.5 (6.00-7.75) at baseline, and significantly decreased to 2(2.00-3.00)/2(2.00-3.00)/4(3.00-4.00)/4(4.00-4.75) at 2 months after 3-session treatment ( P<0.001) respectively. Compared VSS score intergroup, there was no statistically difference between group A and B before ( P>0.05) or after ( P>0.05) treatment. In contrast, compared with group C or D, VSS score of group A or B was significantly lower at baseline ( P<0.001) and final follow-up ( P<0.001). And the excellent rate of patients, self-satisfaction were significantly different for group A(80.77%) vs. group C(56.41%) or D(47.50%), and group B(75.61%) vs. group C or D( P<0.05). No significant adverse effects were reported except for 3 patients with mild transient vesicles, and amonge the 3 cases, hyperpigmentation was observed in 2 cases which was faded within 6 months. Conclusions:A combination of 595 nm pulsed dye laser and CO 2 ablative fractional laser for facial traumatic scars starting from 2 weeks to 1 month post-operation could reach better clinical outcome by attenuating scar formation effectively and with higher patients, self-satisfaction than that from 2-3 months post-operation.

Objective:To assess the efficacy and intervention time of sequential laser treatments for early stage of facial post-traumatic scars which were managed by plastic surgeons.Methods:212 patients in our department with facial post-traumatic scar which were managed by plastic surgeons within 2-12 weeks received 3-session of sequential 595 nm and CO 2 ablative fractional lasertreatments at 8 weeks intervals. They were divided into four groups in this retrospective study. Traumatic scars were first treated by 595 nm pulsed dye laser at 2 weeks (group A), 4 weeks (group B), 8 weeks (group C), 12 weeks (group D) post-operation respectively. Until the vascularity scores of Vancouver scar scale (VSS) fell below 2 points, then scars were treated with CO 2 ablative fractional laser. During the study, all cases were treated with standard silicone gel. Photographs taken before and after each treatment session were independently evaluated and scored by two uninvolved doctors with Vancouver scar rating scale (VSS). Friedman test and Mann-Whitney U test were used for intragroup and intergroup comparison of the difference before and after each session treatment. Patients, self-satisfactory (on 0-100%) and adverse effects were recorded and Chi-square and Fisher’s exact test were used to compare the differences between groups. Results:All 4 groups of patients completed 3-session laser treatments. The VSS score of A/B/C/D group was 3.0 (3.00-5.00) /4.0(3.00-4.00) /6.0 (5.00-6.00) /6.5 (6.00-7.75) at baseline, and significantly decreased to 2(2.00-3.00)/2(2.00-3.00)/4(3.00-4.00)/4(4.00-4.75) at 2 months after 3-session treatment ( P<0.001) respectively. Compared VSS score intergroup, there was no statistically difference between group A and B before ( P>0.05) or after ( P>0.05) treatment. In contrast, compared with group C or D, VSS score of group A or B was significantly lower at baseline ( P<0.001) and final follow-up ( P<0.001). And the excellent rate of patients, self-satisfaction were significantly different for group A(80.77%) vs. group C(56.41%) or D(47.50%), and group B(75.61%) vs. group C or D( P<0.05). No significant adverse effects were reported except for 3 patients with mild transient vesicles, and amonge the 3 cases, hyperpigmentation was observed in 2 cases which was faded within 6 months. Conclusions:A combination of 595 nm pulsed dye laser and CO 2 ablative fractional laser for facial traumatic scars starting from 2 weeks to 1 month post-operation could reach better clinical outcome by attenuating scar formation effectively and with higher patients, self-satisfaction than that from 2-3 months post-operation.

Objective: To investigate the functional recovery and cosmetic effects of pre-expanded pedicled deltopectoral flap. Methods: From January 2008 to December 2018, 42 patients with 56 pre-expanded pedicled deltopectoral flaps from Xijing Hospital of Air Force Military Medical University were followed up at least 6 months. 18 of them were male, the remaining were female. And the average age was (24.7±7.3) years. Then the indicators were tested and evaluated. Tubes with different temperatures were used for temperature sensation test. The flaps were stabbed using a 27 G blunt needle to test algesthesia. Tactile threshold was measured by Semmes-Weinstein monofilament. Two-point discrimination was measured by Disk-Criminator. Elasticity of skin flaps was measured by CK-MC®960. Colors of skin flaps were analyzed by ANTERA®3D system, including L^*a^*b^*, melanin and hemoglobin content. And the postoperative scars were evaluated by the Patient and Observer Scar Assessment Scale (POSAS). The flap retraction rate [(flap area immediately after operation-flap area at the follow-up time)/flap area immediately after operation]was calculated. The satisfaction of patients, doctors and third parties was investigated as well. Statistical analysis of data was performed with SPSS 23.0, satisfaction rate was expressed as percentages. Scar scores were compared by Wilcoxon rank sum test. The values of elasticity, color L^*a^*b^*, melanin and hemoglobin between skin flaps and normal skin were analyzed by paired t test. The difference was statistically significant at P<0.05. Results: The scores of pain, heat and cold sensation were (4.61±0.78), (3.48±0.90) and (4.39±0.81), the tactile threshold was (0.26±0.23) g/mm², and the distance of two-point discrimination was (10.09±4.79) mm. There was no significant difference in elasticity, color b^*and melanin content between skin flap and normal skin of face and neck (P>0.05). The color of flap L^*, a^*and hemoglobin content of flaps were significantly different from those of normal skin from face and neck (P<0.05). The result of self-assessment of patients (POSAS) showed that there were significant differences (P<0.05) in pain, itch and stiffness between facial and chest donor scar. The result of observer evaluation (POSAS) showed that the scar score for all items around facial flap was better than that of chest donor area, the difference was statistically significant (P<0.05), and the retraction rate of flaps was (10.44 ±3.36)%. The satisfaction rates of doctors, patients and the third party were 92.86% (39/42), 71.43% (30/42) and 61.90% (26/42), respectively. Conclusions Excellent functional recovery and reliable cosmetic effect were observed in the facial-cervical scar repair with pre-expanded pedicled deltopectoral flap. Transfer of pre-expanded pedicled deltopectoral flap is an effective method for the treatment of facial-cervical scars.