Purpose: The 21-gene recurrence score (RS) can guide adjuvant chemotherapy decisions in the multidisciplinary treatment (MDT) of patients with early breast cancer. This study aimed to evaluate the influence of the 21-gene RS assay on patient’ compliance with MDT and its association with disease outcomes. Methods: Patients diagnosed with pN0-1, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer between January 2013 and June 2019 were enrolled. A logistic regression model was used to identify parameters associated with treatment adherence. Prognostic indicators were evaluated using the Cox proportional hazard models. Results: After the assay, patients were less likely to violate the treatment plan (14.9% vs. 23.1%, p < 0.001), and higher compliance rates were observed for chemotherapy (p = 0.042), radiotherapy (p = 0.012), and endocrine therapy (p < 0.001). Multivariable analysis demonstrated that the 21-gene RS assay (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.09–1.88; p = 0.009) was independently associated with MDT compliance. Moreover, compliance with MDT was independently associated with better disease-free survival (hazard ratio, 0.43; 95% CI, 0.29–0.64; p < 0.001), regardless of the 21-gene RS assay (interaction p = 0.842). Conclusion The 21-gene RS assay improved the MDT compliance rate in patients with early breast cancer. Adherence to MDT is associated with a better prognosis.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

In 2016, a national one million general population cohort project was set up in China for the first time in "Precision Medicine Research" Key Project, National Key Research and Development Program of China, which consists of general population cohorts in seven areas in China. As one of the seven major areas in China, northeastern China has unique climate and specific dietary patterns, and population aging is serious in this area. And the burden of chronic and non-communicable diseases ranks tops in China. Therefore, it is of great significance to establish a large general population cohort in northeastern China to explore the area specific exposure factors related to pathogenesis and prognosis of chronic and non-communicable diseases, develop new prevention strategies to reduce the burden of the diseases and improve the population health in northeastern China. In July 2018, the general population cohort study in northeastern China was launched, the study includes questionnaire survey, health examination and blood, urine and stool sample collection and detection in recruited participants. By now, the cohort has covered all age groups, and the baseline data of 115 414 persons have been collected. This paper summarizes the design and practice of the general population cohort study in northeastern China to provide reference for related research in China.

Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.

Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.

Objective:To investigate the applied value of serum Cyfra21-1,NSE,CRP and SCCA and pleural effusion Cyfra21-1, NSE in pathological types, clinical stages and combination detection for diagnosis of lung cancer.Methods: Based on chemiluminescence immunoassay,the levels of serum NSE,Cyfra21-1,SCCA,CRP and pleural effusion NSE,Cyfra21-1 in 100 patients with lung cancer (case group) and 50 patients with benign diseases(control group) were determined.Results:The positive rates of serum Cyfra21-1,NSE,SCCA and pleural effusion NSE,Cyfra21-1 were significantly higher in case group than those in control group ( P<0.05).The positive rates of serum SCCA,Cyfra21-1,NSE in stageⅢ,Ⅳwere higher than stageⅠ,Ⅱ,the positive rates of serum CRP and the pleural effusion Cyfra21-1,NSE in stage Ⅱ-Ⅳ were higher than stage Ⅰ(P<0.05).The positive rates of serum and pleural effusion Cyfra21-1 were highest in squamous carcinoma ( P<0.05 ) , the positive rate of serum and pleural effusion NSE was highest in small cell carcinoma ( P<0.05 ) , and the positive rate of serum SCCA and CRP in patients were highest in squamous carcinoma ( P<0.05).The sensitivity of the combination detection of serum tumor markers in diagnosing lung cancer was significantly enhanced (P<0.05),however,the sensitivity of the combination detection of pleural effusion Cyfra21-1,NSE were not enhanced(P>0.05).Conclusion:The serum NSE, Cyfra21-1, CRP, SCCA and pleural effusion NSE, Cyfra21-1 play an important role in the diagnosis of lung cancer and contribute to the pathological type and TNM stage of lung cancer, the combination detection of tumor markers is helpful for the early diagnosis of lung cancer.

Objective To investigate the spatial organization of neurons, blood vessel and astrocytes at different time of reperfusion after focal cerebral ischemia in rats. Methods 24 Sprague-Dawley rats were randomly divided into sham group (n=8), reperfusion 1 day group and reperfusion 2 weeks group. The latter 2 groups were occluded the middle cerebral arteries for an hour and reperfused. All the rats were injected with gelatin ink. The expressions of glial fibrillary acid protein (GFAP) and neuronal nuclear antigen (NeuN) in the brain were observed with immunohistochemistry. Results The vessels located mainly in cortex and nucleus. Most of astrocytes apophysis connected with vessels and neurons. Compared to the sham group, the expression of GFAP increased significantly in ischemic side, and the expression of NeuN decreased 1 day and 2 weeks after ischemia-reperfusion. The vessels decreased in the ischemic side 1 day after cerebral ischemia-reperfusion, and then increased 2 weeks later. Conclusion The organization of neurovascular unit after cerebral ischemia-reperfusion has been observed.

OBJECTIVEIn order to investigate the potential mechanisms in troglitazone-induced apoptosis in HT29 cells, the effects of PPARγ and POX-induced ROS were explored.

METHODS[3- (4, 5)-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide (MTT) assay, Annexin V and PI staining using FACS, plasmid transfection, ROS formation detected by DCFH staining, RNA interference, RT-PCR & RT-QPCR, and Western blotting analyses were employed to investigate the apoptotic effect of troglitazone and the potential role of PPARγ pathway and POX-induced ROS formation in HT29 cells.

RESULTSTroglitazone was found to inhibit the growth of HT29 cells by induction of apoptosis. During this process, mitochondria related pathways including ROS formation, POX expression and cytochrome c release increased, which were inhibited by pretreatment with GW9662, a specific antagonist of PPARγ. These results illustrated that POX upregulation and ROS formation in apoptosis induced by troglitazone was modulated in PPARγ-dependent pattern. Furthermore, the inhibition of ROS and apoptosis after POX siRNA used in troglitazone-treated HT29 cells indicated that POX be essential in the ROS formation and PPARγ-dependent apoptosis induced by troglitazone.

CONCLUSIONThe findings from this study showed that troglitazone-induced apoptosis was mediated by POX-induced ROS formation, at least partly, via PPARγ activation.

Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Chromans ; pharmacology ; Cytochromes c ; genetics ; metabolism ; Gene Expression Regulation, Neoplastic ; HT29 Cells ; Humans ; PPAR gamma ; metabolism ; Proline Oxidase ; metabolism ; Reactive Oxygen Species ; metabolism ; Thiazolidinediones ; pharmacology

Objective To study the Gadolinium-enhanced MRI and diffusion weighted imaging (DWI) characteristics of the chondroid matrix-forming sarcomas.Methods Contrast-enhanced MRI and DWI were performed in 14 eases of chondroid matrix-forming sarcomas (10 chondrosarcomas,4 chondroblastic esteosarcomas) and 13 cases of other types of osteosarcomas.DWI was obtained with a single-shot echo-planar imaging (EPI) sequence using a 1.5 T MR imager with two different b values of 0 and 700 s/mm2.The apparent diffusion coefficient (ADC) values were obtained in GE Functiontool software.The contrast-enhancement pattern was evaluated and the ADC values of ehondroid matrix-forming sarcomas was compared with that of other types of asteosarcoma.Independent sample t-test was performed to evaluate the difference of ADC values between the group of chondroid matrix-forming sarcoma and the group of other types of osteosarcoma.In addition, nonparametrie test was used to assess the difference of ADC values between the chondrosareoma and the chondroblastic osteosarcoma.P value less than 0.05 was considered to represent a statistical significance.Results For 14 eases of ehondroid matrix-forming sarcomas, peripheral enhancement was found in all cases, septonodular enhancement was identified in 12 cases.While 13 eases of other types of osteosarcowas demonstrated heterogeneous enhancement.The mean ADC value of chondroid matrix-forming sarcomas [(2.56 ±0.35) × 10 -3 mm2/s] was significantly higher than that of other types of osteosarcoma [( 1.16±0.20) × 10-3 mm2/s] (t = 12.704,P <0.O1 ).There was no significant difference in the ADC value between the chondrosarcoma and the chondroblastie osteesarcama(Z =0.507 ,P =0.959).Conclusion Contrast-enhanced MRI and DWI can improve differentiation between chondroid matrix-forming sarcomas and other types of osteosarcomas.

Objective To investigate the value of time-intensity curve of dynamic contrast enhancement MR imaging in the discrimination of benign and malignancy in musculoskeletal tumors. Methods Ninety patients were examined with fast acquisition with muhiphase enhanced fast GRE series. The TIC of lesions were obtained using slope images in which pixel intensity reflected the slope value. The curves were classified according to their shapes as type Ⅰ , washout enhancement; type Ⅱ, plateau enhancement; type Ⅲ, gradual enhancement. Taking pathological diagnosis as gold standard, the power of the maximal enhancement slope and curve types in discriminating benign and malignant lesions was evaluated by appropriate statistic analysis. Results There were 49 malignant and 44 benign lesions. The distribution of curve types for malignant tumors was type Ⅰ 75.5% ( 37/49), type Ⅱ 24. 5% (12/49). While the numbers for benign tumors was type Ⅰ 59. 1% ( 26/44 ), type Ⅱ 15.9% ( 7/44 ) and type Ⅲ 25.0% ( 11/44 ), respectively. The patterns of curve types in malignant lesions were different from benign lesions significantly ( χ2 = 14. 008, P < 0. 01 ). The slope value in benign lesion was 6. 80 + 3. 35 and that in malignant lesion was 6. 80±2. 71. The difference was not statistically significant( t = 0. 008, P > 0. 05 ). Type Ⅰ and type Ⅱ (excluding lesions with typical benign morphology ) were suggestive of malignant tumors. Type Ⅲ was indicator of a benign lesion. The diagnostic indices for the shape of TIC criterion were: sensitivity 100%, specificity 50%, positive predictive value 78%, negative predictive value 100% and accuracy 82%, respectively. Conclusion Combined with the characteristic of morphology, the TIC improves the power of MR imaging in discriminating benign from malignant musculoskeletal tumors.