Clinical application of WeChat MDT in the perioperative period of secondary hyperparathyroidism / 中华内分泌外科杂志

Objective:To observe the application effect of the multi-disciplinary team (MDT) process and program supported by WeChat group in the perioperative period of secondary hyperparathyroidism (SHPT) .Methods:A total of 80 SHPT patients who were hospitalized in Hunan Provincial People’s Hospital and Qidong County People’s Hospital from Jul. 2017 to Oct. 2019 were selected and divided into MDT group (40 cases) and control group (40 cases) according to the principle of complete randomization. In MDT group, there were 21 females and 19 males, aged (48.80±9.08) years old, ranging from 26 to 74 years; in the control group, there were 23 females and 17 males, aged (47.90±8.89) years old, ranging from 24 to 74 years. The control group were given a conventional treatment plan, and the MDT group were implemented with the WeChat MDT process on this basis. The perioperative preparation time, operation time, intraoperative blood loss, postoperative extubation time, and continuous full parathyroid were compared between the two groups. The levels of intact parathyroid hormone (iPTH) and blood calcium and phosphorus were compared with the postoperative complications and patient satisfaction in the two groups. The data in this study were analyzed using SPSS 23.0 statistical software.Results:The preoperative preparation time (4.35±1.12) d, operation time (130.00±32.58) min, intraoperative blood loss (15.75±7.89) ml, and postoperative extubation time (3.80±0.82) d in the MDT group were significantly lower than the preoperative preparation time of the control group (6.86±1.85) d, operation time (162.57±41.65) min, intraoperative blood loss (60.75±11.5) ml, postoperative extubation time (5.97±1.25) d ( P<0.05) 1 week after operation, the iPTH (20.86±1.52) pg/ml and blood calcium level (2.23±0.24) mmol/L of the MDT group were significantly lower than those of the control group (103.47±8.27) pg/ml and blood calcium level (2.87±0.21) mmol/L ( P<0.05) , meanwhile the blood phosphorus level of the MDT group (1.52±0.56) mmol/L was significantly higher than the blood phosphorus level of the control group (1.18±0.25) mmol/L ( P<0.05) . The number of complications in the MDT group (20 cases) was significantly lower than the number of complications in the control group (48 cases) ( P<0.05) ; and the satisfaction of treatment in the MDT group (100.00%) was significantly better than that of the control group (80.00%) ( P<0.05) . Conclusion:The WeChat MDT diagnosis and treatment process and treatment plan are safe and effective, which can effectively shorten the operation time, reduce the operation risk, reduce postoperative complications, and increase patient satisfaction. It can be further promoted in the clinic.

Clinical diagnosis and treatment plan of medullary thyroid carcinoma / 中华内分泌外科杂志

Objective:To explore the key factors affecting the formulation of treatment and prognosis of medullary thyroid carcinoma.Methods:Patient data, clinical characteristics and the results of follow-up of typical cases of 23 patients with medullary thyroid carcinoma admitted to Hunan Provincial People’s Hospital Breast and Thyroid Surgery from Apr. 2007 to Mar. 2020 were retrospectively analyzed. The therapeutic schedule and prognosis of medullary thyroid carcinoma were discussed in combination with ATA guidelines and others.Results:Of the 23 patients with MTC, 22 (95.65%) had elevated serum calcitonin, 15 (65.22%) had elevated carcinoembryonic antigen, 3 (13.04%) had suspected abnormal lymph nodes, and 2 (8.70%) had capsule invasion. Thyroid lobectomy, thyroid lobectomy with lateral lymph node dissection in level VI, total thyroidectomy, total thyroidectomy with lateral lymph node dissection in level VI, total thyroidectomy with bilateral lymph node dissection in level VI, total thyroidectomy with bilateral lymph node dissection in level VI with lymph node dissection in level I, II, III, IV, V or VII were performed in 1, 2, 3, 1, 13, 3 cases respectively. 8 cases had postoperative recurrence (34.78%) , of which 7 cases were caused by the first operation. The level of Ctn increased significantly in 2 cases before operation, who underwent total thyroidectomy with bilateral lymph node dissection in level VI, and no recurrence was found after operation.Conclusions:The key to the biological cure of medullary thyroid carcinoma is standardized surgical treatment. The surgery method cannot be determined simply by calcitonin. The modern treatment of medullary thyroid carcinoma needs to follow the principle of standardization and individualization at the same time.

Therapeutic effect evaluation of the modified nipple orthotic device in the treatment of type Ⅱ and Ⅲ inverted nipple / 中华整形外科杂志

Objective@#To investigate the clinical application and efficacy of treatment in inverted nipple with a kind of lactation function preserved method of minimally invasive surgery.@*Methods@#96 patients with type Ⅱ and type Ⅲ inverted nipple admitted by our hospital from January 2013 to December 2017 were selected for treatment by modified self-made nipple orthotic device. Following up 7 months to 5 years to observe the effect of nipple correction and lactation function.@*Results@#87 cases of the patients received satisfactory therapeutic effect, and the lactation function was not affected; 2 cases of type Ⅱ and 3 cases of type Ⅲ inverted nipple were evaluated as medium, with mild nipple retraction; 4 cases were worn for less than 1 month, and the outcome was poor.@*Conclusions@#The modified nipple orthotic device is suitable for type Ⅱ and Ⅲ patients with inverted nipple, which is simple and effective method in nipple inversion.

Risk factors of seroma formation in breast surgery and its prevention and treatment methods / 国际外科学杂志

Objective To identify risk factors for seroma formation and to explore the related prevention and treatment methods.Methods We collected clinical and pathological data of 92 breast cancer patients undergoing modified radical mastectomy in Hu'nan Provincial People's Hospital,from January to September 2016.Seroma formation was studied in relation to age,tumor size,nodal involvement,the number of lymph nodes removed,flap fixation and external compression dressing.Count date were evaluated by the frequency and percentage,comparison between the groups was analyzed by the chi-square test.Multivariate analysis was performed using Logistic regression analysis.Results Seroma occurred in 45.7％ of patients.Age,tumor size,nodal involvement,the number of lymph nodes removed,flap fixation were risk factors of modified radical mastectomy postoperative seroma.In multivariate logistic regression analysis an association of postoperative seroma formation was noted with the number of lymph nodes removed(OR =1.123,95％ CI:1.036-1.218,P ＜ 0.01),age(OR =1.060,95％ CI:1.006-1.116,P＜0.05),flap fixation(OR=0.363,95％CI:0.135-0.977,P ＜0.05).Conclusion The findings suggest that older patients,with extensive lymph node dissection may more likely to form postoperative seroma,flap fixation can reduce the incidence of seroma.

Distinct outcomes in patients with different molecular subtypes of inflammatory breast cancer

To determine the outcome of patients with luminal A, luminal B, human epidermal growth factor receptor-2 [HER-2] positive, and triple negative molecular subtypes of inflammatory breast cancer [IBC] using a retrospective analysis. This study was conducted between February 2004 and February 2010 in 3 different hospitals in China. The clinical outcomes, pathological features, and treatment strategies were analyzed in 67 cases of IBC without distant metastases. A chi-square test and one-way ANOVA were used to assess outcomes between different subtypes. Overall survival [OS] was analyzed using the Kaplan-Meier method and multivariate analysis was conducted using the Cox regression model. The 2-year OS rate was 55% for the entire cohort. Median OS time among patients with luminal A was 35 months, luminal B was 30 months, HER-2 positive was 24 months, and triple negative subtypes was 20 months, and were significantly different from each other [p=0.001]. Using multivariate analysis, luminal A had 76% [p=0.037], luminal B had 54% [p=0.048], and HER-2 positive subtypes had 47% [p=0.032] decreased risk of death compared with the triple negative subtype. Furthermore, elevated Ki-67 labeling was associated with increased risk of death, while the surgical treatment significantly improved patient survival. Breast cancer subtypes are associated with distinct outcomes in IBC patients. Patients that presented with triple negative IBC had poorer outcome than luminal A, luminal B, and HER-2 subtypes. These results indicate that IBC is a heterogeneous disease similar to the conventional breast cancer

Effects of methylprednislone on alveola septal apoptosis in autoimmune emphysema rats / 中国生化药物杂志

Objective To investigate the effects of methyprednislone on the expression of tumor alveolar septal cell apoptosis in autoimmune emphysema rats,in order to provide a theoretical basis for Chronic obstructive pulmonary disease(COPD)pathogenesis and it’s treatment.Methods 24 rats were randomly divided into three groups:normal control group (n=8 ),model group (n=8 )and intervention group (methylprednisolone sodium succinate,n=8).Intraperitoneal injection of primary cultured human umbilical vein endothelial cells were given to establish the autoimmune emphysema models,intervention group was injected with methylprednisolone at the meantime,and normal control group was received adjuvant only.Pathological changes were observed in lung tissues stained by hematoxylin eosin,mean liner intercept(MLI)and mean alveolar numbers(MAN)were measured.The localization of VEGF and VEGFR-2 in lung tissues were detected by immunohistochemical analysis.Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)technique was carried out to detect the alveolar septal cells apoptosis. Results The MLI in model group was higher than that in normal control group,while MAN was lower(P<0.05 );MLI in intervention group was lower than that in model group,but the MAN was higher (P<0.05 ).The localization of VEGF and VEGFR-2 in lung tissues in model group were lower than that in normal control group,and those in intervention group were higher than that in model group,the difference were all statistically significant(P<0.05 ).AI of alveolar septal cell in model group was higher than that in normal control group,which in intervention group was higher than that in model group,the difference were all statistically significant(P<0.05).Conclusion The decreasing of VEGF and VEGFR-2 in lung tissues may cause alveolar septal cell apoptosis and contribute to the pathogenesis of autoimmune emphysema of rats.Methyprednislone can alleviate the form of autoimmune emphysema in rats,which may be ralated to the regulation of VEGF and VEGFR-2 expression and inhibition of alveolar septal cell apoptosis.

Study on serum levels of vitamin D and calcium and expression of tissue calcium-sensing receptor in the breast cancers / 中国医师杂志

ObjectiveTo explore the relationship among 25-hydroxyvitamin D,serum calcium,calcium-sensing receptor,and breast cancer. Methods The expressions of calcium-sensing receptor (CaSR) in primary breast cancer,breast benign tumors,and normal breast tissue beside tumors were determined by immunohistochemistry S-P method as well as the concentration of serum 25 (OH) D and serum calcium in breast cancer and breast benign tumors by Enzyme-linked immunosorbent assay (ELISA),Tribromoarsenazo Ⅲ method.ResultsSerum 25 (OH) D level of breast cancer was significantly lower than the breast benign tumors [ (34.13 ± 14.14) nmol/L vs (50.29 ± 25.65 ) nmol/L,t =2.870,P =0.001 ].Serum level of 25 ( OH ) D in lymph node metastasis positive patient was lower than that in negative group [ (30.8 ± 9.71 ) nmol/L vs (43.7 ± 23.59) nmol/L,t =2.467,P =0.021 ].The positive expression of CaSR in breast cancer(88.9％ )was higher than breast benign tumors(60％,x2 =6.717,P ＜ 0.01 ) and normal breast tissue beside tumors (60％,x2 =5.628,P ＜ 0.05 ).ConclusionsConcentration of serum 25 (OH)D and expression of calcium-sensing receptor in the tissues may be associated with occurrence,development and prognosis of breast cancer.

The expression and clinical significance of CXCR3/CXCL10 in human breast cancer / 中国医师杂志

Objective To investigate the expression and clinical significance of CXCR3/CXCL10in human cancer.Methods CXCR3 and CXCL10 were detected in 60 paraffinic tissues of patients with primary breast cancer,20 of mammary fibroma and 20 of mastopathy by immunohistochemistry S-P method and two stage method.Results The expression of CXCR3 (40/60,66.7％ ) and CXCL10 (45/60,75％)in breast cancer was higher than that in mastopathy [CXCR3(8/20,40％ )x2 =4.44,P =0.035 ;CXCL10( 10/20,50％ )x2 =4.36,P =0.037)].The expression of CXCR3 was related to status of axillary lymph node metastasis,clinical stage and the expression of HER-2 (x2 =4.15,P =0.042; x2 =7.74,P =0.021 ;x2 =4.27,P =0.039).The expression of CXCR3 had positive relationship to the number axillary lymph node metastasis( rs =0.375,P =0.003 ),clinical stage ( rs =0.451,P =0.000).Conclusions CXCR3 may be related to the progression and metastasis of breast cancer,and it may be used as a marker of breast cancer prognosis.

The relationship of vitamin D receptor and β-catenin pathway in intestinal tumor growth / 中国医师杂志

Objective To explore the effect of vitamin D receptor (VDR) in intestinal tumor development and the relationship between VDR and β-catenin signaling pathway. Methods The interaction of vitamin D receptor and β-catenin were detected by co-immunoprecipitation assay after human colonic carcinoma cells SW480 were treated with vitamin D in vitro for 4 hours. The expression of E-cadherin protein was detected by Western blot after treated for 24 hours. To compare APCmin/+VDR-/- and APCmin/+ mice in vivo, the expression of VDR,β-catenin and BrdU proteins in intestinal tumor were determined by immunohistochemistry. The expression of β-catenin protein in tumor and adjacency intestinal was further determined by Western blot. Results After SW480 cells were treated with vitamin D, vitamin D receptor and β-catenin protein showed binding, the expression of E-cadherin protein further increased (Gray value the control group 145.57±4.21,Gray value of the experimental group 109.35±3.56,t＝32.63,P＜0.05). Immunostaining and Western blot detection（Gray value 166.47±2.36） showed a marked increase of β-catenin level(Gray value 140.51±2.57) in APCmin/+VDR-/- tumor compared to APCmin/+ tumor(145.41±3.62,182.35±3.24,t＝2.65,4.36,P＜0.05). Conclusions The role of vitamin D suppressing intestinal tumor may be achieved through VDR affectingβ-catenin signaling pathway.

Liquid flow field measurement in a tube with a combination of stenosis and bifurcation / 生物医学工程学杂志

Two-D liquid velocity field in a tube with a combination of a stenosis and a bifurcation was measured with refractive index matching technique using Laser Doppler Velocimeter (LDV). The flow ratio of main tube to bypass was 1:4. It is found that the axial velocity profile has two peaks in the XOY plane which is skewed to the main tube wall facing the flow from the bypass, and it manifests itself in the form of "M" in the XOZ plane. A two counter-rotating vortices in the main tube cross section downstream the conjunction region is also detected.