Table of Content

20 February 2021, Volume 21 Issue 01

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Whole disease journey management in the diagnosis and treatment of pancreatic cancer

LOU Wen-hui

2021, 21(01):  1-5.  DOI: 10.3969/j.issn.1009-976X.2021.01.001

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The incidence of pancreatic cancer is increasing quickly, with dismal prognosis. In order to improve the long-term survival of pancreatic cancer, it is necessary to employ the disease-centered multidisciplinary model in the diagnosis and treatment. Via effective combination of multidisciplinary team to achieve the whole journey management of diagnosis, staging, precision medicine, rational operation, and supportive care. Improvement of long-term survival could be accomplished as new advances of multi-omics, tumor immunology, target therapy and chemo-radiation therapy.

Historical review and clinical application of nutrition screening and assessment tools

DONG Ming

2021, 21(01):  6-10.  DOI: 10.3969/j.issn.1009-976X.2021.01.002

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Nutritional therapy of perioperative patients in general surgery has great significance for enhancing the safety, recovery, reducing the complications of the surgery, and improving social benefits. This article introduces the history of nutritional screening and assessment tools, and then interpretates deeply their development background and indications, which conducts doctors to implement nutritional treatments on normalization.

Current status and clinical application of the prognostic scoring system for colorectal liver metastasis

ZHANG Guo, ZHANG Rui, CHEN Jin-hong

2021, 21(01):  11-16.  DOI: 10.3969/j.issn.1009-976X.2021.01.003

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Colorectal cancer is the second most common malignant tumor in China, and about 50% of patients will have liver metastases. Effective systemic treatment and active local treatment including surgery are the key to improving the efficacy of patients with colorectal liver metastasis. Recurrence after hepatectomy is the main cause of death in patients with colorectal liver metastasis. The treatment options for patients with different recurrence risks are also different. Therefore, it is very important to establish an effective prognostic scoring system for colorectal liver metastasis to guide its individualized treatment. Clinical Risk Score （CRS） is currently the most widely used prognostic scoring system for patients with colorectal liver metastasis. Other prognostic scoring systems include Tumor Burden Score （TBS）, Genetic And Morphological Evaluation （GAME） score, and Comprehensive Evaluation of Relapse Risk （CERR） score. The continuous improvement of the prognosis scoring system can better help clinicians predict the prognosis of patients with colorectal liver metastasis, and adopt more active intervention methods for high-risk patients to reasonably and effectively prolong the lives of patients.

Original Articles and Clinical Research

The clinical significance of SMC gene family in the diagnosis and prognosis of hepatocellular carcinoma

HUO Li-yun, WEI Ying-cheng, TAN Wen-liang, SHANG Chang-zhen, CHEN Ya-jin

2021, 21(01):  24-28.  DOI: 10.3969/j.issn.1009-976X.2021.01.005

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Objective To explore the relationship between SMCs and the progression of hepatocellular carcinoma （HCC） by bioinformatics analysis, and to explore the clinical significance of SMCs in the diagnosis and prognosis of HCC. Methods In this study, UALCAN and Human Protein Atlas datasets were used to analyze the expression of SMCs in hepatocellular carcinoma and normal liver tissues, as well as its transcriptional level in various stages of hepatocellular carcinoma. After that, we used the GEPIA database to explore the survival curves of SMCs in HCC patients. Results We found that SMCs were highly expressed in HCC tissues （tumor vs. normal, P value <0.0001）, and their transcriptional levels were also related to the tumor stages. The transcriptions of SMC1A, SMC1B, SMC2, SMC3, SMC4, SMC5 and SMC5 in stage 3 liver hepatocellular carcinoma were significantly higher than those in stage1 （stage 1 vs. stage3, P value <0.05）. The expression levels of SMC1A and SMC2 in stage 2 liver hepatocellular carcinoma were stimulated, comparing to their transcription levels in stage 1 （stage 1 vs. stage 2, P value <0.05）. In addition, the survival analysis showed that higher expression of SMC1A, SMC2, SMC3, SMC4 and SMC6 was significantly related to poorer prognosis （P value <0.05）. Conclusion SMCs were highly expressed in HCC tissues and were associated with tumor stages. SMC1A, SMC2, SMC3, SMC4 and SMC6 showed significant value in the diagnosis and prognosis of HCC.

Efficacy of postoperative anticoagulation therapy for venous thrombosis after hepatic resection

MA Ming-lei, YIN Yan-bei, ZHANG Hong-wei

2021, 21(01):  29-35.  DOI: 10.3969/j.issn.1009-976X.2021.01.006

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Objective To evaluate the effectiveness, safety and influencing factors of anticoagulant therapy in the prevention of venous thromboembolism after hepatectomy. Methods This is a prospective research method. The patients who were treated and underwent hepatectomy May 2018 to May 2020 were selected as research objects. The patients were divided into two groups： conventional group （n=96） and anticoagulant group （n=96）. The conventional group was treated with conventional treatment, and the anticoagulant group was treated with enoxaparin sodium on the basis of the conventional group. The incidence of venous thrombosis, bleeding rate, surgery-related indicators, postoperative complications, and coagulation function were observed and analyzed. Results There was no significant difference in baseline characteristics between two groups（P>0.05）. The incidence of VTE in the anticoagulation group and the routine group were 2.1% and 5.2% （P=0.441）. There was no significant difference in Hemorrhage,blood transfusion, infection, liver failure and the Clavien-Dindo classification between the two groups （P>0.05）. Compared with the conventional group, the drainage tube removal time and hospitalization time of the anticoagulant group were longer. There was no statisticallysignificant difference in the incidence of venous thrombosis between patients with hemostasis and patients without hemostasis in the conventional group （P>0.05）. Hypertension, operation time ≥3 h and intraoperative bleeding volume ≥400 mL are independent risk factors for hemorrhage after hepatectomy. There was no statistically significant difference in the levels of platelets and fibrinogen between two groups. The levels of INR, APTT and D-dimer in anticoagulation group were lower than those in conventional group. Conclusion Anticoagulant therapy after liver resection has a tendency to reduce the incidence of venous thrombosis and is safe and feasible.

Construction and functional verification of immortalized human pancreatic stellate cells

HAN Shi-ji, LIAN Guo-da, CHEN Shao-jie, HUANG Kai-hong, LI Jia-jia

2021, 21(01):  36-43.  DOI: 10.3969/j.issn.1009-976X.2021.01.007

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Objective To construct the human pancreatic stellate cell line immortalization and discuss their biological function. Methods We extracted human primary pancreatic stellate cells （hPSCs） by outgrowth and then infected the cells with SV40LT and hTERT genes using lentivirus infection. The cells （named imPSCs） with stable and high expression of SV40LT and hTERT genes were screened with puromycin. The next, qRT-PCR and Western Bolt methods were used to detect the expression levels of the two genes. CCK8 method, karyotype analysis and immunofluorescence method were conducted respectively to detect the growth curve, chromosome number, protein expression of α-SMA, collagen I and fibronectin of the imPSCs. We also performed tumor formation assay in vivo to detect whether the imPSCs had malignant phenotypic transformation. The tumorigenesis of imPSCs was detected by transwell cell co-culture, CCK8 methods, wound healing assay,migration and invasion methods. Results Human primary PSCs were polygonal and spindle shaped, and bright green fluorescence was observed under the microscope after successfully infected lentivirus. In imPSCs, SV40LT and hTERT genes were stably and highly expressed in mRNA and protein levels. The imPSCs had typed “S” growth curve and increased number of chromosomes, but they could not grow into tumors in vivo. The imPSCs showed high expression of α-SMA, collagen I and fibronectin, which had the biological functions and characteristics of PSCs. After co-culture of imPSCs and pancreatic cancer cells, tumor growth was significantly promoted. Conclusion After transfected with SV40LT and hTERT genes, an immortalized human pancreatic stellate cell line was successfully constructed, which could provide experimental materials and models for the study of pancreatic astrocytes themselves and the microenvironment of pancreatic cancer.

Expression and function of transcription factor YY1 in hepatocellular carcinoma

HUANG Yi-pei, LUO Wei-xin, XU Lei-bo

2021, 21(01):  44-52.  DOI: 10.3969/j.issn.1009-976X.2021.01.008

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Objective To investigate the function of transcription factor YY1 in the progression of hepatocellular carcinoma（HCC） and reveal the potential molecular mechanisms. Methods The expression of YY1 in HCC and its relationships with clinicopathological characteristics and prognosis were analyzed in TCGA, GEO and ICGC databases. Immunohistochemical experiments were used to detect the expression of YY1 in tumor and non-tumor tissues collected in our hospital. The effect of YY1 on the proliferation of HCC cells was studied by CCK-8 assay, Edu staining and clone formation experiments. The migration and invasion abilities of HCC cells were measured by Transwell assay. Gene set enrichment analysis, gene co-expression analysis and protein interaction network analysis were conducted to explore the potential molecular mechanism of YY1 function. Results Compared with non-tumor tissues, YY1 expressions were significantly up-regulated in HCC tissues in TCGA, GEO and ICGC databases. Higher YY1 expression indicated poorer survival outcome. Moreover, YY1 expression level was positively correlated with the tumor volume, tumor stage and tumor pathological grade in HCC patients. Immunochemistry assay verified YY1 was significantly up-regulated in tumor tissues in our HCC cohort. Further in vitro experiments found YY1 knockdown or overexpression can inhibit or promote the proliferation, migration and invasion abilities of HCC cells. Gene set enrichment analysis found that the tumor progression related-signaling pathways were significantly enriched in patients with high expression of YY1. Co-expressed gene and protein interaction network analysis indicated YY1 had a highly credible interaction network with FKBP3, RBBP7, H2AFV, H2AFZ, ACTL6A, PAXIP1, NCOA6, SUZ12. Conclusion YY1 was overexpressed in HCC and associated with poor prognosis. YY1 exerted an oncogene effect through promoting the proliferation, migration and invasion abilities of HCC cells and might be a potential drug therapy target for HCC patients.

FOLFIRINOX regimen versus AG regimen as first-line therapy in advanced pancreatic cancer： A multicenter observational study

YUAN Guan-ping, JIANG Zhi-min, MA Dong, PAN Zi-chun, DING Ying, XIE De-rong

2021, 21(01):  53-58.  DOI: 10.3969/j.issn.1009-976X.2021.01.009

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Objective We conducted a multicenter observational study comparing the FOLFIRINOX regimen and the AG regimen as the first-line treatment in advanced pancreatic cancer, and summarized experience to guide clinical practice. Methods Participants of this study were retrospectively recruited from the Guangdong Provincial People′s Hospital, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, the First Affiliated Hospital of Sun Yat-sen University, the First Affiliated Hospital of Guangdong Pharmaceutical University, and the Zhongshan People′s Hospital between January 2016 and June 2020. All these patients were diagnosed with advanced pancreatic cancer. They all received FOLFIRINOX regimen or AG regimen as the first-line treatment, and all had complete survival data. The last follow-up time was October 31, 2020. The primary endpoint was OS. The survival analysis was performed by the Kaplan-Meier method. A two-tailed P-value of less than 0.05 was considered as statistically significant. Results The five centers included a total of 62 patients who met the inclusion and exclusion criteria. According to the first-line chemotherapy regimen, 26 patients were included in the FOLFIRINOX （FFX） regimen group, and the remaining 36 patients were included in the AG regimen group. The median OS of the FFX regimen group and the AG regimen group were 13 months and 11 months, respectively （P=0.202）. And the median PFS were 10 months and 11 months the FFX regimen group and the AG regimen group, respectively（P=0.132）. There was no statistically significant difference in OS and PFS between the two groups. There were 5 patients receiving FFX regimen as the first-line treatment but AG regimen as the second-line, and 6 patients receiving AG regimen as the first-line treatment but FFX regimen as the second-line treatment. A total of 11 patients were included in the analysis. The median OS was 13 months and 11 months, respectively. When the CA199 level increased abnormally, especially 59 times higher than the normal value, the median OS of the AG group （10.21 months） was numerically longer than the FFX group （3.5 months）. Due to the lack of data, statistical analysis of Objective efficiency and adverse reactions was abandoned. Conclusion There were no significant differences in the efficacy between the FOLFIRINOX regimen group and the AG regimen group as the first-line treatment for advanced pancreatic cancer. It seemed that the order of medication didn′t affect the efficacy. The use of CA199 level to predict the efficacy of different treatments may be helpful, and it deserves further exploration.

Expression and significance of 8-Nitroguanine in intrahepatic cholangiocarcinoma with liver fluke infection

LIN Jie, LIU Qing-bo, HE Wei, MA Jing, CHEN Yun-hao, WANG Wei-dong

2021, 21(01):  59-62.  DOI: 10.3969/j.issn.1009-976X.2021.01.010

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Objective To study expression and significance of 8-Nitroguanine in intrahepatic cholangiocarcinoma with liver fluke infection. Methods Expression of 8-nitroguanine in 18 intrahepatic cholangiocarcinoma tissue was detected by enzyme-linked immunosorbent assay （ELISA）, including paracancerous tissue and normal liver tissue. Serum levels of 8-nitroguanine in intrahepatic cholangiocarcinoma patients preoperatively and 18 clonochiasis sinensis infected patients and 18 healthy volunteers were measured by ELISA. RBE cells were treated with different concentrations of 8-nitroguanine and the 50% inhibiting concentration （IC₅₀） was determined by MTT assay. Invasive ability of RBE cell treated with 8-nitroguanine was detected by Transwell assay. Results In 18 intrahepatic cholangiocarcinoma, 8-Nitroguanine levels were significantly higher in tumor tissues than in peritumoral tissues and in normal liver tissues （P<0.05）, and there was no difference between in paracancerous tissues and in normal liver tissues（P>0.05）. And 8-Nitroguanine levels in serum, there was no difference comparable between in intrahepatic cholangiocarcinoma patients preoperatively and clonochiasis sinensis infected patients and 18 healthy volunteers（P>0.05）. 8-Nitroguanine suppressed the proliferation of RBE cells in a dose-dependent manner, but has no effect on cell invasion （P>0.05）. Conclusions Overexpression of 8-Nitroguanine in intrahepatic cholangiocarcinoma with liver fluke infection may be involved in the oncogenesis of disease, instead of tumor progression.

The relationship between duodenal diverticulum and cholangiopancreatic diseases and its effect on ERCP

YAO Jin-ke, GUO Yan-qing, TANG Shuo-guo

2021, 21(01):  63-67.  DOI: 10.3969/j.issn.1009-976X.2021.01.011

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Objective To investigate the relationship between the incidence of duodenal papilla diverticulum and biliary and pancreatic diseases, and the influence on ERCP. Methods A total of 1203 patients, including 475 females and 728 males, underwent abdominal CT from July 1, 2020 to October 1, 2020 in Guangzhou Zengcheng District People′s Hospital. Among them, 23 patients with choledocholithiasis, cholangitis or biliary pancreatitis underwent ERCP. We observed the incidence of duodenal papillary diverticulum, the incidence of duodenal papillary diverticulum in patients with cholangiopancreatic diseases, the incidence of cholangiopancreatic diseases in patients with duodenal papillary diverticulum, and the success rate of ERCP in patients with duodenal papillary diverticulum. And we analyzed the relationship between duodenal diverticulum and cholangiopancreatic diseases and its influence on ERCP. Results The incidence of duodenal diverticulum was higher in women, P<0.05. The incidence of duodenal diverticulum was higher in patients over 40 years old, P<0.05. The incidence of extrahepatic bile duct stones, bile duct dilatation and pancreatitis were higher in patients with duodenal diverticulum than in patients without duodenal diverticulum, P<0.05. And the detection rate of duodenal diverticulum was higher in patients with extrahepatic bile duct stones, cholangitis and pancreatitis, P<0.05. ERCP intubation in duodenal diverticulum was difficult and the success rate was relatively low （P<0.05）. Conclusion Duodenal diverticulum has certain relationship with extrahepatic bile duct stones, cholangitis, pancreatitis and other diseases; ERCP intubation in duodenal diverticulum is difficult and the success rate is relatively low. Paying attention to and understanding of juxtapapillary duodenal diverticulum, preoperative imaging evaluation and mastering ERCP related skills are often helpful to improve the success rate of intubation with juxtapapillary duodenal diverticulum.

Two cases report of reoperation for pancreatic fistula complicated with hemorrhage after pancreatoduodenectomy and literature review

LIU Jun-hao, LUO Yu-rong, LI Hai-liang, LI Xiao-feng, GAO Peng, ZENG Xian-cheng

2021, 21(01):  68-73.  DOI: 10.3969/j.issn.1009-976X.2021.01.012

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Objective This article aim was to review the relaparotomy methods and to discuss the treatment scheme of severe pancreatic fistula with hemorrhage. Methods The diagnosis, treatment and relaparotomy process of two cases of grade C pancreatic fistula complicated withhemorrhage after pancreaticoduodenectomy were retrospectively analyzed, and the reoperation methods of pancreatic fistula complicated with hemorrhage after pancreaticoduodenectomy were reviewed. Results Two patients with grade C pancreatic fistula complicated with hemorrhage underwent the rescue resection. The first patient was found portal vein bleeding when explored the pancreaticointestinal anastomosis. After stopping bleeding, we underwent in-situ pancreaticojejunostomy. The first patient finally recovered. The second patient suffered from delayed hemorrhage and abdominal infection due to pancreatic fistula. No clear responsible blood vessels were found during the reoperation process. The blood vessels with high risk of bleeding were ligated during the relaparotomy, and the Pancreaticointestinal anastomosis was repaired. Eventually, the patient died of multiple systematic organ failure（MSOF）. Conclusion The treatment of pancreatic fistula complicated with. Hemorrhage after PD often requires multidisciplinary participation of interventional department, ICU and surgical department. Surgery still playthe important role in pancreatic fistula complicated with hemorrhage after PD.

Predictive value of lymphocyte subsets for efficacy of neoadjuvant chemotherapy in breast cancer

ZHONG Cui-yu, WANG Jia-wei, HUANG Kang-ling, YAO Yan-dan

2021, 21(01):  74-81.  DOI: 10.3969/j.issn.1009-976X.2021.01.013

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Objective Our study was designed to investigate the predictive value of lymphocyte subsets before treatment for the efficacy of neoadjuvant chemotherapy （NAC） in breast cancer. Methods A total of 109 breast cancer patients received NAC in Sun Yat-sen Memorial Hospital, Sun Yat-sen University from April 2016 to June 2020 were enrolled in this study. Chi-square test and logistics regression were used to analyze the correlation between the proportion of different lymphocyte subsets and pathological complete response （pCR）, and Kaplan-Meier curve was used to evaluate the correlation between the lymphocyte subsets and survival time. At the same time, the relationship between the changes of T cells or NK cells before and after chemotherapy and pCR was evaluated, and the infiltration of T cells and NK cells in tumor sites was detected by immunohistochemical method. Results Patients with T cells proportion >71.90% （P=0.044）, NK cells proportion >36.23% （P=0.049） or Ki67 proliferation index >62.5% （P=0.010） showed a higher pCR rate. However, only high NK cells proportion （95% CI： 0.014-0.736, P=0.024） and high Ki67 proliferation index （95% CI： 0.083~0.752, P=0.014） was predictive for pCR in multivariate analysis. Comparing the changes of NK cells before and after NAC in 83 patients, patients with increased NK cells were found more likely to obtain pCR （P=0.031）. In addition, patients with a higher T cells proportion showed more tumor-infiltrating T cells before treatment, and patients with a higher NK cells proportion showed more tumor-infiltrating NK cells after NAC. Conclusion Higher proportion of T cells or NK cells may indicate a better pathological therapeutic efficacy. In addition, the proportion of peripheral T cells and NK cells may also be related to the tumor-infiltrating T cells and NK cells.

Alisertib, an Aurora a Kinase inhibitor, induces autophagy of colorectal cancer cells and its relationship with p53 expression

REN Bao-jun, JU Yong-le, FENG Jing, CHEN Shu-xiang, LIU Jia-xuan, LUO Zhen-tao, WANG Jia-zhi, YANG Fan, LI De-zhi, DONG Bo-ye, GENG Yan

2021, 21(01):  82-86.  DOI: 10.3969/j.issn.1009-976X.2021.01.014

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Objective To explore the effect of Alisertib （ALS） on human colorectal cancer Caco-2 and HT29 cells in inducing autophagy and its relationship with the expression of p53. Methods In this study, human colorectal cancer Caco-2 and HT29 cells were used for experiments. The experimental groups were treated with 0.1, 1, and 5 μmol/L ALS and the control group was treated with the same concentration of DMSO. The autophagy rate of cells was detected by flow cytometry. The protein expression levels of key regulatory molecules in the process of cell autophagy were examined by wester blotting. Results Compared with the control group, the autophagy rate of Caco-2 cells in the 0.1 and 1 μmol/L Alisertib groups increased to 26.4% and 26.8% （P<0.01）. The autophagy rate of HT29 cells in the 1 and 5 μmol/L ALS groups increased to 36.8% and 42.6% （P<0.01）. Caco-2 cells did not express p53 protein, while HT29 cells expressed p53 protein. Compared with the control group, the ratio of p-PI3K/PI3K, p-Akt/Akt and p-p38/p38 in Caco-2 cells after treatment with 1, 5 μmol/L alisertib decreased to 62.6%, 45.2%, 30.1%, 38.2% and 49.0%, 30.4% （P<0.01）, while the ratio of LC3-II/LC3-I increased by 32.6%, 46.8% （P<0.01）. 1, 5 μmol/L Alisertib caused the p-PI3K/PI3K and p-Akt/Akt ratios of HT29 cells to decrease to 70.9%, 66.3% and 85.2%, 27.2% （P<0.01）, while the ratio of p38/p38 and LC3-Ⅱ/LC3-I increased by 2.1 times, 2.0 times and 78.5%, 84.8% （P<0.05）. Compared with the 5 μmol/L Alisertib group, 10 μmol/L SB202190+5 μmol/L Alisertib increased the apoptotic rate of HT29 cells by 64.7% （P<0.001）, while the apoptotic rate of Caco-2 cells did not change significantly. Conclusion Alisertib induces autophagy in Caco-2 and HT29 cells by inhibiting PI3K/Akt signaling pathway. Alisertib activates the p38 MAPK signaling pathway in HT29 but inhibits the p38 MAPK signaling pathway in Caco-2 cells, which may be related to the expresion of p53 protein.

Expression of HIF-1, CD68 and CD206 in gastric cancer and its clinical significance

ZHOU Tai-cheng, TANG Fu-xin, MA Ning, HUANG En-min, MA Tao, CHEN Jia-lin, CHEN Shuang

2021, 21(01):  87-90.  DOI: 10.3969/j.issn.1009-976X.2021.01.015

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Objective To analyze the expression of hypoxic-induced molecule-1 α（HIF-1α） and tumor-associated macrophages （TAM） related antigens CD68 and CD206 in gastric cancer and adjacent tissues. Methods Immunohistochemistry was used to detect the expression status of HIF-1α, CD68 and CD206 in 43 cases of gastric cancer and adjacent tissues, and the positive rate and number of positive cells of the three proteins were calculated to reveal their correlation with clinical factors. Results The positive expression rates of HIF-1, CD68 and CD206 were 58.1%, 69.8% and 51.2%, respectively, which were higher than that of adjacent tissues （P<0.05）. In gastric cancer and adjacent tissues, the number of CD68⁺ cells in each field was （39.7±7.6） and （8.5±2.8）, respectively; the number of CD206⁺ positive cells was （32.0±9.2） and （3.4±1.8）, respectively; the number of HIF-1α⁺ cells was （22.9±5.6） and （2.1±1.2）, respectively; the differences between groups were statistically significant （P<0.01）. The number of CD206⁺ cells in gastric cancer tissues was positively correlated with the expression of HIF-1α⁺ cells （P<0.01,R²=0.641）. The expression of the three proteins was related to pathological stage and lymph node metastasis（P<0.05）. Conclusion The expression rates and the number of positive cells of CD68, CD206 and HIF-1αin gastric cancer tissues were significantly increased, and CD206 was positively correlated with the expression of HIF-1α. The hypoxia area of gastric cancer has chemotaxis effect on M2 macrophages and promotes the occurrence and development of gastric cancer.

Clinicopathologic features and prognostic factors in young breast cancer： a retrospective study based on the SEER database

ZHANG Hua-yao, XU Shui-ying, LIN Si-yuan, ZHANG Li-hua, ZHANG Zhi-yuan, LIANG Bao-zhen, LIU Ying-sheng, LI Xiang-di

2021, 21(01):  91-95.  DOI: 10.3969/j.issn.1009-976X.2021.01.016

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Objective To investigate the clinicopathological characteristics and prognostic factors of breast cancer ≤35 years old. Methods 171,799 patients with breast cancer from the national cancer institute surveillance, epidemiology, and results database （SEER, 2004-2010） were divided into a young group （4157 patients） and a non-young group （167,642 patients） ≤35 years old or >35 years old, and the clinicopathological differences between the two groups were analyzed by using calcine assay. Breast cancer OS and USES the Kaplan Meier method to calculate the median survival time for survival analysis, use Log-Rank test, single factor analysis of the results of single factor analysis statistically significant factors in the COX proportional hazards regression model with multiple factors analysis, get the independent risk factors affecting the prognosis of patients with breast cancer and the prognosis of patients with breast young independent factors. Results Young group compared to the young group was statistically significant in the clinical pathologic factors include： 35 or > 35 years old or less, staging, histological grading, N staging, molecular classification, whether to buy health insurance, including age, stage, histological grade, N staging, molecular classification, whether to buy health insurance was anindependent factor influence breast cancer head. In KM survival analysis, log-rank test showed that statistically significant factors suggested that patients with breast cancer ≤35 years old had a worse prognosis than those with > and 35 years old. In patients with breast cancer ≤35 years old, staging, histological grading, N staging, molecular typing, and whether to purchase medical insurance were independent factors influencing the prognosis of breast cancer. Conclusion In breast cancer ≤35 years old, higher stage, higher histological grade, more lymph node metastasis, more triple negative breast cancer or HER2 positive breast cancer, and more patients did not buy medical insurance. Age ≤35 years is an independent risk factor affecting the prognosis of breast cancer patients. In patients with breast cancer ≤35 years old, staging, histological grade, N staging, molecular typing, and whether to purchase medical insurance were independent factors influencing the prognosis of breast cancer.

Application of pseudomonas aeruginosa-mannose sensitive hemagglutinin in treatment of simple breast cysts

LI Jun-da, ZHANG Jun-lin, LIN Qi-mou

2021, 21(01):  96-99.  DOI: 10.3969/j.issn.1009-976X.2021.01.017

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Objective To observe the efficacy of pseudomonas aeruginosa-mannose sensitive hemagglutinin （PA-MSHA） in the treatment of simple breast cysts, and to investigate the value of piliated pseudomonas aeruginosa in treating simple breast cysts. Methods 120 cases were divided into 3 groups, each group contained 40 cases. Cases in group A, B and C were treated with ultrasound guided suction combined with injection of PA-MSHA, ethanol and hypertonic sugar, respectively. Adverse effects of each group were observed and recorded. All cases were followed-up for about 24 months. The curative effect and side-effects of treatment were compared between the three groups. Results All cases have completed these treatments successfully. 113 patients were followed-up for about 24 months, while 7 cases were lost. There was no statistical significance difference between the three groups comparing the curative effect （P > 0.10）. Adverse effects were observed in all groups during treatment. The rate of adverse effects of group A was lower than group B and C. There was statistical significance difference between group A and the other two groups （P < 0.016）. Conclusion The ultrasound guided suction combined with injection of pseudomonas aeruginosa-mannose sensitive hemagglutinin has a prominent effect in the treatment of simple breast cysts and the adverse events are rare. The application of pseudomonas aeruginosa-mannose sensitive hemagglutinin in the treatment of simple breast cysts is valuable.

Application of self-made “hat brim” trocar in transoral endoscopic thyroidectomy vestibular approach

LIANG Wen-feng, TANG Zhi-ping, SU Yuan-hang, ZHOU Jian-ping

2021, 21(01):  100-103.  DOI: 10.3969/j.issn.1009-976X.2021.01.018

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Objective To explore the application of “hat brim trocar” in transoral endoscopic thyroidectomy vestibular approach （TOETVA）. Methods A total of 126 cases of TOETVA in our hospital from July 2019 to December 2020 were included in the study, in which 78 cases used self-made trocar （observation group） for creating a working space while 48 cases used the common suspension method （control group）. The time of the working cavity creation, bleeding volume and surgical results were compared. Results All operations were not transferred to open surgery. The self-made trocar group used 3 mmHg carbon dioxide low pressure, 10 mL/min low airflow, and the intraoperative space was all exposed. The auxiliary suspension method uses 6 mmHg, 20 ml/min air flow, and the working cavity creation time was longer than that of the Trocar group compared. There was no statistical differences in blood loss surgical complications, carbon dioxide partial pressure trocar group is better than suspension group. Conclusion The self-made trocar reduced the time of working space construction and operation steps, and reduce carbon dioxide accumulation.

Primary angiosarcoma of the breast： a case report and literature review

KONG Heng, CHEN Ji-xin

2021, 21(01):  104-107.  DOI: 10.3969/j.issn.1009-976X.2021.01.019

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Primary angiosarcoma of the breast is rare, accounting for only 0.04% of all breast tumors. In this paper, we report a case of primary angiosarcoma of the breast that was misdiagnosed by ultrasonicexamination at the first diagnosis. This article will review the relevant literature, mainly pointing out the limitations of ultrasound in the diagnosis of breast angiosarcoma and the necessity of other imaging methods in the diagnosis of breast angiosarcoma.

Staged interventional therapy for coarctation of aorta with the right subclavian artery： a case report

LIU Cong-yong, LIU Yu-qiang, ZHANG Lu, YANG Yan-qi

2021, 21(01):  108-111.  DOI: 10.3969/j.issn.1009-976X.2021.01.020

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Aortic coarctation refers to aortic stenosis, luminal narrowing, resulting in reduced blood flow. Aortic coarctation may be seen in isolation or with two-leaf aortic valve, ventricular septal defect, patent ductus arteriosus, aortic transposition and other lesions.This article reports a case of aortic coarctation with the right subclavian artery and descending aortic aneurysm, the application of custom Armada 35 balloon dilatation catheter and stent graft treatment, in order to improve the clinician awareness of aortic coarctation and make a reasonable choice of treatment.

Clinical study on the application value of R.E.N.A.L., PADUA and C-index nephrometry scores in partial nephrectomy

LI Fa-jiang, CHEN Shuai, HUANG Hong-xing, ZHENG Yi-qun, LI Wei, SHI Ying-jiang, LIAN Wen-qing

2021, 21(01):  112-116.  DOI: 10.3969/j.issn.1009-976X.2021.01.021

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Objective To investigate the application value of R.E.N.A.L., PADUA and C-index nephrometry systems in partial nephrectomy. Methods The clinical data of 134 patients underwent PN between January 2013 and June 2020 were analyzed retrospectively. Abdominopelvic computerized tomography or magnetic resonance imaging was used to obtain R.E.N.A.L., PAUDA and C-index. The correlations between nephrometries and perioperative parameters （warm ischemia time, estimated blood loss, operating time, elevated serum creatinine values and length of hospital stay） were evaluated. Results Sixty-one and seventy-three patients underwent open and laparoscopic partial nephrectomy, respectively. Spearman correlation analysis showed that three nephrometries were correlated with each other. The strongest correlations were between R.E.N.A.L. and PADUA （correlation coefficient： 0.749, P<0.001）, followed by C-Index and PADUA （correlation coefficient：-0.266, P=0.002）. R.E.N.A.L. and PADUA groups were significantly correlated with hot ischemia time and estimated blood loss, but not with operation time, creatinine elevation and length of hospital stay. The C-index score grouping was not only correlated with hot ischemia time and estimated blood loss, but also had significant positive correlation with operation time, and the correlation coefficient was higher than other two nephrometry systems. The C-index score was not also significantly correlated with creatinine elevation and length of hospital stay. Conclusion All the three nephrometry systems can evaluate the complexity of surgery and related risks. C-index system is superior to R.E.N.A.L. and PADUA.

Replantation of the remaining part of articular cartilage treating partial interphalangeal cartilage defect

LONG Wen-hao, LAN Ying, FENG Fan, WANG Wei-ming, SU Yi-xuan

2021, 21(01):  117-119.  DOI: 10.3969/j.issn.1009-976X.2021.01.022

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Objective To investigate the clinical effect of replantation of the remaining part of articular cartilage treating partial interphalangeal cartilage defect. Methods From 2010 June to 2019 August, 16 cases （16 interphalangeal joints） with partial articular cartilage defects, were reviewed and analyzed. And then, 5 were proximal interphalangeal joints and 11 were distal interphalangeal joints. All cases were treated by removing the retained cartilage （the proportion reached at least half the articular facet） and then replanting it. After the surgeries, the stability, the appearance, the joint function were evaluated. Results 16 patients were followed 12 to 60 months （mean 36 months）. No cartilage necrosis was found. The lateral angulation deformities were corrected. The stiffness of the joints and the contracture of the soft tissue were alleviated. The range of motion of the proximal interphalangeal joints was ranged from 60 degrees to 90 degrees, while the distal interphalangeal joints from 40 degrees to 80 degrees. According to the Criteria of Upper Limb Function Evaluation by Chinese Society of Hand Surgery, the cases were ranked excellent 10 cases, good 3 cases, fair 3 cases, the excellent/good rate reached 81.25%. Conclusion Replantation of the remaining part of articular cartilage treating partial interphalangeal cartilage defect can achieve favorable clinical results.

Quadratus lumborum block for postoperative analgesia in puerperae undergoing cesarean section：A systematic review and meta-analysis

LIU Jian, YANG Tong, YIN Qing

2021, 21(01):  120-125.  DOI: 10.3969/j.issn.1009-976X.2021.01.023

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Objective To systematically evaluate the effect of quadratus lumborum block （QLB） on the postoperative analgesia in puerperae undergoing cesarean section. Methods Databases including PubMed, The Cochrane Library, Embase, CBM, Wanfang Data, CNKI, VIP were searched to collect randomized controlled trials （RCTs） about QLB on the postoperative analgesia in puerperae undergoing cesarean section from inception to February 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 10 RCTs studies involving 666 patients were included. The results of meta-analysis showed that, compared with the control group, QLB could reduce the 24-hour opioid requirements （SMD=-1.63, 95%CI： -2.06, -1.20, P<0.00001）, lower the 24-hour PCA demands （SMD=-2.01, 95%CI： -2.35, -1.68, P<0.00001）, and there was no increase in the incidence of opioid-related complications. Several studies reported that QLB on the VAS score at rest and during movement at 24-hour, but quantitative analysis was not possible due to high heterogeneity, and we had conducted only a descriptive analysis of these results. Conclusion The use of QLB for postoperative analgesia in puerperae undergoing cesarean section could reduce the requirements of opioid analgesics, lower the 24-hour PCA demands. It has a widely prospect in the application of multimode analgesia in patients.

Comparison of interventional thrombectomy and anticoagulation for acute deep vein thrombosis of the lower extremity

XING Yue, XU Guo-jian, ZHU Zheng-rong, ZOU Lan, XU Yi-ding, LIANG Xiao-xia, ZHANG Hui-ping, TAN Yan-hong, LUO Can-hua.

2021, 21(01):  126-129.  DOI: 10.3969/j.issn.1009-976X.2021.01.024

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Objective To investigate the clinical efficacy on treatment of lower extremity deep venous thrombosis with thrombolysis combined with iliofemoral vein stenting and anticoagulation. Methods The data of 79 cases were analyzed from June 2016 to January 2019. And the patients were divided into operation group and anticoagulation group according to different treatment methods. The short-term and long-term treatment effect, and stent patency were compared and analyzed. Result There were 31 patients in the operation group and 48 patients in the anticoagulation group. The average decrease of the circumference of the 10 cm below the patella in the operation group was （4.83±1.26） cm, and that in the anticoagulation group was （2.75±0.82） cm, and the difference was statistically significant. At average of 18 months′ follow-up, the incidence of PTS in the operation group was 25.8% compared with 57.8% in control group（P=0.004）. The overall primary patency of stent was 80.6%. The average onset time of the operation group was 5.2 days, while the average villalta score was 6.5. The pearson correlation analysis showed that the onset time was positively correlated with Villalta score, indicating that the earlier the thrombus was treated the better outcome would be concluded. Conclusion CDT combined with stenting is a safe and effective method for the treatment of acute deep venous thrombosis of lower extremities, and the incidence of post thrombotic syndrome is low.

Analysis of the clinical effect of bag correction of infusion port in the treatment of exposure of infusion port

GUAN Yu-ting, HUANG Li, CHEN Jian-ping, ZHANG Zhan-shang, ZENG Guo-bin

2021, 21(01):  130-133.  DOI: 10.3969/j.issn.1009-976X.2021.01.025

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Objective To investigate the effectiveness and feasibility of Pocket correction of infusion port in treating exposure of injection site in transfusion port. Methods From May 2018 to June 2019, 896 patients with venous infusion port implantation in our hospital were selected. Among them, 12 patients underwent bag correction due to exposure of injection seat. Analyse the causes of exposure, and observed the use of infusion port after bag correction. Results All the 12 patients were able to use the port of infusion after the procedure, no infection occurred and the port of injection was exposed again. Conclusion Port pocket correction is an effective treatment for patients with mild exposure of port injection site without port infection. It can avoid re-establishment of venous access, reduce financial burden and reduce trauma.