BACKGROUND:Pedicle screw fixation has been used in children with thoracic injury. Conventional method is screw implantation by hand. This method can meet the needs of surgery, but its accuracy was low, and incidence of complications was high. The application of digital image navigation aid module is possible. OBJECTIVE:To study accuracy and safety of digital image navigation aid module in thoracic pedicle screw placement. METHODS:Eight thoracic vertebral bodies were equal y and randomly assigned to the manual insertion group and the digital image navigation aid module group. Manual insertion group received manual screw insertion. In the digital image navigation aid module group, navigation aid module was made according to CT scan results combined with principle of reverse engineering and rapid prototyping. Pedicle screw was placed using the digital image navigation aid module. RESULTS AND CONCLUSION:(1) Success rate of once screw set was significantly higher in the digital imaging navigation aid module group than in the manual insertion group (P<0.05). (2) Twenty-eight screws were implanted in the digital image navigation aid module group and manual insertion group separately. The excellent and good rate of screw placement was 96%in the digital image navigation aid module group and 75%in the manual insertion group (P<0.05). (3) These findings suggested that digital image navigation aid module can effectively improve the success rate of pedicle screw insertion. Moreover, this method is simple, easy to operate, and can make a personalized nail placement program for each child.

[Objective] To investigate the role SPAG5 play in ovarian adenocarcinoma cell mitosis,Taxol sensitivity and ovarian high grade serous carcinoma patients' prognosis.[Methods] Transient knockdown of SPAG5 in SKOV3 cell were performed,and MTT assay and cell cycle flow cytometry assay were carried out.IHC staining of SPAG5 protein in 110 high grade serous carcinoma patients' tumor tissues were performed,and the expression were analyzed with clinical data and prognosis.Finally,SPAG5 were knocked down in OVCAR3 A2780 and SKOV3 cells followed by 0.5μM Taxol treatment,MTT assay were performed to detect cell viability.[Results] SPAG5 knockdown inhibited cell mitosis of ovarian adenocarcinoma cell SKOV3 by G2/M arrest.High grade serous carcinoma patients after neoadjuvant chemotherapy gained the expression of SPAG5.Patients without neoadjuvant chemotherapy with low SPAG5 expression have poor progress free survival,especially in early stage patients.Patients with low SPAG5 expression also have poorer overall survival,but the difference was not statistically significant.Furthermore,SPAG5 knockdown in OVCAR3 A2780 and SKOV3 cells reduced Taxol sensitivity.[Conclusion] SPAG5 regulated cell mitosis and promoted cell proliferation in ovarian adenocarcinoma cell lines.Expression of SPAG5 in patients' tumor tissues predicted patients' prognosis and Taxol sensitivity.As the results,individualized treatment of high grade serous carcinoma patients is necessary.

AIM:To investigate the effects of voltage-dependent K +channel 1.5 (Kv1.5) on the proliferation and apoptosis of rat pulmonary artery smooth muscle cells (PASMCs) under hypoxia+hypercapnia condition and the relation-ship with mitogen-activated protein kinase(MAPK) signal pathway.METHODS:The PASMCs isolated from the male SD rat were cultured under hypoxia +hypercapnia condition, and randomly divided into normal group (N group), hypoxia+hyper-capnia group (HH group), hypoxia+hypercapnia+DMSO incubation group (HD group), hypoxia+hypercapnia +U0126 (an extracellular signal-regulated kinase 1/2 inhibitor) incubation group (HU group), hypoxia+hypercapnia+SB203580 (a p38 mitogen-activated protein kinase inhibitor ) incubation group (HS group), and hypoxia+hypercapnia+anisomycin (an agonist of MAPK) incubation group (HA group).Cell Counting Kit-8 was used to detect the cell viability.The protein expression of Kv1.5, PCNA and Bax was detected by Western blotting .RESULTS:Compared with N group , the cell via-bility and PCNA protein expression in HH group and HD group were significantly raised (P<0.01), but Kv1.5 and Bax proteins were significantly decreased (P<0.01).No difference between HH group and HD group was observed (P>0.05 ) .Compared with HD group , the cell viability and PCNA protein expression in HU group , HS group and HA group were decreased (P<0.05 or P<0.01), but Kv1.5 protein and Bax protein were raised (P<0.01), with the most significant changes in HA group .CONCLUSION:The regulation of Kv1.5 to the proliferation and apoptosis of PASMCs under hy-poxia+hypercapnia condition might have a relationship with the activation of MAPK signal pathway .

Objective:To detect the status of PIK3CA in triple-negative breast cancer (TNBC) , and to analyze the relationships between PIK3CA mutation and clinical features and its impact on prognosis.Methods:From January 1, 2016 to December 31, 2018, 50 patients with primary TNBC admitted to Xinxiang Central Hospital of Henan Province were collected. The PIK3CA mutation status was detected, and the relationships between PIK3CA mutation and clinical characteristics of patients with TNBC and its impact on prognosis were analyzed.Results:PIK3CA gene mutation was detected in 9 of 50 TNBC patients, with a mutation frequency of 18.0%. H1047R mutation was found in 4 cases, E545K mutation in 3 cases and E542K mutation in 2 cases. PIK3CA gene mutation was not associated with age ( χ2=3.55, P=0.060) , tumor location ( χ2=1.01, P=0.315) , tumor size ( χ2<0.01, P>0.999) , lymph node status ( χ2=0.76, P=0.385) , clinical stage ( χ2=0.65, P=0.420) , Ki-67 value ( χ2<0.01, P>0.999) , P53 status ( χ2=0.02, P=0.894) and human epidermal growth factor receptor-2 (HER-2) status ( χ2=1.65, P=0.200) . Prognostic analysis showed that 3-year disease-free survival rates of wild-type PIK3CA patients was significantly higher than that of mutant PIK3CA patients (80.5% vs. 11.1%, χ2=28.23, P<0.001) . Conclusion:The frequency of PIK3CA gene mutation is higher in TNBC patients. There is no correlation between PIK3CA mutation and clinicopathologic features in TNBC patients. PIK3CA gene mutation may be significantly associated with poor prognosis of TNBC patients.

Objective To observe the long-term effect,adverse reaction and cosmetic outcome of early-stage breast cancer with hypofractionated whole-breast irradiation (HF-WBI) after breast-conserving surgery.Methods A total of 206 patients with stage 0-Ⅱ breast cancer after breast-conserving surgery were included in Shandong Cancer Hospital Affiliated to Shandong University from May 2014 to August 2017.According to radiotherapy fraction,patients were divided into HF-WBI group and conventional whole-breast irradiation (CF-WBI) group.In HF-WBI group,116 patients received whole-breast radiation to 42.56 Gy in 16 fractions followed by tumor bed boost of 9 Gy in 3 fractions or 10 Gy in 5 fractions.In CF-WBI group,90 patients received whole breast radiation to 50 Gy in 25 fractions followed by tumor bed boost of 10 Gy in 5 fractions.The 2-year local recurrence rate,2-year mortality rate,acute adverse reaction,late adverse reaction and cosmetic outcome of the two groups were analyzed.Results The 2-year local recurrence rates of HF-WBI group and CF-WBI group were 0.86％ (1/116) and 2.22％ (2/90) respectively,and there was no significant difference between the two groups (x2 =0.049,P =0.824).The 2-year mortality rates of the two groups were 0.86％ (1/116) and 0 (0/90) respectively,and there was no significant difference (P ＞ 0.999).There were 108 cases (93.1％) in HF-WBI group and 84 cases (93.3％) in CF-WBI group with grade 0-1 acute dermatitis,and 8 cases (6.9％) and 6 cases (6.7％) with grade 2-3 respectively,with no statistically significant difference (x2 =0.004,P =0.948).There were 97 cases (83.6％) in HF-WBI group and 79 cases (87.8％) in CF-WBI group with grade 0-1 bone marrow suppression,and 19 cases (16.4％)and 11 cases (12.2％) with grade 2-4 respectively,with no statistically significant difference (x2 =0.704,P =0.401).In the two groups,there were 1 case (0.9％) and 3 cases (3.3％) with grade 1-2 radiation pneumonitis,and 115 cases (99.1％) and 87 cases (96.7％) with no radiation pneumonitis respectively,and the difference was not statistically significant (x2 =1.626,P =0.202).There was 1 case (0.9％,1.1％) with grade 1 breast edema in each group,and 115 cases (99.1％) and 89 cases (98.9％) did not occur breast edema,with no statistically significant difference (x2 =0.033,P =0.857).In the late adverse reactions,there were 5 cases (4.3％) and 3 cases (3.3％) with skin pigmentation in HF-WBI group and CF-WBI group respectively.There were 2 cases (1.7％,2.2％) with grade 1 subcutaneous tissue fibrosis in each group,and there were 1 case (0.8％) and 2 cases (2.2％) with grade 1 pulmonary fibrosis respectively.The differences between the two groups were not statistically significant (x2 =0.000,P ＞ 0.999;x2 =0.000,P ＞ 0.999;x2 =0.049,P =0.824).The 6-month,1-year and 2-year cosmetic outcome good rates in HF-WBI and CF-WBI group were 96.5％ (111/115) and 93.3％ (84/90),92.1％ (105/114) and 90.0％ (81/90),91.4％ (53/58) and 87.2％ (41/47) respectively.The differences between the two groups were not statistically significant (x2 =0.526,P =0.468;x2 =0.277,P =0.599;x2 =0.476,P =0.490).The whole course of radiotherapy time in HF-WBI group was 25 days or 29 days,which was significantly shorter than the 40 days of CF-WBI group.Conclusion HF-WBI after breast-conserving surgery has the similar long-term effect,acute and late adverse reaction and cosmetic outcome compared with CF-WBI,and the treatment time is significantly shorter.It can be further promoted as the optimal adjuvant radiotherapy for early-stage breast cancer after breast-conserving surgery.

Hypofractionated radiotherapy after breast conserving surgery has become a new standard treatment of early breast cancer. Clinical researches show that α/ β value of breast cancer is lower than that of other tumors,and the breast cancer is more suitable for hypofractionated radiotherapy. Hypofractionated radio-therapy has good economic benefits,and long-term follow-up results from a number of classical randomized con-trolled studies have shown that hypofractionated whole breast irradiation is effective and safe. With the extensive application of hypofractionated irradiation,this technology has been gradually extended to regional nodal irradia-tion,postmastectomy radiotherapy and breast ductal carcinoma in situ.