Triplane technique for breast reconstruction after breast cancer surgery: A case series report.

RATIONALE: Implant-based breast reconstruction is an important method for post-mastectomy breast reconstruction. Currently, the most commonly used technique is the biplane technique. However, the high rate of postoperative complications, the inability of pockets to accommodate larger implants, and the expensive costs of biological mesh make the development of new surgical methods urgent. The triplane technique for breast reconstruction is an ideal candidate method. PATIENT CONCERNS: The main local symptoms were breast lump, abnormal breast skin, nipple discharge, and abnormal nipple or areola in 24 patients. DIAGNOSES: The study included 24 female patients who underwent breast reconstruction using the triplane technique after radical breast cancer surgery. INTERVENTIONS: The surgical procedure involved measuring the dimensions of the breast, designing the incision, and creating a pocket for the implant using the triplane technique, which includes the pectoralis major muscle, the pectoralis major fascia continuing to the rectus abdominis fascia, and the latissimus dorsa muscle fascia continuing to the rectus abdominis fascia. Postoperative follow-up included regular assessments of pain and evaluation of breast appearance. OUTCOMES: No cases of postoperative infection were observed in all patients. During the 1-year follow-up period after surgery, 5 patients (20.8%) who needed radiotherapy after mastectomy for cancer showed slight darkening of skin flap pigment after using the triplane technique implant. No cases of exposure or infection of the expanders were reported, and 1 patient underwent expander replacement with a permanent prosthesis. All patients expressed satisfaction with the reconstructed breast shape. The 10 patients (41.7%) experiencing postoperative swelling and pain. However, the pain gradually subsided during the postoperative recovery period. No cases of local recurrence or distant metastasis of breast cancer were observed during the 1-year-follow-up period. LESSONS: The triplane technique for breast reconstruction after breast cancer surgery provides good implant coverage, reduces the risk of complications, and is cost-effective.

Advanced hormone receptor-positive/human epidermal growth factor receptor 2-positive invasive ductal carcinoma with cecal metastasis: A case report.

The incidence of gastrointestinal metastases from breast cancer (BC) is low. We report a special case of Luminal B (Hormone Receptor positive [HR+]/Human Epidermal Growth Factor receptor 2-positive [HER-2+]) BC. The patient presented with asymptomatic brain metastases two years after radical surgery for modified breast cancer and developed right lower abdominal pain during relief therapy. Electronic gastroenteroscopy revealed inflammatory changes in the cecal mucosa. These changes were confirmed on pathology to be cecal metastasis from BC. The patient's condition was stabilised after treatment with an antibody-drug conjugate (ADC). For patients with BC who develop appendicitis-like symptoms after treatment for invasive ductal carcinoma of the breast, clinicians should be fully aware that the possibility of cecal metastasis needs to be considered, despite the very low probability of occurrence.

Health-related quality of life measured by EQ-5D-3L for the spouses of breast cancer patients.

To explore factors influencing the health-related quality of life of spouses of breast cancer patients and the suitable questionnaires for this purpose. A cross-sectional study was conducted in the Third Affiliated Hospital of Kunming Medical University. The spouses of breast cancer patients were included and evaluated via face-to-face interviews. Self-designed demographic characteristics and disease-related questionnaires, the 12-item health survey questionnaire (SF-12), the three-level European five-dimensional health status scale (EQ-5D-3L), and the Social Support Rate Scale (SSRS) were used. The internal consistency reliability measure Cronbach's coefficient, criterion-related validity, construct validity, and sensitivity were used to evaluate the applicability of the EQ-5D-3L. Univariate and multivariate analyses were performed to analyze the factors associated with the health-related quality of life of spouses of breast cancer patients. We investigated a total of 100 spouses of breast cancer patients. Cronbach's α, the internal consistency reliability coefficient, was 0.502. The EQ-5D-3L health utility score was moderately correlated with PCS-12 (r=0.46, p=0.0001) and weakly correlated with MCS-12 (r=0.35, p=0.0001). The EQ-5D-3L health utility score for the spouses of breast cancer patients was 0.870, and the EQ-VAS was 78.3. In multivariate analysis, social support and cognition of the treatment effect were factors that influenced the EQ-5D-3L health utility score. The EQ-5D-3L has good reliability, validity, and sensitivity for measuring the physiological aspects of the health-related quality of life of spouses of BC patients. EQ-5D-3L was considered suitable for this study.

A network meta-analysis of curative effect of different treatment methods on patients with brain metastasis of breast cancer.

BACKGROUND: Breast cancer (BC) is a malignant tumor with the highest incidence rate worldwide, and its incidence of breast cancer brain metastases is increased in recent years. Although significant progress has been made in the systematic treatment of BC that of breast cancer brain metastases is still very difficult. Organically integrating local and systemic therapies remains an urgent problem to be solved. In this study, a network meta-analysis was performed to collect the treatment effects of different treatment measures on patients with BC brain metastasis in recent years, evaluate and screen the current best clinical treatment scheme, and assist doctors in formulating clinical treatment schemes. METHODS: Keywords were used to search databases, such as the Chinese Journal Full-text Database, VIP Chinese Science and Technology Journal Full-text Database (VP-CSJFD), Wanfang Data Journal Paper Resources (Wangfang), PubMed, the Cochrane Library, and EMBASE. The retrieval period was from the establishment of each database to February 2022. Qualified randomized controlled studies were screened according to the inclusion and exclusion criteria, and Stata 16 software was adopted for mesh meta-analysis of binary variable data. Using R4 0.2 software, and calling GeMTC and JAGS packages in R software, the Bayesian network model analysis of survival data was completed. CONCLUSION: Combined with overall response rate, disease control rate, and overall survival, whole-brain radiation therapy + 3-dimensional conformal radiation therapy + Che may be the intervention measure with the highest objective remission rate for patients with brain metastasis of BC, besides, it may also be the intervention measure of the highest disease control rate in patients after treatment. In contrast, WBRT + Che may be the intervention with the lowest overall survival risk ratio after treatment.

The Psychological Effect of Internet-Based Mindfulness-Based Stress Reduction on the Survivors of Breast Cancer During the COVID-19.

Objective: To examine the efficacy and the role of engagement of an internet-based Mindfulness-based Stress Reduction (iMBSR) for survivors of breast cancer (BC) during the COVID-19 period from January to March in 2020 in China. Methods: 48 survivors of BC were divided into the absentees group and the iMBSR groups according to their attending to the standardized, group-based, 8-week iMBSR. Based on practice time, survivors of BC in the iMBSR were categorized into three subgroups: group 1 (<30 min/day), group 2 (30-60 min/day), and group 3 (>60 min/day). In addition, participants were classified as partial attendees (<4 sessions) and completers (more than 4 sessions) of the iMBSR groups. All participants were evaluated for symptoms of depression, anxiety and insomnia at baseline, mid-intervention, and post-intervention. Results: After an 8-week iMBSR practice, at mid-intervention and post-intervention, participants in iMBSR group had significant improvement in scores and reduction rates of depression, anxiety, and insomnia compared to absentees. Scores of depression and insomnia, reduction rates of depression at post-intervention, scores of anxiety, reduction rates of anxiety and insomnia at mid-intervention and post-intervention, had significant differences among subgroups of practice time. Daily practice time was positively related to reduction rates of depression, anxiety and insomnia at post-intervention in the iMBSR group. Conclusion: Internet-based MBSR showed efficacy in reducing psychological symptoms among survivors of BC. For survivors of BC, iMBSR practice has a potential dose-response efficacy, with a threshold of >30 min daily practice for most optimal symptoms reduction. Trial Registration: Registration number is [ChiCTR2100044309].

A Case Report of Targeted Therapy with Anlotinib in a Patient with Advanced Breast Metaplastic Carcinoma.

Metaplastic breast carcinoma (MBC) is a rare malignant breast tumor, and no effective chemotherapy unique to metaplastic carcinoma exists. As MBC is typically "triple negative", endocrine therapy and molecular therapy targeted to Her2 might not be favorable, resulting in a poor prognosis. Anlotinib is currently being tested in patients with breast or cancer. Here, we report a successful case in which anlotinib was used to treat MBC. A 54-year-old female patient visited the hospital after the discovery of a left breast tumor 10 months prior, and tumor redness and swelling had lasted for more than one month. After admission, relevant examinations were performed. After left breast tumor puncture revealed left emulsified biological cancer, the tumor significantly increased in size, and bleeding was obvious after 2 cycles of the "EC" chemotherapy regimen. The curative effect was evaluated as progressive disease (PD). After two cycles of chemotherapy with the "PCb" regimen, the efficacy was still PD. The Karnofsky performance status (KPS) score of the patient after 4 cycles of chemotherapy was 60 points, with severe anemia, and she could not tolerate chemotherapy. The patient was given radiotherapy to stop bleeding, and the tumor further increased in size during radiotherapy. The curative effect was evaluated as PD. After a multidisciplinary consultation in our hospital, we initiated oral anlotinib (12 mg; 2 weeks on, 1 week off). The tumor significantly decreased in size after taking anlotinib, and the efficacy was evaluated as PR. Adverse reactions during treatment were controlled, and progression-free survival (PFS) reached up to 25+ months. The follow-up is ongoing. The patient has provided written informed consent for the case details and images to be published, and at the same time institutional approval was required to publish the case details, we report this case.

LncRNA MEG3 promotes endoplasmic reticulum stress and suppresses proliferation and invasion of colorectal carcinoma cells through the MEG3/miR-103a-3p/PDHB ceRNA pathway.

LncRNA maternally expressed gene 3 (MEG3) is a potential prognostic and diagnostic biomarker in colorectal carcinoma (CC). However, its cellular functions and mechanism remain not fully uncovered. Relative expression of MEG3, miRNA (miR)-103a-3p, and pyruvate dehydrogenase E1 subunit beta (PDHB) was detected by RT-qPCR and western blotting. Cell proliferation was measured by CCK-8 assay, colony formation assay, and flow cytometry, as well as xenograft tumor assay. Transwell assay examined cell invasion. Endoplasmic reticulum (ER) stress was evaluated by western blotting. Dual-luciferase reporter assay and RNA immunoprecipitation determined the relationship between miR-103a-3p and MEG3 or PDHB. Expression of MEG3 was downregulated in human CC tumor tissues and cells (SW620 and HCT116), accompanied by higher miR-103a-3p and lower PDHB. Restoring MEG3 suppressed cell viability, colony formation ability, and invasion, arrested cell cycle, and induced apoptosis rate in SW620 and HCT116 cells, as well as promoted expression of ER stress-related proteins (GRP78, ATF6, CHOP, caspase-3, and caspase-9). Furthermore, MEG3 overexpression hindered tumor growth and facilitated ER stress in vivo. Molecularly, miR-103a-3p was a target of MEG3, and further targeted PDHB. Similarly, in function, blocking miR-103a-3p suppressed CC in vitro by affecting proliferation, invasion, and ER stress; in addition, restoring miR-103a-3p partially counteracted the suppressive role of MEG3 in CC cells. MEG3 sponged miR-103a-3p to suppress CC malignancy by inducing ER stress and inhibiting cell proliferation and invasion via upregulating PDHB, suggesting a novel MEG3/miR-103a-3p/PDHB ceRNA pathway.

LINC00309 is associated with short disease-free survival in breast cancer.

BACKGROUND: Long non-coding RNAs play an important role in breast cancer. Even with adjuvant hormone therapy, patients with estrogen receptor positive breast cancer can present with recurrences and distant metastases. We investigated whether the expression of a novel long non-coding RNA LINC00309 can predict the outcome of breast cancer, especially for hormone-receptor positive patients. METHODS: This retrospective study collected 290 breast cancer patients including 161 patients with hormone-positive. qPCR was performed to detect the expression of LINC00309. Kaplan-Meier and Cox risk proportion model were applied to disclose the function of LINC00309 for breast cancer prognosis. RESULTS: LINC00309 high expression was an independent predictor for worse disease-free survival (HR = 2.127; 95% CI 1.074-4.212; p = 0.030) and associated with a shorter disease-free survival (p = 0.027), especially in hormone-positive breast cancer patients (p = 0.001). Also LINC00309 high expression was associated with a shorter disease-free survival both in selective estrogen receptor modulator related hormone therapy (p = 0.025) and aromatase inhibitors related hormone therapy (p = 0.048). Moreover, LINC00309 was an independent predictor of worse disease-free survival in hormone-receptor positive breast cancer patients on univariate (HR = 4.505; 95% CI 1.722-11.785; p = 0.002) and multivariate (HR = 4.159; 95% CI 1.537-11.251; p = 0.005) analyses. CONCLUSION: In breast cancer, Linc00309 is significantly associated with poor prognosis and may represent a new marker of prognosis.

The application of methylene blue coloration technique in axillary lymph node dissection of breast cancer.

BACKGROUND: To analyze the associated factors that affect the coloration of methylene blue (MB) in axillary lymph node dissection (ALND) of patients with breast cancer and to explore the tracer effect of MB in high axillary lymph node metastasis, to guide surgical treatment. METHODS: We recruited 170 patients who underwent ALND, all of them were injected MB before operation. We analyzed the relationships between the clinical factors of age, body mass index (BMI), molecular typing, TNM staging, neoadjuvant chemotherapy, injection time and position and the MB coloration by univariate and multivariate analyses. A total of 84 cases were selected for observation of the application value of MB during intervention involving the lymph nodes upper axillary vein. RESULTS: Of 170 cases, 138 cases (81.17%) were colored. Univariate analysis showed that significant differences were observed between differing BMI's (χ2=24.074, P<0.0001) and injection times (χ2=41.207, P<0.0001). Multivariate analysis showed that injection time (P=0.016) was the clinical factor associated with MB coloration. More than 60 minutes before surgery and MB injection, the possibility of methylene blue colored was 0.088 times higher than 10 minutes (P=0.010, 95% CI, 0.014, 0.554). MB was used to track the lymph node upper axillary vein with a sensitivity of 12.5%, a specificity of 100%, a false negative rate of 87.50%, and a false positive rate of 0; the kappa coefficient was 0.051 (χ2=0.679, P=0.404). CONCLUSIONS: Among the clinical factors, MB coloration was worse more than 60 minutes before ALND. Using the technology of MB color, lymph nodes can be clearly identified. It has great guiding value for the doctors who learn the operation initially. However, it is still prudent to use MB for high lymph node dissection.

A retrospective study of lymphatic transverse rectus abdominis myocutaneous/deep inferior epigastric perforator flaps for breast cancer treatment-induced upper-limb lymphoedema.

Breast cancer-related lymphoedema (BCRL) is a common and intractable complication. To evaluate the possible complications of using lymphatic transverse rectus abdominis myocutaneous/deep inferior epigastric perforator (TRAM/DIEP) flaps for breast reconstruction and BCRL treatment, 20 patients with moderate or severe BCRL were retrospectively enrolled between November 2012 and October 2014. 10 patients had undergone lymphatic TRAM/DIEP flap surgery were assigned to the surgery group. 10 patients unwilling to undergo reconstruction were assigned to the physiotherapy group treated with traditional physical therapy. Upper-limb movement and circumference were measured and patients' subjective assessment was assessed using a questionnaire. In the surgery group, all flaps were successfully transferred. BCRL in 8 patients was improved by one level. The upper-limb circumference returned to normal in 1 case, and only 1 patient did not improve. In the physiotherapy group, a slight improvement was noted in 6 patients and unchanged in four cases. From the questionnaires, patients underwent lymphatic TRAM/DIEP flap surgery reported a significantly greater improvement in the affected limb (p < 0.05). In the physiotherapy group, the limb subjective did not improve as well as in the surgery group. Lymphatic TRAM/DIEP is a safe and effective option for patients who suffer from post-mastectomy lymphoedema.

MicroRNA­143 targets CD44 to inhibit breast cancer progression and stem cell-like properties.

CD44 is closely linked to breast cancer progression; however, the regulatory functions of microRNAs (miRs) in breast cancer have yet to be fully elucidated. In order to investigate the regulation of CD44 by miRs in breast cancer, the present study isolated CD44+ and CD44- breast cancer cells by flow cytometry, revealing that CD44+ cells were enriched in transplanted compared with those in primary breast cancers, and that their proliferation and stem-cell sphere formation ability were enhanced. A miRNA array assay indicated that miR-143 expression in CD44+ breast cancer cells was lower than that in CD44- cells. Furthermore, miR-143 was decreased in breast cancer tissues and cell lines compared with that in normal tissues and cells. Restoration of miR-143 expression in CD44+ breast cancer cells inhibited their proliferation and sphere formation. A luciferase reporter assay demonstrated that miR-143 directly tartgeted the 3'-untranslated region of CD44. In addition, miR-143 inhibited metastasis-associated features in breast cancer and reduced tumor growth in a mouse model of breast cancer. In conclusion, the results of the present study demonstrated that miR-143 inhibited the progression and stem-cell properties of breast cancer cells by targeting CD44.

Simultaneous breast reconstruction and treatment of breast cancer-related upper arm lymphedema with lymphatic lower abdominal flap.

BACKGROUND: This study was designed to introduce the key points about the transplantation of lower abdominal flap with vascularized lymph node and to evaluate the effect of breast restoration, breast reconstruction, and lymphatic transplantation to treat upper limb lymphedema after breast cancer surgery. MATERIALS AND METHODS: The study was based on the retrospective study on 10 cases of postmastectomy lymphedema during January 2008 to March 2011. All patients, aged 36 to 50 years, have had one-side upper-limb lymphedema for 3 to 5 years. Six patients had accepted radiotherapy. Four patients had a diagnosis of severe lymphedema, and 2 patients had moderate lymphedema. The isotope radiography before the operation showed obstruction of lymphatic return, and the multidetector computed tomography that followed delivered a clear picture of the abdominal flap blood supply and the blood vessels in the breasts. During the operation, the scar contracture of the axilla was completely relaxed, and all patients accepted abdominal transplantation of lower abdominal flap with vascularized lymph node. After the operation, the elastic bandages were applied for one year as an adjuvant therapy. The follow-up visits were conducted 1, 3, 6, and 12 months after the surgery. The measurement indexes included mid-upper arm circumference, clinical symptoms, and lymphoscintigraphy. RESULTS: All flaps worked well. One patient was found to have delayed wound healing; one patient saw no obvious improvement in lymphedema; 7 patients with lymphedema were relieved with apparent improvement in the affected limbs' mean perimeter and clinical symptoms; one patient recovered; and another patient was lost to follow-up. The mean reduction was 2.122±2.331 cm, and the reduction of the lymphedematous limb was statistically significant between the preoperative and 12-month postoperative groups (P<0.05). The results were good in 4 patients and excellent in one patient. CONCLUSIONS: The transplantation of abdominal flap with vascularized lymph node and breast reconstruction, accompanied by the treatment to upper limb lymphedema and using elastic bandages as an adjuvant therapy, is considered to be an effective method to restore the configuration and function of breasts. Long-term follow-up visits are undergoing, especially the lymphoscintigraphy, 2 years after the operation.

Impact of polysomy 17 on HER2 testing of invasive breast cancer patients.

BACKGROUND: Current American Society of Clinical Oncology/College of American Pathologists guidelines define HER2-positive tumors as those with >6 HER2 genes per nucleus or those with HER2/CEP17 (chromosome 17) ratio>2.2. These guidelines are potentially contradictory in tumors with polysomy of chromosome 17. The current study was performed to determine the impact of polysomy 17 on the interpretation of HER2 testing of invasive breast carcinomas. METHODS: Chromosome 17 copies and HER2 gene status were identified by fluorescent in situ hybridization in 384 cases with invasive breast cancer, and the corresponding HER2 expression was obtained by immunohistochemistry stain. RESULTS: The average CEP17 copy number for the group was 2.1 (range, 1.0-12.4). Forty-eight cases (13.8%, 48/348) were identified as chromosome 17 polysomy with CEP 17 copy number≥3. Ninety-two (26.4%) cases had >6 copies of HER2 per nucleus, and 92 cases (26.4%) qualified as HER2 gene amplified using the HER2/CEP17 ratio (>2.2) guideline. Polysomy 17 showed poorly positive correlations with both HER2 gene copy number and HER2 overexpression (P<0.01, r=0.338 and 0.271, respectively). The distribution of clinicopathologic parameters of Polysomy 17 tumors was more similar to HER2 negative than HER2 positive tumors. CONCLUSIONS: Polysomy 17 is a crucial cause of equivocal HER2 testing results by FISH, depending on which criterion (ratio vs. absolute number) is used for interpretation. Polysomy 17 cannot be an independent predictive factor for HER2 gene amplification or protein overexpression.