As a hot spot in clinical research today, immune checkpoint inhibitor has been recommended by guidelines in the first- and second-line treatments of advanced cervical cancer as immune monotherapy or combination therapy. It has also achieved good efficacy in clinical practice. In locally advanced cervical cancer, immune checkpoint inhibitors have been included in the guidelines for adjuvant therapy, and good tumor regression effects have been achieved in clinical practice. Based on the results of existing trials, immune checkpoint inhibitors have also shown good clinical potential as neoadjuvant therapy. Furthermore, the issue of immunotherapy rechallenge has increasingly captured clinicians’ attention, offering a potential new therapeutic strategy for cervical cancer patients with prior immunotherapy exposure. In this article, the clinical application and research progress of immune checkpoint inhibitors in the treatment of cervical cancer in recent years are summarized to provide valuable ideas and directions for clinical treatment.

Objective:To understand the electrocardiogram and echocardiography examination results of population in key areas of unexplained sudden death in Yunnan Province (referred to as Yunnan sudden death).Methods:From 2014 to 2022, electrocardiogram examination was performed on population (including same incident cases, relatives of the cases, villagers of the affected villages, and control individuals) in key areas of Yunnan sudden death from May to October each year. Echocardiography examination was performed on relatives of the cases and villagers of the affected villages, and the types of electrocardiogram and echocardiography changes were sorted out and analyzed.Results:Electrocardiogram examination was conducted on 1 same incident case, 241 relatives of the cases, 464 villagers of the affected villages, and 99 control individuals, respectively. The types of electrocardiogram changes in the same incident case were Q-T interval prolongation and sinus tachycardia. A total of 17 types of electrocardiogram changes were detected in the relatives of the cases, mainly including sinus arrhythmia (12.45%, 30/241), sinus bradycardia (11.20%, 27/241), and left axis deviation (8.30%, 20/241). A total of 21 types of electrocardiogram changes were detected in the villagers of the affected villages, mainly including left axis deviation (9.48%, 44/464), sinus bradycardia (8.19%, 38/464), and T-wave abnormalities (7.76%, 36/464). A total of 10 types of electrocardiogram changes were detected in the control individuals, mainly including sinus arrhythmia (12.12%, 12/99), T-wave abnormalities (9.09%, 9/99), and sinus bradycardia (7.07%, 7/99). Echocardiography examination was conducted on 49 relatives of the cases and 365 villagers of the affected villages, respectively. A total of 12 types of echocardiography changes were detected in the relatives of the cases, mainly including tricuspid regurgitation (18.37%, 9/49), decreased right ventricular diastolic function (8.16%, 4/49), aortic regurgitation (6.12%, 3/49), and atrial septal defect (6.12%, 3/49). A total of 15 types of echocardiography changes were detected in the villagers of the affected villages, mainly including tricuspid regurgitation (8.77%, 32/365), aortic regurgitation (6.85%, 25/365), and decreased left ventricular diastolic function (6.58%, 24/365).Conclusion:There are many types of changes in electrocardiogram and echocardiography in the population of key areas of Yunnan sudden death.

Objective The literature study the setup errors of head and neck, thoracic, abdominal and pelvic tumors by megavoltage fan-beam CT based image guidance in TOMO-HD to provide the margin enlarging from clinic target volume (CTV) to planning target volume (PTV) in treatment planning system of TOMO-HD. Methods 103 patients with head and neck (30 patients), thoracic (42 patients), abdominal and pelvic (31 patients) carcinoma were enrolled. Megavoltage fan-beam CT based image guidance in tomotherapy-HD was used to acquire CT scan before every treatment. The left-right (X), superior-inferior (Y), anterior-posterior (Z) and rotation (Fy) setup errors of patients can be obtained from the tomography image automatically restructured by the system. Calculating the systematic error and the random error in the three dimensions and check whether the setup data accord with the normal distribution or not, then acquire the data expand in the three directions. Results According to 2593 fan-beam CT scans, the shift errors (µ ± s) in X, Y, Z and Fy (rotation) of three study group were [(−0.31 ± 2.16) mm、(1.09 ± 3.56) mm、(2.36 ± 2.27) mm, (0.29 ± 0.96)°] (head and neck tumor), [(−0.98 ± 2.95) mm、(0.45 ± 6.86) mm、(3.79 ± 2.47) mm, (0.18 ± 0.60)°] (thoracic cancer) and [(−0.86 ± 2.85) mm、(−1.59 ± 6.91) mm、(5.77 ± 2.40) mm, (0.20 ± 0.68)°](abdominal and pelvic carcinoma). The systematic errors (∑) and random errors (σ) in X, Y, Z dimensions of patients with head and neck, thoracic, abdominal and pelvic tumors were (1.06 mm and 1.84 mm), (1.93 mm and 3.43 mm), (2.41 mm and 2.71 mm), (1.10 mm and 2.56 mm), (3.79 mm and 5.46 mm), (1.38 mm and 1.99 mm) and (1.39 mm and 0.87 mm), (4.98 mm and 5.69 mm), (1.19 mm and 2.05 mm), respectively. Conclusion It is recommended as a reference for image guidance in TOMO-HD according to the frequency distribution of setup errors, for patients with head and neck, chest and abdominal and pelvic tumors, the maximum range of motion in three dimensions are (5.00, 5.00, 5.00) mm, (6.63, 17.25, 16.00) mm and (6.49, 16.24, 13.60) mm.

Objective:To investigate the relationship of papillary thyroid microcarcinoma (PTMC) with serum thyroglobulin.Methods:Data of 539 patients with papillary thyroid nodule (≤1cm) in Department of Thyroid and Breast Surgery of the Second Hospital of Anhui Medical University and the Department of Oncology Surgery of Suzhou Municipal Hospital for thyroidectomy were retrospectively analyzed. All of the nodules were classified as TI-RADS 4b with ultrasound. According to the postoperative pathological results, patients were divided into PTMC group (experiment group) and benign tumor group (control group) . The PTMC patients were also divided into lymph node metastasis group (experiment group) and no lymph node metastasis group (control group) based on the cervical lymph node metastasis. Then we analyzed the relationship between thyroid stimulating hormone (TSH) , thyroglobulin antibody (TgAb) , thyroid peroxidase antibody (TPOAb) and thyroglobulin (Tg) with PTMC and lymph node metastasis by SPSS.Results:Age, TSH, Tg and TgAb were independent risk factors for PTMC, B: -0.020, 0.192, 0.026, 0.008, 95% CI: 0.962-0.998, 1.045-1.404, 1.015-1.038, 1.003-1.014, both P<0.05. The relations between PTMC and TSH, Tg and TgAb were positive, while age was in negative correlation with PTMC. Meanwhile, age and thyroglobulin (Tg) were also independent risk factors for lymph node metastasis in PTMC patients, B: -0.025, 0.014, 95% CI: 0.957-0.994, 1.008-1.021, both P<0.05. Age was negatively correlated with lymph node metastasis and Tg was positively correlated with lymph node metastasis. Tg level higher than 26.520 ng/ml indicated that the nodule was PTMC (sensitivity: 0.560, specificity: 0.719) , and Tg level higher than 36.695 ng/ml predicted lymph node metastasis in PTMC patients (sensitivity: 0.532, specificity: 0.788) . Conclusion:Tg is a sensitive serum index for identifying PTMC from benign thyroid nodule, and it is also related to lymph node metastasis in PTMC patients.

Objective:To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of cystic renal masses.Methods:The 19 patients with cystic renal masses undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to December 2019 were retrospectively analyzed. There were 13 males and 6 females. The average age was 46.2 years. The mean body mass index was (25.8±3.1) kg/m 2. The masses located in the left kidney in 7 cases and the right kidney in 12 cases. The ECOG scores were 0. The mean maximum diameter of the tumors was (2.8±1.3) cm. Five cases were diagnosed with Bosniak Ⅲ and 14 cases with Bosniak Ⅳ. According to R. E.N.A.L. scoring, 11 cases were of low difficulty (4-6 points), 7 cases of medium difficulty (7-9 points) and 1 case of high difficulty (10-12 points). The cystic renal masses were ablated by laparoscopic microwave ablation, then followed by partial nephrectomy. Postoperative complications were observed and the prognosis was assessed by CT or MRI. Results:The mean duration of operation was (84.0±20.8) min. The median intraoperative blood loss was 20 (10-50) ml. The median duration of postoperative hospitalization was 3 (2-6) d, and no complications such as bleeding, infection, gross hematuria or urine leakage were observed. According to the malignant degree of cystic renal masses, the patients were divided into low-risk group and high-risk group. The patients with benign cystic kidney tumors or with low biological malignancy were considered as the low-risk group, while the patients with high malignant pathology were considered as the high-risk group. In the low-risk group, there were 4 patients, including 1 patient with papillary adenoma, 1 patient with renal angiomyolipoma, 1 patient with low-grade malignant potential multilocular cystic renal tumor, and 1 patient with renal chromophobe carcinoma (stage T 1a). In the high-risk group, there were 15 cases, including 14 cases of clear cell renal cell carcinoma (AJCC pathological stage: T 1a stage 11 cases, T 1b stage 3 cases; WHO/ISUP classification: 7 cases in grade 1, 6 cases in grade 2, and 1 case in grade 3); 1 case of Type 2 papillary renal cell carcinoma (stage T 1b, grade 2). The median follow-up was 20 months (12-37 months). Both groups survived, and no signs of tumor recurrence, implantation or metastasis were found in chest and abdomen imaging. Blood tests were performed regularly, and no significant abnormalities occurred. Conclusions:The safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for the treatment of cystic renal masses is satisfactory, and postoperative pathology is clear, providing a potential option for cystic renal masses treatment.

Objective: To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy. Methods: The clinicopahtological data of patients evaluated with ⁶⁸Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m². Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T_2a stage, 2 cases in T_2b stage, 17 cases in T_2c stage, 1 case in T_3a stage, 4 cases in T_3b stage and 1 case in T₄ stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis. Results: The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007). Conclusions SUVmax measured on preoperative ⁶⁸Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.

objective:To observe the effect of high-flow nasal cannula (HFNC) oxygen therapy on patients with acute respiratory failure after gastrointestinal operation under general anesthesia and its efficacy on prognosis.Methods:Totally 107 patients with acute respiratory failure after gastrointestinal operation under general anesthesia in ICU of our hospital were selected from January 2017 to June 2019. Patients were randomly divided into the HFNC group ( n=57) and non-invasive ventilation (NIV) group ( n=50). The changes of pH, PaO 2, PaCO 2, PaO 2/FiO 2, SpO 2, heart rate (HR), respiration rate (RR), and intra-abdominal pressure (IAP) before and after oxygen treatment were compared. The differences of comfort level, duration of oxygen treatment, re-intubation rate, 48-h pulmonary infection rate, incidence of anastomotic fistula, length of stay in ICU, length of hospital stay, hospitalization cost, and 28-day mortality were compared between the two groups. The t test of two independent samples was used for the comparison of normal measurement data. Non-normal data were expressed by median (quartile), fractional count data by case number (percentage), and comparison between the two groups by Chi-square test. Results:PaO 2, PaCO 2, PaO 2/FiO 2 and SpO 2 were not significantly different after 2-h oxygen therapy. PH of the HFNC group was lower than that of the NIV group (7.39 ± 0.04 vs. 7.42 ± 0.03), PaO 2, PaCO 2, PaO 2/FiO 2 and SpO 2 were higher than that of the NIV group [ (89.22 ± 8.70) vs. (84.99± 9.76) mmHg, (41.3 ± 3.43) vs. (39.34 ± 4.21) mmHg, (250.07 ± 18.34) vs. (237.89±19.38) mmHg, (96.14 ± 2.19) vs. (94.78 ± 2.76)%, P <0.05]; pH, PaO 2, PaCO 2, PaO 2 /FiO 2 and SpO 2 were significantly higher in the HFNC group than those in the NIV group [ (7.39 ± 0.04) vs. (7.36 ± 0.04) ; (97.2 ± 12.45) vs. (93.82 ± 12.54) mmHg; (40.84 ± 5.22) vs. (45.10 ± 6.40) mmHg; (277.16 ± 13.98) vs. (248.86 ± 12.81) mmHg, (98.14 ± 1.64)% vs. (95.48 ± 2.71) %] after 12 h oxygen treatment. The HR, RR and IAP of the HFNC group were lower than those of the NIV group, and the differences were statistically significant ( P <0.05). The duration of oxygen therapy in the HFNC group was shorter than that in the NIV group [(32.01 ± 7.57) vs. (40.88 ± 8.89) h], the reintubation rate was lower than that in the NIV group (1.75% vs. 12%), the pulmonary infection rate within 48 h oxygen therapy was lower than that in the NIV group (8.78% vs.30%), and the length of stay in ICU was shorter than that in the NIV group [(5.61 ± 1.73) vs. (7.60 ± 2.31) d], and the hospitalization cost was lower than that in the NIV group ( t = 4.822, P <0. 05). Conclusions:HFNC can improve the oxygenation index of patients with hypoxemia after gastrointestinal operation under general anesthesia, reduce oxygen treatment time, reduced reintubation rate, reduce pulmonary infection rate within 48 h, and improve the prognosis.

Objective To investigate the clinical correlations between mechanical power (MP) and lung ultrasound score (LUS), and analyze their evaluation value of prognosis in patients with acute respiratory distress syndrome (ARDS). Methods Patients with moderate to severe ARDS, who underwent invasive mechanical ventilation admitted to intensive care unit (ICU) of the Lianyungang Affiliated Hospital of Xuzhou Medical University from January 2017 to March 2019 were enrolled. The MP and LUS were recorded 0, 24, 48 and 72 hours after ICU admission. The patients were divided into death group and survival group according to the 28-day prognosis. The trends of MP and LUS in the two groups and their differences between groups were analyzed. Then the MP and LUS were analyzed by bivariate correlation analysis, and their correlations with acute physiology and chronic health evaluationⅡ (APACHEⅡ), sequential organ failure assessment (SOFA), oxygenation index (PaO2/FiO2), and blood lactate (Lac) were also analyzed. The predictive value of MP and LUS 0 hour and 72 hours in ICU for 28-day mortality in patients with moderate to severe ARDS was analyzed by receiver operating characteristic (ROC) curve. Results At the end, 83 patients were enrolled, with 32 died and 51 survived in 28-day. The Lac level, APACHEⅡ and SOFA in the death group were significantly higher than those in the survival group, while PaO2/FiO2 was significantly lower than the survival group, and the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the MP and LUS of the survival group showed a significant decrease trend, while the death group showed a significant upward trend. The MP and LUS of the death group 0, 24, 48, 72 hours after ICU admission were significantly higher than those of the survival group [MP (J/min): 20.97±3.34 vs. 17.20±4.71, 21.56±3.48 vs. 16.87±3.85, 22.72±2.97 vs. 16.13±3.52, 25.81±3.46 vs. 15.24±3.78; LUS: 19.17±3.31 vs. 16.27±4.28, 20.28±3.65 vs. 15.27±3.23, 21.53±4.32 vs. 13.63±3.71, 23.94±3.82 vs. 12.53±2.94, all P < 0.05]. There was a significant positive correlation between MP and LUS 0, 24, 48, 72 hours after ICU admission (r value was 0.547, 0.577, 0.754, and 0.783, respectively, all P < 0.01). The MP and LUS at 0 hour of ICU admission were significantly positively correlated with SOFA and PaO2/FiO2 (r value was 0.421, 0.450, and 0.409, 0.536, respectively, all P < 0.01), but no correlation with Lac and APACHEⅡ was found. The ROC curve analysis showed that the MP and LUS at 0 hour and 72 hours had predictive value for the 28-day mortality [the area under the ROC curve (AUC) of MP was 0.836, 0.867; and the AUC of LUS was 0.820, 0.891, all P < 0.01]. Conclusions There was a significant correlation between MP and LUS in patients with moderate to severe ARDS. The MP and LUS could be used early to evaluate the 28-day prognosis of patients with moderate to severe ARDS.

Objective: To systematic review the effect of preoxygenation (PreOx) and apnoeic oxygenation (ApOx) during intubation in the critically ill patients by network Meta-analysis. Methods: The PubMed, Embase, the Cochrane Library, CNKI and Wanfang Data were searched by computer to collect randomized controlled trials (RCT) of PreOx and ApOx techniques in the intensive care unit (ICU) from inception to January 30th, 2019. PreOx techniques (p) included nasal cannula (NC), high flow nasal cannula (HFNC), bag valve mask (BVM), bi-level positive airway pressure (BiPAP), non-rebreather mask (NRM) and non-invasive ventilation (NIV), etc.; ApOx technique (a) referred to HFNC. Experimental group strategy was PreOx combined with ApOx, and control group strategy was PreOx alone. The outcomes were as follows: the lowest value of pulse oximetry (SpO₂) during the intubation procedure, the incidence of severe desaturations (SpO₂ < 0.80), and severe intubation-related complications [including SpO₂ < 0.80, systolic blood pressure < 80 mmHg (1 mmHg = 0.133 kPa), vasopressor 30% dose increment, cardiac arrest and death]. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistic analysis was performed by RevMan 5.3 software, Stata 15.1 software and WinBUGS 1.4.3 software. Results: A total of 7 RCTs involving 796 patients were included. Meta-analysis showed that, compared with the control group, the lowest SpO₂ in the experimental group was significantly increased [mean difference (MD) = 1.42, 95% confidence interval (95%CI) was 0.60 to 2.25, P = 0.000 7], the incidence of severe complications was significantly decreased [odds ratio (OR) = 0.54, 95%CI was 0.32 to 0.92, P = 0.02], but the incidence of SpO₂ < 0.80 did not improve significantly (OR = 0.65, 95%CI was 0.40 to 1.05, P = 0.08). The network Meta-analysis showed that, compared with non-pressure mask (NPM)p, (HFNC+NIV)p+HFNCa (OR = 51.20, 95%CI was 2.06 to 3 518.68) and NIVp (OR = 5.80, 95%CI was 1.25 to 34.70) had a significant reduction in the incidence of SpO₂ < 0.80 (both P < 0.05). There were no significant differences in the incidence of severe complications during intubation among (HFNC+NIV)p+HFNCa, HFNCp+HFNCa, NIVp and NPMp. The occurrence rate of SpO₂ < 0.80 and severe complications using different oxygenation techniques decreased sequentially in NPMp, HFNCp+HFNCa, NIVp and (HFNC+NIV)p+HFNCa. Conclusion (HFNC+NIV)p+HFNCa should be of a priority choice for critically ill patients during intubation.

Objective: To investigate the value of mechanical power (MP) to predict the potential of the lung recruitment maneuver and assess prognoses in patients with acute respiratory distress syndrome (ARDS). Methods: Patients with moderate-to-severe ARDS who required mechanical ventilation therapy longer than 24 hours were randomly selected April 2017 to April 2019. The lung recruitment maneuver (RM) protocol was performed according to the patient's condition, their MP, lung ultrasound score (LUS), oxygenation index (P/F), and dead volume ratio (Vd/Vt), which were monitored before the RM and one hour after the RM. The patients were divided into the lung recruitment maneuver potential positive group (RMP-P group) and lung recruitment maneuver potential negative group (RMP-N group) according to whether the variation in the patient's RM aeration score (ΔLUS) was≥5. Differences in MP between the two groups were compared and correlations between MP variation (ΔMP), aeration score variation (ΔLUS), oxygenation index variation (ΔP/F), and dead volume ratio variation (ΔVd/Vt) were analyzed. The receiver operating characteristic curve (ROC) was used to calculate the predictive value of MP for the potential of RM and the prognosis (28-day mortality) of patients with moderate or severe ARDS. Results: Eighty-three patients were enrolled in the study, 45 in the RMP-P group and 38 in the RMP-N group. There was no statistical difference in the baseline levels between the two groups (P>0.05). After RM treatment, MP, LUS scores, and Vd/Vt for each patient in the two groups decreased significantly compared to the pre-RM values, whereas, the P/F increased significantly (P<0.05). The MP, LUS scores, and Vd/Vt in the RMP-P group were significantly lower than those in the RMP-N group (P<0.05), whereas there was no difference in the P/F between the two groups after RM treatment (P>0.05). The ΔMP, ΔLUS, and ΔVd/Vt in the RMP-P group were significantly higher than those in the RMP-N group (P<0.05). There was no difference in the ΔP/F between the two groups (P>0.05). There was a significant positive correlation between ΔMP and ΔLUS and ΔVd/Vt in all patients (r=0.4746, 0.3995, P<0.01) and no significant correlation withΔP/F (r=0.0314, P>0.05). The area under the ROC curves of ΔMP for predicting the potential of RM was 0.856, with a sensitivity of 91.1% and a specificity of 63.2%. The AUC of the 28-day survival status was 0.788, with a sensitivity of 84.3% and a specificity of 62.5% (P<0.05). Conclusions Mechanical power monitoring before and after RM can be used to predict the potential of the lung recruitment maneuver and assess the prognosis in patients with moderate-to-severe ARDS.