A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.

The occurrence and development of breast cancer depend on the reciprocal effects between breast cancer cells and tumor microenvironment. Adipocytes are not only the component of breast interstitial cells, but also an important part of the tumor microenvironment in breast cancer. Among them, cancer-associated adipocytes, which are located at the invasive front of breast cancer, participate in the progression and metastasis of breast cancer by secreting multiple active factors and related mechanisms. The authors made a brief review on the mechanisms related to the development and therapeutic effects of adipocytes on breast cancer.

Objective:The study was to explore the nipple-areola complex(NAC) blood supply model in Chinese breasts based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and to provide the blood supply knowledge for mammaplasty.Methods:Breast DCE-MRI images of breasts without masses in 245 patients from March 2012 to October 2019 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology were included retrospectively. The breast vessels images were obtained by image subtraction in the Siemens workstation. Axial, coronal and sagittal maximum intensity projection(MIP) images were evaluated, and all vessels supplying the nipple-areola complex were identified by 3D MIP images. Blood supply to the NAC was classified into 9 zones, and vessels of each zone were counted and analyzed. The maximum distance from the vessel to the skin surface of the breast was measured. SPSS 19.0 software was used for statistical analysis. The chi-square test was used to check for significant differences in the distribution of zones between the left breasts and the right breasts. The mean, standard deviation and 95% confidence interval of the distance between vessels and skin were calculated. Using ANOVA to compare the distance between vessels and skin of zones. P<0.05 was statistically significant. Results:There were 490 breasts in 245 DCE-MRI images, of which 97 breasts were found to have masses in 97 DCE-MRI images. The remaining 393 were normal breasts as study subjects. The patients’ ages ranged from 23 to 72 years, with a mean of 43.7 years. 637 source vessels (311 left, 326 right) were identified in 393 breasts (200 left, 193 right). Of the 637 vessels, 269 (42.2%) were in the superomedial zone and 180 (28.3%) were in the superolateral zone. The proportions of vessels in zone medial (57, 8.9%), inferior (37, 5.8%), central (30, 4.7%), inferomedial (25, 3.9%), inferolateral (25, 3.9%), superior (11, 1.7%) and lateral (3, 0.5%) were less than 10%, respectively. The chi-square test showed no significant difference in the distribution of zones ( χ2 =6.4, P=0.602) between the left breasts and the right breasts. Except for the central zone, the mean of maximum distance from the vessels to the skin surface was 0.91 cm, with a 95% confidence interval of 0.86 cm to 0.96 cm. Conclusions:DCE-MRI can clearly show the blood supply to the NAC. Superomedial or superolateral source vessels supplying the NAC were predominant, and the vessels run at a subcutaneous depth of about 1 cm.

The occurrence and development of breast cancer depend on the reciprocal effects between breast cancer cells and tumor microenvironment. Adipocytes are not only the component of breast interstitial cells, but also an important part of the tumor microenvironment in breast cancer. Among them, cancer-associated adipocytes, which are located at the invasive front of breast cancer, participate in the progression and metastasis of breast cancer by secreting multiple active factors and related mechanisms. The authors made a brief review on the mechanisms related to the development and therapeutic effects of adipocytes on breast cancer.

Objective:To use three-dimensional (3D) scanning to measure the preoperative and postoperative nasal parameters of the patients received rhinoplasty with ear cartilage and silicone prosthesis, and to evaluate the clinical effect of the surgery.Methods:Sixteen female patients with an average age of 28.3 years, ranged from 21 to 35 years, received rhinoplasty with ear cartilage and silicone prosthesis in Wuhan Tongji Hospital from June 2018 to February 2019. Preoperative and postoperative 3D scanning was performed to measure nasal parameters, including linear length, angle, and proportional index.Results:All patients were satisfied with the postoperative outcomes. The postoperative nasal length, nasal height, and nasal depth increased significantly, and the postoperative nasal width and nasal tip width decreased. The postoperative nasolabial angle and nasofrontal angle were statistically improved, while the preoperative and postoperative data of columellar facial angle, nasal tip angle, and nasal column-lobular angle were not significantly different. The ratios of nasal depth and nasal width, nasal index and nasal tip protrusion were improved after surgery, while the postoperative ratios of nasal columella and nasal lobules length were not statistically improved.Conclusions:The 3D scanning allows for comprehensive and accurate measurement of the nasal parameters. The rhinoplasty with ear cartilage and silicone prosthesis is more effective in improving the overall contour of the nose, but less effective in improving the aesthetics of the nasal tip.

Objective:The study was to explore the nipple-areola complex(NAC) blood supply model in Chinese breasts based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and to provide the blood supply knowledge for mammaplasty.Methods:Breast DCE-MRI images of breasts without masses in 245 patients from March 2012 to October 2019 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology were included retrospectively. The breast vessels images were obtained by image subtraction in the Siemens workstation. Axial, coronal and sagittal maximum intensity projection(MIP) images were evaluated, and all vessels supplying the nipple-areola complex were identified by 3D MIP images. Blood supply to the NAC was classified into 9 zones, and vessels of each zone were counted and analyzed. The maximum distance from the vessel to the skin surface of the breast was measured. SPSS 19.0 software was used for statistical analysis. The chi-square test was used to check for significant differences in the distribution of zones between the left breasts and the right breasts. The mean, standard deviation and 95% confidence interval of the distance between vessels and skin were calculated. Using ANOVA to compare the distance between vessels and skin of zones. P<0.05 was statistically significant. Results:There were 490 breasts in 245 DCE-MRI images, of which 97 breasts were found to have masses in 97 DCE-MRI images. The remaining 393 were normal breasts as study subjects. The patients’ ages ranged from 23 to 72 years, with a mean of 43.7 years. 637 source vessels (311 left, 326 right) were identified in 393 breasts (200 left, 193 right). Of the 637 vessels, 269 (42.2%) were in the superomedial zone and 180 (28.3%) were in the superolateral zone. The proportions of vessels in zone medial (57, 8.9%), inferior (37, 5.8%), central (30, 4.7%), inferomedial (25, 3.9%), inferolateral (25, 3.9%), superior (11, 1.7%) and lateral (3, 0.5%) were less than 10%, respectively. The chi-square test showed no significant difference in the distribution of zones ( χ2 =6.4, P=0.602) between the left breasts and the right breasts. Except for the central zone, the mean of maximum distance from the vessels to the skin surface was 0.91 cm, with a 95% confidence interval of 0.86 cm to 0.96 cm. Conclusions:DCE-MRI can clearly show the blood supply to the NAC. Superomedial or superolateral source vessels supplying the NAC were predominant, and the vessels run at a subcutaneous depth of about 1 cm.

Objective:This study aimed to explore the use of magnetic resonance imaging (MRI) to measure breast volume and gland volume to guide reconstruction of breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy (NSM).Methods:According to the inclusion criteria, the breast cancer patients admitted to Wuhan Tongji Hospital from September 2018 to June 2019 were selected to undergo breast reconstruction with prosthesis after NSM. Preoperative MRI were used to measure distance from the tumor to the nipple-areola complex and the skin, and estimate the volume of breast and mammary gland. The data of breast volume measured by MRI, gland volume measured by MRI, volume of prosthesis and specimen weight were compared. The data were analyzed using Prism 8.0 software. The paired student t-test was used to compare the difference of two groups. P< 0.05 was considered statistically significant. Linear regression models were used to obtain coefficient of determination ( R2), and R2>0.8 was considered statistically significant. Results:A total of 15 breast cancer patients, aged 28-45 years, with a mean of 35.5 years, were included. There were 13 cases unilateral and 2 cases bilateral. The clinical stages of stage 0, Ⅰ and Ⅱ were 8, 5 and 2 patients, respectively. The average distance o from tumor to nipple-areola complex was (3.1±0.8) cm. One patient suffered postoperative bleeding and was promptly reoperated through the original incision, and the patient recovered well after surgery. All patients felt sensory disturbance of the nipple and areola. There was no complication such as infection, seroma, capsular contracture, prosthesis rupture, and prosthesis shift. At 4-12 months postoperative follow-up, all breasts were basically symmetrical and no tumor recurrence or metastasis occurred, which satisfied the patients. The mean values of the volume of prosthesis, specimen weight, breast volume measured by MRI and gland volume measured by MRI were (471.10±45.60) ml, (244.60±29.14) ml, (243.60±31.16) g, (244.30±16.63) ml. There was significant difference between the breast volume measured by MRI and the specimen weight ( t=10.37, P<0.001), while no statistical difference was found between gland volume measured by MRI and specimen weight ( t=0.20, P=0.847). Similarly, there was significant difference between the breast volume measured by MRI and the volume of prosthesis ( t=5.19, P<0.001), while no statistical difference was found between gland volume measured by MRI and the volume of prosthesis ( t=1.74, P=0.104). The coefficient of determination between gland volume measured by MRI and specimen weight ( R2=0.98) was higher than that of breast volume measured by MRI ( R2=0.82). Similarly, the coefficient of determination between gland volume measured by MRI and the volume of prosthesis ( R2=0.71) was higher than that of breast volume measured by MRI ( R2=0.54). Conclusions:Preoperative MRI can provide guidance to breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy in breast cancer. The gland volume measured by MRI is closer to the specimen weight and the volume of prosthesis than the breast volume measured by MRI.

Objective:This article explores the treatment of stage I thoracoscopic segmentectomy and lobectomy. The clinical efficacy of non-small cell lung cancer is to provide relevant evidence for clinical decision-making.Method:Computer searches were conducted on PubMed, the Cochrane Library, Embase, Web of Science, Science Direct, Ovid Medline, Scopus database, and Google Scholar. The search time was from the establishment of the library to March 2019. A comparative study of thoracic segmental resection and lobectomy for clinical stage I NSCLC was performed and meta-analysis was performed using Revman 5.3 software.Restlus:A total of 16 retrospective clinical controlled studies were included in the study, with a total of 2 090 patients, including 696 in the thoracoscopic segmental resection group and 1 394 in the thoracoscopic lobectomy group. Meta-analysis showed that for clinical stage Ⅰ NSCLC, the incidence of complications after laparoscopic resection and lobectomy( RR=0.78, 95% CI: 0.59-1.02, P=0.07), postoperative recurrence rate( RR=0.78, 95% CI: 0.52-1.17, P=0.23), postoperative hospital stay( MD=-0.27, 95% CI: -0.58 to -0.05, P=0.10) and 5-year survival rate( RR=0.94, 95% CI: 0.87-1.03, P=0.17), tumor-free survival time( RR=0.95, 95% CI: 0.92-1.09, P=0.34), operation time( MD=-0.43, 95% CI: -10.10-9.25, P=0.93) The difference was not statistically significant, but laparoscopic lung segmentectomy can reduce intraoperative blood loss( MD=-23.81, 95% CI: -42.00 to -5.63, P=0.01), shortening Posterior chest tube drainage time( MD=-0.31, 95% CI: -0.51 to -0.12, P=0.002), but in the lymph node dissection, the segmentectomy was less than the lobectomy, the number of lymph node dissection( MD=-4.89, 95% CI: -7.57 to -2.20, P=0.0004). Percentage of postoperative/preoperative FVC%( MD=7.50, 95% CI: 5.81-9.18, P<0.00001) and 1-year postoperative/preoperative FEV1%( MD=8.26, 95% CI: 6.43-10.09, P<0.00001). The difference was statistically significant. Conclusion:In The course of clinical stage I NSCLC treatment, the two procedures were similar in terms of postoperative complications, operation time, recurrence rate, 5-year survival rate, tumor-free survival time and hospital stay, and fewer lung segments in lymph node dissection. In lobectomy, thoracoscopic segmental resection is better in terms of intraoperative blood loss and postoperative chest drainage time. Thoracoscopic segmentectomy may be more suitable for early stage non-small cell lung cancer. treatment method.

Pre-testing preparation is the basis and starting point of genetic testing.The process includes collection of clinical information,formulation of testing scheme,genetic counseling before testing,and completion of informed consent and testing authorization.To effectively identify genetic diseases in clinics can greatly improve the diagnostic rate of next generation sequencing (NGS),thereby reducing medical cost and improving clinical efficacy.The analysis of NGS results relies,to a large extent,on the understanding of genotype-phenotype correlations,therefore it is particularly important to collect and evaluate clinical phenotypes and describe them in uniform standard terms.Different types of genetic diseases or mutations may require specific testing techniques,which can yield twice the result with half the effort.Pre-testing genetic counseling can help patients and their families to understand the significance of relevant genetic testing,formulate individualized testing strategies,and lay a foundation for follow-up.

With high accuracy and precision,next generation sequencing (NGS) has provided a powerful tool for clinical testing of genetic diseases.To follow a standardized experimental procedure is the prerequisite to obtain stable,reliable,and effective NGS data for the assistance of diagnosis and/or screening of genetic diseases.At a conference of genetic testing industry held in Shanghai,May 2019,physicians engaged in the diagnosis and treatment of genetic diseases,experts engaged in clinical laboratory testing of genetic diseases and experts from third-party genetic testing companies have fully discussed the standardization of NGS procedures for the testing of genetic diseases.Experts from different backgrounds have provided opinions for the operation and implementation of NGS testing procedures including sample collection,reception,preservation,library construction,sequencing and data quality control.Based on the discussion,a consensus on the standardization of the testing procedures in NGS laboratories is developed with the aim to standardize NGS testing and accelerate implementation of NGS in clinical settings across China.