Objective To investigate the efficacy and toxicity of thalidomide plus irinotecan and cisplatin treatment for recurrent small cell lung cancer.Methods 62 Patients with recurrent small cell lung cancer in the same period were randomly divided into observation group and control group according to the principle of minimum distribution imbalance index.The observation group patients were treated with thalidomide plus irinotecan and cisplatin chemotherapy,and the control group patients were treated with irinotecan and cisplatin chemotherapy.The efficacy and toxicity of the two groups were compared.Results The overall response rate in the group observation was 86.7％ compared with 63.3％ in the control group,and the difference had statistical significance (x2 =8.52,P ＜ 0.05).The major toxicities were hematologic toxicity and gastrointestinal symptoms,and the side effects differences were not statistically significant (x2 =0.18,P ＞ 0.05).Conclusion The treatment of recurrent small cell lung cancer with irinotecan and cisplatin in combination with thalidomide has high efficiency,and the toxicity can be tolerated.

Objective To explore the ultrasonographic method in fetal coronary sinus (CS) dilation.Methods Totally 145 normal fetuses (normal group) and 72 fetuses of CS dilation (CS group) diagnosed prenatally were retrospectively reviewed.The long axis of coronary sinus was displayed in the non-standard four chamber view and the area of the sagittal view of CS was measured.Transverses scans combined with color Doppler were used to acquire four chamber view,left and right ventricular outflow tract views,three vessel view.In addition,sagittal scans with color Doppler were used to get short-axis view at the level of great arteries,vena cava long axis view,aortic arch view,and ductal arch view.The characteristics of CS were observed.Results CS area of sagittal view was positively correlated with gestational age (normal group:r=0.954,P＜0.05;CSgroup:r=0.904,P＜0.05).In the samegestational weeks,the CS area of the sagittal view in the normal group was less than that in the CS group (all P＜0.01).In CS group,52 fetuses were persistent left superior vena cava,15 fetuses were total anomalous pulmonary venous connection,5 fetuses were associated with right heart pressure overload.Conclusion Fetal CS sagittal section area is positively correlated with gestational age.When the fetal heart ultrasonography found CS dilation,other intracardiac malformations should also be considered.The etilogies of CS dilation should be analyzed clinically through multi-slice,multi-angle scanning.

Objective To analyze the abnormal fetal ductus arteriosus (DA) by echocardiography.Methods Seventy fetuses of abnormal DA diagnosed prenatally were retrospectively reviewed.Transverse scans combined with color Doppler were used to acquire four chamber view,left and right ventricular outflow tract views,three vessel view,and three-vesseltrachea view.In addition,sagittal scans with color Doppler were used to get vena cava long axis view,aortic arch view,and ductal arch view.The spatial relationship of the great arteries and trend of DA were observed.Results Abnormal fetal DA is mainly composed of DA absence,DA abnormal function and DA morphological abnormality.Among 70 cases of fetal DA,9 cases were diagnosed with DA absence,8 cases were DA atresia,11 cases were DA completed closure nearly,9 cases were shown with reverse DA blood perfusion,33 cases were shown with DA curvature and dilatation.Conclusion Prenatal diagnosis of DA absence and DA abnormal function is of great significance.Three-vessel-trachea view and ductal arch view combined with CDFI can make a definitive diagnosis.

Objective To analyze the current status of studies related to home enteral nutrition (HEN) in China,and provide scientific basis for the research and management of HEN in China.Methods We searched CNKI and WanFang Data since it built to January 1st,2018.The included studies were screened and categorized by publication information,study type,subjects of the study,topic,interventions and outcomes.Descriptive analysis was conducted after extraction of information.Results A total of 153 studies were included,of which 37 were observational studies,102 were experimental studies,12 were case report,and 2 were exploring articles.Since 2012,the number of studies has been increasing.Most of the subjects were elderly people who were diagnosed with diseases of digestive system,head and neck tumors and diseases of nervous system.These studies were featured as small sample size and short intervention time,follow-ups by telephone and home visit,less than 1/4 providing professional nutrition support team,and outcomes mainly as complication,nutritional biochemical indices,anthropometric indices and prognosis.Conclusion HEN in China is still in its infancy.The number of relative studies is still small and quality of literatures is very low,but it has been increasing.At present,there are some problems in the implementation of HEN in China,such as lack of standardized management model and professional team,short-term intervention,and single follow-up mode.The elderly and patients with digestive disease,head and neck tumors and nervous disease are the key subjects;more professional nutrition support team and scientific management model should be established in the future.

Objective:To investigate the correlation between the methylation and expression of Runt associated transcription factor 2 (RUNX2) gene in peripheral blood and sensitivity to neoadjuvant chemotherapy in breast cancer.Methods:90 female breast cancer patients who received full-course neoadjuvant chemotherapy and surgical resection for the first time in our hospital from Jan. 2021 to Jun. 2022 were included as the study objects, and 90 healthy women who underwent physical examination in our hospital during the same period were included as the control group. The methylation level of RUNX2 gene in peripheral blood of all subjects was detected by sulfite conversion method, and the mRNA expression level of RUNX2 gene in peripheral blood was detected by fluorescence quantitative PCR. The effects of neoadjuvant chemotherapy in breast cancer patients were divided into sensitive and insensitive groups.Results:The positive rate of RUNX2 gene methylation in peripheral blood of breast cancer patients was 41.11% (37/90) , significantly lower than that of the control group (64.44% (58/90) , the difference was statistically significant ( χ2=9.830, P=0.002) . The mRNA expression level of RUNX2 gene in peripheral blood of breast cancer patients was 1.73±0.24, which was significantly higher than that of the control group (1.19±0.18) , and the difference was statistically significant ( t=5.221, P<0.001) . The mRNA expression level of RUNX2 methylation-positive patients in peripheral blood of breast cancer patients was 1.26±0.20, significantly lower than that of RUNX2 methylation-negative patients (1.84±0.26) , and the difference was statistically significant ( t=4.981, P<0.001) . The positive rate of RUNX2 gene methylation was 49.28% (34/69) in patients with sensitivity to neoadjuvant chemotherapy, significantly higher than 14.29% (3/21) in patients with insensitive chemotherapy, and the difference was statistically significant ( χ2=8.142, P=0.004) . The mRNA expression level of RUNX2 gene in peripheral blood of neoadjuvant chemotherapy sensitive patients was 1.62±0.17, which was significantly lower than that of insensitive patients (2.09±0.22) , and the difference was statistically significant ( t=5.283, P<0.001) . The ROC curve showed that the sensitivity and specificity of RUNX2 mRNA expression in peripheral blood to predict the effect of neoadjuvant chemotherapy were 85.7% and 85.5%, respectively. Conclusion:The methylation and expression level of RUNX2 gene in peripheral blood are related to the sensitivity of neoadjuvant chemotherapy in breast cancer, and can be used as a marker to predict the efficacy of neoadjuvant chemotherapy in breast cancer.

Objective:To investigate the value of serum miR-145 and matrixmetallo proteinase-2 (MMP-2) levels in predicting pathologic complete response (pCR) after neoadjuvant chemotherapy in triple-negative breast cancer.Methods:125 patients with triple-negative breast cancer who received neoadjuvant chemotherapy in the Hospital from Jan. 2022 to Dec. 2023 were prospectively included as the study objects, and 130 healthy people matching the age of the case group who underwent physical examination in our hospital during the same period were included as the healthy control group. Real-time fluorescence quantitative polymerase chain reaction was used to detect the serum miR-145 level of all subjects. Serum MMP-2 levels were determined by enzyme-linked immunosorbent assay (ELISA). After neoadjuvant chemotherapy, patients were evaluated according to Miller-Payne (MP) grading criteria and divided into pCR group and non-PCR group.Results:The serum miR-145 level in patients with tertiary breast cancer was 1.49±0.27, which was significantly lower than that in healthy control group (2.79±0.49), with statistical significance ( t=20.33, P<0.001). The serum MMP-2 level in triple negative breast cancer patients was (153.07±38.36) ng/mL, which was significantly higher than that in healthy control group (84.38±12.63) ng/mL, and the difference was statistically significant ( t=26.13, P<0.001). After neoadjuvant chemotherapy, the serum miR-145 level in non-PCR patients before treatment was 1.36±0.21, which was significantly lower than that in pCR group (1.74±0.20), with statistical significance ( t=9.93, P<0.001). After neoadjuvant chemotherapy, the serum MMP-2 level in non-PCR patients before treatment was (169.57±30.45) ng/mL, which was significantly higher than that in pCR group (121.61±31.79) ng/mL, and the difference was statistically significant ( t=8.24, P<0.001). Pearson correlation analysis showed that there was a significant negative correlation between serum miR-145 and MMP-2 levels in patients with triple-negative breast cancer before treatment ( r=-0.47, P<0.001). ROC curve analysis results showed that serum miR-145 and MMP-2 levels before treatment predicted the sensitivity and specificity of pCR after neoadjuvant chemotherapy for triple-negative breast cancer were 82.9% and 74.4%, 45.1% and 99.8%, respectively. The sensitivity and specificity of pCR after neoadjuvant chemotherapy for triple-negative breast cancer were 84.1% and 88.4%, respectively. Conclusion:Serum miR-145 and MMP-2 levels are related to the efficacy of neoadjuvant chemotherapy in patients with triple-negative breast cancer, and the combined application of the two has certain predictive value.

Objective:To investigate the changes and clinical significance of vascular endothelial growth factor (VEGF) and vascular cell adhesion molecule-1 (VCAM-1) levels in patients undergoing breast cancer resection before and after radiotherapy.Methods:A total of 110 patients who were treated in our hospital from Jun. 2022 to Jun. 2023 for breast cancer and were to receive radiotherapy after surgery were prospectively selected as the observation group. Another 110 healthy volunteers were selected as the control group. The levels of VEGF and VCAM-1 in peripheral blood were compared, and the relationship among general data, tumor pathology and peripheral blood VEGF and VCAM-1 in the observation group was analyzed, and their relationship with disease and prognosis was analyzed.Results:VEGF and VCAM-1 levels in peripheral blood in the observation group were significantly higher ( F=1288.37, 309.32, P<0.05). The levels of VEGF and VCAM-1 in peripheral blood in the observation group were significantly lower than before radiotherapy ( t=23.45, 11.88, P<0.05). Before and after radiotherapy, VEGF and VCAM-1 levels in peripheral blood in the observation group were correlated with tumor stage, tumor differentiation degree and Ki-67 proliferation index ( ttumor stage=7.05, 2.14, 4.52, 4.76, ttumor differentiation degree=7.12, 6.62, 2.81, 3.15, tKi67 proliferation index=7.25, 4.60, 4.24, 2.48, P<0.05) ; Of 110 patients in the observation group, 73 were effective and 34 were ineffective. VEGF and VCAM-1 in effective group were significantly lower ( t=7.27, 9.08, P<0.05). Spearman correlation coefficient analysis showed that VEGF and VCAM-1 levels were significantly positively correlated with tumor stage and Ki67 proliferation index before and after radiotherapy ( rbefore radiotherapy=0.64, 0.54, 0.52, 0.52, rafter radiotherapy=0.32, 0.39, 0.37, 0.24, P<0.05), and negatively correlated with tumor differentiation degree ( rbefore radiotherapy=-0.41, -0.31, rafter radiotherapy=-0.68, -0.41, P<0.05). The prognostic value of combined radiotherapy was 0.801 [95% CI (0.714-0.871) ], which was higher than that of VEGF and VCAM-1 alone 0.690 [95% CI (0.5955-0.775) ] and 0.734 [95% CI (0.641-0.814) ]. Conclusion:The changes of VEGF and VCAM-1 levels in peripheral blood have a certain value in evaluating the short-term prognosis of patients undergoing breast cancer resection by radiotherapy.

Objective:To analyze the X-ray imaging characteristics of calcaneus in adult patients with osteoarticular diseases and its impact on disease diagnosis.Methods:Totally 78 patients (156 ankle joints) with osteoarticular diseases admitted to the Affiliated Hospital of Jining Medical University from June 2019 to June 2022 were selected as research subjects, including 72 cases of osteoarthritis and 6 cases of Kashin-Beck disease. Another 50 volunteers who underwent health examination in this hospital during the same period were selected as control group, all of them underwent calcaneal X-ray examination. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of calcaneal X-ray parameters in predicting adult osteoarticular diseases.Results:Among 72 patients with osteoarthritis, 63 cases (87.50%) showed joint surface sclerosis in the calcaneal X-ray changes. Forty-seven cases (65.28%) had narrowing of the subtalar joint space; 14 cases showed disappearance of the subtalar joint space, accounting for 19.44%. Among the 6 patients with Kashin-Beck disease, the X-ray changes of the calcaneus showed joint surface sclerosis in 6 cases, narrowing of the subtalar joint space in 4 cases, and disappearance of the subtalar joint space in 2 cases. The length, height, Bohler angle, Gissane angle, and inclination angle of the calcaneus in patients with Kashin-Beck disease were all smaller than those in the osteoarthritis group and the control group, the height to length ratio of the calcaneus was higher than that in the osteoarthritis group and the control group, and the difference was statistically significant ( P < 0.05). The length, height, Bohler angle, Gissane angle, and inclination angle of the calcaneus in patients of the osteoarthritis group were all smaller than those in the control group, and the height to length ratio of the calcaneus was higher than that in control group, and the difference was statistically significant ( P < 0.05). ROC curve analysis showed that the sensitivity of Bohler angle, Gissane angle, and the height to length ratio of the calcaneus in predicting osteoarticular diseases (72 patients with osteoarthritis) were 92.5%, 87.6% and 80.4%, respectively, with specificity of 73.0%, 68.8% and 63.1%, respectively. Conclusion:The calcaneal X-ray manifestations of adult patients with osteoarticular diseases vary greatly, among which Bohler angle, Gissane angle, and height to length ratio of the calcaneus have certain accuracy in diagnosis of osteoarthritis.

Objective:To investigate the clinical efficacy, quality of life, safety, and medical expense of second-line treatment with ametinib versus first-line treatment with oxitinib in patients with advanced non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. Methods:This is a prospective clinical research study. A total of 72 patients with NSCLC who received second-line treatment with ametinib at the Affiliated Hospital of Jining Medical University from July 2020 to April 2022 were included in the amitinib group. Sixty-six patients with advanced NSCLC harboring EGFR mutations who underwent first-line treatment with ositinib were included in the ositinib group (one patient dropped out of the study, and sixty-five patients were included in the final analysis). There was no statistically significant difference in general information between the two groups. The ositinib group received ositinib treatment, while the amitinib group received amitinib treatment. After three courses of treatment, the short-term effectiveness was evaluated in both groups. The quality of life was compared before and after three courses of treatment in each group. Adverse reactions and average per-day hospital cost were compared between the two groups.Results:The disease control rate in the amitinib and oxitinib groups were 91.67% (66/72) and 90.77% (59/65), respectively, while the overall response rate was 43.06% (31/72) and 41.54% (27/65), respectively. The disease control rate and overall response rate did not differ significantly between the two groups (both P > 0.05). After treatment, the scores for physical well-being [(21.05 ± 4.18) points vs. (19.16 ± 3.95) points, t = 4.05], social/family well-being [(19.38 ± 2.65) points vs. (17.26 ± 2.28) points, t = 3.11], emotional well-being [(18.83 ± 3.07) points vs. (17.00 ± 2.86) points, t = 3.20], functional well-being [(22.02 ± 3.83) points vs. (20.14 ± 2.98) points, t = 3.83], and additional attention [(26.11 ± 5.00) points vs. (24.33 ± 4.30) points, t = 3.05] in the amitinib group were significantly higher than those in the oxitinib group (all P < 0.05). There was no significant difference in incidence rate of grade 3-4 adverse reactions between amitinib and oxitinib groups [6.94% (5/72) vs. 10.77% (7/65), P > 0.05]. Average per-day hospital cost in the amitinib group was significantly lower than that in the oxitinib group ( t = 4.83, P < 0.05). Conclusion:Second-line treatment with ametinib for advanced NSCLC harboring EGFR mutations can significantly enhance the quality of life and offer comparable short-term efficacy and safety to first-line treatment with oxitinib. Advantageously, its medical cost is relatively lower.

Myelodysplastic syndrome (MDS) is a malignant hematologic tumor, which is currently difficult to cure. The theory of Xuanfu was proposed by Liu Wansu, which is unique in the clinical evidence of Chinese medicine and is less frequently applied to hematological diseases. The application of Xuanfu theory in myelodysplastic syndrome provides new ideas for the treatment of the disease. The abnormal flow of Qi, blood and fluids caused by the occlusion of the Xuanfu is the cause of toxic stasis obstruction, which is the pathogenesis of toxic stasis obstruction. Thus, the method of dispersion of Bone from Xuanfu, the external treatment of Xuanfu, and regulation of liver qi and Xuanfu help to return to normal of opening and closing function of Xuanfu, and release toxic stasis. In this paper, we analyzed the evidence of toxin-stasis obstruction in myelodysplastic syndrome from the theory of Xuanfu, aiming to provide a feasible theoretical basis for clinical treatment of the disease.