Table of Content

20 December 2023, Volume 23 Issue 06

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Original Articles and Clinical Research

FOXP3 promotes cell migration via EMT in hepatocellular cancer

HUANG Zhi-feng, JIAO Yuan-jun, XU Zhe, LIU Ji-kui, HUANG Dong, OU Xi, LIU Xiao-ping

2023, 23(06):  449-454.  DOI: 10.3969/j.issn.1009-976X.2023.06.001

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Objective To investigate the effect andmolecular mechanism of FOXP3 gene on hepatocellular carcinoma cell migration. Methods The cell model of FOXP3 stable knockdown was constructed by lentivirus infection. Real-time fluorescent quantitative PCR （qRT-PCR） and Western blot assays were used to verify the efficiency of virus infection. The migration capacity of hepatocellular carcinoma cells was detected by wound healing assay. Moreover, the expression changes of EMT-related molecules including E-cadherin, N-cadherin and Slug were detected by Western blot assay. Results After infection with FOXP3-shRNA, the expression level of FOXP3 in hepatocellular carcinoma cell lines HepG2 and MHCC97H was significantly decreased. In vitro experiments demonstrated that knockdown of FOXP3 could significantly inhibit the migration ability of hepatocellular carcinoma cells. Western blot experiments revealed that down-regulation of FOXP3 inhibited the EMT process, up-regulated the expression of E-cadherin, and down-regulated the expression of N-cadherin and Slug. Conclusion Down-regulation of FOXP3 inhibited the migration of hepatocellular carcinoma cells by mediating EMT. FOXP3 might be a potential therapeutic target for recurrence and metastasis of hepatocellular carcinoma.

Comparison of short-term clinical efficacy between totally laparoscopy radical distal gastrectomy and laparoscopy-assisted radical distal gastrectomy： a single center prospective cohort study

LU Xiao-yu, ZHENG Cheng-bin, HONG Xiao-zhe, XIE Rong-ming

2023, 23(06):  455-459.  DOI: 10.3969/j.issn.1009-976X.2023.06.002

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Objective To compare the short-term clinical efficacy of totally laparoscopy radical distal gastrectomy and laparoscopy-assisted radical distal gastrectomy. Methods A prospective observational cohort study method was used to continuously include a total of 40 gastric cancer patients who underwent laparoscopic distal radical gastrectomy in our hospital from January 2021 to July 2023, including 20 cases in TLDG group and 20 cases in LADG group. The baseline data, intraoperative and postoperative conditions, and postoperative pathology of the two groups were observed and compared. Results All patients successfully completed laparoscopic radical gastrectomy for gastric cancer. The length of abdominal incision in TLDG group was significantly smaller than that in LADG group, and the difference was statistically significant （P<0.05）. There were no significant differences in operation time, gastrointestinal reconstruction time, blood loss, proximal margin length, distal resection margin length, gastrointestinal reconstruction method, intraoperative blood transfusion and intraoperative complications （P>0.05）. There was no significant difference between the two groups （P>0.05） in comparison of postoperative observational indicators, also in terms of comparison of postoperative pathology. There was one case with HER2（2+）, the rest were HER（1+） and HER（-） as. And one case （2.5%） was interpreted as dMMR by immunohistochemistry. One patient in the TLDG group drained bile-like drainage fluid from the drainage tube the day after surgery, and reoperation confirmed that the duodenal stump leaked, and cured and discharged after duodenostomy. During the follow-up period, two patients in the LADG group underwent laparoscopic partial hepatic resection half a year after surgery, one case showed metastatic moderately differentiated adenocarcinoma after surgery, considering the gastrointestinal source, intravasculature cancer thrombus was visible, and the other cases showed benign nodules with no malignant tumor. Conclusion Total laparoscopic radical distal gastrectomy is safe and effective with the small abdominal incision and cosmetic effect. It does not increase the occurrence of intraoperative and postoperative complications, and can achieve radical resection of gastric cancer.

Effects of bariatric surgery on the prognosis of obese COVID-19 patients： a meta analysis

YU He, HUANG Liang-liang

2023, 23(06):  460-467.  DOI: 10.3969/j.issn.1009-976X.2023.06.003

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Objective To investigate whether bariatric surgery has a protective effect against COVID-19 infection in obese patients. Methods A computer search of medical literature databases, including PubMed, Cochrane Library, Embase, CNKI, Wanfang, etc., was conducted to search for relevant studies on the prognotic effects of previous bariatric surgery on OBESE patients infected with COVID-19. The search period was from January 2020 to June 2023. Results A total of 9 retrospective studies were included. Meta-analysis showed that bariatric surgery could reduce mortality after COVID-19 infection in obese patients （OR=0.46, 95%CI： 0.41-0.51,P<0.00001）. The hospitalization rate decreased （OR=0.67, 95%CI： 0.48-0.93,P=0.02）; Mechanical ventilation rate decreased （OR=0.47, 95%CI： 0.44-0.51,P<0.00001）; ICU admission rate decreased （OR=0.49, 95%CI： 0.35-0.67,P<0.00001）. Conclusion Previous bariatric surgery significantly improves the adverse outcomes of COVID-19 in obese patients

Color doppler ultrasound-based radiomics signature in distinguishing benign and malignant breast nodules

YANG Hui, XU Fan, ZENG Xu-wen

2023, 23(06):  468-472.  DOI: 10.3969/j.issn.1009-976X.2023.06.004

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Objective To explore the value of color doppler flow imaging（CDFI） imaging radiomics signature in the diagnosis of benign and malignant breast nodules. Methods The data of 159 patients （161 cases in total） with breast nodules detected through breast color doppler ultrasound were retrospectively collected. All cases were confirmed by pathology. The 161 cases were divided into group A and group B （98 cases in group A and 63 cases in group B） according to the sample size of benign and malignant. According to the sample size of 7∶3, benign （69∶29） and malignant （44∶19） nodes were randomly selected as the training set （113 cases） and the validation set （48 cases）. For all cases, 1125 features were extracted for each lesion based on the CDFI images of the nodules using the Darwin Research Platform for lesion outlining and feature extraction. Then, the F-classif of the sample variance was used to downscale and filter the features, from which 10 optimal features were selected, and the CDFI-based radiomics signature was established by the logistic regression mode. Usingreceiver′s operating characteristic （ROC） curve to evaluate the efficiency of differential diagnosis between benign and malignant breast nodules. Results The AUC of ultrasound radiomics signature was 0.895（95%CI：0.838-0.951） in training set and 0.904（95%CI：0.801-1.000） in testing set, and theradiomics signature was related to the differential diagnosis of benign and malignant breast nodules （P<0.001）. Conclusion The color doppler ultrasound-based radiomics signature has high efficiency in differential diagnosis of benign and malignant breast nodules, and it can assist the clinic in providing new imaging ideas for early diagnosis of breast nodules, the formulation of treatment plans, and the non-invasive assessment of breast cancer prognosis before surgery.

Observation of bone marrow suppression and adverse reactions after chemotherapy after breast cancer surgery

WAN Jian, LIU Meng-yao, LI Shuai-jie, LIU Yi-ting, LAO Xiao-xia, CHEN Yong

2023, 23(06):  473-479.  DOI: 10.3969/j.issn.1009-976X.2023.06.005

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Objective To observe and analyze the related relationship of myelosuppression after chemotherapy for breast cancer. Methods A total of 120 breast cancer patients from the Breast Department of Guangdong Maternal and Child Health Hospital and the Oncology Department of Shaoyang Central Hospital from January 2022 to June 2023 were collected. The patients were divided into non-myelosuppression group （control group, n=20）, mild myelosuppression group （mild group, n=76）, and severe myelosuppression group （severe group, n=24） according to the situation of postoperative chemotherapy myelosuppression. The postoperative chemotherapy regimens for all patients were EC→T, AC or EC. The collected and preliminary analyzed data included the clinical characteristics of 120 patients, the univariate analysis of myelosuppression after chemotherapy in the three groups of patients, the relationship between postoperative chemotherapy myelosuppression and various adverse reactions, and the relationship between the degree of myelosuppression and the severity of adverse reactions. Results Among the 120 patients who underwent postoperative chemotherapy for breast cancer, 83.3% （100 cases） experienced varying degrees of myelosuppression, among which 76.0% （76 cases） were mild cases （grades Ⅰ and Ⅱ）, 20% （24 cases） were severe cases （grades Ⅲ and Ⅳ）, and 16.7% （20 cases） of the patients did not experience myelosuppression. No patient interrupted or reduced the dose of chemotherapy. The degree of myelosuppression was related to the patient′s age, chemotherapy regimen, nutritional status, and pre-chemotherapy combined with diabetes, and there were statistical significances between the patients in the control group, the mild myelotransplant group, and the severe myelosuppression group （all Ps were less than 0.05）. Among the seven adverse reaction symptoms counted, there was no statistical significance among the patients in the control group, the mild group, and the severe group （all Ps were more than 0.05）. According to the WHO adverse reaction classification standard, the distribution of adverse reaction grades after chemotherapy in patients with different degrees of myelosuppression was different. The more severe the degree of myelosuppression, the higher the grade of adverse reactions （P=0.001）. Conclusion Chemotherapy-induced myelosuppression was associated with patient age, chemotherapy regimen, nutritional status, and pre-chemotherapy comorbid diabetes mellitus; the proportion of chemotherapeutic toxicities occurring may not be related to the degree of myelosuppression, but was associated with the WHO grading of adverse effects.

The efficacy of stage Ⅱ autologous skin patch grafting in 64 patients with deep partial thickness burns on the dorsum of the hand and its effect on inflammatory indices

SUN Jing-en, JIAO Song-song, LIN Wie-hua, LI Gang, ZHANG Zhi

2023, 23(06):  480-484.  DOI: 10.3969/j.issn.1009-976X.2023.06.006

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Objective To analyze the long-term effects of stage Ⅱ autologous skin grafts on deep partial thickness burns of the dorsum of the hand. Methods A total of 64 patients with deep partial thickness burns on the dorsum of the hand admitted to the hospital from January 2020 to March 2023 were retrospectively analysed. The wounds were covered with xenogeneic （porcine） in the stageⅠ, followed by the application of autologous thin intermediate thickness free skin grafts to repair the wounds in phase Ⅱ one week later. The surgical results, complications, satisfaction and inflammatory response indicators were analysed. Results The average wound healing time of these patients was 21.94 d. There were no complications found. Average survival rate is 98.66%, and overall satisfaction was high. WBC, CRP and IL-6 gradually decreased in stageⅠ two days preoperatively, two days postoperatively, two days preoperatively and two days postoperatively in stage Ⅱwhen compared. Conclusion Staged autologous thin intermediate-thickness skin grafting in patients with deep partial thickness burn on the dorsum of the hand was ideal, with a significant reduction in inflammatory response and beneficial to the patients′ functional recovery of the hand.

Comparison of drug-eluting stents and percutaneous transluminal angioplasty in the treatment of autologous arteriovenous fistula stenosis

ZOU Lan, ZHU Zheng-rong

2023, 23(06):  485-489.  DOI: 10.3969/j.issn.1009-976X.2023.06.007

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Objective To compare the efficacy and safety of drug-eluting stents（DES） and percutaneous transluminal angioplasty（PTA） in the treatment of autologous arteriovenous fistula（AVF） stenosis. Methods The clinical data of 87 patients with AVF stenosis and underwent surgery in our hospital from January 2018 to December 2022 were analyzed retrospectively. These patients were divided into PTA group（n=44） and DES group（n=43） according to operative method. The success rate of operation, postoperative diameter and dialysis blood flow of stenosis, primary patency rate at 6 and 12 months after operation and complications within one month after operation were compared between the two groups. Results The clinical success rates of all patients were 100%. The technical success rates of DES group and PTA group were 100% and 91.0%, respectively. The differences of postoperative diameter of stenosis and dialysis blood flow between the two groups were not statistically significant. The primary patency rates of 6 months of DES group and PTA group were 79.1% and 45.5%, respectively. The primary patency rate of 6 months of DES group was statistically superior to PTA group（P=0.001）. The primary patency rates of 12 months of DES group and PTA group were 30.2% and 9.1%, respectively. The primary patency rate of 12 months of DES group was statistically superior to PTA group（P=0.013）. There was no significant difference in the incidence of complications within 1 month after operation between the two groups. Conclusion DES is effective and safe for the treatment of AVF stenosis. Implantation of DES improves the primary patency rate compared with PTA only.

Clinicopathological significance of BIRC5 mRNA and protein expression in lung adenocarcinoma

LIN Rui, LI Guo-sheng, DANG Yi-wu, YANG Da-ping, ZENG Neng-yong, KONG Jin-liang, CHEN Gang

2023, 23(06):  490-497.  DOI: 10.3969/j.issn.1009-976X.2023.06.008

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Objective To investigate the expression and clinicopathological significance of baculoviral inhibitor of apoptosis repeat-containing protein 5 （BIRC5） in lung adenocarcinoma （LUAD） tissue. Methods The expression of BIRC5 mRNA in LUAD and non-cancer lung tissues was collected from high-throughput datasets such as ArrayExpress, GEO, Oncomine, TCGA, and GTEx. SMD and AUC of the sROC cure were calculated; Kaplan-Meier curves were used for the study Association between BIRC5 expression and prognosis in LUAD patients; BIRC5 protein expression level was detected by immunohistochemistry using LUAD tissue microarray. BIRC5-related up-regulated genes were subjected to GO functional annotation, GSEA, and the KEGG signaling pathway analysis. The CIBERCORT algorithm was used to explore the relationship between BIRC5 expression and the immune microenvironment of LUAD. Results A total of 114 high-throughput datasets were included globally, from 22 countries or regions, including 3897 cases of LUAD and 2993 non cancerous lung tissues, and finally merged into 37 platforms. Compared with non cancerous lung tissue, the expression level of BIRC5 mRNA was significantly increased in LUAD tissue （SMD=1.36, AUC=0.90）; The overall survival of LUAD patients with high expression of BIRC5 was significantly lower than those with low expression （hazard ratio=2.017, P<0.05）; At the same time, some experiments on tissue chips found that the expression level of BIRC5 protein was significantly upregulated in 226 cases of LUAD （P<0.05）. The BIRC5 related genes in LUAD may be involved in the formation of cellular components such as chromosomes, involving biological processes such as DNA replication, nuclear division, and chromosome separation, and exerting molecular functions such as ATPase activity and DNA helicase activity. In addition, the high expression group of BIRC5 had a higher level of immune cell infiltration （P<0.05）. Conclusion High expression of BIRC5 may promote the occurrence and progression of LUAD through multiple pathways and immune factors.

Analysis of the predictive value of serum follicle-stimulating hormone combined with thyroglobulin for recurrence after radical surgery in patients with thyroid cancer

XU Dao-hui, LIN Liang-yu

2023, 23(06):  498-503.  DOI: 10.3969/j.issn.1009-976X.2023.06.009

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Objective To explore the predictive value of serum follistatin （FS） combined with thyroglobulin for the radical postoperative recurrence of thyroid cancer. Methods 95 patients in Shaowu Municipal Hospital from July 2017 to December 2019 were selected as recurrence for 3 years （n=32） and no recurrence （n=63）, compared serum FS level and thyroglobulin level, drew serum FS and thyroglobulin prediction ROC curve for postoperative recurrence of thyroid cancer, calculated AUC and combined detection for postoperative recurrence of thyroid cancer, and evaluated the risk factors for radical recurrence of thyroid cancer. Results The serum FS level and thyroglobulin level in the relapse group were significantly higher than those in the no-relapse group （P<0.05）. The AUC of serum FS after radical thyroid cancer was 0.8333 （95%CI： 0.7438-0.9229, P<0.0001）, AUC of CRC was 0.8350 （95%CI： 0.7380-0.9319, P<0.0001）, serum FS for thyroid cancer was 0.9150 （95%CI： 0.8458-0.9842, P<0.0001）. The optimal post-radical recurrence cutoff value of serum FS was 3.38 ng/mL, with prediction sensitivity of 78.79% and 78.13% specificity. The optimal cut-off value of thyroglobulin for postoperative recurrence of thyroid cancer was 217.46 ng/mL, the prediction sensitivity was 75.00% and the specificity was 75.00%. The prediction sensitivity of thyroglobulin and serum FS was 84.38% and 81.25%; the combined test was slightly better than that of thyroglobulin and serum FS alone. Multivariate Logistic regression analysis showed that FS and thyroglobulin were independent risk factors for the recurrence of radical thyroid cancer resection （P<0.05）. Conclusion The serum FS and thyroglobulin levels of patients with recurrence after radical resection of thyroid cancer will increase significantly, and the above indicators have good predictive value for recurrence after radical resection of thyroid cancer, which can be considered in the prognosis evaluation of such patients.

NUDT9 promotes the proliferation of malignant tumors by stabilizing MCM3 protein expression

ZHUANG Shu-ting, HU Kai-shun

2023, 23(06):  504-513.  DOI: 10.3969/j.issn.1009-976X.2023.06.010

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Objective To explore the molecular mechanism of ADP-ribose pyrophosphatase NUDT9 inpromoting tumor proliferation. Methods The expression level of NUDT9 in various tumors was determined by analyzing GEPIA2 database. The protein expression was detected by Western blot. The proliferation rate capability was measured by colony forming assay. The cell cycle was detected by flow cytometry analysis. The proportion of cells in S phasewas detected by EdUstaining assay. Ectopic expression of SFB-NUDT9 constructs combined with coimmunoprecipitation （Co-IP） assayand quantitative mass spectrometry were used to identify the interacting proteins of NUDT9. Two sgRNA and siRNA were designed to silence NUDT9 gene expression in tumor cells, and Western blot was used to detect NUDT9 protein expression level and its effect on the stability of proliferation-related proteins. Results Analysis of GEPIA2 database showed that NUDT9 was highly expressed in various tumor cells. The expression of NUDT9was silenced efficiently by two individual sgRNA and siRNA respectively. Clonal formation assay, flow cytometry analysisand EdU proliferation experiments indicated that NUDT9 knockdownsignificantly inhibited the cell proliferation and S phase progression of cancer cells. Co-IP assay further demonstrated that NUDT9 interacted with cell proliferation related MCM2-7 complex, Moreover, NUDT9 knockdown obviously decreased the protein levels of MCM3, while no significant changes were observed in other components of MCM complex. Both clonal formation and EdU proliferation experiments showed that MCM3 knockdown greatly inhibited the proliferation ability as well as the proportion of cells in S-phase. Conclusion NUDT9 accelerated S phase progressions by regulating the protein expression of MCM3,suggesting that it plays an important role in modulating the proliferation capability of tumor cells.

Case Report

A foreign body in the heart due to penetrating cardiac trauma

ZENG Hui, MENG Yuan-li, HUA Ping

2023, 23(06):  514-516.  DOI: 10.3969/j.issn.1009-976X.2023.06.011

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Penetrating heart traumas are immediate life-threatening situations. We present a case report of a 58-year-old man with a foreign body in his right heart. The injury happened while the man was working 14 hours prior to the actual diagnosis. With respect to the size of the foreign body, its close proximity to the right coronary artery, the potential risk of bleeding, embolization, endocarditis or pericarditis, emergency surgical therapy was indicated. The foreign body was successfully removed。

Case report and literature review： hemangiosarcoma of adrenal-glands

DAI Chun-lei, WU Jun-chao, YUAN Shun-hui, ZHAO Zhi-qiang, HE Shu-chen

2023, 23(06):  517-519.  DOI: 10.3969/j.issn.1009-976X.2023.06.012

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Angiosarcoma is a diverse group of soft tissue sarcomas originating in the blood and lymphatic vessels, most commonly occurring in the elderly and in patients with prior radiation or lymphedema. adrenal angiosarcoma occurring in the adrenal gland is very rare, originating in the adrenal cortex, and the etiological factors and biological behavior remain unclear. This paper reports a case of adrenal angiosarcoma, which was diagnosed by pathological examination and immunohistochemistry after laparoscopic resection of adrenal lesion. Combined with this case, this article reviewed the relevant data at home and abroad to summarize the diagnosis and treatment.

Review

Research progress on “textbook outcome” of radical hepatectomy for liver cancer

XIONG Feng, FAN Li-min, ZHANG Dan-tu, JI Ren

2023, 23(06):  520-封三.  DOI: 10.3969/j.issn.1009-976X.2023.06.013

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Textbook outcome （TO） is a novel comprehensive measurement system consisting of multiple outcome parameters. Only when all parameters meet the standards, the surgery is considered to achieve TO. TO represents the optimal therapeutic effect after surgery, meeting patients′ expectations for the “best” medical care. It is also used to evaluate the quality and effectiveness of surgical treatments for the same disease by different teams, as well as the level of hospitals and healthcare costs. It is a new quality evaluation index system. In 2022, the International Hepato-Pancreato-Biliary Association （IHPBA） published an international expert consensus on the specifically defined textbook outcomes of liver surgery （TOLS）, including minimally invasive liver resection （MILR） and open liver resection （OLR）. This article discusses the evaluation criteria and limitations of traditional liver cancer surgery, the concept of TO, the initial application of TO in the field of hepato-pancreato-biliary surgery, the latest international expert consensus on TOLS, and the advantages and limitations of TOLS. It elaborates on the application and prospects of TO in liver cancer surgery.