Analysis of factors related to non-sentinel lymph node metastasis in 296 sentinel lymph node-positive Chinese breast cancer patients

Objective: Axillary lymph node dissection(ALND) may be unnecessary in 20%–60% of breast cancer patients with sentinel lymph node(NSLN) metastasis. The aim of the present study was to review the medical records of Chinese patients with early-stage breast cancer and positive NSLN metastasis to identify clinicopathological characteristics as risk factors for non-NSLN metastasis.Methods: The medical records of 2008 early-stage breast cancer patients who received intraoperative sentinel lymph node biopsy(SLNB) between 2006 and 2016 were retrospectively reviewed. These patients were clinically and radiologically lymph nodenegative and had no prior history of receiving neoadjuvant chemotherapy or endocrinotherapy. The clinicopathological characteristics of patients with positive NSLN metastasis who underwent ALND were investigated.Results: In the present study, 296 patients with positive NSLN metastases underwent ALND. Positive non-NSLN metastases were confirmed in 95 patients(32.1%). On univariate analysis, ≥ 3 positive NSLN metastases(P <0.01), NSLN macrometastases(P =0.023), and lymphovascular invasion(P = 0.04) were associated with non-NSLN metastasis(P <0.05). In multivariate analysis, the number of positive SLNs was the most significant predictor of non-SLN metastasis. For patients with 0, 1, 2, or 3 associated risk factors, the non-SLN metastatic rates were 11.5%, 22.5%, 35.2%, and 73.1%, respectively.Conclusions: The number of positive NSLNs, NSLN macrometastases, and lymphovascular invasion were correlated with nonSLN metastasis. The number of positive SLNs was an independent predictor for non-NSLN metastasis. When 2 or 3 risk factors were present in one patient, the probability of non-NSLN was higher than that in the American College of Surgeons Oncology Group Z0011 trial(27.3%); thus, avoiding ALND should be considered carefully.

Oil Film Stiffness of Double Involute Gears Based on Thermal EHL Theory

Lubrication failure is one of the main failure forms of gear failure.Time varying meshing stiffness is an important factor affecting the dynamic behavior of gears.However,the influence of oil film stiffness is usually ignored in the research process.In this paper,according to the meshing characteristics of double involute gears,based on the non-Newtonian thermal EHL theory,a new calculation method of normal and tangential oil film stiffness for double involute gears is established by the idea of subsection method.The oil film stiffness difference between double involute gears and common involute gears is analyzed,and the influence of tooth waist order parameters,working conditions,and thermal effect on the oil film stiffness are studied.The results reveal that there are some differences between normal and tangential oil film stiffness between double involute gears and common involute gears,but there is little difference.Compared with the torque,rotation speed and initial viscosity of the lubricating oil,the tooth waist order parameters have less influence on the oil film stiffness.Thermal effect has a certain influence on normal and tangential oil film stiffness,which indicates that the influence of thermal effect on the oil film can not be ignored.This research proposes a calculation method of normal and tangential oil film stiffness suitable for double involute gears,which provides a theoretical basis for improving the stability of the transmission.

Development of Qinba Mountainous Area in the Historical Period from the Perspective of Man-Land Relationship

Taking agricultural development as the starting point,this paper explored the dynamic mechanism and implementation path of agricultural development in Qinba Mountainous Area from the perspective of man-land relationship. It found the regular understanding of ecological changes in Qinba Mountains. It is a comprehensive review and exploration on agricultural development and environmental evolution,and aims to provide a historical reference for the development of the contemporary Qinba Mountains.

Clinical evaluation of the first domestically produced generic isosulfan blue injection in sentinel lymph node biopsy for early breast cancer in China:a multicenter,single-arm,open validation trial(CSBrS-024)

In 2020,the first generic isosulfan blue product for injection(notification number:2020 LP00901,batch number:118210301,5 mL:50 mg,Guangdong Hebo Pharmaceutical Co.,Ltd.)was approved by the National Medical Products Administration of China.This multicenter,single-arm,phase III,open clinical validation trial was organized by the Chinese Society of Breast Surgery to evaluate the efficacy and safety of this domestically produced generic isosulfan blue injection for sentinel lymph node biopsy(SLNB)in patients with early breast cancer(BC)in China.

Elaborative collection of condensed combustion products of solid propellants:Towards a real Solid Rocket Motor(SRM)operational environment

A novel constant-pressure and constant-quenching distance Condensed Combustion Products(CCPs)collection system was developed,coupled with a timing control system,to collect the CCPs formed in the course of burning of aluminum-based composite propellants.The effects of adiabatic graphite plating,collection zone,quenching distance,time series of collection,and propellant burning rate on the microscopic morphology,particle size distribution and unburned aluminum content of CCPs were investigated.It was verified that the graphite plating can provide a high-fidelity high-temperature environment for propellant combustion.The combustion efficiency is improved by 2.44% compared to the bare propellant case.The time series of collection has a significant effect on the combustion efficiency of aluminum,and the combustion efficiency of aluminum in the thermal state(1.2-2.4 s)is 2.75% higher than that in the cold state(0-1.2 s).Similarly,the characteristics of the CCPs in different collection zones are different.At the quenching distance of 5 mm,the combustion efficiency of aluminum in the core zone(85.39%)is much lower than that in the outer zone(92.07%),while the particle size of the CCPs in the core zone(172μm)is larger than that in the outer zone(41μm).This indicates that the core zone is more likely to produce large-sized and incompletely burned agglomerates during the propellant combustion process.Different burning rates also lead to a significant difference in particle size distribution and combustion efficiency.High burning rates result in higher combustion efficiency.A detailed sequence of the elaborative collection process of CCPs is proposed,mainly including the setting of ignition delay time,burning rate,working pressure,plating length and time series of collection.The findings of this study are expected to provide a reliable tool for the evaluation of the combustion efficiency of solid propellants.

Association of a complete breast cancer pathologic response with axillary lymph node metastasis via neoadjuvant chemotherapy:Results from the CSBrS-012 study

To the Editor:In the last decade,neoadjuvant chemotherapy(NAC)has become a well-accepted treatment option for breast cancer,although few detailed description of NAC in China has yet been reported.[1]A previous study found that among patients with clinically node-negative(cN0)breast cancer,97.7%(432/442)with breast pathologic complete response(bpCR)had ypN0(absence of metastases in the axillary lymph nodes);and 71.6%(882/1232)without bpCR achieved ypN0(P<0.001).As for human epidermal growth factor receptor 2(HER2)positive or triple-negative breast cancer(TNBC)that achieved bpCR.

伤口护理区域同质化联动模式的构建及应用

目的构建伤口护理区域同质化联动模式,促进伤口知识和技能在区域内的同质化传递,为患者提供同质化伤口护理。方法开发区域伤口协作诊疗管理软件系统,采用自制的伤口护理现状调查表,调查上海市杨浦区社区护士的伤口护理水平。于2016年11月—12月选取杨浦区内的7名国际造口治疗师,成立师资队伍;于2017年1月— 6月选择6所社区卫生服务中心从事伤口护理的30名护士作为试验组,给予同质化培训,并应用区域伤口协作诊疗管理软件系统进行伤口的同质化护理;从1所三级医院专科团队中抽取32名护士作为对照组,接受常规的专科培训;比较两组护士在专科理论、操作及临床实际护理能力方面的差异。结果基线调查结果显示,伤口造口团队成员的考核成绩比社区护士的考核成绩高,差异有统计学意义(t=-672.27,P<0.01)。接受同质化培训后社区护士在专科理论知识和操作技能方面的得分及临床实际护理能力与三级医院护士比较,差异均无统计学意义(P>0.05),两组专科护理能力和水平趋于同质化。结论伤口护理区域同质化联动模式有利于促进不同医疗机构间专科护理能力和水平的同质化。

CACA Guidelines for Holistic Integrative Management of Breast Cancer

Purpose:Breast cancer is now the most common malignant tumor worldwide.About one-fourth of female cancer patients all over the world sufer from breast cancer.And about one in six female cancer deaths worldwide is caused by breast cancer.In terms of absolute numbers of cases and deaths,China ranks frst in the world.The CACA Guidelines for Holistic Integrative Management of Breast Cancer were edited to help improve the diagnosis and comprehensive treatment in China.Methods:The Grading of Recommendations Assessment,Development and Evaluation(GRADE)was used to classify evidence and consensus.Results:The CACA Guidelines for Holistic Integrative Management of Breast Cancer include the epidemiology of breast cancer,breast cancer screening,breast cancer diagnosis,early breast cancer treatment,advanced breast cancer treatment,follow-up,rehabilitation,and traditional Chinese medicine treatment of breast cancer patients.Conclusion:We to standardize the diagnosis and treatment of breast cancer in China through the formulation of the CACA Guidelines.

“Liquid diode”with“gating”based on shape memory sponge

Superwetting Janus membranes with unique ability in unidirectional liquid transportation,known as“liquid diode”,have attracted much attention.Recently,endowing the Janus membranes with smart controllability becomes a new research hotspot.However,related reports are still rare and limited in regulating surface wettability,which can hardly avoid some imperfections such as the necessary constant external stimuli and change of water solution.Herein,we advanced an unprecedented strategy to smartly control the liquid permeation on Janus membrane by regulating the pore structure of the material,and report a smart Janus sponge(SJS)that is constructed from a super-hydrophilic sponge(SHS)and a hydrophobic shape memory sponge(HSMS).The pore size and thickness of the HSMS can be reversibly changed as it is pressed/recovered based on the excellent shape memory effect.With the variation of the HSMS,the water permeation performance can be smartly controlled,which is embodied in that only when the HSMS is in the pressed state,SJS acts as a“liquid diode”,otherwise it can prevent liquid from penetrating on either side.Finally,based on the smart controllability of the SJS,we simulated the scene of drug administration and demonstrated its potential application in the field of wound dressing.This work firstly reports a shape memory Janus membrane and provides a new way to control the liquid permeation,which can successfully avoid those shortcomings existing in current wetting-responsive Janus membranes.Given its excellent controllability,we believe it has potential applications in intelligent manipulation of liquid.

Safety and Current Status of the COVID-19 Vaccine among Patients with Breast cancer: A Cross-Sectional Study from China

In this study,we aimed to explore the safety and vaccination coverage data of Chinese patients with breast cancer receiving coronavirus disease 2019(COVID-19)vaccination.The patients were recruited from 41 hospitals across 20 Chinese provinces.The vaccination coverage was approximately 22.4%,and the frequency of total adverse events was 13.3%after the first dose and 9.9%after the second dose.The most frequent adverse reaction within 14 days of the first dose was local pain(5.7%).Unvaccinated patients were very likely to reject the vaccine rather than be hesitant in patients with old age(odds ratio[OR],1.238;95%confidence interval[CI],1.101-1.391),chronic disease history(OR,1.189;95%CI,1.057-1.337),and cancer relapse(OR,1.398;95%CI,1.233-1.585).Of the unvaccinated patients with breast cancer,54.1%opted to receive COVID-19 vaccines if more data were available.Considering the safety but low vaccination coverage for breast cancer,increased positive attitudes and acceptance toward COVID-19 vaccines are important.