Objective:To explore the optimal local treatment pattern of supraclavicular lymph node in breast cancer patients with synchronous ipsilateral supraclavicular lymph node metastasis (sISLM).Methods:Clinical data of 128 breast cancer patients with sISLM admitted to the Fourth Hospital of Hebei Medical University from 2010 to 2015 were retrospectively analyzed. Among them, 68 cases were treated with supraclavicular lymph node dissection combined with radiotherapy, and 60 cases received radiotherapy alone. The locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS) were statistically compared between two groups.Results:Univariate analysis demonstrated that the 5-year LRFS, DMFS, PFS and OS did not significantly differ between two groups (all P>0.05). Multivariate analysis revealed that the local treatment pattern of supraclavicular lymph node was an independent prognostic factor for the 5-year DMFS, PFS and OS (all P<0.05). Subgroup analysis showed that when radiotherapy alone was performed, the 5-year OS of patients in the supraclavicular region radiation dose of>50 Gy group were significantly better than that in the 50 Gy group ( P=0.047). When supraclavicular lymph node dissection combined with radiotherapy was delivered, if the number of dissection was less than 10, the 5-year LRFS, DMFS, PFS, OS of patients in the>50 Gy group were all better than those in the 50 Gy group numerically without statistical significance (all P>0.05). If the number of dissection was ≥10, the 5-year LRFS, DMFS, PFS, OS in the 50 Gy group were better than those in the>50 Gy group numerically, whereas significant difference was only found in the 5-year DMFS ( P=0.028). Conclusions:Supraclavicular lymph node dissection combined with radiotherapy may be the optimal local treatment pattern for supraclavicular lymph node. When radiotherapy alone is performed, a radiation boost to the supraclavicular region may improve OS. When supraclavicular lymph node dissection combined with radiotherapy is performed, if the degree of dissection is low, a radiation boost to the supraclavicular region may bring clinical benefits. However, if the degree of dissection is high, a radiation boost to the supraclavicular region may not bring significant clinical benefits.

Objective To explore the clinical effects of transvaginal acupoint injection in the treatment of chronic pelvic pain induced by pelvic floor myofascitis. Methods All 80 patients with pelvic floor myofascitis were randomly assigned to an observation group and a control group, with 40 patients in each group. The observation group was given the treatment of transvaginal pain spot injection, and the control group was given transvaginal non-pain spot injection. Changes of clinical symptoms, signs, pain scores and other indices before the treatment, 1 week and 2 weeks after the treatment between the two groups of patients were observed and compared. Results Comparison of pain scores between the treatment group and the control group before the treatment was not significantly different (P>0.05); pain scores after the treatment in the two groups were significantly lower compared to those before the treatment, and the differences in the two groups were both significant (P<0.01). The curative effects in the treatment group were better than those in the control group (P<0.01). Conclusion Transvaginal acupoint injection is able to significantly alleviate chronic pelvic pain induced by pelvic floor myofascitis, but accurate pain spot injection is required.

Objective To investigate the effect of radiation boost ( Boost ) on further improving overall survival ( OS) and intracranial progression-free survival ( IPFS) of small-cell lung cancer ( SCLC) brain metastases (BM) patients treated by whole-brain radiotherapy (WBRT). Methods A retrospective analysis of 142 consecutive SCLC BM patients admitted between 2013 and 2015 was conducted after excluding those with historical prophylactic cranial irradiation (n=16) or SRT (n=10) or local RT alone (n=1).The Kaplan-Meier curve was utilized to calculate the survival rate. The log-rank test and multivariate Cox proportional hazard regression model were utilized to evaluate clinical prognosis. Results All patients were aged 59. 6 years old on average, and the female proportion was 23％. The quantity of brain metastasis lesion was 1 in 35％, 2-3 in 23％ and ≥4 in 42％, respectively. The proportion of patients receiving chemotherapy was 70％. The median OS was 9. 0 months and the median IPFS was 7. 3 months. The accumulative mortality rate in the non-radiation ( n=53 ) , WBRT ( n=33 ) and WBRT+ Boost ( n=56 ) groups was 92％, 79％ and 73％, and the accumulative failure rate ( death or new/relapsed brain metastasis) was 94％, 82％ and 80％, respectively. Compared with the non-radiation group, WBRT and WBRT+Boost therapies exerted significant effect upon OS ( P=0. 000 and 0. 000) and IPFS ( P=0. 000 and 0. 000) . Compared with WBRT alone, WBRT+ Boost treatment exerted no significant effect upon OS ( P=0. 41 and 0. 51) . Conclusions WBRT can significantly improve OS and IPFS of patients with SCLC-BM. However, concurrent and additional radiation boost does not further improve the survival rate.

Objective:To master the iodine nutrition status of children and pregnant women after adjustment of salt iodization content in Shaanxi Province, and provide scientific basis for preventing and treating iodine deficiency disorders.Methods:In 2018, 107 counties (cities, districts) in Shaanxi Province were divided into three districts in Guanzhong, northern Shaanxi and southern Shaanxi for studying iodine nutrition based on terrain distribution. Among them, each monitoring county (city, district) was further divided into 5 sampling areas according to east, west, south, north, and middle locations. One township (street) was selected in each location, and forty-two 8 - 10 years old non-boarding children (age and sex balanced) and 21 pregnant women were selected in each township (street), edible salt samples and random urine samples were collected for salt iodine, urinary iodine testing, and goiter of children was examined.Results:A total of 34 264 edible salt samples from 8 - 10 years old children and pregnant women were collected, the median salt iodine was 23.80 mg/kg, and the qualified iodized salt consumption rate was 96.98% (33 229/34 264). The median salt iodine and the qualified iodized salt consumption rate were statistically significantly different among the three regions in Guanzhong, northern Shaanxi, and southern Shaanxi ( H = 26.471, χ 2 = 32.371, P < 0.05). A total of 22 895 urine samples were collected from children, with a median urinary iodine of 218.00 μg/L, which was at an ultra-suitable level of iodine nutrition; and 11 369 urine samples from pregnant women were collected, with a median urinary iodine of 181.03 μg/L, which was at an appropriate level of iodine nutrition. The median urinary iodine of pregnant women in Guanzhong, northern Shaanxi, and southern Shaanxi was 186.39, 177.52, and 176.00 μg/L, respectively. A total of 22 895 children aged 8 to 10 years old were examined, the goiter rate was 1.35% (309/22 895), and there was no significant difference between different regions (χ 2 = 3.395, P > 0.05). Conclusions:Shaanxi Province has reached the standard for elimination of persistent iodine deficiency, children's iodine nutrition is at a ultra-suitable level, and pregnant women is at an appropriate level.

Objective:To learn about the iodine nutrition level of school-age children aged 8 - 10 in Shaanxi Province.Methods:From 2017 to 2020, in counties (cities, districts) under the jurisdiction of Shaanxi Province, one township (street) was selected from five directions: East, West, South, North and Middle, one primary school was selected from each township (street), and 42 non-boarding school-age children aged 8 - 10 (age balanced, half male and half female) were selected from each primary school. Random urine samples of children were collected once, and urinary iodine was detected by arsenic-cerium catalytic spectrophotometry.Results:A total of 91 766 children's urine samples were tested from 2017 to 2020, and the median urinary iodine was 221.7 μg/L. Urinary iodine < 100 μg/L accounted for 10.4% (9 554/91 766), 100 - < 200 μg/L accounted for 32.3% (29 602/91 766), 200 - < 300 μg/L accounted for 30.6% (28 065/91 766), and ≥300 μg/L accounted for 26.7% (24 545/91 766). The median of children's urinary iodine in each year was 228.5, 218.0, 211.7, and 230.1 μg/L, respectively, the difference between years was statistically significant ( H = 278.66, P < 0.001). Conclusion:From 2017 to 2020, the iodine nutrition of school-age children aged 8 - 10 in Shaanxi Province is generally in an ultra-suitable state.

Objective:To evaluate the effect of prophylactic irradiation of internal mammary lymph nodes in patients with breast cancer in this Meta-analysis.Methods:CNKI, Wanfang Medical network, CBM, PubMed, EMBASE and Web of Science were searched by computer. The controlled clinical studies comparing whether or not internal mammary lymph node irradiation as an intervention were included and the quality of the included literature was evaluated according to Newcastle-Ottawa Scale (NOS). RevMan 5.3 software and Stata 14 software were used for Meta-analysis.Results:A total of 11 original articles were included, and 13 181 patients were included for Meta-analysis. There was no statistically significant difference in the overall survival (OS) between patients with and without internal mammary lymph node irradiation ( P=0.490). The subgroup analysis using the date of treatment and the degree of risk in the enrolled population as criteria showed that 5-year OS was significantly increased after internal mammary area irradiation in high-risk stage Ⅱ-Ⅲ patients (N+ , T 3-T 4 stage) with the date of treatment of after 2000( P=0.003, 0.006). Compared with patients without internal mammary area irradiation, internal mammary irradiation significantly increased the 5-year disease-free survival (DFS)( P<0.001). Conclusion:Under the modern radiotherapy technology, internal mammary lymph node irradiation improves the DFS of patients, and may bring OS benefits to high-risk stage Ⅱ-Ⅲ breast cancer patients (N+ , T 3-T 4 stage).

BACKGROUND: Patients who underwent lobectomy resection are prone to hypoxemia, and the vast majority present with type I respiratory failure. Thus, improvement of hypoxemia is one of the most important factors to facilitate postoperative recovery of patients. In this study, the superiority-inferiority of different oxygen inhalation methods were compared with high-flow nasal oxygen therapy (HFNO), noninvasive mechanical ventilation (NIMV) and nasal oxygen breath (NOB) in patients with hypoxemia after single-port video-assisted thoracoscopic (VATS) lobectomy, and the clinical efficacy of HFNO in these patients was further investigated. METHODS: A total of 180 patients from the Second Affiliated Hospital of Soochow University in China with hypoxemia who accepting single-port VATS lobectomy from June 2021 to March 2022 were randomly divided into three groups (n=60), which were treated with HFNO, NIMV and NOB, respectively. The results of arterial blood gas analysis, patient's comfort score and incidence of complications were observed before, 1 h, 6 h-12 h and after use. Statistical analyses were conducted using statistical program for social sciences 25.0 (SPSS 25.0), and P<0.05 was considered as statistical significance. RESULTS: For patients with hypoxemia after accepting single-port VATS lobectomy, HFNO was no less effective than NIMV (P=0.333), and both of whom could fast increase patients' partial pressure of oxygen/fraction of inspiration O₂ (PaO₂/FiO₂) compared to NOB (P<0.001). Besides, HFNO shows a great advantage in comfort degree and stay length (P<0.001, P=0.004), and incidence of complications were slightly lower than other groups (P=0.232). But it is worthy to note that HFNO is still slightly less effective than NIMV in patients with postoperative hypoxemia accompanied by elevated partial pressure of carbon dioxide (PaCO₂). CONCLUSIONS For patients with hypoxemia who accepting single-port VATS lobectomy, HFNO can be used as the first choice. However, for patients with postoperative hypoxemia accompanied by elevated PaCO₂, NIMV is still recommended to improve oxygenation.
Carbon Dioxide ; Humans ; Hypoxia/surgery* ; Lung Neoplasms/surgery* ; Oxygen ; Pneumonectomy/methods* ; Thoracic Surgery, Video-Assisted/methods*

Objective    To summarize the clinical experience of the uniportal thoracoscopic anatomical sub-segmentectomy of the basal segment. Methods    The clinical data of 34 patients who underwent uniportal thoracoscopic anatomical sub-segmentectomy of the basal segment in our department between April 2018 and April 2021 were retrospectively analyzed. There were 19 males and 15 females with a median age of 56.5 (28.0-76.0) years, a 3-4 cm incision was made in the 5th intercostal area at the front axillary line, and anatomical sub-segmentectomy of the basal segment was performed. Results     The surgery was successfully performed in all patients, and there was no patient with additional chest incision or transfer to thoracotomy. The median operation time was 165.0 (125.0-220.0) min, intraoperative blood loss was 120.0 (70.0-290.0) mL, thoracic drainage time was 3.5 (2.0-24.0) d, and hospitalization time was 6.0 (3.0-26.0) d. There was no death during the hospitalization. Postoperative complications included 4 patients of atrial fibrillation, 2 patients of blood sputum, 3 patients of persistent air leakage, and they were recovered after conservative treatment. One patient developed pneumothorax after discharge, 1 patient developed pleural effusion, and both of them recovered after drainage. Postoperative pathology showed microinvasive adenocarcinoma in 22 patients, adenocarcinoma in situ in 7 patients, benign tumors in 5 patients. The lymph nodes were negative in all patients. Conclusion     The uniportal thoracoscopic anatomical sub-segmentectomy of the basal segment is safe and feasible, and can be popularized and applied in clinic.