Background and purpose:Internal mammary sentinel lymph node biopsy(IMSLNB)is a minimally invasive diagnostic technique for regional lymph nodes in breast cancer,which can provide accurate lymph staging and guide adjuvant treatment decision,but its clinical application has been controversial.The purpose of this study was to investigate the prognosis of IMSLNB in early breast cancer.Methods:In this study,a retrospective cohort of 7 949 patients with breast cancer from January 1,2016 to December 31,2021 was analyzed.After applying propensity score matching,the patients were divided into IMSLNB group and no-IMSLNB group,and the regional recurrence-free survival(RRFS),local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS),disease-free survival(DFS)and overall survival(OS)of the two groups were compared.This study was approved by the Clinical Research Ethics Committee of the Affiliated Tumor Hospital of Shandong First Medical University(approval number:SDTHEC20130324).Results:A total of 990 patients were included in the final analysis(330 in the IMSLNB group and 660 in the no-IMSLNB group).IMSLN metastasis was found in 54 patients in the IMSLNB group,including 47 patients with axillary lymph node(ALN)metastasis and 7 patients with IMSLN metastasis only.The IMSLN transfer rate was 16.4%.The median follow-up of 41 months showed that the IMSLNB group demonstrated better 3-year DFS[98.4%vs 94.2%,hazard ratio(HR)=0.509;95%CI:0.312-0.828,P=0.007]and 5-year DFS(92.5%vs 87.3%,HR=0.214,95%CI:0.206-0.222,P=0.011)compared with no-IMSLNB group.However,no significant differences were observed in 3-year OS(99.1%vs 99.4%,HR=0.618,95%CI:0.231-1.655,P=0.338)or 5-year OS(98.5%vs 99.1%,HR=0.52,95%CI:0.51-0.53,P=0.392)between the two groups.The 3-year RRFS in the IMSLNB group was better compared with the no-IMSLNB group(99.09%vs 97.73%,HR=0.066;95%CI:0.061-0.071,P=0.048),while no significant differences were observed in 3-year LRFS(99.70%vs 98.19%,HR=0.209;95%CI:0.201-0.217,P=0.130)or DMFS(95.76%vs 96.06%,HR=0.865,95%CI:0.858-0.872,P=0.820)between the two groups.The exploratory subgroup analysis of DFS revealed that patients in the following subgroups could significantly benefit from IM-SLNB(P＜0.05):diagnosis age(≤50 years),premenopausal status,BMI(≤24),lymphovascular invasion(LVI,present),tumor location(lateral),molecular subtype[hormone receptor positive(HR+)/human epidermal growth factor receptor 2 negative(HER2-)],histological type(invasive ductal carcinoma),and axillary lymph node status(positive).Conclusion:IMSLNB can provide more accurate regional lymph node staging for early breast cancer,help optimize adjuvant radiotherapy strategies,and improve patients'DFS and RRFS.It can be promoted as a minimally invasive staging technique for regional lymph nodes.

Background and purpose:Internal mammary sentinel lymph node biopsy(IMSLNB)is a minimally invasive diagnostic technique for regional lymph nodes in breast cancer,which can provide accurate lymph staging and guide adjuvant treatment decision,but its clinical application has been controversial.The purpose of this study was to investigate the prognosis of IMSLNB in early breast cancer.Methods:In this study,a retrospective cohort of 7 949 patients with breast cancer from January 1,2016 to December 31,2021 was analyzed.After applying propensity score matching,the patients were divided into IMSLNB group and no-IMSLNB group,and the regional recurrence-free survival(RRFS),local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS),disease-free survival(DFS)and overall survival(OS)of the two groups were compared.This study was approved by the Clinical Research Ethics Committee of the Affiliated Tumor Hospital of Shandong First Medical University(approval number:SDTHEC20130324).Results:A total of 990 patients were included in the final analysis(330 in the IMSLNB group and 660 in the no-IMSLNB group).IMSLN metastasis was found in 54 patients in the IMSLNB group,including 47 patients with axillary lymph node(ALN)metastasis and 7 patients with IMSLN metastasis only.The IMSLN transfer rate was 16.4%.The median follow-up of 41 months showed that the IMSLNB group demonstrated better 3-year DFS[98.4%vs 94.2%,hazard ratio(HR)=0.509;95%CI:0.312-0.828,P=0.007]and 5-year DFS(92.5%vs 87.3%,HR=0.214,95%CI:0.206-0.222,P=0.011)compared with no-IMSLNB group.However,no significant differences were observed in 3-year OS(99.1%vs 99.4%,HR=0.618,95%CI:0.231-1.655,P=0.338)or 5-year OS(98.5%vs 99.1%,HR=0.52,95%CI:0.51-0.53,P=0.392)between the two groups.The 3-year RRFS in the IMSLNB group was better compared with the no-IMSLNB group(99.09%vs 97.73%,HR=0.066;95%CI:0.061-0.071,P=0.048),while no significant differences were observed in 3-year LRFS(99.70%vs 98.19%,HR=0.209;95%CI:0.201-0.217,P=0.130)or DMFS(95.76%vs 96.06%,HR=0.865,95%CI:0.858-0.872,P=0.820)between the two groups.The exploratory subgroup analysis of DFS revealed that patients in the following subgroups could significantly benefit from IM-SLNB(P＜0.05):diagnosis age(≤50 years),premenopausal status,BMI(≤24),lymphovascular invasion(LVI,present),tumor location(lateral),molecular subtype[hormone receptor positive(HR+)/human epidermal growth factor receptor 2 negative(HER2-)],histological type(invasive ductal carcinoma),and axillary lymph node status(positive).Conclusion:IMSLNB can provide more accurate regional lymph node staging for early breast cancer,help optimize adjuvant radiotherapy strategies,and improve patients'DFS and RRFS.It can be promoted as a minimally invasive staging technique for regional lymph nodes.

Acute suppurative thyroiditis(AST) is a rare thyroid disease, mostly caused by infections such as Staphylococcus aureus, and it is difficult to distinguish from subacute thyroiditis(SAT) at the beginning of the disease. Here we report the clinical data of a young male patient who was initially misdiagnosed as SAT, but was clinically diagnosed as AST with DNSIs accompanied by LS. The clinical features and treatment, combined with related literature, aim to enhance clinicians' understanding of this disease.

Objective To evaluate the precision and effectiveness of ultrasound-guided visualization for nasojejunal tube placement with the"R(right reclining)-S(shoulder)-A(abdominal)"3-point positioning for critically ill patients.Methods A retrospective analysis was conducted on all critically ill patients who underwent nasojejunal tube placement in Department of Critical Medicine of a tertiary hospital in Chongqing from April 2022 to August 2023.According to the position of the catheter,they were divided into a control group and an observation group.The control group received ultrasound-guided nasojejunal tube insertion,while the observation group used the"R-S-A"3-point positioning (the patient were placed in a right lateral position,the nurse stood at the right shoulder of the patient,and the ultrasound operator stood on the right side of the abdomen in the operating direction)for ultrasound-guided nasojejunal tube insertion.And,the control group had no specific requirements for positioning during the procedure.After propensity matching,the time and success rate of catheter insertion and incidence of complications were compared between the 2 groups.Results The time of catheter insertion was significantly shorter (36.2±10.3 vs 42.3±8.3 min),and the success rate of insertion was obviously higher (95.2％ vs 66.7％)in the observation group when compared with the control group (P<0.05).The incidence of complication was 9.5％ in the observation group,and 28.6％ in the control group,but there was no statistical difference between the 2 groups.Conclusion Ultrasound-guided nasojejunal tube placement based on "R-S-A"3-point positioning has high precision and strong effectiveness in critically ill patients,which can shorten the time and improve the success rate of catheter insertion.

Objective To observe the effects of ultrasound-guided serratus anterior plane block(SAPB)for pain relief in the acute phase of rib fractures and its impact on early rehabilitation.Methods This study included 160 patients from Taizhou Central Hospital with unilateral rib fractures undergoing conservative treatment.The patients were randomly divided into two groups,with 80 patients in each group.Group A received flurbiprofen alone for pain relief,while Group B received ultrasound-guided SAPB combined with flurbiprofen.Numerical rating scale(NRS)before treatment and at 1h,6h,12h,24h,and 48h after treatment,additional analgesic use,adverse reactions,functional recovery parameters(including vital capacity,peak expiratory flow,and walking distance),and hospital stay duration were recorded and compared between the two groups.Results The pain scores in Group B were significantly lower than those in Group A at 1h,6h,and 12h after treatment(P＜0.01),with no significant differences at 24h and 48h(P＞0.05).The use of additional analgesics and adverse reactions were significantly less in Group B compared to Group A(P＜0.01).Group B patients had significantly higher vital capacity,peak expiratory flow,and walking distance(P＜0.01).Additionally,the average hospital stay in Group B was significantly shorter than that in Group A(P＜0.01).Conclusion Ultrasound-guided SAPB combined with flurbiprofen is significantly more effective than flurbiprofen alone for treating rib fracture patients.SAPB provides more effective pain control,faster functional recovery,and has a high safety profile.

Objective To establish an HPLC method to determine the content of diosgenin in Paridis Rhizoma; To examine contents of diosgenin in different varieties of Paridis Rhizoma medicinal plants and from different habitats. Methods Shimadzu Inertsil ODS-C18 guard column (150 mm×4.6 mm, 5μm) was used in HPLC system; elution conditions were the mobile phase using 92% acetonitrile and 8% water (isocraticelution) at a flow rate of 1.0 mL/min with 203 nm detection wavelength. The temperature of the column oven was maintained at 30℃.Results Different varieties of Paridis Rhizoma medicinal plants and Paridis Rhizoma medicinal plants from different habitats contained diosgenin. TheParis polyphylla var.pseudothibetica in Yubei district had the highest content (6.813 7 mg/g);Paris polyphylla var.stenophylla in Chengkou County had the middle content (5.758 4 mg/g);Paris yunnanensisFranch in Shizhu county showed the lowest content (1.952 2 mg/g). The results showed that the obvious difference of chemical quality between various cultivated varieties of Paridis Rhizoma medicinal plants, which might be related with origin, variety and the cultivation technology, and so on.Conclusion The diosgenin contents ofParis polyphylla var. pseudothibetica andParis polyphylla var.stenophylla were higher than that of varieties recorded in Chinese Pharmacopeia.Paris polyphylla var.pseudothibetica andParis polyphylla var.stenophylla had important medical value.

Objective To study the amount of rhizospheric microorganisms and soil enzyme activity influenced by Paridis Rhizoma in different locations and of different strains. Methods The amount of rhizospheric microorganisms, soil enzyme activity and their correlation were researched through field survey and collection of rhizospheric soil in Paridis Rhizoma cultivated in Three Gorges Reservoir Region and by microbial dilution plate culture method. Results The amount of rhizospheric microorganisms in Paridis Rhizoma from different habitats showed significant differences. The dominant species in soil microflora was bacteria; the second one was actinomycetes; the fewest one was fungus. The variation trend of the amount of rhizospheric microorganisms was not consistent with the variation trend of rhizospheric microorganisms diversity index. The activity of soil phosphatase, invertase and pepsin in Paridis Rhizoma from different habitats varied. The correlation analysis showed that the correlation between the soil enzyme activity and the amount of rhizospheric microorganisms existed. Conclusion Choosing the suitable strains and habitats of Paridis Rhizoma is beneficial to enhancing the amount of rhizospheric microorganisms and soil enzyme activity, which can create good micro-ecological environment for growth and cultivation of Paridis Rhizoma.

ObjectiveTo study the effects of 9 different drying methods on total saponin content and antioxidant capacity ofParis polyphylla var.yunnanensis.Methods UV-VIS spectrophotometry was used for measuring the total saponin content ofP. polyphylla var.yunnanensis, 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzthiozoline-6)-sulphonic acid (ABTS+) radical scavenging methods were used for evaluating the antioxidant capacity ofP. polyphylla var. yunnanensisextracts.ResultsThe total saponin contents ofP. polyphylla var.yunnanensis dried by different methods existed significant difference. The sample dried at 35℃ showed highest total saponin content (17.557 mg/g). The sample dried in the shade naturally showed middle total saponin content (13.740 mg/g). Based on the results of antioxidant capacity detected by two methods, the samples ofP. polyphylla var. yunnanensis dried by 9 different methods all showed good antioxidant capacity and showed a certain concentration dependence.Conclusion The samples dried at 35℃ have the highest antioxidant capacity. Therefore, drying at 35℃ is a better drying method to obtain high quality and high activity ofP. polyphylla var.yunnanensis.