Multicenter study of the clinicopathological features and recurrence risk prediction model of early-stage breast cancer with low-positive human epidermal growth factor receptor 2 expression in China (Chinese Society of Breast Surgery 021) / 中华医学杂志(英文版)

BACKGROUND@#: Breast cancer with low-positive human epidermal growth factor receptor 2 (HER2) expression has triggered further refinement of evaluation criteria for HER2 expression. We studied the clinicopathological features of early-stage breast cancer with low-positive HER2 expression in China and analyzed prognostic factors.@*METHODS@#: Clinical and pathological data and prognostic information of patients with early-stage breast cancer with low-positive HER2 expression treated by the member units of the Chinese Society of Breast Surgery and Chinese Society of Surgery of Chinese Medical Association, from January 2015 to December 2016 were collected. The prognostic factors of these patients were analyzed.@*RESULTS@#: Twenty-nine hospitals provided valid cases. From 2015 to 2016, a total of 25,096 cases of early-stage breast cancer were treated, 7642 (30.5%) of which had low-positive HER2 expression and were included in the study. After ineligible cases were excluded, 6486 patients were included in the study. The median follow-up time was 57 months (4-76 months). The disease-free survival rate was 92.1% at 5 years, and the overall survival rate was 97.4% at 5 years. At the follow-up, 506 (7.8%) cases of metastasis and 167 (2.6%) deaths were noted. Multivariate Cox regression analysis showed that tumor stage, lymphvascular invasion, and the Ki67 index were related to recurrence and metastasis (P < 0.05). The recurrence risk prediction model was established using a machine learning model and showed that the area under the receiving operator characteristic curve was 0.815 (95% confidence interval: 0.750-0.880).@*CONCLUSIONS@#: Early-stage breast cancer patients with low-positive HER2 expression account for 30.5% of all patients. Tumor stage, lymphvascular invasion, and the Ki67 index are factors affecting prognosis. The recurrence prediction model for breast cancer with low-positive HER2 expression based on a machine learning model had a good clinical reference value for predicting the recurrence risk at 5 years.@*TRIAL REGISTRATION@#: ChiCTR.org.cn, ChiCTR2100046766.

Clinicopathological characteristics and risk factors of female breast hyperplasia in different age groups / 中华普通外科杂志

Objective To analyze clinicopathological characteristics and the potential risk-related factors of female breast hyperplasia in different age groups.Method From Jan 2015 to Dec 2016,patients diagnosed with breast hyperplasia in 12 hospitals were evaluated.All patients completed the self-designed questionnaires on women'health,including basic demographic information,clinic examination information,radiologic information and pathologic results.The patients were divided into a young group (＜ 45 years old) and an elderly group (from 45 to 75 years old).Results There were 3 684 cases of breast hyperplasia,including 2 291 cases in young group and 1 393 cases in elder group,respectively Clinically breast pain type were most commonly observed in both young and older groups (50.3％ vs.42.7％,P ＜ 0.001).While pathological research based on biopsy showed that breast adenopathy were the most common changes in both groups (67.9％ vs.61.7％,P ＜0.001).More breast cancer cases were identified in elder group than that in young group,especially in clinically lump type patients (9.4％ vs.4.2％,P ＜ 0.001).Compared with elder group,patients in young group have different distribution characteristics regarding to fertility factors,lifestyle factors and psychology scale including anxiety and depression.Conclusion Distributions of clinicopathological characteristics and risk factors of female breast hyperplasia differ across different age groups.

A retrospective analysis on the prognostic evaluation of triple-negative breast cancer with prognostic staging according to the AJCC Breast Cancer Staging System, Eighth Edition / 中华外科杂志

Objective@#To investigate the clinical relevance of prognostic staging according to the AJCC Breast Cancer Staging System, Eighth Edition for evaluation of the prognosis of triple-negative breast cancer.@*Methods@#The clinical data of 293 patients with triple-negative breast cancer who were treated at the Breast Disease Center, Peking University First Hospital, between January 2008 and December 2014, were retrospectively analyzed. All patients were female, with age of 53(16) years (M(QR)). The patients were staged according to the AJCC Breast Cancer Staging System, Eighth Edition. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The role of clinical staging and prognostic staging in prognostic evaluation was investigated.@*Results@#In all, 293 patients with triple-negative invasive breast cancer with complete clinical data and follow-up data were treated over a 7-year period. The follow-up time was 64.5(32.8) months, the 5-year overall survival (OS) rate was 83.9%, and the 5-year disease-free survival (DFS) rate was 84.1%. The results showed that clinical staging and prognostic staging were correlated with the DFS rate and OS rate of patients with triple-negative breast cancer (χ2 were 15.395 to 50.084,P=0.00). However, these two staging systems yielded different results. The prognostic stage of 91.8%(269/293) patients was higher than that of the original anatomical stage. There were significant differences in disease-free survival rate (χ2=22.357,P=0.00) and overall survival rate (χ2=50.084, P=0.00) among patients with different clinical stages. There were significant differences in disease-free survival rate (χ2=15.395,P=0.00) and overall survival rate (χ2=29.187,P=0.00)among patients with different prognostic stages.@*Conclusions@#The prognostic stage according to the AJCC Breast Cancer Staging System, Eighth Edition complements the clinical stage. It has a good predictive value for the prognosis of triple-negative breast cancer.

Retrospective study of the differences of biomarker expression between primary lesions of breast cancer and corresponding lymph node metastases / 国际外科学杂志

Objective To investigate the difference of the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein between primary lesions of breast cancer and its synchronous ipsilateral lymph node metastasis,as well as its clinical implications.Methods Retrospectively analyze invasive breast cancer patients treated in Peking University First Hospital from January 2012 to May 2016.The IHC expressions of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein in both the primary and lymph node metastatic lesions are compared and analyzed statistically.The count data were represented as n(％),and comparsion between groups were evaluated using the McNemar test.Results One hundred and fifty-six patients were included,of which on 2 cases (1.3％),estrogen receptor status of primary lesions is different from that of lymph node metastases(P =0.500);on 10 cases (6.4％),progesterone receptor status of primary lesions is different from that of lymph node metastases (P =0.344);on 28 cases (18.0％),Ki-67 protein status of primary lesions is different from that of lymph node metastases (P =0.000 18);on 3 cases (1.9％),human epidermal growth factor receptor 2 status of primary lesions is different from that of lymph node metastases (P =1.000).Conclusion There may be difference between primary lesions and lymph node metastases in the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein,which can provide a reference for individualized treatment of breast cancer patients.

An analysis of 68 invasive lobular breast cancer cases in clinicopathological characteristics and the prognostic determinants / 中华外科杂志

Objective@#To study the clinicopathological characteristics and the prognostic determinants of the invasive lobular carcinoma breast cancer.@*Methods@#This was a retrospective single-center study of invasive lobular breast cancer cases diagnosed from January 2008 to December 2014 at Peking University First Hospital Breast Disease Center. The study enrolled 68 invasive lobular breast cancer patients, which represented 3.64% (68/1 870) of total invasive breast cancer. The median age of all selected patients was 46 years ranging from 36 to 83 years. All patients were restaged based on the 8th edition of AJCC cancer staging system and follow-up data including disease-free survival (DFS) and overall survival (OS) were analyzed to explore the prognostic determinants. The 5-year OS and DFS were calculated using Kaplan-Meier method; the significance of correlations between clinicopathological features and prognostic factors was estimated using log-rank test.@*Results@#There were significant differences in OS between patients with different anatomic stage, prognostic stage, lymph node metastasis, progesterone receptor (PR) expression, lymphvascular invasion and perineural invasion (χ2: 4.318 to 32.394, all P<0.05); significant differences in DFS were also observed between patients with different anatomic stage, prognostic stage, lymph node metastasis, PR expression, human epidermal growth factor receptor-2 expression, Ki-67 level, histological grade and lymphvascular invasion (χ2: 4.347 to 27.369, all P<0.05). Prognostic stages of 52.9% patients changed compared with anatomic stage, among which Luminal subtype mainly downstaged (22/30), however, triple negative subtype mainly upstaged (6/6).@*Conclusions@#Anatomic stage, prognostic stage, lymph node metastasis, PR expression, lymphvascular invasion are the prognostic factors of invasive lobular breast cancer. Regard to invasive lobular breast cancer patients, clinicians should pay close attention to the differences between prognostic stage and anatomic stage.

Predictive factors of pathological complete response in primary human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab-based neoadjuvant chemotherapy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the predictive factors of pathological complete response (pCR) in primary human epidermal growth factor receptor 2 (HER2)-positive breast cancer treated with trastuzumab-based neoadjuvant chemotherapy (NAC).</p><p><b>METHODS</b>Totally 101 patients of primary HER2-positive breast cancer treated with trastuzumab-based NAC and subsequent curative surgical therapy in the Breast Disease Center of Peking University First Hospital from September 2007 to December 2014 were retrospectively reviewed. All patients were female with a median age of 53 (range 23 to 70) years.All patients received a taxanes- and carboplatin-containing chemotherapy, and trastuzumab was administered concurrently.A pCR, defined as the absence of invasive tumor cells in the breast and axillary lymph nodes, was achieved in 37.6% of patients (38/101). For analysis of the associations between clinicopathological factors and pCR, the χ(2) test or Fisher's exact test was used for univariate analysis, and multivariate Logistic regression analysis was performed to estimate OR and 95% CI.</p><p><b>RESULTS</b>Tumor-infiltrating lymphocytes (χ(2)=14.981, P=0.000), hormone receptor (HR) status (χ(2)=9.513, P=0.002), and tumor grade (χ(2)=4.005, P=0.045) were significantly associated with pCR in univariate analysis. Tumor-infiltrating lymphocytes positive (OR=4.74, 95% CI: 1.87 to 12.01, P=0.001) and HR-negative (OR=3.28, 95% CI: 1.31 to 8.20, P=0.011) were independent predictive factors of pCR in multivariate analysis.</p><p><b>CONCLUSION</b>Tumor-infiltrating lymphocytes-positive and HR-negative were independent predictive factors of pCR in primary HER2-positive breast cancer treated with trastuzumab-based NAC.</p>

Neoadjuvant treatment in human epidermal growth factor receptor 2-positive breast cancer / 中华外科杂志

Breast cancer is the most prevalent malignancy among females worldwide. Human epidermal growth factor receptor 2 (HER2)-positive breast cancer represents a subtype with aggressive behavior, poor response to treatment and unfavorable prognosis. Anti-HER2-based neoadjuvant treatment has improved clinical outcomes of patients with HER2-positive disease. Pathological complete response (pCR) after neoadjuvant treatment indicates a favorable prognosis. With the development of HER2-targeted therapy and neoadjuvant treatment, numerous studies focus on the predictive factors of pCR or therapeutic resistance of anti-HER2 therapy. Identification of novel predictive factors in HER2-positive breast cancer, such as tumor-infiltrating lymphocytes, will be helpful for clinical decision.

Analysis on clinical and pathological characteristics of 66 patients with stage IV breast cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To explore the clinical and pathological characteristics of stage IV breast cancer and to analyze their relationship with the morbidity and prognosis.</p><p><b>METHODS</b>The records of 66 patients presenting from January 2008 to December 2014 with stage IV breast cancer were reviewed. All of the patients were women and the median age was 57.5 (31 to 80) years, accounted for 3.01% (66/2 189) among the breast cancer patients treated in the same period. Statistical methods were used to analyze the correlation between clinical and pathological characteristics such as T-stage, N-stage, immuno-histo-chemistry and the morbidity and prognosis of stage IV breast cancer. The influence of patients characteristics to metastasis were compared by χ(2) test. Kaplan-Meier curves were reported for overall survival (OS), and the Log-rank test was used to compare the difference in groups. Cox proportional models were fitted for multivariate analysis.</p><p><b>RESULTS</b>The median survival time of stage IV breast cancer was 56.0 months and the 5-year survival rate was 40%. To metastasis, the effects of age, subtypes, histological grade, hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2)had no significant statistics differences. It was concluded that the expression of HER2 (P=0.003) and HR (P=0.001) as well as single metastasis (P=0.029) were the influencing factors of the survival by multivariate Cox regression analysis. Primary tumor R0 surgery group and no surgery group had no significant statistics differences of overall survival and the 5-year survival rate (P=0.102).</p><p><b>CONCLUSIONS</b>Clinical and pathological characteristics have no effect on metastasis. The expression of HER2 and HR as well as single metastasis play important roles in survival.</p>

Verification of a molecular pathology detection method of sentinel lymph node in breast cancer patients:a comparison between RT-LAMP and GeneSearch / 军事医学

Objective To verify the reliability of our previously established reverse-transcription loop-mediated isother-mal amplification ( RT-LAMP) method for the detection of sentinel lymph nodes metastasis in breast cancer patients .Meth-ods Sentinel lymph nodes of breast cancer patients were analyzed by RT-LAMP and FDA-approved GeneSearch methods respectively, and the consistency of the two methods was assessed with a kappa concordance test.Results One hundred and thirty-four cases of sentinel lymph node samples were collected from seven hospitals in Beijing .Using the GeneSearch assay as the gold standard, the sensitivity, specificity and consistentcy of RT-LAMP were 96.2%(25/26),96.3%(104/108) and 96.3%(129/134), respectively.Statistical analysis showed that the two methods were consistent (Kappa=0.8857, P<0.001).Conclusion RT-LAMP is highly consistent with GeneSearch ,efficient,simple and inexpensive, promising a good prospect of application to intra-operative detection of sentinel lymph nodes metastasis for breast cancer patients.

Re-evaluation of HER2 status in 1 501 invasive breast cancers according to the 2013 American Society of Clinical Oncology/College of American Pathology guidelines / 中华病理学杂志

<p><b>OBJECTIVE</b>To retrospectively evaluate the HER2 status of 1 501 invasive breast cancer (IBC) by immunohistochemistry (IHC) and fluorescent in situ hybridizaion (FISH), and to compare and analyze the changes and their effects, using the 2007 and 2013 American Society of Clinical Oncology/College of American Pathologist(ASCO/CAP) HER2 testing guidelines.</p><p><b>METHODS</b>Tissue handling and HER2 testing were performed according the 2007 ASCO/CAP guideline recommendations. The HER2 status of all newly diagnosed IBC were routinely assessed by IHC, and reflex FISH assay was done on all the IHC equivocal (IHC 2+) cases. The HER2 status of 1 501 cases of IBC was re-evaluated according to these two criteria.</p><p><b>RESULTS</b>Using the 2007 and 2013 ASCO/CAP criteria, the overall positive, equivocal and negative rates of HER2 over-expression and/or amplification in the 1 501 IBCs were 23.05% and 23.52%, 11.59% and 12.52%, and 65.36% and 63.96%, respectively. The positive and equivocal rates increased by 0.47% and 0.93% respectively, but the negative rate decreased by 1.40% when using the new criteria. For HER2 IHC staining using the 2007 and 2013 guidelines, the positive, equivocal and negative rates were 17.99% and 18.13% (+0.13%), 32.51% and 32.91% (+0.40%) and 49.50% and 48, 97% (-0.53%), respectively. FISH for HER2 amplification was done in 348 of the 1 501 IBCs, and using the 2007 and 2013 guidelines, the positive, equivocal and negative rates were 27.59% and 29.02% (+1.43%), 1.15% and 3.74% (+2.59%) and 71.26% and 67.24% (-4.02%), respectively.</p><p><b>CONCLUSIONS</b>The application of 2013 ASCO/CAP guideline could lead to an increase in positive and equivocal rates, and a decrease in negative rate. The influence could be more prominent for the evaluation of FISH result, and would raise the positive and equivocal rates since a mean HER2 copy number is used in the new criteria. Our re-estimation of IHC result was concordant with the prediction of the guideline.</p>

Analysis of detecting value of ultrasound and the clinic-pathological features of axillary metastasis in breast cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the value of ultrasound (US) in predicting axilla status and to investigate the clinic pathologic characters in the axillary node metastasis.</p><p><b>METHODS</b>From June 2012 to June 2013, 323 female primary breast cancer patients who received both axilla ultrasound and pathology examinations were reviewed retrospectively. The features of axillary nodes including diameter, longitudinal-transverse axis ratio, cortical thickness and blood flow grade were used to evaluate axillary status. US accuracy of axillary node metastasis was analyzed correlated with the final pathology results. The clinical and histological features associated with axillary node metastasis was analyzed by χ² test.</p><p><b>RESULTS</b>The proportions of Luminal A-like, Luminal B-like, human epidermalgrowth factor receptor-2 positive and triple negative breast cancer were 11.1% (36/323), 58.5% (189/323), 13.3% (43/323) and 17.0% (55/323) . The sensitivity, specificity, positive predictive value and negative predictive value of axilla US in the diagnosis of nodal metastasis were 35.6% (46/129), 98.9% (181/183), 95.8% (46/48) and 68.6% (181/264). Axillary lymph node metastasis had statistically significant correlation with menopausal status and clinical tumor size (χ² = 4.337, 11.100; P = 0.037, 0.001).</p><p><b>CONCLUSIONS</b>Standardized ultrasound is the basic way to evaluate axilla status. Sentinel lymph node biopsy should be done to acquire accurate preoperative staging of axilla when US shows no signs of metastasis. Axillary lymph node metastasis is significantly related to menopausal status and clinical tumor size, but not significantly related to subtype classification of primary breast cancer.</p>

Study on clinicopathological classification and clinical and pathological characteristics in breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explored the relationship of clinicopathological classification and clinical and pathological characteristics of breast cancer and analyze the value in treatment.</p><p><b>METHODS</b>The patients with invasive breast carcinoma had been treated between January 2011 and December 2012. The breast cancer have been divided into luminal A, luminal B, HER2-positive and triple-negative subtypes according to criteria of St. Gallen International Expert Consensus report 2011. The Mann-Whitney test and Kruskal-Wallis test were used to analyze the relationships between four subtypes and TNM staging, histopathological grading.</p><p><b>RESULTS</b>The 530 cases of invasive breast cancer patients were included in this study. The luminal A was 94 cases (17.7%), the luminal B was of 285 cases (53.8%), the HER2-positive was 59 cases (11.1%), and the triple-negative subtype was 92 cases (17.4%). In luminal B subtype, the HER2-positive was 56 (19.6%) and negative was 229 (80.4%). Most of luminal B was later in grade (71.7% of cases were more than II grade) and stage (66.7% were more than stage II).</p><p><b>CONCLUSIONS</b>Clinical pathological classification is important in the individualized treatments of breast cancer, and the Luminal types (A+B) are more than 71.5% of all breast cancer patients, and they should be paid more attention to the endocrine therapy; Luminal B type accounted for 53.8% of all breast cancer and it needs further study to improve the precision of the diagnosis and treatment.</p>

Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer.</p><p><b>METHODS</b>The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012. The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group). Enhanced MRI was used to measure breast volume, longest diameter of tumor and tumor volume. The correlations between these measurements and those derived from histopathologic findings were assessed. The relationships between the success rate of breast-conserving surgery and MRI- and pathology-based measurement results were statistically analyzed in the breast-conserving group.</p><p><b>RESULTS</b>The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group. Allocation to these groups was based on clinical indications and patient preferences. The cut-off for concurrence between MRI- and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm. In the total mastectomy group, the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%. Correlation coefficients for MRI and histopathology-based measurements of breast volume, tumor volume and tumor volume/breast volume ratio were r = 0.861, 0.569, and 0.600, respectively (all P < 0.001). In the breast-conserving group, with 0.30 cm taken as the cut-off for concurrence, the 95% confidence interval for MRI and pathology-based measurements of the longest diameter of tumor was 29.98%-44.01%. The subjective and objective success rates for breast-conserving surgery were 100% and 88.54%, respectively.</p><p><b>CONCLUSIONS</b>There were significant correlations between dynamic enhanced MRI- and histopathology-based measurements of the longest diameter of breast lesions, breast and tumor volumes, and breast volume/tumor volume ratios. Preoperative MRI examination improves the success rate of breast-conserving surgery.</p>

Protective effect of the combination of glutamine and arginine on intestinal barrier function in rats receiving fluorouracil chemotherapy / 中华临床营养杂志

@#Objective To investigate the protective effect of the combination of glutamine (Gln) and ar-ginine (Arg) on intestinal barrier function in rats receiving fluorouracil (5-FU) chemotherapy.Methods Totally 40 male SD rats receiving 5-FU chemotherapy were equally randomized into four groups:enteral nutrition group,Gln group (enteral nutrition+Gln),Arg group (enteral nutrition+Arg),and Arg+Gln group (enteral nutri-tion+Arg+Gln).Observe the changes post chemotherapy such as the changes of body weight and urine lactulose/mannitol ratio before and after chemotherapy were recorded.On the 8 th post-therapy day,the blood endotoxin level in portal vein was measured,and lymph nodes and blood in portal vein were taken for bacterial culture;colon and jejunum specimens were also taken to measure the height of jejunum villus and the thickness of colon and jejunum.Results Body weights of Gln group,Arg group,and Arg+Gln group significantly increased after chemotherapy (P<0.05).The change of body weight was significantly lower in Arg+Gln group than in Gln group (P=0.002),while no such difference was found when compared with that in Arg group (P>0.05).Lactulose/manni-tol ratio in each group significantly increased after chemotherapy (P<0.05),and the change of lactulose/mannitol ratio was significantly higher in the enteral nutrition group than those in other groups (P=0.000);however,no such difference was found among other groups (P>0.05).The blood endotoxin level in portal vein was signifi-cantly higher in enteral nutrition group than in other groups (P=0.000);the endotoxin level was significantly lower in Gln group than in Arg group (P=O.035) and Arg+Gln group (P=0.000);however,no such differ-ence was found between Arg group and Arg+Gln group (P=0.109).The height of jejunum villus and the thick-ness of jejunum were significantly lower in enteral nutrition group than those in the other groups (P=O.000);the thickness of colon was significantly lower in enteral nutrition group than those in Arg group and Arg+Gln group (P=0.000);however,no such difference was found when compared with Gln group (P=0.058).The thickness of colon (P=0.040) and jejunum (P=0.010) was significantly higher in Gln group than that in Arg group;but there was no significant difference in term of the height of jejunum villus (P=0.286).Compared with Arg+Gln group,the thickness of jejunum in Gln group was significantly higher,but there was no significant difference in terms of the height of jejunum villus (P=0.286) or the thickness of jejunum (P=0.190).The thickness of co-lon was significantly lower in Arg group than in Arg+Gln group (P=0.010),while no such significant difference was found in terms of the height of jejunum villus (P=0.803) or the thickness of colon (P=0.059) when com-pared with Arg+Gln group.The bacterial culture results were not significantly different among all groups.Conclu-sions The combination of Arg and Gln has protective effects on intestinal barrier in rats receiving 5-FU chemother-apy.The protective effect of Gln is superior to that of Arg.No synergistic effect exists between Arg and Gln.

The effects of Nutrison on rat gut barrier after 5-FU chemotherapy / 国际外科学杂志

Objective To investigate and assess the effects of nutrison on rat gut barrier after 5-FU chemo-therapy. Methods Thirty male Sprague-Dawley rats were randomly assigned to three groups: EN group: nutrison intestinal nutrition; STD group: nutrison intestinal nutrition + chemotherapy; CHOW group: chow+ chemotherapy. The changies such as weight, lactulose / mannitol of urine samples before and after chem-otherapy were observed. At the 8th day, colon as well as jejunum tissue were also sampled for pathological examination to measure the height of jejunum villi, the thickness of colon and jejunum. Results Compared to EN group, the body weight the height of jejunum mucosa and the thickness of colon / jejunum loss of STD group was significantly decreased, as well as the L/M inceased. The data showed that CHOW group was bet-ter than EN group. Conclusions Intraperitoneal injection of 5-FU increased the intestinal permeability of rats and damaged the function of intestinal barrier. The intestinal mucosal protection effect of nutrison EN in post-chemotherapy rats was weaker than the effect of a free-eating group.

Diagnosis and surgical therapy of substernal goiter / 中华普通外科杂志

Objective To study the presentation,sensitivity of different diagnostic methods,snrgical modalities and pathological findings for patients of substemal goiter. Methods The clinical data of fifty nine cases of substernal goiter surgically treated were retrospectively analyzed. Results The main symptoms of substernal goiter patients were asymptomatic cervical mass(39/59),airway obstruction (13/59),hyperthyroidism(4/59),hoarseness(3/59)and choke(3/59).The sensitivity of chest X-ray,ultrasonography,CT and scintigraphy was 62.8%,15.8%,85.7%,and 50.0%respectively,and the specificity Was 99.4%,99.8%,99.5%and 99.0%,respectively.Standard cervical approach was successful for thyroidectomy operations in 57 cases.One patient underwent thyroidectomy by sternotomic approach,and another one by combined cervici-sternotomic approach.No major complications or perioperative deaths occurred.Pathology revealed nodular goiter in 48 cases.Grave's disease in one,thyroid adenoma in 2,and carcinoma in 8. Conclusions CT and chest X-ray are sensitive diagnostic techniques for substerual goiter.Cervical approach is appropriate for most substernal goiter.

POSTOPERATIVE RADIOTHERAPY IN STAGE C_2 ADENOCARCINOMA OF RETUM / 中华放射肿瘤学杂志

From June 1976 to December 1989, 76 patients with cancer of the rectum of Duke's stage C2 disease were cured treated by surgical resection . 54 patients received surgery only, 22 patients received surgery in combination with postoperative radiation therapy. Follow-up rate was 98%. Radiotherapy regimen in this study was 40～50 Gy in 4～5 weeks to the pelvic. The results showed that postoperative irradiation group had lower recurrence and distant metastasis rates(48.9%) than those of surgery alone one (96.1%). Survival in patients receiving postoperative radiation was substantially better(40.4%) than surgery only group(14.4%).