Objective To investigate the changes of brain networks function in patients with primary dysmenorrhea(PDM)during menstruation based on topological attributes of brain network.Methods Brain resting-state functional MRI of 57 PDM patients(PDM group)and 50 healthy women(health control[HC]group)were prospectively collected within the first or the second day of menstruation.Clinical scores were obtained and compared between groups.Results Visual analogue scale,cox menstrual symptom scale,self-rating anxiety scale and self-rating depression scale scores in PDM group were all higher than those in HC group(all P＜0.05).At the sparsity of 0.04-0.50,brain networks in both groups conformed to the small world attribute characteristics,and no significant difference of global attributes of brain network was found between groups(all P＞0.05).The node efficiency(Ne)and node degree(Dc)of bilateral posterior cingulate gyrus(PCG),as well as De and node betweenness(Bc)of left middle frontal gyrus(MFG)in PDM group were all higher than those in HC group,while Ne and De of left inferior temporal gyrus in PDM group were lower than those in HC group(all P＜0.01).Compared with HC group,the functional connections between left PCG and right calcarine fissure and surrounding cortex,right lingual gyrus and left MFG,as well as between right PCG and right dorsolateral superior frontal gyrus and left MFG,between right insula and left middle occipital gyrus enhanced in PDM group(all P＜0.001).Conclusion In PDM patients,local brain networks function such as default mode network,central executive network and salience network were over-activated during menstruation,yet the overall brain network still had good coordination and organization.

Objective:To evaluate the clinical application of online adaptive radiotherapy based on iterative cone-beam computed tomography (iCBCT) for the pelvic malignancies.Methods:This was a prospective clinical trial of iCBCT guided online adaptive radiotherapy for pelvic malignancies in Department of Radiation Oncology, Peking Union Medical College Hospital. Clinical data of 13 patients with pelvic malignancies who received online adaptive radiotherapy from August to November, 2022 were preliminarily analyzed (2 cases of cervical cancer, 4 postoperative cervical cancer, 3 postoperative endometrial cancer, 3 bladder cancer and 1 prostate cancer). The feasibility of online adaptive radiotherapy, adaptive radiotherapy time, the frequency and magnitude of edits for organs at risk and target volume, target volume coverage and organs at risk doses were analyzed. Statistical analysis was performed by SPSS software. Data conforming to normal distribution were described by Mean±SD, and data with non-normal distribution were expressed by M ( Q1, Q3). Data with homogeneous variances were analyzed by t-test, and data with non-normal distribution or heterogeneous variances were analyzed by nonparametric test. Results:The average adaptive time was 15 min and 38 s (from acceptance of acquired CBCT scan to completion of the final plan selection). 85.4% (830/972 fractions) of influencer structures (system-defined organs adjacent to and with high impact on the generation of clinical target volume and planning target volume, primarily bladder, rectum and small intestine in pelvic neoplasms) automatically generated by artificial intelligence required no edits or minor editors, and 89.8% (491/547 fractions) of clinical target volume automatically generated by artificial intelligence required no edits or minor editors. The adapted plan was adopted in 98.5% (319/324 fractions) of radiotherapy fractions. Compared with the scheduled plan, the adapted plan showed better target volume coverage and reduced the dose of organs at risk.Conclusions:iCBCT guided online adaptive radiotherapy for the pelvic malignancies can be achieved within clinically acceptable timeslots. In addtion, better dose coverage of target volume shows the advantages of online adaptive radiotherapy.

Objective:To explore the outcomes of T?nnis triple osteotomy for developmental dysplasia of the hip (DDH) in older children.Methods:Clinical data of 21 children (22 hips, 12 left and 10 right hips) treated by T?nnis triple osteotomy from October 2016 to June 2019 were retrospectively analyzed.There were 8 males and 13 females with a mean age of operation at 13.5 (8.6-16.8) years.Based on the T?nnis classification, all the cases were in Grade Ⅰ.Statistical analysis was performed using the SPSS 22.0 statistical software.Results:All recruited patients were followed up for 1.5-3.5 years.Compared with preoperative values and those at the last follow-up visit, the mean Sharp acetabular angle of the affected side recovered from 53.5°±5.2° to 40.8°±2.3°.The mean center-edge angle increased from 10.5°±2.9° to 35.4°±5.6°.The mean acetabular roof angle decreased from 38.6°±2.8° to 6.7°±1.3°.The mean acetabular head index enhanced from (54.3±5.2)% to (86.2±2.7)%.The differences between the preoperative and postoperative values were statistically significant ( t=24.3, 17.6, 50.1, 27.5; all P<0.05). According to the Harris classification, there were 17, 3 and 2 hips achieved excellent, good and fair outcomes at the last follow-up visit, respectively, with the percentage of excellent and good outcomes up to 90.9%(20/22 hips). Accor-ding to the Severin radiographic classification, 8, 12 and 2 hips were in grade Ⅰ, Ⅱ, and Ⅲ, respectively, with the percentage of excellent and good hips at 90.9%(20/22 hips). At the last follow-up visit, the bone healing of iliac and pubic bones was well, and the nonunion of ischial bones were reported in 3 cases (13.6%). Conclusion:The outcome of the T?nnis triple osteotomy is satisfactory for DDH in older children.

Objective:To assess the clinical effect of retrograde elastic stable intramedullary nailing(ESIN) in distal humerus metaphysis-diaphyseal junction fractures in children.Methods:A total of 14 cases of children with distal humerus metaphysis-diaphyseal junction fractures treated by retrograde ESIN in Children′s Hospital of Nanjing Medical University from January 2016 to December 2018 were retrospectively analyzed.There were 9 males and 5 females, aged 3.0-13.2 years old(median: 6.4 years old). Nine cases had fractures on the left side and 5 cases on the right side.Two prebent ESINs were inserted into the proximal humerus metaphysis through the humerus marrow cavity from medial and lateral sides of the distal humerus respectively after the closed/open reduction of fractures.After surgery, the shoulder abductor stent or long arm plaster was used for fixation post-operatively.X - ray examination was performed at regular post-operative follow-up.The stability of internal fixation was analyzed by measuring the Baumann angle and checking whether humeral anterior lines passed through capitulum humeri in lateral radiographs immediately after the surgery and at the last follow-up.Meanwhile, efficacy was evaluated according to Flynn functional evaluation criteria.Results:All the 14 patients in this group were followed up for 10-27 months after the operation, with an average of 18.4 months.The Baumann angle was within the normal range at both the end of the operation and the last follow-up, and no significant difference was observed.Lateral radiographs showed humeral anterior lines passed through the capitulum humeri.According to Flynn functional scores, there were 13 excellent cases and 1 good case.No wound infection, intramedullary nailing displacement, Volkmann contracture, cubital varus deformity, or iatrogenic nerve injury occurred in any of the children.Conclusion:Retrograde ESIN technique is a safe and reliable treatment for children with distal humerus metaphysis-diaphyseal junction fractures.

Objective To evaluate the long-term efficacy of neonatal immunoprophylaxis in children born from mothers infected with hepatitis B virus (HBV),and to clarify whether a booster vaccination is required.Methods Totally 252 children of HBV infected mothers,who were negative for hepatitis B surface antigen (HBsAg) tested in Nanjing Drum Tower Hospital in 2012,were enrolled to participate in this study from July to September,2017.Revaccination of hepatitis B vaccine was recorded and other relevant informations were collected.HBV serologic markers were detected in each child.Results Totally 198 children (78.6％) were followed up.They were (8.4 ± 2.2) years old and 112 cases were boys.All 198 children were negative for both HBsAg and hepatitis B core antibody (anti-HBc).The overall positive rate of hepatitis B surface antibody (anti-HBs) (≥ 10 IU/L) was 65.7％.During period of 2012 to 2017,53 children were boosted with hepatitis B vaccine.Their median anti-HBs titer in 2017 was higher than that in 2012 (327.95 IU/L vs.158.01 IU/L),and the difference was significant (Z =-4.480,P ＜0.05).The other 145 children were not revaccinated,their median anti-HBs titer was decreased from 214.19 IU/L in 2012 to 70.49 IU/L in 2017,and the difference was significant (Z =-6.575,P ＜ 0.05).Of 145 children who were not revaccinated,25 cases had anti-HBs levels ＜ 10 IU/L and 120 cases ≥ 10 IU/L in 2012,and the other 47 cases also showed the antibody ＜ 10 IU/L in 2017,but none of them was infected with HBV.Conclusions Neonatal immunoprophylaxis in infants from HBV-infected can provide long-term protection against hepatitis B.The children with anti-HBs ＜ 10 IU/L are still immune to HBV and booster vaccination for them seems unnecessary.

Objective: To investigate the association between aflatoxin exposure and primary hepatocellular carcinoma (PHC) development. Methods: From December 2013 to May 2016, we selected 214 patients newly diagnosed with PHC as cases, and 214 patients as controls from three hospitals in Chongqing. Cases were confirmed with PHC diagnosis standard. And cases caused by clear reasons such as drug-induced liver injury, alcoholic liver damage, fatty liver and gallstones etiology, were excluded. Controls were included with no cancer and no digestive system disease, and recruited simultaneously with cases. Cases and controls were frequency-matched (1∶1) by same gender and age (±3 years). Peripheral blood and random urine samples were collected and analyzed for serum HBsAg status by biochemistry analyzer, and serum AFB₁-ALB adduct and urinary AFB₁-N⁷-GUA adduct by ELISA. Basic information, living habits and history of disease for patients were obtained by questionnaires. We used wilcoxon rank sum test to compare the median of serum AFB₁-ALB adduct and urinary AFB₁-N⁷-GUA adduct in cases and controls. Logistic regression analyses were performed to assess risk factors for PHC, and synergism index (S) of aflatoxin with other factors was estimated by the method of Andersson. Results: There was no significant difference in age between PHC cases (50.74±9.67) years and controls (51.15±9.90) years. Logistic regression showed that the odds ratio of HBV infection for PHC development was 46.3 (95% CI: 23.3-88.0). There was a significant difference in median concentrations of serum AFB₁-ALB adduct (cases vs controls: 146.23 vs 74.42 ng/g albumin, P<0.001), but no difference in median concentrations of urinary AFB₁-N⁷-GUA adduct was observed (cases vs controls: 0.17 vs 0.14 ng/mg creatinine, P<0.210). The odd ratios for PHC risk after adjustment were 1.9 (95%CI: 1.1-3.4) for AFB₁-ALB adduct, and 2.1 (95%CI: 1.0-4.2) for AFB₁-N⁷-GUA adduct. Moreover, we observed a positive interaction of aflatoxin exposure with HBV, alcohol drinking, and diabetes. The S was 4.7 (95%CI: 2.8-7.9), 3.5 (95%CI: 1.0-12.0), and 12.4 (95%CI: 1.8-84.2), respectively for serum AFB₁-ALB adduct with each of the three factors mentioned, and was 1.9 (95%CI:1.1-3.1), 2.0 (95%CI: 1.1-3.6), and 2.0 (95%CI: 1.1-3.6), respectively for urinary AFB₁-N⁷-GUA adduct with each of the three factors mentioned. Conclusion HBV was still the main risk factor, and AFB₁ exposure was also an independent risk factor for PHC in Chongqing. There was a positive interaction of aflatoxin with HBV, alcohol drinking, and diabetes.

Objective To investigate the safety of trial of labor after cesarean (TOLAC) and clinical factors associated with successful TOLAC and to compare TOLAC with elective repeat caesarean section (ERCS) in terms of obstetric and neonatal outcomes.Methods A prospective cohort study was conducted among gravidas who had a history of lower segment cesarean section and were hospitalized in the Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January to December 2014.Exclusion criteria included indications for caesarean section (such as placenta previa,placenta accreta,twin pregnancy,breech presentation and severe preeclampsia),serious maternal complications after cesarean section,lower uterine segment thinner than 3 mm and poor healing of uterine incision.Totally,287 gravidas were enrolled.Among them,142 chose TOLAC and the other 145 requested ERCS.Clinical data of those gravidas were collected and statistically analyzed by t-test,Log-rank test,Chi-square or Fisher's exact test.Results (1) The success rate of TOLAC was 90.8％ (129/142).There was no significant difference in maternal age,gestational age,thickness of lower uterine segment,interval between the two deliveries and neonatal birth weight and asphyxia rate between the successful (n=129) and unsuccessful (n=13) groups (all P＞0.05).Although the two groups had no significant difference in postpartum hemorrhage (PPH) rate,the gravidas who failed in TOLAC lost more blood than those who succeeded [425 (195-675) vs 200 (50-1 400) ml,P＜0.05].Moreover,higher amniotic fluid contamination rate was observed in the unsuccessful group [6/13 vs 17.1％ (22/129),P＜0.05].In the TOLAC group,99.3％ (141/142) were under continuous fetal heart rate monitoring.Incomplete uterine rupture occurred in one women without serious maternal or neonatal outcomes.The reasons for 13 failed TOLAC cases were unbearable pain during labor,abnormal labor,fetal distress and threatened rupture of uterus.(2) Compared with the ERCS group,the TOLAC group showed shorter interval from last cesarean section to the indexed delivery[5 (2-18) vs 6 (2-19) years],younger maternal age [(31±4) vs (33 ±4) years old] and less blood loss [200 (50-1 400) vs 300 (100-1 500) ml] (all P＜0.05).Conclusion Our study shows that,those who preferred TOLAC were younger,or had shorter pregnancy interval from last cesarean section.The success rate of TOLAC is high for women undergoing systematic prenatal assessment and close management during labor with less blood loss and non-serious maternal and neonatal complications compared with ERCS.

Objective we assessed our institutional outcomes of hybrid treatment for aortic arch disease with supra-aortic debranching and endovascular stent graft repair.Methods From March 2016 to November 2016,6 patients underwent Hybrid total aortic arch repair:1 had aortic arch pseudoaneurysm;1 had type Ⅲ aortic dissection;4 had aortic arch aneurysm because of hypotension,of whom 1 with aneurysm prerupture and 1 with Aortic intramural hematoma.Supra-aortic vessels were involved and high-risk for traditional operations in all patients.Bifurcated artificial vessels were used,main vessel was end-to-side anastomosed with ascending aorta.Branching vessel were end-to-end anastomosed with right innominate artery and left subclavian artery,end-to-side anastomosed with left common carotid artery.Then,stent graft was implanted into ascending aorta and aortic arch.All patients were followed postoperatively,with regularly contrast computed tomography angiogram (CTA) and echocardiography(discharge,three months,six months,and yearly).Results Hybrid procedure with supra-aortic debranching and endovascular stent graft repair were completed in all patients,technical success rate was 100％.There were no perioperative obvious morbidity and mortality,follow-up period were 2-9 months.1 patients had stroke during follow-up period,condition improved after treatment.Supra-aortic vessels were patency and there were no endoleak in all patients.There were no recurrent aortic disease during follow-up period.Conclusion Hybrid aortic arch replacement can be performed with good postoperative and early results in high-risk patients for traditional open repair.

Objective To evaluate the effect of domestic wire-reinforced epidural catheter on the occurrence of adverse events during epidural block.Methods Three hundred ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 41-78 kg,scheduled for elective operations under combined spinal-epidural anesthesia,were randomly divided into 3 groups (n =100 each):polyvinyl chloride epidural catheter group (group A),imported wire-reinforced epidural catheter group (group B) and domestic wire-reinforced epidural catheter group (group C).Combined spinal-epidural anesthesia was performed routinely.The corresponding epidural catheter was inserted in each group.The catheterization without difficulty,paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,intravascular catheter insertion,injection obstruction,easiness during removal of the catheter,bleeding after removal,postoperative paresthesia and epidural hematoma within 1 week after operation were recorded.Results Compared with A group,the incidences of paresthesia during catheterization,the number of patients in whom blood or cerebrospinal fluid was withdrawn from the epidural catheter,injection obstruction and postoperative paresthesia were significantly decreased (P ＜ 0.05),and no significant change was found in the other parameters in B and C groups (P ＞ 0.05).There was no significant difference in all the parameters between B group and C group (P ＞ 0.05).Conclusion Domestic wire-reinforced epidural catheter can decrease the occurrence of catheterization-induced damage to the nerve and blood vessels and the efficacy is comparable with that of imported wire-reinforced epidural catheter.

Objective To compare the effectiveness and safety of Foley catheter(FC)and vaginal prostaglandin E2 suppository(PGE2,Propess)for cervical ripening and labor induction in fullterm pregnant women with unfavorable cervix.Methods A prospective randomized controlled trial was conducted.Women with a term or post-term,live,singleton fetus in cephalic presentation,intact membranes,Bishop score＜6,not in labor,medically indicated for labor induction from June 2009 to December 2009 in Drum Tower Hospital of Nanjing University Medical School were randomly divided into two groups:FC group(n=64)and Propess group(n=62).In FC group,a 16-F Foley catheter was inserted into patient's cervical canal; once past the internal os,the balloon was inflated with 80 ml saline.Intravenous oxytocin was initiated after the balloon was spontaneously extruded from the cervix or after 24 hours.In Propess group,vaginal Propess was used.x2 or Fisher's exact test and t test were used to compare the outcomes,delivery mode and induction success rate between the two groups.Results There were no significant differences in gestational weeks,Bishop score,indication of induction,improvement of Bishop score,success rate of induction,rate of vaginal delivery,total duration of labor and volume of postpartum hemorrhage between the two groups(P ＞ 0.05,respectively).Propess group had a higher rate of vaginal birth within 24 hours[56.5％(35/62)vs 28.1％(18/64),t=10.37,P＜0.05],a higher risk for excessively frequent and hard uterine contraction[17.7％(11/62)vs 0.0％(0/64),P＜0.05]and lower incidence of oxytocin induction/augmentation during labor[21.0％(13/62)vs 87.5％(56/64),x2 =56.27,P＜0.05]than those of FC group.There were no differences in neonatal Apgar score,meconium staining and neonatal birth weight between the two groups.Puerperal infection occured in neither group.Conclusions Under strict control of indication and aseptic manipulation,Foley catheter was as effective and safe as Propess for cervical ripening with lower risk of excessive uterine activity.It is suggested that Foley catheter could be used for cervical ripening,especially in patients with economic difficulty.