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Introduction Synchronous colorectal and prostate malignancies are uncommon, with standard treatment guidelines not yet established. Chemoradiation therapy is involved in both colorectal and prostate cancers. However, differing dosage regimens and effects of irradiation field on anatomical planes for surgery makes management of the synchronous cancers challenging. We report the first case of synchronous prostate and rectal cancer being treated with a combination of treatment modalities with a unique addition of high dose rate prostate brachytherapy boost. Patient concerns The patient, a 69-year-old Chinese gentleman, presented with per-rectal bleeding with alternating bowel habits and a hemoglobin drop. He also had a history of urinary urge incontinence. Diagnosis Following diagnostic workup, he was diagnosed with synchronous rectal adenocarcinoma (T3N1M0) and prostate malignancy (T2bN0M0). Interventions The management consisted of neoadjuvant androgen deprivation therapy (ADT) and pelvic chemoradiation, followed by high dose rate prostate brachytherapy boost and subsequently anterior resection. Outcomes Following therapy, the patient has no evidence of local recurrence or distant metastasis. Conclusion We suggest a new feasible treatment strategy for the management of synchronous colorectal and prostate cancers.

To investigate clinical parameters combined with magnetic resonance imaging (MRI) features including apparent diffusion coefficient (ADC) values in preoperative identification of different subtypes of uterine sarcomas including uterine leiomyosarcoma (LMS), endometrial stromal sarcoma (ESS), and carcinosarcoma (CS).Data from 71 patients with uterine sarcoma confirmed by surgery and pathology were collected. The clinical characteristics, conventional MRI features, mean ADC values, minimum ADC values, and lesion-muscle ADC ratio (rADC) values were compared with different subtypes of uterine sarcomas.Age, clinical manifestation, tumor location, shape, and T1-weighted image (T1WI) signals were significantly different between CS and LMS or ESS (all P

This study retrospectively evaluated the effectiveness and safety of traditional Chinese medicine Shenqilixin Formula (SQLXF) as an adjunctive intervention for treating patients with chronic heart failure (CHF). This retrospective study included 135 patients with CHF. They were allocated to a treatment group or a control group according to the different treatments they received. Seventy five patients in the treatment group underwent SQLXF plus routine treatment, while 60 subjects in the control group received routine treatment only. The primary outcome was cardiac function. It was measured by the left ventricular end diastolic diameter (LVDD), left ventricular ejection fraction (LVEF), cardiac output (CO), every cardiac output (ECO), and cardiac index (CI). The secondary outcome included motor function. It was measured by the standard 6-MinuteWalk Test (6MWT). In addition, adverse events (AEs) were also recorded. Compared to subjects in the control group, patients in the treatment group revealed greater effectiveness in cardiac function, measured by LVEF (P

The use of electric bicycles (EBs) in China is growing. In the present study, we aimed to characterize the pattern and outcomes of EB-related injuries presenting to a major general hospital in China. This was a retrospective review of EB-related injuries presenting to Zhejiang Provincial People's Hospital from 2008 to 2011. Cases were identified from medical records according to diagnosis codes. Data captured included demographics, injury characteristics, and outcomes. A total of 3156 cases were reviewed in the present study. There were 1460 cases of traffic accidents, of which 482 cases were EB-related (32.7%). In addition, most of EB-related cases (44.6%) belonged to the 41- to 60-year-old age group. Median injury severity score was 10. Moreover, 34.9% underwent surgery and 24.7% were admitted to intensive care unit. The median hospitalization cost was 14,269 USD. Fracture (56.5%) was the most frequently diagnosed injury type, and head was the most commonly injured body region (31.1%). EB-related injuries have become a major health concern, making up a sizeable proportion of injuries presenting to the emergency department. Therefore, it is necessary to establish injury prevention and strategies for EB road safety. Implementation of policy such as compulsory helmet use, as well as popularization of EB road safety education should be considered to improve the current situation of EB-related injuries in China.

BACKGROUND It has been reported the rs10757274 SNP (present on locus 9p21 in the gene for CDKN2BAS1) might be associated with susceptibility to coronary artery disease (CAD). Owing to mixed and inconclusive results, we conducted a meta-analysis to investigate the association between rs10757274 polymorphism and the risk of CAD. OBJECTIVES The present study aimed to investigate the relationship between rs10757274 polymorphism and the risk of CAD. METHODS All studies of the rs10757274 SNP with CAD that were published between 2007 and 2018 were retrieved from the PubMed database. Meta-analysis was performed with Stata 14.0 software. The effect size of the rs10757274 SNP with CAD risk was assessed based on the odds ratios (ORs) with calculation of 95% confidence interval (CI). RESULTS Eleven studies including 52,209 subjects (cases: 7990, controls: 44,219) were included in the final data combination. Pooled overall analyses showed that rs10757274 (allele model: P

The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures. Patients included in the National Inpatient Sample (NIS) database (2005–2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events. NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51–2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17–3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43–75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79–0.93). Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.

We evaluated the clinical value of the cerebroplacental ratio (CPR) in predicting neonatal acidosis according to the gestational weeks in late pregnancy.From July 2016 to June 2017, 1018 neonates without acidosis and 218 neonates with acidosis (confirmed postpartum) underwent a prenatal examination and hospital delivery at 28 to 41 weeks in our hospital. The CPR was calculated as the ratio of the prenatal middle cerebral artery-pulsation index (MCA-PI) to the umbilical artery-pulsation index (UA-PI).In neonates without acidosis, the fetal UA-PI decreased with increased gestational age during late pregnancy. Similarly, the MCA-PI decreased with increased gestational age, and decreased significantly during the full pregnancy term. Additionally, the CPR peaked in the middle of the late pregnancy period and then decreased. In contrast, in neonates with acidosis, the prenatal UA-PI increased significantly, MCA-PI declined significantly, and CPR declined significantly in relation to normal values (P < .05). For the prediction of neonatal acidosis, the UA-PI was suitable after 32 weeks and the MCA-PI was suitable before 37 weeks. The cutoff values of the CPR for the prediction of neonatal acidosis at 28 to 31 weeks, 32 to 36 weeks, and 37 to 41 weeks were 1.29, 1.36, and 1.22, respectively. Unlike the UA-PI and MCA-PI, the CPR was suitable as an independent predictor of neonatal acidosis at all late pregnancy weeks. In neonates with acidosis, the z score of the UA-PI increased significantly, whereas the z scores of the MCA-PI and CPR decreased significantly, in relation to normal values (P < .05).The CPR can be used to evaluate the adverse status of fetuses during late pregnancy, providing an early prediction of neonatal acidosis.

Background Rapid progress has been made in research of cadmium-zinc-telluride (CZT) technology in the last few years, which might serve as a new method to diagnose coronary artery disease. However, compared with coronary angiography, the diagnostic value of CZT is still controversial. We aimed to evaluate diagnosis value of coronary angiography versus CZT in coronary artery disease. Methods We searched the database for eligible researches associated with CZT- myocardial perfusion imaging (MPI) and invasive coronary angiography, extracted the relevant data, and rigorously screened it according to the inclusion and exclusion criteria. The accuracy indicators included sensitivity, specificity, accuracy, positive and negative likelihood ratios. Results According to the inclusion and exclusion criteria, we finally found 20 studies containing 2350 patients in this search. Pooled results showed that sensitivity of CZT-MPI was 0.84% and 95% confidence interval (95% CI): 0.78 to 0.89, specificity was 0.72, 95% CI (0.62-0.76), the specificity was lower apparently. The positive likelihood ratio was 3.0, 95% CI (2.4-3.8), the negative likelihood ratio was 0.22, 95% CI (0.16-0.31), diagnostic odds ratio was 14, 95% CI (7.84-17.42). Conclusion This meta-analysis showed that CZT-MPI had satisfactory sensitivity and specificity for diagnosing coronary artery disease. Larger studies are required for further evaluation.

Rationale: Bronchobiliary fistula (BBF) is a rare clinical condition which is characterized by a channel between biliary tract and bronchial tree. BBF can present with fever, dyspnea, and cough. However, it can be easily misdiagnosed as biliary vomiting, dyspnea, or even severe pneumonia. Patient concerns: A 53-year-old woman was diagnosed with breast cancer in April 2011 and underwent radical mastectomy and lymph node dissection, chemotherapy, and radiotherapy. Unfortunately, the patient suffered from bone metastasis during the 1st year and liver metastasis during the 2nd year after radical mastectomy. In 2013, the patient underwent transcatheter arterial chemoembolization therapy twice for liver metastasis. The patient was then treated with radiofrequency ablation (RFA) in 2016. Unfortunately, the patient developed a cough with bitter-tasting yellow sputum and chest tightness 2 weeks after the RFA treatment. Approximately 6 months later, the patient still complained of a cough with yellow sputum and persistent chest tightness. The patient was then admitted to our department. Diagnoses: The presence of bile in the sputum supported a diagnosis of BBF. Bronchoscopy was performed, and the presence of bile in the lavage fluid confirmed the diagnosis of BBF. Interventions: The patient was treated with antibiotics including sulbactam, cefoperazone, levofloxacin and meropenem, was well as hepatoprotectants, nutritional support and other supportive treatments in our department. Outcomes: The patient died because of liver failure. Lessons: This case demonstrates that we should consider the possibility of BBF when patients experience a recurrent cough with discolored sputum after RFA. In particular, a diagnosis of BBF should be considered in patients who do not respond to antibiotic treatment.

Background:Conflict findings of the impact of inhalational anesthetics on postoperative cognitive function are reported. No systematic review has been performed to solve the problem. The aim of the study was to assess the effect of different inhalational anesthetics on postoperative cognitiv

The use of electric bicycles (EBs) in China is growing. In the present study, we aimed to characterize the pattern and outcomes of EB-related injuries presenting to a major general hospital in China.This was a retrospective review of EB-related injuries presenting to Zhejiang Provincial People's Hospital from 2008 to 2011. Cases were identified from medical records according to diagnosis codes. Data captured included demographics, injury characteristics, and outcomes.A total of 3156 cases were reviewed in the present study. There were 1460 cases of traffic accidents, of which 482 cases were EB-related (32.7%). In addition, most of EB-related cases (44.6%) belonged to the 41- to 60-year-old age group. Median injury severity score was 10. Moreover, 34.9% underwent surgery and 24.7% were admitted to intensive care unit. The median hospitalization cost was 14,269 USD. Fracture (56.5%) was the most frequently diagnosed injury type, and head was the most commonly injured body region (31.1%).EB-related injuries have become a major health concern, making up a sizeable proportion of injuries presenting to the emergency department. Therefore, it is necessary to establish injury prevention and strategies for EB road safety. Implementation of policy such as compulsory helmet use, as well as popularization of EB road safety education should be considered to improve the current situation of EB-related injuries in China.