Advances of tumor bed delineation for radiation therapy after breast-conserving surgery / 国际肿瘤学杂志

Radiotherapy following breast conserving surgery is a standard treatment in early stage breast cancer, and tumor bed delineation is a very important part of radiotherapy. Traditionally, operative record, preoperative ultrasound, postoperative scar, clips and other conventional methods were used to contour tumor bed in clinical, but they still have many limitations. In recent years, there were some progress in tumor bed delineation of the new style of lumpectomy cavity filling, preoperative/postoperative MRI images with CT images and other new methods. It is expected to solve the lack of postoperative tumor bed delineation consensus and standard in the future.

Clinical observation of early-stage breast cancer after breast-conserving surgery with hypofractionated radiotherapy / 国际肿瘤学杂志

Objective To observe the long-term effect,adverse reaction and cosmetic outcome of early-stage breast cancer with hypofractionated whole-breast irradiation (HF-WBI) after breast-conserving surgery.Methods A total of 206 patients with stage 0-Ⅱ breast cancer after breast-conserving surgery were included in Shandong Cancer Hospital Affiliated to Shandong University from May 2014 to August 2017.According to radiotherapy fraction,patients were divided into HF-WBI group and conventional whole-breast irradiation (CF-WBI) group.In HF-WBI group,116 patients received whole-breast radiation to 42.56 Gy in 16 fractions followed by tumor bed boost of 9 Gy in 3 fractions or 10 Gy in 5 fractions.In CF-WBI group,90 patients received whole breast radiation to 50 Gy in 25 fractions followed by tumor bed boost of 10 Gy in 5 fractions.The 2-year local recurrence rate,2-year mortality rate,acute adverse reaction,late adverse reaction and cosmetic outcome of the two groups were analyzed.Results The 2-year local recurrence rates of HF-WBI group and CF-WBI group were 0.86％ (1/116) and 2.22％ (2/90) respectively,and there was no significant difference between the two groups (x2 =0.049,P =0.824).The 2-year mortality rates of the two groups were 0.86％ (1/116) and 0 (0/90) respectively,and there was no significant difference (P ＞ 0.999).There were 108 cases (93.1％) in HF-WBI group and 84 cases (93.3％) in CF-WBI group with grade 0-1 acute dermatitis,and 8 cases (6.9％) and 6 cases (6.7％) with grade 2-3 respectively,with no statistically significant difference (x2 =0.004,P =0.948).There were 97 cases (83.6％) in HF-WBI group and 79 cases (87.8％) in CF-WBI group with grade 0-1 bone marrow suppression,and 19 cases (16.4％)and 11 cases (12.2％) with grade 2-4 respectively,with no statistically significant difference (x2 =0.704,P =0.401).In the two groups,there were 1 case (0.9％) and 3 cases (3.3％) with grade 1-2 radiation pneumonitis,and 115 cases (99.1％) and 87 cases (96.7％) with no radiation pneumonitis respectively,and the difference was not statistically significant (x2 =1.626,P =0.202).There was 1 case (0.9％,1.1％) with grade 1 breast edema in each group,and 115 cases (99.1％) and 89 cases (98.9％) did not occur breast edema,with no statistically significant difference (x2 =0.033,P =0.857).In the late adverse reactions,there were 5 cases (4.3％) and 3 cases (3.3％) with skin pigmentation in HF-WBI group and CF-WBI group respectively.There were 2 cases (1.7％,2.2％) with grade 1 subcutaneous tissue fibrosis in each group,and there were 1 case (0.8％) and 2 cases (2.2％) with grade 1 pulmonary fibrosis respectively.The differences between the two groups were not statistically significant (x2 =0.000,P ＞ 0.999;x2 =0.000,P ＞ 0.999;x2 =0.049,P =0.824).The 6-month,1-year and 2-year cosmetic outcome good rates in HF-WBI and CF-WBI group were 96.5％ (111/115) and 93.3％ (84/90),92.1％ (105/114) and 90.0％ (81/90),91.4％ (53/58) and 87.2％ (41/47) respectively.The differences between the two groups were not statistically significant (x2 =0.526,P =0.468;x2 =0.277,P =0.599;x2 =0.476,P =0.490).The whole course of radiotherapy time in HF-WBI group was 25 days or 29 days,which was significantly shorter than the 40 days of CF-WBI group.Conclusion HF-WBI after breast-conserving surgery has the similar long-term effect,acute and late adverse reaction and cosmetic outcome compared with CF-WBI,and the treatment time is significantly shorter.It can be further promoted as the optimal adjuvant radiotherapy for early-stage breast cancer after breast-conserving surgery.

Research progress of hypofractionated whole breast irradiation after breast conserving surgery / 国际肿瘤学杂志

Hypofractionated radiotherapy after breast conserving surgery has become a new standard treatment of early breast cancer. Clinical researches show that α/ β value of breast cancer is lower than that of other tumors,and the breast cancer is more suitable for hypofractionated radiotherapy. Hypofractionated radio-therapy has good economic benefits,and long-term follow-up results from a number of classical randomized con-trolled studies have shown that hypofractionated whole breast irradiation is effective and safe. With the extensive application of hypofractionated irradiation,this technology has been gradually extended to regional nodal irradia-tion,postmastectomy radiotherapy and breast ductal carcinoma in situ.

Research progress of tumor immunotherapy and PD-1/PD-L1 inhibitors / 国际生物医学工程杂志

Immunotherapy has become a new treatment for malignant tumors following surgery,radiotherapy,and chemotherapy.Tumor immunotherapy is a hot topic in basic medical research and clinical research,in which the study on checkpoint protein inhibitors has attracted more attention.The previous studies confirmed that blocking certain checkpoints,such as cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) and programmed cell death protein-1 (PD-1),can exert immunomodulatory effects in solid tumor treatments.Immune checkpoint inhibitors have demonstrated good efficacy in recent years.The PD-1/programmed death ligand-1 (PD-L1) signaling pathway is one of the important pathways for tumor immune escape.PD-1/PD-L 1-targeted drugs can reactivate anti-tumor immunity and achieve good therapeutic effects in the treatment of various tumors.However,anti-PD-1/PD-L1 treatment has a certain adverse reaction rate,and the response rate of treatment needs to be improved.In this paper,the research progress of PD-1/PD-L1 signaling pathway and anti-PD-1/PD-L1 drugs in the treatment of solid tumors was summarized,such as malignant melanoma,lung cancer,renal cell carcinoma,gastrointestinal cancer,bladder cancer,etc.

Molecular typing characterization of food-borne methicillin-resistant Staphylococcus aureus in China / 中华预防医学杂志

Objective@#To analyses the antimicrobial resistance and molecular characterization of 21 MRSA isolates cultured from retail foods from different provinces in China, and evaluate the molecular typing methods.@*Methods@#Twenty-one MRSA isolates were obtained from national foodborne pathogen surveillance network in 2012 (Chinese salad, n=3; milk, n=1; cake, n=2; rice, n=1; cold noodle, n=1; spiced beef, n=1; dumpling, n=1; packed meal, n=1; salad, n=1; raw pork, n=9). The antimicrobial resistance of 21 strains to 12 antimicrobial agents was tested by broth dilution method. Polymerase chain reaction (PCR) and DNA sequencing were performed to obtain the genetic types of MLST (ST) and spa typing. The clonal complex (CC) was assigned by eBURST soft and the MLVA type (MT) and MLVA complex (MC) were identified via the database of the MLVA website (http://www.mlva.net). SmaI pulsed-field gel electrophoresis (SmaⅠ-PFGE) was also carried out to obtain the PFGE patterns of 21 strains. The genetic diversity and discriminatory power of typing were calculated by the Simpson's index of diversity (diversity index, DI) to find out the best genotyping method for MRSA.@*Results@#All MRSA isolates showed multi-drug resistance(MDR), and were resistant to oxacillin, benzylpenicillin, clindamycin and erythromycin, and 71.4% (15/21), 47.6% (10/21), 42.9% (9/21) and 28.6% (6/21) of the MRSA isolates were resistant to tetracycline, ciprofloxacin, trimethoprim/sulfamethoxazole and gentamicin, respectively. Moreover, one strain was found to be resistant to all three antimicrobials of levofloxacin, moxifloxacin and rifampicin. Great diversity was found in these food-associated MRSA (6 STs, 7 spa types, and 9 MTs). PFGE patterns were more diverse than those of other three molecular typing methods (19 pulse types). The index of diversity (DI) of PFGE, MLVA, spa typing and MLST was 0.99, 0.80, 0.73, and 0.61, respectively. Among the MRSA isolates, CC9-ST9-t899-MT929-MC2236 (PFGE Cluster Ⅴ) was the most prevalent clone, which were all cultured from raw pork (9 isolates). Besides, two MRSA were identified as CC59-ST338-t437-MT621-MC621 (PFGE Cluster Ⅳ). Different clone had their own resistance spectrum profiles.@*Conclusion@#The food-borne MRSA isolates were all MDR in this study. Different clones had their own resistance spectrum profiles. MLVA represented a promising tool for molecular epidemiology tracing of MRSA in foodborne disease events.

Laboratory-based characterization and traceability of an outbreak of necrotising enterocolitis / 中华预防医学杂志

Objective@#Laboratory-based characterization and traceability were performed on an outbreak of necrotising enterocolitis (NEC) happened in a maternal and child health care hospital in China.@*Methods@#Thirty-seven samples were collected from 3 NEC cases, that the clinical manifestations was bloody stools. Clostridium spp. isolation and identification were carried out on stool, breast milk, milk-based infant powder and environmental swab samples collected during NEC outbreak from October to November in 2016. Meanwhile, twenty-four swabs samples from ward environmental, staffs' hand as well as articles for neonates daily use were also collected and tested for Clostridium spp. after disinfection following outbreak. Pulsed-field gel electrophoresis (PFGE) analysis was performed on all Clostridium strains obtained.@*Results@#46% (17/37) samples were positive for a presumptive Clostridium spp. during the outbreak of NEC. One type of Clostridium spp. isolates was cultured from 10 samples including the hands of medical staffs, some medical equipments in the ward and milk-based infant powder ingested by the case, it was identified as C.butyricum. Another type of Clostridium spp. isolates was cultured from 2 samples including breast milk and inner wall of breast milk fresh-keeping bag, it was identified as C.sporogens. Both of these two types isolates were cultured from 5 samples including inner wall of breast milk box, inner wall of refrigerator, the handle of case's incubator and the case's stool. PFGE analysis showed that all 15 strains of C. butyricum and 7 strains of C.sporogens isolated from the samples mentioned above produced indistinguishable pulsotypes respectively. No NEC cases were found after disinfection following the outbreak and all samples collected after outbreak were negative for Clostridium spp.@*Conclusion@#The outbreak of NEC was highly related to C. butyricum contamination within the hospital.