Background:: Clear cell renal carcinoma (ccRCC) is one of the most common urological tumors worldwide and metabolic reprogramming is its distinguishing feature. A systematic study on the role of the metabolism-related genes in ccRCC cancer stem cells (CSCs) is still lacking. Moreover, an effective metabolism-related prediction signature is urgently needed to assess the prognosis of ccRCC patients. Methods:: Gene expression profiles of GSE48550 and GSE84546 were analyzed for the role of metabolism-related gene in ccRCC-CSCs. The GSE22541 dataset were used to construct and validate an effective metabolism-related prediction signature to assess the prognosis of ccRCC patients. Results:: For glycolytic metabolism, we found that HKDC1, PFKM and LDHB were significantly upregulated in ccRCC-CSCs in GSE84546. For TCA cycle, ACO1, SDHA and MDH1 were significantly downregulated in ccRCC-CSCs in both GSE48550 and GSE84546. For fatty acid metabolism, CPT1A and ACACB were significantly upregulated in ccRCC-CSCs in GSE84546. It is worth noting that SCD was significantly downregulated in both GSE48550 and GSE84546. For glutamine metabolism, SLC1A5, GLS and GOT1 were significantly upregulated in GSE84546. An eight-gene CSCs metabolism-related risk signature including HKDC1, PFKM, LDHB, IDH1, OGDH, SDHA, GLS and GLUL were constructed to predict the overall survival (OS) of ccRCC patients. Patients could be separated into two groups, and the patients with lower risk scores had longer survival time. Conclusion:: Our study indicated that metabolic reprogramming, including glycolytic metabolism, TCA cycle, fatty acid metabolism and glutamine metabolism, is more obvious in CD105+ renal cells (GSE84546) than CD133+ renal cells (GSE48550). An eight-gene metabolismrelated risk signature including HKDC1, PFKM, LDHB, IDH1, OGDH, SDHA, GLS and GLUL can effectively predict OS in ccRCC.

Objective: Serum lactate (LA) and lactate dehydrogenase (LDH) levels have a major impact on the clinical treatment of malignant tumors and critically ill patients. Nevertheless, the assessment of disease severity in oncology patients admitted to the intensive care unit (ICU) remains incomplete when considering the serum LA and LDH levels. This study aimed to investigate the significance of serum LDH and LA levels in assessing disease severity and predicting clinical outcomes in patients with colorectal cancer (CRC) admitted to the ICU. Methods: This retrospective study included patients with CRC who were admitted to the ICU between January 2017 and December 2022. The patients were divided into three groups based on the tumor treatment methods they had received within 3 months before ICU admission: post-chemotherapy group, post-surgery group, and palliative treatment group. The association between serum LA and LDH levels and disease severity and clinical outcomes was analyzed. Results: Of 137 patients with CRC admitted to the ICU were finally studied. Patients in the post-chemotherapy group exhibited higher serum LA and LDH levels compared to those in the other two groups. Additionally, they had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, longer ICU length of stay, and a higher 30-day mortality. We found a significant positive correlation between serum LA levels and APACHE II scores as well as ICU length of stay and 30-day mortality. In contrast, we only observed a significant positive correlation between serum LDH levels and disease severity in the post-chemotherapy group, whereas no significant correlation between LDH levels and 30-day mortality in any of the three groups. Conclusion: Our study concludes that elevated serum LA levels, rather than LDH levels, are more effective in assessing disease severity and could be used as predictors for clinical outcomes in patients with CRC admitted to the ICU.

Background Historically, research of diced cartilage for rhinoplasty has mainly explored the efficacy of wrapped materials, with few studies dedicated to various sizes of diced cartilage. Objectives The authors of this study sought to evaluate the viability and stability of various-sized free diced cartilage. Methods The remaining costal cartilage was harvested during rhinoplasties and implanted into subcutaneous pockets on the backs of nude mice: shaved cartilage (group A, n = 8), diced cartilage with a diameter <0.5 mm (group B, n = 8), 0.5 to 1.0 mm (group C, n = 8), and 1.0 to 1.5 mm (group D, n = 8). After 12 weeks, weight and volume retention rates, histopathological examinations, and biomechanical properties were evaluated. Results Cartilage grafts in groups A and B showed an obvious loss of contour and severe dispersion. The weight and volume of cartilage graft in group A were significantly decreased (all P < 0.05). Although there was no significant difference, group D (122.8 +/- 15.4%) achieved the highest weight retention rate compared with groups B and C (114.6 +/- 7.1% and 114.3 +/- 10.1%, respectively). Group A showed the most apparent chondrocyte nucleus loss with the least peripheral proliferation, and group D showed the best regeneration potential (all P < 0.05). Group C achieved less chondrocyte nucleus loss than group B (P < 0.05). The compressive elastic modulus increased with the diameter of diced cartilage (all P < 0.05). Conclusions Diced cartilage with a diameter of 1.0 to 1.5 mm may have the highest viability and stability, followed by those of 0.5 to 1.0 mm and <0.5 mm.

Esophageal cancer is a tumor with high morbidity and mortality in China, which is generally diagnosed at late stage and yields poor prognosis. Early diagnosis and correct staging are the basis, and reasonable treatment is the most important. Radiomics can make use of existing imaging resources for deeper mining, and make secondary use of its potential high-throughput data through deep learning or machine learning, thereby establishing a radiomics prediction model. This may become an essential marker of tumor prognosis to predict overall survival or tumor progression, thus stratifying patients at different risk for individualized treatment. In this article, the basic concepts of radiomics, its application in prognostic prediction of esophageal cancer and its combination with clinical and genetic studies were reviewed.

Background: Autologous costal cartilage is widely used as nasal augmentation or nasal reconstruction material. However, no study has focused on the mechanical difference between no calcified costal cartilage and extensive calcified costal cartilage at present. Our study aims to study the loading behavior of calcified costal cartilage under tensile and compressive stress. Method: Human costal cartilage specimen was obtained from five extensive calcified costal cartilage patients and classified into four groups (group A: no calcified costal cartilage; group B: calcified costal cartilage; group C: no calcified costal cartilage after transplantation in BALB/c nude mice for half a year; group D: calcified costal cartilage after transplantation in BALB/c nude mice for half a year). Young's modulus, stress relaxation slope, and relaxation amount were analyzed through tensile and compressive tests using a material testing machine. Results: We included five female patients with extensive calcified costal cartilage. Group B exhibited significantly higher Young's modulus in both the tensile and compressive tests (p < 0.05 in tensile test, p < 0.01 in compressive test), higher relaxation slope (P < 0.01) and higher relaxation amount (p < 0.05 in compression test). After transplantation, the Young's modulus of calcified and non-calcified costal cartilage decreased, except that the calcified costal cartilage increased slightly in the tensile test. The final relaxation slope and relaxation amount had increased at different degrees, but the changes did not change significantly before and after transplantation (P > 0.05). Conclusion: Our results showed that the stiffness of calcified cartilage would increase 30.06% under tension and 126.31% under compression. This study may provide new insights to researchers focusing on extensive calcified costal cartilage can be used for autologous graft material.

目的:构建列线图(nomogram)模型以预测食管鳞癌患者的预后情况,指导个体化治疗.方法:回顾性分析 2002年 1月至2016年 12月国内 10家放疗中心(泛京津冀食管癌协作组-3JECROG)收治的 2680例根治性放疗食管鳞癌患者资料,随机分为训练组和验证组,根据训练组的预后因素构建nomogram模型,并进行训练组内部和验证组外部验证.分别以nomogram模型与AJCC/UICC分期评估两组患者预后及临床获益.结果:全组 1、3、5年生存率分别为 69.0%、37.7%、31.0%.多因素分析肿瘤部位、TNM分期、原发肿瘤体积和是否同步化疗是影响食管癌的独立预后因素(均P＜0.05).在训练组和验证组中nomogram模型的一致性指数(C-index)、AUC值均高于AJCC/UICC分期(均P＜0.001).基于nomogram模型分为低、中、高风险亚组与AJCC/UICC分期比较,nomogram模型的生存曲线之间具有显著性差异(P＜0.001),且 1、3、5年的总生存临床决策曲线(de-cision curve analysis,DCA)下面积均具有显著性差异.结论:本研究构建的nomogram模型较AJCC/UICC分期具有更好的预测能力,有助于食管癌患者的预后判断及指导个体化治疗.

Objective:To evaluate the efficacy and safety of hippocampal avoidance whole-brain irradiation with simultaneous integrated boost in the treatment of brain metastases of lung cancer.Methods:Forty lung cancer patients with brain metastases who received whole-brain radiotherapy with simultaneous integrated boost and hippocampal avoidance in Cancer Hospital, Chinese Academy of Medical Sciences from 2014 to 2020 were enrolled in this study. Brain MRI, survival follow-up and evaluation of side effects were performed before radiotherapy and at 1, 3, 6 and 12 months after radiotherapy, respectively. Overall survival (OS), progression-free survival (PFS) and changes in cognitive function were analyzed. Continuous data were described as Mean ± SD. Categorical data were described by frequency and composition ratio or percentage. Survival analysis was conducted by Kaplan-Meier method. Influencing factors of survival were identified by univariate and multivariate Cox's regression analyses.Results:A total of 40 patients were enrolled in the study. The median follow-up time was 14.2 months and the median OS, PFS and intracranial PFS of all patients were 14.8 months, 6.7 months and 14.8 months, respectively. Multivariate analysis showed that male gender and newly diagnosed stage Ⅳ disease were associated with worse OS and PFS, respectively. The Hopkins verbal learning test-revised (HVLT-R) scores at baseline and 1, 3 and 6 months after radiotherapy were 21.94±2.99, 20.88±3.12, 20.03±3.14, and 19.78±2.98, respectively. The HVLT-R score at 6 months after radiotherapy was decreased by approximately 9.8% compared with the baseline. No grade 3 or above toxic and side effect occurred in the entire cohort.Conclusion:Hippocampal avoidance whole-brain irradiation with simultaneous integrated boost is a safe and effective treatment for brain metastases of lung cancer, which is expected to reduce the impact of radiotherapy on cognitive function.

目的:分析核心结合因子相关儿童急性髓系白血病(CBF-AML)的临床及遗传学特征.方法:回顾性分析2016年1月—2021年12月于中国医学科学院血液病医院儿童血液病诊疗中心确诊的96例初诊CBF-AML患儿的临床资料.总结并比较RUNX1-RUNX1T1与CBFβ-MYH11两种融合基因型患儿的临床及遗传学特征.结果:96例患儿中,RUNX1-RUNX1T1与CBFβ-MYH11两种融合基因型组病例分别为76例(79.2％)和20例(20.8％).CBFβ-MYH11组与RUNX1-RUNX1T1组比较,具有更高的初诊白细胞计数(P=0.001).2组患儿初诊出现白血病髓外浸润比例相当(22.4％vs 20.0％),但CBFβ-MYH11组髓外浸润部位均为中枢神经系统(20.0％,P=0.033),RUNX1-RUNX1T1组髓外浸润部位多为眶周及面部软组织(14.5％,P=0.063).性染色体缺失是儿童CBF-AML中最为常见的附加细胞遗传学异常,总体发生率为34.4％(32/93),且仅发生在RUNX1-RUNX1T1融合基因阳性的AML中.染色体三体现象常见,+8在CBFβ-MYH11组出现频率更高(15.0％,P=0.03).CBF-AML 患儿常见的伴随突变基因有 C-KIT(53.9％)、NRAS(31.6％)、KMT2D(15.8％)、KRAS(13.2％)等.结论:儿童CBF-AML中,CBFβ-MYH11组初诊白细胞水平更高,髓外浸润部位为中枢神经系统.性染色体缺失主要发生在RUNX1-RUNX1T1组,髓外浸润部位常为头面部.C-KIT和RAS突变是CBF-AML中最常见的基因突变类型.

BACKGROUND:There has been no previous study on the availability of different glucocorticoid varieties used in the multimodal cocktail for harvesting autologous costal cartilage. This randomized controlled trial (RCT) was to compare the significance and complications of betamethasone and triamcinolone acetonide as a component of the cocktail for harvesting costal cartilage in patients. MATERIALS AND METHODS:The patients were randomized to two groups. The group A used multimodal cocktail: ropivacaine, parecoxib sodium, epinephrine, and triamcinolone acetonide; group B used multimodal cocktail: ropivacaine, parecoxib sodium, epinephrine, and betamethasone. The primary outcomes were chest pain after surgery evaluated with a visual analog scale (VAS). The secondary outcomes evaluated the quality of recovery. The tertiary outcomes included rescue analgesic consumption, the first feeding time and the time to the first ambulation, and duration of hospital stay. RESULTS:The VAS scores between the two groups was not considered clinically significant, but the groups achieved a VAS score of 3 or less. However, the time until the first rescue analgesia and the number were significantly longer and smaller for group A. Additionally, there were no significant differences between the two groups in the duration of hospital stay, first feeding time, the quality of recovery, and the first ambulation time. CONCLUSION:Adding corticosteroids into the multimodal cocktails could improve pain relief after costal cartilage harvest. And the efficacy of Triamcinolone acetonide was better than betamethasone. LEVEL OF EVIDENCE II:This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ObjectiveTo develop a nomogram to predict prognosis in patients with esophageal squamous cell carcinoma (ESCC) and guide individualized treatment. MethodsFrom January 2002 to December 2016, a total of 2,680 patients with ESCC recruited from 10 national radiotherapy center (3JECROG R-03A) treated with definitive radiotherapy were randomly assigned into a training group and a validation group. A nomogram was built based on prognostic factors associated with the training group and validated using external and internal cohorts. Prognosis and clinical benefits were compared between the nomogram and the AJCC/UICC staging. Results: The respective 1-, 3-, and 5-year overall survival (OS) rates of the whole cohort were 69.0%, 37.7%, and 31.0%. Tumor location, TNM stage, primary tumor volume, and concurrent chemoradiotherapy were found to be independent prognostic factors by multivariate analyses (all P<0.05). Nomogram C-indices and AUC values in the training and validation groups were all significantly higher than those obtained from AJCC/UICC staging. Low, medium, and high risk groups were identified using training nomogram scores. Compared with those obtained by AJCC/UICC staging, the OS curves were separated better, and the areas under the 1-, 3-, and 5-decision curve analysis (DCA) curves were larger when using the nomogram. ConclusionsIn comparison to AJCC/UICC staging, the nomogram more accurately predicted prognosis, contributing to improved prognostic prediction and personalized treatment.

Objective: To compare the incidence of radiation-related toxicities between conventional and hypofractionated intensity-modulated radiation therapy (IMRT) for limited-stage small cell lung cancer (SCLC), and to explore the risk factors of hypofractionated radiotherapy-induced toxicities. Methods: Data were retrospectively collected from consecutive limited-stage SCLC patients treated with definitive concurrent chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2022. The enrolled patients were divided into two groups according to radiation fractionated regimens. Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) was used to evaluate the grade of radiation esophagus injuries and lung injuries. Logistic regression analyses were used to identify factors associated with radiation-related toxicities in the hypofractionated radiotherapy group. Results: Among 211 enrolled patients, 108 cases underwent conventional IMRT and 103 patients received hypofractionated IMRT. The cumulative incidences of acute esophagitis grade ≥2 [38.9% (42/108) vs 35.0% (36/103), P=0.895] and grade ≥ 3 [1.9% (2/108) vs 5.8% (6/103), P=0.132] were similar between conventional and hypofractionated IMRT group. Late esophagus injuries grade ≥2 occurred in one patient in either group. No differences in the cumulative incidence of acute pneumonitis grade ≥2[12.0% (13/108) vs 5.8% (6/103), P=0.172] and late lung injuries grade ≥2[5.6% (6/108) vs 10.7% (11/103), P=0.277] were observed. There was no grade ≥3 lung injuries occurred in either group. Using multiple regression analysis, mean esophageal dose ≥13 Gy (OR=3.33, 95% CI: 1.23-9.01, P=0.018) and the overlapping volume between planning target volume (PTV) and esophageal ≥8 cm(3)(OR=3.99, 95% CI: 1.24-12.79, P=0.020) were identified as the independent risk factors associated with acute esophagitis grade ≥2 in the hypofractionated radiotherapy group. Acute pneumonitis grade ≥2 was correlated with presence of chronic obstructive pulmonary disease (COPD, P=0.025). Late lung injuries grade ≥2 was correlated with tumor location(P=0.036). Conclusions: Hypofractionated IMRT are tolerated with manageable toxicities for limited-stage SCLC patients treated with IMRT. Mean esophageal dose and the overlapping volume between PTV and esophageal are independently predictive factors of acute esophagitis grade ≥2, and COPD and tumor location are valuable factors of lung injuries for limited-stage SCLC patients receiving hyofractionated radiotherapy. Prospective studies are needed to confirm these results.

Importance:Double-agent intravenous chemotherapy concurrent with radiotherapy is the standard of care for patients with inoperable esophageal cancer. However, patients tend to tolerate intravenous chemotherapy less well with age and comorbidities. It is essential to find a better treatment modality that improves survival outcomes without reducing the quality of life. Objective:To evaluate the effectiveness of simultaneous integrated boost radiotherapy (SIB-RT) with concurrent and consolidated oral S-1 chemotherapy for patients aged 70 years and older with inoperable esophageal squamous cell carcinoma (ESCC). Design, Setting, and Participants:This multicenter, phase III randomized clinical trial was conducted between March 2017 and April 2020 in 10 centers in China. Patients with inoperable, locally advanced, clinical stage II to IV ESCC were enrolled and randomized to receive SIB-RT concurrent with and followed by oral S-1 chemotherapy (CRTCT group) or SIB-RT alone (RT group). Data analysis was completed on March 22, 2022. Interventions:In both groups, the planning gross tumor volume was administered with radiation dose of 59.92 Gy and the planning target volume was administered with radiation dose of 50.4 Gy, in 28 fractions each. In the CRTCT group, concurrent S-1 was administered on radiotherapy days, and consolidated S-1 was administered at 4 to 8 weeks after SIB-RT. Main Outcomes and Measures:The primary end point was overall survival (OS) of the intent-to-treat population. Secondary end points were progression-free survival (PFS) and toxicity profile. Results:A total of 330 patients (median [IQR] age, 75.5 [72-79] years; 220 [66.7%] male patients) were included, with 146 patients randomized to the RT group and 184 randomized to the CRTCT group. A total of 107 patients (73.3%) in the RT group and 121 patients (67.9%) in the CRTCT group were clinically diagnosed with stage III to IV disease. At the time of analysis of the 330 patients in the intent-to treat-population (March 22, 2022), OS was improved in the CRTCT group compared with the RT group at 1 year (72.2% vs 62.3%) and 3 years (46.2% vs 33.9%; log-rank P = .02). PFS was similarly improved in the CRTCT group compared with the RT group at 1 year (60.8% vs 49.3%) and 3 years (37.3% vs 27.9%; log-rank P = .04). There was no significant difference in the incidence of treatment-related toxic effects higher than grade 3 between the 2 groups. Grade 5 toxic effects occurred in each group, including 1 patient who experienced myelosuppression and 4 patients with pneumonitis in the RT group and 3 patients with pneumonitis and 2 patients with fever in the CRTCT group. Conclusions and Relevance:These findings suggest that oral S-1 chemotherapy administered with SIB-RT should be considered as an alternative treatment option for patients aged 70 years and older with inoperable ESCC, since it improved survival outcomes without additional treatment-related toxic effects compared with SIB-RT alone. Trial Registration:ClinicalTrials.gov Identifier: NCT02979691.

Objective: To compare the effectiveness of an intercostal nerve block after costal cartilage harvest when a multimodal cocktail or ropivacaine plus patient-controlled analgesia is used, as measured by visual analog scale (VAS) scores, rescue analgesic consumption, and related complications. Materials and Methods: Eligible patients who underwent costal cartilage harvest were equally randomized to receive a multimodal cocktail (multimodal group) or ropivacaine plus patient-controlled analgesia (ropivacaine group). Results: Of 112 patients assessed, 12 (10.7%) patients were excluded and 100 (89.3%) patients were enrolled and assigned to multimodal group (n = 50) and ropivacaine group (n = 50). The VAS scores in the multimodal group were significantly lower than those in the ropivacaine group both at rest (0.924 ± 0.073 vs. 1.920 ± 0.073, p < 0.001) and during coughing (2.340 ± 0.083 vs. 3.944 ± 0.083, p < 0.001) in mixed-effects model analysis. Rescue analgesic consumption and rate of complications were significantly lower in the multimodal group compared with the ropivacaine group (all p < 0.05). Conclusions: Multimodal cocktail improved chest pain after costal cartilage harvest with less rescue analgesic consumption and complications compared with ropivacaine plus patient-controlled analgesia. Clinical Trial Registration: ChiCTR2100042445.

Background Esophageal mucoepidermoid carcinoma (EMEC) is a rare disease. The biological behavior and treatment of this malignancy are not well established. Methods Data from 58 patients with EMEC who underwent esophagectomy were retrospectively analyzed and compared with 5028 patients with esophageal squamous cell carcinoma (ESCC). Kaplan–Meier and multivariate Cox regression analyses were conducted to investigate the association between clinicopathological factors and survival. Results The study cohort included 36 males and 22 females with a median age of 59 years (range, 40-78 years). Of the 47 patients who underwent preoperative esophagoscopic biopsy, only 1 patient was diagnosed with EMEC. EMEC was more often found in female patients (39.7% versus 25.8%, P=0.036) and patients with EMEC had a significantly lower rate of lymph node metastasis (25.0% versus 49.4%, P<0.001) than patients with ESCC. After 1:1 propensity score matching, the 5-year overall survival rate of 55.2% for patients with EMEC was similar to that of 61.9% for patients with ESCC (P=0.399). Conclusions EMEC is a rare disease that more often affects females and these patients has less lymph node metastasis than patients with ESCC. Preoperative esophagoscopic biopsy has difficulty obtaining an accurate pathological diagnosis for EMEC patients. The prognosis for EMEC is similar to that for ESCC.

In this research, we described a very rare case of thrombotic microangiopathy induced by remethylation disorders. A 16-year-old boy presented to the emergency department with 5 months of weakness and fatigue. He was diagnosed with thrombotic microangiopathy based on clinical manifestation and laboratory information, which showed microangiopathic hemolytic anemia, renal impairment, and thrombocytopenia. After a complex diagnostic workup, the metabolite screening parameters and sequencing results guided us toward the diagnosis of remethylation disorders. The patient was diagnosed with thrombotic microangiopathy induced by remethylation disorders (cblC).

Although immune checkpoint inhibitors (ICIs) have influenced the treatment paradigm for multiple solid tumors, increasing evidence suggests that primary and adaptive resistance may limit the long-term efficacy of ICIs. New therapeutic strategies with other drug combinations are hence warranted to enhance the antitumor efficacy of ICIs. As a novel tumor suppressor, histone deacetylase (HDAC) inhibitor tucidinostat has been successfully confirmed to act against hematological malignancies. However, the underlying mechanisms of action for tucidinostat and whether it can manipulate the tumor microenvironment (TME) in solid tumors remain unclear. Three murine tumor models (4T1, LLC, and CT26) were developed to define the significant role of different doses of tucidinostat in TME. The immunotherapeutic effect of tucidinostat combined with anti-programmed cell death ligand 1 antibody (aPD-L1) was demonstrated. Furthermore, the effect of tucidinostat on phenotypic characteristics of peripheral blood mononuclear cells (PBMCs) from lung cancer patients was investigated. With an optimized dose, tucidinostat could alter TME and promote the migration and infiltration of CD8+ T cells into tumors, partially by increasing the activity of C-C motif chemokine ligand 5 (CCL5) via NF-κB signaling. Moreover, tucidinostat significantly promoted M1 polarization of macrophages and increased the in vivo antitumor efficacy of aPD-L1. Tucidinostat also enhanced the expression of the costimulatory molecules on human monocytes, suggesting a novel and improved antigen-presenting function. A combination regimen of tucidinostat and aPD-L1 may work synergistically to reduce tumor burden in patients with cancer by enhancing the immune function and provided a promising treatment strategy to overcome ICI treatment resistance.

Objective:Considerable studies have focused mainly on the facial deformity of Tessier No.0 cleft with a bifid nose, but the deformity of the skull is not well understood. Therefore, our study aimed to explore the evolution of cranial dysmorphology and the chronology of Tessier No.0 cleft with a bifid nose, by three-dimensional measurements.Methods:Ninety-six non-surgical patients and computed tomographic scans were included (Tessier No.0 cleft with a bifid nose, n = 48; controls, n = 48) and divided into five age subgroups. Craniofacial cephalometric measurements were analyzed by Mimics software.Results:The widening of nasal bone was the most remarkable and persistent from 2 years old appropriately. The overall cranial base length in patients compared with controls increased 11.8% (p < 0.01) on average. The middle and posterior cranial fossa increasing accounted for most of this change. The cranial base angles also showed increased obviously. By analyzing the linear of the nasopharynx and respiratory tract, it was found that its development did not affect respiration.Conclusions:The cranial base deformity of Tessier No.0 cleft with a bifid nose consists of the whole skull base and particularly the middle and posterior cranial base length increase. At the same time, there may be late closure of the spheno-occipital synchondrosis and sella displacement. We believe this study is unique in providing valuable data for elucidating the pathological and morphological abnormalities of skull base development in Tessier No.0 cleft with a bifid nose.

BACKGROUND:There was few research on the causes or factors of costal cartilage calcification. Thus, this study aimed to develop a nomogram to predict the possibility of severe costal cartilage calcification.METHODS:The cohort study included 882 patients who underwent computed tomographic (CT) scan of the chest with three-dimensional reconstructions and have completed the questionnaire between June 2020 to October 2021. The potential variables were included age, sex, body mass index (BMI), nation, residence, smoking, drinking, bedtime, exercise, self-pressure, the frequencies of milk, yogurt, carbonated drink, meat, fish, sea food, fruits intake, hypertension, diabetes, thyroid or parathyroid disease and osteoarthritis. We used the least absolute shrinkage and selection operator (LASSO) regression model to identify the optimal predictive features. Multivariable logistic regression analysis was used to build the predicting model. The receiver operating characteristic (ROC) curve and concordance index (C-index) were used to evaluate the accuracy of the nomogram. Moreover, decision curve analysis (DCA) was to estimate the clinical usefulness of the nomogram. Finally, we adopted internal validation of enhanced bootstrap adjustment for optimism to predict the C-index of the model.RESULTS:The predictive nomogram contained 11 clinical features using LASSO regression, and "Sex" and "Age" were the most important factor due to the most significant proportion. The model showed good discrimination with a C-index of 0.805, and the internal validation was 0.735. DCA (the threshold probability of a patient is 1-77%) and the ROC curve [the area under ROC (AUC) was 0.805, and the sensitivity and specificity were 0.647 and 0.894] demonstrated that the nomogram was possibly clinically helpful.CONCLUSIONS:This is the first study to develop a nomogram to predict severe costal cartilage. Use of this nomogram might help patients prevent calcification by changing living habits.

Objective:To compare the set-up errors of mid-thoracic esophageal cancer treated with three different radiotherapy immobilization methods and to analyze its influence on the set-up errors of the supraclavicular and infraclavicular region.Methods:A total of 73 mid-thoracic esophageal cancer patients with supraclavicular lymph node metastasis treated from November 2019 to November 2021 at the Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College were retrospectively reviewed. The sample included 56 males and 17 females, with a median age of 63.6 (36.5-85.3) years. Of these, 24 patients were fixed with a thoracoabdominal flat frame, with both hands crossed on the forehead and 25 had both of their hands placed on the sides of their bodies. In addition, 24 patients were fixed with integrated cervicothoracic immobilization devices with both their hands on the sides of their bodies. Cone beam CT (CBCT) scans were performed once a day at the first five workdays and once a week in the following treatment time. Translational set-up errors in the ( X direction) left and right, ( Y direction) cranial and caudal, ( Z direction) ventral and dorsal directions within the compared target volumes were recorded. The translational set-up error of the three modes of immobilization were compared, and the amplitudes of movement and the three-dimensional spatial displacement of the acromioclavicular joint were measured. Independent sample t-test or Wilcoxon rank sum test were employed to analyze the error values between groups. Results:A total of 208, 195, and 195 CBCT scans were performed in the thoracoabdominal flat frame elevation, the thoracoabdominal flat frame side, and the integrated cervicothoracic immobilization device side groups, respectively. The translational set-up errors of the three groups were recorded for the left and right directions: (0.19±0.15), (0.16±0.15), and (0.14±0.14) cm; the cranial and caudal directions: (0.30±0.24), (0.27±0.22), and (0.21±0.20) cm; and the ventral and dorsal directions: (0.20±0.14), (0.17±0.18), and (0.16±0.17) cm, respectively. The translational set-up errors in the three directions of the integrated cervicothoracic immobilization device side group were better than those of the other two groups. Compared with the integrated cervicothoracic immobilization device side group, all the setup errors showed significant statistical differences ( t=-9.85 to 5.89; all P<0.05), except for the thoracoabdominal flat frame side group in the Y direction ( t=0.85, P>0.05). The three-dimensional displacement d values of the acromioclavicular joint in the three groups were (0.24±0.17), (0.28±0.16), and (0.23±0.13) cm, respectively. The difference of Δ Y between thoracoabdominal flat frame elevation group and integrated cervicothoracic immobilization device side group was statistically significant ((0.11±0.11) cm vs. (0.13±0.11) cm, Z=-2.16, P<0.05). There were also significant differences in Δ Z ((0.18±0.15) cm vs. (0.12±0.10) cm, Z=-4.19, P<0.001) and the three-dimensional spatial displacement d values of the acromioclavicular joint ((0.28±0.16) cm vs. (0.23±0.13) cm, Z=-3.63, P<0.001) between the thoracoabdominal flat frame side and the integrated cervicothoracic immobilization device side groups. Conclusion:For mid-thoracic esophageal cancer patients with irradiated supraclavicular and infraclavicular region, shoulder immobilization using integrated cervicothoracic immobilization devices is better in translational set-up errors and three-dimensional spatial displacement of the acromioclavicular joint than thoracoabdominal flat frame, as it can effectively improve the accuracy of a radiotherapy plan.

Objective: The literature on the patients' satisfaction after rhinoplasty is limited. The purpose of our study was to use the patient-reported outcome measures to study the difference of satisfaction between men and women and between different ages before and after the operation and to explore the factors of postoperative satisfaction difference in Chinese people. Method: A total of 707 patients who underwent surgery at our institution were reviewed. Satisfaction was evaluated by the FACE-Q Rhinoplasty module (FACE-Q RM). Results: Follow-up data were 100% complete and the median follow-up time was 1 year. Postoperatively, there was a significant difference in comparison with preoperative in nose and nostrils items (P<0.001). The satisfaction rate in men and women was 98.36% and 96.90%, respectively. Most men are dissatisfied with their bridges of the nose, and women are not satisfied with the tip. But after the operation, they all improved to a certain extent. Moreover, the rate of satisfaction in younger and older people was 96.80% and 100%, respectively. The younger people were more dissatisfied with the tip and size of the nostrils, whereas the older people were not satisfied with their bridges and well-matched nostrils. Univariate analysis showed that marital status was the factor, influencing satisfaction for nostrils (P=0.005). Conclusion: The FACE-Q RM scales are useful measures to assess patients' satisfaction and confirm in what areas they are satisfied and most importantly, where they are not. We believe that the FACE-Q RM should be used before every patient.