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Objective:To investigate the value of whole-lesion histogram parameters of apparent diffusion coefficient (ADC) in evaluating and predicting the pathological complete response(PCR) to neoadjuvant chemotherapy (NAC) in different subtypes of breast cancer.Methods:This retrospective study included 117 patients with breast cancer who underwent MRI examination before NAC prior to surgery from January 2016 to December 2017 in the First Affiliated Hospital of Nanjing University. All cases were divided into Luminal B, HER2 positive ( n=21) and triple negative ( n=26) groups. The surgical pathology after chemotherapy was evaluated by Miller-Payne (M-P) system and the patients were divided into PCR group and non-PCR (nPCR) group. Firevoxel software was used to generate the whole-lesion ADC histogram. The parameters included mean (ADC mean), skewness, kurtosis, the minimum (ADC min), the maximum (ADC max), 10th percentile(ADC 10%), 50th percentile (ADC 50%) and 90th percentile (ADC 90%). The two independent samples t test or Mann-Whitney U test was used to compare the differences between PCR and nPCR groups in each subtype. The diagnostic performance of statistically different ADC parameters for predicting PCR was evaluated by receiver operating characteristic (ROC) curve. Results:Kurtosis was significantly higher in PCR group than that in nPCR group in HER2 positive subtype ( P=0.039). It achieved an area under the curve (AUC) of 0.813 with sensitivity of 100% and specificity of 68.7% at the optimal cutoff value (1.861) for differentiating PCR from nPCR cases. In triple negative subtype, ADC mean and ADC 50% were smaller in PCR group than those in nPCR group ( P=0.028,0.013). They achieved AUCs of 0.800, 0.842, respectively. When ADC mean of 1.030×10 -3 mm 2/s and ADC 50% of 0.976×10 -3 mm 2/s were used as cutoff value to differentiate PCR from nPCR, the sensitivities were 75.0%, 80.0% and the specificities were 83.3%, 83.3%, respectively. Conclusion:Kurtosis can predict post-NAC PCR in patients with HER2 positive breast cancer, while ADC 50% has a high value in predicting post NAC PCR of triple negative breast cancer patients.
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Objective:To explore the impact of standardized training on the career planning of undergraduate nursing students, and to provide a reference for the formulation of reasonable interventions.Methods:Semi-structured in-depth interviews were conducted among 15 undergraduate nursing students to obtain their real experience, and the data were analyzed using phenomenological methods.Results:Some undergraduates expressed their understanding and acceptance of the training policy and adopted a positive coping attitude; some undergraduates had negative emotions and chose to study or change careers; the main reasons for negative emotions were high economic pressure, family support, and lack of belonging. And lack of relevant information sources and guidance on training.Conclusion:The relevant departments should strengthen the publicity and interpretation of the standardized training system, cultivate professional identity, guide nursing students to choose the appropriate employment direction, and at the same time, they should improve the comprehensive treatment of regulated students and reduce the worries of nursing students when choosing a career, so that they can correctly view standardized training and make correct and reasonable career plans to reduce the brain drain of the nursing team.
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Neoadjuvant therapy has become an indispensable part of the treatment in locally advanced mild-low rectal cancer. Neoadjuvant therapy can cause the regression of the tumor body as well as drainage lymph nodes, which may influence the size, number, and metastatic status of the lymph nodes. In clinical practice, the total number of lymph nodes detected in rectal cancer treated with neoadjuvant therapy were significantly decreased, making it difficult to meet the standard of the NCCN guideline that at least 12 regional lymph nodes should be harvested. The optimal detection of yielded lymph nodes in rectal cancer is essential for accurate staging, response assessment, and adjuvant treatment decision. The lymph node diameter is significantly reduced after neoadjuvant therapy in locally advanced rectal cancer. In general, the number of detected lymph nodes is significantly reduced without additional pathological examination. The detected lymph nodes would increase by deliberate pathological examination, improvement of the detection method, or using a lymph node tracer. However, whether the number of detected lymph nodes is still needed to meet the requirements of the NCCN guideline, and the relationship between the number of detected lymph nodes and the prognosis are still controversial. At present, the number of negative lymph nodes, LNR, LODDS, etc. can be also used to predict prognosis in addition to ypN staging. For patients with ypN0 and ypN+ stage, different evaluation methods can be selected. For patients with ypN0, the number of detected lymph nodes still has important clinical significance for the prognosis and treatment decision. This article will introduce the related issues, and provide more evidence-based diagnosis and treatment practice.
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Objective To summarize and analyze the clinical characteristics,pathological features and follow-up data of patients with pulmonary lymphaugitic carcinomatosis(PLC) caused by gastric cancer.Methods A retrospective analysis was performed on 7 cases of gastric cancer with pulmonary carcinomatosis in Peking University People's Hospital between Jan 2000 and Dec 2017.Results 7 patients were identified from our database.All patients were female,with an average age of (54 ± 18) years.4 patients were treated with respiratory symptoms and 3 patients presented with gastrointestinal symptoms.One patient received gastrectomy,one did chemotherapy,5 patients had other site metastasis,one was still alive at the end of follow up.Patients average survival time was (4.8 ± 4.0) months.Conclusions Pulmonary lymphatic carcinomatosis caused by gastric cancer is rare clinical entity and the prognosis is poor.Patients often present with respiratory symptoms.Chest CT showed diffusely nodular thickening of interlobular septa and peribronchovascular interstitium.Biopsy of the gastric tumor often establish the diagnosis.