Advances in immunotherapy for human epidermal growth factor receptor 2-positive breast cancer / 中华微生物学和免疫学杂志

Human epidermal growth factor receptor 2 (HER2)-targeted therapy has greatly improved the prognosis of HER2-positive breast cancer. HER2-targeted therapy combined with chemotherapy dominated by trastuzumab+ pertuzumab is important in the neoadjuvant therapy, postoperative adjuvant therapy and late-stage standard treatment for HER2-positive breast cancer. Antibody-drug conjugates (ADCs) and tyrosine kinase inhibitors (TKIs) have further improved the efficacy of therapy. However, advanced breast cancer will eventually get a recurrence or drug resistance. HER2-positive breast cancer is characterized by moderate immunogenicity with the presence of large tumor-infiltrating lymphocytes (TILs), which provides a theoretical basis for immunotherapy. The application of HER2-targeted cancer vaccines and immune checkpoint inhibitors is promising and would offer more treatment options for the patients.

Advances in the treatment of ovarian cancer with BRCA gene mutation / 中国综合临床

Ovarian cancer is the most fatal malignant tumor in female reproductive system tumors.In most women, it is diagnosed in a late stage, which largely leads to the poor prognosis of ovarian cancer.Breast cancer susceptibility gene (BRCA) is an important DNA homologous repair gene, which plays a major role in the normal cellular DNA repair mechanism.Its mutation will lead to homologous recombination defects, which will affect the stability of the genome and lead to occurrence of tumors.In recent years, BRCA genetic testing has become a key step in the risk assessment, prognosis, treatment and prevention of ovarian cancer.

Comparison of three internal fixation methods for distal femoral fractures of Müller types C2 and C3 / 中华创伤骨科杂志

Objective:To compare 3 internal fixation methods for the treatment of distal femoral fractures of Müller types C2 and C3.Methods:The clinical data of 58 patients were retrospectively analyzed who had been treated for distal femoral fractures of Müller types C2 and C3 at Department of Orthopaedic Trauma, Ningbo No. 6 Hospital from February 2013 to February 2017. They were divided into 3 groups according to the internal fixation method they had used. In the single incision locking plate group (group A) of 21 cases, there were 13 males and 8 females with an age of 50.6 years±12.9 years. In the double-incision locking plate combined with reconstruction plate group (group B) of 18 cases, there were 11 males and 7 females with an age of 53.5 years±13.0 years. In the single incision locking plate combined with reconstruction plate group(group C) of 19 cases, there were 10 males and 9 females with an age of 48.1 years±12.2 years. The 3 groups were compared in terms of operation time, intraoperative blood loss, intraoperative C-arm fluoroscopy, fracture healing time, incidence of postoperative complications, range of motion of the knee and knee functional recovery.Results:The 3 groups were compatible because there were no significant differences between them in their preoperative general data ( P>0.05). There were no significant differences between groups in the frequency of C-arm fluoroscopy, follow-up time, or incidence of postoperative complications ( P>0.05). The operation time in groups A and C (96.7 min±16.4 min and 101.9 min±16.5 min) and intraoperative blood loss for groups A and C (237.8 mL±47.5 mL and 253.6 mL±46.6 mL) were significantly less than in group B (114.9 min±20.1 min and 290.1 mL±60.9 mL) ( P<0.05); the fracture healing time for groups B and C (6.9 months±1.6 months and 6.6 months±1.7 months) was significantly shorter than for group A (8.4 months±1.9 months) ( P<0.05); the ranges of knee motion 12 months after operation in groups B and C (91.7°±16.7° and 90.9°±14.4°) were significantly larger than that in group A (78.8°±14.4°) ( P<0.05); the excellent and good rates of knee function 12 months after operation in groups B and C [77.8% (14/18) and 73.7% (14/19)] were significantly higher than that in group A [57.1%(12/21)] ( P<0.05). Conclusion:In the treatment of distal femoral fractures of Müller types C2 and C3, application of lateral locking plate and additional anterior locking reconstruction plate via the anterolateral incision at the distal femur can achieve rigid fixation without much damage to the surrounding soft tissues and lead to fine functional recovery of the knee joint because it has the advantages of single incision locking plate and double incision medial and lateral locking plates.

Clinical effect of perforated Kirschner wire tension band in the treatment of olecranon fractures in adults / 中华创伤杂志

Objective:To investigate the clinical effect of perforated kirschner wire tension band in the treatment of olecranon fractures in adults.Methods:A retrospective case-control study was conducted on 56 adult patients with olecranon fractures admitted in Ningbo NO.6 Hospital from May 2013 to February 2017. The perforated Kirschner wire tension band fixation was used in Group A ( n=24), while the common Kirschner wire tension band fixation was used in Group B ( n=32). Group A was composed of 16 males and 8 females at age of (34.0±12.1)years, and Group B was composed of 19 males and 13 females at age of (36.5±11.4)years. According to the Mayo classification, there were 7 patients with type I and 17 with type II in Group A, 15 with type I and 17 with type II in Group B. The operation time, bleeding volume, X transmission times, postoperative visual analogue score (VAS), fracture union time, loosening or failure of internal fixation, skin irritation and elbow joint function Broberg-Morrey score were compared between the two groups. Results:All patients were followed up for 15-21 months (mean, 18 months). In Group A, the operation time, bleeding volume, Xray transmission times, fracture union time and skin irritation were (79.6±22.5)minutes, (111.3±26.2)ml, (7.2±2.2)times, (3.7±0.6)months, 1 case, respectively. In Group B, the operation time, intraoperative hemorrhage, transmission times, fracture healing time and skin irritation were (94.3±27.5)minutes, (152.0±31.4)ml, (11.0±3.4)times, (4. 7±2.2)months, 9 cases, respectively. The difference between the two groups were all significant ( P<0.05). There were no significant difference in VAS, failure of internal fixation and elbow function Broberg-Morrey score between the two groups ( P>0.05). Conclusions:Compared with the anatomic plate, the perforated Kirschner wire tension band in the treatment of adult patients with olecranon fractures cannot only reduce the operation time and transmission times, reduce the intraoperative bleeding volume, but also shorten the fracture union time and avoid the occurrence of skin irritation and other complications.

Comparison of serum cancer antigen 125, human epididymis protein 4, ROMA, and CPH-I for diagnosis of ovarian cancer in Chinese patients with ovarian mass / 南方医科大学学报

OBJECTIVE@#To compare the performance of serum cancer antigen 125 (CA125), human epididymis protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA) and Copenhagen index (CPH-I) for differential diagnosis of benign and malignant diseases in patients with ovarian mass.@*METHODS@#We retrospectively analyzed the data of 719 women with pelvic mass, and the performance of preoperative serum levels of CA125 and HE4, ROMA and CPH-I for differential diagnosis of the masses was compared.@*RESULTS@#Of the 710 women analyzed, 531 were diagnosed with benign ovarian lesions, 44 with borderline ovarian tumors (BOTs), 119 with epithelial ovarian cancers (EOCs), and 25 with non-EOCs. In differentiating ovarian cancer (OC) and BOT from benign lesions, the area under the receiver-operator characteristic (ROC) curve (AUC) was 0.854 for HE4, 0.856 for ROMA, 0.854 for CPH-I, and 0.792 for CA125, demonstrating better diagnostic performance of HE4, ROMA, and CPH-I than CA125 alone; the diagnostic sensitivity was 56.9% for HE4, 70.2% for CA125, 69.1% for ROMA, and 63.8% for CPH-I; the specificity was the best with HE4 (94.4%) and CPH-I (94.7%). In sub-analysis of EOC benign lesions, the AUCs of HE4, ROMA, and CPH-I increased to 0.946, 0.947, and 0.943, respectively, all greater than that of CA125 (0.888). In other sub-analyses, HE4, ROMA, and CPH-I all showed greater AUCs than CA125 alone.@*CONCLUSIONS@#This study confirms the accuracy of HE4, ROMA, and CPH-I for differentiating malignant from benign ovarian mass, and all these 3 tests show better performance than CA125. Furthermore, HE4 and CPH-I is superior to ROMA and CA125 in terms of specificity, while CA125 and ROMA have better diagnostic sensitivities.

Proximal humeral internal locking system combined with fibular strut allograft for treatment of Neer 3-and 4-part factures of proximal humerus in the elderly / 中华创伤骨科杂志

Objective To compare proximal humeral internal locking system (PHILOS) combined with fibular strut allograft versus simple PHILOS for the treatment of Neer 3-and 4-part factures of proximal humerus in the elderly.Methods A retrospective study was conducted of 157 elderly patients with Neer 3-or 4-part facture of proximal humerus who had been treated at Department of Orthopaedics,Ningbo No.6 Hospital from May 2013 to October 2016.They were 76 males and 81 females,aged from 60 to 88 years (average,76.1 years).According to the Neer classification,100 cases were 3-part fractures and 57 4-part fractures.Of them,35 were treated by PHILOS combined with fibular strut allograft (group A) and 122 by PHILOS alone (group B).At the last follow-up,the 2 groups were compared in terms of shoulder joint activity (anteflexion,abduction,internal rotation and external rotation),visual analogue scale (VAS),American Shoulder and Elbow Surgeons (ASES) score,Constant-Murley score,postoperative height loss of the humeral head,humeral head varus angle,complication rate and secondary surgery rate.Results The 157 patients were followed up for 12 to 22 months (mean,16.8 months).The fracture healing time was 13.0 ± 3.8 weeks in group A and 15.6 ± 4.2 weeks in group B,showing a statistically significant difference (P ＜ 0.05).At the last follow-up,for groups A and B respectively,anteflexion was 135.6° ± 17.7° versus 125.4° ± 23.6°,abduction 132.5°±22.7° versus 117.5°±32.7°,external rotation 30.2°± 18.7° versus 21.6°± 17.2°,internal rotation T9 versus T11,VAS score 0.6 ±0.9 points versus 0.9 ± 1.2 points,ASES score 90.2 ±6.8 points versus 82.2 ± 12.3 points,Constant-Murley score 88.5 ±3.6 points versus 72 ±4.9 points,postoperative height loss of the humeral head 0.9 ± 0.1 mm versus 4.2 ± 0.4 mm,and humeral head varus angle 1.2° ± 0.2° versus 4.5° ± 1.9°.The differences between the 2 groups were all statistically significant (P ＜ 0.05).There were no significant differences between the 2 groups in complication rate [14.28％ (5/35) versus 22.13％ (27/122)] or in secondary operation rate[2.85％ (1/35) versus 8.19％ (27/122)] (P ＞ 0.05).Conclusions In the treatment of Neer 3-and 4-part factures of proximal humerus in the elderly,PHILOS combined with fibular strut allograft can improve therapeutic efficacy,because it can provide good support for the medial column of the proximal humerus and the humeral head and thus facilitate the intraoperative reduction of the fracture.

Comparison of PG-SGA, NRS 2002 and BIA in nutritional assessment and screening of patients with gynecologic cancers / 肠外与肠内营养

Objective:To evaluate the application of PG-SGA,NRS 2002 and BIA in nutritional assessment and screening of patients with gynecologic cancers.Methods:118 patients were randomly selected.Nutritional status were evaluated by PG-SGA,NRS 2002 and BIA,and consistency between each tools were compared.Results:The prevalence of malnutrition or nutritional risk of patients were 64.4％ (PG-SGA),57.6％ (NRS 2002),and 33.9％ (BIA) respectively.In all patients,the consistency of PG-SGA and NRS 2002 was high (P ＜ 0.001),while there were not significantly consistent between BIA and PG-SGA,or between BIA and NRS 2002 (P ＜ 0.001).Conclusion:According to the evaluation of PG-SGA or NRS 2002 in gynecologic patients,the prevalence of malnutrition or nutritional risk is high,and these two scales are suitable for nutritional assessment and screening of gynecologic cancer patients,especially in ovarian cancer patients.In addition,BIA may be a promising tool to evaluate cervical cancer patients' nutritional status.

Clinical analysis of inherited metabolic diseases in the neonatal intensive care unit / 中华实用儿科临床杂志

Objective To study the clinical characteristics of inherited metabolic disease(IMD) in the neonatal intensive care unit and to improve the ability of early diagnosis of the disease.Methods A total of 5 590 newborns were hospitalized in the Neonatal Intensive Care Unit (NICU),Fujian Maternity and Children Hospital between January 2012 and April 2015,and 340 neonates who were suspected of IMD consecutively were recruited.Tandem mass spectrometry and gas chromatography-tandem mass spectrometry were used to diagnose IMD.A retrospective study of analyzing the clinical characteristics of the patients of IMD in the NICU was conducted.Results Fifteen neonates were diagnosed as IMD,among whom methylmalonic academia,maple syrup urine disease,hyperphenylalaninemia,citrin deficiency,propionic acidemia,glutaric academia,ornithine transcarbamylase deficiency and primary carnitine deficiency were 5,2,2,2,1,1,1 and 1,respectively.Sixty-six point seven percent (10/15 cases) of IMD onset in the first week after birth were severe.Clinical presentations include the nervous was severe,digestive system and respiratory system symptoms,such as poor response,coma,lethargy,dystonia,convulsion,shortness of breath,dyspnea,milk refusal,diarrhea,jaundice,and so on.The main early manifestations were anorexia,lethargy,seizures and shortness of breath,which were nonspecific.Conclusions Clinical manifestations of IMD are nonspecific.The earlier onset of the disease is more serious,and early tandem mass spectrometry and gas phase chromatography-mass spectrometry are useful for early diagnosis and may guide early clinical intervention.

The investigation of risk factors of post-polypectomy emergency hemorrhage / 中华急诊医学杂志

Objective To explore the risk factors in post-polypectomy hemorrhage in rectum and to discuss the appropriate interventions.Methods A total of 313 patients with 373 polypi were included in this study. The clinical data were analyzed by SPSS 16 software. Results There were 313 patients with colorectal polypus curatively resected and 373 polypi in total.There were 11 (3.5％) patients subjected to post-polypectomy hemorrhage in rectum.Regression analysis showed that the independent risk factor of postpolypectomy hemorrhage in rectum was the hypertension of patients (P ＜ 0.01 ) and this hemorrhage had no significant correlations with patientg'ender,age,size of polypus,pathological characteristics and the methods of polypectomy.Conclusions Hypertension of patients is an independent risk factor in post-polypectomy hemorrhage.