Objective To evaluate the effect of different skin flap management methods on post operative (subcutaneous) fluid collection and skin flap necrosis after modified radical mastectomy for breast cancer. (Methods) A retrospectively analysis of clinical data of 119 cases of breast cancer operated by modified (radical) mastectomy in our hospital in recent four years. Statistically analyse the relationship between 4 different skin flap management methods to postoperative subcutaneous fluid collection and skin flap necrosis. Results 43 out of 119 cases developed postoperative subcutaneous fluid collection and/or skin flap necrosis. There were 13 cases with complication of subcutaneous fluid collection, 3 cases with skin flap necrosis among 79 (cases) treated by transverse incision;20cases with complication of subcutaneous fluid collection, and 7 cases of skin flap necrosis among 40 cases treated by longitudinal incision; 23cases with complication of subcutaneous fluid collection, and 8 cases of skin flap necrosis among 60 cases treated by "skin flap management type one"; 23cases with complication of subcutaneous fluid collection, and 2 cases of skin flap necrosis among 59 cases treated by "skin flap management type two". Conclusions A transverse incision after subcutaneous (injection) of 1∶400 adrenaline saline solution, plus the use of scalpel dissection and the technique of skin flap fixation by the "rivet" method can effectively decrease postoperative development of subcutaneous fluid (collection) and necrosis of incisional skin margins.

In 48 postoperative cases using ear-clinoidal line positioning in radiofrequency thermocoagulation for treatment of trigeminal neuralgia,observing its recurrence and postoperative pain and complications in a five-year review. The successful rate of puncturing one time was 100%. Pain disappeared completely in 46 cases with one therapy. Two cases alleviated pain and decreased outbreak times. No recurrence and postoperative complications were observed. The vertical distance between the needle tip and the ear-clinoidal line were confirmed 8-10 mm in the third branch, 6-7 mm in the twice branch, 4-5 mm in the first branch. In order to avoid the first branch of trigeminal nerve injury, the vertical distance must be less than 6 mm, and the needle tip can not exceed ear-clinoidal line.

Objective:To study the protective effect and the mechanism of esculetin on oxidative-stressed human retinal pigment epithelial cells (ARPE-19) induced by tert-butyl hydroperoxide (t-BHP).Methods:The ARPE-19 cells were divided into blank control group, model control group, 20 μmol/L esculetin group, 40 μmol/L esculetin group, 80 μmol/L esculetin group and 100 μmol/L esculetin group.The cells in the blank control group were normally cultured.The cells in the model control group were treated with 900 μmol/L t-BHP for 4 hours.The rest four groups were treated with 900 μmol/L t-BHP+ different molar concentrations of esculetin respectively for 4 hours.The cell viability of the each group was detected by MTS method.The activity of reactive oxygen species (ROS) was detected by fluorescence staining, and the activity of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) as well as the levels of malondialdehyde (MDA) of the cells from each group were measured with each corresponding assay kit, respectively.Results:The relative viabilities of the cells in the blank control group, model control group, 20 μmol/L esculetin group, 40 μmol/L esculetin group, 80 μmol/L esculetin group and 100 μmol/L esculetin group were (100.00±1.58)%, (49.19±1.06)%, (76.82±3.48)%, (103.90±1.60)%, (111.70±3.36)% and (113.40±3.08)%, respectively.There was a significant difference among the groups ( F=95.44, P<0.01). Compared with the blank control group, the viability of the cells in the model control group was decreased significantly ( P<0.01). Compared with the model control group, the cell viabilities in different concentrations of esculetin groups were increased significantly (all at P<0.01). There were significant differences between the groups in the relative value of ROS fluorescence intensity, MDA level, SOD activity, CAT activity and GSH-Px activity ( F=575.20, 40.61, 1 802.00, 41.62, 38.31; all at P<0.01). Compared with the model control group, the levels of ROS and MDA were decreased significantly, while the activities of SOD, CAT and GSH-Px were increased significantly in different concentrations of esculetin-treated groups (all at P<0.01). Conclusions:Esculetin can protect the oxidative damaged ARPE-19 cells by up-regulating the expression of antioxidant enzymes or antioxidant proteins.

Objective To study the clinical application of intercalated combination of osimertinib and docetaxel in T790M mutation-positive lung adenocarcinoma patients with bone metastasis in the southern Hainan Province. Methods T790M mutation-positive lung adenocarcinoma patients with bone metastasis in the sou-thern Hainan Province treated at the Third People's Hospital of Hainan Province from January 2018 to October 2018 were enrolled,and they were divided into intercalated combination of osimertinib and docetaxel group (n = 32)and osimertinib group (n = 28)according to the treatment. The patients in intercalated combination of osimertinib and docetaxel group received oral osimertinib (80 mg,qd),and received docetaxel (75 mg/ m2 , repeated in three-week intervals)when taking to tumor progression,and oral osimertinib treatment (80 mg, qd)was maintained until tumor partial response or stable disease after chemotherapy. The patients in osimer-tinib group received oral osimertinib (80 mg,qd). The patients in both groups received zoledronic acid. The response rate,disease control rate,overall survival (OS)and the incidence of adverse reactions of both groups were contrastively analyzed. Results The response rate of intercalated combination of osimertinib and doceta-xel group (62. 5％,20 / 32)was higher than that of osimertinib group (35. 7％,10 / 28),and disease control rate (93. 8％,30 / 32)was also higher than that of osimertinib group (67. 9％,19 / 28),with statistically sig-nificant differences (χ2 = 4. 286,P = 0. 038;χ2 = 6. 687,P = 0. 010). The median OS of intercalated combi-nation of osimertinib and docetaxel group was 10. 0 months,which was longer than that of osimertinib group (9. 0 months),with statistically significant difference (χ2 = 5. 917,P = 0. 015). Moreover,the adverse reac-tions in both groups were all grade Ⅰ or Ⅱ,which could be relieved or improved through symptomatic treat-ment. Conclusion Intercalated treatment of osimertinib with docetaxel is safe and effective in T790M muta-tion-positive lung adenocarcinoma patients with bone metastasis in the southern Hainan Province. It can prolong the survival time of patients.

Objective: To evaluate the prognostic impact of tumor deposits on the overall survival (OS) of gastric cancer (GC) patients. Methods: Between January 2007 and December 2012, 312 GC patients undergoing curative resection in The First Affiliated Hospital of Hainan Medical University were enrolled. Patients were categorized into two groups based on the tumor deposit status of postopera-tive pathology: positive group, presence of tumor deposits and negative group, absence of tumor deposits. The correlations of tumor deposit status with clinicopathological and potential prognostic factors were analyzed. Results: Eighty-four (26.9%) patients had tumor deposits. There were significant differences in Borrmann type, tumor size, depth of invasion, N stage, tumor-node-metastasis (TNM) stage, and lymphovascular invasion between the two groups on univariate analysis. Multivariate analysis revealed that Borrmann type, N stage, and lymphovascular invasion were independently associated with the presence of tumor deposits. In univariate survival analy-sis, age, tumor location, Borrmann type, tumor size, TNM stage, type of gastrectomy, lymphovascular invasion, and presence of tumor deposits were found to be significant prognostic factors. GC patients with tumor deposits had a significantly lower 5-year OS rate than those without tumor deposits (5-year OS: 34.5% vs . 67.5% , P<0.001). Multivariate analysis revealed that age, Borrmann type III/IV, TNM stage, lymphovascular invasion, and presence of tumor deposits were independent prognostic factors for this cohort. Further stratified analysis demonstrated that the significant prognostic differences between the two groups were only observed in patients with stage N0-3a disease. There were no significant differences in survival between patients with and without tumor deposits at the N3b stage. The prognosis of GC patients with tumor deposits was independently correlated with N stage, lymphovascular invasion, and postoperative chemotherapy. Conclusions: The presence of tumor deposits was an independent prognostic factor in GC patients and can be used as a prognostic indicator for GC patients with stage N0-3a disease. GC patients with tumor deposits should receive postop-erative chemotherapy regardless of TNM stage.

Objective To compare curative effect between lenvatinib combined with locoregional therapy and locoregional therapy on PD-L1-positive hepatocellular carcinoma patients with type Ⅰ-Ⅲ portal vein tumor thrombus according to Cheng's classification. Methods The patients in lenvatinib combined with locoregional therapy group received orally-administered lenvatinib at a dose of 12 mg qd for patients≥60 kg or 8 mg qd for patients < 60 kg. The locoregional therapy group only received locoregional therapy. We retrospectively analyzed the clinical data and prognosis of two groups. Results The CR+PR were 78.1% and 53.6% in the combination group and locoregional therapy group, respectively (P < 0.05). The response rate, disease control rate and overall survival of the combination group were higher than those in the locoregional therapy group (P < 0.05). Conclusion The curative effect and overall survival of lenvatinib combined with locoregional therapy is better than locoregional therapy on PD-L1-positive hepatocellular carcinoma patients with type Ⅰ-Ⅲ portal vein tumor thrombus according to Cheng's classification.

Objective:To summarize the clinical manifestations, gene variations, diagnosis and treatment of 3 cases with SLC35A2 variations characterized by congenital glycosylation disorder Ⅱm (CDG Ⅱm). Methods:A total of 3 patients admitted to the Department of Pediatrics of Xiangya Hospital of Central South University in China from 2018 to 2020 were examined in detail. The studies till January 2022 were searched with key words of "congenital disorders of glycosylation Ⅱm", " SLC35A2" and "CDG Ⅱm" in both English and Chinese in the databases of China National Knowledge Infrast Ructure (CNKI), Wanfang, Online Mendelian Inheritance in Man and PubMed, and the clinical manifestations, genetic variation, treatments and prognosis of patients with SLC35A2 mutation were summarized. Results:The patients all presented with intractable infantile spasm and global developmental delay, onset in infancy. A variety of antiepileptic treatments had temporary and partial efficacy. Otherwise, proband 2 and 3 presented with abnormal glutamic-pyruvic transaminase and increased platelets. Funduscopy showed dysplasia of the retinal pigment epithelium in both eyes, and they both received D-galactose treatment. A total of 22 relevant case reports, including 99 patients, were collected. The 99 patients all were heterozygous mutations, and a total of 75 different variation sites were reported. The clinical manifestations were characterized by global developmental delay or mental retardation ( n=89), epileptic seizure ( n=75), hypotonia ( n=57), facial deformity ( n=57), skeletal abnormality ( n=50), visual impairment ( n=42), elevated glutamic-pyruvic transaminase ( n=31), gastrointestinal symptoms ( n=28), skin deformity ( n=26), microcephaly ( n=23) and congenital heart disease ( n=12). Craniocerebral magnetic resonance imaging may be normal in the early stage. With age, magnetic resonance imaging may show abnormal white matter signals, brain atrophy, dysplasia of corpus callosum, delayed myelination, enlargement of lateral ventricle, brain stem atrophy and so on. Studies have shown that galactose treatment may be effective. Conclusions:SLC35A2 variants lead to CDG Ⅱm, whose clinical manifestations mainly include epileptic encephalopathy and global developmental delay. Multiple antiepileptic therapies can temporarily or partially control seizures, while oral galactose may improve the clinical symptoms, showing its prospect as a dietary therapy.

Objective:To investigate the expression of coxsackievirus-adenovirus receptor (CAR) in thymic carcinoma and the relationship between CAR and the antitumor activity of oncolytic adenovirus H101.Methods:The expression of CAR in thymic carcinoma tissues and cells were detected by RT-qPCR and Western blot. H101 expression and virus titers in Bcap-37, MP59 and T1889 cells after infection were detected by RT-qPCR and 50% tissue culture infectious dose (TCID 50). The proliferation activity and apoptosis rates of T1889 cells infected with H101 at different multiplicity of infection (MOI) were detected by CCK-8 and flow cytometry. CAR expression in T1889 cells treated with different concentrations of trichostatin A (TSA), a histone deacetylase inhibitor, was detected. H101 expression and virus titers in the TSA-treated and H101-infected cells were detected. Cell activity was detected by CCK-8. The phosphorylation levels of MARK and ERK1/2 and the expression of CAR at protein level in TSA-treated or TSA+ TBHQ (ERK activator) treated cells were detected. Results:CAR expression at both mRNA and protein levels were significantly lower in thymic carcinoma tissues than in adjacent normal tissues ( P<0.01), and lower in MP59 and T1889 cells than in thymic epithelial cells (TEC) and Bcap-37 cells ( P<0.01). H101 expression in MP59 and T1889 cells and the titers of H101 in culture supernatants were significantly lower than those in Bcap-37 cells ( P<0.01). Compared with Bcap-37 cell, the activity of MP59 and T1889 cells was significantly increased and the apoptosis rates were significantly decreased 48 h after H101 infection ( P<0.01). The expression of CAR at both mRNA and protein levels in T1889 cells treated with different concentrations of TSA increased in a dose-dependent manner. When T1889 cells were treated with 0.25 μmol/L of TSA, the expression of H101 at mRNA level and H101 titers were significantly increased ( P<0.05); the phosphorylation levels of MAPK and ERK1/2 proteins were continuously decreased; the expression of CAR was continuously increased. Compared with the TSA treatment group, the expression of CAR at protein level in the TSA+ TBHQ treatment group decreased significantly ( P<0.01), and the p-ERK1/2/ERK1/2 ratio increased significantly ( P<0.01). Conclusions:TSA could up-regulate CAR expression in thymic carcinoma by inhibiting the MARK/ERK1/2 pathway, thereby enhancing the antitumor activity of H101.

Objective: To explore the related factors for efficacy and prognosis of personalized comprehensive treatment for T790Mpositive lung adenocarcinoma patients with bone metastasis. Methods: The clinical data of 68 patients undergoing personalized comprehensive treatment for T790M-positive lung adenocarcinoma with bone metastasis were retrospectively reviewed; chemotherapy, radiotherapy, molecule-targeted agents, Bevacizumab, bisphosphonate and other therapies were chosen for the patients, and the efficacy and prognosis were observed to explore the related factors. Results: Effective rate of personalized comprehensive treatment was 60.3% (41/ 68), with a median survival time of 23 months. Multiple factors showed significant effects on long-term efficacy, such as no radiotherapy, T790M mutation but no KRAS mutation, adjuvant scheme+rescue scheme in prior chemotherapy treatment, N1 stage, isolated bone metastasis, alternative treatment of osimertinib with chemotherapy, less metastasized organs and ECOG scores<2 (P<0.05). Multivariate analysis revealed that T790M mutation but no KRAS mutation (P=0.012), number of metastasized organs =0 or 1 (P=0.000), alternative treatment of osimertinib with chemotherapy (P=0.020), and isolated bone metastasis (P=0.006) were independent protective factors for long-term results of personalized comprehensive treatment for T790M-positive lung adenocarcinoma patients with bone metastasis. Conclusion: Chemotherapy combined with osimertinib, agents of bisphosphonate and other personalized comprehensive treatment prolongs survival time in T790M-positive lung adenocarcinoma patients without KRAS mutation, providing a potential therapeutic model for those patients.