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In order to explore the treatment of Her-2 positive breast cancer patients who failed in multi-line treatments, we retrospectively analyzed the clinical data of a patient with refractory Her-2 positive breast cancer.The patient was initially diagnosed as Her-2 positive advanced breast cancer.After six line treatment in the outer hospital, the patient′s condition was basically in a progressive state.The breast tumor was broken and purulent, the lung metastasis increased, and the patient′s quality of life was poor.The patient was admitted to Department of Breast Surgery of Affiliated Suqian Hospital of Xuzhou Medical University, after MDT discussion, we gave pyrrolotinib combined with capecitabine treatment, the chest wound healed gradually, the lung metastasis gradually reduced, and the quality of life was better.A retrospective analysis of this case showed that pyrrolidine combined with capecitabine may bring hope to Her-2 positive breast cancer patients who failed to receive multi-line therapies, especially those who failed to target therapy.
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Objective To explore the application of paclitaxel or docetaxel combined with cisplatin (TP) with cyclophosphamide,pirirubicin and fluorouracil (FAC) in the primary tumor molecular typing Luminal A,axillary lymph node metastasis three negative breast cancer. Methods From January 2012 to January 2014, the clinical data of forty-nine patients with were selected. All patients were divided into two groups by balance randomization method, TP group and FAC group. Twenty-five patients were treated with TP regimen and 24 patients were treated with FAC regimen. The clinical efficacy was evaluated after six cycles of chemotherapy. Chemotherapy effects,adverse reactions and survival rates of two groups were compared. Results All patients were given intravenous chemotherapy according to the plan and were evaluated for clinical efficacy. The response rate (RR) was 64. 0％ in TP group,including 4 cases of complete remission (CR),12 cases of partial remission (PR),7 cases of stable disease(SD) and 2 cases of progressive disease(PD). The adverse reactions were gastrointestinal reactions and granulocytopenia. The median progression-free survival ( PFS) and overall survival ( OS) were respectively 12. 4 months and 34. 1 months. In FAC group,the response rate ( RR) was 33. 3％,including 2 cases of CR,6 cases of PR,11 cases of SD and 5 cases of PD. The adverse reactions were gastrointestinal reactions,granulocytopenia and premature atrial contraction. The median PFS and OS were 7. 2 months and 20. 7 months respectively. The effective rate of TP group was higher than that of FAC group (χ2=4. 608,P=0. 032),and the progression-free survival time and total survival time were longer than those of FAC group (χ2 =8. 317, 8. 563, P=0. 004, 0. 003 ) . Conclusion Compared to FAC regimen, TP regimen could improve the survival rate of patients better with breast cancer of Primary tumor Luminal A and Axillary Lymph Node Metastasis Triple negative type, and adverse reactions were tolerated, it may be an optimized chemotherapy.
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Objective To establish an efficient method of genotyping for Leprdb/ +mouse offsprings by TaqMan probe quantitative fluorescence PCR. Methods Genome DNA was extracted from tails of 228 Leprdb/ +mouse offsprings. PCR primers and TaqMan probes were designed according to the mutation sites of Lepr gene(rs1801133). Real time PCR assay was applied and SNP loci were typed with SDS software. The genotyping of 2-month old Leprdb/dbmice was validated by the phenotype and Hardy-Weinberg equilibrium test was performed. Results 228 samples were detected by the established TaqMan fluorescence quantitative PCR assay. 64 mice were of GG genotype, with a genotype frequency of 0.1929. 123 mice were of GT genotype, with a genotype frequency of 0.5395. 41 mice were of TT genotype, with a genotype frequency of 0.2807. Compared with the phenotype typing,the sensitivity of the TaqMan fluorescence quantitative PCR was 97.56% and the specificity was 99.47%. Conclusions TaqMan probe quantitative fluorescence PCR assay is a simple and efficient method,and can be used to detect the genotype of Leprdb/ +mouse offsprings.
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Objective To study the expression of lipoic acid synthase(LIAS)in the liver and kidney of Leprdb/db mice with deficient leptin receptor. Methods Eight 10-week old male Leprdb/ +mice and Leprdb/dbmice were included in this study. The body weight of rats in the two groups was measured. Fasting blood glucose(FPG)was measured with blood glucose test strips for all mice after fasting for 8 hours. Blood samples were obtained from the abdominal aorta and the animals were sacrificed. The liver and kidney were weighed. The right lobe of liver and the left kidney samples were fixed in 4% paraformaldehyde for pathological examination. Serum samples were separated and the sereum contents of CHO, TG,HDL and LDL were detected. The mitochondria of liver and kidney tissues were extracted with a mitochondrial isolation kit, and the protein was extracted. The expression of LIAS protein was detected by western blot. Results Histopathological observation showed that the liver and kidney tissues of Leprdb/ +mice have intact and clear structure. But the liver tissue of Leprdb/dbmice showed fatty degeneration, the kidney tissue showed glomerular hypertrophy, basement membrane thickening, mesangial area widened, including mesangial cells and mesangial matrix increased. The GLU,CHO,TG,LDL and AST of Leprdb/dbmice were significantly increased compared with those of Leprdb/ +mice(P<0.05). Compared with Leprdb/ +mice,the LIAS protein expression was significantly increased in the liver and kidney mitochondria of Leprdb/dbmice(P<0.05). Conclusions There is impaired glucose and lipid metabolism in the Leprdb/dbmice which has defect leptin receptor,and the expression of LIAS protein in liver and kidney of the Leprdb/dbmice is higher than that of Leprdb/ +mice.
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Objective To explore the expression of HR and Her?2 in breast cancer primary tumor and axillary lymph node metastasis. Methods Four hundred and twenty?eight female patients with unilateral breast cancer combined with axillary lymph node metastasis treated in the Affiliated Suqian Hospital of Xuzhou Medical University from January 2011 to January 2016 were selected in this study. Immunohistochemistry was used to detect the expression of ER,PR,Her?2 and Ki67 in primary tumor and axillary lymph node metastasis. Results The positive rates of ER expression were 75. 9% ( 325/428 ) and 70. 3% ( 301/428 ) respectively in primary tumor and axillary lymph node metastasis. The positive rates of PR expression were 61. 4% ( 263/428) and 56. 1% ( 240/428 ) respectively in primary tumor and axillary lymph node metastasis. The rates of Her?2 overexpression were 20. 1% ( 86/428) in primary tumor and the positive rate of Her?2 in axillary lymph node metastasis was 22. 7%( 97/428 ) . The positive rates of Ki67 expression were 45. 6%( 195/428 ) and 39. 7%(170/428) respectively in primary tumor and axillary lymph node metastasis. The expression of ER,PR,Her?2 and Ki67 in primary and axillary lymph node metastasis showed no statistical significance ( P>0. 05 ) . The molecular typing of primary tumor and axillary lymph node metastasis were not consistent in 31 patients ( 31/428,7. 24%) ,including 14 cases of primary tumor Luminal A,9 cases of Her?2 overexpression in axillary lymph node metastasis and 5 cases of triple negative breast cancer. Primary tumor Luminal B was detected in 10 cases, while 6 cases of Her?2 overexpression in axillary lymph node metastasis and 4 cases of triple negative breast cancer. Primary tumor Her?2 was overexpressed in 4 cases,while 1 case of Luminal A,3 cases of Luminal B in axillary lymph node metastasis. There were 3 cases of primary tumor triple negative breast cancer,while 2 cases of Luminal B in axillary lymph node metastasis and 1 case of Her?2 overexpression. Conclusion The expressions of ER, PR, Her?2 and Ki67 in primary tumor and axillary lymph node metastasis of some breast cancer were different. Immunohistochemistry for primary tumor and axillary lymph node metastasis of stage II?III breast cancer patients should be routinely carried out. Based on molecular typing of primary tumor and axillary lymph node metastasis,individualized treatment plan can be developed,so that patients will benefit from it.
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Objective To study the method and clinical value of preservation of intercostobrachial nerve( ICBN) by fat dissolving meth-od during breast cancer operation. Methods The clinical data of 50 cases withⅠ~Ⅲa stage breast cancer from January 2013 to June 2013 were analyzed. Fifty patients were randomly divided into two groups,there were 26 patients in preservation group,whose ICBN were preserved by fat dissolving method during axillary lymph nodes dissection,and 24 patients in resection group,whose ICBN were not preserved by routine method during axillary lymph nodes dissection. Comparison of operation times,bleeding volume,the number of axillary lymph nodes dissection and upper arm sensory function of patients after operation between both groups was done. Results The mean time of operation was (102. 3 ± 15. 6) min in preservation group and(95. 6 ± 12. 4) min in resection group,while the number of axillary lymph nodes dissection was (19. 5 ± 8. 8 ) in preservation group and ( 19. 2 ± 9. 5 ) in resection group, with no significant difference between both groups (P>0. 05). Bleeding volume was (51. 2 ± 11. 5)mL in preservation group and (98. 5 ± 13. 4)mL in resection group,with significant differ-ences(P<0. 05). After postoperative one month,we observed upper arm sensory function of patients. It showed that 3 cases of sensory numb-ness or pain occurred in preservation group (11. 5%),20 cases of sensory abnormality occurred in resection group (83. 3%),mainly as sen-sory loss,numbness,pain or burning sensation,there was significant difference between both groups (P<0. 05). All patients were followed up half a year,patients with sensory abnormality in preservation group recovered,and recovery in resection group was not obvious,it still showed sensory abnormality in varying degrees. During the follow-up,no local recurrence or distant metastasis was found in both groups. Conclusion Preserving intercostobrachial nerve by fat dissolving method in breast cancer operation is based on conventional operation and made a few of improvements. It is simple and feasible. During the operation,we find that the axillary neurovascular is clearer,preservation of ICBN is easier. It does not affect the axillary lymph node dissection and operation time,while it can reduce incidence of postoperative sensory abnormality and improve the quality of life of patients,therefore it is worthy of clinical application.
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Objective To study the reasons and prevention of the hoarse voice after continuity-intact recurrent laryngeal nerve (RLN)operation without damage of RLN under naked eyes.Methods Data of 1871 patients undergoing thyroid surgery from Jan.2001 to Jan.2011 were retrospectly analyzed.919 patients had their RLN exposed,among whom 757 patients had bilateral RLN exposed.952 patients didn't have their RLN exposed in the surgery.Results A total of 1676 RLNs were exposed by the routine method and minimally invasive method.All the nerves were confirmed no damage and continuity intact under naked eyes.Hoarse voice occurred to 19patients after surgery,with the percentage of 2.12％ (19/897).The rate of hoarse voice in the non-exposed group was 5.46％ (52/952).The difference of horse voice between the RLN exposed group and non-exposed group had statistical significance(P ＜ 0.05).Conclusions RLN without damage under naked eyes and continuity intact doesn't mean no damage of electroneurophysiology.The rate of RLN damage in the exposed group was less than that in the non-exposed group.The major causes of hoarse voice may include misoperation,heat conduction and postoperative scar adhesion.The key to avoid RLN damage is prevention.