60 yrs) were associated with a higher prevalence of malnutrition (47 6%) than those of 60 yrs and younger (31 5%) Malnutrition was more frequently encountered in cancer patients than other patients (64 5% vs 22 4%) Patients with digestive tract disease had higher rates of malnutrition than those without (52 6% vs 30 0%) FFM, FM, BCM, TBW and ICF was significantly lower in malnourished male and female patients than well nourished patients Conclusion The prevalence of malnutrition in hospitalized surgical patients is high

Objective To explore the expression change of intestinal epithelial tight junction (IJ)protein claudin-1 in mice with fulminant hepatic failure (FHF).Methods FHF was induced with a method that combined intraperitoneal injection of lipopolysaccharide (LPS,10 mg/kg) and D-galactosamine (GalN,800 mg/kg).Control saline (2 ml/kg,ip),LPS (10 mg/kg,ip) and GaIN (800 mg/kg,ip) were also detected.The effect of administration of anti-tumor necrosis factor alpha (TNF-α) IgG antibody (anti-TNF-α IgG,100 μg/per) on the level of TNF-α was assessed before administration of D-galactosamine/lipopolysaccharide.At the 2nd h,6th h,9th h,12th h,24th h after injection in FHF group,the 9th h after injection in control groups and 9th h after injection in anti-TNF-α IgG group,the mice were killed for the collection of large intestine specimens.Claudin-1 was analyzed with immunohistochemistry,Western blotting,and real-time quantitative PCR.Results Tight junction protein claudin-1 was localized along the apical region of the lateral plasma membrane representing the region of tight junctions in surface and crypt epithelial cells.Weakly distributed density of claudin-1 in intestinal mucosa was found in mice with FHF from the 9th h after injection.Compared to saline group,Western blotting analysis demonstrated markedly reduced claudin-1 expression in mice with FHF at the 6th h and 9th h after injection (6th h:0.8600±0.0208 vs 1.0,P ＜0.05; 9th h:0.6633 ±0.0328 vs 1.0,P ＜0.01).Furthermore,the expression of claudin-1 mRNA was markedly reduced at the 6th h,9th h,and 12th h after injection in mice with FHF (6th h:0.3067 ±0.1291 vs 1.0,P ＜0.05; 9th h:0.2233 ±0.1155 vs 1.0,P ＜0.01 ; 12th h:0.5275 ±0.1222 vs 1.0,P ＜0.05).Compared to saline group,no significant difference in claudin-1 expression was found with prophylactic treatment with anti-TNF-α-IgG antibody in mice with FHF at the 9th h after injection (protein:0.9533 ±0.0186 vs 1.0,P ＞0.05; mRNA:0.85 ±0.1437 vs 1.0,P ＞0.05).Conclusions The expression of tight junction protein claudin-1 was reduced at both protein and mRNA levels in intestinal epithelial cells that were induced by TNF-α in mice model of FHF.

Objective To report the clinical features,management and prognosis of local recurrence with inferior vena cava tumor thrombus for renal cell carcinoma after laparoscopic partial nephrectomy.Methods A case of 37-year-old man was admitted to hospital for recurrent renal tumor in May 2013.The patient undervent laparoscopic partial nephrectomy for right kidney mass in June 2011,and renal cell carcinoma was diagnosed by pathological examination.The patient complained about pain of right flank in May 2013.Imaging examination (including CT,MRI and PET-CT) showed a 5 cm tumor on the upper-middle right kidney associated with inferior vena cava tumor thrombus,bulky retroperitoneal lymph nodes and extensive local invasion including psoas,ureter,perirenal fascia.Surgical excision of local recurrence,nephrectomy plus inferior vena eava thrombectomy was performed.Results Right nephrectomy and local recurrence incision plus inferior vena eava thrombectomy was performed successfully.The operation time was 360 min,blood loss was 4 000 ml.The patient was discharged on the 14th day after surgery.The pathological characteristics were as follows:the tumor was limited to the upper-middle right kidney,psoas,ureter,and inferior vena cava tumor thrombus,but carcinoma was not found in the lymph nodes,pelvis and others.The final pathological diagnosis was papillary renal cell carcinoma,type Ⅱ.Local recurrence and other distant metastasis were not demonstrated with CT in 12 months' follow-up.Conclusion Excision of locally recurrent renal cell carcinoma is possible,and complete surgical resection could lead to prolonged disease-free survival.

OBJECTIVETo investigate the effects of direct intratumor injection of the packaged cells with retroviral vector carrying human endostatin (hEN) on the growth inhibition of B16 melanoma in C57/BL6 mice.

METHODSRetroviral vector, pLNC-hEN, was constructed with modified and identified hEN gene. The cell line, PA317, was used to establish ecotropic virus producing cells by transfecting and packing with pLNC-hEN. Then the cells were injected directly into the tumor in C57/BL6 mice bearing B16 melanoma, established by intra-cutaneous injection of B16 cell suspension. The tumor size was measured at different intervals to observe the antitumor effect. Micro-vessel density (MVD) in the tumor tissue was evaluated by immunohistological examination to count the apoptotic cells by TUMEL staining.

RESULTSTumor with diameter of 2 - 3 mm was observed in all mice after 7 - 9 days. The average tumor volume on D3, D5, D7 and D9 after gene transfection was 4.67 +/- 1.1, 22.25 +/- 13.06, 84.17 +/- 43.5 and 155.08 +/- 81.1 mm(3) in the gene therapy group but 136.17 +/- 30.61, 390.17 +/- 220.47, 1 021.67 +/- 537.4 and 2 920.2 +/- 220.01 mm(3) in the control group, the difference of which was statistically significant. The average MVD in the gene therapy and control groups were 8 +/- 2.28 and 28.17 +/- 5.31 while the average apoptotic cell number in the two groups were 23.33 +/- 3.83 and 2.33 +/- 1.21, both of which were statistically significant.

CONCLUSIONThe direct injection of packaged cells carrying hEN gene is able to inhibit the growth of micro-blood vessels and promote tumor cell apoptosis, which ultimately inhibits the growth of B16 melanoma.

Angiogenesis Inhibitors ; therapeutic use ; Animals ; Apoptosis ; Collagen ; genetics ; therapeutic use ; Disease Models, Animal ; Endostatins ; Gene Transfer Techniques ; Genetic Therapy ; Genetic Vectors ; genetics ; Humans ; Melanoma, Experimental ; pathology ; therapy ; Mice ; Mice, Inbred C57BL ; Neoplasm Transplantation ; Peptide Fragments ; genetics ; therapeutic use ; Transfection ; Tumor Cells, Cultured

Objective:To select and obtain relevant evidence of chemotherapy-related constipation for cancer patients at home and abroad and summarize the best evidence.Methods:Chemotherapy-related constipation guidelines, systematic reviews, best practice information booklet, evidence summary and expert consensus for cancer patients were searched on British Medical Journal (BMJ) , National Guideline Clearinghouse (NGC) , National Institute for Health and Care Excellence (NICE) , Australia Joanna Briggs Institute (JBI) Evidence-Based Health Care Center Database, Cochrane Library, Evidence-Based Medicine Guidelines, National Comprehensive Cancer Network, Scottish Intercollegiate Guidelines Network, China Biology Medicine disc, PubMed, CNKI and Wanfang Database by using the computers. The search period was from the construction of the database to May 17, 2019. Two to four researchers independently evaluated the quality of the literatures and extracted the documents that met the standards in combination with the judgment of professionals. The GRADE system was used to classify the quality level of evidence and the strength of recommendations.Results:A total of 6 literatures were included, including 3 guidelines, 2 systematic reviews and 1 summary of evidence. A total of 25 pieces of evidence were summarized from the 4 aspects of evaluation, prevention, management and medication of chemotherapy-related constipation.Conclusions:This study summarizes the best evidence for chemotherapy-related constipation in cancer patients and provides evidence-based evidence for the evaluation, prevention, management and medication of cancer patients with chemotherapy.

In deep inferior epigastric perforator (DIEP) flap breast reconstruction, diffuse venous congestion caused by non-pedicle causes, such as lack of effective communication between deep and superficial venous systems, is very rare. In this paper, a case of young woman who underwent DIEP breast reconstruction after breast cancer mastectomy was reported. Imaging findings showed the absence of bilateral dominant perforators and the lack of communication between the deep and superficial venous system. During operation, the superficial inferior epigastric vessels were dissected in advance. Indocyanine green angiography showed arterial perfusion insufficiency and venous congestion.The flap was successfully salvaged by supercharging/draining with superficial inferior epigastric vessels, preserving the abdominal function of the young patient to the greatest extent.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

In deep inferior epigastric perforator (DIEP) flap breast reconstruction, diffuse venous congestion caused by non-pedicle causes, such as lack of effective communication between deep and superficial venous systems, is very rare. In this paper, a case of young woman who underwent DIEP breast reconstruction after breast cancer mastectomy was reported. Imaging findings showed the absence of bilateral dominant perforators and the lack of communication between the deep and superficial venous system. During operation, the superficial inferior epigastric vessels were dissected in advance. Indocyanine green angiography showed arterial perfusion insufficiency and venous congestion.The flap was successfully salvaged by supercharging/draining with superficial inferior epigastric vessels, preserving the abdominal function of the young patient to the greatest extent.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.