Purpose: To analyze and study the characteristics of diagnosis, multidisciplinary treatment including surgery, chemotherapy and radiotherapy of pregnancy-associated breast cancer. Methods: 9 cases of pregnancy-associated breast cancer were diagnosed and treated in the Department of radiotherapy of Henri Mondor Hospital, the Xllth University of Paris, from December 1992 to June 1999. 3 cases were diagnosed during pregnancy, while the other 6 were diagnosed within one year following pregnancy. 5 cases were treated with breast conservative therapy, 4 cases with modified radical mastectomy. Post-operative radiotherapy was delivered to all of the 9 cases, and 7 cases accepted chemotherapy. Results: 7 of the 9 mammographies and all the 5 breast ultrasonographies revealed tumor images. The stage at the diagnosis was generally late, the proportion of stage I , II and fT was 11 % , 44% and 44% respectively. The median follow-up time was 60 months (9-89 months), disease-free survival was observed in 6 cases, 3 cases had local recurrence or distant metastasis at 14 months to 48 months after the completion of treatment. Conclusions: Delay of diagnosis is frequently observed in pregnancy-associated breast cancer, especially in these cases diagnosed after delivery. Attention should be paid to the physical examination and ultrasonography of the breast during pregnancy and lactation. The principal of treatment is to take into account both the urgency of the disease and the safety of the fetus. Under the condition that the chemotherapy and radiotherapy could be delivered without delay, breast conservative treatment is feasible in early stage pregnancy associated breast cancer

Lobaplatin is the third generation platinum anticancer drug,and has been listed for the clinical treatment of advanced breast cancer,small cell lung cancer and chronic myeloid leukemia.Studies have shown that lobaplatin as the latest third generation platinum anticancer drug,has good water solubility,broadspectrum anti-tumor,strong anti-tumor activity,no cross-resistance with other platinum drugs,low toxicity and many other features.Lobaplatin has shown a clear advantage.

Objective: To investigate the activities of daily living and the use of assistive devices among disabled people demanding assistive devices in Jiading Township, Jiading District, Shanghai Municipality, so as to provide the evidence for the implementation of rehabilitation interventions and the selection of assistive devices for the disabled people living in the community. Methods: The disabled people demanding assistive devices were sampled from 17 communities in Jiading Township in January 2020. A face-to-face questionnaire survey was conducted to collect participants'age, gender, type of disability, provision and use of assistive devices. The activities of daily living were evaluated using the Activities of Daily Living Scale, and the difference in the frequency of assistive device use was compared among the disabled people with different activities of daily living. Results: A total of 377 questionnaires were allocated, and 328 valid questionnaires were recovered, with an effective recovery rate of 87.00%. The respondents included 187 men ( 57.01% ) and 141 women (42.99%), and had a mean age of ( 71.78±13.86 ) years. Among all respondents, limb disability was predominant (248 people, 75.61%), and 84.45% (277 people) were provided with assistive devices. Assessment of activities of daily living showed complete self-care in 85 respondents ( 25.91% ), functional decline in 39 respondents ( 11.89% ) and functional dysfunction in 204 respondents ( 62.20% ). The proportion of functional dysfunction was predominantly detected among disabled people at ages of 80 years and older ( 79.63% ) ( P<0.05 ). Of the disabled people with assistive devices, 139 people used the devices daily ( 50.18% ), and the proportion of daily use of assistive devices was significantly higher in people with functional dysfunctions than in those with complete self-care ( 59.33% vs. 29.41%; P<0.05 ). In addition, no need was identified as the predominant cause of non-provision of assistive devices ( 29 people, 56.86% ). Conclusions Functional dysfunction of daily living is highly prevalent among the disabled people demanding assistive devices in Jiading Township, in whom the elderly are predominant, and the proportion of assistive device use is high among people with functional dysfunctions. The provision of assistive devices recommends to be improved based on assessment of activities of daily living.

Objective To treat hydrosalpinx by using interventional embolization of fallopian tube or laparoscopic salpingectomy before the performance of auxiliary reproductive technology,i.e.in vitro fertilization and embryo transplant (IVF-ET),and to compare the clinical effect,technical advantages and disadvamages between the two methods.Methods A total of 170 patients with tubal infertility who had received IVF-ET were selected,the clinical data were retrospectively analyzed.The patients were divided into three groups:(1) interventional embolization group (n=65),using interventional embolization for hydrosalpinx;(2) laparoscopic salpingectomy group (n=55),adopting laparoscopic salpingectomy for hydrosalpinx;and (3) control group (n=50):for these patients bilateral proximal fallopian tube obstruction was performed,and IVF-ET was directly carried out if the patient had no hydrosalpinx.Results No statistically significant differences in the used dosage of gonadotropin (Gn),E2 level on HCG-injection day,the number of follicles on HCG-injection day,the number of retrieved oocytes,the fertilization rate,cleavage rate,clinical pregnancy rate,abortion rate,and ectopic pregnancy rate existed between each other among the three groups (P＞0.05).The technical success rate in both interventional embolization group and laparoscopic salpingectomy group was 100％.No severe complications occurred.The interventional embolization procedure had some advantages,it could be completed at clinic room,the operation time was short,no anesthesia was needed,the medical cost was low,etc.Conclusion Interventional embolization of fallopian tube and laparoscopic resection are equally effective in treating hydrosalpinx before IVF-ET is conducted.Both methods can improve pregnancy outcome,but interventional embolization method is more simple,safe,economical and effective,which deserves to be the preferred method of treatment.

Objective:To investigate the feasibility of using anastomotic stoma as a long-term vascular access to maintain hemodialysis in patients who cannot establish an effective vascular access after ACUSEAL graft occlusion.Methods:A rare case of brachial artery-right atrium ACUSEAL artificial blood vessel fistula bypass to establish vascular access occlusion, the use of artificial blood vessel anastomosis stoma to establish buttonhole puncture as a long-term vascular access and the corresponding nursing methods.Results:At present, the patients were treated with regular dialysis for 32 months and blunt needle puncture for 23 months.Conclusions:Brachial artery-right atrium ACUSEAL graft is a rare vascular access surgery. As a new type of access with depleted autologous vascular resources, the efficacy is not certain. Because it is different from the traditional vascular prosthesis surgery, once the thrombotic occlusion of the graft fails, the risk and difficulty of reopening by interventional or surgical methods are great. Therefore, it is a challenging and reasonable method to use the limited residual cavity of the anastomosis as a long-term vascular access after occlusion to prolong the service life of the graft.

AIM:To establish a mouse model of immuno-inflammation in central nervous system (CNS) associated with cognitive dysfunction.METHODS:C57BL/6J male mice were divided into 3 groups.Lipopolysaccharide (LPS) was intraperitoneally injected into the mice to induce cognitive impairment.Morris water maze test, passive avoidance test and pole test were used to observe the behavioral changes of mice.The histomorphology was analyzed by the method of immunofluorescence.The detailed molecular mechanism was determined by Western blot.RESULTS:Compared with saline group, LPS induced mouse sickness behavior and memory loss.Microglia activation and neuronal loss in the hippocampus were observed.The expression of neuroinflammatory proteins COX-2 and iNOS in the brain of LPS-induced mice was increased.CONCLUSION:Intraperitoneal injection of LPS induces cognitive dysfunction in mice.

ObjectiveTo explore the ideal minimally invasive surgical method for degenerative lumbar spine stenosis.MethodsFrom March 2008 to August 2010,73 cases with lumbar spinal stenosis underwent minimal invasive surgery were retrospectively analyzed.The patients were divided into different groups by clinical features,imaging manifestations,and concurrent diseases.The minimal invasive surgical methods were chosen according to the classification.Operation time,intra-operative bleeding,and complications were recorded.The lumbar function was evaluated by Oswestry disability index (ODI),and the clinical results were assessed by JOA pre- and postoperatively.ResultsMinimal invasive surgery was completed in all cases,which included 25 cases with bilateral decompression and 48 cases with unilateral approach for bilateral decompression.Twenty-three cases used interbody fusion and percutaneous pedicle screw fixation after decompression.Intraoperative blood loss and operation time were related to surgical methods.One case was complicated with dural tear.Cage was inserted into upper vertebral body during interbody fusion in 1case with osteoporosis,removed the cage and implanted bone fusion.Incisions of 3 cases were poor healing after surgery.The average follow up time was 13 months(range,10-35).JOA score and ODI before surgery were 9.2±5.1 and 62.3％±18.5％ respectively; while 6 months after surgery,JOA score and ODI were 23.5±7.2 and 18.4％±6.4％ respectively.JOA score and ODI showed statistically significant improvements after operation(P＜0.01).Twenty-two cases got solid fusion at the final follow-up.ConclusionTreatment of lumbar spinal stenosis by minimal invasive surgery has satisfactory surgical outcomes,but the proper minimal invasive strategy should be chosen according to specific patients,surgeons and hospitals.

Objective: To investigate effect of the contact surface between the bridge and the adjacent teeth on the stress distribution of the implant and bone tissue and the displacement of the prosthesis in the cantilever fixed implant bridge restoring missing mandibular central incisors. Methods: Two-dimensional images of the mandible and dentition in healthy adults were obtained using CT data. A three-dimensional finite element model of cantilever fixed bridge supported by implants with mandibular central incisor was established by computer reconstruction technique.The contact surface between the bridge and the adjacent natural tooth was designed as "oval" and "trapezoid". The "trapezoid" has a slightly smaller median diameter on the labial side and a slightly larger medial diameter on the lingual side. Loading of 120 N was applied on the tangential margin of the middle line of the long axis of the bridge 41. The direction was set at 0°, which was parallel to the long axis of the tooth and downward. The buccal to lingual and downward angles were 30°, 45° and 60°, respectively, perpendicular to the long axis of the tooth and 90° to the lingual side.The stress distribution of the implant and surrounding bone tissue and the displacement of the prosthesis were compared between the two models. Results: Under axial and buccolingual loading, the maximum equivalent stress peak in the implant and surrounding bone tissue in the cantilever with trapezoidal contact surface design and the maximum displacement of the prosthesis were lower. Moreover, the distribution of stress was more balanced and the concentration range of stress was smaller. With the loading angle increasing, this trend was more obvious. When loading angle increased to 90°, the maximum equivalent stress and the maximum displacement of the elliptic contact surface model implant and surrounding bone tissue were 196 and 101 MPa and 0.196 mm, respectively, while the trapezoidal contact surface model were 157 and 72 MPa and 0.164 mm, respectively. Conclusions The trapezoidal contact surface of the bridge and the adjacent teeth in the cantilever fixed bridge supported by implants with mandibular central incisor is beneficial to reduce the impact of the leverage on the implant and surrounding bone tissue.

Objective:To investigate the predictive value of the epithelial cell proliferation(ECP)pathway genes for the prognosis of elderly non-small cell lung cancer patients treated with immunotherapy.Methods:A total of 106 elderly patients aged 70 years and over receiving immunotherapy in the POPLAR and OAK clinical trials were retrospectively analyzed in October 2022.According to the mutation status, patients were divided into an ECP pathway-related gene mutation group(ECP mutation group, n=25)and an ECP pathway-related gene non-mutation group(ECP non-mutation group, n=81). The primary endpoints were overall survival(OS)and progression-free survival(PFS). Differences in survival and efficacy between the two groups were compared, and subgroup analysis was performed on clinical factors and genes involved in the pathway.Pyclone was used to calculate the distribution of major clones and subclones in each patient, and differences in survival were compared.Results:Survival outcomes were worse in the ECP(+ )group than in the ECP(-)group(mOS: 10.9 months vs.17.1 months, HR=1.84, 95% CI: 1.09-3.08, P<0.05; mPFS: 2.8 months vs.4.2 months, HR=1.58, 95% CI: 1.00-2.51, P<0.05). Of all mutations in ECP pathway-related genes, mutations in the RB1 gene had a significant prognostic effect on all patients, with the negative prognostic effect especially prominent in ECP(+ )patients.Compared with ECP(-)patients, ECP(+ )patients had a shorter mOS(6.9 months vs.12.6 months, HR=3.14, 95% CI: 1.10-8.97, P=0.024). Ten patients had clonal mutations and 15 patients had sub-clonal mutations in ECP pathway-related genes and the former had a shorter mPFS than the latter(1.3 months vs.5.3 months, HR=3.23, 95% CI: 1.25-8.37, P=0.011). Conclusions:Gene mutations in the epithelial cell proliferation pathway are a negative prognostic factor in elderly non-small cell lung cancer patients receiving immunotherapy, and mutations located in the clonal cluster have a stronger impact on the prognosis.

China has entered the task stage of comprehensive medical insurance payment reform, but there are problems restricting the development of innovative medical technology in the reform of diagnosis-related groups(DRG) payment system. The author introduced the international definition and scope of innovative medical technology, and summarized the preconditions and payment policy of short-term payment of innovative medical technology under the DRG payment system; And put forward suggestions in line with China′s actual situation, including clarifying the definition of innovative medical technology, setting access conditions for additional payment or actual payment, setting up special transition funds for high-value innovative drugs, clarifying the payment amount of innovative medical technology, and formulating payment strategies for innovative medical technology.