Objective To explore the reasonable radiotherapy range by analyzing the patterns and characteristics of intra-thoracic lymph node metastasis in small cell lung cancer (SCLC).Methods One hundred and fifty patients with limited-stage SCLC who received radical resection of primary tumor and systemic intra-thoracic lymph node dissection were included in the study.All the lymph nodes in each area were recorded and examined pathologically to analyze the patterns and characteristics of intra-thoracic lymph node metastasis.Results A total of 2372 lymph nodes were found in 631 areas,and a total of 413 positive lymph nodes (17.4％) were found in 188 lymph node areas (29.8％ ).Intra-thoracic lymph node metastasis were found in 88 patients,with a positive rate of 58.7％.The frequencies of metastasis in the area 11,10,7,5,4 were much higher than those in the other areas,and central located lesions and the higher T-stage lung tumors were more likely to develop intra-thoracic lymph node metastasis (x2 =15.32,39.72;P =0.000,0.000,respectively).Tumors located in the right upper lobe and right middle/lower lobe had a higher tendency of metastasis to the areas 4,7,10 and 4,7,10,11,respectively.Tumors located in the left upper lobe and left lower lobe had a higher tendency of metastasis to the areas 4,5,6,10 and 4,7,9,10,11,respectively.Mediastinal lymph node metastasis (N2 ) were found in 72 patients,among whom 29 patients (40.3％ ) had skipping N2 metastasis without hilar metastasis.Tumors located in the upper lobe had a tendency of skipping metastasis to the upper mediastinum,while tumors located in the middle/lower lobe had a tendency of skipping metastasis to the upper and lower mediastinum.Conclusions The lymph node metastases in SCLC follow the lymphatic drainage routes,that is,from intrapulmonary to the hilar and then to the mediastinum,but with some skipping metastases.Tumors located in different lobes have different high risk lymph node areas for metastasis,and elective irradiation to these lymph node areas maybe increase radiotherapy gain ratio in SCLC.

Objective To evaluate clinical risk factors that can predict brain metastasis after complete resection of small cell lung cancer (SCLC) and to assess the role of prophylactic cranial irradiation (PCI) in such kind of patients.Methods Eighty-eight patients with completely resected stage Ⅰ - Ⅲ SCLC from Jan.2000 to Dec.2009 in our hospital were retrospectively analyzed.Kaplan-Meier was used to compare the differences in the incidence of metastasis free survival in different groups.Logistic model was used to assess the independent risk factors for brain metastasis.Results The follow-up rate is 100％,and 37 patients were followed up for more than three years.None of the 3 patients who received PCI developed brain metastasis,while for patients without receiving PCI,24％ developed brain metastases.The incidence of brain metastasis for stage Ⅰ,Ⅱ and Ⅲ SCLC after surgery were 4％,26％ and 29％ ( x2 =7.57,P =0.023),respectively.The median survival time and the 3-year survival rate were 18 months and 25％ for patients who developed brain metastasis,and 48 months and 59％ for those without brain metastasis ( x2 =10.63,P =0.001 ).Both univariate and multivariate analyses showed that pre-treatment disease stage wasindependent risk factor for brain metastasis ( x2 =7.57,8.52 ; P =0.023,0.004 ).Age,sex,tumor location,pathological type,induction chemotherapy,and postoperative chemotherapy/radiotherapy were not significantly correlated with the incidence of brain metastasis ( x2 =0.03,0.00,0.00,2.58,0.01,1.23,0.84;P =0.869,0.998,0.992,0.109,0.936,0.266,0.361,respectively).Conclusions Pre-treatment disease stage was independent risk factor for brain metastasis in SCLC.PCI may be important for stage Ⅱ -Ⅲ SCLC but not for stage Ⅰ disease.<英文关键词>=Carcinoma,small cell lung/surgery; Neoplasm metastasis,brain/prophylactic irradiation; Factors analysis

ObjectiveTo investigate the application of non-contrast and contrast-enhanced 18FDG PET/CT in the delineation of gross tumor volume ( GTV ) of pancreatic cancer.MethodsBetween Jan.2008 and Dec.2009,twenty-one patients with unresectable locally advanced pancreatic cancer or recurrent pancreatic cancer after surgery in our hospital had both non-contrast CT and PET images acquired at the same body position.Among the whole group,eleven patients also had contrast CT images.The image data sets were transferred to the treatment planning workstation for registration.Then gross tumor volumes ( GTV )were delineated independently using the information of PET images,contrast/non-contrast CT scan and contrast/non-contrast PET-CT fusion images.The differences of mean volume in these different sets of GTV were analyzed.Results For the whole group,the mean volume of non-contrast GTVCT,GTVPET,noncontrast GTVPET-CT were 76.9 cm3,47.0 cm3 and 44.5 cm3,respectively.The mean volume of non-contrast GTVPET-CT was significantly smaller than non-contrast GTVCT ( z =-3.91,P =0.000 ).For the eleven patients with contrast CT,the mean volume of contrast GTVCT,GTVPET,contrast GTVPET-CT were 64.1 cm3,45.1 cm3 and 49.3 cm3,respectively.The mean volume of contrast GTVPET-CT was significantly smaller than contrast GTVCT (z =-2.13,P =0.033 ).No significant differences were found between contrast PET-CT and non-contrast PET-CT (z =-0.80,P =0.424).ConclusionsCo-registration of PET and contrast/noncontrast CT information in pancreatic cancer may improve the accuracy of GTV delineation,and possibly reduce the adverse effect of irradiation.

Objective:To investigate the effects of continuous monitoring intracranial pressure (ICP) and brain oxygen partial pressure (PbtO 2) on the prognosis of patients with severe craniocerebral injury. Methods:A prospective randomized controlled trial was conducted. Seventy patients with severe craniocerebral injury with a Glasgow coma score (GCS) 4-8 admitted to the neurosurgical intensive care unit (NICU) of the People's Hospital of Inner Mongolia Autonomous Region from January 2017 to May 2020 were enrolled, and they were divided into ICP monitoring group and ICP+PbtO 2 monitoring group by random number table. Patients in ICP monitoring group received ICP monitoring and were given traditional treatment of controlling ICP and cerebral perfusion pressure (CPP), the therapeutic target was ICP < 20 mmHg (1 mmHg = 0.133 kPa) and CPP > 60 mmHg. Patients in ICP+PbtO 2 monitoring group were given ICP and PbtO 2 monitoring at the same time, and oxygen flow was adjusted on the basis of controlling ICP and CPP to maintain the PbtO 2 > 20 mmHg, and the therapeutic target of ICP and CPP was the same as the ICP monitoring group. ICP and PbtO 2 values were recorded during monitoring in the two groups, the results of CPP, GCS and arterial blood gas analysis were recorded, and the prognosis at 3 months and 6 months after injury was compared by Glasgow outcome scale (GOS) score between the two groups. GOS score > 3 was considered as good prognosis. Kaplan-Meier survival curve was drawn, and the 3-month and 6-month cumulative survival rates of the two groups were analyzed. Linear regression analysis was used to further evaluate the relationship between PbtO 2 and GOS score. Results:Finally, a total of 70 patients with severe craniocerebral injury were enrolled in the analysis, 34 patients received ICP combined with PbtO 2 monitoring and guided therapy, and 36 patients received ICP monitoring alone. The average ICP of ICP+PbtO 2 monitoring group was significantly lower than that of ICP monitoring group (mmHg: 13.4±3.2 vs. 18.2±8.3, P < 0.01). Although the CPP in both groups was great than 60 mmHg, the average CPP of ICP+PbtO 2 monitoring group was significantly higher than that of ICP monitoring group (mmHg: 82.1±10.5 vs. 74.5±11.6, P < 0.01). No significant difference was found in average GCS score or arterial partial pressure of carbon dioxide (PaCO 2) between the ICP+PbtO 2 monitoring group and ICP monitoring group [GCS score: 5.3±2.3 vs. 5.2±2.2, PaCO 2 (mmHg): 33.5±4.8 vs. 32.6±5.2, both P > 0.05]. The average arterial partial pressure of oxygen (PaO 2) of ICP+PbtO 2 monitoring group was obviously higher than that of ICP monitoring group (mmHg: 228.4±93.6 vs. 167.3±81.2, P < 0.01). Compared with the ICP monitoring group, the good outcome rates of 3 months and 6 months after injury in the ICP+PbtO 2 monitoring group were significantly higher (3 months: 67.6% vs. 38.9%, 6 months: 70.6% vs. 41.7%, both P < 0.05). Kaplan-Meier survival curve showed that the 3-month and 6-month cumulative survival rates of ICP+PbtO 2 monitoring group were significantly higher than those of ICP monitoring group (3 months: 85.3% vs. 61.1%, Log-Rank test: χ2 = 5.171, P = 0.023; 6 months: 79.4% vs. 55.6%, Log-Rank test: χ2 = 4.511, P = 0.034). Linear regression analysis showed that PbtO 2 was significantly correlated with GOS score at 3 months and 6 months after injury in patients with severe craniocerebral injury ( r values were 0.951 and 0.933, both P < 0.01). Conclusions:PbtO 2 compared with ICP monitoring guiding therapy is valuable in improving the prognosis of patients with severe craniocerebral injury. It can improve the prognosis at 3-6 months after injury.

Objective To investigate the changes of internal fixation stress under different angles of interior fracture line and different screw placement modes in the case of A?type distal femoral fracture. Methods A 24?year?old healthy male volunteer was recruited to collect the right femur data. CATIA V5R21 software produced a 10 mm fracture gap at the external side of the femur 6.5 cm proximal to the joint line and different angle fracture lines were generated on the internal of the femur at the same height. Based on the actual measured dimensions, the three?dimensional (3D) model of the locking plate and screw was reconstructed using CATIA V5R21 software, ignoring the screw surface threads and then the assembly of the internal fixation of the titanium plate, screws and femur was done. All models were meshed using Hypermesh 13.0 software. The assembled 3D model was input into ABAQUS 6.14 to generate a finite element model. Preliminary finite element biomechanical analysis was performed using the four medial fracture line angles and the stress distribution of the internal fixation under the three screw placement modes, and then the analysis was continued after the optimal screw placement method was re?determined. Results Under an axial loading of 700 N, with the increase of the angle of the fracture line, the stress of the lateral internal fixation gradually increased, and the displacement of the proximal end of the fracture gradually increased. The sequential screw placement method was superior to the leaping screw placement method. The placement of the first screw at the proximal end of the fracture was critical to the distribution of the internal fixation stress. Conclusions The operation plan of the type A of distal femoral fracture needs to be confirmed according to the internal and external fracture′s condition. When the fracture line is at a excessive positive angle or a negative angle, a simple lateral fixation may not provide a stable fracture fixation so that other fixation methods are needed.

Objective To investigate the changes of internal fixation stress under different angles of interior fracture line and different screw placement modes in the case of A?type distal femoral fracture. Methods A 24?year?old healthy male volunteer was recruited to collect the right femur data. CATIA V5R21 software produced a 10 mm fracture gap at the external side of the femur 6.5 cm proximal to the joint line and different angle fracture lines were generated on the internal of the femur at the same height. Based on the actual measured dimensions, the three?dimensional (3D) model of the locking plate and screw was reconstructed using CATIA V5R21 software, ignoring the screw surface threads and then the assembly of the internal fixation of the titanium plate, screws and femur was done. All models were meshed using Hypermesh 13.0 software. The assembled 3D model was input into ABAQUS 6.14 to generate a finite element model. Preliminary finite element biomechanical analysis was performed using the four medial fracture line angles and the stress distribution of the internal fixation under the three screw placement modes, and then the analysis was continued after the optimal screw placement method was re?determined. Results Under an axial loading of 700 N, with the increase of the angle of the fracture line, the stress of the lateral internal fixation gradually increased, and the displacement of the proximal end of the fracture gradually increased. The sequential screw placement method was superior to the leaping screw placement method. The placement of the first screw at the proximal end of the fracture was critical to the distribution of the internal fixation stress. Conclusions The operation plan of the type A of distal femoral fracture needs to be confirmed according to the internal and external fracture′s condition. When the fracture line is at a excessive positive angle or a negative angle, a simple lateral fixation may not provide a stable fracture fixation so that other fixation methods are needed.

Objective:To investigate the role of multimodal neuronavigation intraoperative and sodium fluorescein-guided techniques in microsurgery for intracranial malignant neoplasm.Methods:A retrospective analysis was conducted on 50 patients with intracranial malignant tumors treated by microsurgery from 2016 to 2019 in Inner Mongolia People′s Hospital. Preoperative imaging included computed tomography (CT), computed tomographic angiography (CTA), magnetic resonance imaging (MRI), MRI: MRA, MRV, DWI, PWI, DTI, DTI, MRS sequence scan, and before the operation, they were fused with the functional nervous system navigation workstation of Bo Yilai to make the navigation plan. During the operation, the functional navigation was combined with low dose fluorescein sodium (2 mg/kg) for operation. Intraoperative neuronavigation was used to determine the location of the tumor and its spatial relationship with the pyramidal tract of the main fiber conduction tract and the large blood vessels, and intraoperative yellow fluorescence mode of pentero900 Zeiss microscope showed the boundary between the tumor and normal brain tissue for tumor resection.Results:There were 38 cases of glioma, 10 cases of brain metastasis of lung cancer, 1 case of brain metastasis of renal clear cell carcinoma and 1 case of spindle cell tumor. The accuracy of preoperative neuronavigation was 95%. Compared with the preoperative lesions, MRI of the head was reexamined 3 days after operation to judge the degree of tumor resection. In this group, 38 cases (76%) were totally resected and 12 cases (24%) were subtotal resected. The 6-month survival rate was 85.9%, the 12-month survival rate was 53.1%, the 18-month survival rate was 24.5%, and the survival time was (15.0 ± 3.2) months.Conclusion:Multimodal functional neuronavigation combined with fluorescein sodium staining can locate and label tumors in real time, improve tumor resection rate, and improve the prognosis of brain cancer patients.

Objective:To investigate the application of continuous intracranial pressure (ICP) combined with regional cerebral oxygen saturation (rScO 2) monitoring in patients with hypertensive intracerebral hemorrhage before and after operation of the removal hematoma through small bone window and the effect on the prognosis of patients. Methods:The clinical data of 37 patients with supratentorial hypertensive intracerebral hemorrhage admitted to the neurosurgical intensive care unit of the people′s Hospital of Inner Mongolia Autonomous Region from April 2018 to October 2020 were retrospectively analyzed.ICP monitoring and near infrared spectroscopy (NIRS) were used to monitor the intracranial pressure and rScO 2 concentration before and after the operation, and the changes of intracranial pressure and rScO 2 before and after the operation were analyzed.According to Glasgow Outcome Score (GOS), patients with GOS score>3 were classified as good prognosis group (21 cases), and those with GOS score ≤3 were classified as poor prognosis group (16 cases). Results:The postoperative intracranial pressure((15.80±6.70) mmHg)of patientswith hypertensive intracerebral hemorrhage was lower than that before operation((20.40±5.80) mmHg), and the difference was statistically significant( t=3.226, P=0.002). The postoperative rScO 2 ((62.31±3.85)% )of patientswith hypertensive intracerebral hemorrhage was higher than that before operation((59.73±3.13)%), and the difference was statistically significant( t=3.171, P=0.002). The decrease of intracranial pressure in patients with good prognosis((6.53±2.21) mmHg)was more obvious than that in patients with poor prognosis((4.24±2.30) mmHg). The concentration of rScO 2 increased in both groups.But in the group with good prognosis, the rScO 2 increased((3.99±2.34)%)was significantly higher than that in poor prognosis group((2.32±2.25)%). Six months after operation, there were significant differences in preoperative and postoperative intracranial pressure and rScO 2 between good prognosis group and poor prognosis group, and the difference was statistically significant( t=3.090, 2.176; P=0.004, 0.036). Conclusion:Small bone window evacuation of intracerebral hematoma can significantly reduce the concentration of intracranial pressure and increase the concentration of rScO 2 in patients with intracerebral hemorrhage.The changes of intracranial pressure and rScO 2 before and after operation have potential value in judging the prognosis of patients.

Objective:To explore the application and clinical efficacy of functional neural navigation multimodal image fusion technology combined with intraoperative fluorescein sodium in the surgery of lung cancer brain metastases.Methods:Forty patients with lung cancer and brain metastasis admitted to the Department of Neurosurgery of Inner Mongolia Autonomous Region People's Hospital from January 2020 to January 2024 were collected as the observation group. Another 40 patients with lung cancer brain metastases who underwent microscopic resection at Inner Mongolia Autonomous Region People's Hospital from January 2016 to December 2019 were selected as the control group. All patients received head CT examination, head MRI examination, MRI enhanced sequence and MRA, MRV and DWI sequence scanning before operation. Functional neural navigation system was used to perform preoperative multi-modal image fusion to realize three-dimensional display of tumor lesions, and display the position relationship between tumor and functional areas, conduction bundles and large blood vessels, so as to make preoperative navigation plan. After conducting a fluorescein sodium allergy test on the patient before surgery, a small dose of fluorescein sodium (2 mg/kg) was intravenously injected during the operation. During the operation, neuro navigation was combined with fluorescein sodium to perform tumor resection by displaying the boundary between tumor tissue and normal brain tissue under a Pentero 900 Zeiss microscope 560 fluorescence mode. Both groups collected tumor tissue samples for pathological classification and immunohistochemical analysis, comparing and analyzing differences in tumor resection degree, postoperative occurrence of new neurological dysfunction, postoperative muscle strength improvement, changes in KPS scores before and after surgery, and the occurrence of complications. The metric data that conforms to normal distribution is represented by xˉ± s, and the comparison of means between two groups is conducted using independent sample t-test. Calculate the percentage based on the count data, and compare the inter group rates using the χ2 test. P<0.05 indicates statistical significance of the difference. Results:Compared with the control group, the total tumor resection rate of observation group (75.0% (30/40) ) and KPS score of 3 months after surgery (82.5% (33/40)) were better than those of the control group (52.5% (21/40) and 60% (24/40)), and the differences were statistically significant ( χ2 value was 4.94 and 4.38, P values were 0.026 and 0.036). The rate of postoperative new neurological dysfunction in the observation group (22.5% (9/40)) was lower than that in the control group (45.0% (18/40)), and the difference between the two groups was statistically significant ( χ2=4.53, P=0.033). The length of hospital stay ((21.48±3.23) days), operation time ((216.65±56.76) points) and complication rate (37.5% (15/40)) in observation group were lower than those in control group ((22.43±2.34) days, (225.62±37.68) points, 45.0% (18/40)). However, the difference was not statistically significant ( t/ χ2 values were 1.51, 0.83, and 0.46, respectively; P values were 0.136, 0.408, and 0.496, respectively). The 12-month survival rate of observation group (67.5%(27/45) respectively was significantly higher than that of control group (40.0%(16/40) respectively, and the difference was statistically significant ( χ2=6.08, P=0.014). Conclusion:Functional neural navigation multimodal image fusion technology combined with intraoperative fluorescein sodium can accurately locate the tumor and determine the boundary relationship between the tumor and normal brain tissue during lung cancer brain metastasis surgery, improve tumor resection rate, enhance patient quality of life, and ultimately improve patient prognosis without increasing the risk of related complications.

Objective:To observe the expression of glucose regulated protein 78 (GRP78) in glioma and its clinical value in evaluating clinical prognosis.Methods:A total of 163 patients with glioma who were surgically removed and confirmed after surgery in the People′s Hospital of Inner Mongolia Autonomous Region were collected from March 2012 to October 2015. Immunohistochemical staining was used to observe the expression of GRP78 in patients with different WHO grades of glioma. Chi square test was used to compare the expression of GRP78 in glioma patients with different age, gender and WHO grade. Whether COX regression analysis GRP78 can be used as an independent prognostic indicator was investigated. Time series test and Kaplan Meier analysis were used to analyze the survival time of patients with different GRP78 expression levels.Results:The expression of GRP78 was up-regulated in glioma, and the patients with high expression of GRP78 (positive expression/strongly positive expression) were more common in stage Ⅲ/Ⅳ than in stage Ⅰ/Ⅱ. The expression of GRP78 was not statistically significant in different age and gender groups ( P>0.05), but was statistically significant in different WHO stages ( P<0.01). GRP78 was an independent prognostic factor for glioma ( P = 0.045). The median survival time of patients with glioma was 28 months (95% CI 37.594 to 47.046), of which the survival time of patients with high expression of GRP78 was 15 months (95% CI 12.922 to 40.801); the survival time of patients with low expression of GRP78 was 35 months (95% CI 39.807 to 51.352), and the difference was statistically significant ( P<0.01). The survival time of patients with high expression of GRP78 was significantly shorter than that of patients with low expression of GRP78 ( χ2 = 13.588, P<0.01). Conclusions:The expression level of GRP78 in glioma is significantly increased; high expression of GRP78 is more common in Ⅲ/Ⅳ glioma, and GRP78 can be used as an effective index to evaluate the poor prognosis of glioma.