Simultaneous type III congenital esophageal atresia and patent ductus arteriosus in a low-weight patient: A case report

BACKGROUND We report a low-birth-weight child(1.8 kg)with neonatal type III congenital esophageal atresia(CEA)combined with symptomatic patent ductus arteriosus(PDA).After comprehensive evaluation,esophageal anastomosis was performed on postnatal day 11 after excluding surgical contraindications,and arterial catheter ligation was performed at the same time.Concurrent surgery for CEA combined with PDA has not been clearly reported in the literature.CASE SUMMARY We report a 6-day-old female child with type III CEA and PDA.The patient presented with foam at the mouth after birth,cough and shortness of breath after feeding.At another hospital,she was considered to have neonatal pneumonia,neonatal jaundice and congenital heart disease and transferred to our hospital.After iodine oil radiography of the esophagus and echocardiography we con-firmed diagnosis of CEA and PDA.The diameter of the PDA was 8 mm,with obvious left to right shunting.We performed right rear extrapleural orificium fistula ligation and esophageal anastomosis,and ligation of PDA via left axilla straight incision after 5 d of hospitalization.The operations were successful,and the incision healed after 12 d,and the patient was discharged.We re-examined the patient 1 mo after surgery.She did not vomit when she ate rice flour.Esophageal angiography showed no stricture of the anastomotic stoma.The patient weighed 3.2 kg.CONCLUSION For CEA patients with multiple risk factors,comprehensive,timely and accurate diagnosis and evaluation,and early treatment may improve prognosis.

Comparative effectiveness research on incision healing after lumbar spinal surgery with different TDP irradiation durations

Objective: This research aims to investigate the best "Te Ding Dian Ci Bo Pu Zhi Liao Qi"(TDP) irradiation duration to enhance the efficacy of nursing and patient satisfaction.Methods: A total of 34 eligible patients were randomly divided into the treatment group(n=18) and the control group(n=16) between December 2015 and December 2016. Qualitative and quantitative studies were combined to create an impersonal evaluation of incision pain score, time of stitches removal, duration of hospital stays, patient satisfaction, and subjective experience due to different TDP irradiation durations.Results: The incision pain scores of the treatment group were 3.06±0.899 and 1.35±0.493 before and after treatment, respectively(P< 0.05), whereas those of the control group were 2.46±1.127 and 1.0±0.707 before and after treatment, respectively(P<0.05).No significant difference was found between the treatment group and the control groupup(P>0.05). The time of stitches removal and the duration of hospital stays of the treatment group were 14.85±4.070 and 19.08±6.652, respectively, whereas those of the control group were 14.08±0.641 and 23.15±10.72(P>0.05), respectively. The patient satisfaction degree score of the treatment group was2.77±0.439, whereas that of the control group was 2.08±0.954(P< 0.05).Conclusions: TDP irradiation can effectively relieve the incision pain of patients after lumbar spinal surgery. The treatment group is superior to the control group in patient satisfaction.

Regional location of lymph node metastases predicts survival in patients with de novo metastatic prostate cancer

To report the regional locations of metastases and to estimate the prognostic value of the pattern of regional metastases inmen with metastatic hormone-sensitive prostate cancer (mHSPC), we retrospectively analyzed 870 mHSPC patients betweenNovember 28, 2009, and February 4, 2021, from West China Hospital in Chengdu, China. The patients were initially classifiedinto 5 subgroups according to metastatic patterns as follows: simple bone metastases (G1), concomitant bone and regional lymphnode (LN) metastases (G2), concomitant bone and nonregional LN (NRLN) metastases (G3), lung metastases (G4), and livermetastases (G5). In addition, patients in the G3 group were subclassified as G3a and G3b based on the LN metastatic plane(below or above the diaphragm, respectively). The associations of different metastatic patterns with castration-resistant prostatecancer-free survival (CFS) and overall survival (OS) were analyzed by univariate and multivariate analyses. The results showedthat patients in G1 and G2 had relatively favorable clinical outcomes, patients in G3a and G4 had intermediate prognoses, andpatients in G3b and G5 had the worst survival outcomes. We observed that patients in G3b had outcomes comparable to those inG5 but had a significantly worse prognosis than patients in G3a (median CFS: 8.2 months vs 14.3 months, P = 0.015;medianOS: 38.1 months vs 45.8 months, P = 0.038). In conclusion, metastatic site can predict the prognosis of patients with mHSPC,and the presence of concomitant bone and NRLN metastases is a valuable prognostic factor. Furthermore, our findings indicatethat the farther the NRLNs are located, the more aggressive the disease is.

Prior switching to a second-line nonsteroidal antiandrogen does not impact the therapeutic efficacy of abiraterone acetate in patients with metastatic castration-resistant prostate cancer： a real-world retrospective study

Even in the era of novel targeted agents, switching to a second-line nonsteroidal antiandrogen （NSAA） is still widely used in treating metastatic castration-resistant prostate cancer （mCRPC）, especially in undeveloped countries. However, whether prior treatment with a second-line NSAA would impact the efficacy of abiraterone acetate （Abi） remains uncertain, in the current study, 87 mCRPC patients treated with Abi were analyzed. Among them, 21 were treated with a second-line NSAA （from bicalutamide to flutamide） before receiving abiraterone, while the remaining 66 received Abi directly. Therapeutic efficacy of Abi was compared between those with and without prior second-line NSAA using Kaplan-Meier curves, log-rank test, and Cox regression models. The therapeutic efficacy of Abi was similar between those with or without the prior switching treatment of flutamide, in terms of either prostate-specific antigen progression-free survival （PSA-PFS, 5.5 vs 5.6 months, P = 0.967）, radiographic progression-free survival （rPFS, 12.8 vs 13.4 months, P = 0.508）, overall survival （OS, not reached vs 30.6 months, P = 0.606）, or PSA-response rate （71.4% [15121] vs 60.6% [40166], P = 0.370）. This is the first time that the impact of prior switching of treatment to a second-line NSAA on the efficacy of Abi in mCRPC patients has been addressed. Our data support that, use of prior sequential bicalutamide and flutamide does not seem to preclude response to abiraterone, although larger cohort studies and, ideally, a randomized controlled trial are needed. These findings will facilitate doctors＇ decision-making in the treatment of mCRPC patients, especially for those with previous experience of switching NSAA second-line treatments in the clinic.

An AEE-active Polymer Containing Tetraphenylethene and 9,10-Distyrylanthracene Moieties with Remarkable Mechanochromism

A polymer （poly（9,10）anthracenevinylene-alt-4,4＇-（9,9-bis（4-（4＇-（1,2,2＇-triphenyviny）phenoxy）butyl）-9H- fluorene-2,7-diyl） dibenzaldehyde）, P1） was successfully synthesized through the Wittig-Horner reaction by employing fluorene and 9,10-distyrylanthracene moieties as building blocks for backbone and tetraphenylethenes as pendant groups. Photophysical and thermal properties of the resulting polymeric emitter were fully characterized by ultraviolet-visible （UV- Vis） absorption and photoluminescence （PL） spectra, thermogravimetric analysis （TGA） and differential scanning calorimetry （DSC）. While P1 emits an orange-light centered at 567 nm in dilute tetrahydrofuran （THF） solution, the solid powder of the polymer exhibits strong yellow emission peaked at 541 nm. It is also found that the as-synthesized polymer shows unique property of aggregation-enhanced emission （AEE）. In addition, P1 possesses high thermal stability with a decomposition temperature （Td,5%） of 430 ℃ and high morphological stability with a glass transition temperature （Tg） of 171℃. Under the stimulus of mechanical force, the emission of P1 can be changed from yellow to red （△λmax = 61 rim）, showing a remarkable mechanochromism. The results from XRD analysis suggest that such mechanochromic phenomenonof PI is probably caused by the destruction of crystalline structure, which leads to the conformational planarization of the distyrylanthracene moieties forming by the polymerization and the increase of molecular conjugation of the backbone.

Intraductal carcinoma of the prostate in prostate biopsy samples: correlation with aggressive pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer

Intraductal carcinoma of the prostate(IDC-P)is an aggressive pathological pattern of prostate cancer(PCa).We investigated the association of IDC-P in prostate biopsy(PBx)with several pathological features after radical prostatectomy(RP)and its prognostic value in high-risk PCa.A total of 418 patients with high-risk PCa after RP were included in this study.IDC-P and its architectural patterns were identified according to the 2016 World Health Organization Classification.Chi-squared test and logistic regression were used to investigate the correlation between IDC-P and post-RP pathological features.Kaplan-Meier curves and Cox regression were applied to explore the prognostic value of IDC-P.IDC-P was identified in PBx in 36/418(8.6%)patients.Logistic regression indicated that IDC-P in PBx was independently associated with several pathological features of RP,including Gleason score 8-10(P<0.001),seminal vesicular invasion(P<0.001),and pathological T(pT)3a(P=0.043).Patients with IDC-P in PBx manifested poorer biochemical-free survival(BFS)than those without IDC-P(37.47 months vs not reached,P<0.001).The addition of IDC-P in several prognostic nomograms could improve the predictive accuracy of these tools.We conclude that IDC-P in PBx is positively associated with several aggressive pathological features after RP in high-risk PCa.In addition,IDC-P in PBx could effectively predict the BFS of high-risk PCa patients after RP.

Predictors of efficacy of corticosteroid switching from abiraterone plus prednisone to dexamethasone in patients with metastatic castration-resistant prostate cancer

Corticosteroid switching can reverse abiraterone resistance in some patients with metastatic castration-resistant prostate cancer(mCRPC).Here,we investigated the potential biomarkers for predicting the efficacy of corticosteroid switching during treatment with abiraterone acetate(AA).We retrospectively analyzed 101 mCRPC patients receiving corticosteroid switching from West China Hospital and Sun Yat-Sen University Cancer Center between January 2016 and December 2018.All cases received AA plus prednisone as first-line therapy during mCRPC.Primary end points were biochemical progression-free survival(bPFS)and overall survival(OS).The risk groups were defined based on multivariate analysis.A total of 42(41.6%)and 25(24.8%)patients achieved 30%and 50%decline in prostate-specific antigen(PSA),respectively,after corticosteroid switching.The median bPFS and median OS on AA plus dexamethasone were 4.9(95%confidence interval[CI]:3.7–6.0)months and 18.8(95%CI:16.2–30.2)months,respectively.Aldo-keto reductase family 1 member C3(AKR1C3)expression(hazard ratio[HR]:2.15,95%Cl:1.22–3.80,P=0.008)and baseline serum alkaline phosphatase(ALP;HR:4.95,95%Cl:2.40–10.19,P<0.001)were independent predictors of efficacy before corticosteroid switching in the multivariate analysis of bPFS.Only baseline serum ALP>160 IU l−1(HR:3.41,95%Cl:1.57–7.38,P=0.002)together with PSA level at switch≥50 ng ml−1(HR:2.59,95%Cl:1.22–5.47,P=0.013)independently predicted poorer OS.Based on the predictive factors in multivariate analysis,we developed two risk stratification tools to select candidates for corticosteroid switching.Detection of serum ALP level,PSA level,and tissue AKR1C3 expression in mCRPC patients could help make clinical decisions for corticosteroid switching.

Clinical and oncologic findings of extraprostatic extension on needle biopsy in de novo metastatic prostate cancer

This study aimed to explore the clinical and oncologic findings in patients with de novo metastatic prostate cancer(mPCa)and extraprostatic extension(EPE)on biopsy.We retrospectively evaluated data on 630 patients with de novo mPCa between January 2009 and December 2017 in the West China Hospital(Chengdu,China),including evaluating the relationships between EPE and other variables and the association of EPE with survival outcomes by the Chi-square test,Kaplan–Meier curves,and the Cox proportional-hazards model.EPE was found in 70/630 patients,making a prevalence of 11.1%.The presence of EPE on biopsy was associated with higher Gleason scores and higher incidence of neuroendocrine differentiation(NED),intraductal carcinoma of the prostate(IDC-P),and perineural invasion(PNI).Compared with those without EPE,patients with EPE had shorter castration-resistant prostate cancer-free survival(CFS;median:14.1 vs 17.1 months,P=0.015)and overall survival(OS;median:43.7 vs 68.3 months,P=0.032).According to multivariate analysis,EPE was not an independent predictor for survival.Subgroup analyses demonstrated that patients with favorable characteristics,including negative NED or IDC-P status,Eastern Cooperative Oncology Group(ECOG)score<2,and prostate-specific antigen(PSA)<50 ng ml−1,had worse prognoses if EPE was detected.In patients with PSA<50 ng ml−1,EPE was a negative independent predictor for OS(hazard ratio[HR]:4.239,95%confidence interval[CI]:1.218–14.756,P=0.023).EPE was strongly associated with other aggressive clinicopathological features and poorer CFS and OS.These data suggest that EPE may be an indicator of poor prognosis,particularly in patients,otherwise considered likely to have favorable survival outcomes.