Background and purpose: Many factors have impacts on the surgery approach of breast cancer. The purpose of this study was to analyze the influence factors of breast reconstruction for patients with breast cancer, focusing on the relationship between travel distance and breast reconstruction. Methods: Retrospective review of all female breast cancer patients staging 0-Ⅱ who underwent unilateral or bilateral mastectomy with or without breast reconstruction at Fudan University Shanghai Cancer Center from 1999 to 2015 was conducted in the study. Analysis of travel distance and breast reconstruction rate was performed. Results: Non-Shanghai patients have higher breast reconstruction rate after mastectomy compared with Shanghai patients (6.1％ vs 4.5％, P＜0.001). Travel distance may have an influence on the breast reconstruction rate (P=0.035). Univariate regression analysis showed that the increase of travel distance was the predictor of breast reconstruction, and that the increase of age or body mass index (BMI), or the later TNM stage had a negative correlation with breast reconstruction (P＜0.001). Multiple regression analysis demonstrated that the increase of age or BMI, or the later TNM stage was the independent predictor of the refusal of breast reconstruction (P＜0.001), but travel distance was not (P＞0.05). No significant correlation between the travel distance and breast reconstruction types was indicated. Negative correlation was observed between age and travel distance (P＜0.001). Conclusion: Age, BMI and tumor stage are the main influence factors of breast reconstruction, while travel distance shows a linear correlation with it.

Objective:To research the quality of postoperative recovery of patients with lung cancer through the(PQRS),and compare the recovery quality after video-assisted thoracoscopic surgery (VATS) or traditional open lobectomy.Method:PQRS scale was used to evaluate the recovery of 140 patients with lung lesions preoperatively and postoperative 1 day,3 days,7 days,14 days and 1 month.95 patients who met the set standard and complete the PQRS scales were enrolled and divided into video-assisted thoracoscope group or traditional thoracotomy group.This article mainly compared and analysied the quality of postoperative recovery of patients in both groups.Result:Except the anesthesia time,other general datum showed no statistical difference.In total recovery rate,the video-assisted thoracoscope group has significant difference when compared with the traditional thoracotomy group(P ＜ 0.05).The recovery rates of VATS group in feeling of the harmful factors,emotional factors and the daily life are higher than that of the traditional thoracotomy group,with statistically significant differences(P ＜0.05).However,the recovery rates in the physiological factors and cognitive factors had no statistical difference between two groups(P＞ 0.05).Conclusion:PQRS can effectively evaluate the quality of postoperative recovery in patients with lung cancer,and VATS is helpful to quick recovery postoperatively.

Objective To retrospectively investigate the characteristics of background parenchymal enhancement(BPE)in the contralateral breast following neoadjuvant chemotherapy(NAC)and whether BPE could help predict tumor response in early stage of advanced breast cancer. Methods Data from 161 patients who were diagnosed with unilateral breast cancer and then underwent NAC before surgery were analyzed retrospectively from August 2014 to December 2016.All the patients underwent both bilateral breast MRI scan with contrast enhancement. Two experienced radiologists independently categorized the patients' levels of BPE into four categories (1=minimal, 2=mild, 3=moderate, 4=marked) at baseline and after the 2nd cycle of NAC. All the patients were divided in to pathologic complete response (pCR) group and non-pCR group according to the histopathologic tumour response.The status of estrogen receptor(ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) were recorded before underwent NAC.The t test and Pearson chi-squared test were used to compare the baseline characteristics of the pCR and Non-pCR groups.The kappa test was used to test the inter-observer agreement.The Wilcoxon test was used to test for changes of BPE categories after NAC.The Mann-Whitney U test was used to test the difference of BPE between pre-and post-menopausal status. Associations were evaluated using Binary logistic regression models. Results Fifty nine patients achieved pCR, and 102 patients had residual disease (non-pCR). Age, tumor size, distribution of size, menopausal status and lymph node showed no significance between pCR and non-pCR groups(all P>0.05),while only ER/PR status and HER2 status had a significant difference (P>0.05 in both). Inter-observer agreement regarding BPE categorization was moderate and substantial before and after NAC(Kappa value 0.644 and 0.708).The level of BPE was higher in premenopausal than post-menopausal women both at baseline and after the 2nd cycle of NAC(P<0.01). Decreased BPE was observed in 106 cases(premenopausal 60 cases and postmenopausal 46 cases),and no change in BPE were observed in 55 cases (premenopausal 27 cases and postmenopausal 28 cases). A significant reduction in BPE was observed after the 2nd NAC cycle in the overall cases, pre-and post-menopausal cases (all P<0.01). Logistic model showed that hormonal receptor (HR) negative and HER-2 receptor at baseline and the change of BPE after NAC were the independent factors for predicting pCR. Conclusions Regardless of the menopausal status, BPE showed a reduction after NAC, and it can serve as an additional imaging biomarker of tumour response at an early stage of NAC.

Objective To study the clinical impact of microvascular invasion (MVI) on patients with intrahepatic cholangiocarcinoma (ICC) after R0 resections.Methods The clinicopathological data of 359 patients with ICC who underwent R0 resection in the Zhongshan Hospital,Fudan University between January 2000 and December 2008 were retrospectively studied.Univariate analysis and multivariate analysis were carried out to study factors related to postoperative survival outcomes and recurrence.The impact of MVI on patients with ICC after R0 resection was studied.Results The incidence of MVI was 13.6％ in the study cohort.MVI was correlated with HBV infection (P ＜ 0.05),liver cirrhosis (P ＜ 0.05) and tumor differentiation (P ＜ 0.05).The 1-,3-,5-year overall survival (OS) between the MVI positive and negative groups were 50.0％,20.9％,12.2％ and 63.9％,33.1％,22.0％ respectively (P ＜ 0.05),and the median survival time was 13 months and 18.5 months (P ＜0.05).The 1-,3-,5-year recurrence free survival (RFS) rates between the MVI positive and negative groups were 29.7％,12.7％,8.5％ and 50.6％,26.9％,18.4％,respectively (P ＜0.05),and the median recurrence free survival time was 8 months and 12.5 months (P ＜ 0.05).Multivariate analysis showed that MVI was an independent risk factor affecting recurrence after R0 resection (HR 1.852,95％ CI:1.075 ～ 3.195,P ＜ 0.05).Conclusions The occurrence of MVI in ICC patients was associated with hepatitis B infection.MVI was an independent risk factor affecting recurrence in ICC patients after R0 resection.However,it was not an independent risk factor of overall survival in patients after R0 resection.The clinical impact of MVI on patients with ICC was not as strong as for hepatocellular carcinoma.

Objective To explore the cellular localization of chemokine (C-X-C motif) ligand 1 (CXCL1) in brain tissue and its expres-sion in brain tissue and blood in patients with severe traumatic brain injury (TBI), as well as its correlation with the injury severity. Methods From September, 2013 to October, 2015, 78 cases of TBI with craniotomy admitted to our hospital were involved as TBI group. A total of 78 peripheral blood samples and 19 brain tissue samples were studied. According to the scores of Glasgow Coma Scale (GCS) at admission, the TBI group was classified as severe TBI group (6~8, n=35) and particularly severe TBI group (3~5, n=43). Ten cases of control brain tissue were taken from patients with cerebral aneurysms or benign tumor and also undergoing craniotomy during the same time. Peripheral blood from ten healthy people were involved as the healthy control group. Immunofluorescent double staining was used to detect the cellular local-ization of CXCL1 in brain tissues, and ELISA was used to detect the expression of CXCL1 in brain tissue and blood. The relationship be-tween the level of CXCL1 in peripheral blood at different time and the score of Glasgow Outcome Scale (GOS) was analyzed with Spear-man correlation analysis. Results In normal brain tissue, CXCL1 mainly localized in astrocytes. For severe TBI, CXCL1 mainly expressed in neurons and astrocytes. The level of CXCL1 was higher in brain tissue in the particularly severe TBI group than in the severe TBI group (t=-12.58, P<0.05). In the severe TBI group, the level of CXCL1 in blood reached a peak before surgery, then gradually decreased, and was still higher than that in the healthy control group 14 days after surgery (P<0.05), however, no significant difference was found 30 days after surgery compared to the healthy control group (P>0.05). In the particularly severe TBI group, the level of CXCL1 in blood reached a peak before and one day after surgery, then gradually decreased, and was still higher than that in the healthy control group 30 days after surgery (P<0.05). The level of CXCL1 in blood was higher in the particularly severe TBI group than in the severe TBI group at all time points (P<0.05), and the level before surgery was negatively correlated with the score of GOS in the particularly severe TBI group (r=-0.351, P<0.05). Conclusion The CXCL1 protein of injury brain tissue was mainly colocalized in neurons and astrocytes in severe TBI patients, and the ex-pression was associated with injury severity and outcome.

Objective To investigate the effect of group feedback and formative assessment respectively on teaching effectiveness of endotracheal intubation (ETI).Methods After atheoretical lecturing and theoretical test,eighty three undergraduates were randomized into concurrent-feedback group and groupfeedback group.ETIsimulation training was given respectively by providing concurrent or group feedback in the two groups,and then undergraduates received a skill assessment.After atheoretical lecturing and theoretical test,other 91 undergraduates were randomized into final-assessment group and formative-assessment group.ETIsimulationtraining and skill assessment were given in final-assessment group.Before training,first skill assessment was performed in formative-assessment group,and then feedback was delivered based on the assessment.After training,second skill assessment was given again.Skill assessment was evaluated using the criterion-based task specific checklist combined with global rating scale.t-test was used for comparison between groups.Results There was no statistical difference (P=0.212) in theoretical scores between group-feedback group,and concurrent-feedback group.Skill assessment score of group-feedback group (39.4 ± 4.9) was higher than that in concurrent-feedback group (35.4 ± 4.7),with statistical difference (P=0.000).There was no statistical difference (P=0.395) in theoretical scores between formative-assessment group and final-assessment group.Score of formative-assessment group (39.3 ± 6.2) was higher than that in final-assessment group (32.2 ± 2.4),with statistical difference (P=0.000).Conclusion Terminal feedback or formative assessment could enhance teaching effectiveness of endotracheal intubation among medical students.

Objective To investigate the diagnostic value and characteristics of breast lesion in digital breast tomosynthesis (DBT) in combination with synthesized two-dimensional (2D) images. Methods The prospective study enrolled women older than 18 years with clinically suspected breast lesion.One hundred and sixty seven patients with 177 lesions confirmed by biopsy or surgery were included. All the patients underwent full-field digital mammography(FFDM)and DBT examinations,and synthesized 2D images(V-preview)were reconstructed from DBT.The images of FFDM,V-preview images and DBT plus FFDM, V-preview images were analyzed. The breast imaging reporting and data system (BI-RADS) and characteristic for predicting benign and malignant lesion were also evaluated.The average glandular dose for a single mammographic view between FFDM and DBT was recorded.The Nonparametric Z test was used to compare the differences among four different mammographic images in BI-RADS.The differential diagnostic performance among different mammography was evaluated by ROC analysis.Independent t test was used to compare the average glandular dose between FFDM and DBT.Results One hundred three benign lesions and 74 malignant lesions were confirmed. Compared with FFDM images alone or plus DBT,the diagnostic values of V-preview images alone/or plus DBT were not significantly different(Z=0.187 and 0.226,P=0.851 and 0.821), but compared with V-preview, the diagnostic values of V-preview images plus DBT revealed significant difference(Z=3.546,P<0.01).The area under ROC for V-preview plus DBT were 0.899,and the sensitivity,specificity,and accuracy were 90.5%,89.3%,and 89.3%,separately.For the average glandular dose, there was no significant difference between FFDM (1.48 ± 0.52) mGy and DBT (1.56 ± 0.39) mGy examination(t=1.714,P=0.087).Conclusion Synthesized 2D images from DBT,which may eliminate the need for FFDM,in combination with DBT can improve the diagnostic efficiency.

A new approach based on online coupled liquid chromatography-gas chromatography-mass spectrometry ( LC-GC / MS ) was developed for the rapid determination of 4-( methylnitrosamino )-1-( 3-pyridyl)-1-butanone (NNK) in mainstream cigarette smoke, in which a switching valve was employed to online switching between two-dimensional chromatography. The online LC-GC / MS system used in this study was built by using online gel permeation chromatography-gas chromatography-mass spectrometry except that the micro gel column was replaced by micro alkaline alumina column which was prepared by ourselves before. The NNK in mainstream cigarette smoke was collected by a Cambridge filter pad, then the pad was extracted with dichloromethane, and the extract was quantitatively analyzed by online LC-GC / MS with D4-NNK as an internal standard. Online LC-GC / MS allowed online pretreatment purification, and the sample was subjected to online LC-GC / MS without any prior purification, which reduced human error in analysis process. The injection volume of the present online LC-GC / MS could reach 40 μL, which was 20 times of that of the conventional GC / MS (2. 0 μL of injection volume), and thus significantly improved the sensitivity. Under the optimum conditions, good linearity ( r = 0. 9998) was obtained over the range of 1. 2 - 120 ng / mL. The recoveries at three spiked levels ranged from 93. 9% to 96. 0% , and the limits of detection for qualitative and quantitative detection were 0. 25 ng / mL and 0. 9 ng / mL, respectively. All the results obtained by the present method are comparable to those of standard method recommend by China National Tobacco Company.

OBJECTIVE:To investigate the effects of hyperbaric oxygen combined with flupentixol and melitracen on depres-sion improvement,extremity motor function and ability of daily living and activity in patients with post-stroke depression (PSD). METHODS:60 PSD patients were divided into control group and observation group according to random number table,with 30 cases in each group. Both groups received routine clinical treatment,comprehensive rehabilitation therapy and psychotherapy. The control group was additionally given Flupentixol and melitracen tablets,orally,one tablet each time,in the morning;3 days later, one tablet each time,in the morning and noon,for 4 weeks. Other anti-depressive agents were not given during treatment. Observa-tion group was additionally given hyperbaric oxygen,0.12 MPa,for 90 min,qd,5 times a week,for 4 weeks,on the basis of control group. Depression degree [Hamilton depression scale (HAMD) and Self-rating depression scale(SDS)],extremity motor function [Fugl-Mayer motor function assessment (FMA)] and ability of daily living and activity [modified Barthel index (MBI)] were scored in 2 groups before and after treatment,and ADR was observed. RESULTS:After 4 weeks of treatment,HAMD and SDS of 2 groups were decreased significantly compared to before treatment,while FMA and MBI were increased significantly;the improvement of observation group was significantly better than that of control group,with statistical significance(P<0.05). No ob-vious ADR was found in 2 groups. CONCLUSIONS:Hyperbaric oxygen combined with flupentixol and melitracen can effectively improve PSD,relieve negative emotion and improve extremity motor function and ability of daily living and activity.

OBJECTIVETo evaluate the role of germline mutations of TP53 gene among a Chinese population with high risk for breast cancer.

METHODSA total of 81 BRCA-negative breast cancer probands from cancer families were analyzed using targeted capture and next-generation sequencing. Candidate mutations were verified with Sanger sequencing. Co-segregation analyses were carried out to explore the likely pathogenicity of the mutation.

RESULTSOf the 81 BRCA-negative patients, 3 exonic mutations in the TP53 gene were identified in 3 breast cancer patients. Of these, 2 mutations were previously reported and 1 was novel. One family with TP53 mutation has met the criteria for Li-Fraumeni syndrome (LFS) and accounted for 9.1% of all families who fulfilled the diagnostic criteria for LFS. Two of the carriers were diagnosed with breast cancer under the age of 30, and have accounted for 11.8% (2/17) of all very young (≤30 years) breast cancer patients in our study.

CONCLUSIONThe TP53 germline mutation is more common in Chinese population with a high risk for breast cancer than previously thought. TP53 gene mutation screening should be considered particularly for patients with a family history of LFS and very young age of onset.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Breast Neoplasms ; ethnology ; genetics ; China ; DNA Mutational Analysis ; Exons ; Family Health ; Female ; Genetic Predisposition to Disease ; ethnology ; genetics ; Germ-Line Mutation ; Heterozygote ; Humans ; Li-Fraumeni Syndrome ; ethnology ; genetics ; Male ; Middle Aged ; Pedigree ; Risk Factors ; Tumor Suppressor Protein p53 ; genetics ; Young Adult