Retrospective analysis of BI-RADS 4 and 5 lesions additionally detected by breast MRI / 中华外科杂志

Objectives: To establish a newly-designed scoring system for breast imaging-reporting and data system (BI-RADS) 4 and 5 breast lesions only visible on MRI, and to examine their clinical pathway of biopsy. Methods: The BI-RADS 4 and 5 breast lesions only visible on MRI but not suspected on mammograms or ultrasound between June 2007 and December 2021 at Beijing Hospital were evaluated retrospectively. A total of 209 lesions from 184 patients were finally included. All patients were female, aged (50±11) years (range: 27 to 76 years). All lesions were confirmed by pathology and divided into malignancy and non-malignancy. The lesions were divided into mass and non-mass type using BI-RADS. The receiver operator characteristic (ROC) curve was used to evaluate the diagnostic performance of the new scoring system. Four types of pathology-obtaining pathway were used: biopsy guided by second-look ultrasound, local excision guided by lesion position information on MRI, intraductal lesion excision guided by methylene blue stain and mastectomy. The data between mass and non-mass lesions were compared by Mann-Whitney U test, χ2 test or Fisher exact test,respectively. Results: There were 124 malignant and 85 non-malignant lesions, while 100 mass and 109 non-mass lessions. The sizes between mass and non-mass lesions showed significant difference(M(IQR)) (7.0 (3.0) mm vs. 25.0 (25.0) mm, U=568.000, P<0.01) and their BI-RADS diagnostic accuracy had no significant difference (53.0% (53/100) vs. 65.1% (71/109), χ2=3.184, P=0.074). The areas under ROC curve of the new scoring system for evaluating mass and non-mass were 0.841 and 0.802, respectively. When taking Score 3 as threshold, it can potentially avoid 14.0% (14/100) and 4.6% (5/109) of biopsies in mass and non-mass, respectively. As to pathway of obtaining pathology, second-look ultrasound succeeded more easily in mass than non-mass (41.0% (41/100) vs.26.6% (29/109), χ2=4.851, P=0.028). More MRI-guided local excisions were performed in non-mass than mass (52.3% (57/109) vs. 34.0% (34/100), χ2=7.100, P=0.008). Conclusions: For suspicious breast lesions detected by MRI but not suspected on X-ray or ultrasound, the new scoring system can further increase diagnostic accuracy. The second-look ultrasound plays an important role for obtaining pathology, especially for mass-type lesion.

Value of contrast-enhanced ultrasonography in evaluating the efficacy of neoadjuvant chemotherapy for triple negative breast cancer in the elderly / 中华老年医学杂志

Objective To evaluate the value of contrast-enhanced ultrasonography(CEUS)in neoadjuvant chemotherapy(NAC) for triple negative breast cancer(TNBC)in the elderly.Methods A total of 16 elderly patients with TNBC admitted to hospital from October 2017 to June 2018 were selected,and they underwent ultrasound examination before treatment.Changes in lesion size and time intensity curve (TIC)parameters were compared against postoperative microscopic diagnoses,which were used as the gold standard,to evaluate the effect of NAC in elderly TNBC patients.Results Compared with pre-treatment imaging data,the sum of the diameters of target lesions was reduced by 38.0％ after NAC treatment[(7.29±1.62)cm vs.(4.52± 1.21)cm,t =2.313,P＜0.05],and TIC parameters showed that the peak intensity(PI)and the time to peak(TTP)and the slope of the ascending part of the curve,or Grad,were statistically different between pre and post-NAC treatment measurements[(-65.14± 3.75)dB vs.(57.67± 1.93)dB,(11.57±7.34)s vs.(5.35±0.83)s,(1.21±0.27) vs.(2.29± 0.45),t =3.512,2.271 and 2.727,P =0.003,0.049 and 0.026,respectively].When compared with microscopic examination results,CEUS TIC analysis for evaluating the efficacy of NAC showed an accuracy of 87.5％ (14/16),a sensitivity of 92.9％ (13/14),a specificity of 50.0％ (1/2),a positive predictive value of 81.3％ (13/16) and an inter-method kappa value of 0.429(x2=0.500,P=0.230).Using CEUS to evaluate the efficacy of NAC achieved an accuracy rate of 81.3％(13/16).Conclusions CEUS can effectively evaluate the efficacy of NAC in elderly patients with TNBC,and guide the clinician to develop an accurate,individualized treatment program benefiting the patients.

Comparison of prognosis between invasive micropapillary carcinoma and invasive ductal carcinoma of breast: a single center, retrospective case-control study / 中华外科杂志

Objective@#To elucidate the clinicopathological characters and prognostic factors of invasive micropapillary carcinoma of the breast (IMPC) by compared with invasive ductal carcinoma, not otherwise specified of the breast (IDC).@*Methods@#The retrospective study was performed with female patients who had undergone curative resection for breast cancer without neoadjuvant chemotherapy from June 2008 to April 2016 in Breast Center of Beijing Hospital. Forty-seven mixed or pure IMPC patients and 93 pure IDC patients(admitted in the same center from October 2008 to January 2016 ) were matched for tumor stage, nodal status and age. Follow-up was done every 3 to 6 months postoperatively. The deadline was July 31, 2016. The curves of disease free survival and overall survival were drawn by the Kaplan-Meier method, and survival rates were compared by means of the Log-rank test. Potential prognostic variables that were identified on univariate analysis were analyzed with Cox′s proportional hazards regression model for multivariate analysis. The χ2 test or Fisher′s exact test was used to compare distributions across 2 groups and the Mann-Whitney U test or t test was used to analyze the medians or means of 2 groups.@*Results@#With exact matches, the rates of lymphovascular invasion (LVI) (29.8% vs. 12.9%, χ2=5.885, P=0.015)and histological grade 3 (40.4% vs. 21.5%, χ2=-2.690, P=0.007) were both significantly higher in patients with IMPC than that in IDC group, but the survival between the two pathological types were not significantly different (all P>0.05). The percent of IMPC component didn′t influence the clinicopathologic characters (all P >0.05), but a significantly longer median disease free survival (χ2=11.731, P=0.001) when the patients had more than 50% of IMPC component was found.@*Conclusions@#Higher rates of LVI and histological grade 3 were found in IMPC than that in IDC, but the survival was comparable between the two groups. A longer DFS occurred in patients with IMPC component more than 50%.

Characteristics as well as prevention and control costs of occupational ex-posure to blood-borne pathogens / 中国感染控制杂志

Objective To study the characteristics of occupational exposure to blood-borne pathogens and the cost of prevention and control,and provide evidence for policy making in medical institutions.Methods A prospective study was conducted to collect the data and follow-up data about occupational exposure of health care workers(HC-Ws)from the occupational exposure reporting system of a hospital between June 1,2016 and May 30,2017.Results There were 95 cases of occupational exposure to blood-borne pathogens.Occupational exposure occurred mainly in June,July,and November,peak time for occurrence was 12∶00 at noon.The main occupations of HCWs who sustained occupational exposure were nurses (41.05%),doctors (28.42%),and practice nurses (15.79%).The main departments of occupational exposure were central operating room (21.05%), emergency department (1 1.58%),and interventional radiology department (6.32%).The total cost of prevention and control for 95 times of occupational exposures were 33 235.20 Yuan,with an average of 349.84 Yuan per case.The average cost per case after human immunodeficiency virus (HIV)exposure was the highest (2 787.50 Yuan);and cost of syphilis exposure was the lowest (58.88 Yuan).Conclusion It is necessary to strengthen the training and education of high-risk time,high-risk population,and high-risk departments of occupational exposure to blood-borne pathogens,pre-vention of occupational exposure with high cost of prevention and control such as HIV should be especially paid attention.

Effects of bevacizumab on morphology and apoptosis of human retinal pigment epithelial cells as well as the expression of apoptosis-related factors / 眼科新进展

Objective To investigate the effects of bevacizumab on cell morphology,apoptosis rate and apoptosis-related factors in human retinal pigment epitheliumcells.Methods Human retinal pigment epithelial cells (ARPE-19) were cultured in DMEM/F1 2 medium containing 0.25 g · L-1 bevacizumab and divided into 1-week dosing group and 2-week dosing group according to the different incubation time,respectively.Meanwhile,the control group was set up.Then,the cell morphology and apoptosis of each group were observed by light microscope and flow cytometry,accordingly.The expression levels of apoptosis-promoting genes P53,TP53INP1,Bax and apoptosisinducible gene Bcl-2 mRNA and protein were detected by RT-PCR and Western blot,respectively.Results Light microscopic observation revealed that the cells in the 1-week control group and the 2-week control group showed typical epithelial cell morphology,and were in stone-like,single-layer adherent-like growth.Compared with the control group,part of the cell morphology after bevacizumab treatment changed slightly,and the cells became rounded,the cell body was elongated and the boundary was poor.The apoptotic rates of the 1-week control group,l-week dosing group,2-weekcontrol group and 2-week dosing group were (5.57 ± 1.46) ％,(6.39 ± 1.25) ％,(6.88 ± 1.10)％ and (13.34 ± 1.94)％,respectively,and there was no significant difference in the apoptotic rate between 1-week control group,1-week dosing group and 2-week control group (both P ＞ 0.05),but the apoptotic rate of the 2-week dosing group was significantly higher than that of the 2-week control group,the 1-week dosing group and 1-week control group,and the differences were statistically significant (all P ＜0.01).RT-PCR and Western blot results showed that compared with the 1-week control group,the expression of P53,TP53INP1 and Bax mRNA was up-regulated in 1-week dosing group,but the expression of Bcl-2 mRNA was down-regulated,and the differences were statistically significant (all P ＜ 0.05).The expression levels of P53,TP53INP1 and Bax mRNA in 2-week dosing group were higher than those in 2-week control group and 1-week dosing group,while Bcl-2 mRNA expression was down-regulated,and the differences were statistically significant (all P ＜ 0.05).There was no significant difference in the expression of the above factors in 1-week control group and 2-week control group(all P ＞ 0.05).The protein expressions of above factors were similar to their mRNA expression.Conclusion Bevacizumab can alter the morphology of ARPE-19 ceils,increase the apoptotic rate and up-regulate the expression of apoptosis-promoting factors,but down-regulate the expression of apoptosis-suppression factors in ARPE-19 cells,which may be the reason for the loss of RPE layer in the macula after anti-VEGF therapy.

Simultaneous determination of donafenib and its N-oxide metabolite in human plasma by liquid chromatography-tandem mass spectrometry / 药学学报

Donafenib is the deuterium derivative of sorafenib, and is an anti-tumor drug in clinical trials. An accurate and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for the simultaneous determination of donafenib and its N-oxide metabolite in human plasma. The analytes and internal standards (sorafenib and sorafenib N-oxide) were extracted from plasma by protein precipitation with acetonitrile, and separated on a Gemini C18 (50 mm×2.0 mm, 5 μm) column using a gradient elution procedure. The mobile phase consisted of acetonitrile and 5 mmol·L-1 ammonium acetate (0.2% formic acid) at a flow rate of 0.7 mL·min-1. The total run time was 5.0 min. Positive electrospray ionization was performed using multiple reaction monitoring (MRM) with transitions of m/z 468.2→273.2 for donafenib and m/z 465.2→270.2 for its internal standard sorafenib, m/z 484.2→289.2 for donafenib N-oxide and m/z 481.2→286.2 for its internal standard sorafenib N-oxide. The standard curves were linear in the range of 5.00-5 000 ng·mL-1 for donafenib, and 1.00-1 000 ng·mL-1 for donafenib N-oxide. The method was validated and successfully applied to the pharmacokinetics study of donafenib tosylate tablets in volunteers.

The comparison of characters between invasive micropapillary carcinoma and invasive ductal carcinoma not otherwise specified of the breast / 中华外科杂志

Objective@#To analyze the differences of clinicopathological characters and prognostic factors between invasive micropapillary carcinoma of the breast (IMPC) and invasive ductal carcinoma (IDC) not otherwise specified of the breast.@*Methods@#Patients who were treated from June 2008 to April 2016 in Breast Center of Beijing Hospital were retrospectively analyzed to evaluate the differences between IMPC (n=59) and IDC (n=1 080). Follow-up was done every 3 to 6 months postoperatively with a deadline of July 31, 2016. The curves of disease free survival (DFS) and overall survival (OS) were drawn by Kaplan-Meier method, and survival rates were compared by means of the Log-rank test. Potential prognostic variables which were identified on univariate analysis were analyzed with Cox′s proportional hazards regression model for multivariate analysis.@*Results@#More lymph nodes were involved in IMPC group (χ2=12.168, P=0.007) which led to more later stage in this group (χ2=8.950, P=0.011). IMPC group displayed a significantly increased rate of lymphovascular invasion (LVI) compared to IDC group (χ2=13.511, P = 0.001). The expression rate of estrogen receptor (ER) and progesterone receptor (PR) was higher in IMPC group than that in IDC group (89.8% vs. 76.3% and 88.1% vs. 70.7%, respectively, χ2=5.786, 8.332, all P<0.05). In multivariate analysis performed with the variables found significant in univariate analysis, the only variable found significantly affecting DFS of IMPC group was the T stage (T1-2 and T3-4, OR=5.217, 95%CI: 1.401 to 19.430, P=0.014), while in IDC group, pathological stage (stage Ⅰ to Ⅱ and stage Ⅲ to Ⅳ, OR=1.870, 95% CI: 1.262 to 2.771, P=0.002), lymph node positive ratio (LNR) (OR=2.222, 95%CI: 1.561 to 3.162, P=0.000), PR (OR=1.856, 95%CI: 1.118 to 3.082, P=0.017), and age (<50 years old and ≥50 years old, OR=0.695, 95%CI: 0.488 to 0.989, P=0.043) were prognostic factors. There were two variables found significantly affecting OS of IMPC group, which were T stage (OR=3.713, 95%CI: 1.539 to 8.959, P=0.004) and LNR (OR=2.850, 95%CI: 1.033 to 7.862, P=0.043). While in IDC group, LNR was the only variable found significantly affecting OS (OR=2.129, 95%CI: 1.324 to 3.425, P=0.002). Compared with IDC, the patients with IMPC were more likely to have local or regional recurrence (P=0.006). Although the median DFS interval was longer in IDC group (χ2=9.739, P=0.002), the median OS interval was comparable between the two groups (χ2=0.787, P=0.375).@*Conclusion@#Although IMPC has lymphotropic feature, tendency of LVI and local or regional recurrence, it has an OS which is comparable with IDC.

Hemostatic Effect of Hemocoagulase Agkistrodon on Surgical Wound in Breast Cancer Surgery / 中国医学科学院学报

Objective To evaluate the hemostatic effect of hemocoagulase agkistrodon on surgical wound in breast cancer surgery. Methods Totally 60 patients undergoing breast cancer surgery were enrolled in this prospective,randomized,double-blinded,and controlled study. All the patients met the inclusion and exclusion criteria and signed the informed consent. Hemocoagulase agkistrodon (2 U) was injected 20 minutes before surgery and 4 and 24 hours after surgery in the intervention group (n=30),whereas normal saline was used instead in the control group (n=30). The volume of intraoperative bleeding,wound drainage volume 1-3 days after surgery,and total drainage volume were recorded. Meanwhile,the change of blood coagulation function,treatment safety,and clinical outcomes were observed. Results The intra-operative hemorrhage volume of the intervention group [(95.0±48.3)g] was significantly lower than that of the control group [(144.8±105.4)g] (t=-2.07,P=0.044). The volume of total drainage of the intervention group [(166.7±71.2)g] was significantly lower than that of the control group [(251.4±166.3)g] (t=-2.29,P=0.029). The hemoagglutination indicators were similar in the two groups and no complication such as thrombosis occurred. The length of hospital stay of the intervention group [(15.00±3.53)d] was similar to that of the control group [(15.92±2.32)d] (t=-1.057,P=0.297). No research drug-related adverse event was occurred in our study. Conclusion Hemocoagulase agkistrodon has good hemostatic effect for patients undergoing breast cancer surgery without increasing the risk of thrombosis.

Clinical significance of molecular subtypes of breast cancer in patients aged over 60 years / 中华老年医学杂志

Objective To retrospectively analyze the distribution percentage points of molecular subtypes of breast cancer and investigate its guiding significance in the prognosis and personalized therapy in patients with breast cancer aged over 60 years.Methods A retrospective analysis of all patients with invasive breast cancer aged over 60 years from January 2009 to June 2014 in Breast Center of Beijing Hospital was performed.Based on the immunohistochemical methods recommended in the St.Gallen International Expert Consensus Report 2013,the molecular subtypes of breast cancer in these patients were identified.All patients were followed up every 6 months after operation until December 2014.Clinical pathological characteristics and prognosis indexes in different molecular subtypes of breast cancer were evaluated.Results Totally 770 patients aged over 60 years with invasive breast cancer met the criterion.The luminal A,luminal B,human epidermal growth factor receptor 2 (HER2) over-expression,triple-negative subtypes accounted for 29.1％ (224 cases),47.5 ％ (366 cases),6.5 ％ (50 cases) and 16.9 ％ (130 cases)of patients,respectively.The luminal A subtype of breast cancer had larger tumor size,more lymph node metastasis and more late TNM stage as compared with other subtypes(all P＜0.01).Univariate and multivariate analysis showed that aged ≥ 80 years and the triple-negative molecular subtype were the independent poor prognostic factors for breast cancer(both P＜0.05).The luminal A subtype of breast cancer had relatively good prognosis,while the triple-negative subtype had relatively poor prognosis.Conclusions Molecular subtypes have a significant prognostic effect on breast cancer in patients aged over 60 years,which suggests molecular subtype can be considered as a reference indicator in personalized therapy.Patients aged over 80 years has poor prognosis due to less rational treatment.The reasonable and target treatment based on the molecular subtype of breast cancer should be provided for patients aged over 80 years in clinical medicine.

Research on Rapid Initial Adaption to the Environment of a Plateau / 生物医学与环境科学（英文）

We designed two types of pre-adaption plans for this study. One was a pre-adaption training with progressive intermittent hypoxia, with a constant lower pressure oxygen tank used in the plain before arriving at the plateau (PG). The other was by progressively increasing the time of exposure to hypoxia with oxygen supplied in stages after radical plateau (RG). By testing the blood oxygen saturation (SpO2), heart rate (HR), and quality of sleep after arriving at the 3800 m high plateau, results showed that the pre-acclimatization and radical groups performed better than the control group (CG). Both strategies were equivalent in terms of effects and principles in providing more flexible choices for acclimatization.

Efficacy of structured triglycerides in parenteral nutrition in elderly patients with acute biliary tract infection / 中华老年医学杂志

Objective To investigate the safety and efficacy of structured triglycerides in parenteral nutrition in elderly patients with acute biliary tract infection.Methods 62 elderly patients with acute biliary tract infection under conservative therapy were randomly divided into structured triglycerides (ST) group and medium-chain triglycerides plus long-chain triglycerides (MCT/LCT) group.Patients underwent parenteral nutrition for 5 days.Levels of hepatic enzymes,blood triglycerides,nitrogen balance,fasting blood insulin and glucose were compared between the two groups after 5 days of parenteral nutrition.Results There were no significant differences in levels of hepatic enzymes,blood triglycerides and fasting blood glucose between ST group and MCT/LCT group.Plasma total bilirubin (T-Bill) levels were increased in the two groups,and T-Bill level dropped faster in the ST group than in the MCT/LCT group after 7 days of parenteral nutrition(P＜ 0.05).The difference in total cholesterol level dropping was significant between ST group and MCT/ LCT group (P＜0.05).The cumulative nitrogen balance for 5 days had significant difference between ST and MCT/LCT groups [(4.7-±-2.2) g vs.(2.8±0.7) g,P＜0.05].STG group versus MCT/LCT group had less fluctuation of fasting blood insulin level after 1,4 and 7 days of parenteral nutrition.Conclusions In the acute phase of biliary tract infection in elderly patients,ST-based parenteral nutrition can provide energy and help maintain nitrogen balance,with a little fluctuation of fasting blood insulin level.Short-term nutritional support may have better tolerance in the liver and has little effect on the change of hepatic enzymes.

Initial CT-guided percutaneous biopsy of vertebral lesions: Evaluation of its diagnostic accuracy and clinical value / 华中科技大学学报（医学）（英德文版）

This study aimed to examine the diagnostic accuracy and clinical efficacy of initial CT-guided percutaneous biopsy of the vertebral lesions. A total of 305 percutaneous biopsies of the vertebral lesions were performed under either CT guidance (n=127) or C-arm guidance (n=178). The diagnostic accuracy rate was evaluated by comparing the histopathological diagnosis with the ultimate diagnosis. The histopathological diagnosis was consistent with the ultimate diagnosis in 108 (85.0%, 108/127) cases of CT-guided biopsy and in 135 (75.8%, 135/178) cases of C-arm guided biopsy and there was a significant difference. The accuracy of diagnosis based on biopsies varied with different diseases, including primary benign or malignant tumors, metastatic tumors, inflammatory lesions and fractures. A second biopsy or further examinations were required for patients with negative result obtained in the initial biopsy. The complication rate was 3.1% (4/127) in CT-guided biopsy and 7.3% (13/178) in C-arm guided biopsy. In conclusion, CT-guided percutaneous biopsy is an accurate and safe technique for biopsy of the vertebral lesions.

Analysis of clinical and pathological characteristics of breast carcinoma in elderly female patients / 中华老年医学杂志

Objective To analyze the clinical and pathological characteristics of breast carcinoma in elderly female patients and to offer the standard clinical diagnosis and treatment for breast carcinoma.Methods A total of 178 patients admitted to Breast Center of Beijing Hospital from January to December 2011 were enrolled in this retrospective study.Patients were divided into non-elderly group and elderly group.Clinical features,imaging diagnosis,operation patterns and pathological diagnosis were recorded.The data were analyzed by using SAS 9.1 software.Results The patients diagnosed as breast carcinomas in BI-RAD 4-5 categories by mammography were much more in the elderly group than in the non-elderly group (82.1％ vs.63.0％,P＜0.05).The diagnostic accuracy rates of ultrasonography and mammography in the elderly group were comparable(P＞ 0.05),while in the non-elderly group,the diagnostic accuracy rate of ultrasonography was higher than that of mammography (P＜0.05).The incidence of concurrent diseases was higher in the elderly group than in the non-elderly group (P＜0.05).The patients undergoing breast resection operation were much more in the elderly group than in the non-elderly group (14 cases vs.3 cases,P＜0.05).The pathological diagnosis analysis showed that there were no significant differences in the number of ER-positive cells and PR-positive cells,tumor size,histological grade,pathological stage between the two groups (all P＞0.05).The incidence of lymph node metastasis was lower in the elderly group than in the non-elderly group (P＜0.05).The percentage of Ki-67 positive cells was lower in the elderly group than in the non-elderly group (P＜0.05).The percentage of CerbB-2 strongly positive (+++) cells was lower in the elderly group than in the non-elderly group (5.1 ％ vs.24％,P＜0.05).The invasive ductal carcinoma was the major histological type of breast cancer in both two groups,but there were more mixed type and other type carcinomas in the elderly group than in the non-elderly group (P＜0.05).Conclusions Ultrasonograpy and mammography have better sensitivity for breast cancer in elderly female patients.The surgical protocols are often influenced because more concurrent diseases have occurred in the elderly.There are significant differences in some prognostic factors between the two groups,which may imply a better prognosis in elderly patients.

Differentiation of human promyelocytic leukemia HL-60 cells induced by proanthocyanidin and its mechanism / 中国实验血液学杂志

This study was purposed to investigate the proliferation, differentiation and apoptosis of human promyelocytic leukemia HL-60 cells induced by proanthocyanidin (PAC). HL-60 cells were incubated with 20 mg/L PAC for 24 h, the cell growth was evaluated by CCK-8 assay. the effect of PAC on HL-60 cells was evaluated and the cells morphology was observed by optical microscopy. Expression of CD14 and CD11b, and cell cycle were analyzed by flow cytometry. The results showed that the growth of HL-60 cells was inhibited after treatment with PAC of different concentration in a dose-dependent manner (P < 0.05). 20 mg/L PAC displayed significant effect on HL-60 cells with inhibition ratio (72.3 ± 1.8)% for 24 h. Microscopy displayed that some cells differentiated to relative mature cells after treating for 48 h. Expression of CD14 increased and the expression of CD11b increased a little after treating with 20 mg/L PAC for 24 h, the ratio of cells in G0/G1 phase increased, but the ratio of cells in S phase decreased. The mRNA and protein expression of P21 gene increased, but the protein expression of CDK4 and Cyclin D1 decreased. It is concluded that PAC may inhibit the proliferation of HL-60 cells in vitro, induces the differentiation of HL-60 cells, and arrests the cells in G0/G1 phase. The possible mechanism may be related to up-regulation of P21 gene expression and down-regulation of the protein expression of CDK4 and Cyclin D1.

Expression of BARD1 in sporadic breast carcinoma of the female Han ethnic group and its clinical significance / 中华普通外科杂志

Objective To evaluate the potential relationship between isoforms of BRCA1 associated RING domain 1 ( BARD1 ) and the pathophysiologic markers of sporadic breast carcinoma of female Han ethnic group. Methods The expression of BARD1 isoforms in 39 breast carcinomatous tissue, 12paracancerous-normal breast tissue and 7 controlled normal breast tissue was detected by reverse transcription polymerase chain reaction (RT-PCR) and then cloned and sequenced.The difference of isoforms expression and their clinical significance were analyzed. Results There were four transcriptive products of BARD1 found in all these candidates,named full lenth,isoform γ,isoform δ and isoform e.The positive rate of isoform γ and δ was higher in carcinomatous tissues than in paracancerous-normal tissues and normal breast tissue in healthy women ( P ＜ 0.05 ). Carcinomatous tissue expressed more kinds of isoforms.There was significant difference between carcinomatous tissue and paranormal/nomal tissue ( P =0.0075 ).There was significant correlation between isoform ε positive and poor prognosis factors such as poorly differentiation,HER2 positive,poor pathologic type and larger breast cancer lumps(P ＜ 0.05 ). Conclusions There are significant differences in the expression of BARD1 isoforms among different kinds breast tissues in the female Han ethnic group.Positive isoform ε may predict poor prognosis of breast carcinoma in the female Han ethnic group.

Impact of fish oil enriched total parenteral nutrition on elderly patients after colorectal cancer surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Polyunsaturated omega-3 fatty acids may beneficially influence healing processes and patient outcomes. The aim of this research was to study the clinical efficacy of fish oil enriched total parenteral nutrition in elderly patients after colorectal cancer surgery.</p><p><b>METHODS</b>Fifty-seven elderly patients with colorectal cancer were enrolled in this prospective, randomized, double-blind, controlled clinical trial. All patients received isocaloric and isonitrogenous total parenteral nutrition by continuous infusion (20 - 24 hours per day) for seven days after surgery. The control group (n = 28) received 1.2 g/kg soybean oil per day, whereas the treatment group (n = 29) received 0.2 g/kg fish oil and 1.0 g/kg soybean oil per day. Blood samples were taken pre-operatively, and at days one and eight after the operation. The plasma levels of CD4, CD8, CD4/CD8, interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were measured. Clinical outcomes were then analysed.</p><p><b>RESULTS</b>Patient characteristics were comparable between the two groups. At day eight post-surgery, IL-6, TNF-α and CD8 titres were lower in the treatment group when compared to the control group; these results reached statistical significance. In the treatment group, there were fewer infectious complications and incidences of systemic inflammatory response syndrome (SIRS), and shorter lengths of hospital stay were observed. The total cost of medical care was comparable for the two groups. No serious adverse events occurred in either group.</p><p><b>CONCLUSIONS</b>Fish oil 0.2 g/kg per day administrated to elderly patients after colorectal surgery was safe and may shorten the length of hospital stay and improve clinical outcomes.</p>

Diagnostic significance of Th1/Th2 cytokine pattern in childhood hemophagocytic lymphohistiocytosis / 中华儿科杂志

<p><b>OBJECTIVE</b>To illustrate the diagnostic value of Th1/Th2 cytokine pattern in childhood hemophagocytic lymphohistiocytosis (HLH) and its diagnostic accuracy.</p><p><b>METHOD</b>The BD(TM) CBA Human Th1/Th2 Cytokine Kit II was used to measure the serum Th1 and Th2 cytokines, including Interferon-gamma (IFN-γ), tumor necrosis factor (TNF), interleukin (IL)-10, IL-6, IL-4 and IL-2 in 50 patients with de novo HLH admitted to our hospital from Oct. 2005 to Aug. 2009. The above cytokine levels were also determined in 250 healthy volunteers and 235 patients with sepsis as controls.</p><p><b>RESULT</b>The primary features of these patients were prolonged high-grade fever (50/50), hepatomegaly (44/50), splenomegaly (38/50), hemocytopenia (47/50), hyperferritinemia (49/50), coagulopathy (44/50), hemophagocytosis in bone marrow (42/50), liver dysfunction (42/50) and hypertriglyceridemia (42/50). The IFN-γ, TNF, IL-10, IL-6, IL-4 and IL-2 levels for healthy children were (4.6 ± 1.8) ng/L, (4.0 ± 1.2) ng/L, (6.5 ± 1.3) ng/L, (6.0 ± 1.5) ng/L, (2.9 ± 0.8) ng/L and (2.6 ± 0.7) ng/L, while the median levels of them in acute phase of HLH children were 1138.5 (49.2 - 5000.0) ng/L, 3.4 (1.0 - 25.1) ng/L, 740.5 (26.5 - 5000.0) ng/L, 66.1 (3.9 - 4472.6) ng/L, 3.9 (1.0-32.8) ng/L and 4.0 (1.0 - 51.1) ng/L, respectively. The cytokine levels decreased to 9.1 (1.9 - 180.1) ng/L, 2.9 (1.0 - 11.0) ng/L, 11.4 (2.9 - 184.2) ng/L, 6.5 (1.0 - 44.8) ng/L, 2.7 (1.0 - 6.5) ng/L and 4.1 (1.0 - 12.0) ng/L respectively after remission. The IFN-γ, IL-10 and IL-6 levels in acute phase were significantly higher than those after remission and those of the healthy control (P all < 0.001). IL-4, IL-2 and TNF slightly elevated or at normal range in acute phase of HLH. The patients with sepsis showed a different cytokine pattern, with an extremely high level of IL-6 (median: 251.3 ng/L, range: 8.4- > 5000.0 ng/L) and moderately elevated level of IL-10 (median: 46.5 ng/L, range: 3.1 - 5000.0 ng/L), whereas IFN-γ was only slightly elevated (median: 9.2 ng/L, range: 1.3 - 498.8 ng/L). When the criteria for HLH set as the following: IFN-γ > 100 ng/L, IL-10 > 60 ng/L and the concentration of IFN-γ higher than that of IL-6, the specificity reached as high as 98.7% and the sensitivity was 88.0% for the diagnosis of HLH among patients with HLH and sepsis. Meanwhile, the positive predictive value (PPV) and negative predictive value (NPV) could reach 93.6% and 97.5%, respectively.</p><p><b>CONCLUSION</b>The significant increase of IFN-γ and IL-10 with slightly increased level of IL-6 is a sensitive and specific cytokine pattern for childhood HLH, which is helpful for its diagnosis and differential diagnosis.</p>

Comparison of the benefits of combined nutrition support with enteral nutrition and parenteral nutrition versus sole parenteral nutrition support for elderly patients after pancreaticoduodenectomy / 中华临床营养杂志

Objective To compare the benefits of the combined nutrition support with enteral nutrition (EN)and parenteral nutrition(PN)versus sole PN for elder patients after pancreaticoduodenectomy.Methods The clinical data of 48 consecutive elderly patients who underwent Whipple operations in Beijing Hospital were retrospectively analyzed.Patients were divided into PN+EN group(n=25)and sole PN group(n=23)according to the nutrition support modes.Demographic data as well as data on liver function,endotoxin levels,and post-operative complications were recorded.Mortality,length of hospital stay,and total costs of post-operative management were compared between two groups.Results Endotoxin level increased on the 1stpost-operative day(POD 1) in two groups,but there is not significant difference,and then gradually decreased in beth two groups;however,the decrease rate(compared with the POD 1 level)was significantly higher in PN+EN group than in PN group on POD 7 and 14(P<0.01).The levels of alanine transaminase,aspartate aminotransferase,total bilirubin,and direct bilirubin increased on POD 1 in both groups,but there is not significant difference,and then gradually decreased;however,the decrease rates(compared with the levels on POD 1)were also significantly higher in PN+EN group than in PN group(P<0.05)on POD 14.Infective complication rate in group PN+EN(2/25,8.0%)was significantly lower than that in group PN(6/23,26.0%)(P<0.05).Total complication rate,post-operative hospital stay,and total costs were similar between these both groups.Conclusions PN+EN can effectively reduce endotoxemia and post-operative infective complications and improve liver function without increasing costs.Therefore,it is feasible for elderly patients after pancreaticoduodenectomy.

Monitoring of minimal residual disease in children with acute lymphoblastic leukemia and its prognostic significance / 中华儿科杂志

<p><b>OBJECTIVE</b>Monitoring of minimal residual disease (MRD) is proven to be increasingly valuable for predicting relapse and outcome of childhood acute lymphoblastic leukemia (ALL) and is used to identify patients' risk groups in several current clinical trials. However, the limitation is that most studies focused on the cut-off value at 10(-4) and the time point after induction. The aim of this study was to investigate the predictive values of different MRD levels detected at different chemotherapy phases in childhood ALL.</p><p><b>METHODS</b>One hundred and two patients were enrolled in this study from January 2002 to December 2004 in our hospital. All the patients were treated with modified National Protocol of Childhood ALL in China 1997. MRD levels were detected on the 15th day, 29th day, at 3 months, 6 months and 12 months after initial chemotherapy. All samples were stained with a panel of four colour combinations of fluorochrome conjugated monoclonal antibodies according to the leukemia-associated immunophenotype (LAIP) defined at diagnosis and analyzed by multi-parametric flow cytometry. CD45CD19CD34CD10, CD45CD19CD34CD20 and CD45CD19CD10CD20 were the most common combinations in B lineage ALL, while CD45CD2CD3CD7 and CD45CD2CD3CD34 were the most frequently used immunophenotypes for T lineage ALL. The median follow-up time was 63.3 months ranged from 40.6 to 87.5 months.</p><p><b>RESULTS</b>Of the 102 patients, 64 were male and 38 were female, with a median age of 5.7 (0.2 - 14.8) years. Eighty-eight cases were diagnosed as B lineage ALL and the remaining 14 were T-ALL. The 5-year overall survival (OS) rate and event free survival (EFS) rate for this cohort were (86.9 +/- 3.4)% and (79.9 +/- 4.0)%, respectively. Twelve patients underwent relapse. Among the 102 patients, 14.3% had negative MRD (MRD < 10(-4)) on day 15, 43.9% on day 29, 39.1%, 39.7% and 45.6% had negative MRD at the third, sixth and twelfth month after chemotherapy. Patients who could achieve negative MRD within one year had superior outcome to the others [5-year EFS rates: (92.5 +/- 3.2)% vs. (58.3 +/- 8.6)%, P < 0.001]. The EFS for patients based on MRD levels measured at different stages of therapy were compared by Kaplan-Meier analyses. MRD was predictive of outcome at all 5 time points at a range of thresholds. The optimum threshold, selected for each time point on the basis of log rank analysis, progressively dropped from 10(-2) of day 15 [5-year EFS rates (79.8 +/- 10.3)% vs. (28.6 +/- 17.1)%, P < 0.001], to 10(-3) of day 29 [5-year EFS rates (88.3 +/- 4.9)% vs. (51.3 +/- 14.4)%, P < 0.003], to 10(-4) at 3 [5-year EFS rates (92.4 +/- 5.1)% vs. (65.5 +/- 7.5)%, P < 0.015], 6 [5-year EFS rates (96.3 +/- 3.6)% vs. (65.4 +/- 7.5)%, P < 0.003] and 12 [5-year EFS rates (100.0 +/- 0.0)% vs. (67.7 +/- 8.4)%, P < 0.002] months. And the hazard ratios for relapse and death at higher MRD level groups were 5.91 (95%CI: 1.9 - 18.9), 5.02 (95%CI: 1.5 - 16.5), 5.21 (95%CI: 1.2 - 22.9) and 11.10 (95%CI: 1.5 - 84.5) on day 15, day 29, at month 3 and month 6, respectively. And MRD >or= 10(-2) on day 15 was proven to be an independent predictor by multivariate Cox proportional-hazards regression model.</p><p><b>CONCLUSION</b>Dynamic MRD detection by multi-parametric flow cytometry is highly predictive of outcome for childhood ALL, and the cut-off values at different time points were different.</p>