Table of Content

20 August 2021, Volume 21 Issue 04

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The controversies and hotspots of lymph node dissection for intrahepatic cholangiocarcinoma

LIN Zhi-wen, LIU Hong-zhi, ZENG Yong-yi

2021, 21(04):  377-382.  DOI: 10.3969/j.issn.1009-976X.2021.04.001

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Intrahepatic cholangiocarcinoma is a highly invasive malignant tumor. In recent years, the incidence has been increasing every year, and radical resection is considered as the only effective way to cure ICC. Lymph node metastasis is an important prognostic risk factor for ICC. In the radical resection of intrahepatic cholangiocarcinoma, the issue of lymph node dissection remains controversial, in which whether lymph node dissection, the way and extent of lymph node dissection, as well as the significance and value of lymph node dissection are the focus of the current research. In this paper, the hotspots and controversies of lymph node dissection for intrahepatic cholangiocarcinoma were discussed.

Progress in precise diagnosis and treatment of thyroid tumors

ZHANG Cheng, LUO Ding-yuan, LI Hong-hao

2021, 21(04):  383-386.  DOI: 10.3969/j.issn.1009-976X.2021.04.002

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The precise diagnosis and treatment of thyroid tumors has made great progress recent years, involving many precise diagnostic techniques on cellular and molecular levels of thyroid tumors,andvarious emerging treatment methods based on precise diagnosis. This article will try to review the progress of precise diagnosis and treatment of thyroid tumors from the above aspects.

High cost and frequent adverse events： the future of Cabozantinib for the first-line treatment of metastatic renal cell carcinoma

YANG Jing-ying, XIE Ying-wei, ZHU Ding-jun, XIE Wen-lian

2021, 21(04):  387-391.  DOI: 10.3969/j.issn.1009-976X.2021.04.003

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The drug treatment of metastatic renal cell carcinoma is the focus at present. The 2020 edition of EAU guidelines of renal cell carcinoma recognizes the role of Cabozantinib for the first time and lists it as the first-line treatment for patients who cannot accept immune checkpoint inhibition treatment. This paper will elaborate the treatment mechanism, treatment scheme, treatment effect, adverse events and treatment cost of Cabozantinib, and analyze the advantages and disadvantages of Cabozantinib in detail. It will also compare Cabozantinib with sunitinib, and further explore the prospect of Cabozantinib for metastatic renal cell carcinoma.

Surgical Procedure Explanation

How to identify intrahepatic anatomical structure by laparoscopic ultrasound

WANG Peng, WANG Hong-guang

2021, 21(04):  392-396.  DOI: 10.3969/j.issn.1009-976X.2021.04.004

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Objective To introduce how to identify intrahepatic anatomical structure by laparoscopic ultrasound （LUS）. Methods In one case of laparoscopic hepatectomy, using LUS to complete liver map scanning through different Trocars was performed and its imaging was collected. Results Several standard imaging of intrahepatic anatomical structure were obtained by axial rotation scanning of LUS： ①Right hepatic pedicle, right hepatic vein and middle hepatic vein were scanned by LUS through a subxiphoid Trocar. The right hepatic pedicle branched out into AT and PP, and then branched out into P5, P8 and P6, P7; V5d, V6, V8d and AFV flowed into the right hepatic vein successively, while V4, V5v and V8v flowed into the middle hepatic vein. ②Left hepatic pedicle, left hepatic vein, and middle hepatic vein were scanned by LUS through a trocar under the right costal margin. The left hepatic pedicle branched out into P2, P3, P4, V2, V3 flowed into left hepatic vein, and inferior vena cava and the vertical axis of middle hepatic vein were also scanned from this way. Conclusion The “standard imaging” of LUS in liver scaning is very helpful to identify the intrahepatic anatomical structure correctly. Surgeons must master the essential technique of LUS in liver scaning, which needs in-depth study and repetition training. After that, LUS would play a guiding role in laparoscopic hepatectomy.

Original Articles and Clinical Research

Analysis of TACE on prevention of postoperative recurrence in patient with hepatocellular carcinoma

WU Juan-hua, TAN Hui-min, ZUO Chao-hai, KUANG Nai-le, YU Jie-xiong, CHEN Yun-yang.

2021, 21(04):  397-404.  DOI: 10.3969/j.issn.1009-976X.2021.04.005

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Objective To evaluate the effect of transarterial chemoembolization （TACE）on prevention of postoperative recurrence in patient with hepatocellular carcinoma （HCC）, and screen for the potential beneficiaries. Methods A total of 205 HCC patients underwent radical surgery between January 2014 and November 2018 were enrolled in the study. Patients were divided into subgroups, based on whether receiving TACE, time on receiving TACE, and clinical characteristics, to analyze the differences of recurrence-free survival （RFS）. Results TACE did not prolong RFS in patients with HCC（P>0.05）, but postoperative TACE could mildly reduce the 1- and 2-year recurrence rate in tumor >5 cm, Alpha-fetoprotein （AFP）>200 μg/L, China liver cancer staging （CNLC）Ibabove, Barcelona Clinic Liver Cancer （BCLC）B above subgroup patients, but not recurrence rate after 2 years. Conclusion TACE did not significantly reduce the RFS in patients with resectable HCC, but might reduce the early phase recurrence rate in HCC patients with high recurrence risk.

MrgD regulates fat acid metabolism in HepG2 via inhibiting ERS

OU Ting-ting, ZENG Nan, DU Tao

2021, 21(04):  405-410.  DOI: 10.3969/j.issn.1009-976X.2021.04.006

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Objective Inhibiting the synthesis of fatty acids and cholesterol could effectively reduce the occurrence of liver cancer, which is detrimental to the growth of hepatocarcinoma lesions. This study aims to explore the effect and mechanism of MrgD on the fat metabolism of hepatocyte. Methods The recombinant MrgD overexpression and interference plasmids were packaged by lentivirus to generate stable HepG2 cell lines with MrgD high and low expressions, respectively. In vitro steatosis model induced by free fatty acids, the effect of MrgD on HepG2 cells fatty acid metabolism was evaluated by oil red O staining, and fat synthesis-related genes （SREBP2, ACC1） and endoplasmic reticulum stress （ERS） marker protein （BiP） levels. Results The stable HepG2 cells with high or low expression of MrgD were successfully constructed. In the FFA-induced HepG2 cells, high MrgD expression significantly decreased the lipid droplet deposition and TG production compared with MrgD low expression. Meanwhile, MrgD overexpression inhibited the fat synthesis and ERS-related protein levels induced by fatty acids in HepG2 cells. Correspondingly, the expression levels of the fat synthesis and ERS-related proteins were significantly up-regulated in low-expressing MrgD HepG2 cells. Conclusion The study revealed that MrgD inhibits fat synthesis in hepatocarcinoma cells by regulating endoplasmic reticulum stress in vitro, suggesting that the MrgD pathway may be involved in developing hepatocellular carcinoma.

The correlation between human epidermal growth factor receptor 2 expression and gastric carcinoma histology

LIU Jiang, PAHEREDINI·Yusufu, LI Jian-gang, MA Bo, LI Liang, WANG Jun, WANG Tong, Ahetibieke

2021, 21(04):  411-414.  DOI: 10.3969/j.issn.1009-976X.2021.04.007

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Objective To analysis the positive rate of human epidermal growth factor receptor 2 （HER2） expression among different endoscopic biopsy sites of gastric cancer and its correlation withgastric cancer histological characteristics. Methods Totally 108 cases（87 cases were gastric cancer group and 21 cases were chronic superficial gastritis patientsas normal gastric mucosa group） of inpatients who underwent therapy in The Second Affiliated Hospital of Xinjiang Medical University from January 2017 to January 2020 were collected retrospectively. After admission, the specimens obtained by endoscopy or surgery were pathologically examined. The HER2 positive rates among different biopsy sites in endoscopy and expression of human epidermal growth factor receptor 2 and clinicopathologic features were compared. Results Compared with the normal gastric mucosa group, the gastric cancer group had higherpositive rate of HER2 （17.2% vs. 0.0%,P<0.05）. HER2 positive rates from biopsy specimen were 100%, 90%, 44% and 100% in the surperfical spreading portion, ulcer mound, ulcer bed, and mass portion, respectively. The pathological type of tubular adenocarcinoma and the microscopically free signet ring cells had higher positive rate of HER2 than other tissue types of carcinomas and the microscopically visible signet ring cells（23.0%, 23.6% vs. 3.8%, 6.3%, respectively,P<0.05）. Conclusion The expression of human epidermal growth factor receptor 2 in gastric cancer is correlated with the histopathological characteristics, the positive rate of HER2 in gastric cancer with microscopically free signet ring cells may be higher,when evaluating the expression of HER2 in endoscopy biopsy specimens, the surperfical spreading portion and mass portion should be selected, which can provide reference for comprehensive targeted therapy of gastric cancer.

Laparoscopic hepatectomy and splenic artery ligation in surgical treatment for cirrhotic patients with hepatocellular carcinoma

SU Ru-ping, LI Ni, ZHONG Li, ZHAO Zhi

2021, 21(04):  415-418.  DOI: 10.3969/j.issn.1009-976X.2021.04.008

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Objective To investigate the feasibility and efficacy of laparoscopic hepatectomy （LH） and splenic artery ligation （SAL） for hepatocellular carcinoma （HCC） with portal hypertension（PH）. Methods Clinical data of 28 patients with HCC and PH who underwent surgical treatment in our hospital from February 2018 to February 2020 were analyzed. After laparoscopic staging, all patients started with SAL, followed by locally irregular resection in 19 patients and left lateral segmentectomy in 9 patients. Results All procedure were successfully completed in all the 28 cases with a mean operation time of（102.21±40.33）min, mean blood loss of （71.07±79.41）ml and mean postoperative hospital stay of（6.93±2.90）d. No death and splenic abscess or hepatic failure occurred in postoperative period. The level of white blood celland blood platelet recovered one week after surgery and maintained within normal range one year after surgery. During the 12 to 36 months follow-up, three patients accepted radiofrequency ablation to treat tumor recurrence, one patient died of multiple metastasis, one patient died of upper gastrointestinal hemorrhage, one patient lost to follow-up. Conclusion Laparoscopic hepatectomy with splenic artery ligation showed a feasible method to treat hepatocellular carcinoma combined with portal hypertension, and offered a micro-invasive option for selected patients.

Development of the prognosis signature for hepatocellular carcinoma based on ferroptosis-related genes

WANG Dao-du, ZHAO Qi-jiong, ZHOU Zhi-biao, HE Yong-yue

2021, 21(04):  419-424.  DOI: 10.3969/j.issn.1009-976X.2021.04.009

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Objective Hepatocellular carcinoma （HCC） is one of the most common malignant tumors with poor prognosis and high recurrence rate. Ferroptosis is a recently discovered form of iron-dependent programmed cell death, which is different from cell necrosis, apoptosis, and autophagy and is driven by lipid peroxidation. This study explored the relationship between ferroptosis-related genes with prognosis in HCC patients. Methods Gene expression and corresponding clinicopathological data of HCC patients were downloaded from public databases. Univariate COX regression analysis was used to screen out prognostic ferroptosis-related genes, and Lasso COX regression analysis was used to construct a prognostic model. Multivariate COX regression analysis was used to confirm that the prognostic model was an independent risk factor. Finally, functional analyses were performed using Genome Ontology （GO）, Kyoto Genome Encyclopedia （KEGG）, and Single Sample Gene Enrichment Analysis （ssGSEA）. Results Univariate Cox regression analysis showed that 16 ferroptosis-related genes were significantly associated with prognosis （P<0.0001）. Using Lasso Cox regression analysis, we eventually constructed a prognostic model based on 10 ferroptosis-related genes. All patients in the cohort were divided into high-risk group and low-risk group according to the median of riskScore （Calculated by prognostic model）. The survival rate of patients with HCC in the high-risk group was lower and the survival time was shorter （P<0.05）. Multivariate Cox regression analysis showed that riskScore was an independent prognostic factor for patients with HCC （P<0.001）. In addition, functional analyses revealed significant differences in the immune microenvironment between the high-risk and low-risk groups. Conclusion In this study, a prognostic model based on 10 ferroptosis death-related genes was established and verified as an independent prognostic factor in patients with HCC, which provides a reference for the prognosis of patients with HCC.

Clinical effect of barbed suture in laparoscopic repair of perforation of gastroduodenal ulcer

HUANG Feng-ming, ZHANG Yan-bin, WANG Shu-qin

2021, 21(04):  425-427.  DOI: 10.3969/j.issn.1009-976X.2021.04.010

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Objective To study the clinical effect of barbed suture in laparoscopic repair of perforation of gastroduodenal ulcer. Methods Eighty patients undergoing laparoscopic repair of gastroduodenal ulcer perforation were divided into two groups with forty patients in each group. The observation group was sutured with barbed wire in management of gastroduodenal perforationduring operation, while the control group was sutured with ordinary Microjoe wire. To compare the suture time, operation time, anal recovery time,in hospital time and Incidence of complications in two groups. Results The suture time and operative time of the observation group were （6.64±1.15）min and （37.15±3.49）min, and that of the control group were （9.53±1.28）min and （42.40±3.34）min, which were shorter than that of the control group （P<0.05）. The anal recovery time and in hospital time of the observation group were （39.58±4.78）h and （8.08±0.92）d, and that of the control group were （40.66±4.25）h and （8.35±0.98）d, there were no significant difference between the two groups （P>0.05）. Postoperative pulmonary infection occurred in 4 cases in the observation group and 5 cases in the control group, and the difference between the two groups was not statistically significant （P>0.05）. Conclusion The use of barbs in laparoscopic gastroduodenal perforation repair can shorten the suture time and operation time, is a feasible technology.

A study of surgical excision combined with 5-FU implants in patients with local regional recurrence of breast cancer

GUAN Jian-hua, WEN Jian-kun, LIN Qi-mou, HUNAG Wen-jun

2021, 21(04):  428-431.  DOI: 10.3969/j.issn.1009-976X.2021.04.011

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Objective To evaluate the usefulness and efficient of the surgical excision combined with Fluorouracil（5-FU） Implants in breast cancer patients with local regional relapse （LRR） by comparing with non-surgical. Methods Totally 726 patients treated as breast cancer from January 2010 to December 2019 in Jiangmen Central Hospital were registered, in which 27 patients with LRR were enrolled. Analysis of the general data and prognosis information of two groups, surgical excision with Fluorouracil Implants and non-surgical. Results The treatment decision has no significant correlation with the relapse age, LRR pattern and result of IHC （P>0.05）. Patients accepted surgical excision with Fluorouracil Implants has the reducing risk of secondary LRR significantly, with a median LRPFS is 28 months, while the median LRPFS of patients without surgery is 16 months （χ²=6.38,P=0.012）. Whether accepting the surgical treatment did not improve overall prognosis, and there was no statistically significant difference OS in both groups （P>0.05）. Conclusion For breast cancer patients with LRR, accepted positive surgical excision of the lesions and combined with 5-FU implants, then supplemented by consolidating radiation therapy, which can effectively reinforce the effect of local lesion control, extend the local progression-free survival and improve the quality of life.

Evidence and treatment of post-thyroidectomy hypocalcemia in patients with history of bariatric operations

MA Can-ye, YANG Fan, LI Bao-jin

2021, 21(04):  432-436.  DOI: 10.3969/j.issn.1009-976X.2021.04.012

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Objective To investigate the relationship between of bariatric surgery and thyroidectomy hypocalcemia. Methods Pubmed database, Wanfang database and CNKI database were searched for relatedliteratures,includding bariatric surgery,thyroidectomy, hypocalcemia, low-calciu. Hypocalcemia was investigated in the patients with previous bariatric surgeryhistory underwent thyroidectomy again. Results A total of 16 papersin Pubmed database reporting on 82 patients with hypocalcemia after thyroidectomy, in which 66（80.48%） patients with hypocalcemia underwent RYGB procedure, 5（6.1%） with hypocalcemia underwent SG procedure, 6（7.31%） with hypocalcemia underwent LAGBprocedure, 5（6.1%） with hypocalcemia underwent BPD procedure. Of these cases, 89.02% （73 cases） were females, 10.98% （9 cases） males, 85.36% （70/82）underwent total thyroidectomy, 14.64% （12/82） subtotal thyroidectomy. In the 5 articles mentioned and recorded,34.69% （17/49） patients underwent lymph node dissection. The shortest interval between two operations was 4 months, and the longest is 9.1 years. Conclusion Patients with previous bariatric surgery are at high risk of post-thyroidectomy hypocalcemia. Post-thyroidectomy hypocalcemia was found to be more prevalent in patients with previous RYGB and BPD, but not in previous LAGB and SG. Conventional drugs were effective for most hypocalcemia, but stubborn hypocalcemia could be resolved by surgery.

The value of diffusion-weighted imaging and perfusion weighted imaging in the differential diagnosis of encephalitis and low grade glioma

HUANG Xin-yao, YANG Xie-feng, SU Yan, XING Zhen

2021, 21(04):  437-440.  DOI: 10.3969/j.issn.1009-976X.2021.04.013

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Objective To explore the value of diffusion-weighted imaging （DWI） and perfusion weighted imaging （PWI） in the differential diagnosis of atypical encephalitis and low-grade glioma. Methods The clinical and imaging data of 14 patients with atypical encephalitis and 31 patients with low-grade glioma in our hospital from May 2016 to December 2020 were retrospectively analyzed. Diffusion weighted imaging （DWI） and perfusion weighted imaging （PWI） were performed in all patients. Then the solid components of the lesions and the contralateral normal white matter were measured. The relative minimum apparent diffusion coefficient （rADCmin） and relative maximum cerebral blood volume （rCBVmax） were calculated. The differences of rADCmin and rCBVmax between the two groups were analyzed and compared. Results The rADCmin of atypical encephalitis group was higher than that of low-grade glioma group, and rCBVmax was lower than that of low grade glioma group（P<0.05）. The best threshold of rADCmin for differentiating atypical encephalitis from low grade glioma was 1.14, the sensitivity, specificity and area under the curve （AUC） were 96.77%, 90.00% and 0.903 respectively. The best threshold of rCBVmax for differentiating atypical encephalitis from low grade glioma was 2.26, the sensitivity, specificity and AUC were 64.52%, 100% and 0.726 respectively. Conclusion DWI and PWI are of great value in the differential diagnosis of atypical encephalitis and low-grade gliomas. DWI is superior to PWI in the diagnosis of atypical encephalitis.

Efficacy of gemcitabine bladder perfusion in the treatment of non-muscular invasive bladder cancer and the effect of serum VEGF

WANG Long, WANG Jian, TONG Fa-chun, ZHAI Cheng-xi, LIU Yun-zan, DENG Ren-qiang, WANG Bin

2021, 21(04):  441-444.  DOI: 10.3969/j.issn.1009-976X.2021.04.014

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Objective To explore the clinical effect of Gemcitabine （GEM） bladder perfusion therapy in patients with non-muscular invasive bladder cancer （NMIBC） after transurethral resection of bladder tumor （TURBt） and its influence on serum VEGF. Methods 132 patients with NMIBC who were treated with TURBt in Yuxi People's Hospital from January 2015 to June 2019 were included in this study. The patients were randomly divided into GEM group and Pirarubicin group （Pirarubicin, THP group）, with 66 patients in each group. Both groups were treated with TURBt. The GEM group received GEM bladder perfusion immediately after the operation, and the THP group received THP bladder perfusion immediately after the operation. By comparing the adverse reactions of the two groups during postoperative perfusion treatment, and followed up for 1 year, the recurrence of the two groups was monitored 0.5 years and 1 year after the operation. 4ml fasting venous blood was drawn before the perfusion, 0.5 years and 1 year after the perfusion, respectively, to detect the level of serum VEGF. Results The recurrence rate of the GEM group was lower than that of the THP group at 0.5 and 1 year after perfusion, and the recurrence time was longer than that of the THP group, which was statistically significant （P<0.05）; the serum VEGF levels of the two groups were lower than before the 0.5 year and 1 year after perfusion. The serum VEGF levels of the two groups at 1 year after perfusion were in a decreasing trend compared with 0.5 years after perfusion. However, the serum VEGF levels in the GEM group were significantly lower than those in the THP group at 0.5 and 1 year after perfusion, and the downward trend was greater and the difference was greater （P<0.05）. Conclusion GEM bladder perfusion therapy has achieved better clinical effects after TURBt in NMIBC patients, and has a significant effect on serum VEGF. It can not only effectively prevent and significantly reduce the recurrence rate of patients after surgery, but also improve the recurrence-free survival rate. It has less toxic side effects and causes adverse effects the response is less, which is more conducive to ensuring the prognosis and recovery of patients, and has high clinical application value. It is worthy of vigorous research in clinical treatment, strive for widespread application, and provide patients with appropriate treatment options.

Arthrodesis for the treatment of the carpometacarpal arthritis of the thumb

ZHANG Zheng, LIU Yong-tao, SONG Kun-xiu, ZHAO Wei, ZHANG Dai-jie

2021, 21(04):  445-448.  DOI: 10.3969/j.issn.1009-976X.2021.04.015

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Objective To investigate the clinical effect of arthrodesis in the treatment of thumb first carpometacarpal arthritis. Methods From May 2011 to April 2017, 31 patients with the first carpometacarpal arthritis were treated by arthrodesis, including 8 males and 23 females, aged 42-55 years, with an average age of 48 years. According to Eaton little staging, there were 5 cases in stage Ⅱ and 26 cases in stage Ⅲ. All patients were fixed with Kirschner wire. The first carpometacarpal joint fusion was observed by X-ray film regularly after operation. The grip strength, pinch strength and visual analogue scale （VAS） of pain in each group were measured, and the above results were statistically analyzed. Results All patients were followed up for an average of 26.3 months. Postoperative X-ray showed that all the joints were well fused. The grip strength and interphalangeal pinch strength were increased compared with those before operation, and the VAS score was significantly higher than that before operation. Conclusion Arthrodesis is one of the effective methods to treat the first carpometacarpal arthritis of thumb.

Observation of the enhanced recovery after surgery in patients with femoral intertrochanteric fractures

WU Bo-chu, WU Xian-ju, LUO Chun-qiang

2021, 21(04):  449-452.  DOI: 10.3969/j.issn.1009-976X.2021.04.016

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Objective To investigate the effects of enhanced recovery after surgery （ERAS） on intertrochanteric fracture patients undergoing proximal femoral nail antirotation （PFNA） fixation. Methods 100 patients were included in this retrospective study whichwas adopted betweenpatients treated in an ERAS after intramedullary fixation with those rehabilitated on a regular pathway. The patients were assigned to ERAS group （50 cases） and control group （50 cases）.Clinicaland demographic data were collected among the two pathways including length of hospital stay, Harris hip scores （HHS）, visual analog scale （VAS）, and activity of daily living scale （ADL）. Results ERAS procedure wasassociated with shorter length of hospital stay, lower postoperative VAS scores, earlier mobilization,significant improvement in the mean HHS scores at 3 months postoperatively. The mean length of hospital staydecreased from 6.3±2.8 days to 4.9±2.6 days after implementation of ERAS pathway. Conclusion This series of intertrochanteric fracture patients treated with the orthopedic ERAS procedure demonstratedthat the procedure is capable of reducing LOS and preserving hip function without compromising functional outcome. This improvement was possible without a concomitant increase in postoperative complications and readmission rates.

Approach to the patient with pregnancy and lactation-associated osteoporosis

WANG Chuan, QI Yi-qin, YOU Li-li, YAN Li, LI Feng

2021, 21(04):  453-456.  DOI: 10.3969/j.issn.1009-976X.2021.04.017

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Objective Pregnancy and lactation-associated osteoporosis （PLO） is a rare form of osteoporosis causing significant disability. This case could help increase awareness of the disease and accumulate the experience in diagnosis and treat. Methods The Clinical characteristics were analyzed retrospectively in a patient with PLO regard to the elaborate diagnosis and treatment. Results The PLO patient was young women, with regular menstruation, back pain and limited mobility in the early lactation. Biochemical examination was basically normal, and imaging examination showed multiple vertebral compression fractures, bone mineral density examination indicates osteoporosis. Lactation was terminated after exclusion of other osteoporosis causes and received treatment of calcium, vitamin D, calcitonin, and biphosphonates. The back pain disappeared obviously. The findings are discussed in view of the current literature. Conclusions PLO must be kept in mind in the differential diagnosis in patients presenting with low back pain during or after pregnancy. Most PLO patients have a good prognosis by stopping breastfeeding, giving calcium, vitamin D, bisphosphonates and other drugs, but they should be followed up for a long time.

Practical experience of refeeding syndrome in malnourished patients

HUANG Li-xia, LI Li-ting, ZHANG Lan-lang, YE Hua

2021, 21(04):  457-461.  DOI: 10.3969/j.issn.1009-976X.2021.04.018

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Objective To investigate the clinical features of refeeding syndrome （RFS） in malnourished patients. Methods The data of 67 hospitalized patients with malnutrition were retrospectively analyzed. Among them, 24 were RFS patients （RFS group） and 43 were non-RFS patients （RFS group）. The main criterion for case selection was the Nutritional Risk Screening total score （NRS 2002） ≥3 points, received enteral or parenteral nutrition for more than 3 days after admission and did not receive enteral nutrition before admission. The diagnostic criteria of RFS was referred to the published literature. Results The average age of patients in both groups was close to 70 years old. In terms of disease composition, about 1/3 （32.6% of the non-RFS group and 33.3% of the RFS group） were malnutrition and weight loss associated with cancer radiotherapy and chemotherapy, and about 1/4 of the patients （23.3% of the non-RFS group and 25.0% of the RFS group） were infectious disease, and the difference in disease composition between the two groups was not statistically significant （P>0.05）. The nutritional support of the two groups were similar. About 50% of the patients used normal eating + oral nutrition, and about 40% parenteral nutrition + oral nutrition. The phosphate level, serum magnesium, blood K⁺, and albumin of patients in the RFS group were significantly lower than those in the non-RFS group （P<0.05）. In addition, patients in the RFS group with peripheral edema were significantly higher than those in the non-RFS group （P<0.05）; there was no statistically significant difference in the number of patients with tachycardia and shortness of breath （P>0.05）. During the treatment, the total amount of Na supplementation in the RFS group was significantly higher than that in the non-RFS group （P<0.05）, but there was no significant difference in the amount of phosphate, magnesium and calcium supplementation between the two groups （P>0.05）. The patients were followed up for 1 month, there were no deaths in the RFS group, and one in the non-RFS group died of advanced lung cancer; the average hospital stay in the RFS group was significantly longer than that in the non-RFS group （P<0.05）; four patients in the RFS group were re-admitted to the hospital, and one in the non-RFS group Patients were re-admitted to the hospital, and the difference between the two groups was not statistically significant （P>0.05）. Conclusion In these cases, patients with RFS mostly showed electrolyte balance disorders, lower serum protein levels and peripheral tissue edema, and RFS patients prolonged the hospital stay.

Application of microdissection tungsten needle in transverse preputial island flap urethroplasty for one-stage hypospadias repair

SHI Fen, CHEN Chen, LIANG Wei-qiang, ZHANG Jia-qi, XIAO Xiao-lian, ZHANG Jin-ming

2021, 21(04):  462-466.  DOI: 10.3969/j.issn.1009-976X.2021.04.019

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Objective To summarize the application and result of microdissection tungsten needle in transverse preputial island flap and tube urethroplasty for one-stage hypospadias repair. Methods From May 2013 to October 2019, 226 patients with hypospadias underwent one-stage urethroplasty. The patients ranged in age from 0.5 to 25 years and the average was 3.8 years, including 119 penile shaft hypospadias, 83 penoscrotal hypospadias, 24 scrotal and perineal hypospadias. Microdissection tungsten needle was used for penis degloving, penis chordee resection and transverse pruputial island flap harvesting during the operation. Transverse prepuce island flap was performed to tube urethroplasty for all types of hypospadias one-stage repair. Results Twelve cases of poor wound healing, urinary extravasation and urinary fistula were found 7 to 8 days postoperatively. All patients were followed up for 3 months to 2 years. Twenty-four cases of urinary fistula and partial urethral dehiscence, 2 cases of urethral orifice stricture, 3 cases of urethral stricture, 1 case of urethral diverticulum, 2 cases of recurrences of penile curvature were found. The total complication rate was 32/226 （14.2%）. Conclusion Reasonable application of the advantages of microdissection tungsten needle, the transverse preputial island flap can be finely separated and dissected, and it can safely and effectively obtain good blood supply of transverse preputial island flap for urethroplasty, which is conducive to improving the operation efficiency, reducing tissue damage, promoting tissue healing and reducing postoperative complications.

Case Report

Rare case of multiple type of complication after augmentation mammaplasty by polyacrylamide hydrogel injection

RU Zha, HU Ying, HUANG Sheng-hua, BAI Li, ZHU Lei

2021, 21(04):  467-470.  DOI: 10.3969/j.issn.1009-976X.2021.04.020

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Polyacrylamide hydrogel-injected breast augmentation is following with higher complication rate and highly difficult treatment of these complications. In July 2020, a patient, who accepted augmentation mammaplasty with polyacrylamide hydrogel 20 years ago, noticed her right side of breast gradually enlarging in the past one year, was treated at the department of plastic surgery of the Third Affiliated Hospital of Sun Yet-Sen University. The injections weresucked, and the fibrous capsules were taken out. And the operative region healed properly.

Review

Progress on the prognosis prediction of hepatocellular carcinoma after liver resection

WANG Qing-bin, SHANG Chang-zhen, CHEN Ya-jin

2021, 21(04):  471-476.  DOI: 10.3969/j.issn.1009-976X.2021.04.021

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Hepatocellular carcinoma （HCC） is one of the most common malignant neoplasms in the digestive system and surgical resection is an important method to treat HCC. However, the biological characteristics of HCC determine that there is still a high rate of metastasis and recurrence after radical resection,which finally leads to poor prognosis. Therefore, exploring the prognostic predictive factors for HCC after liver resection will be helpful to provide a more comprehensive reference for the formulation of surgical plans and the selection of postoperative adjuvant treatment measures. This article will review the relevant progress of prognosis prediction of HCC after liver resection from the aspects of tumor staging system, immune-inflammation-related indicators, serum tumor markers, non-coding RNA, liver function, imaging features and clinical models.

Research progress of hyperthermic intraperitoneal chemoperfusion in the treatment of exogenous ruptured hepatocellular carcinoma after hepatectomy

HE YongZhu, QIAN Jun-lin, YE Shao-wei, LIU Li-wen, HE Kun, HUANG Rui-qin, LUO Qi-jie, PENG Peng, HU Ze-min

2021, 21(04):  477-481.  DOI: 10.3969/j.issn.1009-976X.2021.04.022

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As one of the serious complications threatening the life of patients, rupture of liver cancer has the characteristics of sudden onset, rapid progression and danger, which can lead to a high early mortality rate of patients. For patients with ruptured liver cancer, hepatectomy can effectively stop bleeding and take into account the tumor at the same time, especially exogenous ruptured liver cancer can cause cancer cells to fall off and cause intraperitoneal dissemination and implantation. It often leads to poor long-term prognosis of patients after hepatectomy. Hyperthermic intraperitoneal chemoperfusion （HIPEC） can effectively remove or kill the remaining free cancer cells and subclinical lesions in the abdominal cavity in the early stage after operation, and achieve a common radical cure in both macro and micro level. It can become a potential therapy for the prevention of postoperative abdominal metastasis of exogenous ruptured liver cancer. With the development of medical level and the standardization of clinical application of HIPEC, the prophylactic use of HIPEC after operation of all kinds of abdominal malignant tumors can significantly reduce the implantation rate of abdominal cavity and play a clear role in the overall clinical effect. The “hepatectomy+HIPEC” treatment mode of exogenous ruptured liver cancer has a good application prospect, so this article reviews the progress of clinical application of postoperative adjuvant HIPEC for exogenous ruptured liver cancer for clinical reference.

Targeted therapy and immuno-therapy of non-small cell lung cancer harboring rare mutation in EGFR

FENG Hui-yi, WU Ming-wei

2021, 21(04):  482-488.  DOI: 10.3969/j.issn.1009-976X.2021.04.023

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Two types of activation mutations were found in epidermal growth factor receptor （EGFR）： classical mutation and rare mutation, with diverse response to EGFR-TKI treatment or immuno-therapy. It was systemically reviewed the pre-clinical and clinical studies on rare mutations of EGFR of non-small cell lung cancer in this paper.

Impacts of the oncological treatment in the sexual health of women with breast cancer

GAO Si-min, HE Hai-yan

2021, 21(04):  489-494.  DOI: 10.3969/j.issn.1009-976X.2021.04.024

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Patients with breast cancer often experience sexual dysfunction and changes in their sexual life after receiving treatment. Especially in young breast cancer patients, sexual dysfunction can have a greater impact on their daily lives and should be taken seriously. At present, there are few researches on the sexual health of women with breast cancer. Based on the relevant literature at home and abroad, we overview the current impact of breast cancer treatment strategies on patients' sexual life and summarize the status of intervention measures in this paper.