Spindle cell carcinoma of the breast (SpCC) is a very rare variant of breast cancer characterized as large tumor size,high histological grade and high negative expression of hormone receptors and HER2/neu protein.It has a high tendency for local recurrence and distant metastasis,while the axillary lymph node metastasis is less common occured,which leads to poor outcomes.Given the relatively low incidence,our knowledge about SpCC is limited.The main unsolved obstacles are the early dection and diagnosis,and the improvement in treatments.Herein,this article reviewed the clinicopathologic characteristic,diagnosis,treatment and prognosis of the spindle cell carcinoma of breast.

ObjectiveTo assess the value of intraoperative radiotherapy (IORT) combined with postoperative concurrent chemoradiotherapy for locally advanced pancreatic cancer. MethodsFrom May 2008 to May 2011, 85 cases of locally advanced pancreatic cancer patients in our hospital were analyzed retrospectively.The treatment group included 40 cases treated by IORT plus drainage combined with postoperative concurrent chemoradiotherapy ( group A), and the control group included 45 undergoing IORT plus drainage ( group B).The clinical manifestation, operation plan etc.were summed up and all cases were followed up regularly to evaluate the survival time.ResultsThe follow-up time was from 6 to 15 months and the follow-up rate is 90％ (77/85).For group A and group B, the mean survival time was 10.17 ±0.58 months VS 8.05 ±0.48 months and the median survival time was 11.40 months VS 8.30 months.The survival analysis showed that group A had a significant survival advantage than group B (P =0.027 ).10 patients died in group A and 12 patients died in group B.The difference had no statistical significance (P =0.805 ).ConclusionIORT plus postoperative concurrent chemoradiotherapy can improve the survival rate of patients with locally advanced pancreatic cancer.

The pathological subtypes of breast cancer can be further divided into different molecular subtypes based on their immunohistochemical staining, such as estrogen receptor (ER) , progesterone receptor (PR) , human epidermal growth factor receptor2 (HER2) and Ki67 expression, including luminal subtype, HER2 overexpression subtype and triple negative subtype. The luminal subtype is defined as ER and/or PR positive. In molecular mechanism, the expression activity of ER can regulate the expression of PR, so the expression of ER and PR is usually consistent. However, in the process of detection, some breast cancers with inconsistent ER/PR expression often appear, especially those with ER (-) /PR (+) . There is still controversy about whether such cases are true. Patients with this type of breast cancer should be subjected to ER and PR immunohistochemical staining again, and then reclassified according to HER2 status. The expression of ER/PR is closely related to the efficacy of endocrine therapy for breast cancer, so its test results will directly affect the treatment options of clinician. This article will review and discuss the research progress of the causes and mechanisms of ER (-) /PR (+) breast cancer.

Objective To explore the risk factors and metastasis of non-sentinel lymph node (NSLN) in breast cancer patients with sentinel lymph node metastasis≤2. Methods 88 cases of breast cancer with sentinel lymph node metastasis≤2 were retrospectively analyzed. Factors influencing the status of NSLN were studied. Results 8 cases (9.09%) had NSLN metastasis. Variance analysis showed that tumor stage(P=0.014), histolog-ical grade(P=0.014) and ER statuts(P=0.009) were correlated with NSLN metastasis. Logistic analysis showed that only histological grade was the independent predictor for NSLN metastasis (P=0.016,OR=1.150,95%CI=0.598~7.740).18 cases had micro-metastasis of sentinel lymph node and 70 cases had macro-metastasis of sentinel lymph node. The ratio of false negative SLN was 10.23%. The mean follow-up time was 11 months. There was no case of recurrence, metastasis or death. Conclusions The metastasis rate of NSLN is relatively low in breast cancer patients with small number of positive SLNs. NSLN metastasis is related to tumor stage, histological grade, and ER expression.

Objective To explore the clinical significance and treatment regimen of sentinel lymph node(SLN) micrometastases and isolated tumor cell metastasis in breast cancer.Methods Ninety-seven breast cancer patients with sentinel lymph node micrometastases or isolated tumor cell metastasis from January 2013 to December 2015 were retrospectively studied.The patients were assigned to axillary lymph node dissection group (ALND,41 cases) and non axillary lymph node dissection group(non-ALND,56 cases) according to the final surgery mode to the axilla.Disease-free survival(DFS) and overall survival (OS) were compared between the two groups.Results Neither clinico-pathological factors,such as age,tumor size,grade,ER/PR status,HER-2 gene expression,Ki-67 expression and the size of the SLN metastasis,nor the treatment,such as breast surgery,postoperative adjuvant chemotherapy,radiotherapy and hormone therapy were found statistically different between the two groups (P ＞ 0.05).There were 96 patients evaluable with a median follow up of 24 months.The DFS of the ALND and non-ALND group was 97.5％ and 96.6％ (P ＞ 0.05),and the OS was 100％ and 98.2％ (P ＞ 0.05) respectively with no difference between the two groups.There were 2 ispilateral axillary recurrence in the non-ALND group and non in the ALND group.Conclusion Axillary lymph node dissection may be omitted for the breast cancer patients with sentinel lymph node micrometastases and isolated tumor cell metastases.But the postoperative adjuvant systemic treatment should be emphasized.

Objective To evaluate the feasibility of sentinel lymph node biopsy(SLNB)during surgery of breast cancer. MethodsRadioactive colloid and blue dye were injected intradermally around the tumor seperately before the operation and the SLN were detected first by lymph scintigraphy. SLN was detected and located using ?-finder and the blue dye. Axillary lymph node dissection(ALND)was performed routinely after the SLNB. Results Among 116 breast cancer patients,this procedure was successful in 98.3% of cases. The sensitivity, accuracy and false negative rate were 93.6%, 97.4% and 6.4%, respectively. Conclusions SLNB is a simple, safe and reliable technique.Routine ALND could be raplaced by SLNB in breast cancer patients undergoing surgery.

Objective:To construct a nursing training content system of acquired swallowing disorders for intensive care unit (ICU) nurses to provide a reference for clinical nurse training.Methods:Based on a literature review and semi-structured interviews, the first draft of a nursing training content system of acquired swallowing disorders for ICU nurses was formulated. 19 experts participated in 2 rounds of expert correspondence from March to May, 2023. The indicators were screened and assigned values by combining the screening criteria and expert opinions. Finally, the nursing training content system of acquired swallowing disorders for ICU nurses was formed.Results:The effective recovery rates of the second-round expert correspondence questionnaires were 100.0%(21/21) and 90.5% (19/21), respectively; the expert authority coefficients were 0.908 and 0.932, respectively; and the expert coordination coefficients were 0.149 and 0.201, respectively (both P<0.01). The final nursing training content system of acquired swallowing disorders for ICU nurses included 8 primary indicators and 37 secondary indicators. Conclusions:The nursing training content system of acquired swallowing disorders for ICU nurses had scientificity and reliability, and could provide reference and guidance for ICU-acquired swallowing disorders nursing training.

Objective To systematically retrieve,evaluate and integrate the best evidence on the prevention and management of aspiration in critically ill adult patients and had it summarised to form the best evidence so as to provide an evidence-based reference for prevention and management of aspiration.Methods Following the"6S"pyramid model,literatures on prevention and management of aspiration in critically ill adult patients published from January 2013 to August 2023,were retrieved from databases of BMJ Best Practice,UpToDate,Joanna Briggs Institute Evidence-Based Healthcare Centre in Australia,College of Nurses of Ontario in Canada,International Guideline Network,Guidelines.gov of the United States,National Institute for Health and Care Excellence,Scottish Intercollegiate Guidelines Network,PubMed,Embase,Cochrane Library,CINAHL,Chinese Clinical Practice Guidelines Library,Medlive,Chinese Biomedical Literature Database,CNKI,Wanfang Data and VIP.The retrieved data included clinical decisions,guidelines,evidence summaries,expert consensus/recommendations,systematic reviews/meta-analyses,and randomised controlled trials regarding the prevention and management of aspiration in critically ill adult patients.Two researchers who were trained in evidence-based nursing independently conducted literature selection,quality assessment,evidence extraction and synthesis.Results A total of 33 articles were included,with 4 clinical decisions,4 guidelines,5 evidence summaries,8 expert consensuses,9 systematic reviews/meta analysis and 3 randomised controlled trials.Eventually,36 points of best evidence were summarised from 9 themes,namely aspiration risk assessment,airway management,oral hygiene management,positioning management,enteral nutrition management,drug management and prevention,diagnosis and treatment of aspiration,prevention of post-extubation aspiration,aspiration training,and team management.Conclusions This evidence summary can provide healthcare workers with evidence-based support for prevention and management of aspiration in ICU,which will make ICU nursing more scientific and standard.

Objective:To construct the training content system of aspiration prevention and management for ICU nurses, in order to improve the ability of ICU nurses in aspiration prevention and management, and provide a basis for nursing managers to carry out aspiration related training.Methods:This study preliminarily developed an item pool for the training content system of aspiration prevention and management through literature search and semi-structured interviews. From May to June 2023, the purposive sampling method was used to select 19 experts from Beijing, Shandong Province, Hubei Province and other places for two rounds of Delphi expert consultations, to determine the training content system for the prevention and management of aspiration among ICU nurses.Results:The effective response rates of the two-rounds of inquiry questionnaires were 95.5% (21/22) and 90.5% (19/21), respectively. The expert authority coefficients were 0.91 and 0.93, and the Kendall's harmony coefficients were 0.121 and 0.148 ( P<0.01). The final determination of the training content system for ICU nurse aspiration prevention and management included 10 primary indicators and 33 secondary indicators. Conclusions:The construction process of the training content system of aspiration prevention and management for ICU nurses is more scientific, reliable and full, which can guide the clinical practice of ICU nurses and provide reference for nursing managers to carry out education and training related to aspiration.

Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.