Background: In Mainland China, the advance directives (ADs) and end-of-life care of patients with tumours, especially patients with brain tumours who may have lost consciousness or the ability to speak at the early stage of their illness, have been poorly acknowledged. Thus, this study aims to clarify the knowledge and preferences of the ADs and end-of-life care of patients with brain tumours and to investigate the predictors of patients’ preferences.Methods: This was a population-based cross-sectional survey that was conducted via face-to-face interviews. Information on the sociodemographic factors, brain tumour illness, knowledge and preferences of the advance decisions and end-of-life care of the patients were collected.Results: A total of 88.61% of the participants had never heard of ADs, but 65.18% would like to make ADs. Knowledge of ADs, receiving surgical treatment or radiotherapy, less than 70 years old, male, educational qualifications of college or beyond, childless, had medical insurance for nonworking or working urban residents and self-payment of medical expenses were predictors of preference for making ADs. A total of 79.43% participants would like to discuss end-of-life arrangements with medical staff, and 63.29% of participants were willing to receive end-of-life care although it could not delay death. A total of 65.82% patients with brain tumours wanted resuscitation, and as high as 45.45% of the patients thought that they did not need life support if they were in a persistent vegetative state. Brain primary tumours, ages of less than 70 years old, male, educational qualification of junior middle school or below, had children, had new rural cooperative medical insurance and had medical expenses paid by children or spouses were predictors of choosing appropriate palliative care.ConclusionsADs and end-of-life care have been poorly acknowledged amongst patients with brain tumours in mainland China. Additional efforts should be encouraged amongst patients with primary brain tumours, those are undergoing surgery and radiotherapy and those who have low socioeconomic status. A longitudinal and comprehensive study is encouraged to promote a disease-specific ADs amongst Chinese patients with brain tumours.

Although several different techniques have been proposed by leading centers across the world, no consensus has been reached on the safest treatment modality due to poor clinical outcomes (12,(14)(15)(16). We present our experience in treating BBLAs with stent-assisted coil embolization.

Rationale: The differential diagnosis of conditions manifesting as bone and joint pain is complex. Although many individuals with acute leukemia experience bone pain, lumbosacral pain as an early feature of acute lymphoblastic leukemia (ALL) is rare. Patient concerns: Here we report a case of an adult who presented with a 7-month history of persistent lumbosacral pain which had become more severe during the previous month. Diagnoses: Prior to referral, his full blood count revealed no abnormalities, and a computerized tomography scan revealed mild bone hyperplasia of his lumbar vertebrae, with disc herniations of L3–S1. His blood biochemistry and urinary test results had been normal. After referral to our clinic, tests of the morphology, immunology, cytogenetics, and molecular biology of his bone marrow led to a diagnosis of MLL-AF4 fusion positive B-cell ALL. Interventions: Prior to his referral, he had been treated with painkillers by local doctors. The painkillers initially provided pain relief, but their effect wore off over time. After diagnosis, he was started on an adult ALL chemotherapy protocol. Outcomes: His symptoms resolved within a week of starting chemotherapy. At his most recent assessment, 10 months after diagnosis, he was on maintenance chemotherapy and in remission. Lessons: This case illustrates that prolonged lumbosacral pain may be a symptom of a life-threatening condition, rather than only attributable to chronic inflammation or disk herniations. Therefore, clinicians need to pay attention to subtle differences in the clinical presentation of patients with lumbosacral pain.

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Abstract Background: In Mainland China, the advance directives (ADs) and end-of-life care of patients with tumours, especially patients with brain tumours who may have lost consciousness or the ability to speak at the early stage of their illness, have been poorly acknowledged. Thus, this study aims to clarify the knowledge and preferences of the ADs and end-of-life care of patients with brain tumours and to investigate the predictors of patients’ preferences.Methods: This was a population-based cross-sectional survey that was conducted via face-to-face interviews. Information on the sociodemographic factors, brain tumour illness, knowledge and preferences of the advance decisions and end-of-life care of the patients were collected.Results: A total of 88.61% of the participants had never heard of ADs, but 65.18% would like to make ADs. Knowledge of ADs, receiving surgical treatment or radiotherapy, less than 70 years old, male, educational qualifications of college or beyond, childless, had medical insurance for nonworking or working urban residents and self-payment of medical expenses were predictors of preference for making ADs. A total of 79.43% participants would like to discuss end-of-life arrangements with medical staff, and 63.29% of participants were willing to receive end-of-life care although it could not delay death. A total of 65.82% patients with brain tumours wanted resuscitation, and as high as 45.45% of the patients thought that they did not need life support if they were in a persistent vegetative state. Brain primary tumours, ages of less than 70 years old, male, educational qualification of junior middle school or below, had children, had new rural cooperative medical insurance and had medical expenses paid by children or spouses were predictors of choosing appropriate palliative care.Conclusions：ADs and end-of-life care have been poorly acknowledged amongst patients with brain tumours in mainland China. Additional efforts should be encouraged amongst patients with primary brain tumours, those are undergoing surgery and radiotherapy and those who have low socioeconomic status. Appropriate decision-making timing is encouraged to promote AD amongst Chinese patients with brain tumours.

Background: This study aimed to investigate the effects of a high-and low-sodium diets on lithogenesis in a rat experimental model of calcium oxalate stones.Methods: Twenty male Wistar rats were randomly divided into four groups; group A: 4% NaCl+1% ethylene glycol (EG); group B: 8% NaCl+1% EG; group C: 8% NaCl+normal drinking-water; group D: 1% EG +normal diet. All rats were sacrificed 4 weeks later, and blood samples were collected from the heart.The kidneys were collected for Von Kossa staining to evaluate the formation of calcium-containing crystals.The last 24-h urine samples were also gathered for metabolic analysis.Results: Von Kossa staining demonstrated that the rats in both group A and group B had significantly more renal calcium crystals than those in group D. However, 24-h urinary volume increased significantly (142.26±20.91 mL) in group B compared with group A (100.52±28.23 mL), group C (107.36±14.24 mL), group D (40.79±8.71 mL) (P=0.004, 0.012, and 0.000 respectively). Level of urine sodium (Na), potassium (K), chlorine (Cl), and calcium (Ca), urea nitrogen were significantly higher in group B compared with group D. The urine phosphorus, oxalate, and creatinine levels; urine specific gravity; and urine PH were similar between group B and group D. The level of serum sodium was higher in group B (151.26±4.06 mmol/L) compared with group D (145.56±1.12 mmol/L) (P=0.002).Conclusions: A high sodium intake might increase the risk of lithogenesis in susceptible individuals (given by EG) or in individuals with water restriction.

Background: Intracranial vertebral artery dissection aneurysms (VADAs) may cause acute ischemia or hemorrhage, in which case urgent endovascular treatment will be needed. Although the majority of patients obtain a good functional outcome after surgery, a surprising finding has been a poor quality of life (QOL) in follow-up. The purpose of this study was to evaluate clinical efficacy in reconstructive endovascular therapy for acute intracranial VADAs and to analyze the factors contributing to subsequent QOL. Methods: In this prospective study, 33 consecutive VADA patients with subarachnoid hemorrhage were recruited for comparison with 37 VADA patients with posterior circulation cerebral ischemia. All VADA patients were treated using a reconstructive strategy. Clinical, radiological, neurological, and cognitive data, as well as QOL, were assessed at admission and 6 months after surgery. Stoke Specific Quality of Life (SS-QOL) was evaluated for patients with good functional outcome [modified Ranking Scale (mRS) scoring 0-2] for subgroup analysis. Predictors for QOL at follow-up were analyzed by regression model. Results: Immediate angiography after surgery showed complete VADA obliteration in 57 (81.4%) patients and partial obliteration in 13 (18.6%) patients. Three (4.3%) cases suffered from perioperative complications, comprising two cases of stent thrombosis in the hemorrhagic group and one case of posterior inferior cerebellar artery occlusion in the ischemic group. Twenty-five (75.8%) patients in the hemorrhagic group and 30 (81.1%) patients in the ischemic group had a favorable outcome (mRS scoring 0-2) at 6-month follow-up. Follow-up angiography displayed that one case of recurrence occurred separately in both groups. Fifteen of the 33 hemorrhagic patients (45.5%) and 19 of the 37 ischemic patients (51.4%) rated QOL at follow-up as bad (SS-QOL score ≤ 3.9) despite a good functional outcome. Severity of neurological disorder and impaired neurocognition at baseline in VADA patients are proved to be independent predictors for the decline of QOL according to regression analysis. Conclusion: Reconstructive endovascular therapy for acute intracranial VADAs is a safe and effective method with a low complication rate. VADAs lead to impaired QOL Gao et al. Quality of Life in VADAs Reconstructive Therapy at 6-month follow-up, which is attributable to multiple factors. This study demonstrated that neurological and cognitive status at baseline is of significant importance for QOL after VADAs.

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