Abstract:保乳手术（BCS）结合术后放射治疗已成为早期乳腺癌患者的标准治疗方式。于此同时，肿瘤整形外科的进步改善了美容效果并提高了患者的满意度。因此，对乳腺外科医生在BCS中的要求不仅仅是实施有足够手术切缘的肿瘤切除，还应保证术后乳房的外观。内镜辅助下的乳房保留手术（EBCS）因其减少术后疤痕的优势在十多年前开始发展起来。近来，一些临床机构报道了EBCS的可行性、肿瘤预后、美容效果及患者的满意情况。笔者回顾了目前为止的关于EBCS的临床研究，并予以讨论。

Abstract:Objective: To assess the clinical effect of application of endoscopic techniques in axillary lymph node dissection and pedicled greater omental flap breast reconstruction. Methods: The data of 35 patients with stage I and II breast cancer undergoing minimally invasive radical resection plus minimally invasive breast reconstruction were analyzed. The patients underwent endoscopic axillary lymph node dissection and endoscopically assisted tumor quadrantectomy first, and then immediate breast reconstruction by the laparoscopically harvested pedicled greater omental flap through subcutaneous tunnel was performed. Results: The average time for the entire operation was 318 min, in which, the average time for endoscopic axillary lymph node dissection was 41 min, and for laparoscopic pedicled greater omental flap harvest was 59 min, and the average intraoperative blood loss was 75 mL (largely during mastectomy). One case developed partial omental necrosis because the gastroepiploic artery was injured during the operation and only one omental artery was used instead for blood supply to pedicle flap, fat liquefaction of the incision occurred in one case, and in the remaining cases, the greater omental flap survived; no abdominal complications occurred, and the axillary shape as well as upper limb function were satisfactory. The cosmetic outcome was “excellent” in 28 cases, “good” in 6 cases, and “fair” in one case. Conclusion: The endoscopic axillary lymph node dissection combined with laparoscopically harvested pedicled omental flap for immediate breast reconstruction is safe and feasible, and the procedure achieves better results for minimal invasion and aesthetic requirements.

Abstract:Objective: To investigate the feasibility and safety of breast conserving surgery for early-stage breast cancer with the assistance of INTRABEAM intraoperative radiotherapy (IORT). Methods: Seventeen eligible female patients with early-stage breast cancer were enrolled from November 2012 to July 2013, and all of them underwent IORT-assisted radical breast conserving surgery. The surgical site condition, incidence of local complications and acute radiation injury in the patients were observed after surgery, and the cosmetic results of the breast and short-term therapeutic efficacy were assessed through follow-up clinical visits. Results: IORT-assisted radical breast conserving surgery was completed in all patients with a median intraoperative irradiation time of 25 (20–35) min. Four patients (23.5%) needed external whole-breast irradiation after operation. The main early postoperative complications included excessive fluid in the residual dead space (11.8%), and evident redness and swelling of the skin of the breast (17.6%). No evident hematoma in the residual dead space or wound infection was noted in any of the patients, and all patients tolerated the intraoperative irradiation well. The early follow-up survey showed that the good cosmetic rate of the affected breast after surgery was 76.5%, and there was 100% rate of relapse-free survival, metastasis-free survival and overall survival. Conclusion: IORT-assisted radical breast conserving surgery is relatively safe and reliable for selected patients with early-stage breast cancer.

Abstract:Objective: To investigate the feasibility of first-stage silicone prosthesis breast reconstruction with nipple-areolar complex (NAC) preservation for repairing the defect following mastectomy for benign and malignant breast tumor. Methods: From January 2008 to November 2012, 15 patients each with benign or malignant breast tumor were selected, and underwent the first-stage breast reconstruction with silicone prosthesis implantation beneath the pectoralis major muscle after mastectomy, and the NAC was preserved during surgery. Postoperative follow-up was conducted for 13-48 months, and the cosmetic results, complications and clinical outcomes of the patients were observed. Results: Of the 30 patients, 28 cases were satisfied with the postoperative breast shape, and capsular contracture of the prosthesis and prosthesis leakage occurred in one case each at 1.5 and 2 years after surgery, respectively. No residual, recurrent or metastatic tumor associated with NAC preservation was observed. Conclusion: First-stage silicone prosthesis breast reconstruction after breast tumor resection with NAC preservation can not only successfully treat the breast tumor but also meet the aesthetic requirements for breast appearance of patients, with no risk of increasing the incidence of complications, or of residual, recurrent or metastatic tumor.

Abstract:Objective: To assess the clinical efficacy of the modified radical mastectomy with first-stage breast reconstruction using extended latissimus dorsi flap in treatment of breast cancer. Methods: The clinical data of 150 patients with breast cancer undergoing total mastectomy from March 2008 to March 2013 were retrospectively analyzed. Of the patients, the traditional modified radical mastectomy was performed in 28 cases, skin sparing total mastectomy was performed in 47 cases, and nipple sparing total mastectomy was performed in 75 cases, and all of the cases received synchronous breast reconstruction using extended latissimus dorsi flap. Results: The operation was performed successfully in 149 patients and failed in one patient. The excellent/good rate of the appearance evaluation of the reconstructed breast reached 91.27% (136/149). After surgery, partial nipple necrosis occurred in 4 patients, and chest skin contusion with exfoliation occurred in 3 patients, all of which healed spontaneously without special treatment; dorsal hematoma occurred in 8 patients, of whom 6 cases resolved by puncture and aspiration, one case was cured by removal of the fibrous capsule, and one case was cured after resection of the sinus tract and false membrane; local skin necrosis at the margin of wound occurred in 2 patients, and partial necrosis in the donor region of the flap occurred in 2 patients, which were resolved by a second surgery; ischemic necrosis of the graft occurred in one case, which was treated by surgical resection. Followed-up was performed for 8 to 73 months (18 patients were lost to follow-up, all of whom had disease-free survival before lost to follow-up), during which time, 2 patients developed bone metastases, one case each developed pulmonary metastases and supraclavicular lymph node metastases, and no local recurrence occurred in any of the patients. Conclusion: Modified radical mastectomy with first-stage breast reconstruction using extended latissimus dorsi flap in treatment of breast cancer is safe and effective, and is especially suitable for the patients with small or medium breast size.

Abstract:Objective: To investigate the clinical characteristics, treatment methods and prognosis of postoperative chest wall breast cancer recurrence. Methods: The clinical data of 113 patients with postoperative chest wall breast cancer recurrence treated at the Affiliated Tumor Hospital of Xinjiang Medical University from January 2004 to June 2014 were collected, and the relations of the various factors with survival of the patients were analyzed. Results: Of the patients, the survival time after chest wall breast cancer recurrence was from 5 to 102 months, with a median survival time of 41 months; the 1-, 2- and 5-year survival rate was 100.0%, 85.0%, and 38.0%, respectively. Univariate analysis showed that tumor size, lymph node metastasis, TNM stage, hormone receptor expression, HER-2 receptor expression, postoperative radiation therapy, targeted therapy, endocrinotherapy, time of disease-free survival to chest wall recurrence, and surgical resection and radiotherapy of the recurrent tumor were associated with the survival of the patients after chest wall recurrence (all P<0.05); multivariate analysis identified that TNM stage, hormone receptor expression, HER-2 receptor expression, targeted therapy, time of disease-free survival to chest wall recurrence were independent prognostic factors for the survival of the patients after chest wall recurrence (all P<0.05). Conclusion: Postoperative chest wall breast cancer recurrence has a relatively mild prognosis, and comprehensive treatment may help improve the cure rate.

Abstract:Objective: To investigate the anti-tumor effect of the transfection of plasmid containing CD/TK double suicide genes mediated by microbubble-enhanced ultrasound exposure on breast cancer in vivo. Methods: After the xenograft tumor model was created in nude mice using human breast cancer MCF-7 cells, the tumor-bearing mice were randomly divided into control group, plasmid group, ultrasonic irradiation group and ultrasonic irradiation plus microbubble agent group, with 5 mice in each group. Mice in control group were only given the corresponding CD and TK prodrugs (5-fluorocytosine and ganciclovir), mice in plasmid group were injected with the plasmids (containing CD/TK gene) and prodrugs, mice in ultrasonic irradiation group were injected with plasmids and prodrugs combined with ultrasonic irradiation, and those in ultrasonic irradiation plus microbubble agent group were injected with targeted ultrasonic contrast agent (mixture of plasmids and microbubble agent) combined with ultrasonic irradiation. The growth of the tumors was recorded during the experiment. After the tumors were enucleated at post-treatment day 5, the tumor inhibition rate in each group was calculated, the transfection of the target genes in the tumors was observed by an inverted fluorescence microscope, and the transfection efficiency was also analyzed; the expression of the target genes was determined by RT-PCR method; the microvessel density (MVD) of the tumors was detected by immunohistochemical staining. Results: Compared with control group, the tumor growth in plasmid group showed no obvious difference (P>0.05), while in both ultrasonic irradiation group and ultrasonic irradiation with microbubble agent group it was significantly inhibited (both P<0.05), and tumor inhibition rate in plasmid group, ultrasonic irradiation group and ultrasonic irradiation plus microbubble agent group was 3.72%, 21.40% and 47.13%, respectively. The gene transfection efficiency in plasmid group, ultrasonic irradiation group and ultrasonic irradiation plus microbubble agent group was 0.78%, 2.81% and 23.87%,respectively, which in the latter group was significantly higher than that in the former two groups (both P<0.05). The positive DNA fragment of CD/TK gene was present in the tumors from the ultrasonic irradiation group or ultrasonic irradiation plus microbubble agent group, but was absent in those from control group and plasmid group. The MVD count in tumors from both ultrasonic irradiation group and ultrasonic irradiation plus microbubble agent group was significantly lower than that in control group (both P<0.05), which in ultrasonic irradiation with microbubble agent group was even lower than that in ultrasonic irradiation group (both P<0.05), but showed no statistical difference between plasmid group and control group (P>0.05). Conclusion: The double suicide gene system mediated by microbubble-enhanced ultrasonic irradiation can effectively increase the transfection efficiency and expression of the target gene, and thereby exert an enhanced inhibitory effect on tumor growth and angiogenesis.

Abstract:Objective: To investigate the reversal effect of the PI3K/Akt singling pathway inhibitor MK-2206 on drug resistance in human breast cancer cells and its mechanism. Methods: The inhibitory effects of doxorubicin and MK-2206 on growth of MCF-7 cells (doxorubicin-sensitive) and MCF-7/ADR cells (doxorubicin-resistant) were examined by CCK-8 assay and their IC50 values were calculated. Based on the IC50 results, MCF-7 and MCF-7/ADR cells were treated with a selected low-toxic concentration of doxorubicin alone or combined with different concentrations of MK-2206, and then the influence of MK-2206 on doxorubicin-resistance and doxorubicin-induced apoptosis, and on doxorubicin accumulation in MCF-7/ADR cells were detected by CCK-8 assay and flow cytometry, respectively. MCF-7 and MCF-7/ADR cells were treated with MK-2206 alone, and then the expressions of the proteins associated with PI3K/Akt signaling pathway were determined by Western blot. Results: The proliferations in both types of cells were significantly inhibited by either doxorubicin or MK-2206 treatment, and the IC50 value of doxorubicin for MCF-7/ADR cells was significantly higher than that for MCF-7 cells (P<0.05), while the IC50 values between MK-2206 for the both type of cells had no significant difference (P>0.05). The IC50 values of doxorubicin for both types of cells were decreased by combination treatment of MK-2206, but the decreasing degree in MCF-7/ADR cells was significantly greater than that in MCF-7 cells (P<0.05). MK-2206 exerted no obvious influence on the doxorubicin-induced apoptosis in MCF-7 cells, but significantly increased the doxorubicin-induced apoptosis in MCF-7/ADR cells (P<0.05). No significant difference was noted in doxorubicin accumulation among MCF-7/ADR cells treated with various concentrations of MK-2206 (P>0.05). After MK-2206 treatment alone, the protein expression of p-(Thr308) Akt was significantly down-regulated (P<0.05), and the protein expression of p-(Thr246) PRAS40 showed no significant change (P>0.05) in MCF-7 cells, while both of the above protein expressions were significantly down-regulated in MCF-7/ADR cells (both P<0.05). Conclusion: MK-2206 can partially reverse the drug resistance in breast cancer cells via inhibition of the PI3K/Akt signaling pathway, in which PRAS40 protein activation may contribute importantly to the drug resistance in breast cancer cells.

Abstract:Objective: To investigate the expression of adrenergic receptors in breast cancer cells and changes in breast cancer cell proliferation after their blockage. Methods: The expressions of adrenergic α1-, α2-, β1- and β2-receptor in breast cancer MCF-7 (ER-positive) and MDA-MB-231 (ER-negative) cells were examined by immunocytochemical staining. The proliferation of the two types of breast cancer cells was analyzed by MTT assay after they were exposed to norepinephrine and carvedilol (non-selective blocker of adrenergic receptors) alone, or in combination, respectively. Results: The MCF-7 and MDA-MB-231 cells both expressed the adrenergic α- and β-receptor, but the expression levels of the adrenergic-receptor subgroups were different between them. The α1- and β1-receptor showed a relatively strong expression while α2- and β2-receptor showed a relatively weak expression in MCF-7 cells, but there was an opposite pattern of expression in MDA-MB-231 cells. The proliferation of both types of breast cancer cells was significantly inhibited by carvedilol treatment, with a certain time- and concentration dependent trend toward higher inhibition, and some of the differences had statistical significance (all P<0.05); the proliferation of both types of breast cancer cells were significantly increased after norepinephrine treatment, which was concentration-dependently antagonized by carvedilol co-treatment, and all the differences reached statistical significance (all P<0.05). Conclusion: Both adrenergic α- and β-receptor are present in breast cancer cells with varying levels of expression, and non-selective blockage of adrenergic receptors can effectively suppress the proliferation of breast cancer cells.

Abstract:

Objective: To investigate miRNA-639 (miR-639) expression in breast cancer and its relations with growth, invasion and metastasis of the breast cancer. Methods: The miR-639 expression in 60 specimens of breast cancer tissue (30 metastatic cases and 30 non-metastatic cases) and 30 specimens of tumor adjacent tissue, along with human breast cancer MD231 and MCF-7 cells were detected by using fluorescent quantitative PCR. The relationship between miR-639 expression level and clinicopathologic features of breast cancer patients was analyzed. The effects of miR-639 on the proliferation, migration and invasion of breast cancer were evaluated by CCK-8 assay, wound scratch assay and Boyden chamber assays, respectively. Results: MiR-639 expression level in breast cancer tissues was significantly higher than that in adjacent tissue, in metastatic breast cancer tissue was significantly higher than that in non-metastatic tissue, and in highly invasive MD231 cells was significantly higher than that in low invasive MCF-7 cells, with all differences reaching statistical significance (all P<0.05). Among the studied clinicopathologic factors, the miR-639 expression was only associated with the M stage of the breast cancer patients (P<0.01). The proliferative, migratory and invasive abilities of MD231 cells were significantly decreased after miR-639 inhibitor transfection, whereas in MCF-7 cells they were significantly increased after miR-639 transfection (all P<0.05). Conclusion: MiR-639 expression is elevated in breast cancer, and the abilities of proliferation, migration and invasion of breast cancer are increased proportionately with the level of miR-639 expression.

Abstract:Objective: To investigate the expressions of enhancer of zeste homolog 2 (EZH2) and chromobox homolog 7 (CBX7) in breast cancer tissue and their clinical significance. Methods: The gene and protein expressions of EZH2 and CBX7 in normal mammary tissues, benign breast tumor tissues and breast cancer tissues were determined by RT-PCR and immunohistochemical staining, respectively. The relationship between EZH2 and CBX7 expressions in breast cancer tissue, and the relations of their expressions with clinicopathologic factors of breast cancer were analyzed. Results: In normal mammary tissue, benign breast tumor tissue and breast cancer tissue, both EZH2 mRNA expression level and protein expression rate were increased significantly in an increasing order, whereas those of CBX7 showed exactly opposite patterns, and all the differences reached statistical significance (all P<0.05). Both the mRNA and protein expression between EZH2 and CBX7 in breast cancer tissue exhibited a significant negative correlation (r=–0.414, P=0.008; r=–1.000, P=0.015). Both mRNA and protein expression of EZH2 and CBX7 were significantly related to lymph node metastasis and clinical stage (all P<0.05), but not associated with the age, menstrual status, tumor size or histologic classification of the patient (all P>0.05). Conclusion: EZH2 expression is increased and CBX7 expression is decreased in breast cancer tissue, and the reciprocity between them may participate in the processes of the malignant transformation of breast tissue as well as invasion and metastasis of breast cancer.

Abstract:Objective: To analyze the expression of β-catenin and cyclin D1 in the primary lesion and lymph node metastasis of breast cancer and its relation with invasion and metastasis of breast cancer. Methods: Using immunohistochemical staining, the expression of β-catenin and cyclin D1 in the primary lesions and metastases from 55 cases of triple negative breast cancer (TNBC) in which 21 cases had lymph node metastases, and 55 cases non-TNBC in which 25 cases had lymph node metastases was determined. Results: In 46 cases with lymph node metastases, both the β-catenin ectopic expression rate and cyclin D1 positive expression rate in the metastases were significantly higher than those in the primary tumor (54.3% vs. 76.1%; 63.0% vs. 82.6%, both P<0.05), and the β-catenin ectopic expression rate and cyclin D1 positive expression rate had positive correlation in either the primary or metastatic tumor (r=0.29; r=0.38, both P<0.05). Whether it was in the primary lesion or metastasis, there was no statistical difference in the β-catenin ectopic expression rate or cyclin D1 positive expression rate between TNBC and non-TNBC (all P>0.05). Conclusion: High β-catenin ectopic expression and cyclin D1 positive expression is associated with a high potential of invasion and metastasis in breast cancer, but the even higher potential of invasion and metastasis of TNBC may be associated with other mechanisms that are independent of Wnt signaling pathway.

Abstract:Objective: To investigate the clinical significance of the BRAF gene mutation in papillary thyroid carcinoma (PTC). Methods: One-hundred and twenty-two eligible PTC patients undergoing surgical treatment within the past 2 years were selected. DNA samples of the patients were extracted from paraffin sections and the V600E mutation of the BRAF gene (BRAFV600E) was detected by fluorescent PCR. The relations of BRAFV600E mutation with clinicopathologic factors and central compartment lymph node metastasis were analyzed. Results: The incidence of BRAFV600E mutation was 69.0% (87/126) in the 126 PTC patients. Univariate and multivariate analysis showed that BRAFV600E mutation was significantly related to lymph node metastasis (P<0.05), and central compartment lymph node metastasis was significantly associated with age, tumor size, tumor stage and BRAFV600E mutation (all P<0.05). Further analysis demonstrated that BRAFV600E mutation had no significant relation with central compartment lymph node metastasis in patients whose tumor size was equal to or less than 10 mm (P>0.05), while among patients with tumor size larger than 10 mm, the incidence of central compartment lymph node metastasis was significantly higher in positive BRAFV600E mutation cases than that in negative BRAFV600E mutation ones (P<0.05). Conclusion: BRAFV600E mutation is an independent predictor associated with aggressive tumor behavior and is an independent predictive factor for central compartment neck dissection. In those cases with positive BRAFV600E mutation, the larger the size of the tumor, the more important it is to perform central compartment neck dissection.

Abstract:

Objective: To investigate the efficacy of neoadjuvant chemotherapy in treatment of triple negative breast cancer (TNBC). Methods: The clinical data of 63 patients with stage I to III TNBC treated from January 2009 to January 2013 were analyzed retrospectively. Of the patients, 31 cases received preoperative neoadjuvant chemotherapy (neoadjuvant chemotherapy group) and 32 cases directly underwent surgery and postoperative adjuvant therapy (postoperative adjuvant therapy group). Sequential taxanes after anthracycline-based regimen was adopted in either neoadjuvant chemotherapy or postoperative adjuvant therapy. The preoperative benefit in neoadjuvant chemotherapy group of patients was analyzed, and the postoperative recurrence, metastasis and survival of the two groups of patients were compared. Results: The overall preoperative benefit rate among the 31 patients in neoadjuvant chemotherapy group was 100%, in which the complete response rate reached 61.29% (19/31). Local recurrence or distant metastasis within postoperative 3 years occurred in 13 cases (41.94%) in neoadjuvant chemotherapy group and 22 cases (68.75%) in postoperative adjuvant therapy group respectively, and the difference between the two groups had statistical significance (χ2=4.585, P<0.05). In neoadjuvant chemotherapy group and postoperative adjuvant therapy group, the 3-year disease-free survival rate was 48.38% and 25.00%, and 5-year overall survival rate was 38.71% and 9.78% respectively, and these two parameters in neoadjuvant chemotherapy group were significantly better than those in postoperative adjuvant therapy group (χ2=4.870, P=0.027; χ2=7.469, P=0.006). Conclusion: Neoadjuvant chemotherapy with an anthracycline-based regimen plus taxanes can effectively benefit the TNBC patients, and its long-term efficacy is also better than that of postoperative adjuvant chemotherapy.

Abstract:Objective: To analyze the clinical characteristics and outcomes of resectable breast cancer of different molecular subtypes in Uygur females. Methods: The data of 528 Uygur female patients with complete medical record, and initial diagnosis and surgical treatment in Affiliated Tumor Hospital of Xinjiang Medical University between January 2007 and April 2009 were collected. The clinical features, recurrence, metastasis and survival of different breast cancer subtypes were analyzed. Results: Among the 528 patients, 95 cases were luminal A subtype, 224 cases were luminal B subtype, 56 cases were HER-2-enriched subtype, and 153 cases were triple negative breast cancer (TNBC). In TNBC patients, the constituent ratios of cases with clinical stage III, age at onset equal to or less than 35 years, and number of axillary lymph nodes equal to or more than 4 were significantly higher than those in patients of other subtypes; the constituent ratio of cases with tumor size larger than 2 cm in patients with hormone-receptor-negative breast cancer was significantly higher than in those with hormone-receptor-positive breast cancer; the constituent ratio of HER-2-enriched subtype was significantly higher than other subtypes in group of patients aged from 36 to 65 years; the constituent ratio of cases having family history of malignant neoplasm in luminal B subtype patients was significantly higher than that in patients of other subtypes (all P<0.05). In patients with recurrence and metastasis, the visceral metastasis was frequently seen in HER-2-enriched subtype (16/27, 59.3%) and TNBC (55/94, 58.5%) cases, bone metastasis was mainly seen in cases of luminal A subtype (11/19, 60.0%), and the local recurrence rate in TNBC cases (6/94, 6.4%) was lower than that in cases of other subtypes. For patients of luminal A, luminal B, HER-2-enriched subtype and TNBC, the 5-year overall survival rate was 91.6%, 85.6%, 75.0% and 65.3%, and the 5-year disease-free survival rate was 83.1%, 75.9%, 55.4% and 44.4%, respectively. All the differences had statistical significance (all P<0.05). Conclusion: Among Uygur female breast cancer patients, luminal B is the most common molecular subtype, and those with luminal A subtype have a relatively good prognosis, while those with HER-2-enriched subtype and TNBC have an unfavorable outcome.

Abstract:Objective: To investigate the changes in bone metabolic markers and bone mineral density (BMD) among breast cancer patients during the early stage of aromatase inhibitor (AI) adjuvant treatment. Methods: Postmenopausal patients with hormone receptor positive breast cancer, aged from 55 to 65 years, who had completed surgical treatment and/or adjuvant radiotherapy or chemotherapy, and was scheduled to receive AI adjuvant treatment were selected. Before and after AI treatment for 6 months, the serum levels of the bone formation marker procollagen type 1 N-terminal propeptide (PINP) and N-terminal osteocalcin (N-MID) and bone resorption marker β C-terminal cross-linked telopeptides of type I collagen (β-CTx) were detected, and the BMD (T-score) of lumbar spine and hip were also determined. Results: A total of 113 patients were enrolled with an average age of 58.9 years. In the entire group of patients, the PINP level was increased above the normal reference range before treatment, and was further elevated after treatment compared with the pre-treatment level (P<0.05); the N-MID level showed no significant change before and after AI treatment (P>0.05); the post-treatment β-CTx level was significantly higher than that before treatment (P<0.05); the T-scores of lumbar spine and hip had appeared as negative before treatment, and the negativities were further increased, but reached no statistical significance versus those before treatment (both P>0.05). After AI treatment for 6 months, the T-scores of both of lumbar spine and hip, except the correlation between T-score of hip and N-MID did not reach a statistical significance (P>0.05), and showed a significant negative correlation with the levels of each bone formation and bone resorption marker (all P<0.05). Conclusion: There is a mild bone loss in postmenopausal breast cancer patients at 55 to 65 years of age, and the bone turnover activity is further enhanced after AI treatment for 6 months, so the bone-forming agents and antiresorptive therapy should be considered.

Abstract:Objective: To investigate the clinical efficacy of preemptive analgesia with combination use of parecoxib sodium and dezocine in radical mastectomy. Methods: One-hundred and seventy patients undergoing radical mastectomy were divided into control group, preemptive analgesia group and combined preemptive analgesia group, and were injected with normal saline, parecoxib sodium or parecoxib sodium plus dezocine before anesthesia induction, respectively. The visual analog scale (VAS) scores of the patients were recorded at postoperative 2, 6, 12, 24, and 48 h for comparing the analgesic effects among the groups, and the cardiovascular responses and incidence of adverse reactions were also compared among groups. Results: The VAS score in preemptive analgesia group or combined preemptive analgesia group was significantly lower than that in control group at any predefined time point (all P<0.05), which in combined preemptive analgesia group was significantly lower than that in preemptive analgesia group at postoperative 2 h (P<0.05), and still lower than that in preemptive analgesia group at postoperative 6 to 48 h, but did not reach statistical significance (all P>0.05). The heart rate (HR) and mean arterial pressure (MAP) of patients in both preemptive analgesia group and combined preemptive analgesia group were lower than those in control group before the induction of anesthesia to completion of operation, and were significantly lower than those in control group from 5 min after endotracheal intubation to completion of operation (all P<0.05), while no significant difference was observed between the two preemptive analgesia groups (all P>0.05). The incidence of adverse reactions in either preemptive analgesia group or combined preemptive analgesia group was significantly lower than that in control group (both P<0.05), and incidence of nausea, vomiting and dizziness in combined preemptive analgesia group was higher than that in preemptive analgesia group, but no statistical significance was reached (P>0.05). Conclusion: Preemptive analgesia of parecoxib sodium plus dezocine has good clinical efficacy in radical mastectomy, which may not cause the increase of cardiovascular response, but probably increase the incidence of nausea, vomiting and dizziness.

Abstract:Objective: To assess the significance of microcalcification under ultrasound in differential diagnosis between benign and malignant thyroid nodules and its relation with clinicopathologic features of papillary thyroid carcinoma (PTC). Methods: Seven-hundred and forty-three patients with thyroid nodules undergoing surgical treatment from May 2011 to November 2013 in Xiangya Hospital of Central South University were reviewed. The general data and results of preoperative ultrasound and postoperative pathology were analyzed. Results: Among the 743 cases of thyroid nodules, 137 cases (18.44%) were malignant nodules; 168 cases showed microcalcification, in which 81 cases (48.2%) were malignant nodules. The incidence of malignant nodules in cases with microcalcification was significantly higher than that of those without microcalcification (P<0.05). In cases with microcalcification, those with clustered microcalcification, predominantly solid nodules, blood-filled nodules and presence of lymph node calcification had increased incidence of thyroid cancer (all P<0.05). In PTC with microcalcification, the ratios of larger tumor size, thyroid capsule invasion and lymph node metastasis were increased (all P<0.05). Conclusion: Microcalcification of thyroid nodules under ultrasound has significant implication in differential diagnosis between benign and malignant thyroid nodules, which in combination with other ultrasonic features may further improve the diagnostic accuracy rate for thyroid cancer. PTC with microcalcification may relate to unfavorable clinicopathologic features.

Abstract:Objective: To evaluate the application value of sutureless technique using harmonic scalpel in open thyroid surgery. Methods: The clinical data of 148 patients undergoing thyroid surgery form October 2012 to June 2013 were retrospectively analyzed. Of the patients, sutureless technique using harmonic scalpel was applied during surgery in 78 cases (harmonic scalpel group), and high frequency electric knife combined with conventional hemostatic techniques such as suture ligation was performed in another 70 cases (conventional group). The operative time, intraoperative blood loss and the incidence of complications were compared between the two groups. Results: There was no statistical difference in surgical procedure and disease constitution between the two groups (P>0.05). The operative time and intraoperative blood loss were significantly reduced in harmonic scalpel group compared with conventional group in the same surgical type (both P<0.05). No postoperative bleeding, laryngeal recurrent nerve paralysis, or permanent hypoparathyroidism occurred in any of the patients of both groups, transient hypoparathyroidism occurred in one case in harmonic scalpel group and 2 cases in conventional group respectively, and the overall incidence of postoperative complications in the two groups had no statistical difference (P>0.05). Conclusion: Application of sutureless technique with harmonic scalpel in open thyroid surgery can shorten the operative time and reduce intraoperative blood loss, and does not increase the incidence of postoperative complications, so it has a certain value in clinical application.

Abstract:Objective: To investigate the clinicopathologic features and pattern of cervical lymph node metastasis in patients with papillary thyroid microcarcinoma (PTMC) and concomitant Hashimoto’s thyroiditis (HT). Methods: The clinical data of 284 PTMC patients treated during October 2008 to October 2012 were retrospectively analyzed. The patients were divided into observational group (n=58) and control group (n=226) according to whether or not they were complicated with HT. The relations of the concomitant PTMC and HT with the clinicopathologic factors, and the affecting factors for cervical lymph node metastasis of the PTMC patients were analyzed. Results: Among the 58 patients with PTMC and HT, 52 cases (89.7%) were female. Univariate analysis showed that sex, multiple lesions, lateral cervical lymph node metastases, and lateral neck along with central compartment lymph node metastases were significantly related to the concomitant PTMC and HT (all P<0.05). Multivariate analysis showed that concomitant PTMC and HT was an independent risk factor for lateral cervical lymph node metastases and lateral neck together with central compartment lymph node metastases (all P<0.05). Conclusion: Concomitant PTMC and HT is more common in female patients, and frequently presents with multiple lesions and lateral neck serial metastases.

Abstract:

Neoadjuvant chemotherapy is an important part of a systemic treatment of breast cancer, but problems of how to select sensitive drugs, develop individualized treatment plans and estimate the outcome, needs further research. In this paper, the authors address 4 perspectives: the significance of neoadjuvant chemotherapy and the patients suitable to receive it; the use of complete pathologic response as a prognostic marker; selection of drugs and treatment regimens and molecular classification-based neoadjuvant chemotherapy.

Abstract:Breast cancer is a common malignant tumor among women, with its prevalence ranking first among malignant diseases in women in our country, so attention is increasingly being paid to this disease. Regulatory T cells (Tregs) play an important role in breast cancer immune response, and the therapeutic strategy of targeting Tregs in breast cancer appears to have potential feasibility. In this paper, the authors address the issues in this field.