Table of Content

20 December 2021, Volume 21 Issue 06

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Original Articles and Clinical Research

Bioinformatics analysis of the diagnostic and prognostic value of the NDC1 gene in colon cancer： a study based on TCGA database

HU Ming-chao, ZHU Bao-song

2021, 21(06):  598-602.  DOI: 10.3969/j.issn.1009-976X.2021.06.002

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Objective The aim of this study was to determine the role of the NDC1 gene in the diagnosis and prognostic assessment of patients with colon cancer. Methods RNA-Seq data of NDC1 gene and corresponding clinicopathological and prognostic parameters of each patient were downloaded from The Cancer Genome Atlas （TCGA） database, and R software was used to draw scatter plots and analyze the differential expression of NDC1 in tumor tissues and normal tissues, the receiver operating characteristic curve （ROC） was used to analyze the diagnostic efficacy of NDC1 gene expression in differentiating colon cancer patients from healthy individuals. The relationship between NDC1 gene expression and survival of colon cancer patients was analyzed by searching the Kaplan-Meier curves from GEPIA database. The relationship between NDC1 gene expression and clinicopathological characteristics of colon cancer patients was analyzed by chi-square test and the factors affecting the prognosis of colon cancer were analyzed by univariate and multifactorial Cox regression models. Results The median NDC1 expression was 3.797（3.411~4.118）, which was higher than that of normal tissues 3.09 （2.897~3.297） and the difference was statistically significant （P<0.05）, and the NDC1 expression in 41 paired tissues were also higher than that of the normal tissues adjacent to the tumor（P<0.05）. The ROC curve showed a higher diagnostic value of NDC1 gene for colon cancer （AUC=0.8515, 95% CI：0.8115~0.8915, P<0.001）. Patients with high NDC1 expression had lower number of lymph node metastases, better pathological stage and less lymphatic invasion compared with those with low NDC1 expression （P<0.05）. Colon cancer patients with low NDC1 gene expression had lower overall survival rates compared to those with high expression （P<0.05）. The results of univariate COX analysis showed that patients' age, T-stage, N-stage, M-stage, pathological stage, lymphatic invasion and NDC1 gene expression were all factors affecting the prognosis of patients with colon cancer （P>0.05）. The results of the multifactorial COX analysis showed that age, M stage, and pathological stage were independent factors in the prognosis of colon cancer patients （P<0.05）. Conclusion NDC1 gene has the potential to be a novel biological marker for the diagnosis and prognostic assessment of colon cancer

Expression and clinical significance of VEGF-A and PI3K/AKT pathways in colorectal cancer

XU Run-qiang, LIU Yu-ping, ZHANG Hai-liang, LIU Hai-sheng, LIU Yu-jun, YAO Jin-ke

2021, 21(06):  603-607.  DOI: 10.3969/j.issn.1009-976X.2021.06.003

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Objective To study the expression and clinical significance of vascular endothelial growth factor （VEGF）-A and phosphatidylinositol 3-kinase （PI3K）/protein kinase B （AKT） pathway in colorectal cancer. Methods From September 2013 to September 2015, 80 patients with colorectal cancer were selected, As an observation group, At the same time, the normal intestinal mucosal tissue was cut off as the control group. The VEGF-A, PI3K and AKT expression levels of cancer tissues and adjacent tissues were detected by immunohistochemistry, the positive expression rate was counted and the difference between the two groups was compared. Univariate analysis of the correlation between VEGF-A、PI3K and AKT expression in colorectal cancer and clinicopathological data, Spearman correlation analysis VEGF-A correlation with PI3K and AKT expression. After 5 years, The survival rate of VEGF-A、PI3K and AKT positive and negative expression patients was compared. Results The positive rate of VEGF-A, PI3K and AKT expression in the observation group was significantly higher than that in the control group （P<0.05）. There was no significant correlation between VEGF-A, PI3K and AKT expression levels of colorectal cancer patients and clinical data such as sex, age, tumor diameter, tumor and location （P>0.05）, significantly correlated with TNM stage, differentiation degree, lymph node metastasis and invasion depth （P<0.05）. There was a significant positive correlation between VEGF-A expression and PI3K, AKT expression in colorectal cancer （r=0.625, 0.517; all P<0.05）. The survival rate of colorectal cancer VEGF-A and PI3K and AKT positive expression patients was significantly lower than that of negative group （P<0.05）. Conclusion VEGF-A, PI3K and AKT in colorectal cancer tissues are highly expressed, and showed significant correlation with tumor stage, lymph node metastasis, differentiation and depth of invasion, it also reduces survival, may be involved in the development of colorectal cancer, It is of great significance for clinical diagnosis and treatment.

Expression of NEK7 in patients with primary hepatocellular carcinoma and its clinical significance

SONG Yan-zhou, KANG Zhi-long, SU Yi-nan, ZHANG Yi-ming, ZHAO Xin, LI Zhi-wei, LI Wei

2021, 21(06):  608-613.  DOI: 10.3969/j.issn.1009-976X.2021.06.004

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Objective To explore the relationship between the expression of NEK7 in clinical cases and the clinical biological characteristics and prognosis of liver cancer patients. Methods Based on the liver cancer mRNA data provided by the TCGA database, Cox regression and LASSO screening were used to select important prognostic variables, and Spearman correlation analysis between the expression of NEK7 and closely related molecules for the prognosis of liver cancer was performed. Immumohistochemical staining was used to test the differences in NEK7 expression in cancer tissues, adjacent tissues and non-tumor liver tissues of liver cancer specimens, and the relationship between their different expressions and the pathological characteristics of liver cancer patients was analyzed. We also explored the prognostic differences of patients with different expression levels of liver cancer. Results The expression of mRNA molecules CCDC21 and GTF3C2, which closely related to the prognosis of liver cancer, had a significant correlation with NEK7. Univariate analysis showed that the factors affecting the prognosis of liver cancer patients were mainly the degree of tumor differentiation, whether there were tumor thrombi and NEK7 expression. The expression of NEK7 in liver cancer tissues was significantly increased in cancer tissues, and its expression level and intensity were related to degree of liver cancer differentiation, Child stage and whether there are cancer emboli. In patients with liver cancer that overexpressed NEK7, their survival time was significantly reduced. Conclusion There is a significant correlation between NEK7 and mRNA molecules closely related to the prognosis of liver cancer. The prognostic factors of patients with liver cancer mainly include the degree of tumor differentiation, whether it is associated with tumor thrombus and the expression of NEK. NEK7 is highly expressed in liver cancer tissues, and its expression level and intensity are related to degree of liver cancer differentiation, Child stage and whether there are cancer emboli. Survival analysis shows that patients with positive expression of NEK7 have significantly shorter survival time.

Experimental study of circKDM4B on the proliferation, migration and invasion of hepatocellular carcinoma cells

MA Xiao-wu, TAN Wen-liang, YANG Lei, XIE Zhi-qin, WANG Qing-bin, CHEN Ya-jin, SHANG Chang-zhen

2021, 21(06):  614-619.  DOI: 10.3969/j.issn.1009-976X.2021.06.005

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Objective To clarify the role of circKDM4B on the proliferation, apoptosis, invasion and migration of hepatocellular carcinoma （HCC） cells. Methods In vitro stability of circKDM4B was examined by RNase R treatment, and its location in cells was determined by fluorescence in situ technique （FISH）. The expression of circKDM4B was silenced by small interfering RNA （siRNA） in SNU 387 and Huh7 cells, respectively, then verified by qRT-PCR. After that, CCK-8 assay, EdU assay, wound healing assay, transwell assays and flow cytometry were used to detect the effects of circKDM4B silencing on HCC cell proliferation, apoptosis, invasion and migration. Results circKDM4B was stable in vitro and not affected by RNase R. FISH showed that circKDM4B was mainly located in cytoplasm. After transfection with si-circKDM4B, the expression levels of circKDM4B were down-regulated. CCK-8, EdU assay and flow cytometry showed that knock-down of circKDM4B significantly inhibited the proliferation ability of HCC cells, and promoted the apoptosis of HCC cells. While wound healing and transwell assay confirmed that knock-down of circKDM4B inhibited the migration and invasion ability of HCC cells. Conclusion circKDM4B is stably located in the cytoplasm of HCC cells, and promotes the proliferation, migration and invasion while inhibits apoptosis of HCC cells, which suggests its potential role as a novel therapy target for HCC.

Comparison of the diagnostic value of conventional ultrasound and contrast-enhanced ultrasound in active bleeding after liver transplantation

ZHAO Ning-bo, HUANG Xiu-ling, ZHANG Yu, ZHOU Dan, LI Yi-jun, DENG Fen, HUANG Jia, FENG Cheng, HU Hong-xing

2021, 21(06):  620-624.  DOI: 10.3969/j.issn.1009-976X.2021.06.006

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Objective To investigate the diagnostic value of routine ultrasound and contrast-enhanced ultrasound in active bleeding after liver transplantation. Methods Routine ultrasound and contrast-enhanced ultrasound images of 33 patients with active bleeding after liver transplantation from April 2019 to July 2021 were analyzed. Surgical exploration or endoscopic surgery is the “gold standard”. Results The accuracy of routine ultrasound and contrast-enhanced ultrasound in the diagnosis of active bleeding after liver transplantation were 27.3% （9/33） and 96.9% （32/33）, respectively. The difference was statistically significant （χ2=31.165,P< 0.05）, and the accuracy of bleeding point location was 27.3% （9/33） and 87.8% （29/33）, respectively （χ2=22.393, P< 0.05）. Conclusion Contrast-enhanced ultrasonography is more accurate than conventional ultrasound in diagnosing active bleeding during perioperative period of liver transplantation, which provides an important basis for clinical diagnosis and treatment.

Laparoscopic assisted transanal total mesorectal excision for lower rectal cancer： an analysis of 48 cases

DENG Jian-zhong, YANG Ping, JI Yong, QIU Lei, LIN Zi-yang, YU Si

2021, 21(06):  625-630.  DOI: 10.3969/j.issn.1009-976X.2021.06.007

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Objective To explore the preliminary experience of laparoscopic assisted transanal total mesorectal excision in the treatment of lower rectal cancer. Methods The clinical data of 48 patients with laparoscopic assisted transanal total mesorectal excision from January 2017 to June 2020 were retrospectively analyzed （group A）, and compared with 186 patients with laparoscopic total mesorectal excision in the same period （group B）. Results There were no statistically significant differences in age, sex ratio, mean maximum tumor diameter, mean intraoperative blood loss, mean number of harvested lymph nodes, postoperative complications, preoperative Wexner score, preoperative anal maximum systolic pressure, postoperative Wexner score and postoperative anal maximum systolic pressure between group A and B （P>0.05）. However, there were significant differences between the two groups in the average distance from the lower edge of the tumor to the dental line, the average body mass index, and the average operation time （P<0.05）. In group A, there was no significant difference in age, maximum diameter of tumor, proportion of neoadjuvant radiotherapy and chemotherapy, blood loss during operation, lymph nodes harvested and postoperative complications （P>0.05）, but the difference between the distance between the lower margin of tumor and the dental line, BMI and operation time was statistically significant （P<0.05）. Conclusions Laparoscopic assisted transanal total mesorectal excision is effective in the treatment of lower rectal cancer, especially for male patients with low rectal cancer and pelvic stenosis, but it should be fully prepared and carried out orderly.

Experience in the treatment of SOX neoadjuvant chemotherapy in advanced gastric cancer

CAO Hong-tao, WANG Xiao-long, CHEN Liang, LIN Bo, TANG Ting-ting, MA Ke-qiang, JI Teng-fei, CAO Tian-sheng, WANG Jian, ZHANG Wen-wei, YANG Jian-rong, LU Zhuo-cai, YOU Tian, HE Qing-qing, HUANG Jin-min, ZHOU Ti-xia

2021, 21(06):  631-635.  DOI: 10.3969/j.issn.1009-976X.2021.06.008

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Objective To observe the effect of neoadjuvant chemotherapy regimen of oxaliplatin combined with S-1 （SOX regimen） on resection rate and clinical efficacy in patients with advanced gastric cancer. Methods Fourty cases of advanced gastric cancer cases in the Qinghai Provincial People's Hospital and Huadu District People's Hospital of Guangzhou from May 2016 to July 2019 were included. All the cases were divided into chemotherapy group （n=20） and non-chemotherapy group （n=20） accorded to the different treatment methods. Both groups were given conventional surgery, and the chemotherapy group were given SOX chemotherapy on this basis. Observed the following indicators： The patients in the chemotherapy group were compared the imaging findings of the gastric wall, local lymph node, portal vein tumor thrombus before and after the chemotherapy. the pyloric obstruction, the edema of the gastric wall, adhesion of tumor and surrounding tissue were compared intraoperative and surgical resection rate, intraoperative blood loss, lymph node metastasis, average hospital stay were compared postoperative. Moerover, R0 resection and postoperative TNM staging were compared between the two groups. Results Compared with the non-chemotherapy group group, in the chemotherapy group, the gastric wall thin, the tumor shrinkaged, the enlargement of the lymph nodes reduced and disappeared and the portal vein tumor thrombus significantly improved after chemotherapy. The pyloric obstruction and gastric wall edema significantly improved in chemotherapy group （P<0.05）. There were no significant difference in the age, gender and intraoperative blood loss between the two groups （P>0.05）. Surgical resection rate, lymph node metastasis and average hospital stay have difference between the two groups （P<0.05）. The neoadjuvant chemotherapy with SOX also significantly improved the R0 resection and reduced the postoperative TNM staging （P<0.05）. Conclusion Neoadjuvant chemotherapy with SOX can significantly improve the radical resection rate in advanced gastric cancer patients with stage T3 and above, and is well tolerated in patients with advanced gastric cancer, which is worthy of promotion in clinical practice.

Effect of vacuum-assisted excision and open surgery on breastfeeding capability of breast fibroadenoma patients

YANG Jian-min, ZOU Su-wen, LI Min-ying, OU Qiao-yan

2021, 21(06):  636-639.  DOI: 10.3969/j.issn.1009-976X.2021.06.009

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Objective To investigate the effect of vacuum-assisted excision and open surgery on breastfeeding capability of breast fibroadenoma patients. Methods A total of 264 patients with unilateral single fibroadenoma resection in the Breast Disease Center of Guangdong Women and Children's Hospital from January 2014 to December 2017 were screened. Breastfeeding questionnaire was conducted to the patients, and related factors affecting postoperative breastfeeding were analyzed. Results All patients were successfully breast-fed after operation, but the capability varies among different patients.In the general population, galactostasis was more likely to occur on the operative side than on the healthy side, and in 76.8% （63/82） of the patients with galactostasis on the operative side, the galactostasis quadrant was consistent with the preoperative tumor location. Chi-square analysis showed that preoperative tumor location quadrant, surgical method and time between operation and lactation had no significant effects on the occurrence of galactostasis on the operative side, and the differences were not statistically significant （P>0.05）; However, multivariate Logistic regression showed that preoperative tumor size, distance from the tumor center to the nipple, distance between the incision and the nipple and conditions of the operative side nipple were important factors affecting the occurrence of galactostasis and reduced milk yield, with statistical significance （P<0.05）. Conclusion After the operation of breast fibroadenoma, all patients were successfully breast-fed, but the operative side is more prone to galactostasis than the healthy side. The size of the tumor, the distance from the tumor center to the nipple, the distance between the incision and the nipple, and the conditions of the operative side nipple are important factors affecting the occurrence of galactostasis.

Impact of carbon nanoparticle injecting during surgery for cN1b stage papillary thyroid carcinoma operative effect and prognosis

MIN Lei, CHEN Wei-chun, HUANG Zhi-heng

2021, 21(06):  640-644.  DOI: 10.3969/j.issn.1009-976X.2021.06.010

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Objective Current studies generally support that intraoperatively injecting carbon nanoparticle（CNP） not only preserves parathyroid function but also improves neck dissection for cN0 stage papillary thyroid carcinoma（PTC）. However, impact of using CNP for cN1b stage PTC is still unknown. This study explored utility of CNP during therapeutic neck dissection and evaluation of oncology outcomes. Methods From Jan. 2017 to Jun. 2019, 142 consecutive cN1b PTC patients from the University of Hong Kong Shenzhen Hospital were recruited. All the patients underwent total thyroidectomy and compartmental neck dissection. Seventy-seven were injected CNP intraoperatively（CNP group） while 65 were operated without CNP（control group）. Study endpoints included number of total and metastatic lateral lymph node, postoperative stimulated thyroglobulin（Tg） before radioactive iodine（RAI） ablation, non-stimulated Tg after RAI, postoperative parathyroid hormone（PTH）,calcium. Results Demographics and operative time were comparable between the two groups. There was no significance for number of both total and metastatic lateral lymph node retrieved（22.13±9.95 vs. 21.10±10.69,P=0.583 and 4.29±3.12 vs. 3.96±3.69,P=0.574, respectively）. However, postoperative stimulated Tg was significantly higher in CNP group（2.59 ng/mL vs. 0.67 ng/mL, P=0.046）, while there was no significance for post-RAI suppressed Tg between the two groups（0.1 ng/mL vs. 0.1 ng/mL, P=0.205）. Postoperative Day 1 PTH was significantly lower in CNP group（8.1 pmol/L vs. 13.6 pmol/L, P=0.044）. Morbidity of post 6 month hypoparathyroidism has no significance between two groups. Conclusion Intraoperative injecting CNP may not facilitate lateral neck dissection and postoperative Tg level for cN1b PTC. Conversely, it has potential harm to postoperative short-term parathyroid function. Using CNP should be taken into consideration cautiously for cN1b PTC.

The clinical practice of transoral endoscopic thyroidectomy vestibular approachand its comparison with open thyroidectomy

XIE Yun-yun, WU Xian-jiang, DAI Lei, ZHANG Wei-dong, WANG Ying-chun

2021, 21(06):  645-650.  DOI: 10.3969/j.issn.1009-976X.2021.06.011

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Objective The clinical practice oftransoral endoscopic thyroidectomy vestibular approach（TOETVA） and its comparison with open thyroidectomy. Methods The clinical data of 90 patients of thyroidectomy from March 2019 to December 2019 werecollected and retrospectively analyzed in the Ningbo Huamei hospital, Chinese Academy of Sciences,Department of thyroid surgery. The patients were assigned to TOETVA（45 cases） and conventional open thyroidectomy （the sample size of patients with traditional openthyroidectomy is large, 45 cases were selected by random sampling）, the gender, age, BMI, pathological type, cleaning the number of lymph nodes, and the operative time, postoperative drainage,postoperative complications and associated long-term prognostic indicators were compared. Results There was no statistically significant difference between the two surgical procedures in preoperative and postoperative clinical data,and there was no significant difference in intraoperative indicators such asbleeding volume and lymphatic dissection between the two groups. Butcompared with the open group, the intraoperative operation time was longer （P<0.05）, the operation cost was moreexpensive, and the length of hospitalization time was shorter. Conclusion TOETVA is safe and feasible in selecting suitable patients. It has advantages in cosmetic effect.

Application of simplified anatomy of inguinal region in laparoscopic inguinal hernia repair

LI Yingru, GAN Wen-chang, YANG Wei-sheng, JIANG Zhi-peng, ZHOU Tai-cheng, HOU Ze-hui, MA Ning, CHEN Shuang

2021, 21(06):  651-653.  DOI: 10.3969/j.issn.1009-976X.2021.06.012

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Objective To investigate the clinical efficacy, safety and feasibility of simplified inguinal area anatomy in endoscopic inguinal hernia repair. Methods The clinical data of 80 patients with inguinal hernia in the Sixth Affiliated Hospital of Sun Yat-sen University from September 2018 to March 2019 were retrospectively analyzed. There were 59 males and 21 females, aged from 18 to 80 （53.8±21.5） years old. There were 21 on the left side, 48 on the right side, and 11 on both sides. All patients underwent endoscopic transabdominal extraperitoneal inguinal hernia repair, and the operative time, intraoperative blood loss, postoperative hospital stay and postoperative complications were observed. Results All the 80 patients completed the operation successfully, and none of them was converted to open surgery. The operative time of unilateral hernia patients was 27.8~51.4 （43.2± 5.6） min, and that of bilateral hernia patients was 55.6~103.3 （73.8± 10.4） min, the intraoperative blood loss was 2~6 （3.6± 1.1） mL, and the hospital stay was 2~5 （3.1± 1.8） days. Postoperative seroma occurred in 2 patients, and groin pain occurred in 2 patients on the first day after operation, which could be relieved after corresponding treatment. Seventy-four patients were followed up from September 1, 2018 to December 31, 2019, for an average of 9 months. None of the patients recurred during the follow-up. Conclusion The simplified inguinal region anatomy is simple and easy to understand, can effectively shorten the learning curve of TAPP surgery, and it is conducive to the standardization of surgery, suitable for popularization and application.

Preparation of animal cream low density CT contrast agent and its application in gastrointestinal bleeding

YUAN Jian-peng, SHEN Ping, HUANG Wen-sheng, CHI Ze-lin, WEN Dan, CHENG Xian-wen, XI Wei-jia

2021, 21(06):  654-657.  DOI: 10.3969/j.issn.1009-976X.2021.06.013

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Objective A new type of low density gastrointestinal tract contrast agent is prepared by using simple and easily available materials, so as to realize accurate display and positioning of gastrointestinal bleeding. Methods Using edible whipped cream and xanthan gum as materials, a low density contrast agent was prepared after stirring with a mixer at 160-260 r/min for about 5 minutes at a temperature of about 7 ℃. Then test its stability at different temperatures, observe its uniformity on the CT scan image and measure the CT value, compare its density with the blood clot, and finally use the pig's small intestine, saline bag and plasma mixed with heparin to simulate gastrointestinal bleeding, to compare its display and positioning effect on hemorrhage foci with water, so as to explore the application value of this low-density contrast agent in gastrointestinal hemorrhage. Results The low density contrast agent showed good stability at room temperature （25 ℃） and refrigerator temperature （2 ℃~4 ℃）; the CT scan image showed that its uniformity was relatively high, and the measured CT value ranges -500 to -700 Hu, which is obviously different from the density of blood clot; compared with water, this low density contrast agent has obvious advantages in the display and positioning of hemorrhage foci. Conclusion The gastrointestinal lowdensity contrast agent made of edible whipped cream and xanthan gum has good stability and high uniformity, it can display and locate the hemorrhage foci accurately, so it has an important clinical value for the diagnosis of gastrointestinal bleeding.

Retrospective analysis for the effect of a single low dose of methylprednisolone on systemic inflammatory response syndrome after percutaneous nephrolithotomy

ZHAO Peng-peng, HUANG Jian-hua, XU Zhan-ping

2021, 21(06):  658-662.  DOI: 10.3969/j.issn.1009-976X.2021.06.014

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Objective To explore the effect of a single low dose of methylprednisolone on systemic inflammatory response syndrome （SIRS） after percutaneous nephrolithotomy （PCNL）. Methods There were 315 patients diagnosed with renal calculi and received PCNL in the urology Department of our hospital from January 2019 to May 2021. After exclusion, 237 cases were included in the statistical analysis. And the patients were divided into two groups according to whether methylprednisolone was used before the operation. The incidence of SIRS and the data of other prognostic indicators were recorded. Results There were 120 patients in the methylprednone group and 117 patients in the control group. There was no significant different between the two groups about preoperative baseline indicators（P<0.05）. Indicators： Compared with the control group, the PCT and HSCRP of the methylprednone group were lower at postoperative hour two and atpostoperative day one（P<0.05）. Clinical outcomes showed incidence of fever on the day of surgery and postoperative hospital stay in the methylprednone group were lower than that in the control group（P<0.05）. There was no significant difference between the two groups in the incidence of SIRS, positive blood culture, sepsis, ICU stay（P>0.05）. Conclusion A single low dose of methylprednone before PCNL was beneficial for decreasing levels of PCT and HSCRP, caused a shorter postoperative hospital stay. It has no preventive effect on the occurrence of postoperative SIRS.

The effects of different approaches in the treatment of intra-articular calcaneal fractures and their effects on patients' stress levels

WENG Ke-jie, ZHANG Yu-feng, QIU Xue-li, CHEN Shu-xin, SHEN Hui-yang, LIU Cheng

2021, 21(06):  663-667.  DOI: 10.3969/j.issn.1009-976X.2021.06.015

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Objective To explore the effects of different approaches in the treatment of intra-articular calcaneal fractures and their effects on patients' stress levels. Methods A total of 108 patients with calcaneal intra-articular fractures admitted to our hospital from October 2016 to December 2019 were selected and divided into an observation group （56 cases） and a control group （52 cases） according to different approaches. The group was treated with a small incision in the sinus tarsi, and the control group was treated with an L-shaped incision in the lateral calcaneus. The perioperative situation of the two groups of patients was compared and analyzed. The American Foot and Ankle Association Foot Function Score System （AOFAS） was used to evaluate the functional recovery of the patients at 6 months after the operation. Imaging examination was performed at 6 months after the operation. The two groups were compared before the operation. Differences in postoperative stress levels, statistics of postoperative complications between the two groups. Results The operation time of the observation group was higher than that of the traditional group, and its intraoperative bleeding, postoperative drainage, incision length and hospital stay were significantly shorter than those of the control group （P<0.05）. The effective rates of functional recovery in the two groups at 6 months after operation were 91.07% and 71.92%, respectively. The observation group was significantly higher than the control group （P<0.05）. Compared with preoperatively, the width, height, and Bohle angle of the calcaneus in the two groups were significantly increased at 6 months after surgery, while the Gissane angle was significantly decreased （P<0.05）. 1 day after operation, the levels of pain stress index substance P （SP） and neuropeptide Y （NPY）, inflammation stress index interleukin-1β （IL-1β）, tumor necrosis factor-α （TNF-α） The level was significantly higher than that before operation （P<0.05）, and the above indicators in the observation group were significantly lower than those in the control group （P<0.05）. The incidence of complications in the two groups was 7.15% and 21.15%, respectively, and the observation group was significantly lower than the control group （P<0.05）. Conclusion Compared with traditional L-shape approach, minimally invasive sinus tarsi approach can significantly reduce surgical trauma of patients with calcaneal fractures, promote recovery of Bohle and Gissane angles of calcaneus, reduce the patient's stress level, with few complications and significant effects.

Observation and analysis of nursing omissions in the rehabilitation process of elderly patients undergoing with stroke after cranial drilling

ZHANG Mei-hua, ZHANG Wen-ting

2021, 21(06):  668-672.  DOI: 10.3969/j.issn.1009-976X.2021.06.016

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Objective To investigate and analyze omissions or misses in the continued treatment and nursing process of elderly patients during the rehabilitation period. Methods This study adopts a prospective approach, 8 elderly inpatients and 14 discharged patients who need to be bedridden were selected as the research objects. According to the different nursing procedures, the patients are divided into professional nursing （nursing during hospitalization, n=8） and community nursing （Outpatient and community care for discharged patients, n=7 cases） and self-care （home care, n=7）, observation time was 10 days. The treatment and nursing errors and omissions were observed and recorded during the rehabilitation process. Results During the set 10-day observation period, the professional group, the community group and the family group recorded a total of 1926, 1601, and 1346 nursing items. The professional group found a total of 86 nursing errors （4.4%）, including 43 cases of omissions and nursing delays （2.2%） and 43 （2.2%）; community group found 183 nursing errors （11.5%）, missing 102（6.4%） and nursing delay 81 （5.1%）; family group found 251 nursing errors （18.7%）, 130 （9.7%） missed and 121 （9.0%） nursing delay were missed. The difference between the three groups was statistically significant （P < 0.05）. There were 15 important nursing omissions in the professional group, 80 important nursing omissions in the community group, and 133 omissions in the family group. Conclusion Home care lacking routine training has a high rate of omissions and an increase in the proportion of patients with adverse events. Monitoring and timely correction of nursing items with a higher frequency will help reduce the incidence of complications and recovery of patients.

Case Report

The successful application of inetetamab combined with pyrotinib in the treatment of HER-2 positive advanced breast cancer： a case report

GUI Xiu-juan, ZHAO Jian-li, WANG Ying, CHAI Jie, DIN Lin-xiao-xiao, YAO He-rui

2021, 21(06):  675-678.  DOI: 10.3969/j.issn.1009-976X.2021.06.018

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Approximately 15%~20% of patients with metastatic breast cancer have HER2-positive disease, which isassociated with more aggressive disease biology and historically, a poorer prognosis relative to other molecular subtypes. The application of trastuzumab has greatly improved patients outcomes,however, trastuzumab-resistance is common. We presented a HER-2 positive metastatic breast cancer case, who was diagnosed as primary trastuzumab resistance and successfully treated with inetetamab combined with pyrotinib and eribulin.

Review

A systematic review of the mechanisms of osteoarthritis and metabolic syndrome

LI Bo

2021, 21(06):  679-683.  DOI: 10.3969/j.issn.1009-976X.2021.06.019

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Both osteoarthritis and metabolic syndrome are systemic diseases, which are closely related to global oxidative stress, inflammatory response, vascular endothelial damage, genetic genes, hormone secretion, metabolic abnormalities, obesity, biomechanical changes, hypertension and lipid metabolism abnormalities. Osteoarthritis and metabolic syndrome are interrelated and promote each other in pathogenesis. Actively controlling of metabolic syndrome,the progression of osteoarthritis can be alleviated. Improving osteoarthritis activity limitations, metabolic syndrome maybe improved. Because of the holistic concept, another thinking model for clinical diagnosis and treatment of osteoarthritis is provided.

Current status of diagnosis and treatment of testicular tumors in children

KONG Ling-qi, QU Yan-lin, ZHU Fan-he

2021, 21(06):  684-687.  DOI: 10.3969/j.issn.1009-976X.2021.06.020

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There are significant differences in pathological characteristics, treatment options, and clinical prognosis of testicular tumors between children and adults. Due to the low incidence of testicular tumors in children, more pathological analysis, and large differences in treatment options, clinicians are required to have a wealth of relevant medical knowledge and clinical skills in order to diagnose, accurately type, and treat testicular tumors early. At present, there are not many studies on pediatric testicular tumors, and the relatively small number of patients leads to research limitations and research bias. Therefore, the understanding of pediatric testicular tumors is limited. This article reviews the progress in diagnosis and treatment of testicular tumors.

Prevention and treatment of chylothorax in thoracic surgery

WU Zhuo-peng, YANG Jie

2021, 21(06):  688-692.  DOI: 10.3969/j.issn.1009-976X.2021.06.021

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Chylothorax is a rare and serious complication after thoracic surgery, leading to severe nutritional consumption, physiological disorders and immunosuppression in patients. Understanding the pathophysiology of chylothorax is the basis of the management principle for chylothorax. Conservative treatment aims to reduce the production of chyle through nutritional intervention, and to control symptoms through chyle drainage, with the end point being the spontaneous closure of lymphatic vessels. The timing of surgical intervention is still controversial, and either ligation or embolization of thoracic ducthave become an alternative to open surgery. The treatment method to be adopted should be judged and decided according to the patient's own condition. Overemphasis on surgery and inappropriate conservative treatment are not the best clinical choice. This article only reviews the current status and new developments in the treatment and prevention of secondary chylothorax after thoracic surgery.