Objective To investigate the relationship between serum levels of CA15-3, CA-125 and CEA in postoperative breast cancer patients and clinicopathological parameters and pathogenetic condition turnover. Methods From January 2004 to December 2007, 219 breast disease cases with integrity clinical information, admitted to general surgery and oncology department of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, were collected. The serum concentrations of CA15-3, CA-125 and CEA were determined by chemiluminescent immunoassay(CLIA). Wilcoxon Kruskal Wallis analysis, crosstable analysis and spearman correlation analysis were used to investigate the association between the serum concentration and clinical parameters and pathogenetic condition turnover. Results The serum concentrations of CA15-3,CA-125 and CEA in metastatic breast cancer group were significantly higher than those in nonmetastatic group(P=0.000). The sensitivity of the 3 tumor markers in combination was 64.1% in metastatic breast cancer diagnosis. CA15-3 and CA-125 at the time of initial metastasis were correlated with estrogen receptor state(PCA15-3=0.039, PCA-125=0.049). The level of 3 tumor markers in multiorgan metastatic group were significantly higher than those in single organ metastastic patients(P=0.000). There were significant differences between the levels of CA15-3 and CEA in distant metastatic group and those in local metastatic group (PCA15-3=0.001,PCEA=0.022). Conclusion The high serum concentrations of CA15-3,CEA and CA-125 were useful in monitoring the metastasis. The high serum levels of CA15-3 and/or CA-125 may indicate that the patients will be more sensitive to endocrine therapy.

Objective · To prepare the liposomal pemetrexed and investigate its effects on MCF-7 breast cancer cells in vitro and nude mice bearing MCF-7 xenograft tumors. Methods · Liposomal pemetrexed was prepared by film dispersion method. Inhibition of MCF-7 breast cancer cell lines was evaluated by CCK-8 method, and anti-tumor effects were investigated on Balb/c nude mice bearing MCF-7 xenograft tumors. Results · Liposomal pemetrexed inhibited the growth of MCF-7 cells. When the concentrations of pemetrexed were 0.20, 0.40 and 10.00 μg/mL, the cell viability in experiment group (liposomal pemetrexed) was significantly lower than that in control group (pemetrexed of same concentration gradient), with P values of 0.013, 0.035 and 0.041, respectively. Compared with blank group (same volume of PBS), the volumes and weights of tumors of nude mice in experiment group(liposomal pemetrexed) and control group (same volume of pemetrexed) were significantly lower, and the volume and weight of tumor in experiment group were also significantly lower than those in control group (P=0.000). Conclusion · Compared to bulk drug of pemetrexed, liposomal pemetrexed can inhibit the growth of MCF-7 breast cancer cells and the Balb/c nude mice bearing MCF-7 xenograft tumors.

As the pregnant patient with breast cancer is in a special physiological period, both the efficacy of mother and the safety of developing fetus should be considered during the whole process of diagnosis and treatment.It is particularly important for multidisciplinary teams including breast, obstetrics and nursing departments to make a secure and effective individualized plan for those in different gestational week and different stages of breast cancer development. Pregnancy risk assessment and whole-process multidisciplinary case management mode for breast cancer during pregnancy are helpful for the early detection of abnormal health status of pregnant women and fetuses, enabling rapid and efficient treatment, reducing the occurrence of adverse medical events, and maximizing the safety of pregnant women and fetuses. Obstetricians should pay attention to the chief complaints of pregnant women and conduct regular breast ultrasound examinations. Once anything suspicious is found, breast surgeons need to take charge of a multidisciplinary discussion. Not only should the multidisciplinary collaborative outpatient clinic determine the treatment plan for breast cancer during pregnancy, but also the concept of multidisciplinary collaboration should be incorporated into the follow-up treatment process, including active surgical treatment, selection of neoadjuvant chemotherapy and adjuvant chemotherapy, avoidance of endocrine therapy, targeted therapy and radiotherapy, and adherence to multidisciplinary follow-up, etc. Multidisciplinary case management of breast cancer during pregnancy is necessary and feasible, and more prospective clinical studies need to be carried out to help improve clinical diagnosis and treatment strategies.

Reasonable and effective breast cancer screening can make early diagnosis of breast cancer, improve the cure rate, prolong survival and improve the patients′ quality of life. China has made preliminary exploration and attempt in breast cancer screening, however, there are still some problems that have not been solved in terms of the proportion of opportunistic screening, the selection of screening targets, methods and frequency, and the judgment of screening results. Therefore, this article analyzes the above problems in details, and presents some thoughts and recommendations on how to optimize the breast cancer screening strategies and implementation effects in China, from the experience of clinical practice, under the background of constantly emerging new research results and techniques and the rapid development of artificial intelligence, that is, to adjust measures to local conditions, provide personalized strategies, achieve precise screening, preach and educate, ensure health insurance coverage, improve quality control, offer technical support and employ artificial intelligence.

There is no treatment norm on the fertility issue of breast cancer patients. The clinical studies show that the effects of chemotherapy and endocrine treatment on menstrual cycle and ovarian function have connection with patients' age, therapeutic regimen and drug dose. The time to be pregnant should be decided according to the stage of tumor and the therapeutic regimen. The trimester of pregnancy and tumor stage should be considered when making the therapeutic regimen for the breast cancer patients during pregnancy. And it is not recommended to choose the induced abortion for the therapeutic aim. Theoretically, ovarian function inhibition drugs have great application prospects, while, of which the long-term affect on human body and the relation with tumor development need more researches to study. The available evidence-based practices consider that the pregnancy after breast cancer treatment has no adverse affects on the prognosis of early and middle stage breast cancer patients. More study results are needed to normalize and detail the therapeutic regimen and fertility guidance.
Breast Neoplasms ; therapy ; Female ; Fertility Preservation ; Humans ; Pregnancy ; Prognosis

Objective:To investigate the correlation between malnutrition and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with ischemic stroke received intravenous thrombolysis in the Department of Neurology, Nanjing Jiangbei People's Hospital from January 2018 to December 2021 were retrospectively enrolled. Nutritional status was assessed by geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI). END was defined as an increase of ≥4 in the National Institutes of Health Stroke Scale score within 24 h after intravenous thrombolysis compared with the baseline value. The demographic and baseline clinical data of the patients in the END group and the non-END group were compared. Multivariate logistic regression analysis was used to determine the independent correlation between malnutrition and END. Results:A total of 256 patients were enrolled, including 156 males (60.9%), aged 65.6±12.0 years. According to GNRI and PNI, there were 122 (46.7%) and 62 (24.2%) patients with malnutrition respectively. END occurred in 37 patients (14.5%) during hospitalization. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, there was a significant independent correlation between malnutrition and END after intravenous thrombolysis in patients with acute ischemic stroke (severe malnutrition as assessed by GNRI compared to normal nutritional status: odds ratio 5.736, 95% confidence interval 1.033-31.866, P=0.046; severe malnutrition as assessed by PNI compared to normal nutritional status: odds ratio 4.928, 95% confidence interval 1.589-15.282, P=0.006). Conclusion:Malnutrition is very common in patients with acute ischemic stroke and has a significant correlation with END after intravenous thrombolysis.

Objective: To investigate the principles of diagnosis and treatment of breast cancer during pregnancy. Methods: Clinical data of patients with breast cancer during pregnancy admitted to Obstetrics and Gynecology Hospital of Fudan University between January 2012 to July 2017 were analyzed retrospectively. A total of 17 patients were diagnosed with breast cancer in pregnancy, the median age was 32 years (range from 25 to 45 years old), pathological staging revealed 2 patient with stage 0, 1 with stage Ⅱa, 7 with stage Ⅱb, 1 with stage Ⅲa, 2 with stage Ⅲc, 4 with stage Ⅳ. Results: Thirteen patients received surgical treatment in pregnancy, the gestational age at surgery was (27.7±4.6) weeks; 2 patients with ductal carcinoma in situ received mastectomy, 11 patients with breast cancer underwent modified radical mastectomy. In patients undergoing surgery during pregnancy, no prophylactic contractions were used in 4 patients who had been treated earlier, there were 2 patients with frequent contractions within 24 hours after operation in these patients. Follow-up 9 patients were given oral nifedipine to prevent contractions, no obvious contractions occurred after the operation. Seven patients received chemotherapy during pregnancy; the chemotherapy of 4 cases of triple negative breast cancer was weekly paclitaxel sequential epirubicin and cyclophosphamide, the chemotherapy of the other three patients was docetaxel sequential epirubicin and cyclophosphamide. Fifteen patients underwent cesarean section to terminate pregnancy, 2 patients underwent spontaneous labor. The gestational age of birth was (36.9 ±1.3) weeks. Less than 35 weeks of termination of pregnancy occurred in one patient, the fetus was delivered to the neonatal intensive care unit due to neonatal respiratory distress syndrome, and suffered from congenital dysaudia. The prognosis of the other 16 survived infants was good. The median follow-up time was 10 months (range from 4 to 27) months, in 13 patients of stage 0 to Ⅲc, one patient were diagnosed with bone metastasis at 12 months after surgery, the remaining 12 patients had no disease progression, the progression free survival rate was 12/13, the overall survival rate was 13/13. Among the 4 patients with stage Ⅳ, one died in 7 months after delivery, one had new liver metastasis in 8 months after delivery. The remaining 2 patients were in stable condition. Conclusions Breast cancer in pregnancy can be treated effectively, multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary. Chemotherapy during pregnancy is safe for maternal-fetal, but it needed a large sample of clinical studies and long-term follow-up. The neonatal outcome was associated with gestational age, and therefore premature delivery was avoided as much as possible during treatment.

The pregnancy rate of young breast cancer patients is far lower than that of the general population, which is possibly related to many factors such as patients' concern about tumor recurrence, ovarian dysfunction caused by chemotherapy, long endocrine treatment cycle, lack of professional multidisciplinary cooperation team and so on. At present, there is limited data on fertility preservation before tumor treatment and successful pregnancy and delivery after treatment for young breast cancer patients. In order to successfully carry out the fertility preservation of young female breast cancer patients, strengthen their physical and mental health, promote the return of social roles and improve the health level of their offsprings, this article reviews the factors affecting fertility, the appropriate population for fertility preservation, and the impact on the prognosis of breast cancer, as well as the timing and methods of fertility preservation and recovery opportunities in young women with breast cancer.

Objective:To investigate the correlation between the degree of hepatic fibrosis and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke (AIS) and its predictive value.Methods:Patients with AIS received intravenous thrombolysis at Nanjing Jiangbei Hospital from January 2018 to March 2023 were retrospectively included. Hepatic fibrosis-4 index (FIB-4) was used to evaluate the degree of hepatic fibrosis in patients. FIB-4 ≥ 2.67 was defined as severe hepatic fibrosis. END was defined as an increase of ≥4 from baseline on the National Institutes of Health Stroke Scale (NIHSS) score within 24 h after intravenous thrombolysis. The relevant factors of END were analyzed through univariate analysis and multivariate logistic regression model. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of FIB-4 for END. Results:A total of 313 patients were included, of which 184 (58.8%) were male, aged 64.8±11.8 years old. The median baseline NIHSS score was 6 (interquartile range, 4-9), and the median FIB-4 was 1.76 (interquartile range, 1.28-2.56). Forty-five patients (14.4%) experienced END. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, higher FIB-4 was significantly independently correlated with END (odds ratio 2.121, 95% confidence interval 1.422-3.162; P=0.001). ROC curve analysis shows that FIB-4 has a good predictive value for END (the area under the curve 0.689, 95% confidence interval 0.595-0.784; P=0.001). The optimal cutoff value of FIB-4 was 1.82, and its sensitivity and specificity in predicting END were 71.1% and 54.9%, respectively. Conclusion:FIB-4 has good predictive value for END in patients with AIS after intravenous thrombolysis.

Cancer treatments may improve the long-term survival rate of young patients with breast cancer, but also lead to a decrease in fertility. With the younger incidence of breast cancer in China, the fertility needs of this group have received more attention, and fertility preservation technology suitable for cancer patients is developing continuously. However, there are still many problems in the implementation of fertility preservation for young breast cancer patients in China. Patients and breast surgeons have insufficient understanding and conservative attitudes towards fertility preservation technology. And there is a lack of reproductive experts in the treatment process. What′s more, the long-term follow-up and information management of patients undergoing fertility preservation are defective. In response to the above, this paper discusses how to deal with patients with potential reproductive needs in clinical practice from the perspective of breast surgeons. The first is to improve their own understanding of fertility preservation, such as the progress of relevant technologies and applicable population, when to intervene, when and how to get pregnant after cancer treatment. Secondly, education for patients must be strengthened, which should include not only fertility preservation, but also scientific contraceptive methods during cancer treatment and treatment measures for unexpected pregnancy. Finally, hospitals and relevant units should standardize the multidisciplinary team of breast cancer, and strengthen the comprehensive management of young breast cancer patients, thus to provide young breast cancer patients with more scientific cancer treatment programs and more reproductive opportunities.