Objective To evaluate the effects of the modified opration of benign tumor in parotid gland on the prevention of Frey syndrome.Methods the Parotid benign tumor resection in 28 cases were selected,according to the different treatment methods were divided into observation group of 12 cases,16 cases of the control group.The modified surgical patients in the observation group,two flap method,preservation,preservation of parotid masseter fascia in the branches of the great auricular nerve and parotid region resection,the control group was treated by routine tumors of the parotid gland and parotid superficial lobectomy or resection.Patients were followed up for 6 months to 1 years,underwent minor test,the incidence of Frey syndrome in 2 cases were recorded,postoperative incidence of Frey syndrome were compared.Results The incidence of Frey syndrome in the observation group was significantly reduced compared with the control group.The difference was statistically significant (χ2 =7.479,P <0.05 ). Conclusion The effects of modified opetation combined with secondry disc method in benign tumor of parotid gland on the prevention of Frey syndrome has obvious advantages comparing with the control.

OBJECTIVETo study the morphologic classification and its clinical significance of giant left atrium (GLA) combined with mitral valvular disease.

METHODSBetween January 1993 and December 1999, a total of 62 consecutive patients with mitral valvular disease, whose preoperative left atrial endodiastolic volume index >/= 300 ml/m(2) or endosystolic diameter >/= 6.0 cm, were enrolled as research candidates. Morphologically, GLA was classified by Q Hierarchical cluster analysis according to the right or left side cardiothoracic ratio of the left atrium (r- or l-LATR) on an anteroposterior chest roentgenogram and the ratio of the distant diameter of the left main bronchus to the approximate diameter of the left main bronchus (LBDd/Dp) or to the trachea (LB/TR) on an left anterior oblique chest roentgenogram.

RESULTSAccording to r-LATR and l-LATR, the morphology of GLA was classified clinically into three types: type L (l-LATR >/= 0.6 and r-LATR < 0.58), type R (r-LATR >/= 0.58 and l-LATR < 0.6) and type B (r-LATR >/= 0.58 and l-LATR >/= 0.6). According to LBDd/Dp and LB/TR, GLA in type L and B was further classified into two subtypes, respectively: left posterior downward type (L(I) and B(I)), in which LBDd/Dp is equal or exceeds 0.38 or LB/TR is equal or exceeds 0.33, and left posterior upward type (L(II) and B(II)), in which LBDd/Dp is less than 0.38 or LB/TR less than 0.33.

CONCLUSIONThe morphologic classification of GLA may represent the main pathophysiological changes of GLA and might be a guideline for the selection of the optimal plication procedures of GLA in patients with valve diseases.

Adolescent ; Adult ; Cardiomegaly ; pathology ; Female ; Heart Atria ; pathology ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency ; pathology ; Mitral Valve Stenosis ; pathology

Pancreaticoduodenectomy (PD) is an established surgical treatment for pancreatic and periampullary diseases. Abdominal drainage after PD has been routinely used for many years to early detect complications and to promote rapid recovery of patients. However, with the introduction of enhanced recovery after surgery, controversies exist on the safety and effectiveness of routine use of abdominal drainage after PD. This article reviewed the controversies on whether routine abdominal drainage are necessary after PD, how to place abdominal drains, and when to remove abdominal drains.

Objective To evaluate the clinical efficacy and safety of simultaneous enhanced accelerated radiation therapy for brain metastases (SMART-Brain) combined with functional area protection. Methods SMART-Brain was planned for 60 patients with multiple brain metastases. Using the whole brain intensity modulation technique, important functional areas such as hippocampus were protected against irradiation by delivering a dose of 30 Gy in 10 fractions. Meanwhile, a high dose of 40 Gy was delivered to brain metastases in 10 fractions. All patients were followed up to evaluate the efficacy, incidence of adverse reactions, median overall survival (OS), and intracranial progression-free survival (IPFS). Results The effective rate was 73.33% (44 cases), the disease control rate was 91.67% (55 cases), median OS was 15.2 months, and IPFS was 12 months. The 1 and 2-year OS was 66.7% and 26.4%, and the 1-year IPFS was 46.7%. The MMSE scores at 1, 3, and 6 months after SMART showed no significant differences compared with baseline scores (P > 0.05). Grade 2 and above inner ear damage such as otitis media, hearing loss, and dizziness was absent. Conclusion Smart-Brain can significantly reduce the treatment time and better protect the organs at risk, and serves as an economical, safe, and effective radiotherapy regimen in areas with limited technical conditions.

Objective To investigate the effect of couch rotation angle on non-coplanar static intensity-modulated radiotherapy (IMRT) plan for gastric cancer and to provide a reference for clinical planning. Methods A retrospective analysis was conducted on patients who recently underwent postoperative IMRT for gastric cancer. Twenty patients who received radiotherapy in the centre of Radiation Oncology of Huanggang Central Hospital from August 2022 to January 2023 were selected. That were selected to receive a seven-field coplanar static IMRT plan based on a couch rotation angle of 0° as the control group. Then, based on the coplanar IMRT plan, only the couch rotation angle of gantry angles 30° and 330° was changed to 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, and 90°, respectively, and nine different non-coplanar plans were established. The homogeneity index (HI), conformity index (CI) of the target volume, and monitor unit (MU), as well as D_mean, V₂₀, and V₃₀ of the left and right kidneys, D_max, D_mean, V₁₀, V₂₀, and V₃₀ of the spinal cord, and D_max, D_mean, V₁₀, V₂₀, V₃₀, and V₄₀ of the small intestine and liver were compared among the 10 plans. The MU and the dosimetric parameters of the target volumes and When the couch rotation angle was 60°, the minimum HI and maximum CI of the target volume were 0.0714±0.0089 and 0.9271±0.0108, respectively, and the minimum MU was 438±26, with the best homogeneity and conformity in the target volume and the shortest machine treatment time (P＜0.05). When the couch rotation angle was 10°, the D_max of the small intestine was lowest, being (4620.73±99.27) cGy. When the couch rotation angle was 60°, the D_mean of the left and right kidneys was lowest, being (1246.30±130.35) cGy and (1001.52±103.33) cGy, respectively; the V₂₀ of the left and right kidneys was lowest, being 22.87±6.29 and 19.69±1.84, respectively; the V₁₀ and V₃₀ of the spinal cord were lowest, being 40.08±4.92 and 1.68±0.34, respectively (P＜0.05). Conclusion The couch rotation angle has some influence on the postoperative treatment planning for patients with gastric cancer. In the design of non-coplanar plan for gastric cancer, the couch rotation angle of 60° contributes to establishing a better radiotherapy plan.

Objective To investigate the short-term efficacy of celiac plexus block combined with the interstitial permanent implantation of ¹²⁵I seeds in the treatment of advanced pancreatic cancer (inoperable locally advanced and metastatic pancreatic cancers). Methods A total of 100 patients with advanced pancreatic cancer were selected and treated with celiac plexus block combined with the interstitial permanent implantation of ¹²⁵I seeds under CT guidance. Pain relief and changes in the tumor marker CA19-9 were assessed on the seventh day, the first and third months after surgery. In the third month after surgery, tumor size was assessed by CT. Results Among the 100 patients with advanced pancreatic cancer, complete response (CR) was found in 12 cases, partial response (PR) in 78 cases, stable disease in five cases, and progression of disease in five cases three months after surgery. The CA19-9 level and the sum of short and long tumor diameters were significantly decreased (both P<0.01). A total of 100 patients had severe pain before treatment (visual analogue scale (VAS)): 7–10 points), 59 patients reported pain disappearance (VAS: 0 points), 35 patients had mild pain (VAS: 1–3 points), and six patients experienced moderate pain (VAS: 4–6 points) in the third month after treatment. The pain relief rate was 100%. Conclusion Celiac plexus block combined with the interstitial permanent implantation of ¹²⁵I seeds has good short-term efficacy and can effectively improve short-term pain in patients with advanced pancreatic cancer.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.