Objective:To establish a brain metastasis (BM) prediction model for limited-stage small cell lung cancer (LS-SCLC) patients who achieved complete response (CR) or partial response (PR) after thoracic chemoradiotherapy, and to explore the value of prophylactic cranial irradiation (PCI) in different risk groups.Methods:Clinical data of 274 patients with LS-SCLC who achieved CR/PR after thoracic chemoradiotherapy in Tianjin Medical University Cancer Institute & Hospital from January 2010 to December 2021 were retrospectively analyzed, including 144 cases in the PCI group and 130 in the non-PCI group. The nomogram was developed based on variables determined by univariate and multivariate analyses in the non-PCI group. The bootstrap method, receiver operating characteristics (ROC) curve, calibration curve and decision curve analysis (DCA) were employed to evaluate the predictive power and clinical benefits of the model. Patients were stratified into high- and low-risk groups based on risk scores. The brain metastases-free survival (BMFS), progression-free survival (PFS), extracranial progression-free survival (ePFS) and overall survival (OS) were compared between patients with and without PCI in different risk-stratified populations using the log-rank test.Results:The nomogram included five variables: systemic immune inflammation index (SII), lymphocyte-to-monocyte ratio (LMR), pro-gastrin-releasing peptide precursor (ProGRP), neuron-specific enolase (NSE), and blood calcium. The area under the ROC curve (AUC) of the nomogram in predicting 1- and 2-year BMFS was 0.761 and 0.822. In the low-risk group, there was no significant difference in the BMFS ( P=0.374), PFS ( P=0.551), ePFS ( P=0.508) and OS ( P=0.767) between the PCI and non-PCI groups. In the high-risk group, PCI could significantly increase the BMFS ( P<0.001) and PFS ( P=0.022), while there was no significant difference in the ePFS ( P=0.963) and OS ( P=0.632). And propensity score-matching (PSM) analysis showed similar results. Conclusions:PCI does not improve OS in LS-SCLC patients regardless of high or low risk of BM. However, PCI significantly prolong the BMFS and PFS in patients at a high risk of BM.

Objective:To investigate the effects of estimated dose of radiation to immune cells (EDRIC) on overall survival (OS), local progression-free survival (LPFS) and distant metastasis-free survival (DMFS) in limited-stage small-cell lung cancer (LS-SCLC) with different tumor burdens.Methods:Clinical data of 216 patients with LS-SCLC who initially received conventional fractionated radiotherapy of the chest for radical treatment in Tianjin Medical University Cancer Institute and Hospital from 2013 to 2019 were retrospectively analyzed. EDRIC was calculated based on the model developed by Jin et al. and tumor burdens were assessed by gross tumor volume (GTV) or clinical stage. The study endpoints were OS, LPFS and DMFS, which were calculated from the date of diagnosis. The optimal cut-off value of EDRIC was calculated by R language. The correlation between EDRIC and tumor burdens was analyzed using Spearman's correlations. Survival analysis was performed by Cox proportional hazards regression model and Kaplan-Meier curve. Results:The median follow-up time for the whole group was 47.8 months, and the median OS and DMFS was 34.6 months and 18.5 months, respectively, while the median LPFS did not reach. The optimal cut-off value of EDRIC was 6.8 Gy. Cox multivariate analysis showed that EDRIC was an independent prognostic factor affecting OS and DMFS. EDRIC was weakly correlated with GTV or clinical stage. Stratified by the median GTV, OS ( P=0.021) and DMFS ( P=0.030) were significantly shortened and LPFS had a tendency of shortening ( P=0.107) when EDRIC>6.8 Gy compared with those when EDRIC ≤ 6.8 Gy in the GTV ≤ 34.6 cm 3 group; EDRIC had little effect on OS, LPFS, and DMFS ( P=0.133, 0.420, 0.374) in the GTV>34.6 cm 3 group. Stratified by clinical stage, OS ( P=0.003) and DMFS ( P=0.032) were significantly shortened and LPFS ( P=0.125) tended to shorten when EDRIC>6.8 Gy in stage I, II and IIIA groups; EDRIC exerted slight effect on OS, LPFS, and DMFS ( P=0.377, 0.439, 0.484) in stage IIIB and IIIC groups. Conclusion:EDRIC is an important factor affecting prognosis and exerts more significant impact on prognosis in patients with smaller tumor burden.

Objective:To understand the level of iodine nutrition in the areas with iodine deficiency and high iodine in Anyang City of Henan Province, and to provide a basis for taking targeted prevention and treatment measures and scientific adjustment of intervention strategies.Methods:In 2019, three areas with iodine deficiency (median iodine in water < 10 μg/L) and three areas with high water iodine (median iodine in water > 100 μg/L) were selected from counties (cities and districts) in Anyang City by stratified random sampling. Children aged 8-10 and pregnant women were selected in areas with high iodine and areas with iodine deficiency, respectively. Urine samples and salt samples were collected and tested, and children's thyroids were examined by B-mode ultrasound.Results:A total of 654 salt samples were collected in iodine deficiency areas, among which non-iodized salt accounted for 1.83% (12/654). A total of 628 salt samples were collected from areas with high iodine, among which non-iodized salt accounted for 6.05% (38/628). The difference in non-iodized salt rate between the two areas was statistically significant (χ 2=15.19, P < 0.05). A total of 654 urine samples were collected from children in iodine deficiency areas, with a median of 211.15 μg/L of urinary iodine, and 628 urine samples were collected from high iodine areas, with a median of 390.50 μg/L of urinary iodine. The difference was statistically significant ( U=- 18.34, P < 0.05). A total of 300 urine samples were collected from pregnant women in iodine deficiency areas, with a median of 223.95 μg/L, and 127 urine samples were collected from pregnant women in high iodine areas, with a median of 258.00 μg/L. The difference was statistically significant ( U=- 4.07, P < 0.05). The thyroid volume of 560 children in the iodine deficient areas was detected, and the swelling rate was 1.43% (8/560). The thyroid volume of 628 children in high iodine areas was detected, and the swelling rate was 2.07% (13/628). Conclusion:The iodine nutrition level of the population in the iodine deficiency areas of Anyang City is appropriate, while the iodine nutrition level of the population in the water source high iodine areas is excessive.

Objective:To understand the iodine content of drinking water and iodine nutrition of key population in Anyang City, Henan Province, and to provide a basis for taking targeted prevention and control measures and scientific adjustment of intervention strategies.Methods:In 2019, stratified sampling method was used to carry out water iodine survey in all townships in Anyang City, and in townships with the median water iodine > 10 μg/L, water iodine survey was carried out in administrative villages, and water iodine content was detected. Two hundred children aged 8 - 10 years and 100 pregnant women were selected from each county (city, district) to test iodine contents of their household salt and urine, respectively.Results:Six hundred and eight water samples were collected in Anyang City, and the median water iodine was 5.98 μg/L. One thousand one hundred and fifty-six samples were collected, and the median water iodine was 34.10 μg/L. A total of 1 605 salt samples were collected in the city, and the median salt iodine was 24.30 mg/kg, the coverage rate of iodized salt was 91.8% (1 473/ 1 605). A total of 1 605 urine samples were collected from children in the city, and the median urinary iodine was 170.10 μg/L. Urine samples of 804 pregnant women were collected, and the median urinary iodine was 190.00 μg/L.Conclusion:Most areas of Anyang City still belong to iodine deficiency area, and the median urinary iodine of children and pregnant women is within the suitable range of iodine.

Objective To study the use of preoperative indocyanine green retention test at 15 minutes (ICG R15) in the prediction of liver functional reserve in patients with hilar cholangiocarcinoma (HCCA).Methods The clinical data of 62 patients with HCCA treated in our department from March 2016 to March 2018 was reviewed.The relationship between preoperative ICG R15 and postoperative hepatic insufficiency was analyzed.The relationship between preoperative ICG R15 and Child-Pugh scoring was also studied.Univariate analysis was used to evaluate the risk factors of postoperative liver dysfunction.Logistic regression was used to assess the independent risk factors of postoperative liver dysfunction.The regression equation between independent risk factors and postoperative liver dysfunction was established.Results Among the 62 patients,ICG R15 was less than 10.0％ in 26 patients,between 10.0％ and 19.0％ in 17 patients,between 20.0％ and 29.0％ in 9 patients,between 30.0％ and 39.0％ in 5 patients,and over 40.0％ in 5 patients.There were 29 patients with a Child-Pugh A grading and 33 patients with a Child-Pugh B grading in the preoperative evaluation of liver function.The Wilcoxon W rank sum test was used to compare the preoperative ICG R15 in patients with Child-Pugh grading A and B separately.The ICG R15 in Child-Pugh grading A patients was significantly lower than those in Child-Pugh B grading patients (P ＜0.05).There were no significant differences in age,gender,history of previous liver diseases,duration of operation,and intraoperative blood loss (P ＞ 0.05) between the normal liver function group and the liver dysfunction group.However,there was a significant difference in the preoperative ICG R15 and preoperative bilirubin levels (P ＜ 0.05) between the two groups.The preoperative ICG R15 and preoperative bilirubin levels were significant risk factors of postoperative hepatic insufficiency.Regression analysis suggested that preoperative ICG R15 level was an independent risk factor of postoperative hepatic insufficiency (P ＜ 0.05).A regression equation:logit(P) =0.185 × preoperative ICG R15-3.152 could be constructed.Conclusions ICG R15 is an ideal clinical indicator for evaluation of preoperative liver functional reserve in patients with HCCA.It predicted the recovery of postoperative liver function.

Objective To investigate the iodine nutritional status of rural residents in Anyang City of Henan Province,and to provide theoretical basis for making policy adjustment on iodine supplement. Methods In 2015, Tangyin County and Anyang County were chosen from Anyang City, one township was selected from each county based on five orientations of east, west, south, north and centre, four villages were chosen from each township,15 households were taken from each village, and kitchen salt samples were collected to detect salt iodine;tap water samples were collected to detect water iodine.In the selected county,one medical institution was selected, 100 women of childbearing age,pregnant women,lactating women and infants aged 0-2 years old were selected to detect urinary iodine; one primary school was selected in the selected township, and 20 children aged 8 - 10 years old were selected to detect urinary iodine. Salt iodine was determined using direct titration (GB/T 13025.7-1999);urinary iodine and water iodine were determined using arsenic cerium catalytic spectrophotometry(WS/T 107-2006). Results A total of 600 salt samples were collected, half from Anyang County and half from Tangyin County, the medians of salt iodine were 27.59,29.15 mg/kg,respectively,the difference was statistically significant(Z = - 4.92, P <0.05).A total of 47 water samples were collected,21 from Anyang County and 26 from Tangyin County,the medians of water iodine were 9.44,5.37 μg/L,respectively,the difference was not statistically significant(Z=-0.30, P > 0.05). A total of 985 key people were surveyed, children, women of childbearing age, pregnant women, lactating women and infants were 200, 205, 197, 187, 196, respectively, the medians of urinary iodine were 253.05, 249.80, 177.10, 266.40, 247.85 μg/L, respectively, the differences were statistically significant (χ2=29.76, P < 0.05). Urinary iodine levels of childbearing age women (226.60,313.85 μg/L),lactating women(230.85,286.20 μg/L) and infants (222.35, 275.35 μg/L) were compared between Anyang County and Tangyin County, the differences were statistically significant (Z=3.33,2.21,3.13,P<0.05).Conclusion The iodine nutritional status of rural residents in Anyang City is basically good,but the urinary iodine levels of general population are high.

Sphincter of Oddi dysfunction (SDO) is the obstruction of ampulla of Vater,resulting from abnormality of contraction of sphincter of Oddi,which causes the reflux of bile and pancreatic juice and promotes a series of pathophysiological changes in cholangiopancreatic system.Because of lack of typical clinical symptoms and specific diagnostic methods,the standards of diagnosis and therapy are still unclear.Recently,new changes happened in this field with the development of endoscopy and large-scale clinical trials.This review summarized the latest advances on sphincter of Oddi dysfunction in recent years.

Objective To explore the application value of common bile duct re-exploration under laparoscope combined with choledochoscope in patients with intra- and extrahepatic bile duct stone. Methods Clinical data of 79 patients with intra- and extrahepatic bile duct stone who had previous operative history of biliary tract in Zhongshan Hospital Affiliated to Fudan Univesity between June 2014 and May 2016 were retrospectively analyzed. According to the treatment method, the patients were divided into the laparoscope combined with choledochoscope group (two-scope group) and laparotomy group. There were 43 cases in two-scope group, including 18 males and 25 females with the average age of (63±14) years. There were 36 cases in laparotomy group, including 19 males and 17 females with the age of (63±12) years. The informed consents of all patients were obtained and the local ethical committee approval was received.The operation time and hospitalization expenses of two groups were compared by t test. The intraoperative blood loss, postoperative recovery time of gastrointestinal tract were compared by Z test. The incidence of complications was compared by Chi-square test or Fisher's exact probability method. Results The operation time of patients in two-scope group was (5.2±1.8) h, significantly longer than (2.4±1.3) h of the laparotomy group (t=7.371, P<0.05). The median of intraoperative blood loss in two-scope group was 30(5-200) ml and was 40(10-400) ml in laparotomy group, and no significant difference was observed (Z=-0.270, P>0.05). The postoperative recovery time of gastrointestinal tract and postoperative hospitalization time in two-scope group was 3(1-9) and 8(3-18) d respectively, and was 3(1-29) and 9(2-97) d in laparotomy group, and no significant difference was observed (Z=-1.475, -2.023; P>0.05). The hospitalization expenses of the two-scope group was 34(7-96) thousand yuan, significantly more than 28(14-96) thousand yuan of the laparotomy group (Z=2.495, P<0.05).The postoperative residual rate of stone,incidence of bile leakage and incision infection of the two-scope group was respectively 12%(5/43), 0 and 0, and was 19%(7/36), 6%(2/36) and 3%(1/36) in laparotomy group, and no significant difference was observed (P>0.05). Conclusions Laparoscope combined with choledochoscope is a safe and effective operation for intra- and extrahepatic bile duct stone with previous operative history of biliary tract.

Objective To investigate the iodine nutrition status of school-age children in Anyang,and analyze its related influencing factors.Method Monitoring data on urinary iodine of school-aged children and iodized salt were collected from 2011 to 2015,its general situation was described,and differences in age,sex,residential area type and year were compared.Results Totally 13 371 iodized salt samples were collected in Anyang City from 2011 to 2015,and 12 205 were qualified iodized salt.The median of iodized salt was 26.91 mg/kg.Totally 1 282 urinary iodine samples of school-age children were monitored in Anyang City,and its median of urinary iodine was 237.0 μg/L,the constituent ratio of urinary iodine of children under 100 μg/L and above 300 μg/L was 14.5％(186/ 1 282) and 35.3％ (452/1 282),respectively,the results of urinary iodine were different in different years,and the differences were statistically significant (x2 =36A1,P＜ 0.05);the differences of the residential area type,sex and age had no influence on the urinary iodine of school-age children,and the differences were not statistically significant (Z =-1.07,-0.94,x2 =6.50,P ＞ 0.05).Conclusion The iodine-nutritional status of school-age children is more than adequate,the concentration of urinary iodine is high,and the differences of the residential area type,sex and age have no influence on the urinary iodine of school-age children.

Objective To understand the situation of iodine of Taishan nuclear power station employees,and assess the relationships between iodine nutrition and thyroid nodule of Taishan nuclear power station in Taishan,Guangdong.Methods Totally 300 people were selected from of Taishan nuclear power station through stratifiedrandom sampling method,random urine samples were collected and urinary iodine level was tested in 2014.According to 20 to 29 years old,30 to 39 years old,40 to 59 years old,3 age groups were sampled,and each age group was 100 people.Drinking water and edible salt samples of the of nuclear power station were collected and iodine level was tested.Daily dietary intake of the staff was investigated,and daily iodine intake was calculated.Result of thyroid B ultrasonic of the employees (1 091) were studied,and detection rate of thyroid nodule was calculated.Results Totally 308 urine samples were tested,and the median urinary iodine was 193 μg/L.The difference of urinary iodine between 20-year-old group (201 μg/L) and 30-year-old group (165 μg/L) was statistically significant (P ＜ 0.05).A total of 9 iodized salt samples were collected,with an average iodine value of (24.4 ± 0.5)mg/kg.A total of 9 water samples were collected,the median of water iodine was 20.5 μg/L in 3 centralized water supply samples.The daily iodine intake per capita of the staff was 274.0 μg/d,the highest contribution among all the varieties of food was iodized salt,the second was seafood,which were 45.26 percent and 41.86 percent,respectively.A total of 99 thyroid nodules and suspicious nodules were detected in 1 091,and the prevalence was 9.07 percent (99/1 091).The prevalence of people aged 40-59 [15.6％ (22/141)] was significantly higher than those of people aged 20 to 29 [8.1％ (51/633)] and aged 30 to 39 [8.2％ (26/317)],and the differences were statistically significant (P ＜ 0.05).Conclusions The iodine nutrition of Taishan nuclear power station employees is appropriate as a whole.The detection rate of thyroid nodules is higher in people aged 40 to 59.