Zhonghua yi xue za zhi最新文献

This study aimed to investigate the efficacy of inverted door flap (IDF) combined with transcanal approach to the tympanic antrum (TCAA) technique under the endoscope for treatment of middle ear cholesteatoma. Outcomes of patients treated with combined techniques at the First People's Hospital of Foshan City between March 2021 and March 2023 were evaluated. A total of 31 patients (33 ears, 16 males and 15 females) aged (42.9±15.9) years were included. The patients were divided into three groups based on the extent of cholesteatoma involvement: the lateral ossicular chain (LOC) group (8 ears), the internal ossicular chain (IOC) group (11 ears), and the mastoid antrum and mastoid process (MA/MP) group (14 ears). No complications occurred postoperatively, such as cholesteatoma recurrence, facial paralysis and infection. The median (Q₁, Q₃) follow-up duration was 12 (7, 18) months. The results showed a median (Q₁, Q₃) dry ear duration of 1.5 (1.5, 2.0) months, and a dry ear rate of 97.0% (32/33) at six months postoperatively. Specifically, 7 out of 8 patients in the LOC group had dry ears, while all patients in the IOC group and the MA/MP group had dry ears 6 months after surgery. The current study demonstrates that IDF combined with TCAA techniques are safe and effective in the treatment of middle ear cholesteatoma, with rapid achievement of dry ear.

Objective: To establish and validate a nomogram based on clinical characteristics and metabolic parameters derived from ¹⁸F-fluorodeoxyglucose positron emission tomography and computed tomography (¹⁸F-FDG PET/CT) for prediction of high-grade patterns (HGP) in invasive lung adenocarcinoma. Methods: The clinical and PET/CT image data of 311 patients who were confirmed invasive lung adenocarcinoma and underwent pre-treatment ¹⁸F-FDG PET/CT scan in Beijing Hospital between October 2017 and March 2022 were retrospectively collected. The enrolled patients were divided into HGP group (196 patients) and non-HGP group (115 patients) according to the presence and absence of HGP. The data were divided into training set and validation set at 7∶3 ratio using R statistical software and simple random allocation. A nomogram prediction model was constructed in training set. The area under the curve (AUC) of receiver operating characteristic (ROC) was depicted in the training and validation set respectively for assessing the prediction efficacy. The goodness of fit, consistency between predicted and observed probability and clinical usefulness of the model were evaluated by Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA). Results: The age of 311 patients were (65.6±10.9) years and included 148 males (47.6%). In training set of 217 patients, 141 (65.0%) contained HGP while in validation set of 94 patients, 55 (58.5%) contained HGP. Gender in training set, serum carcino-embryonic antigen (CEA) in validation set, smoking history, clinical stage, cytokeratin fragments (CYFRA21-1), maximum standardized uptake value (SUV_max), mean standardized uptake value (SUV_mean), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and maximum diameter (D_max) in both sets showed significant differences between HGP and non-HGP groups (all P<0.05). The variables integrated in the model were gender, clinical stage, CYFRA21-1, SUV_mean and TLG. The AUC (95%CI) of the ROC curve in training and validation set were 0.888 (0.844-0.932) and 0.925 (0.872-0.977), the sensitivity and specificity were 85.1%, 79.0% and 83.6%, 89.7%, respectively. The model showed good goodness of fit (training set: χ²=8.247, P=0.410, validation set: χ²=1.636, P=0.990). Calibration curve and DCA also indicated good consistency and clinical net benefit of the nomogram model. Conclusion: The nomogram model based on clinical features and metabolic parameters derived from ¹⁸F-FDG PET/CT could effectively predict the presence of HGP in invasive lung adenocarcinoma and be beneficial to treatment planning.

T-cell immune response is an important component of antiviral immunity, it is of great significance to determine their absolute counts, relative frequencies and functionalities for evaluating protective immunity in individuals and population. However, there is a lack of guidelines or a consensus on assays for antigen-specific T cells. It is necessary to evaluate the SARS-CoV-2-specific T cells in population during and after COVID-19 epidemic. To standardize the detection method for SARS-CoV-2-specific T cells, the Chinese Society for Immunology organized experts and reached a consensus on the detection method, biomarker combination scheme, technical points of SOP, quality control, data analysis and interpretation of results, personnel training, etc. The consensus is of guiding significance to establish standard detection methods and operating procedures for SARS-CoV-2-specific T cells, which is beneficial for the consistency and comparability of results from different laboratories, and also provides reference for antigen-specific T cell standard detection methods for other pathogens (such as influenza) infection.

Objective: To compare the diagnostic value of fluorine 18-labelled prostate-specific membrane antigen (PSMA) PET/CT PRIMARY score and PSMA expression score for clinically significant prostate cancer (csPCa). Methods: The data of 70 patients with prostate cancer who underwent radical prostatectomy at Beijing Hospital from February 1, 2019 to February 29, 2024 were retrospectively analyzed. All patients underwent whole body ¹⁸F-PSMA PET/CT examination before surgery and pathological large sections of prostate specimens were made after surgery. According to the pathological section results, the lesions were divided into csPCa group (Gleason scores≥7) and non-csPCa group (Gleason scores=6 or benign). The PRIMARY score and PSMA expression score were used to evaluate prostatic lesions on PSMA PET/CT images, respectively. The differences in PRIMARY score, PSMA expression score, maximum standardized uptake value (SUV_max), lesion-to-background ratios (LBR), PSMA uptake characteristics, and location distribution were compared between csPCa group and non-csPCa group. Multivariate logistic regression analysis was performed to determine the correlation factors for the incidence of csPCa. By plotting the receiver operator characteristic (ROC) curve and calculating the area under the curve (AUC), the optimal diagnostic threshold for csPCa of each factor was determined. The differences in AUC were compared using the Delong test. Quantitative data was represented as M (Q₁, Q₃). Results: The 70 patients aged 70 (64, 75) years with a total of 108 lesions, including 83 lesions (76.9%) in the csPCa group and 25 lesions (23.1%) in the non-csPCa group. There were differences between csPCa group and non-csPCa group in PRIMARY score [4 (3, 5) vs 2 (1, 4)], PSMA expression score [2 (2, 2) vs 1 (1, 2)], SUV_max [9.10 (5.70, 15.80) vs 5.40 (3.35, 6.90)], LBR [2.86 (2.09, 4.53) vs 1.96 (1.42, 2.58)], and proportion of focal uptake patterns [74.7% (62/83) vs 32.0% (8/25)] (all P<0.05). There was no statistically significant difference in the location distribution between the two groups (P>0.05). Multivariate logistic regression analysis indicated the higher the PRIMARY score, the higher the risk of developing csPCa (OR=1.863, 95%CI: 1.360-2.552). ROC curves revealed that the AUCs of the PRIMARY score and PSMA expression score for csPCa were 0.751 (95%CI: 0.659-0.829) and 0.697 (95%CI: 0.601-0.781), respectively, without statistically difference (Z=1.438, P>0.05). The cut-off values for diagnosing csPCa were 3 score for PRIMARY score and 2 score for PSMA expression score, respectively. Conclusions: The higher the ¹⁸F-PSMA PET/CT PRIMARY score, the higher the risk of developing csPCa. The PRIMARY score has good diagnostic efficacy for csPCa.

Objective: To simplify the Chinese version of the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ), develop the simplified Chinese version of VIMSSQ, and evaluate its performance. Methods: A cross-sectional study was conducted between May and July 2023. The Chinese version of the VIMSSQ was distributed to 783 university students at North China University of Science and Technology. Items were selected on the basis of their coverage rates, item-total correlation coefficients, Cronbach's alpha coefficients, and factor loadings, resulting in the simplified Chinese VIMSSQ. Eighty participants from the initial cohort were recruited to complete a virtual reality (VR) black-and-white checkerboard visual stimulation test, the simplified Chinese VIMSSQ, and the Simulator Sickness Questionnaire (SSQ). The internal consistency, test-retest reliability, criterion validity, and discriminative ability of the simplified Chinese VIMSSQ were evaluated. Results: A total of 757 valid questionnaires were collected, with an effective response rate of 96.68% (757/783). Among the 757 participants, 205 were male and 552 were female, with a median age (Q₁, Q₃) of 19 (18, 20) years. Smartphone usage showed the highest coverage rate [99.60% (754/757)]. The simplified Chinese VIMSSQ included three items, with the Cronbach's alpha coefficient of 0.909, the test-retest reliability of 0.908, and the criterion validity of 0.899. SSQ symptom scores were lower in mildly susceptible participants compared to moderately susceptible participants [30 (15, 63) vs 77 (53, 105), P=0.012], and significantly lower in moderately susceptible participants compared to severely susceptible participants [77 (53, 105) vs 137 (94, 164), P<0.001]. Conclusion: The simplified Chinese VIMSSQ demonstrates good reliability, validity, and discriminative ability.

Objective: To investigate the impact of SMARCA4 mutations on the outcomes of patients with advanced lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutations. Methods: In the Memorial Sloan Kettering Cancer Center (MSK) MetTropism study, 960 patients with advanced EGFR-mutated lung adenocarcinoma were screened and included in the MSK cohort, composing of 313 males and 647 females, with a median [M(Q₁, Q₃)] age of 64 (56, 72) years. A retrospective analysis was conducted on the data of 178 patients with advanced EGFR-mutated lung adenocarcinoma who received EGFR tyrosine kinase inhibitors (TKIs) treatment in the Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, from January 2018 to December 2022. Among these patients, 69 were males and 109 were females, with a median age of 63 (54, 69) years. The follow-up of patients from the First Affiliated Hospital of Nanjing Medical University was conducted up to December 31, 2023, with a median follow-up time of 26.6 (95%CI: 24.6-28.6) months for the entire cohort, and 29 patients were lost to follow-up. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare the relationship between SMARCA4 gene alternations and prognosis. Results: In the 960 patients of the MSK cohort with advanced EGFR-mutated lung adenocarcinoma, the SMARCA4 gene alternations rate was 4.2% (40/960). The median overall survival (OS) for patients without SMARCA4 gene alternations was 41.5 (95%CI: 35.6-47.3) months, which was superior to that of patients with SMARCA4 gene alternations [15.6 (95%CI: 7.9-23.4) months, P<0.001]. Patients with SMARCA4 gene alternations had a higher risk of mortality, with an HR (95%CI) of 1.97 (1.35 to 2.88). Among the 178 patients with advanced EGFR-mutated lung adenocarcinoma from the First Affiliated Hospital of Nanjing Medical University, the SMARCA4 gene alternations rate was 4.5% (8/178). The median progression-free survival (PFS) for patients without SMARCA4 gene alternations was 16.1 (95%CI: 12.2-20.0) months, which was superior to the median PFS of patients with SMARCA4 gene alternations [6.0 (95%CI: 1.3-10.7) months, P<0.001]. The median OS for patients without SMARCA4 gene alternations was 50.1 (95%CI: 28.1-72.1) months, which was also superior to the median OS of patients with SMARCA4 gene alternations [17.6 (95%CI: 15.4-19.8) months, P=0.001]. Conclusion: SMARCA4 alternation is an important factor associated with poor prognosis in patients with advanced EGFR-mutant lung adenocarcinoma.

The epidemiological characteristics and surgical treatment of inpatients with superficial hemangioma in Shandong province were investigated and analyzed. The first-page medical records of hospitalized patients with superficial hemangioma from 2019 to 2020 reported by all secondary and above medical institutions in Shandong province were selected from the National Health Information Platform of Shandong province to analyze their population characteristics and surgical treatment. A total of 3 775 patients with superficial hemangioma were included, with the age of [M(Q₁, Q₃)] 3.0(0, 33.0)years, including 1 419 males (37.6%) and 2 356 females (62.4%). The head and neck superficial hemangioma accounted for the highest proportion of 37.8% (1 425/3 775), followed by limbs 34.5% (1 302/3 775) and trunk 24.4% (922/3 775). Infants accounted for the highest proportion of 37.2% (1 406/3 775). There were 2 874 (76.1%) patients with superficial hemangioma received surgical treatment, and the proportion of male patients receiving surgery was higher than that of female patients[78.2%(1 110/1 419) vs 74.9%(1 764/2 356), P=0.019]. The proportion of patients receiving surgery increased with age (P_trend<0.001). In terms of different parts, the proportion of patients with superficial hemangioma in the limbs who received surgery was the highest at 86.2%(1 123/1 302) (P<0.001). The majority of the surgical operations were secondary surgery (55.8%, 1 110/1 988), elective surgery (91.4%, 1 818/1 988), class Ⅰ incision (53.5%, 1 338/2 501), and general anesthesia (50.9%, 1 219/2 397). The main treatment method was resection (48.1%, 1 816/3 775). The study found that the majority of inpatients with superficial hemangioma in Shandong province were mostly in head and neck, with more females than males, and infants being the main group, and surgical treatment was the main treatment.

Mild cognitive impairment (MCI) is a state of objective cognitive decline that falls between normal aging and dementia, with a high prevalence among the elderly in China. Cognitive impairments in MCI patients involve multiple cognitive domains such as memory, language, attention, executive, visuospatial functions, and social cognition, as well as non-cognitive domains such as neuropsychiatric, mood, sleep, daily living activities, and frailty. The assessment and clinical diagnosis of MCI highly rely on neuropsychological testing. In order to standardize the neuropsychological assessment of MCI, the Dementia and Cognitive Disorders Group of the Chinese Society of Neurology formulated this consensus document. It recommends tools for assessing global cognition, various cognitive domains, and non-cognitive functions suitable for both clinical and research settings. The consensus proposes assessment procedures and precautions based on the experiences of domestic researchers. Based on the latest international and domestic research advancements, using the Delphi method and the GRADE evidence system, 24 recommendations were formulated in 5 aspects of MCI: global cognitive function assessment, various cognitive domains assessment, non-cognitive assessment, the use of neuropsychological scales, and precautions in neuropsychological assessment, aiming to improve the diagnosis and management of MCI in China.