Objective To investigate the different operation methods for kyphosis deformity of ankylosing spondylitis(AS)complicated with cervical vertebral fracture and their effects.Methods A retrospective case series study was conducted to analyze the clinical data of 19 patients with AS kyphosis complicated with cervical vertebral fracture admitted to Henan People's Hospital from April 2007 lo October 2017.There were 18 males and one female,aged 28-73 years,with an average age of 38.6 years.Among the patients,17 were complicated with spinal cord dysfunction.According to the American spinal injury association(ASIA)classification,there were four patients with grade A,five with grade B,five with grade C and three with grade D.According to the degree of nerve injury and the displacement of fracture,reduction and fixation or orthopedic fixation were selected;14 patients with severe nerve injury(ASIA grades A-C)were treated with reduction and fixation,of which six were treated by simple anterior approach,two by simple posterior approach,five by combined anterior-posterior approach,and one by combined anterior-posterior approach 2 months after Halo fixation.Five patients with ASIA grade D or E were treated with orthopedic fixation.Firstly,kyphosis was corrected with manual technique and the Halo external fixator was installed,and then surgical fixation fusion was performed via simple posterior approach(one patient)or combined anterior-posterior approach(four patients).Visual analogue scale(VAS)was used to evaluate the relief of neck pain.The improvement of nerve function,the effect of orthopedic fixation,the fracture healing time and the postoperative complications were recorded.Results One patient died 11 days after operation due to pulmonary infection and respiratory failure.The remaining patients were followed up for 1-10 years,with an average of 27.3 months.The neck pain in all patients was relieved significantly,and the VAS score[(2.9±0.9)points]decreased significantly 3 days after operation compared with that before operation[(8.2±1.0)points](P＜ 0.05).The nerve function of 12 patients improved significantly(P＜ 0.05).The chin-brow vertical angle of the patients after orthopedic fixation was 60-180(mean,11.8°),suggesting that the level vision function was restored.Fracture healing time ranged from 3 to 8 months,with an average of 3.9 months.There were 4 patients with cerebrospinal fluid leakage and three patients with pulmonary infection.No complications such as wound infection and aggravation of nerve injury occurred.Conclusions For AS kyphosis combined with cervical spine fracture,if without severe nerve injury,manual correction of kyphosis and installation of Halo frame followed by fixation and fusion can effectively correct spinal deformity and improve the quality of life.Patients with severe spinal cord injury should avoid stage I correction and receive reduction of fracture and long segment fusion fixation as far as possible to facilitate the recovery of nerve function.

Objective:To evaluate the application of visual feedback coaching method, which is embedded in an optical surface monitoring system, in deep inspiration breath holding during the radiotherapy in left breast cancer patients after breast-conserving surgery.Methods:Thirty patients with left breast cancer, who were scheduled to receive the whole breast radiotherapy after breast-conserving surgery, met the requirements of deep inspiration breath holding after respiratory coaching with the visual feedback coaching module in the optical surface monitoring system. Active breathing control equipment was used to control breath-holding state and CT simulation was performed. During treatment, optical surface monitoring system was used to guide radiotherapy. All patients were randomly divided into two groups. In group A ( n=15), visual feedback respiratory training method was utilized and not employed in group B ( n=15). In group A, the visual feedback coaching bar of the optical surface monitoring system was implemented, while audio interactive method was employed to guide patients to hold their breath. Real-time data of optical body surface monitoring were used to compare the interfraction reproducibility and intrafraction stability of breath holding fraction between two groups. Besides, the number of breath holding and treatment time per fraction were also compared. GraphPad prism 6.0 software was used for data processing and mapping, and SPSS 21.0 software was used for analyzing mean value and normality testing. Results:Compared with the control group, the reproducibility in the experiment group was reduced from 1.5 mm to 0.7 mm, the stability was reduced from 1.1 mm to 0.8 mm, the mean number of breath holding required per fraction was decreased from 4.6 to 2.4, the mean beam-on time per fraction from 336 s to 235 s, and the treatment time per fraction was shortened from 847 s to 602 s (all P<0.05), respectively. Conclusions:The application of visual feedback coaching method can improve the reproducibility and stability of breath holding during radiotherapy for left breast cancer, and it can also effectively reduce the number of breath holding and shorten the treatment time per fraction.

Objective:To form the expert consensus on screening and evaluation of dysphagia with oral cancer patients (abbreviated as Consensus) , so as to standardize the relevant contents of screening and evaluation of dysphagia in the whole cycle of oral cancer. Methods:By referring to domestic and foreign literature related to dysphagia, combining with the specialty characteristics of oral cancer and the clinical experience of experts, a preliminary consensus was formed through in-depth interviews with experts. A total of 21 experts were selected for three rounds of expert letter consultation and expert meeting, the corresponding items were sorted out, analyzed and modified based on expert opinions, and the Consensus was finally formed. Results:The effective recovery rates of the three rounds of correspondence were 100.00% (21/21) , the expert authority coefficient was 0.91, the variation coefficient of each item was 0.04-0.20, and Kendall's harmony coefficient was 0.05 ( P<0.05) . The final consensus included four aspects, such as the effect of oral cancer on swallowing, the clinical manifestations of dysphagia, the basic procedures of screening and evaluation and the prevention and treatment of complications during evaluation. Conclusions:This Consensus is scientific and practical, which can provide clinical guidance for the screening and evaluation of dysphagia in the whole cycle of oral cancer.

Objective:To investigate the setup errors of postoperative radiotherapy immobilized with integrated cervicothoracic board (mask) system in breast cancer patients.Methods:Thirty-two breast cancer patients treated with postoperative radiotherapy immobilized with integrated cervicothoracic board (mask) system were prospectively recruited in this study. Breast/chest wall (cw) and supra/infraclavicular nodal region (sc) were irradiated with intensity-modulated radiotherapy. CBCT location verification in radiotherapy and target areas of the breast/chest wall and upper and lower collarbone were carried out, respectively. The consistency between setup errors and the position of the upper and lower target areas of 239 CBCT images was analyzed.Results:The translational setup errors of the breast/chest wall in the X-cw (left-right), Y-cw (superior-inferior), Z-cw (anterior-posterior) directions were (1.84±2.36) mm, (1.99±2.48) mm, and (1.75±1.86) mm, respectively. The translational setup errors of the supra/infraclavicular nodal region in the X-sc (left-right), Y-sc (superior-inferior), Z-sc (anterior-posterior) directions were (1.98±2.44) mm, (1.98±2.48) mm, and (1.71±1.79) mm, respectively. The differences of translational setup errors between the breast/chest wall and supra/infraclavicular nodal region in the X, Y, Z directions were (0.38±0.66) mm, (0.07±0.41) mm, and (0.45±0.92) mm, respectively. Conclusion:For the breast cancer patients treated with postoperative radiotherapy covering breast/chest wall and supra/infraclavicular nodal region, the integrated cervicothoracic board (mask) immobilization system provides good reproducibility and yields Sfew setup errors.

Objective To evaluate the effect of surgery-radiotherapy interval (SRI) on clinical prognosis of locally advanced stage c Ⅱ-Ⅲ breast cancer patients treated with neoadjuvant chemtherapy and modified radical mastectomy.Methods Clinical data of 1 087 breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy from 11 hospitals in China were retrospectively analyzed.The optimal threshold value of SRI upon clinical prognosis was determined by maxstat method.The effect of SRI on clinical prognosis was evaluated by using multivariate Cox regression analysis and propensity score matching (PSM).Results The median follow-up time was 72.9 months.The 5-year disease-free survival (DFS) and overall survival (OS) rates were 68.1％ and 81.8％.All patients were divided into SRI ≤18 weeks (n=917) and SRI＞ 18 weeks groups (n=170).Multivariate Cox regression analysis demonstrated that hormone receptor status (P＜0.001),pathological T stage (P＜0.001),pathological N stage (P＜0.001) and SRI (P=0.023) were independent influencing factors of DFS.Hormone receptor status (P=0.013),pathological T stage (P=0.006),pathological N stage (P＜0.001),endocrine therapy (P=0.013) and SRI (P=0.001) were significantly associated with OS.After balancing the clinical and pathological factors with PSM,patients with SRI＜ 18 weeks had superior DFS and OS to those with SRI＞ 18 weeks.Conclusions SRI affects the clinical prognosis of locally advanced breast cancer patients treated with neoadjuvant chemotherapy and modified radical mastectomy.Radiotherapy should be performed within 18 weeks after mastectomy.

OBJECTIVESince 1986, the reference of birth weight for gestational age has not been updated. The aim of this study was to set up Chinese neonatal network to investigate the current situation of birth weight in China, especially preterm birth weight, to develop the new reference for birth weight for gestational age and birth weight curve.

METHODA nationwide neonatology network was established in China. This survey was carried out in 63 hospitals of 23 provinces, municipalities and autonomous regions. We continuously collected the information of live births in participating hospitals during the study period of 2011-2014. Data describing birth weight and gestational age were collected prospectively. Newborn's birth weight was measured by electronic scale within 2 hours after birth when baby was undressed. The evaluation of gestational age was based on the combination of mother's last menstrual period, ultrasound in first trimester and gestational age estimation by gestational age scoring system.

STATISTICAL ANALYSISthe growth curve was drawn by using LMSP method, which was conducted in GAMLSS 1.9-4 software package in R software 2.11.1.

RESULTA total of 159 334 newborn infants were enrolled in this study. There were 84 447 male and 74 907 female. The mean birth weight was (3 232 ± 555) g, the mean birth weight of male newborn was (3 271 ± 576) g, the mean weight of female newborn was (3 188 ± 528) g. The test of the variables' distribution suggested that the distribution of gestational age and birth weight did not fit the normal distribution, the optimal distribution for them was BCT distribution. The Q-Q plot test and worm plot test suggested that this curve fitted the distribution optimally. The male and female neonatal birth weight curve was developed using the same method.

CONCLUSIONUsing GAMLSS method to establish nationwide neonatal birth weight curve, and the first time to update the birth weight reference in recent 28 years.

Birth Weight ; China ; Female ; Gestational Age ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Male