Breast-conserving surgery (BCS) has become the most common treatment for breast ductal carcinoma in situ (DCIS).BCS followed by radiotherapy (RT) can reduce the risk of recurrence.However,controversy exists regarding the region of RT,which low-risk patients can avoid RT after BCS,and the role of accelerated partial breast irradiation (APBI) in the treatment of BCS.However,most trials have indicated that all DCIS patients can obtain benefit from RT after BCS.Further prospective studies are warranted to identify whether RT can be safely omitted for low-risk patients with DCIS.Long-term results of ongoing studies on outcome of BCS alone suggest that RT should be routinely recommended after BCS for all patients except those with contraindication.

Neuropathic cancer pain (NCP) arises from physical or chemical damage to peripheral or central neurons or in the neural conduction system.The mechanisms of NCP include pain directly related to tumor involvement,pain associated with chemotherapy,radiotherapy and surgery,neuropathic syndromes associated with paraneoplastic syndromes,inflammation and other factors.A detailed history and careful physical examination are important means of diagnosis of NCP.The clinical evaluation of NCP should use standardized pain assessment scale.Till now,the treatments of NCP include opioid combined with auxiliary analgesic drugs,interventional treatment and gene treatment.Deciding treatment strategies according to the pathogenesis of NCP,multidisciplinary collaboration,combined therapy with different analgesic drugs and technologies are the therapeutic directions for NCP.

Objective:To investigate the clinical efficacy of Neurotropin combined with oxycodone hydrochloride in moderating the severe pain in neuropathic cancer pain (NCP) patients. Methods: NCP patients who received drug therapy with a visual analog scale (VAS) score of>4 were randomly divided into the placebo combined oxycodone group (group A) and Neurotropin combined oxy-codone group (group B). The VAS score, pain relief rate, frequency of pain outbreaks, average dose of oxycodone per day, and adverse drug reactions between the two groups were compared. Results:The VAS scores in groups A and B both had significant reduction after treatment (P<0.05), whereas the VAS score in group B after 14 days of treatment decreased more significantly than that in group A (P=0.03). The pain relief rate in group B patients 14 days after treatment was significantly higher than that in group A (P<0.001). The out-break pain in groups A and B 7 and 14 days after treatment significantly decreased, whereas the outbreak pain in group B was signifi-cantly lower than that in group A (P values were 0.07 and 0.07, respectively). The average dose of oxycodone per day in group B 14 days after treatment was lower than that in group A (P<0.001). Adverse reactions, such as nausea and vomiting, in group B were signifi-cantly less than those in group A (P<0.05). Conclusion:Neurotropin combined with oxycodone can effectively lower the NCP, average dose of oxycodone per day, and adverse reactions.

Objective To observe the clinical effect of treatment of duodenal trauma intubation duodenal decompression jejunostomy jointly by the duodenal catheter decompression.Methods 60 patients with duodenal trauma were randomly divided into two groups,30 cases were treated with simple duodenal catheter decompression as control group,30 cases treated with duodenal catheter decompression joint jejunum ostomy intubation duodenal decompression as the observation group,generally observed two groups of patients surgery and postoperative complications,in the day of surgery and postoperative 7d evaluation of patients with nutritional status.Results The surgical time and blood loss of the two groups had no statistically significant difference(P＞0.05),the observation group had no case of duodenal fistula and four cases in the control group(13.33％)occumed duodenal fistula.The difference between the two groups was statistically significant(x2=4.286,P＜0.05).Postoperative concurrent abdominal abscess,lung infection,wound infection had no statistically significant differences(P＞0.05).After observation group 7d body mass and right upper arm muscle circumference stability was significantly higher than that in the control group(x2=7.519,9.868,both P＜0.05).Conclusion Jejunostomy joint duodenal catheter decompression intubation duodenal decompression in treatment of duodenal trauma surgical decompression had significant effect,can significantly reduce the incidence of fistula,improve patients nutritional status,promote the duodenal wound healing.

Objective To evaluate the clinical efficacy and toxicities of radical intensity-modulated radiotherapy (IMRT) combined with reduction in dose of prophylactic irradiation in the treatment of stage Ⅲ small cell lung cancer (SCLC).Methods A retrospective analysis was performed on the clinical data of 40 patients with stage Ⅲ SCLC who were admitted from January 2010 to August 2012.The prescribed dose was 60 Gy in 30 fractions to the primary gross tumor volume and was 54 Gy in 30 fractions to the planning target volume.All patients received induction chemotherapy,31 patients received adjuvant chemotherapy,and 22 patients received concurrent chemoradiotherapy;the platinum-based chemotherapy combined with etoposide or teniposide was adopted.Prophylactic cranial irradiation (25 Gy in 10 fractions) was administered to 17 patients.The short-term tumor response was evaluated by RECIST 1.0,and radiation-related toxicities were assessed by CTCAE 4.0.Overall survival (OS),local recurrence-free survival (LRFS),and progression-free survival (PFS) were calculated by Kaplan-Meier method.Results The short-term tumor response rate was 98％.The follow-up rate was 100％.Twenty-two patients were followed up for at least 2 years.The 1-and 2-year OS rates were 84％ and 48％,respectively; the LRFS rates were 89％ and 85％,respectively; the PFS rates were 61％ and 41％,respectively.Grade 0-1 radiation-related pneumonia was observed in 65％(26/40) of all patients,grade 2 in 25％ (10/40),grade 3 in 5％ (2/40),and grade 5 in 5％ (2/40).Grade 0-1 radiation-related esophagitis was observed in 53％ (21/40) of all patients,grade 2 in 43％ (17/40),and grade 3 in 5 ％ (2/40).Conclusions Preliminary results from this study suggested that IMRT combined with reduction in dose of prophylactic irradiation is safe and effective in patients with stage Ⅲ SCLC and is worth further evaluation in a large,prospective,randomized study.

Objective To determine the relationship between dietary fiber intake and risk of prostate cancer.Methods Electronic databases including PubMed,EMBase,Cochrane library,China National Knowledge Internet (CNKI),Wanfang and CBMwere searched to find eligible studies.Random-effects relative risk (RR)and its corresponding 95%CI were used.Besides,random-effects dose-response analyses were also performed to clarify the dose-response relations.Results Ten studies,including five cohort studies and five case-control studies,were eligible and included in this Meta-analysis.The pooled RR of prostate cancer for the highest compared with the lowest dietary fiber intake was 0.87 (95%CI:0.77-0.99,Z =2.10,P =0.035). In addition,pooled estimated data showed that risk of prostate cancer was significantly associated with soluble fiber (RR =0.78,95%CI:0.64-0.95,Z =2.45,P =0.014)and insoluble fiber (RR =0.65,95%CI:0.45-0.88,Z =2.79,P =0.005),but not with fruit,vegetable and cereal fiber intake.However,in dose-response analysis,no significant association was reported (RR =0.996,95%CI:0.989-1.002).Sensitivity analysis showed that the overall results were relatively stable,and omission of any single study had little effect on the combined results.Conclusion Dietary fiber intake is negative related to the risk of prostate cancer. Intake of dietary fiber is recommended to prevent prostate cancer.Considering the limitations of the included studies,more well-designed prospective studies will be needed to confirm our findings.

Objective:To evaluate the radiotherapeutic strategy for the treatment of recurrent esophageal cancer after radical re-section and determine relevant prognostic factors. Methods:A total of 66 patients with esophageal carcinoma and exhibited recurrence after radical surgery were retrospectively reviewed from Jan 2007 to Jun 2010. The median interval of recurrence from the initial sur-gery was 10.6 months. Among the 66 patients, 50 suffered from loco-regional recurrences alone, and 16 developed distant metastases in addition to loco-regional recurrences. Among the 66 patients, 10 were treated with radiotherapy after recurrence, 23 were treated with chemotherapy alone, and 33 were treated with radiotherapy combined with chemotherapy. Among the 33 patients, 22 were initially treat-ed with chemotherapy and 11 were initially treated with radiotherapy. The median total dose of the external radiotherapy was 60 Gy with 6 MV X-ray of a linear accelerator. Results:The median survival period after recurrence was 14.3 months (95%CI=12.4~16.2 months). The 1-, 2-, and 3-year survival rates were 61.9%, 25.9%, and 16.5%, respectively. The median survival period after recurrence in the patients who were treated with chemotherapy alone, radiotherapy alone, and radiotherapy combined with chemotherapy were 11.4, 25.5, and 14.3 months, respectively. The patients who developed distant metastases treated with chemotherapy initially showed better survival outcome than those treated with radiotherapy (P=0.032). Univariate analysis results showed the following prognostic factors:tumor location before surgery;operation mode;whether or not recurrence was detected with distant metastases;and therapy af-ter recurrence. Multivariate analysis results showed that tumor location before surgery was an independent prognostic factor. Conclu-sion:Tumor location may indicate prognosis after recurrence. Patients with recurrent esophageal carcinoma and developed distant me-tastases treated with chemotherapy may initially benefit from a longer survival rate.

Objective:To investigate the effect and toxicity of short-course and hypofractionated palliative thoracic radiotherapy (PTR) for advanced non-small cell lung cancer (NSCLC). Methods:A total of 25 patients with stageⅢB and stageⅣNSCLC, who underwent PTR from September 2010 to July 2006, were retrospectively analyzed. The PTR regime was 45 Gy in 15 fractions. Symptom relief, effect, and toxicity after completion of PTR were assessed. Survival was analyzed using the Kaplan-Meier method. Results:Except for one patient who completed only 36 Gy in 12 fractions, all other patients completed all plans. The thoracic symptoms of 18 patients were relieved. The response rates for the five main symptoms were:hemoptysis 87.5%(7/8), cough 70.6%(12/17), pain 73.3%(11/15), dyspnea 57.1%(8/14), and hoarseness 50%(1/2). The complete response and partial response after PTR was 28%, and no grade 3 or higher toxicities occurred. The median time of overall survival (OS) is 13 months (95%CI:6.6 months to 19.5 months), and one-year OS is 51.5%. According to the univariate analysis, KPS before PTR, the number of post-PTR was significantly related to the survival. Conclusion:For advanced NSCLC patients, the PTR regime given as 45 Gy in 15 fractions evidently relieved thoracic symptoms, improved OS, and shortened treatment time. Recent relevant adverse radiotherapy reactions are low, and more prospective clinical studies must be conducted.

Objective:This study aims to analyze the relationship between the effect of induction chemotherapy and the timing of radiotherapy in limited-disease or limited-stage small-cell lung cancer (LSCLC). Methods: Data from 148 LSCLC patients who re-ceived induction chemotherapy and radiotherapy between January 2009 and December 2012 were retrospectively analyzed. The effect of two to three cycles of induction chemotherapy was evaluated according to the RECIST version 1.1, which includes complete re-sponse (CR), partial response (PR), stable disease, and progressive disease. CR and PR were used to calculate response rate. The pa-tients were divided into early and late groups based on immediate radiotherapy after two to three cycles of induction chemotherapy. The survival rate was analyzed using the Kaplan-Meier method. Log-rank test and Cox regression model were used to evaluate the influenc-ing factors of the survival rate. Results: The median overall survival (OS) and progression-free survival (PFS) were 22.8 and 13.0 months, respectively. The early and late radiotherapy groups exhibited OS of 34.0 and 18.0 months, respectively, and corresponding PFS of 16.8 and 10.9 months. In the subgroup analysis, for the patients who responded to the induction chemotherapy, the early and late radiotherapy groups showed median OS of 18.0 and 19.5 months, respectively, and corresponding PFS of 19.4 and 11.7 months. For the patients who had no response to the induction chemotherapy, the early and late radiotherapy groups exhibited median OS of 18.0 and 9.5 months, respectively, and corresponding PFS of 12.4 and 10.3 months. Conclusion:All LSCLC patients who received two to three cycles of induction chemotherapy should receive radiotherapy as soon as possible after chemotherapy, regardless of their response to the induction chemotherapy.

Objective To explore the risk factors of the occurence and 28-day death of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU). Methods A prospective multicentral cohort study was conducted. The patients from five ICUs of grade A tertiary hospitals in Beijing from July 2009 to March 2014, including sepsis,septic shock,trauma,pneumonia,aspiration,massive blood transfusion,bacteremia and pulmonary contusion,were enrolled. Researchers in each center reported the records with uniform tables,which included demographic,systemic conditions,the primary disease,and the severity within 24 hours,past history and so on. According to the admission diagnosis in ICU,these patients were divided into ARDS group and other severe disease control group. The risk factors of occurence and prognosis of ARDS were analyzed by univariate analysis,multivariate logistic regression and multivariate COX regression analysis. Kaplan-Meier method was applied to draw the 28-day survival curves of the two groups. Results There were 343 critical patients included in this prospective multicenter cohort study,of which 163 patients who developed ARDS were considered as ARDS group(2 case lost to follow-up, and 49 died)and 180 patients who did not developed ARDS regarded as severe control group(1 case lost to follow-up, and 34 died). The 28-day mortality of ARDS group was significantly higher than that of severe control group〔30.43%(49/161)vs. 18.99%(34/179),χ2=6.013,P=0.014〕. Multivariate logistic analysis showed that aspiration〔odds ratio(OR)=6.390,95% confidence interval(95%CI)=2.046-19.953,P=0.001〕,history of alcohol (OR=4.854,95%CI=1.730-13.617,P=0.003),sepsis(OR=2.859,95%CI=1.507-5.425,P=0.001), pneumonia(OR=2.822,95%CI=1.640-4.855,P<0.001),acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score(OR=1.050,95%CI=1.007-1.094,P=0.022)were significantly associated with increased risk of ARDS occurence. When respiratory rate>30 beats/min(OR=3.305,95%CI=1.910-5.721,P<0.001), heart rate>100 beats/min(OR=2.101,95%CI=1.048-4.213,P=0.037)happened in critically ill patients, it highly suggested ARDS would happen. The proportion of the patients whose serum creatinine>176.8 μmol/L in ARDS group was lower than that in control group(OR=0.387,95%CI=0.205-0.733,P=0.004). Multivariate COX regression analysis showed that old age and septic shock were significantly associated with the increased risk of in 28-day death of ARDS〔advanced age:hazard ratio(HR)=1.040,95%CI=1.018-1.064,P<0.001;septic shock:HR=3.209,95%CI=1.676-6.146,P<0.001〕. Kaplan-Meier showed that the survival patients in ARDS group was significantly lower than those in severe control group(χ2=7.032,P=0.008). Conclusions Among critical ill patients,aspiration,history of alcohol,sepsis,pneumonia,increased APACHEⅡ score were the risk factors of ARDS development. Respiratory rate>30 beats/min and heart rate>100 beats/min could predict the occurrence of ARDS in critical patients. Old age and septic shock were the risk factors of 28-day death of ARDS.