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25 July 2021, Volume 48 Issue 04
    

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  • Indispensable or unimportant: discussion on the controversy of neoadjuvant chemotherapy for gastric cancer
    ZHU Xiao-dong, CHEN Si-yuan
    jms. 2021, 48(04): 427-434. https://doi.org/10.3969/j.issn.1672-8467.2021.04.001
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    Gastric cancer is one of the malignant tumors threatening human health.Due to the insidious onset and the lack of early screening,90% of gastric cancer patients are in locally advanced or advanced stages when diagnosed,and the overall 5-year survival rate is less than 30% in China.For the composition ratio of gastric cancer in our country cannot be changed immediately,whether the 5-year survival rate of total patients with gastric cancer can be significantly improved depends largely on how to improve the survival rate of patients with locally advanced gastric cancer,which accounts for nearly 70%.It seems to be a feasible strategy to achieve tumor downstaging through neoadjuvant chemotherapy to increase the rate of radical resection and ultimately improve survival of locally advanced gastric cancer.However,the benefit of neoadjuvant chemotherapy remains controversial due to the heterogeneity of clinical trials and gastric cancer itself.This review summarizes the key research progress,the advantages and disadvantages of neoadjuvant chemotherapy for gastric cancer,and discusses the role of neoadjuvant chemotherapy in the treatment of gastric cancer.
    • Papers
  • Deep learning model exploration of colposcopy image based on cervical epithelial and vascular features
    LI Yan-yun, WANG Yong-ming, ZHOU Qi, LI Yi-xue, WANG Zhen, WANG Jue, MENG Yan, CAI Qing-qing, SUI Long, HUA Ke-qin
    jms. 2021, 48(04): 435-442. https://doi.org/10.3969/j.issn.1672-8467.2021.04.002
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    Objective To explore the feasibility of object detection and deep learning model applied on the localization and classification of cervical precancerous lesions based on identifying the epithelial and vascular features in colposcopy images. Methods A total of 28 975 colposcopic images were collected from Mar 2018 to Jul 2019 in the Obstetrics and Gynecology Hospital of Fudan University,including cervical low-grade lesion(5 708 patients),high-grade lesion(2 206 patients)and cervical cancer(514 patients).According to the colposcopy standardized terminology of the International Federation for Cervical Pathology and Colposcopy and American Society for Colposcopy and Cervical Pathology,39 858 valid labels were obtained after pixel-level labeling based on 16 types of cervical epithelial and vascular signs.In order to reduce the error of fine-grained labeling,labels were further classified into three categories:low-grade,high-grade and cancer. Using ResNet101 pre-training network after secondary transfer learning as feature extractor,the models of high-grade lesion object detection and three categories (low-grade,high-grade and cancer) object detection based on Faster-RCNN network structure were constructed respectively. Results Based on the ResNet101 model of ImageNet pre-training,the first transfer learning was performed through the open source colposcopy data of cervical transformation zone classification,and the second transfer learning was carried out based on our own data of lesion classification to obtain the feature extractor. The average recognition accuracy mAP@IOU=0.5 obtained on the high-grade lesion model and the three categories model were 0.82 and 0.67,respectively. Conclusion Using the large sample data of the largest colposcopy center in China,the deep learning model can make a good performance in the detection of cervical precancerous lesions based on the fine labeling of epithelial and vascular features.Although there was still room for improvement on accuracy, these models were shown to be potential for cervical cancer screening, especially on guidance for location.
  • Expressions of Src kinases in normal developing brain and immature brains with hypoxic-ischemic white matter injury of rats
    QIU Han, QIAN Tian-yang, WU Tong, WANG Lai-shuan
    jms. 2021, 48(04): 443-450. https://doi.org/10.3969/j.issn.1672-8467.2021.04.003
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    Objective To investigate the expressions of phosphorylated Src kinase in normal developing brains and immature brains with hypoxic-ischemic white matter injury of rats. Methods Three-day-old Sprague-Dawley rat pups were subjected to right carotid artery ligation,followed by 2.5 h of hypoxia (6% oxygen). The neuropathological changes were observed by hematoxylin-eosin (HE)staining,Western blot and immunofluorescence. Brain tissues were collected from control and hypoxia-ischemia (HI) group rats at postnatal day 6,10 and 17. Expression of phosphorylated Src was evaluated by Western blot and immunofluorescence.The relationship of phosphorylated Src kinases and oligodendrocytes (OLs) was evaluated by triple immunofluorescence staining. Results In the control group,the expression of phosphorylated Src kinases peaked at 6 and 10 days after birth.Phosphorylated Src kinases was predominantly present in mature OLs, which was rarely observed in oligodendrocyte precursor cells.In the 3-day rat hypoxic-ischemic white matter injury model,phosphorylated Src kinases decreased significantly 3 days after injury (6 days after birth) (P=0.0007,n=6-7 for each group).At 7 days after injury (10 days after birth) and 14 days (17 days after birth) after injury,phosphorylated Src kinases returned to the level of control group,and there was no statistically significant difference between control group and HI group (n=3 for each group). Conclusion In normal developing brains of rats,the expression of phosphorylated Src kinases has a time rhythm and decreases after HI injury.
  • Correlation between cytokines and post-stroke complex regional pain syndrome: a retrospective study
    QIU Xiao, LIU Pei-le, HUA Yan, LU Rong-rong, BAI Yu-long
    jms. 2021, 48(04): 451-456,487. https://doi.org/10.3969/j.issn.1672-8467.2021.04.004
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    Objective To investigate the correlation between plasma cytokine and the presence of post-stroke complex regional pain syndrome (CRPS),and to investigate the application value of cytokine in the diagnosis of post-stroke CRPS. Methods The patients admitted to Department of Rehabilitation,Huashan Hospital North for first stroke from Jan 2017 to Dec 2020 were collected consecutively,and the patients with stroke course less than 6 months were included in the study. Patients were divided into CRPS group and non-CRPS group according to the occurrence of CRPS.A retrospective case-control study was conducted to analyze the changes of plasma cytokines including IL-1,IL-2R,IL-6,IL-8,IL-10 and TNF-α. Meanwhile,the correlation between abnormal cytokines and CRPS severity score (CSS) and NRS pain score was analyzed in CRPS group. Results In a total of 201 cases,31 cases were diagnosed with CRPS and 170 cases were not.There was no significant correlation between gender, nature of lesion and the occurrence of CRPS.CRPS was weakly correlated with age (correlation coefficient 0.253,P<0.05).The elevated rates of plasma IL-1β (22.6% vs. 8.2%),IL-8 (9.1% vs. 0.6%) and TNF-α (67.7% vs. 48.2%) in CRPS group were higher than those in non-CRPS group (all P<0.05).The levels of IL-2R,IL-6,IL-8 and TNF-α in CRPS group were higher than those in non-CRPS group without statistical difference.CSS was higher when TNF-α elevated (correlation coefficient 0.489, P<0.05). NRS was higher when IL-2R elevated (correlation coefficient 0.442,P<0.05). Conclusion The increase of plasma pro-inflammatory cytokines IL-1β,IL-8 and TNF-α may be correlated with the incidence of CRPS. The increase of TNF-α may be correlated with the severity of CRPS, and the increase of IL-2R may be correlated with NRS pain score.
  • Analysis of 22 cases of Behcet's disease associated with trisomy 8 and literature review
    MA Hai-fen, SHEN Yan, LUO Dan, CAI Jian-fei, ZOU Jun, GUAN Jian-long
    jms. 2021, 48(04): 457-462. https://doi.org/10.3969/j.issn.1672-8467.2021.04.005
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    Objective To investigate the clinical characteristics of trisomy 8 in the pathogenesis of Bechcet's disease (BD). Methods We analyzed 22 BD with trisomy 8 patients admitted to Huadong Hospital,Fudan University from Oct 2012 to Jul 2020,and retrieved 46 cases of BD combined with trisomy 8 from Chinese and English literature database,the clinical characteristics were compared and analyzed. Results Among 22 BD patients with trisomy 8,there were 5 males and 17 females, and the mean age of onset was (45.6±11.4) years.The clinical features included recurrent oral ulcers (100%),peripheral blood loss (100%),vulvar ulcers (86.4%),skin lesions (63.6%),positive acupuncture reaction (46.4%) and arthritis (27.3%).Myelodysplastic syndromes (MDS) were found in 5 patients (22.7%),intestinal ulcers in 15 patients (68.2%),and MRI of one patient (4.5%) showed abnormal signal foci in the left cerebellum (20 mm×15 mm),with slight edema around the foci,and possibly gliomas.No ocular, cardiac or vascular involvement was found in all patients. Compared with 46 patients from literature search, the rate of MDS was different (P<0.001),the other manifestations were consistent.Five patients showed MDS (22.7%),and the other 17 patients showed abnormal bone marrow cells in different degrees.Between MDS and no MDS patients,there was significant difference in hemoglobin (P<0.05),but no significant differences in age,sex,intestinal ulcer,white blood cell,platelet,ESR and CRP.Compared with BD without trisomy 8,women were more common in group of BD with trisomy 8 (P=0.040),less eye damage (P=0.033),more intestinal ulcers (P<0.001) and were more likely to complicated with MDS (P<0.001) in group of BD with trisomy 8.There were no significant differences in oral ulcers,vulvar ulcers,arthritis,skin lesions, nervous system lesions,vascular lesions and heart disease between patients with and withrout trisomy 8. Conclusion BD with trisomy 8 patients are more likely to suffer from peripheral blood cytopenia and intestinal ulcers.The pathogenesis of BD with trisomy 8 is unknown,which is different from typical BD and MDS in diagnosis, treatment and prognosis.
  • Contrast-enhanced ultrasound features of surgically confirmed liver focal nodular hyperplasia in correlation with lesion size
    ZHANG Wei-bin, WANG Wen-ping, DONG Yi, WANG Han-tao, XU Ya-dan, CAO Jia-ying
    jms. 2021, 48(04): 463-468. https://doi.org/10.3969/j.issn.1672-8467.2021.04.006
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    Objective To assess the typical contrast enhanced ultrasound (CEUS) enhancement characters of hepatic focal nodular hyperplasia (FNH),and to analyze the correlation with lesion size and fatty liver background. Methods We retrospectively assessed CEUS characteristics in 51 cases of FNH pathologically confirmed after surgical resection during Oct 2017 to Dec 2019,and analyzed the differences in 3 groups with different lesion sizes (<3 cm,3-5 cm,>5 cm) and 2 groups with different liver background (fatty liver,normal liver). Results All FNH lesions displayed a rapid hyper-enhancement in arterial phase of CEUS.During the arterial phase,41.2% (21/51) lesions showed gushing-spring enhancement;29.4% (15/51) showed spoke-like enhancement; 21.6% (11/51) showed dendritic enhancement;7.8% (4/51) showed whole enhancement. The detection rate of central scar was 31.4% (16/51).The appearance rate of feeding arteries was 74.5% (38/51). According to echogenicity shift of the lesions in various phases,96.1% (49/51) FNH showed "fast-in and slow-out" or "fast-in and synchronous-out", and only 3.9% (2/51) showed "fast-in and fast-out".In the above performances,the detection rate of gushing-spring enhancement increased to 71.4% (15/21) in lesions <3 cm,that of dendritic enhancement increased to 50% (5/10) in lesions >5 cm, and that of central scar increased to 60% (6/10) in lesions >5 cm.Significant difference was found in those performance in different size groups (Fisher's exact test, P<0.05). In addition,performance on CEUS showed no significant difference in different liver background groups (Fisher's exact test or χ2 test). Conclusion The characteristic signs of FNH at CEUS include gushing-spring sign,spoke-wheel sign,central scar and feeding artery. Gushing-spring sign is more valuable for diagnosing small size FNH (<3 cm),while central scar is useful for diagnosing larger FNH lesion (>5 cm).
  • Association between urinary cotinine level in preschool children and parental smoking behavior
    ZHU Hui-wei, XIAO Qian-yi, HE Jing-yi, Abu S. Abdullah, ZHENG Pin-pin
    jms. 2021, 48(04): 469-475. https://doi.org/10.3969/j.issn.1672-8467.2021.04.007
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    Objective To investigate the association between the urine cotinine level of preschool children exposed to secondhand smoke (SHS) and smoking behavior of smokers in family. Methods In Mar 2018,a total of 379 smoking families with children aged 2-5 years were recruited by cluster sampling in Hetou,Luoyang,Yongfeng and Tongyu districts in Taizhou City of Zhejiang Province,China.Face-to-face interviews were conducted with smokers to collect information on basic demographics and smoking behavior.Urine samples from children with the written informed consent from their guardians were collected.Liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was used to detect their urinary cotinine level. A multiple linear regression method was used to analyze the relationship between urinary cotinine level and smoking behaviors. Results The geometric mean of urinary cotinine concentration in children was 2.064 ng/mL (95%CI:1.895-2.241).In multivariate regression analysis,after adjusting for confounding factors,the potential predictors of children's urinary cotinine levels were smoking frequency in family (β=0.114,P=0.027) and the average number of cigarettes smoked daily in front of children (β=0.177,P=0.002).In addition, correlation analysis between smoking behaviors of smokers showed that smoking frequency, the average number of cigarettes smoked daily in household,and the average number of cigarettes smoked daily in front of children were positively correlated (P<0.05);The average number of cigarettes smoked daily in front of children was negatively correlated with ventilation during smoking in household (r=-0.166,P=0.001). Conclusion The level of children's urinary cotinine is positively correlated with parental smoking frequency and the average number of cigarettes smoked daily in front of children.However,whether the house is ventilated when smoking does not reduce children's SHS exposure.This study provides evidence for health education and health promotion for constructing smoke-free families in rural areas of China.
  • Application of renal tumor complexity assessment systems in preoperatively predicting WHO/ISUP nuclear grade of clear-cell renal cell carcinoma
    XU Pei-rong, HUANG Jia-qi, ZHANG Si-hong, XIANG Zhuo-yi, LI Yao-hui, HE Min-ke, ZHU Yan-jun, GUO Jian-ming, WANG Hang
    jms. 2021, 48(04): 476-480. https://doi.org/10.3969/j.issn.1672-8467.2021.04.008
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    Objective To assess the application of renal tumor complexity assessment systems in preoperatively predicting WHO/ISUP nuclear grade of clear-cell renal cell carcinoma (ccRCC). Methods Between Jan 2017 and Dec 2019,1 272 ccRCC patients diagnosed by postoperative pathology in Zhongshan Hospital,Fudan University,including 867 males and 405 females were analyzed retrospectively.The age ranged from 19 to 86 years,with an average of 58 years.The tumors in left and right kidney were observed in 614 and 658 cases,respectively.Renal tumor complexity was quantified using the RENAL score,PADUA score,and Zhongshan score.The histological nuclear grade was assessed by WHO/ISUP classification.WHO/ISUP grade Ⅰand Ⅱ were classified as low grade,and WHO/ISUP grade Ⅲ and Ⅳ were classified as high grade. Results All the 1 272 patients underwent surgery successfully,including 766 nephron-sparing surgery and 506 radical nephrectomy.Open surgery,traditional laparoscopic surgery and robot-assisted laparoscopic surgery were performed in 536,433 and 303 patients,respectively.According to WHO/ISUP classification,there were 62 patients in grade Ⅰ,963 patients in grade Ⅱ,219 patients in grade Ⅲ,and 28 patients in grade Ⅳ.In the RENAL score,the proportions of high WHO/ISUP grade in low,medium and high complexity tumor were 4.0% (11/273),16.3% (94/576) and 33.6%(142/423),respectively.In PADUA score,the proportions of high WHO/ISUP grade in low,medium and high complexity tumor were 2.6% (5/196),8.3%(21/254) and 26.9%(221/822),respectively.In Zhongshan score,the proportion of high WHO/ISUP grade in low,medium and high complexity tumor was 0.9% (1/109),6.4% (23/362)and 27.8% (223/801),respectively.In all the three score systems,the proportions of high WHO/ISUP nuclear grades in low,medium and high complexity tumor were significantly different (P<0.001).However,there was no difference among the three score systems (P=0.102).In addition,WHO/ISUP Ⅲ-Ⅳ accounted for more than 50% of tumors with RENAL score >10 and PADUA score >12.Tumors with Zhongshan score >14 were all WHO/ISUP Ⅲ-Ⅳ. Conclusion There is a positive correlation between tumor complexity of ccRCC and WHO/ISUP nuclear grade.The combined application of RENAL score,PADUA score and Zhongshan score can better preoperatively predict WHO/ISUP nuclear grade of ccRCC.
  • Study on the economic burden of multi-drug resistant tuberculosis patients in three cities in eastern China
    LI Zhi-peng, SHENG Yu-chao, ZHANG Yang, ZHOU Hui, ZHANG Hai-qing, MENG Xu, ZHAO Qi
    jms. 2021, 48(04): 481-487. https://doi.org/10.3969/j.issn.1672-8467.2021.04.009
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    Objective To understand the economic burden of multi-drug resistant tuberculosis (MDR-TB) patients in three cities in eastern China,and to find ways to reduce the financial burden on the patients. Methods The subjects of the study were MDR-TB patients registered and treated in designated hospitals in Xuzhou,Suqian of Jiangsu Province and Ganzhou of Jiangxi Province.Face-to-face investigation was conducted on the patients undergoing treatment,and telephone survey was conducted on the patients who have completed treatment by a self-designed questionnaire to collect demographic sociological information and economic burden of MDR-TB patients.χ2 test and linear regression were used to analyze the economic burden of MDR-TB patients. Results A total of 233 patients with MDR-TB were registered in the 3 cities,of which 82 patients received reduction of medical expenses from global fund projects.Therefore,151 patients with an average age of (43.36±16.18) years were successfully investigated finally.There were 124 male patients (82.1%).The total direct financial burden of MDR-TB patients was 28 987 yuan on average, with a median of 23 740 (14 100-37 580) yuan.The results of multivariate linear regression showed that the direct economic burden of the patients in Xuzhou was significantly higher than that in Suqian (P=0.001) and Ganzhou (P<0.001).The annual median family income of MDR-TB patients before treatment was 40 000 (20 000-60 000) yuan,and the median family income before treatment was 20 000 (0-36 000) yuan. The percentage of families with catastrophic health expenditure was 48.3%.The proportion of patients with catastrophic health expenditure in Xuzhou was significantly higher than that in the other two cities (P=0.003). Conclusion The economic burden of MDR-TB patients in the 3 cities in eastern China was heavy and varied greatly with different medical insurance policies and therapeutic regimens.The government should strengthen the coverage or reimbursement of medical insurance,and increase the subsidy of MDR-TB patients to reduce the economic burden on patients.
  • Job stress of employees in different states of workplace health promotion
    WEI Min-qi, WANG Jian, LIU Tao, WU Jia-jie, SHEN Jie, FU Hua
    jms. 2021, 48(04): 488-493,519. https://doi.org/10.3969/j.issn.1672-8467.2021.04.010
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    Objective To understand the job stress of employees in different states of workplace health promotion,in order to provide scientific evidence on workplace health promotion. Methods Our research objects were employees of enterprises and institutions in Minhang District of Shanghai.Through cluster random sampling,25 enterprises and institutions in Minhang District were selected.The minimum sample size of each enterprise in the survey was calculated based on the total number of employees in this enterprise,then the subjects were randomly selected according to the employees' job number in the enterprise.Based on informed consent and voluntary participation,a cross-sectional survey was conducted among the subjects.The general demographic characteristics and environment conditions of workplace of the subjects were collected,and their work stress was surveyed by a simple job stress questionnaire. The job stress of respondents in different states of workplace health promotion were compared. Results A total of 1 356 employees were surveyed.The detection rate of work stress was 43.44%.The average scores of job demand,job autonomy,social support and job satisfaction were 6.32±1.42,6.28±1.18,7.53±1.36 and 6.22±1.49,respectively.Compared with the employees of no-healthy units,employees' job demand,job autonomy,social support and job satisfaction scores in healthy units were relatively higher (P<0.001).There was no differences in the ratio of demand/control (D/C) and detection rate of job stress between the two groups (P>0.05).When there was a department of occupational health and safety management in work unit or a special person in charge of occupational health and safety management in the workplace,employees' job demand,job autonomy,social support and job satisfaction scores were higher (P<0.001),and the ratio of D/C and detection rate of job stress were relatively lower (P<0.05).The respondents who had paid attention to the unit's health promotion activities/trainings or who had participated in the occupational health and safety training organized by the unit had stronger tolerance to job demand,weaker perception and lower scores of job demand (P<0.001),while their perception of job autonomy and social support as well as job satisfaction were relatively stronger (P<0.001),both the ratio of D/C and the detection rate of job stress were relatively lower (P<0.05). Conclusion The job stress of employees in different states of workplace health promotion were not similar. In order to reduce the occupational stress level of employees, employers can improve the adaptability and control ability to work requirements of workers by taking the construction of healthy units as the starting point.
  • Prevalence and associated factors of cognitive impairment and physical frailty among community-dwelling older adults aged 75 years and above
    HAN Jun, WANG Jun-qiao, WANG Yue, XIE Bo-qin
    jms. 2021, 48(04): 494-502,544. https://doi.org/10.3969/j.issn.1672-8467.2021.04.011
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    Objective To examine the prevalence of physical frailty and cognitive impairment among community-dwelling older adults aged 75 and above;to examine the association between physical frailty and cognitive impairment;and to identify the factors associated with this two conditions. Methods A cross-sectional study was conducted.From Jul to Aug 2018,a three-stage sampling was adopted to select 2000 people aged 75 and above from 3 streets,40 neighborhood committees in Xuhui District,Shanghai as the research objects.Frailty Phenotype,Mini-mental State Examination,Mini Nutritional Assessment Short Form and Geriatric Depression Scale were used for questionnaire investigation. Results A total of 2000 questionnaires were sent out and 1915 were recovered with a recovery rate of 98.8%.Among them,288 questionnaires with incomplete data were excluded,and 1627 were valid,with an effective rate of 85.0%.About 55.7% and 25.5% of the elderly were suffering from pre-physical frailty and physical frailty respectively;the elderly with suspected dementia and mild cognitive impairment accounted for 3.6% and 40.3%,respectively.Pearson correlation analysis showed that there was a significant negative correlation between the scores of Frailty Phenotype and Mini-mental State Examination (r=-0.33,P<0.001) in the elderly aged 75 and above in the community.Ordered Logistic regression analysis showed that age (OR=2.40),medical burden (OR=1.29),type of chronic disease (OR:1.37-2.81),chronic pain (OR=1.45),nutritional status (OR:2.21-11.55),depression (OR:1.87-3.17) and cognitive function (OR=1.07) were the major factors affecting physical frailty (including pre physical frailty) in the elderly aged 75 and above in the community.Multiple Logistic regression analysis showed that Primary school and below (OR=9.44),out-of-marriage (OR=2.73),hearing impairment (OR=2.72),nutritional status (OR:6.05-6.63),depression (OR:14.40-15.10),and physical frailty (OR=1.72) were the factors affecting the suspected dementia in the elderly aged 75 and above in the community.Age (OR=1.76), educational level (OR:1.75-4.12),out-of-marriage (OR=1.62),living alone (OR=0.67),monthly income (OR=1.43),nutritional status (OR:2.31-3.73),depression (OR:1.44-1.81),and physical frailty (OR=1.16) were the factors affecting the mild cognitive impairment in the elderly aged 75 and above in the community;the Mini-mental State Examination score of the older robust or pre physical frailty was 1.07 times higher than those with physical frailty,and the Frailty Phenotype score of the older with suspected dementia and mild cognitive impairment was 1.72 times and 1.16 times higher than those with normal cognitive function. Conclusion In the community,55.7% of the elderly aged 75 years and above had physical frailty,and 40.3% had mild cognitive impairment.Old age,malnutrition or the risk of malnutrition, and depression were the common influencing factors of physical frailty and cognitive impairment, which were closely related and interrelated.
  • Value of ultrasound-guided biopsy in the diagnosis of extrapulmonary tuberculosis
    ZHANG Hui, MA Xin, LIU Jian-jian, HUANG Jing-jing, FENG Yan-ling, QIAN Xue-qin, SHI Xia, LU Qing, CAO Jia-ying
    jms. 2021, 48(04): 503-507. https://doi.org/10.3969/j.issn.1672-8467.2021.04.012
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    Objective To explore how to improve the diagnostic value of ultrasound-guided biopsy for extrapulmonary tuberculosis (EPTB). Methods A total of 152 patients with clinically suspected EPTB or unknown diagnosis underwent ultrasound-guided needle biopsy.The diagnostic efficacy of 4 methods including tissue section with special staining,gene X-Pert MTB/RIF detection,tuberculosis culture and smear was comprehensively analyzed. Results one hundred and eight cases were definitely diagnosed with tuberculosis,and finally 112 cases were diagnosed clinically.The positive rate (detection rate) of diagnosis in each group were as follows:70.4% (88/125) in pathological group with the suspicious diagnosis rate of 5.6% (7/125);71.2% (74/104) in gene X-Pert MTB/RIF group;43.7% (45/103) in culture group;46.4% (52/112) in smear group.There was no false positive case in this study. Conclusion Ultrasonal-guided biopsy is safe,convenient and effective in the diagnosis of EPTB.Combined with relevant laboratory tests,the diagnostic rate can be improved.The diagnostic efficacy of pathology and gene X-Pert MTB/RIF examination is significantly higher than that of culture and smear examinations.
  • Predictive factors of nonclassic radiation-induced liver disease after hypofractioned helical tomotherapy in hepatocelluar carcinoma
    WANG Bo-yan, ZENG Zhao-chong, ZHANG Jian-ying
    jms. 2021, 48(04): 508-513. https://doi.org/10.3969/j.issn.1672-8467.2021.04.013
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    Objective To analyze the relationship between the clinical and dosimetric parameters and radiation-induced liver disease (RILD) of hepatocellular carcinoma (HCC) patients who received hypofractioned helical tomotherapy (HT). Methods From Jun 2011 to Jun 2015,a total of 40 HCC patients who received hypofractioned HT in Zhongshan Hospital, Fudan University were enrolled. Clinical characteristics and dose-volume histogram (DVH) were collected.Liver functions were evaluated before and after radiotherapy.Binary Logistics and optimal cut-off value of receiver operating characteristic (ROC) curve were engaged to analyze the risk factor of RILD. Results Among the 40 HCC patients,38 (95.0%) were male and 2 (5.0%) were female,with a median age of 52 (22-86) years old.There were 8 (20.0%),8 (20.0%), 13 (32.5%) and 11 (27.5%) patients with clinical stage Ⅰ to Ⅳ respectively.All patients were Child-Pugh A.The median dose was 53.8 Gy (range from 28.6 Gy to 63.0 Gy). We observed that the mean dose to normal liver (MDTNL) was independent risk factor via multivariate binary Logistic analyses[OR=1.941,95%CI:1.023-3.679,P=0.042].The optimal cut-off value of ROC curve for MDTNL was 21.06 Gy;the sensitivity and specificity of the dichotomized MDTNL were 100% and 84.4%,respectively. Conclusion MDTNL may be an independent predicting factor for nonclassic RILD after hypofractioned HT in HCC patients. MDTNL <21.06 Gy may be used as reference for radiotherapy planning.
    • Method and Technique
  • Application of next-generation sequencing in the diagnosis of periprosthetic joint infection pathogens
    JIANG Hao-chen, SONG Chun-feng, ZHU Wen-run, PANG Zhi-ying, BAI Yang, CAO Lu, CHEN Ji-fei, GUO Chang-an
    jms. 2021, 48(04): 514-519. https://doi.org/10.3969/j.issn.1672-8467.2021.04.014
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    Objective To evaluate the capability of metagenomic next-generation sequencing (mNGS) in the pathogen diagnosis of periprosthetic joint infection (PJI) in order to provide clinical experience of choosing diagnostic methods. Methods From Jan 2017 to Dec 2019,patients with borderline symptoms were involved in this study.Intraoperative synovial fluid and periprosthetic tissues were both collected for microbial culture and mNGS.The pathogens were identified by symptoms,therapy and positive results. Results According to the criteria of Musculoskeletal Infection Society (MSIS),13 patients were diagnosed as PJI.The positive rate of mNGS was 84.62%,which was higher than that of culture method (76.92%).Staphylococcus aureus,Enterococcus faecium,Candida albicans and Mycoplasma hominis were the main detected pathogens of PJI.The detection time of mNGS was 48 h,which was significantly shorter than culture method (14 d). Conclusion With higher speed of detection in PJI,mNGS can provide vital etiological evidence for early accurate diagnosis of PJI.mNGS is an effective complement to microbial culture method, especially in culture-negative PJI.
    • Medical Experience Communications
  • A cross-sectional survey on information access through hospital's official account on new media and its association with antenatal care knowledge and health behaviors of pregnant women under COVID-19 epidemic
    LI Xing-ying, CHEN Wei-yi, JIN Long-mei, ZHANG Xiao-hua, YANG Feng-yun, SHEN Lian-di, ZHANG Xin-wen, LA Xue-na, ABUDUKELIMU Nazhakaiti, XIE Zhen-yu, ZHU Xiao-ling, WANG Li, JIANG Hong
    jms. 2021, 48(04): 520-526. https://doi.org/10.3969/j.issn.1672-8467.2021.04.015
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    Objective To explore the association between accessing antenatal care information through hospitals' official new media accounts and antenatal care knowledge and individual prevention behavior under COVID-19 epidemic,and to provide evidence for improving the emergency plan for maternity health care services in China under public health emergencies. Methods The online survey was conducted from Feb 5th to Mar 1st,2020,at the peak of the COVID-19 epidemic in China. Approaches of accessing antenatal care information,COVID-19 related antenatal care knowledge and individual prevention behavior was collected via cross-sectional design. Results A total of 1 936 valid questionnaires were obtained from 21 provinces,autonomous regions and municipalities.Under the COVID-19 epidemic,75.4% of the pregnant women reported they got institutional service and health education information from hospitals' official new media accounts such as WeChat and Weibo. Multivariate Logistic analysis showed that pregnant women who received information from official accounts of new media had higher scores of COVID-19 relevant antenatal care knowledge (aOR=1.36,95%CI:1.08-1.71,P<0.01)and individual prevention behaviors(aOR=1.46,95%CI:1.18-1.82,P<0.01) than those who obtained information from other sources. Conclusion The access to antenatal care knowledge via hospitals' official social media accounts was associated with better antenatal care knowledge and individual prevention behaviors among pregnant women. Under major public health emergency,it is suggested for health institutions to disseminate antenatal health care information via hospitals' official accounts in new media like Wechat and Weibo. Appropriate training should be developed to ensure the quality of health education and service provision in official new media accounts.
  • Construction and exploration of chronic disease management service model in Internet hospital for children's hospital
    SHI Yu, LIU Gong-bao, SHEN Guo-mei, XU Jie, CAO Di, ZHAI Xiao-wen
    jms. 2021, 48(04): 527-531. https://doi.org/10.3969/j.issn.1672-8467.2021.04.016
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    Objective This article aimed to explore the preliminary management experience of the chronic disease management service model of Internet hospital for children's hospital. Methods We analyzed the operating indicators of the Internet hospital in Children's Hospital,Fudan University in 2020,and illustrated the role of the Internet hospital in the management of chronic disease. Results The Internet hospital of our hospital has opened 22 clinical departments and registered 334 doctors,accounting for 71.2% of the total number of our doctors. A total of 39 782 patients were treated,including 37 722 free consultations,of which 17 861 were chronic diseases.Medical insurance patients accounted for 19%,and 52% were out-of-town patients.The patient satisfaction rate reached 96.4%. Conclusion We established an online and offline specialist chronic disease service model based on the Internet hospital,with offline specialists as the main body.It facilitates the follow-up of children with special diseases,increased the follow-up of patients with chronic diseases,and contributes to the management of chronic diseases in the specialties.
  • Occurrence of residual stones after choledocholithotomy and its impact factors
    YAN Zhe, LU Pin-xiang, SHEN Yu-gen, ZHANG Zheng-dong, JI Wen-bin
    jms. 2021, 48(04): 532-535. https://doi.org/10.3969/j.issn.1672-8467.2021.04.017
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    Objective To explore the occurrence of residual stones after common bile duct exploration and its impact factors. Methods Clinical data of 134 patients with choledocholithiasis and choledocholithotomy was collected in Central Hospital of Xuhui District from Oct 2016 to Dec 2019,and descriptive analysis and multiple regression analysis were used. Results The rate of postoperative residual stone was 29.9%.The residual rate of stones was 42.9% in the patients with more than 3 stones in the first operation,which was significantly higher than that in the patients with stones ≤ 3 (15.6%)(χ2=11.40, P<0.05).The number of common bile duct stones more than three was still related to the residual stones after T-tube drainage of common bile duct exploration (P=0.001),and the OR value increased from 4.050 to 4.503 after adjusting the operation method,intrahepatic bile duct stones and other factors. Conclusion The residual stones after common bile duct exploration might be related to more than 3 stones in the first operation. Choledochoscopy should be carefully strengthened in the exploration of the common bile duct,and the T tube should be effectively fixed. Primary suture of the common bile duct should be careful for patients with more than 3 stones during the operation.
  • Effect of nalbuphine on postoperative analgesia in patients undergoing laparoscopic radical cervical cancer surgery
    CHEN Jia-wei, ZHANG Le, HUANG Shao-qiang, JIAO Jing
    jms. 2021, 48(04): 536-540. https://doi.org/10.3969/j.issn.1672-8467.2021.04.018
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    Objective To observe the effect of nalbuphine on postoperative analgesia after laparoscopic radical cervical cancer surgery. Methods Sixty patients with ASA Ⅰ-Ⅱ underwent laparoscopic radical cervical cancer surgery in Obstetrics & Grnecology Hospital,Fudan University from Sep 2017 to Feb 2018 were randomly divided into group nalbuphine (N,n=29) and group sufentanil (S,n=27) by random number table.Nalbuphine and sufentanil were used for pain management during the perioperative period respectively.We measured visual analogue score (VAS) in motion and static state at postoperative 2,6,12,24 and 48 h,the number of patient-controlled analgesia (PCA),the number of nausea, vomiting and adverse reactions. Results VAS scores in both static and motion state at postoperative 2,6,12 h as well as VAS scores in motion state at postoperative 24 h in group N were significantly lower than those in group S (P<0.05).The number of PCA,nausea,vomiting and other adverse reactions in the two groups were not significantly different. Conclusion Compared with sufentanil, nalbuphine was associated with lower postoperative pain score after laparoscopic radical surgery for cervical cancer without increasing adverse reactions.
    • Reviews
  • Research progress on mechanisms of corneal pain
    XU Rui, LI Shuang-shuang, HAN Yuan, LI Wen-xian
    jms. 2021, 48(04): 541-544. https://doi.org/10.3969/j.issn.1672-8467.2021.04.019
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    Cornea is the most sensitive tissue with densest nerve terminal.The incidence of corneal pain is high and the causes of corneal pain are diverse.Corneal pain has a variety of symptoms and its mechanisms are complex.This article aims to summarize the work in anatomy,signal transduction,peripheral and central sensitization,vitro and vivo experimental modelin corneal pain,hoping to improve comprehension of its mechanism and find clues for effective the rapeutic regimen.
  • Research progress on ultrasound medicine in diagnosis and evaluation of chemotherapy effect of ovarian tumor
    CHENG Guang-wen, QI Jiu-ling, DING Hong
    jms. 2021, 48(04): 545-550. https://doi.org/10.3969/j.issn.1672-8467.2021.04.020
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    Ovarian cancer is the main cause of death of gynecological malignant tumors.The progress of ultrasound technology has improved the ability to identify more subtle features of adnexal masses and is the main examination tool for ovarian tumors. Due to the extensive development of neoadjuvant chemotherapy for advanced ovarian cancer,it is necessary to evaluate the therapeutic effect, adjust the treatment plan in time and improve the prognosis of patients. The combination of multiple modes of ultrasound can be real-time and dynamically observe the size,texture and blood supply of the tumor, which can be used to evaluate the curative effect of ovarian cancer after chemotherapy.This article reviewed the application value of multimodal ultrasound in the diagnosis and evaluation for chemotherapy efficacy of ovarian tumors.
  • Research progress on pathophysiological mechanism and clinical significance of the enlarged perivascular spaces
    LIANG Wen-cong, CHEN Yang-kun, XIAO Wei-min
    jms. 2021, 48(04): 551-557. https://doi.org/10.3969/j.issn.1672-8467.2021.04.021
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    Enlarged perivascular spaces (EPVS) referred to the enlargement of the diameter of the spaces filled with fluid around the small blood vessels in the brain;with the understanding of cerebral small vessel disease pathogenesis,now it is thought as a kind of early imaging sign of cerebral small vessel disease.But its pathophysiological mechanism is still unclear,which may be associated with vascular pulsation,respiratory movement,sleep-wake cycle,brain glymphatic dysfunction and aquaporin 4.An increasing number of evidences suggest that EPVS has an impact on cognitive impairment and depression.This article reviews the anatomic features,imaging evaluation,pathophysiological mechanisms of EPVS and its relationship between cognitive impairment and depression.
    • Short Report
  • Distinctive colony morphology categorized by emm genotypes of Streptococcus pyogenes
    OUYANG Lin, WANG Xiao-guang, SONG Chi-ping, CHEN Ming-liang, ZHANG Ying-hua
    jms. 2021, 48(04): 558-561. https://doi.org/10.3969/j.issn.1672-8467.2021.04.022
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    To categorize the specific colony morphology of Streptococcus pyogenes with different emm types,the colony characteristics of a total of 179 S. pyogenes strains isolated from children patients with scarlet fever from Jan 2019 to Dec 2019 were observed and described. And emm gene sequencing and typing were performed. The distinctive colony morphology was observed in 4 emm types (emm12,emm1,emm3 and emm4). The colonies of emm12 type and its subtypes isolates were smooth or rough in a diameter of 0.5 mm.Compared with emm12, emm1 type and its subtypes were all smooth and presented much bigger colonies than emm12,which were in a diameter of 1 mm as double as emm12. Quite different from others, emm3 type were mucoid with the largest diameter of 3-4 mm. The colonies of emm4 type was about 0.5 mm in diameter with smooth or rough surface, but their beta-hemolytic were slightly different from the colonies of other 3 types.The isolates of S. pyogenes with different emm genotypes owned their special colony morphology.The subtype colonies within the same genotype had the same characteristics. Specific colony morphology could be used for helping to early differentiate emm genotypes of S. pyogenes.
    • Case Reports
  • Comparison of intrauterine imaging and pathology in fetal congenital infantile fibrosarcoma: 2 cases report and literature review
    ZHOU Qing, CAI Shu-lei, TAO Xiang, ZHANG Guo-fu, ZHANG He
    jms. 2021, 48(04): 562-564,568. https://doi.org/10.3969/j.issn.1672-8467.2021.04.023
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    The incidence of congenital infantile fibrosarcoma (CIFS) is rare, and there are few reports of prenatal diagnosis.In this paper,MRI features of 2 cases of CIFS in uterus were analyzed retrospectively and were compared with pathological findings. In order to further increase the understanding of prenatal diagnosis of this disease,the potential biological behaviors and imaging characteristics of this disease were analyzed.
  • Tree-in-bud pattern on chest CT due to obstructive hypertrophic cardiomyopathy: a case report
    ZHANG Long-fu, SHEN Qin-jun, YE Ling, ZHU Lei
    jms. 2021, 48(04): 565-568. https://doi.org/10.3969/j.issn.1672-8467.2021.04.024
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    The patient had cough,chest tightness and shortness of breath for more than 2 months, and chest CT showed tree-in-bud pattern (TIB) and ground glass patchy shadows.Considering the possibility of small airway disorders caused by infection, anti-infection and symptomatic treatment were applied,but the patient's symptoms did not improve.After admission, amino-terminal pro-brain natriuretic peptide (NT-proBNP) was detected to be elevated.Combined with the pulmonary ground glass patchy shadows and the possibility of cardiogenic pulmonary edema,further improved cardiac ultrasound confirmed the diagnosis of obstructive hypertrophic cardiomyopathy.The pressure difference of left ventricular outflow tract was significantly increased.After treatment for improving cardiac function,the symptoms improved and the lung lesions were absorbed.This paper mainly introduces the etiology,formation mechanism and differential diagnosis of TIB,so as to improve the understanding of clinicians on TIB.
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