Objective:To investigate the effect of hybrid intensity modulated radiotherapy (Hy-IMRT) on immune function in patients with locally advanced breast cancer surgery and the treatment efficacy.Methods:A total of 94 patients with locally advanced breast cancer who underwent modified radical mastectomy for breast cancer and required postoperative radiotherapy in Changzhou Cancer Hospital in Jiangsu Province from January 2015 to January 2017 were selected. The patients were divided into Hy-IMRT group (observation group, 47 cases) and three-dimensional conformal radiotherapy (3DCRT) group (control group, 47 cases) according to the random number table method. The dose and related radiophysical parameters of the respective target areas of the two groups, adverse reactions during and after radiotherapy, cytokines and T lymphocyte subsets before and after radiotherapy, 3-year local recurrence rate, distant metastasis rate and mortality were observed and compared between the two groups.Results:The dose obtained by 95% (D 95%) [(4 945.6±36.1) Gy vs. (4 754.0±35.6) Gy] and target area conformity (CI) of the target volume (0.7±0.1 vs. 0.5±0.1) in the observation group were greater than those in the control group, and the differences were statistically significant (both P<0.05); the target volume of 110% of the prescription dose (V 110%) [(1.6±0.5) cm 3 vs. (8.4±1.2) cm 3], the target volume of more than 105% of the prescription dose (V 105%) [(19.3±3.5) cm 3 vs. (26.6±5.6) cm 3] and the heterogeneity index (HI) (1.1±0.1 vs. 1.3±0.1) in the observation group were all smaller than those of the control group, and the differences were statistically significant (all P < 0.05). The incidence of acute skin adverse reactions [53.2% (25/47) vs. 74.5% (35/47)] and the incidence of bone marrow suppression [40.4% (19/47) vs. 70.2% (33/47)] in the observation group were lower than those in the control group, and the differences were statistically significant (both P < 0.05). There were no significant differences in levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), CD4 +, CD8 +, and CD4 +/CD8 + between the two groups before radiotherapy (all P > 0.05). At the end of radiotherapy, the levels of IL-6, TNF-α and CD8 + were higher in both groups than before radiotherapy (all P < 0.05), and CD4 + and CD4 +/CD8 + were lower than before radiotherapy (both P < 0.05). The levels of IL-6, TNF-α and CD8 + in the observation group were lower than those in the control group, while the CD4 + and CD4 +/CD8 + were higher than those in the control group (all P < 0.05). The 3-year local recurrence rate [34.04% (16/47) vs. 42.55% (20/47)], distant metastasis rate [25.53% (12/47) vs. 38.30% (18/47)] and mortality rate [14.89% (7/47) vs. 19.15% (9/47)] in the observation group were lower than those in the control group, but the differences were not statistically significant (all P > 0.05). Conclusion:Compared with 3DCRT, the Hy-IMRT has less effect on the immune function of locally advanced breast cancer patients after modified radical resection, and the incidences of acute skin reaction and bone marrow adverse reaction are low.

Objective: To investigate the etiology and clinical characteristics of vocal fold paralysis in children. To provide useful information for diagnosis, management and prognosis in the clinical work. Methods: Two hundred and seven children with vocal fold paralysis in Children′s Hospital of Fudan University were retrospectively studied, and followed-up. Results: All the patients had hoarseness.151 cases had vocal paralysis in the left side and the main etiology was pulmonary arterial hypertension.43 cases had bilateral vocal paralysis and all of them had respiratory problems.The main etiology were congenital tracheoesophageal malformations.13 cases had vocal paralysis in the right side.In terms of etiology, 8 cases were related to intracranial lesions, 2 cases were idiopathic. Conclusions The main etiologies of left vocal fold paralysis were cardiovascular diseases, and bilateral vocal paralysis were congenital tracheoesophageal malformations.The main etiologies of right vocal fold paralysis were neoplastic and central lesion.The prognosis of bilateral vocal fold paralysis and right vocal fold paralysis was poor.

OBJECTIVE To provide methodology re ference for conducting health state disutility estimation and calculating health output in pharmacoeconomic evaluation. METHODS Literatures about health state disutility estimation of malignant tumor drugs-related adverse events were retrieved from 3 Chinese databases such as CNKI ，Wanfang database and VIP and 3 English database such as PubMed ，Web of Science and the Cochrane Library from inception to July 2021. After 2 researchers independently screened the literature and extracted the data ，qualitative analysis was conducted. The modified decision-making technical support documents of the National Institute for Health and Care Excellence were used for quality evaluation. The practice and existing problems of health state disutility measurement were summarized to put forward some suggestions. RESULTS A total of 77 literatures were included. The first literature was published in 1991，and the number of publications increased in a fluctuating manner. 77 literatures involved 120 kinds of adverse events ，mainly utility studies （49，63.64％），only 3 （3.90％） were investigated in China. A total of 35 literatures（45.45％）had no statement of study design type ，48（62.34％）had no statement of health status development method ，52（67.53％）had no statement of health status verification method ，46（59.74％）set and explained the basic health status ，and 20（25.97％）were ranked for the health status . The utility measurement tools used were mainly the standard game method and the European five-dimensional health scale （23 literatures each ，accounting for 29.87％）. The research objects of 45 literatures（58.44％）were patients ，and 63（81.82％）did not specify the representative test of the population. Utility report types included negative value ，non-negative value and non-negative value of consolidated basic status. A total of 45 literatures（58.44％）had no statement of statistical method of utility. Overall quality score of included studies was 0.683. CONCLUSIONS The current disutility estimation include 4 key links of basic study design ， health status confirmation， utility estimation survey and survey data E-mail：luyuqiong96@foxmail.com statistics. The deficiencies of related studies are the lack of data based on the Chinese population ，the inconsistent type ofresult reporting ，and the incomplete report of measurement- related critical items. It is recommended to standardize the basic implementation path of disutility estimation ，formulate guidelines for health status utility value estimation ，and strengthen multidisciplinary cooperation so as to improve the quality of health status utility value estimation .

OBJECTIVE To explore the merging methods and influencing factors of health state disutility values estimation. METHODS Retrieved from 6 Chinese and English databases such as CNKI and PubMed ，the literatures about disutility values of diarrhea caused by antitumor drugs were collected from the inception to July 2021. After 2 researchers independently screened the literature，extracted the data ，assessed the quality ，the Meta-analysis and regression analysis were conducted using Stata 16.0 software. RESULTS Fifteen literatures were included. The results of Meta-analysis showed that diarrhea caused by antitumor drugs had a significant impact on health utility [ MD＝－0.26，95％CI（－0.30，－0.22），P＜0.05]. The results of subgroup analysis showed that the disutility values of the 3 types of negative value ，non-negative value changed into negative value ，and non-negative value combined with basic state changed into to negative value were MD ＝－0.14，95％CI（－0.19，－0.09）；MD＝－0.46，95％CI （－0.56，－0.36）；MD＝－0.12，95％CI（－0.20，－0.05），respectively. Meta regression results showed that the year of publication ， survey country/region ，severity of adverse events ，basic state settings ，utility estimation tools ，utility report types ，and utility statistical methods significantly affected the value of diarrhea disutility （P＜0.05）. CONCLUSIONS Disutility values for treatment-related symptoms or complications should be fully considered when inputting the parameters to the economic evaluation model. In the study or application of disutility values ，the types of utility reports should be distiguished ，and the core influencing factors such as the investigation country or region ，the severity of symptoms or complications ，and whether the basic state is set should be focus on.

OBJECTIVE To learn the practical experience of medical insurance payment standards adjustment in Japan and South Korea， which will serve as a reference for the improvement of simple renewal mechanism in China. METHODS Retrieving relevant literature from CNKI and related policy documents from official websites of Japan and South Korea， the medical insurance payment standards adjustment practice in Japan and South Korea would be elucidated from 2 perspectives of adjustment criteria and formulas， and then were compared with the current simple renewal mechanism in China to clarify the areas where simple renewal mechanism in China can be optimized and propose several suggestions. RESULTS & CONCLUSIONS In terms of adjustment methods， Japan and South Korea were similar to China. For excessive drugs， the reduction rate of drugs was calculated based on the situation of excess and adjustments were implemented； however， there were differences in the specific adjustment criteria and formulas. Japan and South Korea adopted a linear price reduction approach for drugs with significant oversupply， while China adopted a gradient price reduction approach for drugs with both current and expected oversupply. The results of the comparative analysis show that China has initially established simple renewal mechanisms that are in line with the national conditions and the actual medical insurance situation， and has taken some innovative measures， including considering the current and expected oversupply of drugs and introducing a halving mechanism in the adjustment formula. However， there are also certain shortcomings， such as a relatively single set of indicators for adjusting conditions and a too broad range of gradient price reduction in adjustment formulas， which fail to fully reflect the market-oriented mechanism of “volume for price”. It is recommended that China’s medical insurance department increase consideration of drug fund expenditures， refine the gradient price reduction range of adjustment formulas， increase policy preferences for special category drugs when adding new indications， and further improve the mechanism for simple renewal.