Objective To compare the efficacy and safety of trastuzumab versus the combination of tras-tuzumab and lapatinib added to neoadjuvant chemotherapy in HER2-positive breast cancer. Methods We searched PubMed,MEDLINE,The Cochrane Library,Web of Science,CNKI,Wanfang datebase and the abstracts of major international conferences in recent 5 years to identify randomized controlled trials which met the inclusion and exclusion criteria. Study selection and analyses were undertaken according to the Cochrane Hand-book. Meta-analysis was performed using RevMan 5. 0 software. Results Four trials were identified with 779 eli-gible patients. The results of meta-analyses showed that the rate of pathological complete response was significant-ly higher in the group receiving rastuzumab and tlapatinib than that in the group with trastuzumab alone(53. 3%vs 38. 8% ,RR =1. 39,95 % CI:1. 20-1. 63;P < 0. 001). No statistical differences were observed in regarding adverse events among patients receiving trastuzumab or the combination of trastuzumab and lapatinib,except the grade Ⅲ-Ⅳ diarrhea(2. 2% vs 25. 6% ,RR =11. 54,95% CI:5. 69-23. 41;P <0. 001). Conclusion The com-bination of trastuzumab and lapatinib added to neoadjuvant chemotherapy in HER2-positive breast cancer is more effective,without more adverse reactions except diarrhea;it ia an effective and safe treatment.

Objective To investigate the clinical efficacy and safety of hyperthermic intraperitoneal perfusion chemotherapy (HIPC) in treatment of advanced colorectal cancer.Methods The Meta-analysis was applied to analyze 8 randomized controlled quantitative studies published at domestic and abroad.These patients treated by HIPC after radical operation with colorectal cancer were included for the treatment group,and those treated only by radical operation with colorectal cancer for the control group.Relative risk (RR) of outcome variable of 3-year and 5-year survival rate and safety between the two groups were compared.Results There were 8 selected literatures,including 1 501 cases,in which 765 cases for treatment group,and 736 cases for control group.RR of 5-year survival rate of the total patients was 2.39 (95% CI:1.66-3.45).RR of 3-year survival rate of the total patients was 2.13 (95% CI:1.45-3.13).The results demonstrated that HIPC could improve 5-year and 3-year survival rate,and sensitivity analysis confirmed the conclusions more reliable.The security was described in 5 literatures,the available information showed smaller potential security issue.Conclusions HIPC after radical operation of advanced colorectal cancer can increase 5-year and 3-year survival rate of patients,improve the prognosis of patients.Whether patients with increased incidence of postoperative complications related to the HIPC is no clear-cut conclusions for lack of related research.

Objective To evaluate laparoscopic continuous circulatory hyperthermic intraperitoneal chemotherapy (CHIPC) in the treatment of malignant ascites from peritoneal carcinomatosis.Methods From March 2006 to March 2008, 21 patients of malignant ascites secondary to peritoneal carcinomatosis received CHIPC with three courses of treatment for each patient. The first course was performed in operation room under general anesthesia, the second and third were performed in patients ward or intensive care unit (ICU), NS solution of mitomycin-C and cisplatin was delivered by continuous circulatary perfusion into peritoneal cavity at a rate of 500 ml/min for 90 min with an inflow temperature of 43 degrees C. Results Intraoperative course was uneventful in all cases, and mean operative time was (80 ± 18) min. There was no postoperative deaths and severe complications. After treatment patients KPS KPS (Karnofsky,KPS)grades rose from 10-40, with an average rise of (22.2 ± 2.4) (P ＜ 0.01). After laparoscopic CHIPC, clinical complete regression of ascites and related symptoms was achieved in 19 patients, and partial remission achieved in 2 patients. Follow-up was made to all patients until the death which occurred at post laparoscope-assisted CHIPC 1 - 9 months, with a median survival time of 6 months.Two patients who underwent partial remission suffered from port site seeding and tumor metastasis leading to death after treatment at 1 and 2 months respectively. Conclusions Laparoscopy-assisted CHIPC is effective for the treatment of malignant ascites from inoperable peritoneal carcinomatosis and improves the quality of life of these patients.

Objective To investigate the safety of the laparoscopic pancreaticoduodenectomy (LPD) in 70 years of age or older patients.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients (age ≥70 years old) who underwent pancreaticoduodenectomy in the West China Hospital of Sichuan University between January 2012 and December 2016 were collected.Twenty patients undergoing LPD were allocated into the LPD group,and 20 receiving open pancreaticoduodenectomy (OPD) who were selected by random number table during the same period were allocated into the OPD group.Observation indicators included:(1) intraoperative situations;(2) postoperative situations;(3) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival after discharge and tumor recurrence and metastasis up to March 2017.Measurement data with normal distribution was represented as x±s,and comparison between groups were evaluated with the t test.Measurement data with skewed distribution were described as median (range) and comparison between groups was analyzed using the nonparametric test.Comparison of count data was analyzed using the chi-square test.Comparison of ranked data was analyzed by non parametric test.Results (1) Intraoperative situations:1 patient in the LPD group was converted to open surgery,with a conversive rate of 5.0％ (1/20).Operative time and volume of intraoperative blood loss were (463 ± 10) minutes,210.5 mL (152.5-300.0 mL) in the LPD group and (332± 25) minutes,420.0 mL (350.1-493.8 mL) in the OPD group,showing statistically significant differences between the 2 groups (t =5.48,Z =-3.98,P＜0.05).Cases with intraoperative blood transfusion and pylorus preservation were respectively 4,14 in the LPD group and 6,10 in the OPD group,showing no statistically significant difference between the 2 groups (x2=0.53,1.67,P＞0.05).The results of intraoperative rapid frozen pathological examination showed negative margin of the 40 patients.(2) Postoperative situations:cases in ICU,cases with postoperative analgesia,time for out-of-bed activity,time to anal exsufflation and time for intake were 17,7,(2.2±0.7)days,(4.2± 0.9)days,(4.8±0.7)days in the LPD group and 6,15,(3.6±0.8)days,(5.7±0.9)days,(7.1 ± 2.7)days in the OPD group,showing statistically significant differences between the 2 groups (x2 =12.34,6.47,t=-6.18,-6.55,-3.65,P＜0.05).Pancreatic fistula,delayed gastric emptying (Grade B),postoperative bleeding (Grade B),biliary fistula,pulmonary infection,intestinal obstruction,wound infection,reoperation and major complication were respectively detected in 2,3,1,1,3,1,0,2,3 patients of the LPD group and 2,4,1,1,4,1,2,3,4 in patients of the OPD group,showing no statistically significant difference between the 2 groups (x2 =0.00,0.17,0.00,0.00,0.17,0.00,2.11,0.23,0.17,P＞0.05).Results of postoperative pathological examination showed that duodenal adenocarcinoma,ampullary carcinoma,lower bile duct carcinoma,pancreatic ductal adenocarcinoma and pancreatic cystic tumor were respectively detected in 8,2,5,3,2 patients of the LPD group and 10,2,4,2,2 patients of the OPD group,showing no statistically significant difference between the 2 groups (x2 =0.53,P＞0.05).Duration of postoperative hospital stay in the LPD and OPD groups were (19± 13) days and (15±7) days,respectively,showing no statistically significant difference between the 2 groups (t =1.28,P＞ 0.05).Results of postoperative oncology showed that tumor diameter,number of lymph node dissected,number of positive lymph nodes,cases with negative margin,cases in T1N0M0,T2N0M0,T3N0M0,T3N1M0,T4N0M0,T4N1M0 of TNM staging were respectively (2.4±0.7)cm,15.4±2.3,2,20,2,7,8,2,1,0 in the LPD group and (2.8±0.9)cm,14.4±2.5,3,20,1,8,5,2,3,1 in the OPD group,with no statistically significant difference between the 2 groups (t =-1.64,1.32,x2 =0.23,0.00,Z =-0.69,P＞ 0.05).(3) Follow-up situation:1 patient died respectively in both groups within the postoperative 30 days.Thirty-eight patients were followed up for 1-26 months,with a median time of 14 months.During follow-up,2 patients had tumor recurrence and 1 died of myocardial infarction in the LPD group;3 had tumor recurrence and 1 died of tumor recurrence in the OPD group.Conclusion LPD in 70 years of age or older patients is not only safe and feasible,but also significantly reduce volume of intraoperative blood loss and demand of analgesia,as well as quickly resume normal diet and activities.

Objective:To investigate the clinical effect of perforated kirschner wire tension band in the treatment of olecranon fractures in adults.Methods:A retrospective case-control study was conducted on 56 adult patients with olecranon fractures admitted in Ningbo NO.6 Hospital from May 2013 to February 2017. The perforated Kirschner wire tension band fixation was used in Group A ( n=24), while the common Kirschner wire tension band fixation was used in Group B ( n=32). Group A was composed of 16 males and 8 females at age of (34.0±12.1)years, and Group B was composed of 19 males and 13 females at age of (36.5±11.4)years. According to the Mayo classification, there were 7 patients with type I and 17 with type II in Group A, 15 with type I and 17 with type II in Group B. The operation time, bleeding volume, X transmission times, postoperative visual analogue score (VAS), fracture union time, loosening or failure of internal fixation, skin irritation and elbow joint function Broberg-Morrey score were compared between the two groups. Results:All patients were followed up for 15-21 months (mean, 18 months). In Group A, the operation time, bleeding volume, Xray transmission times, fracture union time and skin irritation were (79.6±22.5)minutes, (111.3±26.2)ml, (7.2±2.2)times, (3.7±0.6)months, 1 case, respectively. In Group B, the operation time, intraoperative hemorrhage, transmission times, fracture healing time and skin irritation were (94.3±27.5)minutes, (152.0±31.4)ml, (11.0±3.4)times, (4. 7±2.2)months, 9 cases, respectively. The difference between the two groups were all significant ( P<0.05). There were no significant difference in VAS, failure of internal fixation and elbow function Broberg-Morrey score between the two groups ( P>0.05). Conclusions:Compared with the anatomic plate, the perforated Kirschner wire tension band in the treatment of adult patients with olecranon fractures cannot only reduce the operation time and transmission times, reduce the intraoperative bleeding volume, but also shorten the fracture union time and avoid the occurrence of skin irritation and other complications.

Objective:To compare 3 internal fixation methods for the treatment of distal femoral fractures of Müller types C2 and C3.Methods:The clinical data of 58 patients were retrospectively analyzed who had been treated for distal femoral fractures of Müller types C2 and C3 at Department of Orthopaedic Trauma, Ningbo No. 6 Hospital from February 2013 to February 2017. They were divided into 3 groups according to the internal fixation method they had used. In the single incision locking plate group (group A) of 21 cases, there were 13 males and 8 females with an age of 50.6 years±12.9 years. In the double-incision locking plate combined with reconstruction plate group (group B) of 18 cases, there were 11 males and 7 females with an age of 53.5 years±13.0 years. In the single incision locking plate combined with reconstruction plate group(group C) of 19 cases, there were 10 males and 9 females with an age of 48.1 years±12.2 years. The 3 groups were compared in terms of operation time, intraoperative blood loss, intraoperative C-arm fluoroscopy, fracture healing time, incidence of postoperative complications, range of motion of the knee and knee functional recovery.Results:The 3 groups were compatible because there were no significant differences between them in their preoperative general data ( P>0.05). There were no significant differences between groups in the frequency of C-arm fluoroscopy, follow-up time, or incidence of postoperative complications ( P>0.05). The operation time in groups A and C (96.7 min±16.4 min and 101.9 min±16.5 min) and intraoperative blood loss for groups A and C (237.8 mL±47.5 mL and 253.6 mL±46.6 mL) were significantly less than in group B (114.9 min±20.1 min and 290.1 mL±60.9 mL) ( P<0.05); the fracture healing time for groups B and C (6.9 months±1.6 months and 6.6 months±1.7 months) was significantly shorter than for group A (8.4 months±1.9 months) ( P<0.05); the ranges of knee motion 12 months after operation in groups B and C (91.7°±16.7° and 90.9°±14.4°) were significantly larger than that in group A (78.8°±14.4°) ( P<0.05); the excellent and good rates of knee function 12 months after operation in groups B and C [77.8% (14/18) and 73.7% (14/19)] were significantly higher than that in group A [57.1%(12/21)] ( P<0.05). Conclusion:In the treatment of distal femoral fractures of Müller types C2 and C3, application of lateral locking plate and additional anterior locking reconstruction plate via the anterolateral incision at the distal femur can achieve rigid fixation without much damage to the surrounding soft tissues and lead to fine functional recovery of the knee joint because it has the advantages of single incision locking plate and double incision medial and lateral locking plates.

Objective To investigate the role of network platform for treatment and rescue of acute and severe cerebrovascular diseases in improving treatment level of patients with acute ischemic stroke.Methods The differences of number of patients accepted venous thrombolysis, number of patients accepted emergency intravascular interventional treatment, and time from admission to intravenous thrombolysis (door to needle time [DNT]) were analyzed in patients with acute ischemic stroke admitted to our hospital in the first year (2016) and the second and third years (2017 and 2018) of construction of network platform for treatment and rescue of acute and severe cerebrovascular diseases in Yunfu city. The National Institutes of Health Stroke Scale (NIHSS) scores were compared in 120 patients selected randomly from online referral (study group,n=60) and non-online referral (control group,n=60) within the same time periods in 2018.Results In 2017 and 2018, the number of patients accepted intravenous thrombolysis was 85 and 103, respectively, and the rate of intravenous thrombolysis was 9.92％ and 9.83％; they were all significantly larger/higher than those in 2016 (n=50, 6.97％,P<0.05). In 2017 and 2018, the number of patients accepted emergency endovascular treatment was 56 and 129, respectively, and the emergency endovascular treatment rate was 6.53％ and 12.31％; they were all higher than those in 2016 (n=44 and 6.14％), and the differences between those in 2018 and 2016 were statistically significant (P<0.05). The DNT ([82.00±18.75] min in 2017 and [77.00±32.17] min in 2018) was significantly shorter than that in 2016 ([109.00±30.58] min,P<0.05). The NIHSS scores of the study group and control group were 4.70±3.64 and 8.90±5.62, respectively, after one week of treatment, both of which were lower than those before treatment (14.30±6.29 and 13.60±6.37); and after treatment, the NIHSS scores of the treatment group were statistically lower than those of the control group (P<0.05). Conclusion Construction and effective operation of network platform for treatment and rescue of acute and severe cerebrovascular diseases is an effective guarantee to improve the success rate of treatment for patients with acute ischemic stroke.

Objective:To investigate the difference in the radiation sensitivity of hematopoietic stem and progenitor cells (HSPCs) derived from fetal liver and bone marrow.Methods:HSPCs from fetal liver of 14.5 d embryo or bone marrow of 8 week-old mice were isolated to receive a single dose of 5 or 10 Gy irradiation in vitro using a 60Co irradiator. Twelve hours later, the cell apoptosis, mitochondrial reactive oxygen species (ROS) level, colony formation ability and DNA damage in HSPCs were detected. Freshly isolated HSPCs were injected into lethally irradiated CD45.1 + C57BL/6J mice (4.5 Gy+ 5 Gy with an interval of 30 min) Chimerism rate, lineage constitution, and cell cycle were analyzed 12 weeks after transplantation. Results:Compared with bone marrow HSPCs after irradiation, the percentage of apoptosis in fetal liver HSPCs was significantly higher ( t=16.21, 12.27, P<0.05), the level of ROS was dramatically elevated ( t=68.72, 18.89, P<0.05). At 10 Gy, fetal liver HSPCs could not form colonies at all ( t=12.41, 15.67, 9.46, P<0.05). γ-H2AX immunofluorescence staining showed that the DNA damage of fetal liver HSPCs was more severe after irradiation, and the number of Foci formed was significantly higher than that of bone marrow HSPCs ( t=2.27, 2.03, P< 0.05), which indicated that fetal liver HSPCs were more sensitive to radiation. The chimerism rate of transplanted fetal liver HSPCs was lower than that of bone marrow cells ( t=5.84, P<0.05) with a higher proportion of myeloid lineage, suggesting that fetal liver HSPCs had lower in vivo reconstitution capacity than bone marrow HSPCs and were more prone to myeloid differentiation. The cell cycle of bone marrow HSPCs from transplanted chimeric mice was examined, and the proportion of S-phase was significantly higher in the fetal liver group than that in the bone marrow group ( t=2.89, P<0.05). Mitochondrial stress results showed that fetal liver HSPCs had higher basal respiratory capacity ( t=39.19, P<0.05), proton leakage ( t=6.64, P<0.05), ATP production ( t=9.33, P<0.05), and coupling efficiency ( t=7.10, P<0.05) than bone marrow c-Kit + cells, while respiratory reserve capacity ( t=5.53, P< 0.05) was lower than that of bone marrow c-Kit + cells. Conclusions:HSPCs derived from fetal liver display higher radiosensitivty compared with bone marrow HSPCs, laying the foundation for an in-depth illustration of the effects of radiation on hematopoietic stem cells at different developmental stages.

Objective:To investigate the efficacy of the posterior axillary approach combined with the deltoid pectoralis major approach in the treatment of proximal humeral fracture combined with lower glenoid fracture.Methods:From July 2019 to September 2021, 7 patients were treated at Department of Traumatic Othopeadics, The Sixth Hospital of Ningbo for proximal humeral fracture combined with lower glenoid fracture by internal fixation via the posterior axillary approach combined with the deltoid pectoralis major approach. They were 2 males and 5 females, aged from 51 to 78 years (average, 62.9 years). All fractures were closed ones. According to the Neer classification for the proximal humeral fractures, there were one case of type Ⅱ, one case of type Ⅲ, 3 cases of type Ⅳ and 2 cases of type Ⅵ. According to the Ideberg classification for the glenoid fractures, 5 cases were type Ⅰ and 2 cases type Ⅱ. The anteroposterior, lateral and axillary X-ray films of the affected shoulder were taken at 6 and 12 weeks, and 6 and 12 months after operation to follow up fracture healing and occurrence of complications. The Constant-Murley shoulder joint scores and the Disability of Arm Shoulder and Hand (DASH) scores for the upper limb dysfunction were recorded at the last follow-up for all patients.Results:All the 7 patients were followed up for 8 to 15 months (mean, 11.9 months). Bone union was achieved after an average of 4.3 months (from 3 to 6 months) in all patients. None of the functional activities was affected in all by postoperative shoulder joint instability, incision infection or axillary scar hyperplasia. At the last follow-up, their Constant-Murley scores averaged 83.4 points (from 55 to 92 points), and their DASH scores 13.5 points (from 4.2 to 33.3 points).Conclusion:In the treatment of proximal humeral fracture combined with lower glenoid fracture, the posterior axillary approach combined with the deltoid pectoralis major approach can lead to fine early curative efficacy due to their advantageous possibilities to allow for easy fracture reduction, reliable fixation and early rehabilitation.

Objective:To study the effect of different doses of 60Co γ-ray ionizing radiation on mitochondrial function in mouse hematopoietic stem and progenitor cells (HSPCs). Methods:C57BL/6 mice were divided into control group, 1 Gy irradiation group and 4.5 Gy irradiation group. The mitochondrial functions were detected at 12 h and 24 h after irradiation, including ROS level, membrane potential, mitochondrial structure, and mitochondrial stress. Bone marrow c-Kit + cells received a single 15 Gy irradiation in vitro, after 24 h, mitochondrial function was detected. Results:It was found that mice leukocytes ( t=12.41, 18.31, 16.48, 14.16, 19.08, 20.25, P<0.05), red blood cells ( t=4.81, 6.62, P<0.05) and platelets ( t=4.33, 6.68, P<0.05) were significantly reduced. The numbers of bone marrow colony formation unit ( t=16.27, 55.66, 17.06, 43.75, P<0.05), and HSPCs ( t=5.16, 11.55, P<0.05) were decreased dose-dependently post-irradiation. Under 1 Gy irradiation, the mitochondrial function and mitochondrial basal metabolic index of HSPCs ( t= 7.36, 3.68, 4.58, 3.15, 3.15, P<0.05) were enhanced at 24 h post-irradiation. Under 4.5 Gy irradiation, mitochondrial number, mitochondrial membrane potential ( t=12.29, 10.46, P<0.05), maximal respiration and spare respiratory capacity were decreased ( t=7.81, 5.78, 6.70, 5.83, P<0.05), ROS level was increased ( t=4.63, 4.12, P<0.05). The basal respiration and oxidative phosphorylated ATP production were reduced at 12 h after irradiation ( t=8.48, 3.80, P<0.05); and the proton leakage was increased ( t=6.57, P<0.05) and coupling efficiency was reduced ( t=11.43, P<0.05) at 24 h after irradiation. In cultured c-Kit + cells, the level of ROS ( t=11.30, P<0.05) and the maximum respiration and spare respiratory capacity were increased ( t=4.25, 3.44, P<0.05) while the mitochondrial membrane potential was decreased ( t=34.92, P<0.05) significantly. Conclusions:A method for systematically assessing mitochondrial function in HSPCs was established, and the effect of ionizing radiation on mitochondrial function of HSPCs was clarified, laying a foundation for further revealing the mechanism of ionizing radiation-induced mitochondrial damage in HSPCs.