Objective:To establish the first Mini-Formative Evaluation of Radiation Oncology (Mini-FERO) scale in China and evaluate its preliminary application value in the standardized training for radiation oncology resident physicians.Methods:Based on the educational curriculum and examination requirements for the standardized training for radiation oncology resident physicians, as well as the standardized Mini-Clinical Evaluation Exercise (Mini-CEX) scale commonly used in clinical practice, the Mini-Formative Evaluation of Radiation Oncology (Mini-FERO) scale was developed to facilitate the standardized training for resident physicians in the field of radiation oncology. In this prospective study, a randomization method using a random number table was employed to select a cohort of 26 resident physicians who completed their rotations in Department of Radiation Oncology at the Cancer Hospital, Chinese Academy of Medical Sciences from March 1, 2021 to December 31, 2021. The Mini-FERO scale was administered in the initial, middle, and final stages during the rotation period. The differences in evaluation scores before and after the assessments were analyzed by paired t-test. Furthermore, participating resident physicians and supervising teachers provided satisfaction ratings, and a comprehensive evaluation of the Mini-FERO scale was conducted. Results:The average scores of the three examinations of 26 resident physicians demonstrated a successive improvement, with individual performance in each assessed category also showing progressive enhancement. The second evaluation exhibited a more pronounced score increase compared to the first evaluation, with a mean improvement of (1.43±1.02) points ( t=7.13, P<0.001); while the third evaluation had a mean improvement of (0.41±0.50) points ( t=4.07, P<0.001) compaired to the second evaluation, with a mean difference of (1.02±1.15) points between the two ( t=4.53, P<0.001). The average time required for the assessments was (34.31±24.46) min. Overall satisfaction ratings from the evaluated resident physicians for the Mini-FERO scale were (8.42±0.85) points, and supervising teachers reported an overall satisfaction rating of (8.45±0.85) points. The satisfaction rate was 96% (25/26). Conclusions:In this study, the Mini-FERO scale was successfully developed and validated in the context of clinical teaching practice for radiation oncology resident physicians. The Mini-FERO scale is proven to be a feasible tool for assessing the gradual improvement of resident physicians throughout their learning process in the field of radiation oncology. Importantly, it offers the advantages of short assessment time, thereby avoiding additional burden on supervising teachers. The adoption of the Mini-FERO scale addresses current limitations of lacking of formative evaluation in the standardized training for radiation oncology resident physicians.

Objective:To identify the risk factors of non-sentinel lymph node (nSLN) metastasis in breast cancer patients with 1~2 positive axillary sentinel lymph node (SLN) and construct an accurate prediction model.Methods:Retrospective chart review was performed in 917 breast cancer patients who underwent surgery treatment between 2002 and 2017 and pathologically confirmed 1-2 positive SLNs. According to the date of surgery, patients were divided into training group (497 cases) and validation group (420 cases). A nomogram was built to predict nSLN metastasis and the accuracy of the model was validated.Results:Among the 917 patients, 251 (27.4%) had nSLN metastasis. Univariate analysis showed tumor grade, lymphovascular invasion (LVI), extra-capsular extension (ECE), the number of positive and negative SLN and macro-metastasis of SLN were associated with nSLN metastasis (all P<0.05). Multivariate Logistic regression analysis showed the numbers of positive SLN, negative SLN and macro-metastasis of SLN were independent predictors of nSLN metastasis (all P<0.05). A nomogram was constructed based on the 6 factors. The area under the receiver operating characteristic curve was 0.718 for the training group and 0.742 for the validation group. Conclusion:We have developed a nomogram that uses 6 risk factors commonly available to accurately estimate the likelihood of nSLN metastasis for individual patient, which might be helpful for radiation oncologists to make a decision on regional nodal irradiation.

Objective:To identify the risk factors of non-sentinel lymph node (nSLN) metastasis in breast cancer patients with 1~2 positive axillary sentinel lymph node (SLN) and construct an accurate prediction model.Methods:Retrospective chart review was performed in 917 breast cancer patients who underwent surgery treatment between 2002 and 2017 and pathologically confirmed 1-2 positive SLNs. According to the date of surgery, patients were divided into training group (497 cases) and validation group (420 cases). A nomogram was built to predict nSLN metastasis and the accuracy of the model was validated.Results:Among the 917 patients, 251 (27.4%) had nSLN metastasis. Univariate analysis showed tumor grade, lymphovascular invasion (LVI), extra-capsular extension (ECE), the number of positive and negative SLN and macro-metastasis of SLN were associated with nSLN metastasis (all P<0.05). Multivariate Logistic regression analysis showed the numbers of positive SLN, negative SLN and macro-metastasis of SLN were independent predictors of nSLN metastasis (all P<0.05). A nomogram was constructed based on the 6 factors. The area under the receiver operating characteristic curve was 0.718 for the training group and 0.742 for the validation group. Conclusion:We have developed a nomogram that uses 6 risk factors commonly available to accurately estimate the likelihood of nSLN metastasis for individual patient, which might be helpful for radiation oncologists to make a decision on regional nodal irradiation.

Objective To investigate the clinical efficacy of percutaneous vertebroplasty (PVP) with bone filling container (BFC) and percutaneous kyphoplasty (PKP) by unilateral puncture approach in the treatment of osteoporotic vertebral compression fractures.Methods A retrospective case control study was conducted on 65 patients (65 vertebral bodies) with osteoporotic vertebral compression fractures (OVCF) who received PVP from March 2015 to March 2017 in Henan Provincial People's Hospital.There were 21 males and 44 females,aged 60-91 years,with an average of 76.2 years.The patients were divided into PVP with BFC group (BFC group) and PKP group treated by unilateral puncture approach.There were 10 males and 23 females in BFC group,with an average age of 75.8 years (range,60-91 years).The injured segments were distributed at T10 in seven patients,T11 in nine,T12 in eight,L1 in five,and L2 in four patients.There were 11 males and 21 females in PKP group,with an average age of 76.7 years (range,60-88 years).The injured segments were distributed at T10 in five patients,T11 in seven,T12 in ten,L1 in eight,and L2 in two patients.The operation time,cement leakage,as well as pain visual analogue score (VAS),modified Oswestry dysfunction index (ODI) and the Cobb angle of the fractured vertebral body at 3 days after operation and 12 months after operation were recorded and compared.Results All operations were completed successfully,without serious complications.The patients were followed up for 16-29 months [(21.2 ± 4.5) months] in BFC group and 15-32 months [(23.8 ± 6.2) months] in PKP group.The operation time was (27.8 ± 3.6) minutes in BFC group and (31.0 ± 5.2) minutes in PKP group (P ＜ 0.05).Postoperative X-ray and CT showed that bone cements leakage occurred in three patients of BFC group (9％) and in ten patients of PKP group (31％) (P ＜0.05).The VAS at 3 days after operation in BFC group and PKP group was (2.3 ± 1.0) points and (2.1 ±0.8)points respectively.The VAS at 12 months after operation in BFC group and PKP group was (0.7 ± 0.7) points and (O.8 ± 0.7) points respectively.The postoperative VAS was significantly decreased compared with the preoperative VAS (P ＜0.05),but there was no significant difference between the two groups (P ＞ 0.05).The modified ODI at 3 days after operation in BFC group and PKP group were (31.5 ± 4.7) ％ and (30.4 ± 5.7) ％,respectively.The modified ODI at 12 months after operation in BFC group and PKP group was (16.7 ±4.9)％ and (15.1 ±5.6)％,respectively.The postoperative ODI were significantly decreased compared with the preoperative ODI(P ＜0.05),but there was no significant difference between the two groups (P ＞ 0.05).The Cobb angle of the fractured vertebral body at 3 days after operation in BFC group and PKP group was (9.2 ± 3.0) ° and (10.0 ±2.9)°,respectively.The Cobb angle of the fractured vertebral body at 12 months after operation was (9.6 ± 2.8)° and (10.3 ± 3.0)°respectively.The postoperative Cobb angle was significantly decreased compared with the preoperative Cobb angle (P ＜ 0.05),but there was no significant difference between the two groups (P ＞ 0.05).Conclusions For OVCF,PVP with BFC by unilateral puncture approach can shorten the operation time and reduce the leakage rate of bone cement.It has similar effects with PKP in pain relief,function improvement of daily life and the correction of fracture vertebral kyphosis.

Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures ( OVCFs) in the critically ill patients under lateral decubitus postition. Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017. There were 27 males and 70 females, aged 59-99 years [(78. 5 ± 13. 2) years]. There were 11 patients with three-segment fracture, nine patients with two-segment fracture and 77 patients with single fracture. All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians. Preoperative and intraoperative blood loss were recorded. Preoperative and postoperative respiratory rate, heart rate, systolic pressure, oxygen saturation and acute physiology and chronic health evaluation score II ( APACHE II ) , height of vertebral compression site, and injured vertebrae Cobb angle were evaluated. The visual analogue scale ( VAS) and Oswestry dysfunction index ( ODI) were assessed to define function improvement. Meanwhile, the occurrence of re-fracture and complications were recorded. Results All patients were followed up for 3-8 months [(6.3 ±2.9)months]. The operation time was (69. 2 ± 25. 9) minutes, and the amount of intraoperative bleeding was (7. 5 ± 2. 6)ml. There were no significant differences in respiratory rate, heart rate, systolic blood pressure or oxygen saturation before operation and after operation ( P > 0. 05 ) . No surgical discontinuation or deterioration occurred. The APACHE II score was (15. 2 ± 3. 7) points before operation and (8. 4 ± 0.7)points at 24 hours after operation (P <0.05). The compression height parameter of the injured vertebraewas(17.2±3.6)mmbeforesurgery,(20.4±41.3)mmatoneweekaftersurgery,and(18.8± 1.3)mm at the last follow-up (P >0. 05). The Cobb angle was (25. 6 ± 9. 3)° before operation, (20.7±2.5)° at one week after operation and (18.5±3.1)° at the last follow-up (P>0.05). The VAS score was (8. 5 ± 1. 2)points before operation, (2. 1 ± 0. 3)points at one week after operation, and (3. 2 ± 1. 1)points at the last follow-up, respectively. The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS ( P<0. 05 ) , but there was no significant difference between the former two (P>0. 05). The ODI value was 39. 9 ± 3. 4 before operation, 20. 2 ± 5. 2 at one week after operation, and 17. 2 ± 2. 0 at the last follow-up . The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI ( P <0. 05),showing improvement trend during the follow-up (P<0. 05). No re-fracture occurred during the follow-up. No serious complications such as nerve injury, pulmonary embolism or death occurred during the operation and postoperative follow-up. Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction, shorten the operation time, relieve postoperative pain and promote functional recovery. It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine.

Objective To evaluate the efficacy of modified posterior unilateral subtotal corpectomy osteotomy correction for old thoracolumbar vertebral fractures combined with kyphosis. Methods A retrospective case series study was conducted to analyze 18 patients with old thoracolumbar vertebral fractures combined with kyphosis admitted to the Henan Provincial People's Hospital from January 2012 to October 2016. There were 10 males and eight females, aged 25-70 years, with an average age of 38. 2 years. The injured segments and osteotomy segments included T11 in one patient, T12 in four, L1 in six, and L2 in seven. Five patients had neurological impairment symptoms classified as grade D according to Frankel's classification. All patients underwent the modified posterior unilateral subtotal corpectomy osteotomy correction. The operation time and intraoperative blood loss were recorded. The visual analogue score (VAS), Oswestry dysfunction index (ODI) and kyphosis Cobb angle were compared before operation, half a year after operation and at the last follow-up. The osteotomy fusion was evaluated by Suk criterion and Frankel grading was used to evaluate the recovery of nerve function. The complications were also recorded. Results All patients were followed up for 12-24 months, with an average of 17. 6 months. The operation time was 160-285 minutes [(190. 0 ± 42. 6) minutes, and the intraoperative blood loss was 500-800 ml [(610. 0 ± 134. 3) ml]. The difference of kyphosis Cobb angle between preoperative [(40.5±9.8)°] and [(5.5 ±1.6)°] at 6 months postoperatively had statistical significance (P <0. 05). Compared with the kyphosis Cobb angle of 6 months postoperatively [(5. 5 ± 1. 6)°], the Cobb angle at the final follow-up [(6. 2 ± 1. 5)°] did not change significantly (P>0. 05). The VAS score and ODI at 6 months after operation and at the final follow-up [(3. 1 ± 1. 3)points,(2. 7 ± 0. 7)points and 7. 5 ± 5. 1, 6. 4 ± 2. 5] were significantly different compared with those before operation [(7. 6 ± 2. 4)points, 68. 7 ± 10. 4] (P<0. 05). Bone cutting surface was healed osseously in all patients. The five patients with preoperative neurological impairment of grade D were assigned with grade E at the last follow up. There were two patients with dural rupture and one with pleural effusion during the operation. No complications such as nerve damage, infection or thrombosis occurred. No loosening, fracture or heterotopic ossification occurred during follow-up. Conclusion For old thoracolumbar vertebral fracture combined with kyphosis, the modified posterior unilateral vertebral column resection through unilateral approach can not only achieve the bone fusion between the injured vertebra and the adjacent vertebral body, but also avoid the shortening of the spine, correcting kyphosis and relieving pain, with low incidence of complications.

Objective To investigate the effect of LncRNA HULC on radiosensitivity of osteosarcoma cells. Methods Osteosarcoma cells OS732 was infected by shRNA HULC lentivirus, and the interference effect was determined by qRT-PCR. Osteosarcoma cells infected with shRNA HULC lentivirus were irradiated with 8 Gy X-rays. MTT, PI monochrome staining and Annexin V-FITC/PI double staining were used to detect cell proliferation, cell cycle and apoptosis, respectively. Western blot was used to detect the protein levels of p21, Cyclin D1, C-Caspase-3 and Cyt-C in cytoplasm and mitochondria. Plate cloning assay was used to evaluate cell radiosensitivity. Results The expression of HULC in osteosarcoma cells was significantly down-regulated by shRNA HULC lentivirus infection. Down-regulation of HULC or irradiation inhibited osteosarcoma cell proliferation [(100. 00±9. 65)％ vs. (71. 36±5. 27)％, (63. 48± 5. 93)％, t=4. 512, 5. 585, P<0. 05 ] , blocked cell cycle [ ( 50. 15 ± 5. 14 )％ vs. ( 62. 35 ± 4. 22 )％, (66. 05±5. 23)％,t=3. 177,3. 756,P<0. 05], induced cell apoptosis [(2. 98±0. 23)％ vs. (22. 61± 3. 26)％, (26. 14±2. 81)％,t=8. 898,10. 498,P<0. 05], promoted the expressions of p21 and Cyclin D1 in cells, down-regulated the level of C-Caspase-3 protein, increased the level of Cyt-C protein in cytoplasm, and down-regulated the level of Cyt-C protein in mitochondria. Downregulation of HULC combined with irradiation yield much more effects on cell proliferation inhibition [ ( 71. 36 ± 5. 27 )％, (63.48±5.93)％ vs. (49.32±5.76)％, t=4.890, 2.967, P<0.05], cell cycle arrest [(62.35± 4. 22)％, (66. 05±5. 23)％ vs. (77. 17±7. 54)％, t=2. 983, 2. 106, P<0. 05], apoptosis induction [(22. 61±3. 26)％, (26. 14±2. 81)％ vs. (36. 21±3. 26) ％,t=6. 164, 4. 564, P<0. 05] and the expressions of p21, Cyclin D1, C-Caspase-3 and Cyt-C in osteosarcoma cells. The radiosensitization ratio of down-regulation of HULC was 1. 432. Conclusions Down-regulation of HULC enhances radiosensitivity of osteosarcoma cells, which may be related to cell cycle arrest and apoptosis induction.

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 investigate the clinical efficacy of posterior screw-rod single vertebra internal fixation for anterior atlas arch displaced fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 13 patients with anterior atlas arch displaced fracture admitted to Henan Provincial People's Hospital from January 2010 to March 2016.There were eight males and five females,aged 28-62 years[(40,0±9.2)years].According to Frankel grading,there was one patient with grade C and 12 patients with grade D.All patients were treated with posterior cohesive reduction with screw-rod system.Operation time,blood loss,intraoperative and postoperative complications were recorded.The operation time,intraoperative blood loss,internal fixation position,fracture healing and bone graft fusion were recorded.The Japanese orthopedic- association(JOA)score,visual analogue scale(VAS),Frankel grade,and cervical motion range were compared before and at the last follow-up.The intraoperative and postoperative complications were recorded.Results All patients were followed up for 29～68 months[(48.2±14.5)months].The operation time was 50-75 minutes[(59.5±6.5)minutes],and blood loss was 55-80 ml[(62.5±8.3)ml].After operation,fracture lines were well reset,nerve compression was relieved,pillow neck pain was alleviated,and limb function was significantly improved.CT scans confirmed bony union in al 1 patients 6 months after operation.The JOA score at the last follow-up[(15.4±0.7)points]was significantly higher than that before operation[(7.9±1.3)points](P＜ 0.05).The preoperative VAS was significantly decreased from(6.2±0.9)points to(1.9±1.0)points at the last follow-up(P＜ 0.05).The range of motion of cervical spine was close to the normal level with 70°-91°[(80.7±7.0)°]of anteflexion and extension,131°-157°[(142.9±9.1)°]of horizontal rotation,and 78°-89°[(83.8±3.2)°]of lateral flexion.One patient with incision infection and five neck stiffness as well as limited neck movement were reported,but all were cured or improved significantly after symptomatic treatment.No internal fixation lossening or breakage was found.Conclusions Posterior screw-rod single vertebra internal fixation for anterior atlas arch displaced fracture has the advantages of shortened operation time,less bleeding,less complication,good reduction as well as restored motor function of atlantoaxial joint.

Objective To investigate the effect of pressure ulcer risk warning system in the pressure ulcer management in patients undergoing thoracolumbar fracture surgery.Methods A retrospective case control study was performed to analyze the clinical data of 120 patients with thoracolumbar fracture who underwent posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery at People's Hospital of Henan Province from October 2016 to September 2018.There were 76 males and 44 females,aged 45-80 years [(59.2 ± 7.2) years].A total of 60 patients received treatment and care under the pressure ulcer early warning system (early warning group),while 60 patients were given assessment form for pressure ulcer management (control group).The time of filling in the assessment form,the implementation score of pressure ulcer prevention measures,the incidence of pressure ulcer,visual analogue pain score (VAS) and patient satisfaction were compared between the two groups.Results In the control group and early warning group,the time of filling in the form was (121.5 ± 9.0) minutes and (11.3 ± 2.0) minutes (P ＜ 0.01),the implementation score of pressure ulcer prevention measures was (85.9 ± 3.8) points and (96.0 ± 2.2)points (P ＜ 0.01),and the pressure ulcer incidence was 25％ (15 patients) and 3％ (two patients),respectively (P ＜0.01).In the control group,the preoperative VAS was (7.3 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (3.7 ± 1.1) points,(3.2 ± 0.9) points,(2.4 ± 1.0) points,(2.3 ± 0.8) points,respectively.In the early warning group,the preoperative VAS was (7.4 ± 1.3) points,and the VAS at 6 hours,24 hours,48 hours,72 hours after operation were (2.9 ± 0.7) points,(2.4 ± 0.7) points,(1.8 ± 0.7) points,(1.6 ± 0.8) points,respectively.There was no significant difference in preoperative VAS between the two groups (P ＞ 0.05),while significant differences were found between the postoperative VAS (P ＜ 0.01).The satisfaction score in the control group was (94.6 ± 1.4) points,while that of the early warning group was (98.3 ± 1.1) points (P ＜ 0.01).Conclusion For patients undergoing posterior thoracolumbar pedicle screw fixation and intervertebral bone graft fusion surgery,the pressure ulcer risk warning system is convenient and reduces the incidence of pressure ulcer,thus alleviating patients'pain and improving patients' satisfaction.