Correlation between the number of circulating tumor cells in peripheral blood and clinicopathological features of patients with breast cancer / 肿瘤研究与临床

Objective:To investigate the correlation between the number of circulating tumor cells (CTC) in peripheral blood and clinicopathological features of patients with breast cancer.Methods:The clinical data of 104 breast cancer patients at Guangzhou Panyu Central Hospital between January 2017 and May 2020 were retrospectively analyzed. The number of CTC in peripheral blood, the levels of serum tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen (CA)125, CA153] were detected. In blood samples, the number of CTC ≥ 2/ml was defined as CTC positive. Immunohistochemistry was used to analyze the protein expression of Ki-67 in tumor tissues. The association of CTC with clinicopathological features, serum tumor markers and Ki-67 protein expression was also analyzed.Results:The CTC positive rate was 80.77% (84/104). There were statistically significant differences in composition of whether there was vascular tumor thrombus (χ 2 = 0.860, P = 0.009), axillary lymph node metastasis (χ 2 = 12.382, P<0.01), N staging ( P = 0.002) and TNM staging (χ 2 = 7.698, P = 0.006) between patients with CTC positive and negative. However, there were no statistically significant differences in composition of age ( t = 0.634, P = 0.528), tumor quadrant (χ 2 = 6.523, P = 0.163), molecular subtyping (χ 2 = 4.164, P = 0.384), histological grade (χ 2 = 1.901, P = 0.387), T staging ( P = 0.099) and whether there was nerve invasion (χ 2 = 0.092, P = 0.761). The levels of serum CEA and CA125 in CTC positive patients were higher than those in CTC negative patients [median ( P25, P75): 2.50 ng/ml (2.21 ng/ml, 2.92 ng/ml) vs. 1.89 ng/ml (1.61 ng/ml, 2.35 ng/ml); 13.81 U/ml (11.79 U/ml, 16.28 U/ml) vs. 11.17 U/ml (8.91 U/ml, 12.80 U/ml); all P < 0.05], and CTC was positively correlated with serum CEA and CA153 levels ( r = 0.520, P<0.01; r = 0.497, P<0.01); CTC was not related to Ki-67 protein expression (χ 2 = 0.512, P = 0.474). Conclusion:The number of CTC in peripheral blood is closely related to clinical staging, lymph node or hematogenous metastasis, tumor markers CEA and CA153 levels of breast cancer. The increased number of CTC may cause tumor progression and metastasis.

Balloon-assisted clipping for giant unruptured intracranial aneurysms of internal carotid artery / 国际脑血管病杂志

Objective To investigate the efficacy and clinical value of balloon-assisted clipping for the treatment of giant unruptured intracranial aneurysms of internal carotid artery. Methods Patients with giant unruptured intracranial aneurysm of intracranial segment of internal carotid artery treated with balloon-assisted clipping in the Department of Neurosurgery, Xiangya Hospital, Central South University from September 2017 to May 2018 were enrolled retrospectively. The proximal internal carotid artery or the aneurysm neck were temporarily blocked by balloon, and then the aneurysm was clipped in the hybrid operating room. Demographic data, preoperative symptoms, aneurysm characteristics, position of balloon placement, intraoperative angiography, complications, and follow-up results were collected. Results A total of 12 patients with giant (diameter >2 cm) unruptured intracranial aneurysm of intracranial segment of internal carotid artery were enrolled. They were all successfully clipped using balloon-assisted clipping in the hybrid operating room. Among them, 1 was located in the ophthalmic segment, 3 in the supraclinoid segment, 4 in the posterior communicating segment, 2 in the anterior choroidal artery segment, and 2 in the bifurcation of the internal carotid artery. The balloons were placed in the proximal end of internal carotid artery in 9 cases and in the neck of aneurysm in 3 cases. Intraoperative angiography showed that 12 aneurysms were completely occluded; 1 had severe stenosis of parent artery, and 1 had mild stenosis. Postoperative complications included cerebral infarction in 1 case, temporary diabetes insipidus in 1 case (returned to normal 1 week after operation), hemiplegia in 1 case, and epilepsy in 1 case. Glasgow Outcome Scale score at discharge showed 5 in 9 cases, 4 in 2 cases, and 3 in 1 case. The patients were followed up for 2.3 to 12 months after operation (median 7.5 months). Reexamination of CT angiography showed no recurrence of aneurysm. Glasgow Outcome Scale score was 5 in 11 cases and 4 in 1 case. Conclusions The use of balloon-assisted clipping technique in the hybrid operating room for the treatment of giant intracranial segmental aneurysms of the internal carotid artery is safe and effective, and has a good long-term outcome.

Early surgical treatment of patients with intracerebral hematoma from ruptured intracranial aneurysms / 国际脑血管病杂志

Objective To investigate the clinical effects and influencing factors of the outcomes of early microsurgical treatment in patients with intracerebral hematoma from ruptured intracranial aneurysm. Methods From 2010 to 2016, patients with intracerebral hematoma from ruptured intracranial aneurysm admitted to the Department of Neurosurgery, Xinyu People's Hospital were enrolled retrospectively. The demographic data, Hunt-Hess grade,Glasgow coma scale(GCS)score,imaging data,and procedure-related complications were collected. Glasgow outcome scale (GOS) score was used to evaluate the outcomes. Four to 5 were defined as good outcome and 1 to 3 were defined as poor outcome. The Hunt-Hess gradesⅡ-Ⅲ were used as the low-grade group and the Ⅳ-Ⅴ grades were used as the high-grade group. The survival rate and quality of life of both groups of patients were compared according to the GOS scores. Results A total of 36 patients were enrolled during the study, including 32 with subarachnoid hemorrhage and intracerebral hematoma and 4 with simple intracerebral hematoma. Hunt-Hess grade was grade Ⅱ in 2 cases, Ⅲ in 18 cases, Ⅳ in 14 cases, and Ⅴ in 2 cases. Distribution of responsible aneurysms:18 patients in middle cerebral artery, 9 in anterior communicating artery, 6 in anterior cerebral artery, 3 in posterior communicating artery, including 4 patients with multiple aneurysms. All patients underwent aneurysm clipping+hematoma removal under the general anesthesia within 36 h after onset,24 of them were treated with decompressive craniectomy. One patient died of severe brain swelling after intraoperative reruptureof the aneurysm,1 died of postoperative massive cerebral infarction, and 1 died of severe pulmonary infection and diabetes after giving up further treatment. Thirty-three survivors were followed up for 1 year, 29 had good outcome(80.5％) and 7 had poor outcome (19.5％). There were significant differences in survival rate and quality of life between the low-grade group and the high-grade group (P=0.001). There were significant differences in the Hunt-Hess grade, baseline GCS score, and proportion of patients receiving decompressive craniectomy between the good outcome group and the poor outcome group.Conclusion The Hunt-Hess grade, baseline GCS score, and decompressive craniectomy were the influencing factors of the outcomes in patients with intracerebral hematoma from ruptured intracranial aneurysm. Removal of hematoma and aneurysm clipping should be performed as early as possible,and decompressive craniectomy should be performed if necessary.

Association of serum transforming growth factor-β1 with radiation injury and survival of patients with early-stage nasopharyngeal carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the changes in serum transforming growth factor-β1 (TGF-β1) in patients with early-stage nasopharyngeal carcinoma (NPC) after radiotherapy and explore the correlation of serum TGF-β1 with radiation injury and disease-free survival.</p><p><b>METHODS</b>The average serum TGF-β1 level (50.2∓3.2 ng/ml) determined from 32 healthy volunteers was used as the standard value for NPC patients in this trial. Fifty-seven patients with early-stage (T1-2N0-1M0) NPC without prior treatment were divided into two groups with serum TGF-β1 level before treatment lower than or equal to the standard value (group A, 29 cases) and a level beyond the standard value (group B, 28 cases). Serum TGF-β1 level was determined in all the patients before, during and after the radiotherapy to evaluate the radiation injury and therapeutic effect.</p><p><b>RESULTS</b>The serum TGF-β1 level before radiotherapy was significantly lower in group A than in group B (35.4∓1.4 vs 58.8∓1.0 ng/ml, P<0.05). After radiotherapy, acute radiation mucositis and skin reaction was significantly severer in group B (P<0.05). The serum TGF-β1 level before radiotherapy was significantly higher in patients with grade 3 acute radiation mucositis and skin reaction than in those with injuries below grade 3 (54.0∓2.2 vs 42.0∓2.3 ng/ml and 54.3∓2.4 vs 43.4∓2.2 ng/ml, P<0.05). The two groups showed no significant differences in the locoregional failure rate (3.4% vs 7.1%), distant metastasis rate (3.4% vs 10.8%) or disease-free survival (P>0.05).</p><p><b>CONCLUSIONS</b>Radiotherapy can significantly decrease serum TGF-β1 level in early NPC patients. Serum TGF-β1 level before radiotherapy can help predict the degree of acute radiation mucositis and skin reaction, but shows no correlation with disease-free survival of early-stage NPC patients.</p>

Three dimensional conformal radiotherapy combined with gemcitabine chemotherapy for locally advanced non-small cell lung cancer / 中国医师进修杂志

Objective To evaluate the acute side effects and efficacy of three dimensional conformal radiotherapy (3D-CRT) combined with gemcitabine chemotherapy for locally advanced non-small cell lung cancer (NSCLC). Methods From January 2006 to December 2007, 90 cases with advanced NSCLC were divided into two groups, treatment group of 45 patients were tre.ated with 3D-CRT and gemcitabine, control group of 45 patients were treated with gemcitabine and conventional radiotherapy. Chemotherapy consisted of intravenously gemeitabine 350 mg/m2 on day 1, 8, 15, 22, 29, 36. Radioactive source was used with X ray of 6 MV or 15 MV. Irradiatial target area were lung site and mediastinal node. Results The complete remission (CR)and remission rate(RR) in centrol group were 5 cases (11.1%) and 28 cases(62.2%), but in treatment group were 13 cases (28.9%) and 38 cases (84.4%), respectively. The difference of response rate in two groups was significant(P < 0.05). The rate of acute radiation-induced pneumonifis and esophagitis in control group (28.9%, 35.6%)were higher than those in treatment group (11.1%, 17.8%), there were significant difference between two groups (P < 0.05). Conclusions Concurrent application of gemcitabine and 3D-CRT can improve the RR for locally advanced NSCLC, and the acute toxicity are lower than those of gemcitabine and conventional radiotherapy. The clinical study is needed, but the late effect shoud be followed.