Objective To investigate the efficacy of 3D conformal radiotherapy for late-stage pancreatic cancer and determine relavent prognostic factors.Methods Fifty patients with advanced pancreatic cancer were divided into 3 groups according to treatment planning: palliative radiotherapy (group A) at 10.8-56 Gy, radiotherapy alone (group B) at 8-60.5 Gy and concurrent chemoradiother-apy (group C) at 10-64 Gy.All patients received 3D-conformal radiotherapy, and smaller multiple ports were used for palliative treatment whereas large fields including pancreatic tumors and adjacent lymph node drainage system were adopted in the beginning of radiotherapy.Concurrent chemotherapy with gemcitabine (200-600 mg/m~2) alone was used with weekly protocol.Results The duration of follow-up was 3-35 months.Forty three patients died during the follow-up for multiple metastasis, de-teriation, secondary infection and hemorrhage.Among the seven surviving patients, 3 received concur-rent radiotherapy, 3 radiotherapy alone and 1 palliative radiotherapy.Only 1 patient was alive in group A.However, the symtoms were relieved in 46% of the patients.The median survival time was 5.07 months whereas it was 4.33 months for patients received less than 45 Gy and 7.33 months for patients received 45 Gy or more.Three patients were alive in group B and the symptoms were relieved in 81% of the patients.The median survival time was 6.65 months whereas it was 4.36 months for patients received less than 45 Gy and 8.33 months for patients received 45 Gy or more.Three patients were a-live in group C and the symptoms were relieved in 89% of the patients.The median survival time was 9.89 months.One patient survived for 3 months after 8 Gy irradiation.The median survival time was 10.73 months for patients received 45 Gy or more.Conclusion 3D-conformal radiotherapy is safe and effective in treatment of advanced pancreatic cancer.The symptom relieving rate and median survival time seem to be related to patient's status, extent of disease, choice of treatment and irradiation dos-age.3D-confromal concurrent chemoradiotherapy leads to the longest survival time in some patients.

Objective:To analyze the clinical characteristics of patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR), and to explore the risk factors leading to poor prognosis.Methods:The clinical data of 95 patients with ECPR admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to May 2023 were retrospectively analyzed. According to the survival status at the time of discharge, the patients were divided into the survival group and death group. The difference of clinical data between the two groups was compared to explore the risk factors related to death and poor prognosis. Risk factors associated with death were identified by Binary Logistic regression analysis. Results:A total of 95 patients with ECPR were included in this study, 62 (65.3%) died and 33 (34.7%) survived at discharge. Patients in the death group had longer low blood flow time [40 (30, 52.5) min vs. 30 (24.5, 40) min ] and total cardiac arrest time[40 (30, 52.5) min vs. 30(24.5, 40) min], shorter total hospital stay [3 (2, 7.25) d vs. 19 (13.5, 31) d] and extracorporeal membrane oxygenation (ECMO) assisted time [26.5 (17, 50) h vs. 62 (44, 80.5) h], and more IHCA patients (56.5% vs. 33.3%) and less had spontaneous rhythm recovery before ECMO (37.1% vs. 84.8%). Initial lactate value [(14.008 ± 5.188) mmol/L vs.(11.23 ± 4.718) mmol/L], APACHEⅡ score [(30.10 ± 7.45) vs. (25.88 ± 7.68)] and SOFA score [12 (10.75, 16) vs. 10 (9.5, 13)] were higher ( P< 0.05). Conclusions:No spontaneous rhythm recovery before ECMO, high initial lactic acid and high SOFA score are independent risk factors for poor prognosis in ECPR patients.

Objective To investigate the clinical effect of respiratory trainer in the patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) undergoing non-invasive positive pressure ven-tilation.Methods A total of 85 patients with COPD undergoing non-invasive positive pressure ventilation ad-mitted and treated in the Affiliated Minda Hospital of Hubei Nationalities University during 2019-2023 were selected as the study subjects and divided into the experiment group and the control group through random number table method.The control group adopted the symptomatic and supportive treatment such as routine non-invasive positive pressure ventilation,anti-infection,preparation aspiration for spasmolysis and eliminating phlegm,while on the base of the control group,the experiment group adopted respiratory trainer (K5) for re-spiratory training each once in the morning and at night.The differences in the related indexes were compared between the two groups.Results The percentage of forced expiratory volume in the first second (FEV1％),forced expiratory volume in 1 second/forced lung capacity (FEV1/FVC),COPD assessment test (CAT) score,modified Medical Research Council Dyspnea Scale (mMRC) score,6-min walking distance (6MWD),SGRQ score,maximum inspiratory pressure (MIP),maximum expiratory pressure (MEP),partial pressure of carbon dioxide (PaCO2) and PaO2 on 3,7 d after treatment in both groups had statistically significant differ-ence compared with before treatment (P<0.05),and the improvement of the above indicators in the experi-ment group was more significant compared with the control group (P<0.05).Conclusion Respiratory train-er could improve the clinical effect and pulmonary ventilation function in the patients with acute exacerbation of COPD undergoing non-invasive positive pressure ventilation.

Background Research on the relationship between ambient temperature and preterm birth has received increasing attention, but the conclusions of the previous literature are inconsistent. Objective To explore the impact of environmental temperature exposure in Ningbo on premature delivery of pregnant women. Methods The birth information, preterm birth data, and age of pregnant women from January 2016 to September 2020 were collected by the electronic medical record system of Ningbo Women’s and Children’s Hospital. Meteorological data for the same period were obtained through Ningbo Meteorological Bureau, including daily average temperature, daily average relative humidity, and daily average air pressure. Daily concentrations of SO₂, NO₂, and PM₁₀ were derived through the air quality real-time release system on the website of Ningbo Environmental Protection Bureau. A distributed lag nonlinear model was used to analyze the impact of environmental temperature on preterm birth by stratifying pregnant women’s age and birth delivery mode. Results The incidence rate of preterm birth in Ningbo from 2016 to 2020 was 5.91%. The exposure-response curve between environmental temperature and preterm birth presented a “U” shape. Taking 22.5 ℃ as a reference, the cumulative effect of 31 ℃ (the 95th percentile) and 32 ℃ (the 99th percentile) over a 21-day lag on preterm delivery was statistically significant, and the related RR (95%CI) values were 1.67 (1.05-2.65) and 1.85 (1.09-3.14) respectively. The results of stratified analysis showed that among pregnant women ≥30 years old, the 21-day cumulative effects of 31 ℃ and 32 ℃ on preterm delivery were statistically significant, and the related RR (95%CI) values were 2.09 (1.08-4.05) and 2.36 (1.11-5.03) respectively; among pregnant women with natural delivery, the 21-day cumulative effect of 32 ℃ on preterm delivery was statistically significant, and the RR (95%CI) was 1.95 (1.02-3.74). Conclusion Exposure of pregnant women to high temperature during pregnancy could increase the risk of preterm birth, and there is a delayed cumulative effect.

Esophageal squamous cell carcinoma can easily penetrate into the esophageal wall and invade adjacent organs due to the lack of serosa. Stage cT4b tumors involving organs adjacent to the aorta, vertebral body, trachea, or bronchus were considered unresectable. For unresectable esophageal squamous cell carcinoma, radical chemoradiotherapy or chemotherapy is recommended. However, the therapeutic effect is poor. With the advent of conversion surgery, surgical resection is feasible after induction therapy for patients with esophageal tumors that are initially unresectable due to adjacent organ invasion or distant metastasis. This article reviews the research on conversion surgery for unresectable esophageal squamous cell carcinoma in recent years in order to explore the clinical application prospects of conversion surgery.