预测乳腺癌术后切口愈合不良的列线图模型建立

目的探讨乳腺癌术后切口愈合不良的危险因素,构建预测术后切口愈合不良发生的列线图模型,并评估模型的预测效果。 方法采用便利抽样法,选择2016年1月至2021年10月徐州医科大学附属淮安医院行乳腺癌手术的813例患者,根据术后切口愈合情况分为愈合良好组（767例）和愈合不良组（46例）。收集两组患者基本信息、病理特征及手术情况开展单因素分析,通过多因素Logistic回归分析筛选术后切口愈合不良的危险因素,利用R 4.1.3软件绘制术后切口愈合不良发生的列线图预测模型并评估其区分度和符合度。 结果愈合不良组年龄、营养不良、合并糖尿病、贫血及手术切口为纵切口比例、置引流管时间与愈合良好组比较,差异均有统计学意义（P<0.05）。Logistic回归分析显示,乳腺癌术后切口愈合不良发生的主要危险因素为年龄大（OR=1.269）、营养不良（OR=2.376）、合并糖尿病（OR=2.262）、贫血（OR=2.227）、置引流管时间长（OR=1.571）（均P<0.05）;受试者工作特征曲线及校准曲线分析结果显示,构建的列线图预测模型区分度（曲线下面积为0.785,95% CI：0.725~0.845）及符合度（拟合优度HL检验χ²=8.294,P=0.405）均较高。 结论基于年龄、营养不良、合并糖尿病、贫血、置引流管时间5项危险因素构建的乳腺癌术后切口愈合不良列线图模型具有较好的预测效能。     

应用补片治疗食管裂孔疝术后复发的临床分析

目的探讨临床应用补片治疗食管裂孔疝（HH）术后复发的因素。 方法回顾性分析2010年11月至2021年5月于上海长征医院甲乳疝外科行补片加固食管裂孔疝修补术15例患者的术后复发情况。HH复发的主观指标主要依据改良Visick评分系统,客观指标包括术后半年随访时的胃镜、上消化道钡餐、上腹部CT和高分辨食管测压和24 h pH监测。症状性复发者首先经影像学检查评估有无客观证据,存在症状反复但无明确解剖复发证据者,需经食管测压和24 h pH监测有无抗反流屏障功能的损害和病理性反流,必要时结合阻抗检查评价反流与症状的相关性。 结果15例患者复发时间距初次手术时间6~121个月,中位时间28个月。其中小HH（Ⅰ~Ⅱ型）4例,巨大HH（Ⅲ~Ⅳ型）11例。使用的3种类型补片的数量为4层SIS 5例,6层SIS 8例,复合补片2例。再发胃灼热、胃内容物反流等症状者10例,均为生物补片病例;以吞咽困难为主要表现3例（2例为复合补片）。症状与检查结果不对应者4例（26.66%）。术后上腹部CT提示HH复发2例,但无明显GERD症状反复;自述GERD症状再现,但无明确影像学HH复发证据,食管测压和pH-阻抗监测未见病理性反流2例,均有轻度焦虑。再次手术探查4例,其中合成补片1例,生物补片3例,术前评估均提示有不同程度的HH复发。切取补片所在部位活检1例（合成补片）,见显著胶原蛋白沉积和包裹的合成纤维组织。 结论应用补片治疗HH术后复发,重点分析其与解剖结构改变的相关性是决定再手术与否的关键。     

经腹腹膜前疝修补术与Lichtenstein术治疗老年嵌顿性腹股沟疝的临床疗效对比

目的对比评价经腹腹膜前疝修补术（TAPP）与Lichtenstein无张力疝修补术治疗老年嵌顿性腹股沟疝的临床疗效。 方法回顾性分析2015年1月至2018年1月天津市人民医院和天津市第三中心医院收治的95例老年嵌顿性腹股沟疝患者,依据手术方式不同分为腹腔镜组（TAPP）和开放组（Lichtenstein）,对比2组患者一般资料、手术时间、住院时间、首次通便时间、术后并发症发生率及复发率等指标。 结果腹腔镜组患者平均手术时间（65.45±9.72）min,平均住院时间（6.86±1.12）d,首次通便时间平均（2.60±0.70）d。开放组患者平均手术时间（63.13±11.05）min,平均住院时间（7.52±1.36）d,首次通便时间平均（2.80±1.03）d,2组患者手术时间、住院时间及首次通便时间差异均无统计学意义（P>0.05）。腹腔镜组患者术后并发症发生率及复发率明显低于开放组（P<0.05) 。 结论腹腔镜手术治疗老年嵌顿性腹股沟疝更加安全有效,在满足手术适应证条件下,应首选腹腔镜手术治疗。     

评估应用术前PLR、NLR及AGR预测乳腺癌患者预后的价值

目的探究术前血小板淋巴细胞比值（PLR）、中性粒细胞淋巴细胞比值（NLR）及白蛋白球蛋白比值（AGR）在评估乳腺癌患者预后中的价值。 方法选取2013年1月至2017年12月收治的1184例浸润性乳腺癌女性患者为浸润性乳腺癌组,随机选取仅患乳腺纤维腺瘤的患者279例为乳腺纤维腺瘤组。收集患者一般资料、术后病理资料、血型、术前外周血血小板、中性粒细胞、淋巴细胞数量以及血清白蛋白和球蛋白水平,并计算得出PLR、NLR及AGR。应用受试者功能特征曲线下面积来评估三者预测乳腺癌患者预后的能力。本研究使用SPSS 20.0及MedCalc软件进行统计学分析和绘图,P<0.05代表差异具有统计学意义。 结果浸润性乳腺癌患者的术前PLR及NLR均值显著高于乳腺纤维腺瘤患者（P<0.05）,而AGR低于乳腺纤维腺瘤患者（P<0.05）。Cox比例回归风险分析显示,患者的诊断年龄、PLR、NLR、AGR、肿瘤直径、组织学分级、阳性淋巴结个数和分子分型均为乳腺癌的预后危险因素（P<0.05）。ROC曲线分析结果得出,PLR、NLR及AGR的最佳诊断临界值分别为147.4、2.9及1.7。应用术前PLR（AUC=0.796,P<0.001）、NLR（AUC=0.716,P<0.001）及AGR（AUC=0.748,P<0.001）预测乳腺癌患者预后均有价值,且PLR价值更高。 结论术前PLR、NLR及AGR对乳腺癌患者预后的判断均具价值,三者相比,PLR价值更高,有望成为判断乳腺癌患者预后的补充指标。     

Prospective validation study of Cernea classification for predicting EMG alterations of the external branch of the superior laryngeal nerve

Purposes

Cernea classification is applied to describe the external branch of the superior laryngeal nerve (EBSLN). Using intraoperative neural monitoring we evaluated whether or not this classification is useful for predicting which EBSLN subtype has an increased risk of injury.

Methods

An analysis of 400 EBSLN. The identification of EBSLN was achieved with both cricothyroid muscle twitch and the glottis evoked electromyography response. We defined S1 initial EBSLN stimulation at identification and S2 final nerve stimulation achieved in the most cranial aspect of the nerve exposed above the area of surgical dissection after superior artery ligation.

Results

The mean S1 amplitude acquired was 259+/67 (180–421), 321 +/79 (192–391), 371 +/38 (200–551) μV, respectively, for type 1, 2A, 2B (p = 0.08). The S1 and S2 amplitudes were similar in type 1 (p = 0.3). The S1 and S2 determinations changed significantly in type 2A and 2B (p = 0.04 and 0.03). EBSLN which demonstrated a >25 % decreased amplitude in S2 increased significantly from Type 1 (4.9 %) to Type 2A (11.2 %) and 2B (18 %) (p = 0.01). None of type 1, 2.8 % type 2A and 3 % type 2B showed a loss of EBSLN conductivity. The latency determinations did not vary significantly for any parameter compared.

Conclusions

The Cernea classification was, therefore, found to predict the risk of EBSLN stress. We identified amplitude differences between S1 and S2 determinations in type 2A and 2B, thus confirming that surgical dissection in these subtypes is, therefore, extremely difficult to perform.

     

多灶甲状腺微小乳头状癌的临床特征分析

目的:探讨多灶甲状腺微小乳头状癌(PTMC)的临床病理特征。方法:回顾性分析2013年5月—2016年4月297例手术治疗并经病理证实的PTMC患者临床资料。结果:297例PTMC患者中,多灶PTMC 70例(23.6%)。与单灶PTMC患者比较,多灶PTMC患者肿瘤直径小(0.54 cm vs.0.69 cm)、包膜侵犯率高(18.6%vs.8.8%)、行甲状腺全切比例高(87.1%vs.41.4%),差异均有统计学意义(均P0.05)。癌灶数≥3多灶PTMC患者与癌灶数=2的PTMC患者比较,前者合并双侧癌的比例增高(88.2%vs.44.4%)、中央区淋巴结转移的比例增高(47.1%vs.22.2%),差异均有统计学意义(均P0.05)。结论:多灶PTMC的病灶更为微小且更易出现包膜侵犯;多灶PTMC的病灶数越多合并双侧癌和中央区淋巴结转移的风险就越大;多灶PTMC应常规行预防性中央区淋巴结清扫。     

Foxp3+调节性T细胞与乳腺癌淋巴结转移及增殖的关系

目的:探讨Foxp3~+调节性T细胞(Tregs)与乳腺癌淋巴结转移及增殖的关系。方法:用免疫组化法检测168例女性乳腺癌患者癌组织中CD4和Foxp3(调节性T细胞标志)的表达,以42例女性乳腺良性病变乳腺组织为对照,分析Tregs与乳腺癌淋巴结转移及乳腺癌组织细胞核增殖相关抗原Ki-67表达的关系。结果:乳腺癌组织中CD4~+T细胞与Foxp3~+T细胞(Tregs)的数量均高于乳腺良性病变组织,差异均有统计学意义(均P0.05);有淋巴结转移的乳腺癌组织中CD4~+T细胞与Foxp3~+T细胞数均高于无淋巴结转移的乳腺癌组织,但仅后者差异有统计学意义(P0.05)。乳腺癌组织中Tregs的浸润数量与Ki-67表达之间无关(P0.05)。结论:乳腺癌组织微环境存在免疫抑制,Tregs浸润数量与淋巴结转移关系密切,但与肿瘤增殖无关,提示Tregs可作为判断乳腺癌患者有无淋巴结转移的新指标。     

Fatigue,anxiety and depression overrule the role of oncological treatment in predicting self-reported health complaints in women with breast cancer compared to healthy controls

BackgroundWomen with breast cancer often attribute their health problems as side effects caused by oncological treatments. The aim of the study was to examine and compare self-reported health complaints (SHC) in postmenopausal patients with breast cancer to healthy controls.MethodWomen with breast cancer (N = 196) filled in 5 questionnaires 1–2 years after surgery; SHC Inventory, Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES), Fatigue – Functional Assessment of Cancer Therapy-Fatigue subscale (FACIT-F), Fatigue Visual Analog Scale (Fatigue VAS), and Hospital Anxiety and Depression Scale (HADS). Controls comprised 101 blood donors who reported on the questionnaires except for HADS. Bonferroni adjustment and p < 0.0017 was considered statistically significant for SHC Inventory, p < 0.05 for the remaining questionnaires.ResultsThe patients, mean age 58.0 (SD 9.5), reported significantly more self-reported health complaints, whereof 6 of 29 complaints were significantly elevated compared to the controls, mean age 57.0 (SD 5.8) (p < 0.001). HADS scores in patients fell into normal range, mean 6.3 (SD 5.7). A subgroup of 48 patients experienced more frequent and severe symptoms in all the questionnaires compared to the remaining 148 patients, and the 101 controls. Among the patients, fatigue, anxiety and depression explained 49% of the total variance in self-reported health complaints (p ≤ 0.001).ConclusionMost women with breast cancer (76%) reported health complaints equal to the healthy controls. Fatigue, anxiety and depression, not oncological treatments, were significant predictors for the complaints.     

Mechanism of Regulatory Effect of MicroRNA-206 on Connexin 43 in Distant Metastasis of Breast Cancer

Background:

MicroRNA-206 (miR-206) and connexin 43 (Cx43) are related with the distant metastasis of breast cancer. It remains unclear whether the regulatory effect of miR-206 on Cx43 is involved in metastasis of breast cancer.

Methods:

Using quantitative real-time polymerase chain reaction and Western blot, the expressions of miR-206 and Cx43 were determined in breast cancer tissues, hepatic and pulmonary metastasis (PM), and cell lines (MCF-10A, MCF-7, and MDA-MB-231). MCF-7/MDA-M-231 cells were transfected with lentivirus-shRNA vectors to enhance/inhibit miR-206, and then Cx43 expression was observed. Cell counting kit-8 assay and Transwell method were used to detect their changes in proliferation, migration, and invasion activity. The mutant plasmids of Cx43-3’ untranslated region (3’UTR) at position 478–484 and position 1609–1615 were constructed. Luciferase reporter assay was performed to observe the effects of miR-206 on luciferase expression of different mutant plasmids and to confirm the potential binding sites of Cx43.

Results:

Cx43 protein expression in hepatic and PM was significantly higher than that in the primary tumor, while no significant difference was showed in messenger RNA (mRNA) expression. MiR-206 mRNA expression in hepatic and PM was significantly lower than that in the primary tumor. Cx43 mRNA and protein levels, as well as cell proliferation, migration, and invasion capabilities, were all significantly improved in MDA-MB-231 cells after reducing miR-206 expression but decreased in MCF-7 cells after elevating miR-206 expression, which demonstrated a significantly negative correlation between miR-206 and Cx43 expression (P = 0.03). MiR-206 can drastically decrease Cx43 expression of MCF-7 cells but exerts no effects on Cx43 expression in 293 cells transfected with the Cx43 coding region but the lack of Cx43-3’UTR, suggesting that Cx43-3’UTR may be the key in Cx43 regulated by miR-206. Luciferase expression showed that the inhibition efficiency was reduced by 46.80% in position 478–484 mutant, 16.72% in position 1609–1615 mutant; the inhibition was totally disappeared in double mutant (P = 0.02).

Conclusions:

MiR-206 can regulate the expression of Cx43, the cytobiological activity, and the metastasis of breast cancer through binding to the two binding sites in Cx43-3’UTR: position 478–484 and position 1609–1615.