Effects of psychological intervention on negative emotions and psychological resilience in breast cancer patients after radical mastectomy

Breast cancer(BC)is the most common malignant tumor in women,and the treatment process not only results in physical pain but also significant psychological distress in patients.Psychological intervention(PI)has been recognized as an important approach in treating postoperative psychological disorders in BC patients.It has been proven that PI has a significant therapeutic effect on postoperative psychological disorders,improving patients'negative emotions,enhancing their psychological resilience,and effectively enhancing their quality of life and treatment compliance.

Clinical outcome analysis of 98 elderly women with early-stage breast cancer undergoing modified radical mastectomy or simple mastectomy

Objective: The aim of our study was to analyze the clinical results and prognosis for early elderly patients after surgery and to explore the rational treatment. Methods: Between January 1992 and December 2008, 98 early elderly breast cancer patients aged ≥ 65 years were treated with surgery, of which 52 patients received modified radical mastectomy and 46 patients received simple mastectomy. Results: Sixty-four (65.3%) patients had comorbidities including coronary heart disease, hypertension, diabetes, etc. After a median follow up of 56 months (21 to 280 months), the 5-year cumulative survival rate of breast modified radical mastectomy group and mastectomy group were 84.0% and 82.7%, separately (P = 0.653). The 5-year recurrence rate were 3.8% and 8.1%, separately (P = 0.504). Conclusion: The simple mastectomy is suitable for the treatment of early elderly breast cancer patients for its lower complication and recurrence rate. Early old women with breast cancer may be safely treated by simple mastectomy. Our findings suggest that modified radical mastectomy does not significantly increase the overall survival.

Fifty-Year-Follow-up Results Compared with Shorter Follow-up of Breast Cancer Patients Undergoing Radical Mastectomy with or without Adjuvant Radiotherapy

Background: To evaluate the effect of follow-up length on the outcome of breast cancer patients, we compared the 50- and 25-year follow-up results in terms of cure rate, overall mortality and mortalities from breast cancer, second cancer, and benign diseases. Methods: 763 patients treated for breast cancer between February 1953 and September 1976, were followed up until December 2014. They were divided into two cohorts;earlier cohort exclusively underwent radical mastectomy plus adjuvant radiotherapy, while later cohort had radical mastectomy alone. Assuming that in all patients follow-up was terminated at 50 or 25 years after diagnosis, likelihood ratio test and stratified Log-rank tests were performed to evaluate the differences in cure rate and overall survival between the two cohorts. Results: During the 50 years, radical mastectomy alone compared with radical mastectomy plus adjuvant radiotherapy is associated with a significantly higher cure rate, and higher survivals regardless of whether the death was from breast cancer, second cancer, benign causes or any causes. However, if follow-up information is limited to 25 years, the advantage of radical mastectomy alone is partly offset and the survival difference between the two cohorts becomes less significant. Conclusion: Radiotherapy to breast cancer may adversely affect not only mortality from breast cancer, but mortalities unrelated to breast cancer. Since such deaths occur later, they may fail to be detected unless follow-up is long enough. Thus, deleterious effects of radiotherapy may be underestimated. Exceedingly long follow-up is required to accurately estimate the cure rate and the long-term effect of radiotherapy.

Effect of epidural block combined intravenous general anesthesia stress on the stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy

Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function.

Combined thoracic paravertebral block and interscalene brachial plexus block for modified radical mastectomy:A case report

BACKGROUND Modified radical mastectomy(MRM)is the most common surgical treatment for breast cancer.General anesthesia poses a challenge in fragile MRM patients,including cardiovascular instability,insufficient postoperative pain control,nausea and vomiting.Thoracic paravertebral block(TPVB)is adequate for simple mastectomy,but its combination with interscalene brachial plexus block(IBPB)has not yet been proved to be an effective anesthesia method for MRM.CASE SUMMARY We describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities.An ultrasound-guided TPVB was placed at T2-T3 and T5-T6,and combined with IBPB,with administration of 10,15 and 5 mL of 0.5%ropivacaine,respectively.A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min.Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery.None of the patients required additional narcotics,vasopressors,or conversion to general anesthesia.The maximum pain score was 2 on an 11-point numerical rating scale.Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis.CONCLUSION This case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM,providing good postoperative analgesia.

Effects of dezocine on cardiovascular response, stress response and cellular immune function before anesthesia induction in radical mastectomy for breast cancer

Objective: To investigate the effects of dezocine on cardiovascular response, stress response and cellular immune function before anesthesia induction in radical mastectomy for breast cancer. Methods: From January 2014 to January 2018, 220 patients with breast cancer undergoing modified radical mastectomy were randomly divided into observation group (110 cases) and control group (110 cases). The observation group was given dezocine before induction of anesthesia, while the control group was given the same amount of Sodium Chloride Injection. Heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), aldosterone (ALD), renin (REN), cortisol (Cor), angiotensin Ⅱ (Ang-Ⅱ) and the level of T cell subsets at 5 time points before anesthesia (T1), 2 h after operation (T2), 10 hours (T3), 24 h (T4) and 48 h (T5) after operation were compared between the two groups. Results:There was no significant difference in HR and MAP between the two groups before anesthesia (30 min). HR and MAP of the two groups were higher at 2 h after operation and 10 h after operation than before, and the HR and MAP of the control group were higher than those of the observation group. There was no significant difference in ALD, REN, Cor and Ang-Ⅱ between the two groups at 30 min before anesthesia and 48 h after operation. ALD, REN, Cor and Ang-Ⅱ in the two groups at 2 h after operation and 10 h, 24 h after operation were higher than those at the 30 min before anesthesia, and ALD, REN, Cor and Ang-Ⅱ in the control group were higher than those in the observation group. There was no significant difference in CD3+, CD4+, CD4+/ CD8+ between the two groups at 30 min before anesthesia and 48 h after operation. CD3+, CD4+, CD4+/CD8+ in the two groups at 2 h after operation and 10 h, 24 h after operation were lower than those at the 30 min before anesthesia, and CD3+, CD4+, CD4+/CD8+ in the control group were lower than those in the observation group. Conclusion: Dezocine before anesthesia induction in radical mastectomy can effectively reduce cardiovascular response and stress response, and play a protective role in cellular immune function.

Effects of ultrasound-guided thoracic paravertebral block combined with general anesthesia on the secretion of pain-related mediators after modified radical mastectomy

Objective: To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anesthesia on the secretion of pain-related mediators after modified radical mastectomy. Methods: A total of 108 patients with breast cancer who were treated with modified radical mastectomy in this hospital between July 2015 and February 2017 were divided into the control group (n=54) and paravertebral block group (n=54) by random number table. Control group received routine general anesthesia, and paravertebral block group received ultrasound-guided thoracic paravertebral block combined with general anesthesia. The differences in serum levels of pain mediators, inflammatory factors and stress hormones were compared between the two groups of patients immediately after surgery (T0), 6h after surgery (T1), 12h after surgery (T2) and 24h after surgery (T3). Results: At T0, there was no statistically significant difference in serum levels of pain mediators, inflammatory factors and stress hormones between the two groups. At T1, T2 and T3, serum pain mediators NPY, PGE2 and 5-HT levels of paravertebral block group were lower than those of control group;serum inflammatory factors IL-1, IL-6, TNF-α and MCP-1 levels were lower than those of control group;serum stress hormones ACTH, Cor, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion: ultrasound-guided thoracic paravertebral block combined with general anesthesia can effectively reduce the release of pain mediators and relieve the systemic inflammatory stress response after modified radical mastectomy.

Effect of ultrasound-guided serratus anterior plane block on the pain, inflammation and oxidation after radical mastectomy

Objective:To study the effect of ultrasound-guided serratus anterior plane block on the pain, inflammation and oxidation after radical mastectomy.Methods: Patients who underwent radical mastectomy in Qinghai Provincial People's Hospital between March 2015 and December 2017 were selected as the research subjects and randomly divided into the experimental group who accepted ultrasound-guided serratus anterior plane block combined with general anesthesia and the control group who accepted general anesthesia. The pain mediators, inflammatory molecules and oxidative stress molecules were measured before surgery and 3 d after surgery.Results: Compared with those of same group before surgery, serum NPY, SP, PGE2, CGRP, IL-1β, IL-18, TNF-α, MDA and 8-iso-PGF2 levels as well as peripheral blood NF-κB, NLRP3, NOX4 and MPO expression intensity of both groups of patients were increasing whereas serum SOD levels were decreasing after surgery, and serum NPY, SP, PGE2, CGRP, IL-1β, IL-18, TNF-α, MDA and 8-iso-PGF2 levels as well as peripheral blood NF-κB, NLRP3, NOX4 and MPO expression intensity of experimental group after surgery were lower than those of control group whereas serum SOD level was higher than that of control group.Conclusion:Ultrasound-guided serratus anterior plane block has significant inhibitory effect on the pain, inflammation and oxidation degree after radical mastectomy.

Effect of Breast Conserving Sentinel Lymph Node Biopsy(SLNB)and Modified Radical Mastectomy on Patients with Early Breast Cancer

Objective:To study the clinical effect of breast conserving combined with sentinel lymph node biopsy and modified radical mastectomy in patients with early breast cancer.Methods:Female patients with early breast cancer in clinical stage I and II were selected as the main objects of this study,the study period started from July 2017 to July 2020.In the breast conserving and sentinel lymph node biopsy patients,50 cases were randomly selected as the experimental group;50 cases in the modified radical mastectomy patients were randomly selected as the control group.The clinical intervention effect of the two groups was analyzed.Results:the perioperative indexes of the experimental group were shorter than those of the control group,the patients recovered faster,the incidence of complications in the experimental group was lower,and the quality of life scores of the experimental group were significantly higher than those of the control group,and the difference was statistically significant,the intervention effect of the experimental group was also better.Conclusion:The application of breast conserving and sentinel lymph node biopsy in the treatment of early breast cancer can promote the recovery of patients,shorten the operation time and reduce the rate of complications,which has significant clinical significance.

Effect of dexmedetomidine on Th1/Th2 cytokine and immune function in patients undergoing radical mastectomy

Objective: To investigate the effect of dexmedetomidine on Th1/Th2 cytokines and immune function in patients with breast cancer after radical mastectomy. Methods: In our hospital from July 2016 to July 2017 undergoing radical mastectomy for breast cancer were studied in 79 patients, were randomly divided into observation group and control group. Two groups of patients with routine preoperative preparation, monitoring blood pressure, electrocardiogram, heart rate, pulse, oxygen saturation, establish vein channel, using propofol, remifentanil, vecuronium induced anesthesia, observation group before induction of anesthesia, dexmedetomidine 1 μg/kg, 10 min after infusion, followed by 0.5 μg/kg/h continuous infusion to the end of the operation, the control group with normal saline continuous infusion till the end of the operation. Two groups of patients before induction of anesthesia (T0), at the end of operation (T1), 6 h after operation (T2), 24 h after operation (T3), 72 h after operation (T4) from peripheral venous blood determination of interleukin-2 by ELISA method (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10) and interferon gamma (IFN-γ), calculated IFN-γ/IL-4 in T0, T2, T3, T4from peripheral blood. CD3+, CD4+, CD8+, NK cells were determined by flow cytometry and CD4+/CD8+ were calculated. Results: Two groups of IL-2 and IFN- in T1, T2, T3gamma, T4is higher than T0, IL-10 less than T0, and the observation group IFN-γ/IL-4 is higher than T0, the control group was lower than that of T0when compared with T0significant difference, 2 in group IL-4 had no obvious changes were observed in group IL-2;IFN-γ, IFN-γ/IL-4 in T1, T2, T3, T4higher than the control group, IL-10 was lower than the control group, significant difference between the 2 groups. CD3+, CD4+, CD4+/CD8+, NK cells in T2group was lower than that of T0, T3, and CD8+ had no obvious change, compared with T0significant difference;the observation group CD3+, CD4+, CD4+/CD8+, T2, T3in NK cells was higher than the control group, significant difference between the 2 groups. Conclusion: Dexmedetomidine can inhibit the stress response during the perioperative period of radical mastectomy, correct the balance disorder of Th1/Th2, improve the level of T lymphocyte subsets, and exert better immune protection function.

Observation on the Therapeutic Effects of Qingre Shengji Ointment(清热生肌膏)on Acute Radiation Dermatitis After Modified Radical Mastectomy

Objective:To observe the curative effect of Qingre Shengji Ointment(清热生肌膏)on acute radiation dermatitis caused by radiotherapy after modified radical mastectomy.Methods:100 patients with radiotherapy after modified radical mastectomy in our hospital from June 2019 to December 2020 were randomly divided into treatment group and control group,with 50 cases in each group.The treatment group was given Qingre Shengji Ointment(清热生肌膏)on the basis of routine nursing,and the intervention began until one week after radiotherapy,while the control group was given routine nursing.Observe and record the occurrence time of acute radiation dermatitis,the degree of acute radiation dermatitis,changes of skin erythema,pruritus,pain,changes of interleukin-6(IL-6)and curative effect were evaluated.The degree of dermatitis was evaluated by RTOG grading standard,the erythema was evaluated by TCM symptom score,and pruritus and pain were evaluated by visual analogue scale(VAS).Blood routine,liver and kidney function,electrocardiogram and other safety indicators and adverse reactions were recorded before and after the study.Results:The time of acute radiation dermatitis was 6-11 days(median 8 days)in the treatment group and 8-14 days(median 10 days)in the control group(P<0.01).The degree and probability of acute radiation dermatitis in the treatment group were 82%(41/50)in grade I,16%(8/50)in grade II and 2%(1/50)in grade III.The degree and probability of acute radiation dermatitis in the control group were 54%(27/50)in grade I,40%(20/50)in grade II and 6%(3/50)in grade III(P<0.05).The highest TCM symptom score of skin erythema in the treatment group was lower than that in the control group(P<0.01).The results of generalized estimation equation show that,The VAS scores of pruritus and pain were(1.34±0.01)and(2.08±0.02)(Waldχ^(2)=1198.123,P<0.01)in the treatment group and(2.08±1.74)(Wald^(2)=1547.804,P<0.01)in the control group,respectively.Compared with the control group,the VAS scores of pruritus and pain were(1.14±0.01)and(2.08±1.74)(Wald^(2)=1547.804,P<0.01)in the treatment group.After observation,the curative effect of the treatment group was better than that of the control group(P<0.05),and the subjective symptoms of patients were obviously improved.After treatment,the level of IL-6 in the treatment group was significantly lower than that before treatment,and was lower than that in the control group(P<0.01).Conclusion:Qingre Shengji Ointment(清热生肌膏)can prevent and treat acute radiation dermatitis to some extent,and its mechanism may be to inhibit the release of inflammatory cytokines,reduce the degree of dermatitis,improve the quality of life of patients,and its safety is good.VAS score can subjectively evaluate the changes of itching and pain,and it is easy to use,so it is worthy of clinical application.

Breast-conserving therapy and modified radical mastectomy for primary breast carcinoma:a matched comparative study

Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886） （P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900） （P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.

Clinical Observation of Breast Conserving Surgery and Modified Radical Mastectomy in the Treatment of Early Breast Cancer

The purpose of the study was to compare the clinical efficacy of breast conserving surgery and modified radical mastectomy in the treatment of early breast cancer.Firstly,the clinical data of 74 patients with early breast cancer treated in our hospital from June 2015 to June 2016 were retrospectively analyzed.Among them,37 patients treated with breast-conserving surgery were set as the study group,and 37 patients treated with modified radical surgery were set as the control group,and the therapeutic effects of the two groups were compared.The results showed that compared with the control group,the incision length,intraoperative blood loss,operation time and hospital stay time were better in the study group,and the excellent and good rate of postoperative breast beauty was higher,with statistically significant differences(P<0.05).There were no statistically significant differences in distant metastasis rate,local recurrence rate,axillary lymph node recurrence rate and fatality rate between the two groups(P>0.05).Therefore,breast-conserving surgery and modified radical surgery have better efficacy in the treatment of early breast cancer,but breast-conserving surgery has more advantages,such as smaller incision,less intraoperative blood loss,shorter operative time and hospital stay,and better postoperative aesthetic effect,which can be used as the first choice for early breast cancer.

Effect of ultrasound-guided pleural paravertebral block combined with general anesthesia on serum monocyte chemokinin-1, interleukin-6 and interleukin-10 levels in patients with early breast cancer after modified radical mastectomy

Objective: To investigate the effect of ultrasound-guided pleural paravertebral block combined with general anesthesia on serum monocyte chemokinin-1 (McP-1), interleukin-6 (il-1) and il-10 levels in patients with early breast cancer after modified radical mastectomy. Methods: A total of 76 patients with early breast cancer from October 2015 to July 2018 were selected from our hospital and divided into study group (n=38) and control group (n=38). The control group received general anesthesia, and the study group received ultrasound-guided paravertebral block combined with general anesthesia. Data of two groups of perioperative situation (PCIA press the number, volume of intraoperative sufentanil and PACU time), preoperative and postoperative 12 h, 24 h serum factor (MCP-1, IL-6, IL-10) level, after 2 h, 4 h, 8 h, 12 h, 24 h when pain (VAS) score, preoperative (T1), 15 min after the anesthesia (T2), 5 min after surgery (T3) hemodynamic state [heart rate (HR), mean arterial pressure (MAP)], the incidence of adverse reactions were counted. Results: (1) Perioperative status: PCIA presses, intraoperative dose of sufentanil and PACU duration in the study group were less than those in the control group. (2) Serum factors: there was no significant difference in serum McP-1, il-6 and il-10 levels between the two groups before operation. The serum levels of McP-1, il-6 and il-10 in the two groups 12 h after operation were higher than those before operation. The serum levels of McP-1, il-6 and il-10 in the two groups at 24 h after surgery were significantly lower than those at 12 h after surgery, and the serum levels of McP-1, il-6 and il-10 in the group at 12 h and 24 h after surgery were lower than those of the control group. (3) Pain degree: the VAS score of the study group at 2 h, 4 h, 8 h, 12 h and 24 h after surgery was lower than that of the control group. (4) Hemodynamics: there was no significant difference in HR and MAP between the two groups during T1, HR and MAP in T2 were lower than those in T1, but the level of each indicator in the study group was higher than that in the control group. (5) Adverse Reactions: the incidence of adverse reactions was lower in the study group (10.53%) than in the control group (28.95%). Conclusion: The application of ultrasound guided early breast cancer modified radical block complex general anesthesia thoracic vertebra, can reduce the dosage of anesthetic drugs, shorten the PACU, residence time, reduce postoperative pain, maintain stable hemodynamic state, inhibiting inflammatory reaction caused by surgical trauma degree, and can reduce the incidence of adverse reactions, and has safety.

The impact of chemotherapy-naïve open radical cystectomy delay and perioperative transfusion on the recurrence-free survival: A perioperative parameters-based nomogram

Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.

A Stable Open-Shell Conjugated Diradical Polymer with Ultra-High Photothermal Conversion Efficiency for NIR-Ⅱ Photo-Immunotherapy of Metastatic Tumor

Massive efforts have been concentrated on the advance of eminent near-infrared(NIR) photothermal materials(PTMs) in the NIR-Ⅱ window(1000–1700 nm), especially organic PTMs because of their intrinsic biological safety compared with inorganic PTMs. However, so far, only a few NIR-Ⅱresponsive organic PTMs was explored, and their photothermal conversion efficiencies(PCEs) still remain relatively low. Herein, donor–acceptor conjugated diradical polymers with open-shell characteristics are explored for synergistically photothermal immunotherapy of metastatic tumors in the NIR-Ⅱ window. By employing side-chain regulation, the conjugated diradical polymer TTB-2 with obvious NIR-Ⅱ absorption was developed, and its nanoparticles realize a record-breaking PCE of 87.7% upon NIR-Ⅱ light illustration. In vitro and in vivo experiments demonstrate that TTB-2 nanoparticles show good tumor photoablation with navigation of photoacoustic imaging in the NIR-Ⅱ window, without any side-effect. Moreover, by combining with PD-1 antibody,the pulmonary metastasis of breast cancer is high-effectively prevented by the efficient photo-immunity effect. Thus, this study explores superior PTMs for cancer metastasis theranostics in the NIR-Ⅱ window, offering a new horizon in developing radical-characteristic NIR-Ⅱ photothermal materials.

Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection

BACKGROUND Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer.However,there is a debate concerning their differential effects on cognitive function,anxiety,and depression in patients undergoing this procedure.AIM To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function,anxiety,depression,and organ function in patients undergoing radical resection of gastric cancer.METHODS A total of 80 patients were involved in this research.The subjects were divided into two groups:Propofol group and sevoflurane group.The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment(LOTCA),and anxiety and depression were assessed with the aid of the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Hemodynamic indicators,oxidative stress levels,and pulmonary function were also measured.RESULTS The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group.Additionally,the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group.The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group.Moreover,the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group.CONCLUSION Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer.Propofol anesthesia has a minimal effect on patients'pulmonary function,consequently enhancing their postoperative recovery.Sevoflurane anesthesia causes less impairment on patients'cognitive function and mitigates negative emotions,leading to an improved postoperative mental state.Therefore,the selection of anesthetic agents should be based on the individual patient's specific circumstances.

Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer

BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

Free radicals trigger the closure of open pores in lignin-derived hard carbons toward improved sodium-storage capacity

The chemical activation of various precursors is effective for creating additional closed pores in hard carbons for sodium storage.However,the formation mechanism of closed pores under the influence of pore-forming agents is not well understood.Herein,an effective chemical activation followed by a high-temperature self-healing strategy is employed to generate interconnected closed pores in lignin-derived hard carbon(HCs).By systematic experimental design combined with electron paramagnetic res-onance spectroscopy,it can be found that the content of free radicals in the carbon matrix influences the closure of open pores at high temperatures.Excessively high activation temperature(>700 C)leads to a low free radical concentration,making it difficult to achieve self-healing of open pores at high tempera-tures.By activation at 700°C,a balance between pore making and self-healing is achieved in the final hard carbon.A large number of free radicals triggers rapid growth and aggregation of carbon microcrys-tals,blocking pre-formed open micropores and creating additional interconnected closed pores in as-obtained hard carbons.As a result,the optimized carbon anode(LK-700-1300)delivers a high reversible capacity of 330.8 mA h g^(-1) at 0.03 A g^(-1),which is an increase of 86 mA h g^(-1) compared to the pristine lignin-derived carbon anode(L-700-1300),and exhibits a good rate performance(202.1 mA h g^(-1) at 1 A g^(-1)).This work provides a universal and effective guidance for tuning closed pores of hard carbons from otherprecursors.

Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy:A singlecenter retrospective study

BACKGROUND The population of elderly patients with gastric cancer is increasing,which is a major public health issue in China.Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer.AIM To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy.METHODS A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020.RESULTS The overall rate of malnutrition was 31.8%.The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group(P<0.001).Nutritional characteristics in the malnourished group,including body mass index,prognostic nutritional index(PNI),albumin,prealbumin,and hemoglobin,were all significantly lower than those in the well-nourished group.The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the wellnourished group(22.1%vs 33.5%,P=0.001).Age≥70 years(HR=1.216,95%CI:1.048-1.411),PNI<44.5(HR=1.792,95%CI:1.058-3.032),operation time≥160 minutes(HR=1.431,95%CI:1.237-1.656),and postoperative complications grade III or higher(HR=2.191,95%CI:1.604-2.991)were all recognized as independent risk factors associated with delayed discharge.CONCLUSION Malnutrition is relatively common in elderly patients undergoing gastrectomy.Low PNI is an independent risk factor associated with delay discharge.More strategies are needed to improve the clinical outcome of these patients.