Influential factors of psychological state and their correlation with nutritional risk in patients undergoing thoracic tumor radiotherapy / 中国基层医药

Objective:To investigate the prevalence of anxiety and depression in patients undergoing thoracic tumor radiotherapy, preliminarily evaluate the nutritional risk of patients, and analyze the possible influential factors of anxiety and depression and their correlation with nutritional risk, providing a theoretical basis for further formulating a personalized psychological nursing plan for patients undergoing thoracic tumor radiotherapy.Methods:A total of 121 patients who underwent thoracic tumor radiotherapy between April 2019 and March 2020 in Cancer Hospital of The University of Chinese Academy of Sciences were selected for this study. We evaluated patients' psychological statuses using the Hospital Anxiety and Depression Scale and patients' nutritional risk using the Nutrition Risk Screening. We performed univariate analysis, unconditional logistic regression analysis, and contingency analysis to analyze the factors that affected the psychological status of patients undergoing thoracic tumor radiotherapy and correlate patients' psychological status with nutritional risk.Results:Among 121 patients, 99 (81.8%) patients undergoing thoracic tumor radiotherapy would develop or had developed anxiety, and 42 (34.7%) patients were at the boundary of depression or had depression. Correlation analysis revealed that nutritional risk was correlated with the prevalence of anxiety and depression. Logistic regression analysis showed that surgery, first radiotherapy, and nutritional risk were the factors that affected the prevalence of anxiety. Marital status, location of tumors, surgery, first radiotherapy, and nutritional risk affected the prevalence of depression.Conclusion:Patients undergoing thoracic tumor radiotherapy have serious psychological problems. Nutritional risk is positively correlated with the prevalence of anxiety and depression. Surgery and first radiotherapy are the factors that affect the prevalence of anxiety and depression.

The role of the radiologist in the assessment of thoracic changes after radiotherapy / O papel do radiologista na avaliação das alterações torácicas após radioterapia

Abstract Radiotherapy plays a central role in the palliative and curative treatment of neoplasms of the chest wall or intrathoracic structures. However, despite technical advances, radiotherapy can alter previously normal organs and tissues, those alterations presenting as various types of imaging findings. Post-radiation alterations must be promptly recognized by radiologists, in order to avoid confusion between complications of radiotherapy and the recurrence of a tumor. This pictorial essay aims to illustrate different thoracic changes after radiotherapy.

Resumo A radioterapia tem papel fundamental no tratamento curativo ou paliativo de neoplasias da parede torácica ou intratorácicas. No entanto, mesmo com o avanço das técnicas, órgãos e tecidos vizinhos podem ser acometidos e apresentar alterações que devem ser reconhecidas pelos radiologistas, de maneira a evitar confusão com recidiva das lesões inicialmente tratadas, ou mesmo com outras complicações do tratamento oncológico. O objetivo deste ensaio iconográfico é ilustrar as diferentes consequências torácicas da radioterapia.

Diffusion-weighted magnetic resonance imaging for differentiating between benign and malignant thoracic lymph nodes: a meta-analysis / Ressonância magnética ponderada em difusão para a diferenciação entre linfonodos torácicos malignos de benignos: uma meta-análise

Abstract Objective: To establish the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) in discriminating malignant from non-malignant thoracic lymph nodes. Materials and Methods: This was a meta-analysis involving systematic searches of the MEDLINE, EMBASE, and Web of Science databases up through April 2020. Studies reporting thoracic DWI and lymph node evaluation were included. The pooled sensitivity, specificity, diagnostic odds ratio, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated. Results: We evaluated six studies, involving a collective total of 356 mediastinal lymph nodes in 214 patients. Thoracic DWI had a pooled sensitivity and specificity of 92% (95% confidence interval [95% CI]: 71-98%) and 93% (95% CI: 79-98%), respectively. The positive and negative likelihood ratios were 13.2 (95% CI: 4.0-43.8) and 0.09 (95% CI: 0.02-0.36), respectively. The diagnostic odds ratio was 149 (95% CI: 18-1,243), and the AUC was 0.97 (95% CI: 0.95-0.98). Conclusion: DWI is a reproducible technique and has demonstrated high accuracy for differentiating between malignant and benign states in thoracic lymph nodes.

Resumo Objetivo: Uma meta-análise foi realizada para estabelecer o desempenho diagnóstico da ressonância magnética com imagem ponderada em difusão (DWI) na discriminação de linfonodos torácicos malignos de benignos. Materiais e Métodos: MEDLINE, EMBASE e Web of Science foram sistematicamente pesquisados até abril de 2020. Foram incluídos estudos que relatavam o uso de DWI na avaliação de linfonodos torácicos. Sensibilidade, especificidade, razão de chances de diagnóstico, valores preditivos positivos e negativos e área sob a curva (AUC) foram calculados. Resultados: Foram encontrados 356 linfonodos mediastinais de 214 pacientes nos seis estudos incluídos. DWI produziu sensibilidade e especificidade combinadas de 92% (intervalo de confiança 95% [IC 95%]: 71-98%) e 93% (IC 95%: 79-98%), respectivamente. A razão de verossimilhança positiva foi de 13,2 (IC 95%: 4,0-43,8), a razão de verossimilhança negativa foi de 0,09 (IC 95%: 0,02-0,36); A razão de chances de diagnóstico foi de 149 (IC 95%: 18-1.243). A DWI teve uma AUC de 0,97 (IC 95%: 0,95-0,98). Conclusão: DWI é uma técnica reprodutível que demonstrou alta acurácia na diferenciação de estados malignos e benignos nos linfonodos torácicos.

Application of modified tracking components in CyberKnife treatment of thoracic and abdominal tumors / 肿瘤研究与临床

Objective@#To improve synchrony tracking components of CyberKnife (tracking vest and tracking markers) and to analyze the clinical application value of the improved tracking components in CyberKnife treatment of thoracic and abdominal tumors.@*Methods@#The tracking apron was made of knitted four-side elastic spandex cloth and suture design of Velcro, which was used to stick the tracking markers on the chest and abdomen of patients. The tracking markers added a 2 cm thick light foam block to the bottom of the original markers, and then the hook face of the Velcro was fixed to the bottom of the light foam. The improved trace component (the improved component) and the original component (the vendor component) were applied to the lung tracking treatment model, and the manufacturer components were included in the reference group. Adoption of improved components into the observation group; 20 different types of respiratory waveforms were simulated and applied to the same mold plan. After treatment, the coverage rate, mean standard deviation, maximum standard deviation and the slope of XYZ-axis vs. R correlation graph were recorded. The relevant parameters of Synchrony model and wearable time of two components were compared, and the application significances of the improved tracking component in the breathing tracking process of the CyberKnife were evaluated.@*Results@#The maximum slope [median(interquartile range)] of XYZ-axis vs. R related graph in the reference group was 0.73 (3.89), 0.27 (0.49) and 0.34 (1.02), respectively. The maximum slope of XYZ-axis vs. R related graph in the observation group was 0.70 (2.78), 0.31 (0.30) and 0.36 (0.75), respectively. There was no statistically significant difference in the slope of XYZ-axis vs. R between the reference group and the observation group (all P > 0.05). There was no significant difference in the average standard error and maximum standard error between the reference group and the observation group [(1.7±0.4) mm vs. (1.7±0.5) mm, t=-0.382, P= 0.710; (2.0±0.6) mm vs. (1.7±0.5) mm, t=-0.877, P= 0.401], and the difference of the model coverage rate between the two groups was statistically significant [(48±18)% vs. (60±22)%, t= 2.762, P= 0.042]. The setup time of tracking components in the observation group was less than that in the reference group, and the difference was statistically significant [(44±24) s vs. (81±15) s, t=-4.310, P= 0.001].@*Conclusions@#The improved tracking components are comparable to the manufacturer tracking components in the standard error of the Synchrony model. The improved components shorten the wear time and appropriately improve the coverage of the Synchrony model.

SMARCA4-deficient primary thoracic sarcoma:a clinicopathological analysis of five cases / 中华病理学杂志

Objective@#To investigate the clinicopathological characteristics of SMARCA4- deficient thoracic sarcomas.@*Methods@#The clinical features and CT scans of SMARCA4-deficient thoracic sarcomas (n=5) diagnosed at Fudan University Cancer Hospital from December 2016 to October 2018 were reviewed. Hematoxylin-eosin staining, immunohistochemistry and targeted next generation sequencing were performed in available cases along with a literature review.@*Results@#All 5 patients were males with age ranging from 32 to 65 years (average 54 years; median 61 years). Four patients were smokers except one with unknown smoking history. The average maximum diameter of tumor was 5.6 cm. Tumor primary sites included thoracic wall,thoracic cavity,lung and mediastinum. Histologically,tumor cells formed solid sheets or anastomosing islands with brisk mitotic figures accompanying with large areas of necrosis. Three cases focally exhibited rhabdoid morphology and vesicular chromatin. Immunohistochemically, SMARCA4, SMARCA2 and Claudin-4 were negative in all cases and all tumors demonstrated SOX2 and SMARCB1 nuclear positive staining. Among 3 cases analyzed by targeted next generation sequencing, concurrent SMARCA4 and p53 mutation was detected in all three cases. Mutations of STK11, ERBB4, NF2, GNAS, MTOR,MET and FGFR1 amplification were also detected among the three cases. The follow-up information was available in all 5 cases. Two patients died of the tumor. One relapsed multiple times after surgeries but was alive with disease. Two patients received radical excisions without relapse.@*Conclusions@#SMARCA4-deficient thoracic sarcoma is a rare but highly-aggressive tumor with dismal prognosis. The tumor is featured by rhabdoid morphology histologically and distinctive immunohistochemical and molecular phenotype.

Effect of different doses of low molecular weight heparin on coagulation mechanism in thoracic cancer surgery / 中国医师杂志

Objective@#To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery.@*Methods@#A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery (lung cancer, esophageal cancer, cardiac cancer) from February 2015 to October 2018. According to the Caprini risk assessment model, 101 patients with high risk of deep venous thrombosis were randomly assigned to groups A, B and C. Control group A (34 cases) did not use low molecular weight heparin; group B (34 cases) used prophylactic low molecular weight heparin calcium after operation; group C (33 cases) used therapeutic low molecular weight heparin calcium after operation. The platelet count (PLT), fibrinogen (FIB), prothrombin time (PT), D-dimer (D-D), postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation.@*Results@#The incidence of deep venous thrombosis (DVT) was 11.76% in group A, 2.94% in group B and 3.03% in group C, with significant difference between group B and C and group A (P<0.05), but there was no significant difference between group B and C (P>0.05). The levels of FIB and D-D after operation were significantly higher than those before operation (P<0.05), but the levels of indexes in group B and C were significantly lower than those in group A (P<0.05).@*Conclusions@#Low molecular weight heparin calcium does not increase bleeding and thoracic drainage, which is beneficial to improve the hypercoagulable state of patients and has good safety. However, the use of low molecular weight heparin calcium in different doses (prevention amount and treatment amount) has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index.

Effect of different doses of low molecular weight heparin on coagulation mechanism in thoracic cancer surgery / 中国医师杂志

Objective To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery.Methods A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery (lung cancer,esophageal cancer,cardiac cancer) from February 2015 to October 2018.According to the Caprini risk assessment model,101 patients with high risk of deep venous thrombosis were randomly assigned to groups A,B and C.Control group A (34 cases) did not use low molecular weight heparin;group B (34 cases) used prophylactic low molecular weight heparin calcium after operation;group C (33 cases) used therapeutic low molecular weight heparin calcium after operation.The platelet count (PLT),fibrinogen (FIB),prothrombin time (PT),D-dimer (D-D),postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation.Results The incidence of deep venous thrombosis (DVT) was 11.76％ in group A,2.94％ in group B and 3.03％ in group C,with significant difference between group B and C and group A (P ＜ 0.05),but there was no significant difference between group B and C (P ＞ 0.05).The levels of FIB and D-D after operation were significantly higher than those before operation (P ＜ 0.05),but the levels of indexes in group B and C were significantly lower than those in group A (P ＜ 0.05).Conclusions Low molecular weight heparin calcium does not increase bleeding and thoracic drainage,which is beneficial to improve the hypercoagulable state of patients and has good safety.However,the use of low molecular weight heparin calcium in different doses (prevention amount and treatment amount) has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index.

A study on the status quo and its influencing factors of depression and anxiety in postoperative patients with thoracic neoplasms / 中国胸心血管外科临床杂志

@#Objective    To investigate the status quo and influencing factors of depression and anxiety in postoperative patients with thoracic neoplasms. Methods    The general information questionnaire and Huaxi emotional-distress index scale (HEI) were adopted to survey 70 patients after surgery of thoracic neoplasms at the thoracic nursing outpatients from September to November 2016. There were 43 males and 27 females with age of 18-78 (56.20±11.34) years. Results    The prevalence rate of depression and anxiety among postoperative patients with thoracic neoplasms was 50.0%, and moderate to severe negative emotions predominated. There was significant difference in educational levels, postoperative hospitalization and postoperative complications (P<0.05), while no significant difference in age, gender, disease types, complicated diseases, surgical procedures, pathological stages and hospitalization expenditures between patients with unhealthy emotions and normal emotions (P>0.05). Conclusion    There is a high prevalence rate of negative emotion among postoperative patients with thoracic neoplasms. Educational levels, postoperative hospitalization and postoperative complications are important factors for negative emotion.

SPECT/CT-guided percutaneous transthoracic needle biopsy of thoracic masses / 中华核医学与分子影像杂志

Objective To investigate a real-time imaging guided percutaneous transthoracic needle biopsy (PTNB) for thoracic masses with SPECT/CT.Methods From March to June 2016,a total of 12 patients (7 males,5 females;average age:(59.2± 13.2) years) with thoracic lesions suspicious for malignancy underwent 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT/CT-guided PTNB.The hot spot areas were chosen from the thorax 99Tcm-MIBI SPECT/CT images as the sampling targets.Subsequent guiding CT scans were repeatedly fused with the prior SPECT images to realize the real-time guiding of the biopsy needle puncture step by step,until reaching to the target margin.Masses were sampled after confirming that the needle tips reached planned areas.Pathological results,total time of examination,time of PTNB procedure,complication,CT radiation dosage were recorded.Results Based on 99Tcm-MIBI SPECT/CT results,biopsies targeted the most suspicious areas within lesions.All biopsy procedures yielded diagnostic results.Eleven patients had positive results of malignancy,and 1 patient with inflammation.There were no severe complications.Total time of examination was (74.3±10.4) min,and (33.5±9.1) min for PTNB.Radiation dosage of CT was (6.1±1.7) mSv,36％ of which was caused by CT-guiding ((2.2±1.0) mSv).Conclusion Multimodal of SPECT/CT fusion imaging is useful for thorax biopsy planning and guiding,and can increase overall performance of safety and feasibility.

Dosimetry evaluation for CT guided 125I seeds implantation assisted by three-dimensional-printing coplanar coordinate template in chest malignant tumor / 中华核医学与分子影像杂志

Objective To verify the accuracy of three-dimensional printing coplanar coordinate template (3D-PCCT) technology for 125I seeds implantations in chest tumor at dosimetry level.Methods From January 2016 to June 2017,a total of 22 patients (15 males,7 females;median age 62 years) with chest tumors who received 3D-PCCT assisted 125I seeds implantation in Peking University Third Hospital were enrolled in this retrospective study.There were 8 patients with primary lung cancer and 14 with metastatic carcinoma.The sites for implantation included lung (12 cases),mediastinum (2 cases) and chest wall (8 cases).The prescribed dose was 110-180 Gy.The preoperative plan design,puncture and seeds implantation guided by template were carried out and the dose distribution of postoperative plan was compared with that of preoperative plan.Dose parameters included dose delivered to 90％ gross tumor volume (D90),minimum peripheral dose,the percentage of GTV receiving 100％ prescription dose (V100),the percentage of GTV receiving 150％ prescription dose (V150),conformity index,external index of target volume,uniformity index,D2 cm3 of spinal cord and aorta,and V20 of affected side lung.Wilcoxon signed rank test was used to analyze the data.Results The median D90 was 150.4(125.6,187.0) Gy.Postoperative D90 was higher than the prescribed dose in 68％ (15/22) cases.For median value of most parameters,there were no significant differences between the postoperative plans and preoperative plans (all P＞0.05) except for the actual V100,which was lower than the preplanned (95.5％ vs 97.2％;P=O.040).Conclusion 3D-PCCT could provide good accuracy in 125I seeds implantation for chest tumor.

Efficacy and toxicity of stereotactic radiotherapy after thoracic tumor radiotherapy / 重庆医学

Objective To investigate the efficacy and safety of using stereotactic radiotherapy (SRT) technique for conducting re-therapy after thoracic tumor radiotherapy.Methods Thirty-eight patientswith SRT after receiving thoracic conventional radiotherapy (RT) in our hospital from July 2012 to November 2014 were selected.The treatment target area included the lung local primary lesion,recurrent lesions and lung metastasis tumor.Results Median dose of previous RT was 48 Gy (30-56 Gy).Median biologically equivalent effective dose (alpha/beta=10.0,BED10) of receiving SRT was 62 Gy (39-72 Gy).Median follow up time was 12.30 months;1-,2-year local progression-free survival (LPFS) was 76.32％ and 63.16 ％ respectively.Median recurrence-free (RFS) and overall survival (OS) were 13.20 months and 21.00 months respectively.Grade 2 and 3 pulmonary toxicity was 15.79 ％ and 7.89 ％ respectively.Other grade 2-4 toxicities adverse reactions included chest pain (15.79 ％),fatigue (18.42 ％) and skin lesion(2.63％).No grade 5 toxic injury occurred.Conclusion SRT can be safely and effectively used in the patients previously receiving thoracic RT.

Research advances in radiation?induced heart disease / 中华放射肿瘤学杂志

Radiation?induced heart disease ( RIHD) is a common type of radiation?induced damages in chest radiotherapy. There are no obvious short?term symptoms in patients with RIHD. However, RIHD causes irreversible permanent damages to the heart over time, which undermines the quality of life. Patients with severe RIHD even have a risk of death from myocardial infarction caused by coronary atherosclerosis. This paper summarizes the research advances in epidemiology, diagnosis, mechanisms of radiation?induced injury in various parts of the heart, radiotherapy techniques, and treatment. Reduction in radiation range and dose, early diagnosis, and early treatment are recommended for patients to reduce heart injury and improve the quality of life.

Investigation of depression and anxiety emotion in perioperative patients with thoracic neoplasms / 中国胸心血管外科临床杂志

@#Objective    To understand the status quo of depression and anxiety emotion in perioperative patients with thoracic neoplasms under the concept of enhanced recovery after surgery. Methods    Huaxi emotional-distress index scale (HEI) was adopted to investigate the mental status of 195 patients with thoracic neoplasms in Department of Thoracic Surgery, West China Hospital, and the nursing outpatients between September and November in 2016. There were 118 males and 77 females at age of 17–80 (55.72±12.66) years. Results    There was significant difference in mental health level between the preoperative patients and the postoperative patients (3.70±3.41 vs. 11.01±9.78, P<0.001). The incidence of depression and anxiety emotion in the postoperative patients was significantly higher than that in the preoperative patients (50.00% vs. 9.60%, P<0.001). Besides, there was significant difference of depression and anxiety degree between the preoperative patients and postoperative patients (P<0.001). Moderate to severe depression and anxiety were mostly found in the postoperative patients while mild to moderate depression and anxiety in the preoperative patients. Conclusion    Patients with thoracic neoplasms have much emotional obstacle in perioperative period. The incidence and severity degree of depression and anxiety emotion in postoperative patients are higher than those in preoperative patients.

Complicaciones postoperatorias y resultados clínicos en pacientes operados por cáncer torácico y gastrointestinal: Estudio de cohorte prospectivo / Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: A prospective cohort study

RESUMEN Objetivo: Determinar la influencia de las complicaciones postoperatorias sobre los resultados clínicos en pacientes operados por cáncer torácico y gastrointestinal. Métodos: Se realizó un estudio de cohorte prospectivo de 179 pacientes consecutivos que fueron operados de tórax o vías digestivas por cáncer y admitidos en una unidad de cuidados intensivos oncológicos. Se evaluó la incidencia de las complicaciones postoperatorias mediante el Postoperative Morbidity Survey y su influencia sobre la mortalidad y estadía hospitalaria. Resultados: Se presentaron complicaciones postoperatorias en 54 sujetos (30,2%); las más frecuentes fueron las pulmonares (14,5%), el dolor (12,9%), las cardiovasculares (11,7%), las infecciosas (11,2%) y las de la herida quirúrgica (10,1%). En el análisis multivariado de regresión logística las complicaciones pulmonares (OR 18,68; IC95% 5,59 - 62,39; p < 0,0001), cardiovasculares (OR 5,06; IC95% 1,49 - 17,13; p = 0,009), gastrointestinales (OR 26,09; IC95% 6,80 - 100,16; p < 0,0001), infecciosas (OR 20,55; IC95% 5,99 - 70,56; p < 0,0001) y renales (OR 18,27; IC95% 3,88 - 83,35; p < 0,0001) se relacionaron de forma independiente con la mortalidad hospitalaria. La ocurrencia de al menos una complicación incrementó la probabilidad de permanecer hospitalizado (Log Rank test; p = 0,002). Conclusiones: Las complicaciones postoperatorias son trastornos frecuentes y asociados con malos resultados clínicos, por lo que se deben realizar cambios estructurales y de proceso para reducir la morbilidad y mortalidad postoperatorias.

ABSTRACT Objective: This study sought to determine the influence of postoperative complications on the clinical outcomes of patients who underwent thoracic and gastrointestinal cancer surgery. Methods: A prospective cohort study was conducted regarding 179 consecutive patients who received thorax or digestive tract surgery due to cancer and were admitted to an oncological intensive care unit. The Postoperative Morbidity Survey was used to evaluate the incidence of postoperative complications. The influence of postoperative complications on both mortality and length of hospital stay were also assessed. Results: Postoperative complications were found for 54 patients (30.2%); the most common complications were respiratory problems (14.5%), pain (12.9%), cardiovascular problems (11.7%), infectious disease (11.2%), and surgical wounds (10.1%). A multivariate logistic regression found that respiratory complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001), cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009), gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p < 0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p < 0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p < 0.0001) were independently associated with hospital mortality. The occurrence of at least one complication increased the likelihood of remaining hospitalized (log-rank test, p = 0.002). Conclusions: Postoperative complications are frequent disorders that are associated with poor clinical outcomes; thus, structural and procedural changes should be implemented to reduce postoperative morbidity and mortality.

Blastoma pleuropulmonar: caso clínico / Pleuropulmonary blastoma: case report

El blastoma pleuropulmonar es un tumor pulmonar raro de la infancia, que puede manifestarse con lesiones quísticas o sólidas, como un hallazgo radiológico o con clínica respiratoria. Presentamos el caso de un niño de 2 años de edad que consultó en su primer cuadro obstructivo con imagen sospechosa de malformación pulmonar en el lóbulo superior izquierdo en la radiografía y la tomografía de tórax. Se realizó cirugía, que evidenció una malformación quistica en el segmento ápico posterior del lóbulo superior izquierdo. Recibimos el informe de anatomía patológica con diagnóstico de blastoma pleuropulmonar tipo I. Comenzó el seguimiento por Oncología e inició el tratamiento con ciclofosfamida y vincristina, con buena tolerancia.

Pleuropulmonary blastoma is a rare lung tumor of childhood that can occur with cystic or solid lesions, as a radiological finding with or without respiratory symptoms. We report the case of a 2 year old toddler in his first pulmonary obstructive episode with suspected toracic malformation of the left upper lobe in his chest x-ray and tomography. Surgery was performed showing cystic malformation of the left upper lobe. We received the pathology report with diagnosis of type I pleuropulmonary blastoma. He began follow-up with Oncology initiating treatment with cyclophosphamide and vincristine, well tolerated.

Multivariate analysis of elderly patients with thoracic malignancies caused by radioactive radiation pneumonitis / 中国医师杂志

Objective To investigate elderly patients with thoracic radiotherapy nausea result after risk factors associated with radiation pneumonitis.Methods The clinical data of a total of 440 cases of cancer patients with chest radiation therapy during January 2010-January 2014 were collected retrospectively.Of them,76 cases of radiation pneumonitis after radiotherapy were compared with other patients.The unconditional Logistic regression analysis was used to analyze the relationship of radiation pneumonitis and different factors including smoking,pulmonary dysfunction,combination with chemotherapy,radiation dose,and radiation sites.Results Elderly incidence of radiation pneumonitis was 17.27％.Multivariate Logistic regression analysis revealed the chi-square value of smoking,pulmonary dysfunction,combined with chemotherapy,radiation dose,and radiation sites was significant correlation (x2 =16.936,19.633,11.531,17.133,10.178,P ＜0.05),and the correlation degree was gradually decreased from pulmonary dysfunction,radiation dose,smoking,combined chemotherapy,to radiation site.Conclusions Elderly patients with thoracic malignancies after radiotherapy had more radiation pneumonitis,which was related to smoking,previous chemotherapy PO2 ＜ 80％,combined with chemotherapy,radiation dose ≥ 55 Gy,and low-lung radiation.The correlation degree was gradually decreased from chemotherapy before PO2 ＜ 80％,the radiation dose ≥55 Gy,smoking,combined chemotherapy,to low-lung radiation.

Research advances in the pathogenesis of radiation-induced myocardial damage / 中华放射肿瘤学杂志

The Medline and CNKI databases were searched with the key words of radiation-induced myocardial damage,damage pathway,pathogenesis,and intervention,and 37 articles were obtained.The pathogenesis of radiation-induced myocardial damage may be related to various mechanisms such as oxidative stress,transforming growth factor-β,renin-angiotensin system,mast cells,and endothelial dysfunction.The pathogenesis of radiation-induced myocardial damage is a complex process involving various mechanisms,and currently,there are ongoing studies on the cellular and molecular mechanisms involved in its pathogenesis and interventions.

Advances in biological predictors of radioactive esophagitis / 中国医师杂志

Radioactive esophagitis is one of the most common complications in thoracic tumor radiotherapy,biological factors such as single nucleotide polymorphisms (SNPs),miRNAs,and HIV infection may play key roles in the occurrence and development of radioactive esophagitis,and they have become an active field in protection areas of radiotherapy.We can identify the patients who may cause radioactive esophageal in high dose radiotherapy as early as possible,and modify the treatment plan to protect the esophagus.Therefore the biological factors of radioactive esophagitis are of important clinical significance.

Utilización de placas costales de titanio en la reconstrucción de grandes defectos de la pared torácica postresección de tumores / Use of titanium ribs plates for reconstruction of large full-thickness thoracic wall defect after a tumor resection

La reconstrucción de grandes defectos de la pared torácica continúa siendo un tema controversial. Las complicaciones por este tipo de resecciones van de 46% a 69% con los antiguos materiales de osteosíntesis. La reciente incorporación del titanio, debido a que es inoxidable, químicamente inerte y que rápidamente se adapta a la forma de la pared torácica, lo hace un material ideal para este tipo de procedimientos. Se presenta el caso clínico de un paciente de 54 años, portador de enfermedad de Von Recklinghausen, en el que se realiza resección de un tumor de la cara anterolateral derecha del tórax, que incluye cuatro arcos costales y sus correspondientes cartílagos reconstruyéndose con placas de titanio y malla de Prolene. El paciente evolucionó favorablemente en el posoperatorio, sin complicaciones. Este tipo de sistemas de osteosíntesis con placas de titanio MatrixRib® brindan un material seguro y con buenos resultados tanto funcionales como cosméticos.

Reconstruction of full thickness thoracic wall defects remains a controversial topic, with older osteosynthesis materials complication rates ranging from 46 to 69%. Recent introduction of titanium in the making of the plates, makes this material ideal for this type of procedures due to being stainless, chemically inert and the fact that the ribs adapt correctly to the thorax shape. We present the case of a 56 year old male, with Von Recklinghausen disease in whom we performed a resection of an anteroateral chest wall tumor, which included four costal arches and the corresponding cartilage. Reconstruction with titanum plates and prolene mesh was performed. The patient had no postoperative complications. This ostesynthesis system with titanium plates matrix rib provides both functional, safe and good cosmetic results.

A reconstrução de grandes defeitos da parede torácica continua sendo um tema controversial. As complicações por este tipo de ressecções variam entre 46% a 69% dos casos com os antigos materiais de osteosíntese. A recente incorporação do titânio, um material inoxidável, quimicamente inerte e que se adapta rapidamente à forma da parede torácica, faz com que seja um material ideal para este tipo de procedimentos. Apresenta-se o caso clínico de um paciente de 54 anos, portador de doença de Von Recklinghausen, que foi submetido à ressecção de um tumor da parede anterolateral direita do tórax, que incluiu quatro arcos costais e as correspondentes cartilagens e reconstrução com placas de titânio e malha de Prolene. O paciente teve uma evolução favorável no pós-operatório, sem complicações. Este tipo de sistemas de osteosíntese com placas de titânio MatrixRib® oferecem um material seguro com bons resultados tanto funcionais como cosméticos.

Effect of reducing the radiation pneumonitis by abdominal breathing exercises in patients with chest malignant tumors / 中国实用护理杂志

Objective To evaluate the prophylactic effect of abdominal breathing exercises on radiation pneumonitis in patients with chest malignant tumors.Methods 100 patients with chest malignant tumors were given radiotherapy and divided with random digit table into the exercise group and the control group with 50 patients in each group.The incidence rate of radiation pneumonitis in both groups was compared.The prophylactic effect of abdominal breathing exercises on radiation pneumonitis was evaluated.Results The incidence of radiation pneumonitis in abdominal breathing exercise group was significantly reduced [34％ (17/50) vs.56％ (28/50),Z=2.397,P＜0.05],the incidences of grade Ⅰ [22％ (11/50) vs.30％ (15/50)] and grade Ⅱ [12％ (6/50) vs.18％ (9/50)] radiation pneumonitis decreased,and no grade Ⅲ and Ⅳ radiation pneumonitis occurred.Conclusions The incidence of radiation pneumonitis in patients with chest malignant tumors treated with radiation therapy may be decreased by abdominal breathing exercises,which may be widely applied in patients treated with radiation therapy.