Objective:To analyze the factors affecting delayed chemotherapy in children with Burkitt lymphoma (BL) and their influence on prognosis.Methods:Retrospective cohort study. Clinical data of 591 children aged ≤18 years with BL from May 2017 to December 2022 in China Net Childhood Lymphoma (CNCL) was collected. The patients were treated according to the protocol CNCL-BL-2017. According to the clinical characteristics, therapeutic regimen was divided into group A, group B and group C .Based on whether the total chemotherapy time was delayed, patients were divided into two groups: the delayed chemotherapy group and the non-delayed chemotherapy group. Based on the total delayed time of chemotherapy, patients in group C were divided into non-delayed chemotherapy group, 1-7 days delayed group and more than 7 days delayed group. Relationships between delayed chemotherapy and gender, age, tumor lysis syndrome before chemotherapy, bone marrow involvement, disease group (B/C group), serum lactate dehydrogenase (LDH) > 4 times than normal, grade Ⅲ-Ⅳ myelosuppression after chemotherapy, minimal residual disease in the interim assessment, and severe infection (including severe pneumonia, sepsis, meningitis, chickenpox, etc.) were analyzed. Logistic analysis was used to identify the relevant factors. Kaplan-Meier method was used to analyze the patients' survival information. Log-Rank was used for comparison between groups.Results:Among 591 patients, 504 were males and 87 were females, the follow-up time was 34.8 (18.6,50.1) months. The 3-year overall survival (OS) rate was (92.5±1.1)%,and the 3-year event-free survival (EFS) rate was (90.5±1.2)%. Seventy-three (12.4%) patients were in delayed chemotherapy group and 518 (87.6%) patients were in non-delayed chemotherapy group. The reasons for chemotherapy delay included 72 cases (98.6%) of severe infection, 65 cases (89.0%) of bone marrow suppression, 35 cases (47.9%) of organ dysfunction, 22 cases (30.1%) of tumor lysis syndrome,etc. There were 7 cases of chemotherapy delay in group B, which were seen in COPADM (vincristine+cyclophosphamide+prednisone+daunorubicin+methotrexate+intrathecal injection,4 cases) and CYM (methotrexate+cytarabine+intrathecal injection,3 cases) stages. There were 66 cases of chemotherapy delay in group C, which were common in COPADM (28 cases) and CYVE 1 (low dose cytarabine+high dose cytarabine+etoposide+methotrexate, 12 cases) stages. Multinomial Logistic regression analysis showed that the age over 10 years old ( OR=0.54,95% CI 0.30-0.93), tumor lysis syndrome before chemotherapy ( OR=0.48,95% CI 0.27-0.84) and grade Ⅲ-Ⅳ myelosuppression after chemotherapy ( OR=0.55,95% CI 0.33-0.91)were independent risk factors for chemotherapy delay.The 3-year OS rate and the 3-year EFS rate of children with Burkitt lymphoma in the delayed chemotherapy group were lower than those in the non-delayed chemotherapy group ((79.4±4.9)% vs. (94.2±1.1)%, (80.2±4.8)% vs. (92.0±1.2)%,both P<0.05). The 3-year OS rate of the group C with chemotherapy delay >7 days (42 cases) was lower than that of the group with chemotherapy delay of 1-7 days (22 cases) and the non-delay group (399 cases) ((76.7±6.9)% vs. (81.8±8.2)% vs. (92.7±1.3)%, P=0.002).The 3-year OS rate of the chemotherapy delay group (9 cases) in the COP (vincristine+cyclophosphamide+prednisone) phase was lower than that of the non-chemotherapy delay group (454 cases) ((66.7±15.7)% vs. (91.3±1.4)%, P=0.005). Similarly, the 3-year OS rate of the chemotherapy delay group (11 cases) in the COPADM1 phase was lower than that of the non-chemotherapy delay group (452 cases) ((63.6±14.5)% vs. (91.5±1.3)%, P=0.001). Conclusions:The delayed chemotherapy was related to the age over 10 years old, tumor lysis syndrome before chemotherapy and grade Ⅲ-Ⅳ myelosuppression after chemotherapy in pediatric BL. There is a significant relationship between delayed chemotherapy and prognosis of BL in children.

Aiming at the problems of missing important features, inconspicuous details and unclear textures in the fusion of multimodal medical images, this paper proposes a method of computed tomography (CT) image and magnetic resonance imaging (MRI) image fusion using generative adversarial network (GAN) and convolutional neural network (CNN) under image enhancement. The generator aimed at high-frequency feature images and used double discriminators to target the fusion images after inverse transform; Then high-frequency feature images were fused by trained GAN model, and low-frequency feature images were fused by CNN pre-training model based on transfer learning. Experimental results showed that, compared with the current advanced fusion algorithm, the proposed method had more abundant texture details and clearer contour edge information in subjective representation. In the evaluation of objective indicators, Q ^AB/F, information entropy (IE), spatial frequency (SF), structural similarity (SSIM), mutual information (MI) and visual information fidelity for fusion (VIFF) were 2.0%, 6.3%, 7.0%, 5.5%, 9.0% and 3.3% higher than the best test results, respectively. The fused image can be effectively applied to medical diagnosis to further improve the diagnostic efficiency.
Image Processing, Computer-Assisted/methods* ; Neural Networks, Computer ; Tomography, X-Ray Computed ; Magnetic Resonance Imaging/methods* ; Algorithms

ObjectiveTo study the effect of Buyang Huanwutang on Kelch-like Ech-related protein 1 （Keap1）/nuclear factor E₂-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） antioxidant signaling pathway in rats with idiopathic pulmonary fibrosis （IPF） and explore the mechanism of this prescription in the treatment of IPF. MethodForty SPF-grade male SD rats were assigned into a sham operation group， a model group， a Buyang Huanwutang group， and a nintedanib group according to random number table method， with 10 rats in each group. IPF rat model was established by intratracheal infusion of bleomycin （0.005 g·kg^-1） in other groups except the sham operation group. Buyang Huanwutang group was administrated with Buyang Huanwutang (14.84 g·kg^-1)，intragastric administration of nitedanib suspension (0.1 g·kg^-1)，sham operation group and model group were given equal volume of normal saline， for 28 days. After lung function test， serum and lung tissue samples were collected. Hematoxylin-eosin （HE） staining and Masson trichrome staining were employed to observe the pathological changes of the lung tissue. The content of hydroxyproline （HYP） in lung tissue was detected. The levels of malondialdehyde （MDA） in serum and lung tissue， and the activities of superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px） and catalase （CAT） were determined. The mRNA and protein levels of Keap1， Nrf2， and HO-1 was determined by Real-time fluorescent quantitative polymerase chain reaction， immunohistochemical staining， and Western blot. ResultCompared with the sham operation group， the modeling increased the resistance and elasticity and decreased the compliance of respiratory system （P<0.01）， elevated the lung index， pathological score， and HYP content in lung tissue （P<0.01）， and enriched MDA in serum and lung tissue， while it decreased the activities of SOD， GSH-Px， and CAT （P<0.01）. Furthermore， the modeling down-regulated the mRNA and protein levels of Keap1 and up-regulated those of Nrf2 and HO-1 in lung tissue （P<0.01）. Compared with the model group， Buyang Huanwutang decreased the resistance and elasticity and increased the compliance of respiratory system （P<0.01）， lowered the lung index， pathological score， and HYP content in lung tissue （P<0.01）， and reduced MDA in serum and lung tissue， while it increased the activities of SOD， GSH-Px， and CAT （P<0.01）. Additionally， Buyang Huanwutang down-regulated the expression of Keap1 and up-regulated that of Nrf2 and HO-1 in lung tissue （P<0.05， P<0.01）. ConclusionBuyang Huanwutang can activate Keap1/Nrf2/HO-1 signaling pathway to enhance the antioxidant capacity and slow down the pathological process of IPF in rats.

Objective:To evaluate the effect of continuous pump ropivacaine in rectus sheath in the postoperative analgesia after abdominoplasty.Methods:Patients with abdominoplasty who were admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from August 2020 to December 2021 were retrospectively analyzed. They were divided into 2 groups: the control group received patient-controlled intravenous analgesia (PCIA) after the operation, sufentanil 100 μg + normal saline diluted to 100 ml, the rate was 2 ml/h, lasted for 48 h, locking time 15 min, Bolus: 0.5 ml; the study group underwent postoperative rectus abdominis intrathecal intubation and continuously infused 0.262 5% ropivacaine saline mixture 100 ml, the rate was 2 ml/h, lasted for 48 h, the locking time is 15 min, Bolus: 0.5 ml. The method of catheter placement in the study group: a catheter was placed unilaterally in the anterior sheath of the rectus abdominis under direct vision, and an incision was made 2 cm below the umbilical plane. The other end is pierced from the umbilicus and connected to the analgesic pump. The visual analogue scale (VAS) for pain and the number of analgesic pump boluses at 24 h and 48 h after operation, the occurrence of postoperative adverse drug reactions and the patient satisfaction at 1 month after operation were collected. The normally distributed measurement data were expressed as Mean±SD, and the comparison between the two groups was analyzed by t-test; the count data was expressed by the frequency (percentage), and the Fisher’s test was used for analysis. Results:A total of 56 patients were included, including 9 males and 47 females, ranging in age from 27 to 53 years old, with ASA graded from 1 to 2, body mass index (BMI) ranged from 26 to 33 kg/m 2. Their rectus abdominis separation ranged from 3 to 7 cm. Compared with the control group, the pain VAS score of the study group at 48 hours after the operation was lower (3.9±1.5 vs. 5.2±1.4, P<0.05), and the number of analgesic boluses was reduced (2.9±0.3 vs. 3.9±0.4, P<0.05), the incidence of adverse reactions such as nausea, vomiting decreased( P<0.05). The satisfaction rate 1 month after operation in the study group was significantly higher than that in the control group [100.0% (30/30) vs. 42.3% (11/26), P<0.05]. Conclusions:Continuous infusion of ropivacaine through anterior rectus intrathecal cannula can effectively relieve abdominal pain after total abdominoplasty, reduce adverse reactions caused by postoperative analgesics, improve patient comfort during hospitalization, and improve overall surgical satisfaction.

Objective:To evaluate the effect of continuous pump ropivacaine in rectus sheath in the postoperative analgesia after abdominoplasty.Methods:Patients with abdominoplasty who were admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from August 2020 to December 2021 were retrospectively analyzed. They were divided into 2 groups: the control group received patient-controlled intravenous analgesia (PCIA) after the operation, sufentanil 100 μg + normal saline diluted to 100 ml, the rate was 2 ml/h, lasted for 48 h, locking time 15 min, Bolus: 0.5 ml; the study group underwent postoperative rectus abdominis intrathecal intubation and continuously infused 0.262 5% ropivacaine saline mixture 100 ml, the rate was 2 ml/h, lasted for 48 h, the locking time is 15 min, Bolus: 0.5 ml. The method of catheter placement in the study group: a catheter was placed unilaterally in the anterior sheath of the rectus abdominis under direct vision, and an incision was made 2 cm below the umbilical plane. The other end is pierced from the umbilicus and connected to the analgesic pump. The visual analogue scale (VAS) for pain and the number of analgesic pump boluses at 24 h and 48 h after operation, the occurrence of postoperative adverse drug reactions and the patient satisfaction at 1 month after operation were collected. The normally distributed measurement data were expressed as Mean±SD, and the comparison between the two groups was analyzed by t-test; the count data was expressed by the frequency (percentage), and the Fisher’s test was used for analysis. Results:A total of 56 patients were included, including 9 males and 47 females, ranging in age from 27 to 53 years old, with ASA graded from 1 to 2, body mass index (BMI) ranged from 26 to 33 kg/m 2. Their rectus abdominis separation ranged from 3 to 7 cm. Compared with the control group, the pain VAS score of the study group at 48 hours after the operation was lower (3.9±1.5 vs. 5.2±1.4, P<0.05), and the number of analgesic boluses was reduced (2.9±0.3 vs. 3.9±0.4, P<0.05), the incidence of adverse reactions such as nausea, vomiting decreased( P<0.05). The satisfaction rate 1 month after operation in the study group was significantly higher than that in the control group [100.0% (30/30) vs. 42.3% (11/26), P<0.05]. Conclusions:Continuous infusion of ropivacaine through anterior rectus intrathecal cannula can effectively relieve abdominal pain after total abdominoplasty, reduce adverse reactions caused by postoperative analgesics, improve patient comfort during hospitalization, and improve overall surgical satisfaction.

Objective:To evaluate the testing capacity of HIV-1 viral load testing laboratories, and to provide data references for further improving the accuracy of laboratory test result in China.Methods:The test result of 155 positive samples distributed by the National AIDS Reference Laboratory to each laboratory from 2005 to 2019 were summarized and grouped according to the test assay and sample number. The independent sample t-test was used to evaluate the economic status and the proficiency testing (PT) assessment period on the stability of the test results. And, one-way analysis of variance was used to evaluate the influence of the types of laboratories and reagents on the stability of test results.Results:The number of HIV-1 viral load testing laboratories increased from 13 in 2005 to 267 in 2019. The participating institutions were mainly centers for disease control and prevention(CDC)and hospitals. Since 2015, the excellent rate of laboratories has remained above 85%, and the unqualified rate has remained below 3%. The associated factor analysis showed that the laboratory testing stability of HIV-1 viral load associated with the PT assessment period and the types of testing reagents, and the laboratories participating in the PT assessment for more than 5 years showed better stability.Conclusions:Participating in the annual proficiency testing program helped improve the laboratory capability of HIV-1 viral load testing in China.

Objective: To investigate the rationale for appropriate diagnostic methods and treatment protocols for unexpected gallbladder carcinoma(UGC). Methods: The clinical and pathological data of 45 patients with UGC admitted at Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine,from January 2008 to December 2017 were retrospectively collected and analyzed.There were 11 males(28.9%) and 34 females(71.1%),aged 68 years(range:27 to 68 years).And there were 20 cases who aged above 70 years. Twenty-four cases were diagnosed preoperatively as cholecystolithiasis plus chronic cholecystitis.Ten cases were diagnosed preoperatively as cholecystolithiasis plus actue cholecystitis.Six cases were diagnosed preoperatively as cholecystolithiasis plus choledocholith.Six cases were admitted because of gallbladder polyp and 1 case was admitted because of gallbladder adenomyomatosis. Results: Thirty-four patients with UGC received radical surgery.Among them,11 patients experienced postoperative complication and no posterative mortality occoured during hospital stay.Thirteen patients were diagnosed with T1b UGC, the harvested lymph node of Nx, N0, N1 and N2 was 2, 9, 1 and 1, respectively.In addition, 2 cases were identified to have local-regional tumor recurrence during our rescue radical surgery.The median overall survival time of the patients who did not receive radical surgery was 7 months(range:2-56 months).Nevertheless,the median overall survival time for patients diagnosed with T1, T2 and T3 tumors who received radical surgery, was 41 months(range: 19-82 months), 33.5 months(range: 31-36 months) and 17 months(range: 7-46 months), respectively. Conclusions For patients with UGC, rescue radical surgery can achieve a better survival time.Furhtermore, our experience proved that rescue radical surgery for UGC is safe and feasible.Therefore,rescue radical surgery should be performed in patients with diagnose with UGC especially those T1b patients.

Objective: To evaluate the role of anatomical hepatectomy in the treatment of intrahepatic cholangiocarcinoma. Methods: The cases of intrahepatic cholangiocarcinoma who received curative surgery in two hospitals from 2010 to 2015 were analyzed retrospectively. Among the 98 patients enrolled in this study, 55 were male and 43 were female. The median age was 61 years. According to receiving anatomical hepatectomy or not, the 98 cases were divided into two groups: non-anatomical hepatectomy(n=30) and anatomical hepatectomy(n=68). The surgical results were compared between the two groups.Survival curves were plotted by the Kaplan-Meier method and compared by the log-rank test. The influence of each prognostic factor identified by univariate analysis was multivariate analysis by Cox′s proportional hazard regression. Results: The duration of surgery was significantly prolonged in the anatomical hepatectomy group((196.4±94.9)minutes vs. (166.2±65.7)minutes, P=0.027), while there was no significant difference in terms of other surgical results such as intraoperative blood transfusion, postoperative morbidity and mortality rate. Compared to non-anatomical hepatectomy, anatomical hepatectomy significantly improved long-term survival results(14 months vs. 11 months)(χ²=4.641, P=0.031). Single variable analysis indicated that tumor differentiation, tumor numbers, T stage, N stage, anatomical hepatectomy and adjuvant therapy significantly affected overall survival. Multivariate analysis demonstrated that tumor numbers(HR=0.522, 95% CI: 0.259-0.974, P=0.042) and anatomical hepatectomy(HR=1.858, 95%CI: 1.092-3.161, P=0.022) were two independent prognostic factors for overall survival. Conclusion Compared to non-anatomical hepatectomy, anatomical hepatectomy performed for intrahepatic cholangiocarcinoma is not only safe but also beneficial for long-term survival.

Small cell lung cancer (SCLC) accounts for approximately 20％ of lung carcinomas.Nearly 30％ of patients with lung cancer are diagnosed over the age of 70 years and about 10％ over 80 years.Chemotherapy is the cornerstone of treatment for SCLC.However,elderly patients tolerate chemotherapy poorly as compared to their younger counterparts because of age-related progressive reduction in organ functions and the presence of comorbidities.Therefore,the best approach towards the development of active and well-tolerated chemotherapy regimens for elderly patients with SCLC is to design clinical trials that are based specifically on geriatric assessments.This review focuses on the major issues related to the treatment of elderly patients with SCLC.

Objective:To investigate whether endogenous hydrogen sulfide (H2 S)was involved in the pathogenesis of osteoarthritis (OA)and its underlying mechanism,to detect H2 S and its synthases ex-pression in knee cartilage in patients diagnosed with different severity of OA,and to explore the transcrip-tion and expression of gene MMP-13 in chondrocytes treated with IL-1βor H2S.Methods:Synovial fluids of the in-patients with different severity of OA hospitalized in Peking University First Hospital were collected for measurement of H2 S content using methylene blue assay.Articular cartilages of the patients who underwent knee arthroplasty were collected for the cell culture of relatively normal chondrocytes.The chondrocytes were cultured to the P3 generation and H2 S molecular probes were used for detection of endogenous H2 S generation in the chondrocytes.Immunocytochemistry was used to detect the localization of H2 S synthases including cystathionine β-synthase (CBS),cystathionine-γ-lyase (CSE),and mercap-topyruvate sulfurtransferase (MPST)in OA chondrocytes.Western blot was used to quantify the protein expressions of CSE,MPST,and CBS in cartilage tissues of the patients who were diagnosed with OA and underwent knee arthroplasty.The relatively normal human chondrocytes were cultured to passage 3 and then divided into 4 groups for different treatments:(1 )the normal control group,no reagent was added;(2)the IL-1βgroup,5 μg/L of IL-1βwas added;(3)the IL-1β+H2S group,200 μmol/L of NaHS was added 30 min before adding 5 μg/L of IL-1β;(4)the H2 S group,200 μmol/L of NaHS was added. The transcription and expression of gene MMP-13 in chondrocytes of each group were determined with Real-time PCR and Western blot,respectively.And the total NF-κB p65 and phosphorylated NF-κB p65 in chondrocytes were detected with Western blot.Results:The content of H2 S in the synovial fluid of degenerative knee was (14.3 ±3.3)μmol/L.Expressions of endogenous H2 S and its synthases including CBS,CSE and MPST were present in the cytoplasm of chondrocytes.CSE protein expression in Grade 3 (defined by outerbridge grading)cartilage tissues was significantly increased as compared with that of Grade 1 cartilage tissues (1.67 ±0.09 vs.1.26 ±0.11,P<0.05).However,no significant difference of CBS or MPST expression among the different groups was observed.The expression of MMP-13 protein in the IL-1βgroup was significantly higher than that in the normal chondrocytes (1 .87 ±0.67 vs.0.22 ± 0.10,P<0.05 ),and that in the IL-1β+H2 S group was significantly decreased than that in the IL-1βgroup (0.55 ±0.11 vs.1.87 ±0.67,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.The transcription of MMP-13 protein in the IL-1βgroup was significantly higher than that in the normal chondrocytes (31.40 ±0.31 vs.1.00 ±0.00,P<0.05), and that in the IL-1β+H2 S group was significantly decreased than that in the IL-1βgroup (24.41 ± 1.28 vs.31.40 ±0.31,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.The total NF-κB p65 in the IL-1βgroup was significantly higher than that in the normal chondrocytes (2.13 ±0.08 vs.0.73 ±0.08,P<0.05),and that in the IL-1β+H2S group was significantly decreased than that in the IL-1βgroup (1 .24 ±0.13 vs.2.13 ±0.08,P<0.05 ),and that in the H2 S group had no significant difference compared with that in the normal control group.The phosphorylated NF-κB p65 in IL-1βgroup was significantly higher than that in the normal chondrocytes (1.30 ±0.13 vs.0.19 ±0.04,P<0.05),and that in IL-1β+H2S group was significantly decreased than that in the IL-1βgroup (0.92 ±0.26 vs.1.30 ±0.13,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.Conclusion:H2 S affected the cartilage degeneration by partly inhibiting the degradation of extracellular matrix.