Effect comparison between autologous tissue breast reconstruction and breast-conserving plastic surgery in breast cancer / 肿瘤研究与临床

Objective:To investigate the differences in survival, recurrence, metastasis and breast reconstruction satisfaction between autologous tissue breast reconstruction and breast-conserving plastic surgery in breast cancer patients.Methods:A retrospective case series analysis and cohort study was conducted. Clinical data of 144 breast cancer patients in Shanxi Province Cancer Hospital from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into breast-conserving plastic surgery group (treated with breast-conserving plastic surgery) and breast reconstruction group [treated with autologous tissue breast reconstruction (transverse rectus abdominis musculocutaneous flap)] according to the surgical methods, and the intervention effect, BREAST-Q scale score and breast aesthetic effect were compared. The patients were followed-up for 1 year, and their survival, local vecurrence and distant metastasis status were recorded.Results:There were 72 patients in the breast-conserving plastic surgery group, aged (45±1) years old, and 72 patients in the breast reconstruction group, aged (45±2) years old. Patients in the breast reconstruction group and breast-conserving plastic surgery group survived 1 year after surgery, and the differences in local recurrence rate [1.39% (1/72) vs. 2.78% (2/72), χ2 = 0.34, P = 0.560] and distant metastasis rate [1.39% (1/72) vs. 1.39% (1/72), χ2 = 0.00, P = 1.000] were not statistically significant. The BREAST-Q scale breast satisfaction score in the breast reconstruction group was higher than that in the breast-conserving plastic surgery group [(87±6) points vs. (67±5) points], and the difference was statistically significant ( t = 14.33, P < 0.001); the differences in scores of psychosocial health, sexual health, physical health of the chest, and the adverse effects of radiotherapy between the two groups were not statistically significant (all P > 0.05). The rate of excellent and good aesthetic outcomes for the breast in the breast reconstruction group was higher than that in the breast-conserving plastic surgery group [95.83% (69/72) vs. 69.44% (50/72)], and the difference was statistically significant ( χ2 = 17.47, P < 0.001). Conclusions:The survival, recurrence and metastasis in breast cancer patients with autologous tissue breast reconstruction and breast-conserving plastic surgery are similar, and there are no differences in psychosocial health, sexual health, physical health of the chest and the adverse effects of radiotherapy, but breast aesthetic effect of autologous tissue breast reconstruction is better, and the patients are more satisfied with their breasts.

Progress of CDK4/6 inhibitors in treatment of hormone receptor-positive and human epithelial growth factor receptor 2-negative breast cancer / 肿瘤研究与临床

Cyclin-dependent kinase (CDK)4/6 inhibitors combined with traditional endocrine therapy can significantly improve the progression-free survival and overall survival of hormone receptor-positive and human epithelial growth factor receptor 2-negative breast cancer patients. But different drugs, dosage and medication cycle will also bring different efficacy and safety incidents to patients. At the same time, confirming whether CDK4/6 inhibitors are equally applicable to Chinese breast cancer patients is not only an academic hotspot concerned by domestic clinicians, but also a practical need in actual diagnosis and treatment. This article reviews the classic clinical trials of drugs and the latest research progress.

Application value of the aortic dissection detection risk score plus D-dimer for the early diagnosis of acute aortic dissection / 中国基层医药

Objective:To investigate the application value of aortic dissection detection risk score (ADD-RS) combined with D-dimer (DD) in the early diagnosis of acute aortic dissection (AAD).Methods:The clinical data of 70 patients with suspected aortic dissection detection admitted to The Second Hospital of Jiaxing from August 2019 to April 2020 were collected. All patients were scored using the ADD-RS, and grouped according to the scoring results. The sensitivity and specificity of ADD-RS plus DD in the early diagnosis of AAD were calculated. The areas under the receiver operating characteristic (ROC) curves that were plotted for drADD-RS plus DD versus DD alone to screen AAD were compared to evaluate efficacy. Results:CT angiography results showed that among 70 patients with suspected AAD, 29 patients had AAD and 41 patients had no AAD. A total of 21 patients were scored 0, 41 patients were scored > 1, and 8 patients were scored > 0. ADD-RS > 0 had an overall sensitivity of 79.31% and a specificity of 36.59% for AAD diagnosis. DD test results had an overall sensitivity of 86.20% and a specificity of 36.50% for AAD diagnosis. The area under the ROC curve of ADD-RS = 0 plus DD-negative result and the area under the ROC curve of DD-negative result alone in ruling out AAD were 0.885 with 95% CI (0.786-0.949) and 0.787 with 95% CI (0.673-0.876), respectively. The difference between the two groups was statistically significant ( P = 0.024). Conclusion:Compared with DD-negative result alone, the ADD-RS = 0 plus DD-negative result strategy offers greater specificity to rule out AAD. The combined strategy has a greater efficacy in ruling out AAD. However, a multi-center study involving a large sample is required for in-depth evaluation.

Study on the efficacy and influencing factors of pyrotinib in treatment of patients with human epidermal growth factor receptor 2-positive metastatic breast cancer / 肿瘤研究与临床

Objective:To evaluate the efficacy of oral pyrotinib in treatment of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer in the real world, and to explore its influencing factors.Methods:The clinical data of 148 patients with HER2-positive metastatic breast cancer treated with oral pyrrolitinib in Shanxi Cancer Hospital from September 2018 to December 2020 were retrospectively analyzed. The efficacy was evaluated according to the efficacy evaluation criteria for solid tumors, version 1.1, and the adverse effects were graded according to the National Cancer Institute common terminology criteria of adverse effects, version 4.0. The Kaplan-Meier method was used to draw progression-free survival (PFS) curves, the patients were stratified by different clinical characteristics, and log-rank test was used for univariate analysis of PFS; the multivariate analysis of PFS was performed using Cox proportional hazards model.Results:The objective response rate (ORR) of 148 patients was 71.6% (106/148), and the disease control rate (DCR) was 89.2% (132/148). The overall median PFS time was 11.0 months (95% CI 10.1-11.9 months), and the median PFS of 19 patients with brain metastases was 10.0 months (95% CI 7.4-12.6 months). The differences in PFS between patients stratified by disease-free interval (DFI), the number of metastatic site and Eastern Cooperative Oncology Group (ECOG) score were statistically significant (all P < 0.05), but the difference in PFS between patients with negative and positive hormone receptor was not statistically significant ( P > 0.05). Multivariate Cox regression analysis showed that DFI (>1 year vs. ≤1 year: HR = 5.254, 95% CI 0.728-37.933, P = 0.046) and ECOG score (≥2 points vs. 0-1 point: HR = 2.454, 95% CI 1.261-4.788, P = 0.008) were independent influencing factors of PFS. The most common ≥grade 3 adverse effects were diarrhea (31 cases, 20.9%) and hand-foot syndrome (38 cases, 25.8%). Conclusions:The pyrotinib has definite efficacy and good safety in the treatment of HER2-positive metastatic breast cancer in the real world, especially for patients with DFI > 1 year and ECOG score 0-1 point, the efficacy and safety are particularly good.

Progress of hereditary breast cancer with breast cancer susceptibility gene 1/2 mutations / 肿瘤研究与临床

Hereditary breast cancer refers to malignant tumors caused by pathogenic germline mutations of breast cancer susceptibility genes (BRCA). At present, it is believed that BRCA1/2 genes are most closely related to the development of hereditary breast cancer. Mutation will lead to loss of normal function, instability of genome, and then lead to tumorigenesis. Especially for those with germline mutations, not only the risk of breast cancer will be greatly increased, but also the probability of ovarian cancer and other cancers will be increased. With the emergence and clinical application of poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitors, BRCA1/2 genes have been regarded as new targets for the treatment of breast cancer. This article reviews the latest research of breast cancer with BRCA1/2 gene mutations.

A survey on the current status and related factors of influenza vaccination among health care workers in tertiary hospitals of Xining city during the influenza epidemic season from 2017 to 2018 / 中华预防医学杂志

Objective@#To evaluate the current status and related factors of influenza vaccination among health care workers (HCWs) in tertiary hospitals of Xining city after the implementation of the free influenza vaccination policy.@*Methods@#In August 2018, the cluster sampling method was used to select four medical institutions in Xining that had previously conducted investigations and interventions. All HCWs(excluding logistic staff) in each medical institution were included in the study. A total of 3 260 valid respondents were included. Questionnaires were used to collect the demographic characteristics, influenza and influenza vaccination awareness, implementation of free policy in the influenza epidemic season from 2017 to 2018, influenza vaccination status, awareness of influenza vaccination schedule and free policy. The multivariate logistic regression model was used to analyze related factors of influenza vaccination.@*Results@#The age of respondents was (31.41±5.00) years. The influenza vaccination rate was 6.80% (226/3 260) in 2017-2018 influenza epidemic season. After controlling for related factors, the awareness of the influenza vaccination schedule (OR=17.05, 95%CI: 5.86-49.59), vaccination frequency (OR=8.22, 95%CI: 2.98-22.61) and the free policy (OR=3.15, 95%CI: 1.49-6.67) had higher vaccination rate.@*Conclusion@#The influenza vaccination rate of HCWs in tertiary hospitals of Xining city was low. Increasing the awareness of the vaccination schedule, frequency and free policy may promote the influenza vaccination rate of HCWs.

Research progress of IgE-mediated type Ⅰ allergic reaction and tumors / 肿瘤研究与临床

Activation of the immune system to reach the tumor treatment,is a long-term goal of immunology and oncology.With the development of basic immunotherapy applied in the research of tumors,the relations between the allergic reaction and oncology have attracted more and more researchers' attentions.There exists some connections between IgE-mediated type Ⅰ allergic reaction and tumors,but the detailed correlations are not determined yet so far.Allergic reactions may reduce the occurrence of cancer risk,but also need more in-depth research and a large sample of evidence-based medical evidence to prove its related mechanism.

Advances in research of antitumor efficacy of mammalian target of sirolimus inhibitor everolimus / 肿瘤研究与临床

Mammalian target of sirolimus (mTOR) is a serine / threonine protein kinase,it widely expresses in cells and has been indicated as a reliable target for tumor treatment.Everolimus,a rapamycin derivative is an oral mTOR inhibitor.It improves the drug properties of rapamycin,and inhibits mammalian tumor cell growth and differentiation.In March 2009,everolimus was approved for the treatment of advanced renal cell carcinoma by US Food and Drug Addministration.At present,some clinical research advances on antitumor efficacy of everolimus in breast cancer,lung cancer,gastric cancer and other tumors have been proceeded.

Application of SELDI proteomic patterns in serological diagnosis of breast cancer / 肿瘤研究与临床

Objective To explore the application of serum SELDI proteomic patterns to distinguish breast cancer patients from healthy individuals.Methods All serum samples from 101 breast cancer patients and 45 healthy individuals were analyzed by surface-enhanced laser desorption/ionization time-of-fight mass spectrometry (SELDI-TOF-MS).The spectra were generated on weak cation exchange (WCX2) chips,and protein peaks clustering and classification analysis were made using Biomaker Wizard software and Biomarker Pattern software (BPS).Then the pattern was evaluated by blinded test.Results 49 different proteins were found to have statistically differential expression levels between breast cancer and normal control sera (P ＜ 0.05).A diagnostic model consisting of three protein peaks (M/Z 5627,8124 and 2864) could do the best in the diagnosis between breast cancer and healthy individual.When the diagnostic model was tested with the blinded test set,it yielded a positive value of 95 ％ (139/146),a sensitivity of 97 ％ (98/101) and a specificity of 91％ (41/45).Conclusion These results suggested that serum SELDI protein profiling can distinguish breast cancer patients from normal subjects with relatively high sensitivity and specificity.SELDI-TOF-MS plays a valuable role in the diagnosis of breast cancer and the discovery of new tumor-specific protein biomarkers.

Radiographic Index Analysis of the Cervical Spine Curvature and the Range of Flexion-extension / 中国医师杂志

Objective To provide a new method for measuring cervical spine curvature and the range of flexion-extension and to analyse the radiographic features of the cervical degeneration.Methods The study included 78 patients with cervical spondylosis,90 patients with neck symptoms and 86 normal volunteers.The three groups were compared with each other by the indexes of the cervical spine curvature and the range of flexion-extension.Results There was significantly difference among three groups in the cervical vertebrae lordosis at neutral position.The range of flexion-extension of cervical spondylosis in the patients was smaller than that of the normal volunteers.Conclusions The index method can accurately depict the cervical spine curvature and the range of flexion-extension.There is definitive order in symptom appearance,alterations of physiologic curvature and flexion-extension in the cervical degeneration.