Analysis of Significant Genes and Pathways in Esophageal Cancer Based on Gene Expression Omnibus Database / 中国医学科学杂志(英文版)

Objective To screen antigen targets for immunotherapy by analyzing over-expressed genes, and to identify significant pathways and molecular mechanisms in esophageal cancer by using bioinformatic methods such as enrichment analysis, protein-protein interaction (PPI) network, and survival analysis based on the Gene Expression Omnibus (GEO) database.Methods By screening with highly expressed genes, we mainly analyzed proteins MUC13 and EPCAM with transmembrane domain and antigen epitope from TMHMM and IEDB websites. Significant genes and pathways associated with the pathogenesis of esophageal cancer were identified using enrichment analysis, PPI network, and survival analysis. Several software and platforms including Prism 8, R language, Cytoscape, DAVID, STRING, and GEPIA platform were used in the search and/or figure creation.Results Genes MUC13 and EPCAM were over-expressed with several antigen epitopes in esophageal squamous cell carcinoma (ESCC) tissue. Enrichment analysis revealed that the process of keratinization was focused and a series of genes were related with the development of esophageal cancer. Four genes including ALDH3A1, C2, SLC6A1,and ZBTB7C were screened with significant P value of survival curve.Conclusions Genes MUC13 and EPCAM may be promising antigen targets or biomarkers for esophageal cancer. Keratinization may greatly impact the pathogenesis of esophageal cancer. Genes ALDH3A1, C2, SLC6A1,and ZBTB7C may play important roles in the development of esophageal cancer.

Clinical analysis of liver dysfunction induced by SHR-1210 alone or combined with apatinib and chemotherapy in patients with advanced esophageal squamous cell carcinoma / 中华肿瘤杂志

Objective: To investigate the clinical characteristics of abnormal liver function in patients with advanced esophageal squamous carcinoma treated with programmed death-1 (PD-1) antibody SHR-1210 alone or in combination with apatinib and chemotherapy. Methods: Clinical data of 73 patients with esophageal squamous carcinoma from 2 prospective clinical studies conducted at the Cancer Hospital Chinese Academy of Medical Sciences from May 11, 2016, to November 19, 2019, were analyzed, and logistic regression analysis was used for the analysis of influencing factors. Results: Of the 73 patients, 35 had abnormal liver function. 13 of the 43 patients treated with PD-1 antibody monotherapy (PD-1 monotherapy group) had abnormal liver function, and the median time to first abnormal liver function was 55 days. Of the 30 patients treated with PD-1 antibody in combination with apatinib and chemotherapy (PD-1 combination group), 22 had abnormal liver function, and the median time to first abnormal liver function was 41 days. Of the 35 patients with abnormal liver function, 2 had clinical symptoms, including malaise and loss of appetite, and 1 had jaundice. 28 of the 35 patients with abnormal liver function returned to normal and 7 improved to grade 1, and none of the patients had serious life-threatening or fatal liver function abnormalities. Combination therapy was a risk factor for patients to develop abnormal liver function (P=0.007). Conclusions: Most of the liver function abnormalities that occur during treatment with PD-1 antibody SHR-1210 alone or in combination with apatinib and chemotherapy are mild, and liver function can return to normal or improve with symptomatic treatment. For patients who receive PD-1 antibody in combination with targeted therapy and chemotherapy and have a history of long-term previous smoking, alcohol consumption and hepatitis B virus infection, liver function should be monitored and actively managed in a timely manner.

Endoscopy assisted sub-pectoral fascial breast augmentation and reconstruction: preliminary clinical results / 中华医学美学美容杂志

Objective:To investigate the preliminary effects of sub-pectoral fascial breast augmentation and reconstruction.Methods:Six patients (10 breasts) of mammary dysplasia, mastatrophy, prophylactic mastectomy, unilateral breast defect with contralateral mastatrophy were included in the study from Oct. 2019 to July 2021. The mean patient age was 29 years (range, 20 to 35 years). All the textured and smooth cohesive gel implants were inserted under pectoralis major fascia by endoscopic-assisted, incisions were including axillary, around areola and inferior mammary fold approaches. The prophylactic mastectomy cases were performed nipple sparing mastectomy and sub-pectoral fascial breast restoration with implants. The fat and fascia tissue were well reserved to give a satisfying coverage of the appropriate implant. Negative pressure drainage and moulding dressing were used after the surgery.Results:Ten breast augmentation and restoration with a mean implant size of 200 cc (range, 180-300 cc). Less immediate postoperative pain and bleeding were reported. Patients were followed up for an average of 10 months (range, 6 to 21 months). There were no cases of major malpositions, double-bubble and bottom out symptoms. The overall outcome was with better symmetry and satisfaction with time passed by, and no secondary surgical procedures needed.Conclusions:Primary and satisfactory results have been obtained in subfascial breast augmentation and restoration for indications. With the endoscopic-assisted accurate pectoral fascial dissection, and well reserved soft tissue coverage, this technique could avoid the pectoralis major muscle ablation and keep the advantages of sub-glandular plane.

Impact of aesthetic suture techniques training in improving the suture quality of non-plastic surgeons / 中华医学美学美容杂志

Objective:To investigate the effect and necessity of aesthetic suture techniques training in improving the suture quality of non-plastic surgeons.Methods:The well-planned aesthetic suture techniques training programs were run in non-plastic surgery senior residents and attending surgeons at Peking University People＇s Hospital from January 2017 to January 2019. There were 120 senior residents and attending surgeons included (aged from 25-32 years, average 28.9 years, with 66 males and 54 females). Mixed teaching methods were used such as video shows, lectures, surgery live show and scenario simulation. Baseline tests were taken before the training. Suture quality tests were taken when the trainings came to the end. Self-assessments were carried out both before and after the trainings.Results:Eight rounds of aesthetic suture techniques training were accomplished and 120 trainees were included in all. One hundred and two trainees passed the test while eight failed, while 10 trainees were absent in some courses or the final test. The passing rate was 85.0%. The scales of suture tools and material selection, incision design, subcutaneous tissue suture quality, tension relaxation, aesthetic suture appearance, and flexibility of different suture techniques were sharply improved after the training in both subjective and objective assessments.Conclusions:The aesthetic suture techniques training is effective in improving the suture quality of non-plastic surgeons, which is worthy to generalize in resident training.

Exploration and practice of Wechat-based patient signature for paperless medical records against COVID-19 / 中华医院管理杂志

December 2019 witnessed the outbreak of COVID-19 in Wuhan city. Tongji Hospital, as a designated hospital for treatment of critical patients, shoulders the diagnosis and treatment tasks of numerous critical patients of COVID-19.For the purpose of handling their medical records and effectively preventing the nosocomial infection of the disease, the hospital put in place both the electronic signature system of patients based on a Wechat applet and a paperless medical record total solution based on the data center. These measures overcome the challenges incurred by patients′ signature on paper-based records and medical records archiving during the epidemic. On the other hand, they can not only downsize the paper-based medical records, minimize the risk of infection caused by paper-based medical records via physical contacts, but also effectively save the hospital of its operating costs and improve its efficiency of clinical work.

The application of Pacman flap in reconstruction for skin and soft tissue defects / 中华整形外科杂志

Objective@#To introduce the experience in skin and soft tissue defects reconstruction using Pacman flap.@*Methods@#From April 2015 to April 2018, clinical data of 18 patients using Pacman flap for soft tissue defect repair were reviewed. They were 8 males and 10 females, aged from 18 to 87 years (median age of 60 years). Eight patients had benign lesions, but 10 patients had malignant tumors. The defects were on face (n=12), trunk (n=3), and limbs (n=3). The size of tissue defects ranged from 0.9 cm×0.9 cm to 10.0 cm×9.0 cm. The flap was designed along edge of the defect. Two proximal triangular flap were separated, and sutured in contraposition. The rest of the flap was advanced to cover the defect.@*Results@#The postoperative follow-up period ranged from 2 months to 20 months (median time of 9 months). All flap survived without necrosis. Hematoma occurred in 2 patients, were healed after debridement. All patients were satisfied with the aesthetic and functional outcomes.@*Conclusions@#The technique of Pacman flap is a simple and effective method to repair the skin and soft tissue defects.

Analysis of satisfaction and quality of life of 54 patients after breast reconstruction: a retrospective study / 中华整形外科杂志

Objective@#This is a study to evaluate complication rate, satisfaction and quality of life after breast reconstruction under different classifications. The classification criteria are the timing of operation, surgical procedures, and patients′age.@*Methods@#By reviewing the surgical cases from August 2004 to June 2018, the authors summarized the data of 102 patients with breast reconstruction of the same surgeon in Peking University People′s Hospital and Plastic Surgery Hospital (Institute) CAMS PUMC. Fifty-four patients who met the inclusion criteria and completed the BREAST-Q breast reconstruction module scale, were divided into immediate group or delayed group, according to the timing of operation; divided into abdomen group or other procedures group, according to the surgical procedure; and divided into the young patients′group or senior patients′group according to age. The index were (1) postoperative complication rate, (2)satisfaction with breasts, psychosocial well-being, physical well-being of chest and abdomen, sexual well-being, satisfaction with outcome, satisfaction with information, satisfaction with care (based on the BREAST-Q scale).@*Results@#Complication rate was 9.1%(1/11) in the immediate group, 16.3%(7/43) in the delayed group, 14.7%(5/34) in the abdomen group, 15.0%(3/20) in other procedures group, 13.6%(3/22) in the young patients′group, and 15.6%(5/32) in the senior patients′group. There was no significant difference in the incidence of complications (P>0.05). The postoperative scores of satisfaction with breasts, psychological well-being and sexual well-being were significantly higher in the immediate group than in the delayed group(P=0.026, P<0.001 and P=0.001, respectively). The score of postoperative physical well-being of chest was significantly higher in the abdomen group than other procedures group(P=0.020). The score physical well-being of abdomen was lower compared with the preoperative in the abdomen group (P<0.001). The score of physical well-being of abdomen was lower in the senior patients′group than that of the young patients′group (P=0.010).@*Conclusions@#The complication incidence of breast reconstruction patients was similar among different groups. The breast reconstruction surgery can significantly improve satisfaction and quality of life of patients. To some extent, immediate breast reconstruction can reduce the psychological and physiological effects of breast loss on patients, leading to higher postoperative satisfaction. Breast reconstruction with abdominal flaps can provide patients with better chest health but poor abdomen health. Although elderly patients undergoing breast reconstruction will have poor physical well-being of abdomen, they can still achieve higher satisfaction of operation.

The preliminary application of 3-dimensional visual technique without eyepiece in repairing breast defect af-ter radical mastectomy in 2 cases of breast cancer / 中华显微外科杂志

To investigate the possibility of microsurgical anastomosis of artery, vein and lymphat-ic vessel under 3-dimension screen without eyepiece. Methods During March, 2019, 2 cases (48 and 62 years old) were operated for breast reconstruction, chest wall deformity modified, and axillary scar contracture release, under 3-dimension screen without eyepiece.Deep epigastric artery perforators (artery and vein) dissections were carried on, and microsurgical anastomosis of artery, vein and lymphatic vessel were finished. Coupler was used to do the end-to-end anastomosis of veins (2.5 mm), interrupted suture end-to-end anastomosis with 9-0 nylon for artery (2.0 mm). Reverse arm lymphatic dynamic fluorescence methylene blue tracer under Near Infrared Imaging was used to test the func-tion of lymphatic system. The ends of 2 dominant drainage lymphatic vessels was found in the released axillary area (0.2 mm and 0.3 mm, respectively), and were anastomosis to the vein (0.5 mm) of lateral chest lymphatic tissue.Im-mediate methylene blue tracer under near infrared imaging was used to confirm the patency of lymphatic vessels-veins anastomosis and follow-up post operation. Flap were monitored use HHD. Results Two patients recovered well, and the flaps survived completely with appreciated appearances. The lymphedema of the arms were getting better, the peripheral diameter was reduced by about 2.0 cm compared with that before operation. Conclusion The technique of microsurgical anastomosis of artery, vein and lymphatic vessel without eyepiece under 3-dimension screen is possi-ble and safe.

The origin and development history of operating room / 中华整形外科杂志

In the history of modern medicine, the operating room has undergone a series of evolution since its origin. This article explains the etymology of operating theatre and illustrates the history of its origin and development. Transformed from anatomical amphitheatre and currently to surgical amphitheatre to modern operating room, the design purpose of operating room has changed from demonstration and teaching to elimination of infection and and to the pursuit of higher aseptic principles nowadays. The promotion of antisepsis and advent of anaesthesia changed the operating room in the past. In the future, the renewal of scientific ideas and technological progress will continue to promote the evolution of the form and content of the operating room and keep it moving towards medical humanism.

Experince of ICGA-guided breast reconstruction with abdominal flap / 中华整形外科杂志

Objective@#This article provides an overview of our experience using indocyanine green angiography (ICGA) in breast reconstruction with abdominal flap to ascertain the application value of ICGA and its usage in decreasing postoperative complications.@*Methods@#A total of 21 breast reconstructions with intraoperative ICGA were analyzed retrospectively, including 7 bilateral deep inferior epigastric perforator (DIEP) flaps, 5 pedicled transverse rectus abdominis myocutaneous (TRAM) flaps with contralateral free TRAM flaps, 4 pedicled TRAM flaps with contralateral DIEP flaps, 3 unilateral DIEP flaps and 2 unilateral pedicled TRAM flaps. According to different breast reconstruction methods, ICGA were applied respectively after flap harvesting and vessel anastomosis, in order to evaluate the blood supply of flaps and vessel perfusion.@*Results@#A total of 52 ICGA were performed and recorded intraoperatively without any indocyanine green-associated complications. The operation methods were modified according to ICGA findings in 6 of 21 cases. The distal part of flaps were discarded due to poor perfusion in 2 cases (1 DIEP flap and 1 TRAM flap), additional free vessel anastomosis were needed in 2 cases to ensure sufficient blood supply, 2 vascular complication including 1 vascular occlusion and 1 vascular thrombosis were found and managed in time. During the follow-up (range from 3 to 30 months, median of 16 months), no vascular crisis was reported. All flaps survived satisfactorily without partial or whole flap necrosis or wound infection.@*Conclusions@#Intraoperative ICGA can provide real-time information of flap′s blood supply and vessel perfusion to evaluate the conditions of flaps and vascular anastomosis, which can help surgeons take actions accordingly to increase the successful rate of breast reconstruction.

The influence of molecular classification of breast cancer on the safety of breast-conserving surgery / 中华肿瘤杂志

Objective@#To analyze the relationship between the breast cancer molecular classification and the prognosis of patients underwent breast-conserving therapy and to discuss the safety of the breast conserving surgery from the choice of operation in terms of breast cancer molecular classification.@*Methods@#Clinical data of 618 patients with breast-conserving therapy in Tianjin Medical University Cancer Institute and Hospital from August 2005 to August 2010 were analyzed retrospectively. According to the molecular classification when breast cancer was diagnosed, patients were subdivided into five groups, including Luminal A, Luminal B1, Luminal B2, HER-2-positive and Triple-negative. Clinicopathological characteristics and prognosis were compared among five groups and the influencing factors of local recurrence, distant metastasis and overall survival were analyzed.@*Results@#Among 618 patients, there were 148 cases Luminal A, 231 cases Luminal B1, 63 cases Luminal B2, 40 cases HER-2-positive and 136 cases Triple-negative. The age, family history, TNM stage, calcification, histological grade, pathological type and response to endocrine therapy of these 5 molecular types of breast cancer patients were significantly different (all P<0.05). The 5-year local regional recurrence-free survival rates of Luminal A, Luminal B1, Luminal B2, HER-2-positive and Triple-negative were 99.3%, 98.7%, 98.4%, 94.9% and 95.9%, respectively, without significant differences (P=0.104). The 5-year distant metastasis-free survival rates of these 5 types were 97.3%, 95.7%, 93.7%, 87.5% and 91.4%, respectively, with significant differences (P=0.013). Moreover, the 5-year overall survival rates of these 5 types were 98.6%, 97.8%, 98.4%, 92.5% and 95.6%, respectively, without significant differences (P=0.153). Multifactor analysis showed that radiotherapy (HR=0.036, P=0.049) and the number of lymph node metastases (HR=10.72, P=0.004) were independent factors of local recurrence of breast cancer patients underwent breast-conserving therapy. The age (HR=0.369, P=0.046), status of surgical margin (HR=5.486, P=0.007), number of lymph node metastases (HR=2.882, P=0.023) and molecular typing (HR=5.191, P=0.008) were independent factors of distant metastasis of above breast cancer patients. None of the factors were found to be independent factors of the overall survival of these breast cancer patients.@*Conclusions@#Breast conserving therapy does not increase the risks of local recurrence and death of HER-2-positive and Triple-negative breast cancer patients. Therefore, breast conserving therapy can be accepted by patients with HER-2-positive and Triple-negative breast cancer.

Microsurgery skills training strategy: part one—non-living animal models training / 中华整形外科杂志

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Microsurgery skills training strategy: part one—non-living animal models training / 中华整形外科杂志

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Microsurgery skills training strategy: part one—non-living animal models training / 中华整形外科杂志

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Experince of supermicrosurgical lymphaticovenular anastomosis with intraoperative indocyanine green lymphangiography / 中华整形外科杂志

Objective@#To figure out the clinical application value of indocyanine green (ICG) lymphangiography in supermicrosurgical lymphaticovenular anastomosis.@*Methods@#A total of 6 supermicrosurgical lymphaticovenular anastomosis with intraoperative ICG lymphangiography were performed during April 2015 to May 2017 and were analyzed retrospectively. All the cases are female (range from 30 to 54 years old, median of 46.5 years old), including 3 cases for prevention and 3 cases for treatment of lymphedema.@*Results@#A total 6 supermicrosurgical lymphaticovenular anastomosis were performed with intraoperative ICG lymphangiography to make sure the influx of lymph fluid to the vein. During the median of 23 months follow-up (range from 7 to 32 months), the 3 preventive cases did not show upper limb lymphedema and the 3 theraputic cases were relieved at different levels.@*Conclusions@#Intraoperative ICG lymphangiography can provide real-time information to locate suitable lymph vessels and ascertain the anastomotic patency in supermicrosurgical lymphaticovenular anastomosis, thus improve the operation effectiveness.

Current status and trends of breast reconstruction with simultaneously treatment and prevention of upper limb lymphedema / 中华整形外科杂志

Breast cancer is one of the highest incidence of all malignant tumors of women in China now. Surgical treatment of breast cancer always leaves patients with problems, such as defect of breast, deformity of chest wall, sunken of axilla and upper limb lymphedema, making great influences on patients′ physical and mental health and their quality of life. This review mainly focuses on the current status and trends of breast reconstruction with simultaneously prevention and treatment of upper limb lymphedema, by introducing surgical methods such as breast reconstruction with latissimus dorsi myocutaneous flap / abdominal flap with vascularized lymph nodes transfer, lymph vessel anastomosis, lymph vessel and vein venous anastomosis, fat grafting and liposuction, as well as the image examinations in surgery and the conservative treatment of upper limb lymphedema.

Modulation of mesenchymal stem cells on autophagy in hippocampus of rats with hypoxic-ischemic brain damage / 上海交通大学学报（医学版）

Objective·To investigate the effect of mesenchymal stem cells (MSCs) on autophagy in hippocampus of neonatal rats with hypoxic-ischemic brain damage (HIBD). Methods·Western blotting was used to detect the expression levels of autophagy associated proteins Beclin1, LC3 Ⅱ , and p62 in the hippocampus of HIBD rats following MSCs transplantation and oxygen glucose deprivation (OGD)-injured primary neurons following MSCs seperated coculture. The learning-memory function in the HIBD rats after MSCs transplantation was tested by Morris water maze test. Transmission electron microscopy was also used to observe the number of autophagic neurons in OGD damaged neurons after coculture with MSCs. Results·The levels of Beclin1 and LC3 Ⅱ protein expressions were significantly increased at 12-24 h in the rat hippocampus following HIBD injury. MSCs transplantation statistically downregulated the autophagy level in the hippocampus, and obviously improved the learning-memory function of HIBD rats. Meanwhile, the levels of Beclin1 and LC3 Ⅱ protein expressions in the primary neurons in vitro were also induced by OGD for 12 h. MSCs seperated coculture significantly downregulated the autophagy level of hippocampal neurons by OGD injury, decreased the number of autophagosome in the OGD-injured neurons. Conclusion·MSCs may inhibit the autophagy of hippocampal neurons by partly regulating the damaged microenvironment to improve the learning and memory function of HIBD rats.

Impact of immediate breast reconstruction on the onset of adjuvant chemotherapy and on the postoperative complications / 中华肿瘤杂志

Objective@#To explore the impact of immediate breast reconstruction on the onset of adjuvant chemotherapy and on the postoperative complications.@*Methods@#We retrospectively analyzed the clinical data from female breast cancer patients treated by either modified radical mastectomy with immediate breast reconstruction(IBR) ( n=108) or modified radical mastectomy alone(n=115), followed by adjuvant chemotherapy at our department between January 2011 and December 2012.@*Results@#There was no significant difference in the overall complication rates between the IBR group and modified radical mastectomy group (49.1% vs. 52.2%, P=0.87). However, more secondary surgery was applied in the IBR group than the modified radical mastectomy group (13.0% vs. 1.7%, P=0.001). However, the incidence of hematoma in the modified radical mastectomy group was significantly higher than the IBR group (17.4% vs. 4.6%, P=0.003). There was a significant difference in the onset of adjuvant chemotherapy between the IBR group and modified radical mastectomy group (21 days vs. 11days, P<0.001).@*Conclusions@#Immediate breast reconstruction has no significant impact on the overall complication rate, but increases the incidence of secondary surgery, especially after the initiation of chemotherapy. In addition, it slightly delays adjuvant chemotherapy in the patients.

Effects of high insulin on chemotherapeutic sensitivity in MCF-7/ADR cells / 天津医药

Objective To analyse the effects of high insulin on the expression and function of P-glycoprotein (P-gp), and preliminarily investigate the influence of insulin on chemotherapeutic sensitivity in MCF-7/ADR cells. Methods MCF-7/ADR cells were cultured with different concentrations of insulin(0.001, 0.005, 0.01, 0.05 and 0.1μmol/L). Real-time PCR was used to detect the expression of P-gp mRNA. Western blot assay was used to detect the expression level of P-gp. Rhodamine 123 was used to detect the efflux function level of P-gp. Cell viability and chemotherapeutic sensitivity were detected by MTT assay. Results High concentration of insulin (0.1 μmol/L) promoted the proliferation of MCF-7/ADR cells. The concentration of insulin (0.05 and 0.1 μmol/L) accelerated P-gp mRNA and protein expression, which also augmented the efflux function of P-glycoprotein and reduced the chemotherapeutic sensitivity to epirubicin. Conclusion High concentration of insulin may influence the drug resistance of breast cancer cells by promoting the expression and function of P-glycoprotein of MCF-7/ADR cells.

Treatment of an adult patient with skeletal crossbite and mandibular deviation by distalization of the mandibu-lar molar / 实用口腔医学杂志

An adult patient with skeletal crossbite and mandibular deviation was treated by mandibular molar distalization using micro-im-plant and intermaxillary traction.After treatment,the facial contour of the patient was improved,the Class Ⅰ molar and cuspid relationship was achieved.