A Clinical Analysis of Prognosis and Patient-Reported Outcomes of Oncoplastic Breast-Conserving Surgery for Early Breast Cancer: A Retrospective Cohort Study.

PURPOSE: Approximately 25-30% of patients suffer from breast deformity and/or asymmetry after conventional breast-conserving surgery (CBCS). Generally, it is thought that oncoplastic breast-conserving surgery (OBCS) results in an improved cosmetic result; however, studies comparing the prognosis and aesthetic outcomes of CBCS and OBCS in early breast cancer (EBC) are inadequate. METHODS: A total of 143 patients were included in this retrospective cohort study; 53 underwent OBCS and 90 underwent CBCS. The resected weight, complications, esthetic results, patient satisfaction, and recurrence rate were compared between the groups. Patient-reported outcomes (PRO) were assessed by the BREAST-Q questionnaire. RESULTS: The mean age of the patients in OBCS group was 43.8 years. This was younger than that in CBCS group (49.1 years, p < 0.001). Postoperative complications (11.3% vs. 8.9%, p = 0.64) and re-excision (5.7% vs. 6.7%, p > 0.99) rates were similar. The OBCS group had higher breast satisfaction and psychosocial well-being than the CBCS group (75 vs. 63, p < 0.001 and 84 vs. 77, p = 0.05); however, sexual well-being (56 vs. 66, p = 0.05) and physical well-being (65 vs. 76, p < 0.001) were worse in OBCS. After 42.3 (range: 12.6-69.2)-month median follow-up, no difference in event-free survival (EFS) was demonstrated between the groups (p = 0.13). CONCLUSION: Although OBCS has the better aesthetic outcomes and identical oncological safety in comparison with CBCS, the sexual and physical well-being in OBCS are not improved for Asian patients. Hence, choosing an appropriate procedure may be more important for the typically small to moderate-sized breasts characteristic of Asian females unlike Westerners. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mesenchymal Stem Cells Enhance Chemotaxis of Activated T Cells through the CCL2-CCR2 Axis In Vitro.

Activation and migration of donor T cells to the host target organs are critical mechanisms in the pathogenesis of graft-versus-host disease (GVHD). The role of monocyte chemoattractant protein-1 (MCP-1/CCL2) and its receptor CCR2 in the recruitment of T cells during immune or inflammatory response is also well known. For elucidation of the mechanism of the therapeutic effect of human bone marrow derived-mesenchymal stem cells (MSC) in GVHD, we studied the effect of these cells on migration of activated donor T cells through the CCL2-CCR2 axis in vitro. MSC were expanded from donors' bone marrow mononuclear cells. After co-culturing of IL-2-activated T cells with allogeneic MSC at different ratios, the levels of CCL2 in supernatants were measured by ELISA, and CCR2 expression in CD4+/CD8+ T cells subsets were detected by flow cytometry. The effect of MSC on the migration of activated T cells in the Transwell system was studied in the absence or presence of CCL2. Our results show that CCL2 levels in supernatants of co-cultures were significantly higher than in MSC monoculture and this increase depended on the number of MSC. MSC inhibited proliferation of T cells, but did not change the percentages of CD4+ and CD8+ T cells subsets. MSC can up-regulate the CCR2 expression in CD8+ subsets rather than in CD4+ subsets; MSC enhanced migration of IL-2-activated T cells to CCL2 by increasing the expression of CCR2. The data demonstrate that MSC can enhance chemotaxis of cytokine-activated T cells through the CCL2-CCR2 axis in vitro.

[Clinical characteristics and prognostic risk factors analysis of carbapenem-resistant organism in the department of hematology].

Objective: To study the distribution and drug resistance of Carbapenem-Resistant Organism (CRO) and to analysis the risk factors of CRO 30-day mortality. Methods: A total of 181 patients with CRO infection diagnosed in Department of Hematology, Fujian Medical University Union Hospital from January 2018 to June 2020 were retrospectively investigated. The clinical and laboratory data of the patients were collected, the prognosis of patients diagnosed with CRO infection in day 30 was followed up, and the risk factors of prognosis were analyzed. The clinical significance of Carbapenem-Resistant Enterobacteriaceae (CRE) active screening was further evaluated in the CRE subgroup. Results: Among the total of 181 CRO isolates, 47.2% were CRE, 37.0% were Pseudomonas aeruginosa, and 32.6% were Klebsiella pneumoniae, which were highly resistant to carbapenem and had high MIC value, 76.8% (139/181) of CRO were MIC of imipenem resistance≥16 µg/ml. The main sources of isolates were blood and sputum. The 30-day all-cause mortality rates of patients with CRO or CRE infection were (41.4±3.7) % and (44.7±5.4) %, respectively. The COX multivariate regression analysis showed that the level of procalcitonin >0.2 ng/ml and the MIC value of imipenem resistance ≥ 16 µg/ml were independent risk factors for 30-day mortality of CRO infected patients. The CRE subgroup analysis showed that MIC value of imipenem resistance ≥16 µg/ml were independent risk factors for 30-day mortality of CRE infected patients. The 30-day cumulative survival rate of patients with CRE active screening was higher than the patients without CRE active screening [ (68.0±9.3) % vs (50.0±6.5) %, P=0.21]. Conclusion: The high MIC value of imipenem resistance isolates seriously affects the prognosis of patients with CRO infection in the hematology department, and the mortality rate was high. CRE active screening is expected for early prevention, early diagnosis, and early treatment for high-risk patients.

[Characteristics of renal cortical perfusion and its association with renal function among elderly patients with renal artery stenosis].

Objective: To evaluate the characteristics of renal cortical blood perfusion assessed by contrast-enhanced ultrasound (CEUS) in elderly patients with renal artery stenosis (RAS) and its relationship with renal function. Methods: Ninety-three elderly patients diagnosed with RAS, who were admitted in Beijing Hospital during June 2017 and December 2018, were retrospectively enrolled. According to the degree of RAS, 186 renal arteries were divided into normal renal artery group (n=79), mild RAS group (30% to 49%, n=59), moderate RAS group (50% to 70%, n=33), and severe RAS group (70% to 99%, n=15). Renal cortical blood perfusion and renal glomerular filtration rate (GFR) were measured by CEUS and radionuclide renal dynamic imaging. According to the renal GFR, 186 kidneys were divided into normal renal function group (GFR≥35 ml/min, n=42) and mild renal insufficiency group (35 ml/min>GFR≥25 ml/min, n=51), moderate renal insufficiency group (25 ml/min>GFR≥15 ml/min, n=75) and severe renal insufficiency group (GFR<15 ml/min, n=18). The renal cortical blood perfusion time-intensity curve (TIC) and related parameters were analyzed, including the area under the curve (AUC), the slope of the ascending branch (A), the peak intensity (PI), the peak time (TTP) and the mean transit time (MTT), the kidneys of different RAS groups and patients with different renal function groups were analyzed. Pearson correlation analysis was used to evaluate the correlation between renal cortical blood perfusion parameters and renal GFR. Results: (1) Renal cortical blood perfusion and GFR: CEUS showed that parameter A of TIC was significantly reduced, while TTP was prolonged in the mild renal artery stenosis group compared with the normal renal artery group (both P<0.05), GFP was similar between the two groups. Cortical perfusion parameters, such as AUC, A, PI and GFR were significantly lower, while TTP and MTT were significantly prolonged in the moderate and severe renal artery stenosis group than in the normal and mild stenosis groups (all P<0.05). Compared with the moderate stenosis group, AUC, A, PI and GFR were significantly lower while TTP, MTT were significantly prolonged in the severe renal artery stenosis group (all P<0.05). (2) TIC showed that the renal perfusion parameters, AUC, PI and A were significantly lower, while TTP was significantly longer in the mild renal dysfunction group than in the normal renal function group (all P<0.001). The changes aggravated in proportion with renal dysfunction. (3) Correlation between perfusion parameters and GFR: Pearson correlation analysis showed that the AUC (r=0.774, P<0.05), A (r=0.815, P<0.05) and PI (r=0.772, P<0.05) were positively correlated with GFR; serum creatinine level (r=-0.841, P<0.05), renal function grading (r=-0.731, P<0.05), TTP (r=-0.803, P<0.05) and MTT (r=-0.741, P<0.05) were negative correlated with GFR. The degree of stenosis was negatively correlated with GFR (r=-0.427, P<0.05). Conclusion: Cortical perfusion parameters differ significantly among patients with various degree of RAS and renal dysfunction. The renal cortical blood perfusion parameters are correlated with renal GFR.

[Diagnostic value of contrast-enhanced ultrasound for accessory renal artery among patients suspected of renal artery stenosis].

Objective: To evaluate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of accessory renal artery (ARA) in patients suspected of renal artery stenosis. Methods: Cases were derived from patients suspected diagnosis of renal artery stenosis during October 2017 and July 2018 by CEUS.A total of 28 kidneys with ARA in 25 cases were diagnosed by dynamic continuous observation by two ultrasound physicians separately. If there was disagreement, the superior physician would made the judgment. DSA or CTA examination was performed at the same period, and its consistency with CEUS diagnosis of ARA was analyzed. Results: DSA or CTA identified RAS in 32 ARA, color-coded duplex ultrasonography (CCDS) in 12 and CEUS in 28. The sensitivity in detecting ARA was 37.5% for CCDS and 84.4% for CEUS, the specificity was 0% for CCDS and 94.4% for CEUS, while the accuracy was significantly different with CCDS compared with CEUS (60.0% vs 88.0%). Thus, CEUS significantly improved the ARA detection rate compared with CCDS (84.4% vs 37.5%, χ(2)=15.56, P<0.01). Compared with CTA or DSA, CEUS showed good consistency in ARA diagnosis (kappa value was 0.752, P<0.05). Conclusion: CEUS can display and evaluate ARA in real time accurately, which provides a new technology for further clinical research of ARA.

[Diagnostic value of contrast-enhanced sonography and digital subtraction angiography for renal artery stenosis].

Objective: To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) and digital subtraction angiography (DSA) for renal artery stenosis (RAS). Methods: Fifty-seven hypertensive patients suspected for RAS admitted in Beijing Hospital from September 2017 to August 2018 were enrolled. All 114 renal arteries were assessed by CEUS and DSA. RAS was subdivided into low-(30%-50%), moderate-(50%-69%) and high-grade (70%-99%) subgroups. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were compared between CEUS and DSA results. Results: Fifty-seven hypertensive patients (31 males, mean age 57.1 years) involving 114 renal arteries were included. Overall, DSA identified RAS in 71(62.3%) renal arteries, mild RAS, 34(29.8%); moderate RAS, 23(20.2%); severe RAS, 14(12.3%). With CEUS, the sensitivity, specificity, accuracy, PPV and NPV for detecting mild-grade RAS were 85.3%, 97.3%, 91.5%, 96.7% and 87.8%; for detecting moderate-grade RAS were 82.6%, 97.9%, 92.9%, 95.0% and 92.2%; for detecting high-grade RAS were 85.7%, 98.2%, 95.8%, 92.3% and 96.5%. The measure of agreement kappa was 0.92 between CEUS and DSA. Conclusion: CEUS is a safe and accurate method for the diagnosis and severity classification of RAS, especially those with kidney injury.

[Distribution and drug resistance of pathogens of blood stream infection in patients with hematological malignancies after chemotherapy].

Objective: To investigate the distribution and resistance of pathogens isolated from blood cultures in patients with hematological malignancies after chemotherapy in Union Hospital of Fujian Medical University so as to understand the real situation of blood stream infection (BSI) and provide the basis for rational use of antibiotics in clinic. Methods: The data of 657 strains isolated from blood culture specimens of patients with hematological malignancies from January 2013 to December 2016 were collected analyzed. Results: A total of 657 cases of blood culture positive bacterial strains were included in the study, involving 410 cases (62.4%) with single Gram-negative bacteria (G(-) bacteria) , 163 cases (24.8%) with single Gram-positive bacteria (G(+) bacteria) , 50 cases (7.6%) with single fungi. The most common 5 isolates in blood culture were Klebsiella pneumoniae (17.5%) , Escherichia coli (17.2%) , Coagulase negative staphylococci (CNS) (14.9%) , Pseudomonas aeruginosa (14.2%) and Staphylococcus aureus (3.5%) . The extended-spectrum beta-lactamase (ESBL) production rates of Klebsiella pneumoniae and Escherichia coli were 25.2% and 55.8%, respectively. ESBL producing strains were almost more resistant than non-ESBL producing strains. The resistance rates of Enterobacteriaceae to carbapenems, piperacillin/tazobactam and tigecycline were lower than 14.0%. The resistance rates of Pseudomonas aeruginosa to a variety of drugs were lower than 12.0%. Tigecycline-resistant Acinetobacter baumannii bacteria were not detected, and the resistance rates of Acinetobacter baumannii to cefixime and cefotaxime were 7.1%. Methicillin-resistant strains in CNS (MRCNS) and in Staphylococcus aureus (MRSA) accounted for 84.7% and 43.5%, respectively. Vancomycin, linezolid and tigecycline-resistant G(+) bacteria were not detected. Conclusion: The pathogens isolated from blood culture were widely distributed. Most of them were G(-) bacteria, and the resistance to antibiotics was quite common. Furhermore, vancomycin, linezolid and tigecycline can be chosen empirically to treat patiens who ar suspected to have G(+) bacterial BSI.

[Incidence of singleton macrosomia in Beijing and its risk factors].

OBJECTIVE: To evaluate the prevalence of macrosomia in Beijing in 2013 and identify its risk factors. METHODS: Retrospective six months analysis of 14 188 full-term singleton pregnant women from 15 hospitals with different levels in Beijing in 2013. Each participant's demographic data and medical information were collected individually by questionnaires. Multiple logistic regression analysis was used to examine the associations between variables and the risk of macrosomia. RESULTS: (1)The total prevalence of macrosomia was 7.069% (1 003/14 188) in Beijing in 2013. (2)The prevalence varied between the 15 hospitals, the lowest was 5.36% (89/1 659), while the highest reached 8.80%(46/523). Furthermore, the incidence of macrosomia was 1.284 times (95% CI: 1.114- 1.480, P=0.001) higher in the second graded hospitals than that in the tertiary hospitals. (3) Multiple logistic regression analyses showed that risk factors for macrosomia were maternal height≥160 cm (adjusted OR=1.875, 95% CI: 1.559- 2.256), pre-pregnant body mass index (p-BMI) ≥24.0 kg/m(2) (24.0- 27.9 kg/m(2): adjusted OR=1.696, 95% CI: 1.426- 2.018; p-BMI≥28.0 kg/m(2): adjusted OR=2.393, 95% CI: 1.831- 3.127), gestational weight gain (GWG) ≥15.9 kg (adjusted OR=2.462, 95% CI: 2.125- 2.853), gravidity>1 (adjusted OR=1.408, 95% CI: 1.224- 1.620), gestational weeks≥40 (adjusted OR=2.007, 95%CI: 1.745-2.308) and gestational diabetes mellitus (adjusted OR=1.522, 95%CI: 1.298-1.784). GWG≥15.9 kg, p-BMI≥28.0 kg/m(2) and gestational weeks≥40 were three risk factors that had the strongest associations with macrosomia (all P<0.01). CONCLUSIONS: The prevalence of macrosomia in hospitals with different levels is obvious different. Gestational weeks, p-BMI and GWG are three main controllable risk factors for macrosomia, thus should receive more attentions.

Sirtuin 3 inhibits hepatocellular carcinoma growth through the glycogen synthase kinase-3ß/BCL2-associated X protein-dependent apoptotic pathway.

SIRT3 is a class III histone deacetylase that has been implicated in a variety of cancers. The role of SIRT3 in hepatocellular carcinoma (HCC) remains elusive. In this study, we found that SIRT3 expression was frequently repressed in HCC and its downregulation was closely associated with tumor grade and size. Ectopic expression of SIRT3 inhibited cell growth and induced apoptosis in HCC cells, whereas depletion of SIRT3 in immortalized hepatocyte promoted cell growth and decreased epirubicin-induced apoptosis. Mechanistic studies revealed that SIRT3 deacetylated and activated glycogen synthase kinase-3ß (GSK-3ß), which subsequently induced expression and mitochondrial translocation of the pro-apoptotic protein BCL2-associated X protein (Bax) to promote apoptosis. GSK-3ß inhibitor or gene silencing of BAX reversed SIRT3-induced growth inhibition and apoptosis. Furthermore, SIRT3 overexpression also suppressed tumor growth in vivo. Together, this study reveals a role of SIRT3/GSK-3ß/Bax signaling pathway in the suppression of HCC growth, and also suggests that targeting this pathway may represent a potential therapeutic approach for HCC treatment.

Lenalidomide affect expression level of cereblon protein in multiple myeloma cell line RPMI8226.

We investigated the mechanisms of action of immuno-modulatory drug (lenalidomide) on the protein expression of cereblon (CRBN) and their therapeutic targets in the multiple myeloma cell line RPMI8226. The multiple myeloma cell line RPMI8226 was cultured and treated with different concentrations of lenalidomide and bortezomib to determine the proliferation inhibition rate, apoptosis rate, and protein expression of CRBN. The results revealed that both lenalidomide and bortezomib inhibited the proliferation of RPMI8226 and promoted cell apoptosis. However, the protein expression of CRBN decreased signifi-cantly after treatment with lenalidomide, while bortezomib had no effect on the expression of CRBN. We confirmed that CRBN may be a target of lenalidomide.

A rare disorder mimics otitis media: Langerhans cell histiocytosis of the temporal bone in a child with interstitial pulmonary fibrosis.

Langerhans cell histiocytosis (LCH) is a rare disease ranging from a benign to a rapidly fatal condition affecting young children predominantly, and is characterized by an abnormal clonal proliferation of Langerhans cells. We report a case of a 3-year-old child presenting with a 1-year history of otorrhea and otorrhagia followed by a 6-month history of postauricular swelling in the right ear. Imaging demonstrated a large mass of organized tissue. A biopsy was conducted, and the diagnosis of LCH was confirmed by histopathological and immunohistochemical examination. The child was treated with a 12-month course of vinblastine chemotherapy with prednisolone. No clinical evidence of recurrence was noticed after 3 years of follow-up. This rare case highlights the importance for otolaryngologists to keep LCH in mind for differential diagnosis in very young patients with symptoms and signs suggestive of acute mastoiditis or chronic otitis media.

Polymorphism in heme oxygenase-1 (HO-1) promoter and alcohol are related to the risk of esophageal squamous cell carcinoma on Chinese males.

UNLABELLED: Chronic alcohol drinking is astrong risk factor for esophageal squamous cell carcinoma (ESCC). In this study, the correlation between the HO-1 gene promoter polymorphism and alcohol, along with the risk of ESCC on Chinese males, was analyzed.The case-control study was performed in 143 ESCC patients and 264 cancer-free controls. All subjects were males. Allelotypic frequencies of (GT)n repeat were examed by PCR-based genotyping and DNA sequencing. The frequencies of L-allele and L-allele carriers (S/L and L/L genotypes) was significantly higher in ESCC patients than in controls (p =0.001 and 0.004), The adjusted ORs for ESCC with S/L and L/L genotypes vs S/S genotype was 2.212 (95% CI 1.297-3.775, p= 0.004). The adjusted ORs for light, moderate and heavy drinking was 1.467, 5.215 and 9.525 respectively among L-allele carriers (S/L and L/L genotypes )and 1.389, 2.096 and 3.039 respectively for the S/S genotype. Length of a(GT)n repeat in the HO-1 gene promoter may be associated with the development of ESCC in Chinese male drinkers. Reducing alcohol intake might be most protective among L-allele carriers of this polymorphism. KEYWORDS: esophageal squamous cell carcinoma; heme oxygenase-1 promoter polymorphism; alcohol drinking.

Two-stage SBR for treatment of oil refinery wastewater.

A two-stage sequencing batch reactor (SBR) system was used for treatment of oily wastewater with COD and oil and grease (O&G) concentrations ranging from 1,722-7,826 mg/L and 5,365-13,350 mg/L, respectively. A suitable start-up protocol was developed using gradual increase in oily wastewater composition with methanol as the co-substrate. This strategy enabled a short acclimation period of 12 days for the sludge in the two-stage SBR to adapt to the oily wastewater. After acclimation, the 1st stage and 2nd stage SBRs were able to achieve COD removals of 47.0+/-2.4% and 95.3+/-0.5%, respectively. The 1st stage SBR was able to achieve 99.8+/-0.1% of O&G removal and effluent O&G from the 1st stage SBR was only 6+/-2 mg/L. The 2nd stage SBR was used to further remove COD in the effluent from the 1st stage SBR. The final effluent from the 2nd stage SBR had a COD concentration of 97+/-16 mg/L with no detectable O&G content. Thus, a two-stage SBR system was shown to be feasible for treating high strength oily wastewater to meet the local discharge standards.

[Evaluation of the effect of streptomycin perfusion of the labyrinth in the treatment of Meniere's disease and endolymphatic hydrops].

OBJECTIVE: To investigate the clinical effect of streptomycin perfusion of the labyrinth (SPL) in the treatment of Meniere's disease. METHOD: 13 patients with Meniere's disease and 3 patients with delayed endolymphatic hydrops (DEH) underwent SPL. The follow-up time was between 5 and 7 years (average 6.3 years). RESULT: Vertigo was completely controlled in 9 patients, substantialy controlled in 4, limitedly controlled in 2 and not controlled in 1. Hearing was improved in 1 patients, stabilized in 5 and worse in 10. Tinnitus was improved in 3 patients, stabilized in 5 and worse in 8. CONCLUSION: SPL is a safe and effective method in the treatment of Meniere's disease and DEH, but the hearing may be insulted and tinnitus may be worse in some patients.

Correlative study on the expression of p53 and DNA ploidy in acute nonlymphocytic leukemia.

We used the flow cytometric immunoassay to study the correlation between the rumor-suppressor gene product p53- and the DNA ploidy in 30 de novo cases of acute nonlymphocytic leukemia (ANLL). The results showed that 15 cases were positive expression for p53. As compared with p53 negative (p53) cases, the patients with positive p53 (p53+) had higher percentage of bone marrow blasts and lower peripheral leukocyte and platelet counts, which had no influence on the complete remission rate. Before treatment, DNA diploidy was seen in 18 cases including 12 p53- cases, and DNA aneuploidy in 12 cases including 9 p53+. After therapy, aneuploidy could be transformed into diploidy. Patients with P53+ or having aneuploidy in complete remission were at risk for early relapse. We believe that p53 may be involved in the process of leukemogenesis and progression of ANLL.