Objective:To investigate the efficacy and safety of albumin-bound paclitaxel combined with epirubicin and cyclophosphamide in neoadjuvant chemotherapy for breast cancer.Methods:Clinicopathological data of 48 breast cancer patients who received neoadjuvant chemotherapy and surgery from August 2018 to November 2019 in Shaanxi Provincial Cancer Hospital were retrospectively analyzed. The primary endpoints were pathological complete remission (pCR) rate, objective response rate (ORR) and clinical benefit rate (CBR). The secondary endpoint was the adverse reactions of chemotherapy.Results:The incompletion rate of the protocol-specified courses in all patients was 10.4% (5/48). The pCR rate was 31.2% (15/48), the ORR was 87.5% (42/48), and the CBR was 95.8% (46/48). No statistic difference of pCR rate was obtained in subgroups of patients' age, clinical stage, histological grade, cN stage, and human epidermal growth factor receptor 2 (HER2) status (all P > 0.05), but it was higher in the Ki-67 high-expression group (Ki-67 positive index ≥30%) [46.7% (14/30) vs. 16.7% (3/18), χ2 = 4.427, P = 0.035]. Common adverse reactions which almost were grade 1-2 included leucopenia (93.8%, 45/48), neutropenia (93.8%, 45/48), arthralgia (27.1%, 13/48), fatigue (22.9%, 11/48), peripheral neuropathy (18.8%, 9/48), and nausea and vomiting (18.8%, 9/48). The overall incidence rate of grade 3-4 adverse reactions was 18.8% (9/48). Conclusion:The albumin-bound paclitaxel combined with epirubicin and cyclophosphamide can achieve high pCR rate in neoadjuvant chemotherapy for breast cancer, and the regimen is well tolerated.

Objective To analyze the characteristics on injuries,using data from the Jiangsu sentinel hospitals,from 2006 to 2013,to develop a injury prevention strategy.Methods Data was collected from the ‘National Injury Monitoring Report Card' of six sentinel hospitals from two surveillance points from 2006 to 2013.Results Information from 448 778 cases was analyzed.The numbers of male cases outnumbered the females,with sex ratio as 1.72:1.The top five causes of injuries were as follows:falls (27.21％),traffic-related (26.23％),blunt (17.50％),knife/sharp instrument (13.87％) and animal injury (6.59％).Injuries mainly occurred in June,July and August,at 8 to 10 O'clock in the morning.The major places where injuries occurred were road/street (31.58％),home (23.47％),industries and construction sites (21.38％).Recreation activities (36.12％),driving vehicle (25.26％),and at work (24.78％) were the major activities when injuries took place.Most injury cases were unintentional(92.65％) and deliberately(violence/attack) (6.36％).Conclusion All the injuries showed an yearly increase,from 2006 to 2013,with main causes as falls and traffic-related ones.Injuries among teenagers and the elderly should be paid special attention to,with targeted interventions taken.

Gallbladder cancer is a high malignancy which is predisposed to invade adjacent organs and have lymph node metastasis. Gallbladder cancer is not sensitive to radiotherapy or chemotherapy with the worst prognosis among biliary tract cancers. At present, radical resection is the only possible method to cure gallbladder cancer. However, there are still many controversies about the surgical strategies, the extent of liver resection and lymph node dissection, and the treatment of incidental gallbladder cancer. In addition, under the background of the great success of immunotherapy and targeted therapy in a variety of solid tumors, it is also a question worthy of further considerations that whether the status of surgery in the treatment of advanced gallbladder cancer will be changed in the near future.

Objective To understand the epidemiological characteristics of head injuries through data gathered from the Jiangsu Injury Surveillance System.Methods Data on head injury that occurred during 2006-2014 were collected from the Jiangsu injury surveillance system and analyzed by SPSS 19.0 software.Results From 2006 to 2014,data on 133 172 cases of head injuries were collected which accounting for 26.2％ (133 172/509 175) of all the injury cases.Among them,males were 2.18 times higher than the females.The top five leading causes of head injuries were falls 24.6％ (32 796/133 172),blunt force injuries 24.4％ (32 446/133 172),motor car accident injuries 20.3％ (26 993/133 172),knife or sharp force injuries 10.7％ (14 183/133 172) and non-motor car accident injuries 6.7％ (8 919/133 172).Main locations that head injuries occured would involve roads/ streets 32.5％ (43 262/133 172),working places 22.2％ (29 526/133 172),at home 20.5％ (27 925/ 133 172) and public residences 10.8％ (14 367/133 172).Recreation activates 37.9％ (50 479/133 172),driving 26.1％(34 749/133 172),paid jobs 24.8％ (33 034/133 172) were the three major activities related to head injuries.Severity of injuries would depend on the situations on site.As for minor injuries,bruise accounted for 63.5％ (67 929/106 912).Brain trauma 21.5％ (5 119/23 803) and fracture 14.9％ (3 554/23 803) appeared an increasing trend.Severe injuries would include brain trauma 74.6％ (1 833/2 457).78.8％ (104 940/133 172) of the patients with head injuries would go home after receiving treatment the hospital,with fetality only as 0.1％ (134/133 172).Conclusion Data from the Jiangsu surveillance program showed that Head injury appeared the highest proportion among all the body injuries that called for special attention.

OBJECTIVETo investigate the application value of the Overlap method in digestive tract reconstruction of totally laparoscopic left colectomy(TLLC) and its potential advantage.

METHODSThe retrospective cohort study was adopted. Clinicopathological data of 16 patients with left colon cancer who underwent TLLC and Overlap anastomosis between August 2016 and August 2017 at Tangdu Hospital were retrospectively collected as Overlap group. Twenty-one patients who underwent laparoscopic assisted left colectomy (LALC) between January 2015 and July 2016 at Tangdu Hospital were used as control (traditional group). The intraoperative and postoperative data were compared between the two groups. During digestive tract reconstruction in the Overlap group, the proximal colon and distal colon were lined up side by side; a side-to-side anastomosis was conducted on colic band with a 60 mm linear stapler; and the common entry hole was closed using running suture. While in traditional group, the bowel was pulled out of abdominal wall through the assisted incision; the sample was resected and a proximal and distal end-to-end anastomosis was performed.

RESULTSIn Overlap group, 10 cases were male and 6 cases were female, with a mean age of (66.4±4.8) years and a BMI of (23.6±2.3) kg/m; the tumor located in distal transverse colon in 1 case, in splenic flexure in 2 cases, in descending colon in 4 cases, in upper sigmoid colon in 9 cases. TLLC was successfully completed in all the cases without conversion to laparotomy. In traditional group, 12 cases were male and 9 cases were female, with mean age of (65.9±5.8) years and BMI of (22.7±2.8) kg/m; the tumor located in the distal transverse colon in 1 case, in the splenic flexure in 3 cases, in the descending colon in 6 cases, in the upper sigmoid colon in 11 cases. No statistically significant differences in baseline data were found between the two groups (all P>0.05). Compared to the traditional group, the total operation time was shorter [(143.4±11.1) minutes vs. (166.4±16.5) minutes, t=4.792, P=0.000], the anastomosis time was prolonged [(44.3±3.3) minutes vs. (22.4±3.0) minutes, t=-20.948, P=0.000], the amount of bleeding was reduced [(46.6±13.6) ml vs. (70.5±20.0) ml, t=4.106, P=0.000], and the incision length was shorter [(3.9±0.9) cm vs. (6.7±1.3) cm, t=7.056, P=0.000] in the Overlap group. There were no significant differences in lymph nodes harvested (17.3±2.9 vs. 15.5±3.0), time to flatus [(2.8±1.3) days vs. (2.6±1.0)days], postoperative complications [6.2%(1/16) vs. 9.5%(2/21)] and postoperative hospitalization [(4.6±1.4) days vs.(4.7±1.2) days] between the two groups (all P>0.05).

CONCLUSIONThe Overlap reconstruction method in totally laparoscopic left colectomy is a safe and feasible procedure, and provides less injury and better cosmetic outcome of abdominal wall.

Aged ; Colectomy ; Colonic Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; Laparotomy ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Retrospective Studies ; Treatment Outcome

Objective:To analyze the gene variants in patients with primary distal renal tubular acidosis (dRTA), and explore the correlation between the genotype and phenotype.Methods:The Sanger direct sequencing or whole-exome sequencing was used to identify causal variants and the variation pathogenicity was evaluated according to 2015 American College of Medical Genetics and Genomics (ACMG) standards and guidelines in 44 dRTA patients (37 families) diagnosed in the Affiliated Qingdao Municipal Hospital of Qingdao University and the Affiliated Hospital of Qingdao University from April 2010 to September 2020. The clinical features of the patients were summarized, and the correlation between the genotype and phenotype was investigated.Results:Seven variants of SLC4A1 gene, 17 variants of ATP6V0A4 gene, and 15 variants of ATP6V1B1 gene were identified in 44 patients with dRTA, and of which 11 variants were new ones. According to ACMG guidelines, the pathogenic, likely pathogenic, benign variants among the 39 variants were 22, 16 and 1, respectively. Nine patients were autosomal dominant hereditary dRTA caused by SLC4A1 gene mutation, 4 patients with autosomal recessive hereditary dRTA complicated with Southeast Asian ovalocytosis and anemia were caused by SLC4A1 gene mutation, and 14 patients caused by ATP6V0A4 gene mutation and 8 patients caused by ATP6V1B1 gene mutation were autosomal recessive hereditary dRTA; Two children with dRTA were found to carry one monoallelic defect in ATP6V1B1, and no causal gene mutation was identified in 7 patients. One patient showed incomplete dRTA, and the other 43 patients showed complete dRTA. The prevalence of sensory neural hearing loss caused by ATP6V0A4 and ATP6V1B1 mutation were 2/14 and 6/10 respectively. The frequency of chronic kidney disease in adults, children and infants were 4/4, 2/4, and 1/36, separately. After the drug treatment based on potassium citrate and sodium citrate, the growth and development (28/40) and electrolyte disturbance (41/44) of most patients were significantly improved. Conclusions:The present study has identified 39 variants of SLC4A1, ATP6V0A4 and ATP6V1B1 genes in 44 patients with dRTA, including 11 novel ones. There is a close relationship between genotype and phenotype in dRTA patients and most patients' conditions were improved after proper treatment. This study enriches the human gene mutation database and provides valuable references for diagnosis, treatment and genetic counseling in patients with dRTA.

Objective: To identify and analyze the variants of the KCNJ1 gene in five Chinese patients with Bartter syndrome type 2 (BS2), and to describe their clinical features as well as treatment results. Methods: Data and blood samples of five BS2 patients and their relatives confirmed by Qingdao Municipal Hospital from June 2012 to January 2019 were collected. Whole-exome-sequencing (WES) based on the second generation high throughput sequencing was performed to detect variants. The 2015 American College of Medical Genetics and Genomics Standards and Guidelines were applied to analyze the pathogenicity of the variants. The clinical features and laboratory results were retrospectively studied. The response to treatment and follow-up data were reviewed. Results: Ten variants including six novel ones of KCNJ1 gene were identified through WES and verified by Sanger dideoxy sequencing. Missense variants accounted for the highest proportion. The common symptoms and signs of five BS2 patients from high to low incidence were polydipsia and polyuria (5/5), one of them (1/5) presented with diabetes insipidus; maternal polyhydramnios and premature delivery (4/5); growth retardation (3/5). Initially, two patients presented with hypochloremic metabolic alkalosis and hypokalemia, whereas the acid-base disturbance was absent in the others. One patient experienced hyperkalemia. In terms of calcium-phosphorus metabolism, one patient had evident parathyroid hormone (PTH) resistance (hypocalcemia, hyperphosphatemia and markedly elevated serum intact PTH levels), three presented with PTH overacting (hypercalcemia, hypophosphatemia and mild elevated serum intact PTH levels), and one showed normal blood calcium and phosphorus concentrations with high-normal serum intact PTH levels. All patients had nephrocalcinosis or hypercalciuria, and one of them complicated with nephrolithiasis. Indomethacin helped to correct the growth retardation, halt polydipsia polyuria, decrease the elevated urinary calcium excretion, and normalize electrolyte disturbance as well as PTH parameters in some patients. Conclusions This investigation identifies ten variants of KCNJ1 gene, including six ones that have not been previously reported, which will enrich the human gene mutation database (HGMD). These patients in our study have atypical BS phenotype, so that careful differentiation from other parathyroid diseases will be required for clinicians.