Objective To explore the effectiveness and safety of endoscopic retrograde cholangiopancreatography(ERCP)in the super-older patients(≥ 90 years old)with calculus of common bile duct.Methods This study retrospectively analyzed the data of elderly patients ≥ 65 years old with calculus of common bile duct who received ERCP treatment from January 2011 to December 2023.Among of them,patients ≥ 90 years old were in the super-older group,and patients over 65 years old but under 90 years old were in the non-super-older group.Subsequently,the baseline data of gender,number of stones,stone size,cholecystolithiasis,periampullary diverticulum,and common bile duct intubation of patients in the two groups were matched by the 1∶1 propensity score matching method.After successful matching,the surgical success rate,stone removal rate,complication rate,and hospital stay in the two groups were compared.Results 428 older patients with calculus of common bile duct were included in this study,including 45 patients in the super-older group and 383 patients in the non-super-older group.After matching baseline data with a 1∶1 propensity score matching,44 patients were included in both the super-older group and non-super-older group.There was no statistically significant difference in the total underlying disease rate between the two groups[81.82％(36/44)vs 65.91％(29/44),P=0.189],but the incidence rate of stroke[34.09％(15/44)vs 6.82％(3/44)]and the ASA grading(grade Ⅲ or Ⅳ)[97.73％(43/44)vs 38.64％(17/44)]in the super-older group were significantly higher than those in the non-super-older group(P＜0.01).There were no statistically significant differences between the two groups in terms of ERCP surgical success rate[90.91％(40/44)vs 93.18％(41/44)],stone removal rate[65.91％(29/44)vs 81.82％(36/44)],complication rate[43.18％(19/44)vs 27.27％(12/44)],and median length of stay(15.00dvs 14.50 d)(P＞0.05).Conclusion ERCP is safe and effective in the super-older patients with calculus of common bile duct.

Objective:To evaluate the impact of postoperative radiotherapy (RT) and associated risk factors on the prognosis of patients undergoing postmastectomy breast reconstruction (PMBR) for breast cancer.Methods:A retrospective analysis was conducted on 1593 breast cancer patients who underwent PMBR at Tianjin Medical University Cancer Institute & Hospital between January 2010 and October 2023. Patients were divided into an RT group ( n = 351) and a non-RT group ( n =1242) based on whether postoperative radiotherapy was administered. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was the incidence of revision surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used for pairing. Continuous variables were compared between the two groups using the independent samples t-tests, while categorical variables were compared using chi-square tests, and survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards model was used to analyze survival influencing factors, and include propensity factors with P<0.2 in univariate analysis into multivariate analysis. Results:In the RT group, there were 3 deaths (0.9%) and 21 cases of disease progression (6.0%); in the non-RT group, 7 patients died (0.56%) and 40 experienced disease progression (3.22%). The median OS was 20.1 months (range: 0.1-164.9), and the median PFS was 19.5 months (range: 0.1-160.9). Pregnancy-associated breast cancer and higher N stage were identified as significant risk factors for OS, while neoadjuvant therapy, absence of adjuvant chemotherapy or endocrine therapy, and higher T stage were significant risk factors affecting patients' PFS. Radiotherapy significantly reduced the survival risk for PMBR patients with pregnancy-associated breast cancer or those receiving neoadjuvant therapy ( P=0.019, 0.027). Compared with other reconstruction methods, implant-based reconstruction was associated with a lower incidence of postmastectomy revision surgery(10.5% vs. 17.0%, P<0.001). Even after radiotherapy, the revision surgery incidence for implant-based reconstruction remained lower than that of other methods (12.2% vs. 14.2%, P=0.591). Compared with other reconstruction types, expander-based reconstruction was associated with an increased incidence of revision surgery (31.9% vs. 10.9%, P<0.001). Conclusions:Postmastectomy radiotherapy can reduce survival risk in PMBR patients with pregnancy-associated breast cancer or who received neoadjuvant therapy, showing positive effects on OS and PFS in high-risk patients. Pregnancy, higher T/N stage, and specific treatment strategies are critical factors influencing the prognosis of PMBR patients. Implant-based reconstruction is associated with a lower incidence of revision surgery, which remains low even after RT, whereas expander-based reconstruction may increase the long-term risk of revision surgery.

Objective:To investigate the changes of respiratory function and lung volume after bariatric surgery using spiral CT three-dimensional imaging technology.Methods:Using the prospective study method, the medical records of 30 subjects undergoing sleeve gastrectomy (LSG) in the Eighth Department of General Surgery, the Second Hospital of Hebei Medical University from Jan. 2023 to Jun. 2024 were collected. Among them, 12 were males and 18 were females, aged from 20 to 45 years, with the average age of 31.1 years old. Chest CT scans were completed within 1 week before surgery and 6 months after surgery. The subject′s CT plain scan reconstructed thin-layer images of the mediastinal window were transferred to a GE workstation, and the lung volumes of both lungs and each lobe and the tracheal wall area of the five bronchial segments (RB1, RB4, RB10, LB1 + 2 and LB10) were calculated as a percentage of the airway cross-sectional area (WA%), and the posterior intercostal position corresponding to the diaphragm was recorded. Paired t-test and rank-sum test were used to compare preoperative and postoperative differences.Results:Compared with pre-operation, the subject′s body mass index decreased significantly 6 months after bariatric surgery [(42.22±7.31) kg/m 2vs (30.12±5.59) kg/m 2,t=7.31, P<0.001)]. Except for left lower lobe [(1.15±0.23) L vs (1.27±0.24) L, t=1.97, P=0.054] and right middle lobe [(0.57±0.16) L vs (0.83±0.16) L, t=1.38, P=0.172], the remaining lung parts were significantly larger after surgery than before surgery: right upper lobe [(0.80±0.17) L vs (0.94±0.19) L, t=2.79, P=0.007], right lower lobe [(1.08±0.14) L vs (1.22±0.19) L, t=3.23, P=0.002], left upper lobe [(1.12±0.20) L vs (1.24±0.23) L, t=2.26, P=0.014]. Overall, right lung volume [(2.44±0.33) L vs (2.79±0.41) L, t=3.62, P=0.001], left lung volume [(2.27±0.36) L vs (2.52±0.39) L, t=2.53, P=0.014] and total lung volume [(4.71±0.60) L vs (5.30±0.71) L, t=3.48, P=0.001] all increased significantly at 6 months after surgery compared with before surgery. All five segments of bronchus (WA%) were significantly reduced after surgery than before surgery: RB1: [(62.82±4.66) vs (66.85±3.99), t=3.60, P=0.001]; RB4: [(61.24±5.28) vs (64.31±5.51), t=2.20, P=0.031]; RB10: [(60.03±4.64) vs (62.97±5.73), t=2.18, P=0.033]; LB1+ 2: [(63.61±5.05) vs (67.90±4.30), t=3.54, P=0.001]; LB10: [(58.73±6.49) vs (62.01±5.06), t=2.17, P=0.034)]. The posterior intercostal position corresponding to the diaphragm dropped from an average of 7-8 intercostal spaces to 8-9 intercostal spaces, with a significant difference (rank mean 22.77 vs 38.23, Z=-3.67, P<0.001). Conclusion:Bariatric surgery can significantly reduce weight, reduce the pressure of chest and abdominal, improve lung compliance, reduce the internal pressure of the chest, lower the diaphragm, expand the lung volume and airway cross-sectional area, restore the original airway anatomy and respiratory physiology, so it can effectively improve the respiratory function and lung structure abnormalities caused by obesity.

Objective To explore the effectiveness and safety of endoscopic retrograde cholangiopancreatography(ERCP)in the super-older patients(≥ 90 years old)with calculus of common bile duct.Methods This study retrospectively analyzed the data of elderly patients ≥ 65 years old with calculus of common bile duct who received ERCP treatment from January 2011 to December 2023.Among of them,patients ≥ 90 years old were in the super-older group,and patients over 65 years old but under 90 years old were in the non-super-older group.Subsequently,the baseline data of gender,number of stones,stone size,cholecystolithiasis,periampullary diverticulum,and common bile duct intubation of patients in the two groups were matched by the 1∶1 propensity score matching method.After successful matching,the surgical success rate,stone removal rate,complication rate,and hospital stay in the two groups were compared.Results 428 older patients with calculus of common bile duct were included in this study,including 45 patients in the super-older group and 383 patients in the non-super-older group.After matching baseline data with a 1∶1 propensity score matching,44 patients were included in both the super-older group and non-super-older group.There was no statistically significant difference in the total underlying disease rate between the two groups[81.82％(36/44)vs 65.91％(29/44),P=0.189],but the incidence rate of stroke[34.09％(15/44)vs 6.82％(3/44)]and the ASA grading(grade Ⅲ or Ⅳ)[97.73％(43/44)vs 38.64％(17/44)]in the super-older group were significantly higher than those in the non-super-older group(P＜0.01).There were no statistically significant differences between the two groups in terms of ERCP surgical success rate[90.91％(40/44)vs 93.18％(41/44)],stone removal rate[65.91％(29/44)vs 81.82％(36/44)],complication rate[43.18％(19/44)vs 27.27％(12/44)],and median length of stay(15.00dvs 14.50 d)(P＞0.05).Conclusion ERCP is safe and effective in the super-older patients with calculus of common bile duct.

Objective:To evaluate the impact of postoperative radiotherapy (RT) and associated risk factors on the prognosis of patients undergoing postmastectomy breast reconstruction (PMBR) for breast cancer.Methods:A retrospective analysis was conducted on 1593 breast cancer patients who underwent PMBR at Tianjin Medical University Cancer Institute & Hospital between January 2010 and October 2023. Patients were divided into an RT group ( n = 351) and a non-RT group ( n =1242) based on whether postoperative radiotherapy was administered. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was the incidence of revision surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used for pairing. Continuous variables were compared between the two groups using the independent samples t-tests, while categorical variables were compared using chi-square tests, and survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards model was used to analyze survival influencing factors, and include propensity factors with P<0.2 in univariate analysis into multivariate analysis. Results:In the RT group, there were 3 deaths (0.9%) and 21 cases of disease progression (6.0%); in the non-RT group, 7 patients died (0.56%) and 40 experienced disease progression (3.22%). The median OS was 20.1 months (range: 0.1-164.9), and the median PFS was 19.5 months (range: 0.1-160.9). Pregnancy-associated breast cancer and higher N stage were identified as significant risk factors for OS, while neoadjuvant therapy, absence of adjuvant chemotherapy or endocrine therapy, and higher T stage were significant risk factors affecting patients' PFS. Radiotherapy significantly reduced the survival risk for PMBR patients with pregnancy-associated breast cancer or those receiving neoadjuvant therapy ( P=0.019, 0.027). Compared with other reconstruction methods, implant-based reconstruction was associated with a lower incidence of postmastectomy revision surgery(10.5% vs. 17.0%, P<0.001). Even after radiotherapy, the revision surgery incidence for implant-based reconstruction remained lower than that of other methods (12.2% vs. 14.2%, P=0.591). Compared with other reconstruction types, expander-based reconstruction was associated with an increased incidence of revision surgery (31.9% vs. 10.9%, P<0.001). Conclusions:Postmastectomy radiotherapy can reduce survival risk in PMBR patients with pregnancy-associated breast cancer or who received neoadjuvant therapy, showing positive effects on OS and PFS in high-risk patients. Pregnancy, higher T/N stage, and specific treatment strategies are critical factors influencing the prognosis of PMBR patients. Implant-based reconstruction is associated with a lower incidence of revision surgery, which remains low even after RT, whereas expander-based reconstruction may increase the long-term risk of revision surgery.

Objective:Transcriptomics combined with proteomics was used to analyze the potential signaling pathways of epidermal growth factor-like domain 9 (EGFL9) affecting the proliferation, invasion and migration of hepatocellular carcinoma.Methods:RNA interference technique was used to build hepatocellular carcinoma cell line with EGFL9 Huh-7 gene knockdown, the control group (NC group) and experimental group (KD group), each group of three samples, were performed the transcriptome and proteomics analysis, screening differences genes and proteins, to express the correlation analysis, cluster analysis, and subsequently gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) were used for gene function and pathway annotation enrichment analysis, respectively.Results:Based on omics analysis, there were 8 335 different genes in KD group compared with NC group, among which 4 207 were up-regulated and 4 128 were down-regulated. There were 298 different proteins, of which 188 were up-regulated and 110 down-regulated. Based on the combined analysis of the two omics, 213 differentially expressed genes were found. Among them, the top three common differentially expressed genes at the level of transcription and translation were transferrin receptor 2 (TFR2), annexin A1 (ANXA1) and solute carrier family 38 member 2(SLC38A2). The common differentially expressed genes were significantly enriched in cell cycle signaling pathway, amino acid biosynthesis pathway, p53 signaling pathway and glycolysis/gluconeogenesis signaling pathway.Conclusion:EGFL9 may participate in the regulation of cell function of hepatocellular carcinoma cells by regulating the expression of TFR2, ANXA1, LC38A2 and other genes, and may play a role through the regulation of cell cycle and other molecular signaling pathways.

Background::Breast cancer is ranked among the most prevalent malignancies in the Chinese female population. However, comprehensive reports detailing the latest epidemiological data and attributable disease burden have not been extensively documented.Methods::In 2018, high-quality cancer surveillance data were recorded in 700 population-based cancer registries in China. We extracted data on female breast cancers (International Classification of Diseases, Tenth Revision [ICD-10]: C50) and estimated the incidence and mortality in 2022 according to the baseline data and corresponding trends from 2010 to 2018. Pathological types were classified according to the ICD for Oncology, 3rd Edition codes. Disability-adjusted life years (DALYs) were calculated as the sum of the years of life lost (YLLs) and years lived with disability (YLDs).Results::In 2022, approximately 357,200 new female breast cancer cases and 75,000 deaths occurred in China, accounting for 15.59% and 7.94% of total new cancer cases and deaths, respectively. The age-standardized incidence rate (ASIR) was 33.04 per 100,000. When analyzed by pathological type, the ASIRs for papillary neoplasms, invasive breast carcinoma, rare and salivary gland-type tumors, and other types were 1.13, 29.79, 0.24, and 1.88 per 100,000, respectively. The age-standardized mortality rate (ASMR) was 6.10 per 100,000. A total of 2,628,000 DALYs were found to be attributable to female breast cancer in China, comprising 2,278,300 YLLs and 349,700 YLDs. The ASIR, ASMR, and age-standardized rate (ASR) for DALYs in urban areas were consistently higher than those in rural areas. We observed a four-fold increase in the ASIR and ASR for DALYs and an eight-fold increase in the ASMR among females over 55 years compared with those aged under 55 years.Conclusion::These data provide invaluable insights into the latest epidemiology of female breast cancer in China and highlight the urgency for disease prevention and control strategy formulation.

Objective:To detect the expression of methyl methanesulfonate and UV sensitive gene clone 81 (Mus81) in hepatocellular carcinoma(HCC) and to observe the effects of Mus81 on the migration, invasion and metastatic ability of human HCC cells.Methods:Thirty-two tissue specimens were selected from HCC tissues and corresponding paraneoplastic tissues of patients with HCC who underwent surgical resection in Guangzhou Red Cross Hospital Affiliated to Jinan University from January 2020 to June 2021. The expression levels of Mus81 in 32 HCC specimens, 374 HCC samples from the cancer genome atlas database, human normal liver cell line HL-7702 and human HCC cell lines JHH-7, Huh-7 and Hep3B were analyzed. Mus81 knockdown in JHH-7, Huh-7 and overexpressed in Hep3B HCC cell lines were constructed, and the effects of Mus81 on HCC cells were observed by scratch assay, Transwell migration and invasion assay and tail vein injection transfer assay in nude mice.Results:The expression of Mus81 was higher in HCC tissues or cell lines than which in paraneoplastic tissues or normal hepatocyte lines (all P<0.05). The migration rate, metastatic and invasive cell numbers of Mus81-knockdown Huh-7 HCC cells were 22.24%±2.16%, 49.04±5.62, 3.81±1.08, the negative control group were 26.89%±1.15%, 86.81±4.79, 19.78±3.30, and the differences between the two groups were statistically significant ( t=4.24, 26.59, 23.92, all P<0.01). The migration rate, metastatic and invasive cell numbers of Mus81-overexpressed Hep3B HCC cells were 80.57%±5.12%, 18.74±8.07, 33.81±8.44, which were significantly higher than those of the empty vector group 64.17%±7.20%, 10.96±5.32, 3.04±1.13, and the differences were statistically significant ( t=4.15, 4.18, 18.78, all P<0.01). Tail vein transfer experiments in nude mice showed that the total fluorescence expression, weight of metastatic tumors, and the metastatic rates in kidney, vertebral column, neck, axilla and subcutis in nude mice injected with Mus81-knockdown JHH-7 cells were significantly lower than those in the control group (all P<0.05). Conclusion:Mus81 gene expression is upregulated in HCC and promotes the migration, invasion and metastatic ability of HCC cells, suggesting that Mus81 may be a potential therapeutic target for HCC.

Objective:To investigate the expression of zinc finger protein 22 (ZNF22) gene in hepatocellular carcinoma (HCC) and its effect on tumor proliferation, apoptosis, invasion and metastasis of HCC.Methods:The expression of ZNF22 in 32 HCC specimens, and 371 HCC samples from the cancer genome atlas database were analyzed. ZNF22 knockdown and negative control SNU-449 and JHH-7 HCC cell lines were constructed. The effects of ZNF22 on HCC cells were observed by cell proliferation assay, plate clone formation assay, apoptosis assay, scratch healing assay, Transwell invasion assay, subcutaneous tumor formation, tail vein injection transfer, and small animal live imaging assay in nude mice.Results:The expression of ZNF22 gene is higher in HCC tissues than in paracellular carcinoma tissues, and the difference was statistically significant ( P<0.001). The growth rate of SNU-449 and JHH-7 cells in ZNF22 knockdown group was lower than that in control group, and the difference was statistically significant ( P<0.001). Compared with negative control group, the clone number formed by SNU-449 cells in ZNF22 knockdown group decreased (26±8 vs. 59±5, P<0.01), the level of apoptosis increased (6.60%±0.22% vs. 2.38%±0.30%, P<0.001), the migration rate decreased (14.47%±6.42% vs. 68.84%±8.01%, P<0.001), and the number of invasive cells decreased (48.00±2.23 vs. 179.00±4.81, P<0.001). There was no obvious tumor growth after subcutaneous injection of JHH-7 cells into nude mice in ZNF22 knockdown group, and the systemic fluorescence expression was lower than that of the negative control group, and the difference was statistically significant ( P<0.05). No metastases were observed on autopsy in knockdown group nude mice. Conclusion:ZNF22 is highly expressed in HCC while knockdowing ZNF22 gene inhibited the growth, proliferation, invasion, metastasis of HCC cells, and induced apoptosis of HCC cells.

Objective:To investigate the application value and clinical effect of tissue expansion in post-mastectomy breast reconstruction.Methods:From January 2013 to May 2019, 173 patients (38.2±8.0 years old) with body mass index (BMI) of (21.5±2.1) kg/m 2 were treated in Peking University Third Hospital. There were 76 cases on the right side and 97 cases on the left side; 8 cases underwent nipple sparing mastectomy, and 165 cases underwent modified radical mastectomy; 150 cases received chemotherapy and 9 cases received radiotherapy. In the first stage, immediate or delayed chest wall soft tissue expansion was performed. In the second stage, implant replacement, autologous tissue transplantation, or the combination of these two methods was performed to complete the breast reconstruction. All patients were followed up and the clinical effect was evaluated by Harris evaluation method. Results:Among 173 cases, 95 cases were provided immediate reconstruction, and 78 cases were applied delayed reconstruction. The period of tissue expansion was (7.7±3.2) months. During the second stage of reconstruction, implant exchange was conducted in 105 cases, 48 cases received implant exchange with autologous fat injection, 17 cases were performed implant exchange with endoscopy-assisted latissimus dorsi muscle transfer, and 3 cases were applied deep inferior epigastric perforator flap (DIEP) transplantation. The average follow-up time was 12.6 months (3.5-41.0 months). One patient had local tumor recurrence, and the implant was finally removed. The reconstruction effects were evaluated by Harris method, which showed that 23 cases had excellent appearance, 129 cases were good, 13 cases were fair, 7 cases were poor, and 88.4% (152/172) patients were good or above.Conclusions:Tissue expansion plays an important role as a transfer station in post-mastectomy breast reconstruction. In the second stage, the breast reconstruction method can be flexibly selected. Tissue expansion has a wide range of indications, and is especially suitable for immediate post-mastectomy breast reconstruction. Good result can be obtained by using this technique.