Modified load sharing rip-stop technique in patients with traumatic transtendinous rotator cuff tear: Surgical technique and clinical outcomes

BackgroundTranstendinous rotator cuff tear is likely to occur due to trauma in sports activities, with a frequency of <2% of total rotator cuff tears. These tears are difficult to treat because of limited tendon tissue in the proximal stump, and standard repair techniques are sometimes ineffective. Few studies have reported on the repair technique and clinical outcomes for transtendinous rotator cuff tear, and an appropriate repair technique has, therefore, not been established. The purpose of this study was to use our modified load sharing rip-stop technique to repair transtendinous rotator cuff tear and to clarify the clinical effectiveness of this technique.MethodsThis was a retrospective case series review of eight patients who underwent the modified load sharing rip-stop technique for repairing traumatic transtendinous rotator cuff tear between January 2013 and June 2017. The eight patients were followed up for at least 2 years (range: 24–41 months). Cuff integrity was evaluated using magnetic resonance imaging at 12 months after surgery using the Sugaya classification. We evaluated the pre- and postoperative ranges of motion, American Shoulder and Elbow Surgeons score, Constant Shoulder Score, and muscle strength at 90° abduction. Data were analyzed using the Mann–Whitney U test and Fisher's exact tests. P < .05 was considered to indicate statistical significance.ResultsSix patients were classified as Sugaya I and two as Sugaya II. ASES score (38.5–90.2, P = .0008), Constant shoulder score (36.5–79, P = .002), flexion (85°–158.1°, P = .002), abduction (85°–157.5°, P = .001), external rotation (38.8°–55°, P = .024), and muscle strength at 90° abduction (2.95–5.39 kg, P = .028) improved significantly. Six patients were able to return to their previous sports activity.ConclusionUsing our modified load sharing rip-stop technique for repair of transtendinous rotator cuff tear, patients obtained good clinical outcomes and could return to sports activities.     

Cost-effectiveness of postmastectomy hypofractionated radiation therapy vs conventional fractionated radiation therapy for high-risk breast cancer

BackgroundThe phase 3 NCT00793962 trial demonstrated that postmastectomy hypofractionated radiation therapy (HFRT) was noninferior to conventional fractionated radiation therapy (CFRT) in patients with high-risk breast cancer. This study assessed the cost-effectiveness of postmastectomy HFRT vs CFRT based on the NCT00793962 trial.MethodsA Markov model was adopted to synthesize the medical costs and health benefits of patients with high-risk breast cancer based on data from the NCT00793962 trial. Main outcomes were discounted lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). We employed a time-dependent horizon from Chinese, French and USA payer perspectives. Model robustness was evaluated with one-way and probabilistic sensitivity analyses.ResultsPatients receiving CFRT versus HFRT gained an incremental 0.0163 QALYs, 0.0118 QALYs and 0.0028 QALYs; meanwhile an incremental cost of $2351.92, $4978.34 and $8812.70 from Chinese, French and USA payer perspectives, respectively. Thus CFRT versus HFRT yielded an ICER of $144,281.47, $420,636.10 and $3,187,955.76 per QALY from Chinese, French and USA payer perspectives, respectively. HFRT could maintain a trend of >50% probabilities of cost-effectiveness below a willingness-to-pay (WTP) of $178,882.00 in China, while HFRT was dominant relative to CFRT, regardless of the WTP values in France and the USA. Sensitivity analyses indicated that the ICERs were most sensitive to the parameters of overall survival after radiotherapy.ConclusionsPostmastectomy HFRT could be used as a cost-effective substitute for CFRT in patients with high-risk breast cancer and should be considered in appropriately selected patients.     

Incidence,risk factors and survival of patients with brain metastases at initial metastatic breast cancer diagnosis in China

PurposeTo characterize the incidence, risk factors and survival of patients with brain metastases at initial diagnosis of metastatic breast cancer (MBC) in China.MethodsThe China National Cancer Center database was used to identify 2087 MBC patients diagnosed between 2003 and 2015. Clinicopathological features, treatment and survival information were extracted. Multivariable logistic and Cox regression were performed to determine factors predictive of brain metastases at MBC diagnosis and survival, respectively.ResultsBrain metastases occurred in ninety patients (4.3%) at MBC diagnosis, and in 27 patients (2.5%), 42 patients (7.2%) and 21 patients (5.2%) with hormone receptor positive, human epidermal growth factor receptor 2 negative (HR + HER2-), HER2-positive and triple negative breast cancer (TNBC), respectively. HER2-positive subtype (OR = 2.38; 95% CI 1.40–4.04; p < 0.0001), TNBC subtype (OR = 1.89; 95% CI 1.02–3.51; p = 0.005), and metastases to all three sites of bone, liver and lungs (OR = 3.23; 95% CI 1.52–6.87; p = 0.002) were shown to increase the risk of BM at MBC diagnosis. Median survival after BM was 23.7 months. First-line tyrosine kinase inhibitors (TKI) improved survival compared to trastuzumab-based regimen (44.9 vs 35.4 months, p = 0.09). Factors that independently decreased BM death risk were ECOG<2, brain metastases only and multidisciplinary treatment.ConclusionHER2-positive and TNBC subtypes have a higher incidence of BM at initial MBC diagnosis. Brain screening might be considered in patients with HER2-positive disease at MBC diagnosis, and further prospective randomized study is warranted.     

The impact of different doses of antithymocyte globulin conditioning on immune reconstitution upon hematopoietic stem cell transplantation

IntroductionAnti-thymocyte globulin (ATG) is used prior to allogeneic hematopoietic stem cell transplantation (allo-HSCT) for graft-versus-host disease (GVHD) prophylaxis. Two different ATG doses (7.5 or 10 mg/kg) were evaluated in comparison with a group without ATG therapy.MethodsWe retrospectively analyzed 132 patients who were transplanted with HSCT without ATG (non-ATG), or who received 7.5 mg/kg ATG (ATG-7.5) or 10 mg/kg ATG (ATG-10) prior to transplantation. The immune cells (CD3⁺CD4⁺ T cells, CD3⁺CD8⁺ T cells, CD19⁺ B cells and CD16⁺CD56⁺ NK cells) were examined in peripheral blood every three months post-HSCT for 12 months.ResultsCompared with non-ATG group, combined ATG-7.5/ATG-10 groups had significantly lower CD3⁺CD4⁺ T cells and higher CD3⁺CD8⁺ T cells at 3, 6, 9, 12 months post-HSCT; thus, displaying a lower CD4/CD8 ratio in the ATG groups compared to non-ATG group. The ratio of CD19⁺ B cells was statistically lower (at 3rd month, p = .014; at 6th month, p = .025) in combined ATG-7.5/ATG-10 groups at 3 and 6 months post-HSCT, but not at 9 and 12 months after HSCT. The ratios of CD3⁺CD4⁺ T cells, CD3⁺CD8⁺ T cells, CD19⁺ B cells and CD16⁺CD56⁺ NK cells were similar between the ATG-7.5 and ATG-10 groups at all examined time points. The overall survival (OS), progression-free survival (PFS), relapse and acute GVHD (aGVHD) were comparable among recipients without ATG therapy and with ATG-7.5 or/and ATG-10 therapies. Multivariate analysis revealed that immune cells ratios were not independent factors affecting prognosis.ConclusionThe ATG therapy at higher and lower doses led to a delayed reconstitution of T cells and the inversion of CD4/CD8 ratio for at least one year after HSCT.     

68Ga-PSMA PET/CT在前列腺癌术前诊断及手术策略制订中的应用

目的评估⁶⁸Ga标记的前列腺特异性膜抗原(⁶⁸Ga-PSMA)PET/CT对前列腺癌的诊断效能,并探讨⁶⁸Ga-PSMA PET/CT对术前制订保留血管神经束(NVB)和淋巴结清扫策略的指导作用。方法回顾性分析2018年6月至2019年10月中国医学科学院肿瘤医院行⁶⁸Ga-PSMA PET/CT检查的46例初诊疑似前列腺癌患者的临床资料。中位年龄66.50(60.00,69.25)岁,中位前列腺特异性抗原(PSA)值15.97(8.58,33.10)ng/ml。46例中,41例⁶⁸Ga-PSMA PET/CT检查诊断为肿瘤,6例诊断有淋巴结转移;5例诊断为前列腺增生或前列腺炎。46例中40例同期行mpMRI检查,33例诊断为肿瘤,6例诊断有淋巴结转移;46例中17例同期行^11C-胆碱PET/CT检查,12例诊断为肿瘤,4例诊断有淋巴结转移。41例PSMA-PET/CT诊断为前列腺癌的患者中,高危22例,中危19例;其中37例行mpMRI检查,15例行^11C-胆碱PET/CT检查。41例均行根治性前列腺切除术。根据⁶⁸Ga-PSMA PET/CT显示的肿瘤位置,术前制订NVB处理策略:若肿瘤邻近前列腺单侧包膜,则保留健侧的NVB;若肿瘤局限于前列腺内,则保留双侧NVB。共16例保留了NVB(单侧6例,双侧10例)。对中高危组患者常规行淋巴结清扫。采用配对χ²检验或Fisher精确检验比较⁶⁸Ga-PSMA PET/CT、mpMRI、^11C-胆碱PET/CT对病灶检出的敏感性和特异性。采用Spearman相关分析检测⁶⁸Ga-PSMA PET/CT的SUV_max值与Gleason评分和治疗前PSA值的相关性。结果 41例行根治术患者术后病理确诊为前列腺癌,手术切缘均未见癌组织;中位Gleason评分8(7,9)分;病理分期20例≤pT_2c期,21例≥pT₃期;7例淋巴结阳性(11枚阳性淋巴结)。术后30 d内7例(17.1%)发生并发症,Clavien-Dindo分级均≤2级。41例术后随访中位时间16(12,20)个月,术后1、6、12个月分别有19例(46.3%)、39例(95.1%)、41例(100.0%)恢复控尿。5例未行手术的患者中,4例行抗生素治疗后PSA下降;1例PSA未下降者行穿刺活检,病理未见癌。⁶⁸Ga-PSMA PET/CT诊断前列腺癌的敏感性为100.0%(41/41),显著优于^11C-胆碱PET/CT[80.0%(12/15),P=0.016]和mpMRI[83.7%(31/37),P=0.009];特异性为100.0%(5/5),与^11C-胆碱PET/CT[100.0%(2/2),P=1.000]和mpMRI [33.3%(1/3),P=0.107]的差异均无统计学意义。41例中,⁶⁸Ga-PSMA PET/CT诊断淋巴结转移的敏感性[71.4%(5/7)]与^11C-胆碱PET/CT的差异无统计学意义[75.0%(3/4),P=1.000],与mpMRI的差异有统计学意义[16.7%(1/6),P=0.016]。Gleason评分≥8分与<8分患者⁶⁸Ga-PSMA PET/CT的原发灶SUV_max值分别为19.60(9.58,24.38)与8.55(5.18,12.88);治疗前PSA值≥20 ng/ml与<20 ng/ml患者的SUV_max值分别为19.40(13.00,23.5)与8.40(5.35,13.95),差异均有统计学意义(P<0.05)。结论 ⁶⁸Ga-PSMA PET/CT对前列腺癌原发病灶诊断的敏感性高、特异性高,术前可根据PSMA PET/CT显示的肿瘤位置,制订是否保留NVB的处理策略;但其对淋巴结转移灶诊断的敏感性还不足以指导术前制订淋巴结清扫策略。     

完全腹腔镜根治性膀胱切除加体内改良回肠通道术的学习效果分析

目的分析术者对完全腹腔镜根治性膀胱切除(LRC)+改良回肠通道术(MIC)的学习效果。方法回顾性分析首都医科大学附属北京朝阳医院2014年4月至2019年10月42例接受完全LRC+MIC患者的临床资料。男34例,女8例;年龄(63.4±9.1)岁。其中术者1行34例手术,术者2行8例。将术者1的34例按时间顺序分为3组,第1~12例为A组,第13~23例为B组,第24~34例为C组;术者2实施的8例为D组。4组中有腹部手术史者分别为0、1、4、3例,差异有统计学意义(P<0.05);4组年龄、体质指数、美国麻醉医师协会评分等差异均无统计学意义(P>0.05)。改良术式的重要步骤包括光源透射下离断肠系膜、输出袢固定的条件下行输尿管-输出袢反流性对端吻合、缝合后腹膜缺口。比较各组患者手术时间、构建回肠通道时间、出血量、并发症发生比例、淋巴结清扫数量、切缘阳性比例等重要手术指标。结果各组手术均顺利完成,均无中转开放手术。A~C组手术时间分别为330.0(320.0,360.0)、300.0(250.0,308.0)、270.0(216.0,324.0)min,差异有统计学意义(P=0.010);3组构建回肠通道时间分别为136.5(131.3,147.5)、92.0(79.0,119.0)、79.0(72.0,115.0)min,差异有统计学意义(P<0.001)。手术时间和构建回肠通道时间组间两两比较,A、B组,A、C组差异均有统计学意义(P<0.05),B、C组差异无统计学意义(P>0.05)。3组出血量[200.0(125.0,300.0)、100.0(100.0,150.0)、200.0(100.0,400.0)ml]、并发症发生比例[4/12、4/11、3/11]、淋巴结清扫数量[(19.0±10.7)、(16.0±9.8)、(23.3±8.5)枚]、切缘阳性比例(1/12、1/11、2/11)的比较,差异均无统计学意义(P>0.05)。D组手术时间420.0(350.0,450.0)min,与A组比较差异有统计学意义(P<0.05)。D组出血量200.0(112.5,350.0)ml,并发症发生比例2/8,淋巴结清扫数量(13.8±7.1)个,切缘阳性比例1/8,与A组比较差异均无统计学意义(P>0.05)。结论完全LRC+MIC学习效果明显,随着手术例数的增加,手术时间及构建回肠通道时间显著下降;该术式具有较好的可重复性和安全性。     

药用植物金荞麦中黄酮类化合物积累的时空变化规律

目的 探究药用植物金荞麦不同生育期各器官中黄酮类化合物积累的时空分布规律,为金荞麦合理采收、资源化利用和高价值开发提供科学依据。方法 以根茎繁殖不同生长年限的金荞麦为研究对象,在不同生育时期采集根、茎、叶、花器官,采用高效液相色谱法测定各器官样品中儿茶素、表儿茶素、芦丁和总黄酮含量。结果 随着金荞麦生育期推进,植株不同器官的黄酮类化合物积累增加,以秋季地上部分枯萎后的含量最高;不同生育时期叶片中的儿茶素、表儿茶素、芦丁和总黄酮含量均显著高于根茎和茎秆（P<0.05）。不同器官间儿茶素、表儿茶素、芦丁和总黄酮含量差异有统计学意义（P<0.05）,花中儿茶素、芦丁和总黄酮含量最高;表儿茶素含量在茎秆中最低。黄酮类物质含量在根茎不同部位差异有统计学意义（P<0.05）,表儿茶素和总黄酮含量在根茎不同组织部位表现为须根>韧皮部>根茎（不含须根）>木质部（P<0.05）,儿茶素和芦丁分别在须根和韧皮部含量最高。1年生与2年生金荞麦植株不同器官的黄酮类化合物含量差异无统计学意义。结论 在不考虑产量的前提下,根茎繁殖金荞麦种植1年即可采收,适宜采收期为11月上旬。     

当归抽薹开花过程中赤霉素代谢水平及其关键酶基因克隆与表达分析

目的 对当归Angelica sinensis 16个赤霉素（gibberellins,GAs）进行含量测定、GAs代谢酶基因筛选并进行生物信息学分析、关键基因克隆及表达验证,以期为调控当归抽薹开花提供理论依据。方法 利用HPLC-MS/MS对不同材料中GAs含量进行测定与分析,基于当归全长转录组筛选直接参与GAs代谢酶基因,利用在线工具进行生物信息学分析,并对关键酶基因GA2ox6和GA20ox1表达水平进行q RT-PCR检测。结果 在所测定的16个GAs中,8个GAs含量在早薹植株中高于非早薹植株,13个GAs含量随植株发育时期延长逐渐增加。当归全长转录组中含有9个直接参与GAs代谢的酶基因,可分为6个亚家族,共含有6个保守基序,亚细胞定位于细胞质。GA2ox6和GA20ox1基因克隆片段由于插入序列与全长转录组测序片段存在长度差异。GA2ox6基因在抽薹植株、随种苗春化作用和植株发育时期延长呈现低表达,而在冷冻规避春化作用种苗中呈现高表达,GA20ox1基因则相反;GA2ox6和GA20ox1基因在叶和茎中相对于根均呈现高表达。结论 当归含有9个直接参与GAs代谢的酶基因,各成...     

霍山石斛多糖的结构分析、生物活性研究进展及与不同种间多糖成分差异性分析

霍山石斛Dendrobium huoshanense作为一种名贵的滋补类中药,收载于《中国药典》2020年版。多糖为其主要活性成分之一,具有免疫调节、保肝、抗肿瘤、抗氧化和抗炎等药理活性。通过查阅国内外文献,基于中国知网及PubMed等中英文文献数据库分析当前研究现状及研究热点;总结霍山石斛多糖（Dendrobium huoshanense polysaccharide,DHP）的提取分离、结构解析及其生物活性;分析其多糖成分与其他常用石斛品种的差异性。以期更好地开发利用DHP,为DHP产品的深入开发与研究及质量标准完善提供参考和思路。