Perioperative care of nipple-areola complex-sparing mastectomy and one-stage breast reconstruction via endoscopic axillary approach for ductal carcinoma in situ: A case report.

RATIONALE: Breast cancer represents a prevalent malignancy that primarily impacts women, with pronounced consequences on their overarching health. The major therapeutic approach, encompassing surgical procedures, can often culminate in mastectomy, potentially inciting psychological turmoil and disorders. PATIENT CONCERNS: A patient was admitted to our facility on May 5, 2023, precipitated by the discovery of bilateral breast masses during a routine physical examination conducted 3 days before admission. DIAGNOSIS: The breasts were symmetric, with the right nipple inverted and a palpable mass in the upper outer quadrant of the right breast, measuring approximately 5 cm × 4 cm. The mass was firm with indistinct borders, relatively regular morphology, poor mobility, and no tenderness. Outpatient color Doppler ultrasound revealed heterogeneous echogenicity in the right breast, classified as Breast Imaging Reporting and Data System (BI-RADS) category 0, along with multiple ductal dilatations. The left breast exhibited a hypoechoic area (BI-RADS 3), indicative of proliferative changes. Radiographic mammography confirmed diffuse changes in the right breast (BI-RADS 0) and proliferative signs in the left breast (BI-RADS 2). Biopsy results reveal significant atypical ductal hyperplasia consistent with intermediate-grade ductal carcinoma in situ. This patient was diagnosed as ductal carcinoma in situ of the right breast (cTisN0M0 and Stage 0), accompanied by a left breast mass. INTERVENTIONS: On May 15, 2023, the patient was readmitted for further surgical intervention. Following relevant auxiliary examinations, the patient underwent nipple-areola complex-sparing radical mastectomy for the right breast, sentinel lymph node biopsy in the right axillary area, prosthesis-based breast reconstruction for the right breast, and microrotatotomy of the left breast mass on the left side on May 17. OUTCOMES: The patient made a successful recovery under scrupulous perioperative supervision and was discharged 7 days post-surgery. LESSONS: The axillary approach for endoscopic mammary gland excision and immediate implant reconstruction permits patients to preserve the esthetics of the female form while undergoing conventional medical treatment. This methodology considerably enhances the psychophysical health of the patients, thereby marking it as an advantageous practice worthy of broad dissemination in the medical community.

Attenuation of histone H4 lysine 16 acetylation (H4K16ac) elicits a neuroprotection against ischemic stroke by alleviating the autophagic/lysosomal dysfunction in neurons at the penumbra.

A modest autophagy benefits neuroprotection while an excessive autophagy leads to neuronal death after cerebral ischemia, but what governs an appropriate autophagy remains to be understood. Studies indicated that acetylation of histone H4 at lysine16 (H4K16ac) strongly modulated autophagic/lysosomal signaling pathway. Thus, this study was to investigate whether the autophagic neuronal injury could be alleviated by amending H4K16ac level after ischemic stroke. A rat model of middle cerebral artery occlusion (MCAO)/reperfusion was prepared to investigate dynamic variations between H4K16ac and autophagy at the penumbra. The results illustrated that the significantly elevated H4K16ac was coupled with dramatically promoted autophagic activity at 4 h after the insult, suggesting H4K16ac tightly controlled autophagic signaling. After that, H4K16ac level was altered by pretreatment with trichostatin A (TSA, a H4K16ac facilitator) and MG149 (a H4K16ac inhibitor), respectively. Four hours after MCAO/reperfusion, the penumbral tissues were obtained to detect the key proteins in autophagic/lysosomal pathway by western blot and immunofluorescence, respectively. Meanwhile, the infarct volume, neurological deficits, and neuron survival were assessed to evaluate the neurological outcomes. The results showed that TSA-promoted H4K16ac led to an excessively up-regulated autophagy resulting in autophagic/lysosomal dysfunction, as indicated by the accumulated autophagic substrates and exacerbated lysosomal inefficiency in neurons. By contrast, MG149-depressed H4K16ac significantly down-regulated autophagic activity and thereby restored the impaired autophagic flux. Consequently, the neurological injury was markedly alleviated in MCAO + MG149 group, compared with that in MCAO group. Our study suggests that the H4K16ac attenuation elicits neuroprotection against ischemic stroke by ameliorating autophagic/lysosomal dysfunction in neurons.

Ginkgo biloba leaf extract (EGb-761) elicits neuroprotection against cerebral ischemia/reperfusion injury by enhancement of autophagy flux in neurons in the penumbra.

OBJECTIVES: Ginkgo biloba leaf extract (EGb-761) injection has been widely used as adjuvant therapy for cerebral stroke in China. However, its underlying pharmacological mechanism is not completely understood. The present study aimed to investigate whether the therapeutic effects of EGb-761 are exerted by modulating autophagy flux. MATERIALS AND METHODS: Ischemic cerebral stroke was prepared in male Sprague-Dawley rats by middle cerebral artery occlusion (MCAO) followed by reperfusion. The MCAO/reperfusion rats were then treated with EGb-761 injection once daily for 7 days. Thereafter, the brain tissues in the ischemic penumbra were obtained to detect the key proteins in the autophagic/lysosomal pathway with Beclin1, LC3, (SQSTM1)/p62, ubiquitin, LAMP-1, cathepsin B, and cathepsin D antibodies by western blot and immunofluorescence. Meanwhile, the infarct volume, neurological deficits, and neuronal apoptosis were assessed to evaluate the therapeutic outcomes. RESULTS: The results illustrated that EGb-761 treatment was not only able to promote the autophagic activities of Beclin1 and LC3-II in neurons, but also could enhance the autophagic clearance, as indicated by reinforced lysosomal activities of LAMP-1, cathepsin B, and cathepsin D, as well as alleviating autophagic accumulation of ubiquitin and insoluble p62 in the MCAO+EGb-761 group, compared with those in the MCAO+saline group. Meanwhile, cerebral ischemia-induced neurological deficits, infarct volume, and neuronal apoptosis were significantly attenuated by 7 days of EGb-761 therapy. CONCLUSION: Our data suggest that EGb-761 injection can elicit a neuroprotective efficacy against MCAO/reperfusion injury, and this neuroprotection may be exerted by enhancement of autophagy flux in neurons in the ischemic penumbra.

Natural Products Treat Atopic Dermatitis via NF-κB Signaling Pathway： A Review / 中国实验方剂学杂志

Atopic dermatitis （AD） is a chronic， recurrent， inflammatory， and pruritus skin disease caused by multiple internal and external factors， ranking first in the global burden of skin diseases. Due to the adverse reactions and high costs of conventional treatments and biologics， the development of natural products has attracted much attention. The nuclear factor-κB （NF-κB） signaling pathway is a key pathway for inhibiting inflammation and modulating immunity. This paper summarizes the pharmacological effects and molecular mechanisms of natural products such as flavonoids， alkaloids， phenols， terpenoids， coumarins， glycosides， and anthraquinones via NF-κB signaling pathway， aiming to provide guidance for the development of natural products. Basic studies have shown that natural products have high safety and efficacy. Oral or topical administration of natural products can regulate the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）， mitogen-activated protein kinase （MAPK）， nuclear factor erythroid 2-related factor 2 （Nrf2）， high mobility group box 1 protein （HMGB1）/receptor for advanced glycation endproducts （RAGE）， and nucleotide-binding oligomerization domain-like receptor protein 3 （NLRP3） signaling pathways to exert anti-inflammatory， anti-allergy， antioxidant activities， thus reversing the pathological changes of AD. However， it is worth noting that the clinical application of natural products is still insufficient， and more rigorous clinical trials are still needed to verify their effects. The basic experiments and clinical evidence prove that natural products may play a role in alleviating AD， which provide a basis for evaluating the functioning mechanism of natural active substances and enrich the candidates for the development of potential drugs.

Analysis of prophylactic use of antibiotics during perioperative period of type Ⅰ incision in the Second People's Hospital of Jincheng of Shanxi Province from 2014 to 2016 / 中国基层医药

Objective To analyze the use of antibiotics in perioperative period of type 1 incision in our hospital from 2014 to 2016.Methods The type Ⅰ incision of clean operation cases in our hospital from January 2014 to December 2016 were selected as the research subjects.Among them,201 cases were assigned as the control group from January 2014 to July 2015,while 202 cases were set as observation group from August 2015 to December 2016.General intervention in the using status of antibiotics was adopted for the controls,meanwhile,intensive intervention was given to observation groups.At the same time,the types of antibiotics,the beginning time and duration of antibiotics use were compared between the two groups.Results Before operation,the antibiotics use proportion of 0.5-1 h in the observation group was significantly higher than that in the control group (89.11％ vs.54.73％).The antibiotics use proportion of preoperative 1-24h (1.9％ vs.24.4％) and postoperative drug use ratio (8.91％ vs.20.9％)were significantly lower than those in the control group,the differences were statistically significant (x2 =59.027,44.251,11.420,all P ＜ 0.05).The ratio of treatment duration ≤ 1 d in the observation group (89.6％ vs.62.7％)was significantly higher than the control group,the proportions of 1 ＜ T ≤ 2d (9.9％ vs.22.4％) and ＞ 2d (0.5 ％ vs.14.9％) in the observation group were significantly lower than those in the control group,the differences were statistically significant (x2 =40.226,11.613,29.546,all P ＜ 0.05).In the observation group,the ratios of the first generation cephalosporin (79.7％ vs.48.2％) and the second generation cephalosporin (12.8％ vs.5.4％) were significantly higher than those of the control group (all P ＜ 0.05).The proportions of the third generation cephalosporin and fluoroquinolones were significantly lower than those of the control group,the differences were statistically significant (x2 =43.246,6.614,47.960,8.203,all P＜0.05).Conclusion After the intensive intervention,the duration of prophylaxis and drug selection in the perioperative period of type 1 incision is more reasonable.

Study on the population-genetics of Mycobacterium tuberculosis from Sichuan Basin in China / 中华流行病学杂志

Objective To explore the population-genetics characteristics of Mycobacterium tuberculosis (MTB) prevailing at the Sichuan basin of China.Methods A total of 413 MTB strains collected from Sichuan basin were genotyped by large sequence polymorphism (LSP) and 15 loci variable number tandem repeat (VNTR).Difference between the distribution of lineage population was analyzed by x 2-test and the discriminatory ability of each VNTR locus was evaluated under the Hunter-Gaston Discriminatory Index (HGI).Both phylogeny on population level and genetic structure were demonstrated through N-J tree and the Minimal Spanning Tree (MST).Genetic differentiation of different lineage strains was analyzed by Analysis of Molecular Variance (AMOVA).Time of the Most Recent Common Ancestor (TMRCA) was calculated based on the Bayesian model.Results Four hundred and thirteen MTBs were divided into two major lineages,in which the Beijing lineage accounted for 56.2％ (232/413) and the Euro-American lineage for 43.8％ (181/413).There was no significant difference of population distribution between the two lineages (P＞0.05).The N-J tree of Beijing lineage MTB presented distinctly "star-like" and 72.4％ strains were grouped to one clonal complex in MST.The Euro-American lineages MTB presented "branch-like" in N-J tree and were grouped into multiple clonal complexes in MST.There was significant genetic differentiation in Beijing lineage MTBs between Chongqing and Sichuan (FST=0.018 91,P＜0.05),but not in the Euro-American lineage MTB (FST=0.005 19,P＞0.05).TMRCA of the largest clonal complex in Euro-American lineage MTB appeared to be 723 (95％ CI:517-946) years.Conclusion Both Beijing lineage and Euro-American lineage MTBs were competitively prevalent in the Sichuan basin.There was some difference noticed between the two lineages referring to genetic differentiation.The invasion of Euro-American lineages MTB to the basin area might be associated with a war occurred in this area about 720 years ago.

The risk factors for worsening renal function in patients with chronic heart failure / 中华内科杂志

Objective To investigate the risk factors of worsening renal function (WRF) in patients with chronic heart failure ( CHF) and WRF influence on prognosis. Methods A case-control study were undertaken to analyze independent risk factor statistically related to incidence of WRF, and to assess the influence of WRF on prognosis. Results The independent predictors of WRF were creatinine level at admission (OR 2.248,95% CI 1.088-4.647, P = 0.029) and NYHA class on admission ( OR 2.485, 95% CI 1.3854. 459, P = 0.002). The mortality of patient with WRF was obviously higher than that of control group during hospitalization( OR 3. 824,95% CI 2. 452-5. 637 ,P ＜0.015). Conclusions WRF is a common complication among patients hospitalized for CHF, and is obviously associated with mortality during hospitalization. Higher creatinine level and weak heart function are independent risk factors for incidence of WRF of patients with CHF.