Objective To compare the clinical efficacy between liposuction combined with circumareolar small incision and three-port endoscopic surgery for the treatment of Simon Ⅱ gynecomastia (GYN). Methods Comparative case data of 120 patients with GYN were retrospectively analyzed, 61 patients in the open group underwent circumareolar small incision mastectomy after liposuction, and 59 patients in the endoscopic group underwent three-port endoscopic mastectomy after liposuction. The two groups were compared in terms of surgery-related indexes, occurrence of postoperative complications and patient satisfaction. Results The unilateral operation time of the open group was shorter than that of the endoscopic group, the unilateral gland resection weight in the open group was more than that in the endoscopic group, the hospitalization cost of the open group was less than that of the endoscopic group (all P<0.01). There was no significant difference in unilateral liposuction volume, drainage volume on the first postoperative day, and time to drain removal between the two groups (P>0.05). The incidence of complications in the open group and the endoscopic group were 8.2% and 13.6% respectively, and there was no significant difference between the two groups (P>0.05). The difference in the overall satisfaction scores between the two groups was not statistically significant (P>0.05). Conclusions Liposuction combined with circumareolar small incision or three-port endoscopic surgery both has good cosmetic effects in the treatment of Simon Ⅱ GYN. The operation with circumareolar small incision is simple, has a shorter operation time, costs less, and does not require special equipment, which is suitable for promotion and application in medical institutions.

Gain-of-function mutations in KIT or PDGFRA receptor tyrosine kinase are key drivers of most gastrointestinal stromal tumor (GIST). The continuous development of tyrosine kinase inhibitors, such as imatinib, sunitinib, anlotinib, regorafenib, ripretinib and avapritinib, has greatly improved the overall survival of patients with advanced GIST. This article reviewed the efficacy (including objective response rate, disease stability rate, median progression free survival) and common adverse events of representative tyrosine kinase inhibitors in the treatment of advanced GIST in recent years, aiming to provide a clinical basis for the treatment options of patients with advanced GIST.

Objective To investigate the effects of Aurora kinase A(AURKA)on the tumor microenvironment of colorectal cancer(CRC)and to predict the active compounds in Chinese herbs that can target AURKA.Methods Based on the transcriptomic data and clinical information from 380 CRC tissues and 51 paracancerous tissues in The Cancer Genome Atlas(TCGA)database,the infiltration of different cells in the tumor tissues was analyzed using xCell and the binding of active compounds of Chinese herbs with AURKA was predicted through molecular docking.Results The expression of AURKA was significantly upregulated in CRC tissues compared with that in paracancerous tissues(P＜0.05),and CRC patients with high AURKA expression had shorter overall survival.Compared with the AURKA low-expression group,the abundance of macrophages,monocytes,and effector memory CD4+and CD8+T cells was significantly downregulated in the AURKA high-expression group(P＜0.05).In addition,the cytotoxicity of T cells was significantly reduced(P＜0.05).Further analysis revealed that AURKA expression was positively correlated with the abundance of myeloid-derived suppressor cells(MDSCs)and the expression levels of their chemokines CXCL2 and CXCL5(P＜0.05).Genes that were differentially expressed between the AURKA high-and low-expression groups were mainly enriched in monocyte migration,chemokine-induced cellular responses,and other related processes.Chinese herbal compounds,including hesperidin,aristololactam A Ⅱ a,anacardic acid,coumestrol,and 17β-estradiol,all showed binding energies to AURKA lower than-1.2 kcal/mol,indicating a certain level of binding stability.Among these Chinese herbal compounds,17β-estradiol exhibited the best binding stability to AURKA-3UOL.Conclusion The high expression of AURKA in CRC tissues suggests a poor clinical prognosis.AURKA can promote the development of a suppressive immune microenvironment in CRC,and 17β-estradiol,an active compound from Chinese herbs,is a potential therapeutic agent targeting AURKA.

Objective : To investigate the role of dapagliflozin ( DAPA) in ox⁃LDL⁃induced pyroptosis of human myeloid leukemia monocytes (THP⁃1) derived foam cells . Methods : THP⁃1 ⁃derived foam cell pyroptosis model was constructed by ox⁃LDL⁃induced THP⁃1derived macrophages . The experimental groups were set as follows : the blank control group(NC) , the ox⁃LDL group(ox⁃LDL) , and the drug intervention group(ox⁃LDL + DAPA) . Oil Red Ostaining was used to detect the foam cell levels of macrophages . The cell proliferation and toxicity assay kit was used to detect the effect of DAPA on foam cell viability . Hoechst 33342/propidium iodide(PI) double staining was used to detect THP⁃1 derived foam cell pyroptosis . Cell immunofluorescence double staining was used to detect the effect of DAPA on the expression of pyroptosis key factor Caspase⁃1 in foam cells . The activity of lactate dehydrogenase (LDH) in the cell culture medium was detected using a microplate enzyme⁃linked immunosorbent assay. qRT⁃PCR and Western blot were used to detect the mRNA and protein expression levels of Nod⁃like receptor pyrindomain containing 3 (NLRP3) , cystein⁃containing aspartate⁃specific protease⁃1( Caspase⁃1 ) , apoptosis⁃associated⁃speck⁃like protein containing CARD(ASC) ,gasdermin⁃D (GSDMD) , interleukin(IL) Ⅳ18 and IL⁃1β , respectively . Results : The CCK⁃8 assay indicated that the optimal intervention concentration of DAPA was 10 μmol/L. Oil Red O staining confirmed the successful construction of the THP⁃1 ⁃derived foam cell pyroptosis model . Compared with the blank control group , the expression levels of NLRP3 , Caspase⁃1 , ASC , GSDMD , IL⁃18 , IL⁃1β mRNA and protein significantly increased in ox⁃LDL group(P < 0. 05) , as well as the number of PI⁃positive cells and LDH activity(P < 0. 05) , the fluorescence intensity of Caspase⁃1 and the number of redlipid droplets in the cytoplasm of the cells . However , these effects were significantly reversed after DAPA intervention in the ox⁃LDL + DAPA group(P < 0. 05) . Conclusion DAPA inhibits ox⁃LDL⁃induced pyroptosis in THP⁃1 ⁃derived foam cells .

Objective To explore the clinical efficacy of laparoscopic inguinal hernia repair (LIHR) in elderly patients.Methods The retrospective cohort study was adopted.The clinical data of 3 203 patients with inguinal hernias (3 847 sides) who were adnitted to the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between January 2001 and December 2013 were collected.Of 3 203 patients,979 (1 107 sides) with age ＜ 60 years and 2 224 (2 740 sides) with age ≥ 60 years were respectively allocated into the under 60 years group and 60 years or older group.The surgical procedures including transabdominal preperitoneal (TAPP) approach,total extraperitoneal (TEP) approach and intraperitoneal onlay mesh (IPOM) approach were selected and performed by doctors in the same team.There were light-weight and heavy-weight patches.Observation indicators included (1) overall operation situations,(2) surgical comparison between the 2 groups,(3)comparison of postoperative indicators between the 2 groups,(4) follow-up.Follow-up using telephone interview and outpatient examination was performed to detect the recovery time of non-restricted activity,recurrence of hernia and complications.Measurement data with normal distribution were represented as ~ ± s and comparison between groups was done by the t test.Comparisons of count data were analyzed using the chi-square test or Fisher exact probability.Ranked data were compared by the nonparametric rank sum test.Results (1) Overall operation situations:3 203 patients with inguinal hernias (3 847 sides) underwent LIHR,including 1 475 (1 677 sides) using TAPP approach,1 718 (2 154 sides) using TEP approach and 10 (16 sides) using IPOM approach (6 using TAPP and IOPM approaches in each side).The light-weight patch was used in 2 206 sides and heavy-weight patch was used in 1 641 sides.Operation time was (31 ± 12) minutes in all 3 203 patients,(27 ±9)minutes in 2 559 patients with unilateral hernia and (44 ± 12)minutes in 644 patients with bilateral hernia,respectively.Duration of postoperative hospital stay was (1.5 ± 1.2) days.(2) Surgical comparison between the 2 groups:TAPP approach,TEP approach,IPOM approach,light-weight patch and heavy-weight patch were performed to 567,538,2,751,356 sides in the under 60 years group and 1 110,1 616,14,1 455,1 285 sides in the 60 years or older group,respectively,with statistically significant differences in above indicators between the 2 groups (X2 =37.976,70.022,P ＜ 0.05).Operation time in unilateral hernia and bilateral hernia and total operation time were (27 ± 9)minutes,(42 ± 10)minutes,(29 ± 10)minutes in the under 60 years group and (27 ± 10)minutes,(44 ± 12)minutes,(3 1 ± 13)minutes in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (t =-0.106,-1.768,-4.445,P ＞ 0.05).(3) Comparison of postoperative indicators between the 2 groups:the pain score at postoperative day 1 and duration of postoperative hospital stay were 2.4 ± 1.1,(1.5 ± 1.1) days in the under 60 years group and 2.3 ± 1.0,(1.5 ± 1.3) days in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (t =1.419,-0.126,P ＞0.05).(4) Follow-up:all the patients were followed up for 23-60 months,with a median time of 43 months.Cases with non-restricted activity recovery at postoperative week 2 and 4 were 973,978 in the under 60 years group and 2 208,2 222 in the 60 years or older group,respectively,showing no statistically significant difference between the 2 groups (X2=0.113,P ＞0.05).The recurrence of hernia,severe complications,serum tumescence,paresthesia and enteroparalysis were detected in 1,0,49,5,1 sides in the under 60 years group and 11,3,132,16,2 sides in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (x2=1.556,0.269,0.254,P ＞ 0.05).The urinary retention in the under 60 years group and 60 years or older group was respectively detected in 6 and 44 sides,showing a statistically significant difference between 2 groups (x2=6.956,P ＜ 0.05).Conclusion LIHR is safe and effective in elderly patients,and it can achieve good clinical efficacy under selecting reasonable operation procedures and patches.

Objective To explore the effect and safety of preoperative impact chemotherapy in the treatment of advanced gastric cancer patients.Methods 104 patients with advanced gastric cancer were randomly divided into two groups,including 54 cases of observation group,54 cases of control group.The observation group was given modified FOLFOX7 regimen for 2 courses before operation,and 6 courses FOLFOX7 regimen after operation.The control group was given routine operation and FOLFOX7 regimen for 8 coures.The effective rate,l-year,2-year,3-year survival rate and toxic effects after operation were observed.Results In observation group,the effective rate was 59.3％,the curative resection rate was 81.5％,and the overall resectability rate was 90.7％,and those was 35.2％,59.3％,75.9％ in control group,all the difference was statistically significant( x2 =8.55,6.39,4.27,all P ＜ 0.05 ).The 1 -year,2-year survival rates after operation were not significantly different ( x2 =0.38,2.06,all P ＞0.05 ),while the difference was significant at 3-year after operation( x2 =4.06,P ＜ 0.05 ).There was no significant difference on the toxic effects between the two groups ( P ＞ 0.05 ).Conclusion Modified FOLFOX7 regimen is effective and well-tolerable for patients with advanced gastric cancer,and it could contribute to improve the overall resectability rate and survival rate after operation.

Objectives:To discuss and analyse the causes of local recurrence after Dixon operation.　Methods:Retrospective analysis was made on 72 cases after resection of rectal cancer by Dixon operation in our department from 1995 to 1999.　Results:The local recurrence rate after Dixon operation was 12.5%(9 cases),the recurrence time was 3～26 months,and 16.2 months in an average after the operation.Seven cases of recurrence were within 2 years.The recurrence location occurred at the anastomotic stoma (6 cases),pelvic cavity (2 cases) and the perinum (1 cases) respectively.Based on Dukes classification, it showed one case of phase A, three cases of phase B and five cases of phase C.According to pathological classification, there were one case of papillary adenocarcinoma,five cases of rubiformadenocarcinoma and three cases of mucoid adenocarcinoma.A length from the lower margin of the tumors to the distal resection site,seven cases were within 3 cm,and two cases were beyond 3 cm.　Conclusions:The causes for local recurrence after operation were related to Duke classification,pathological types,length from the lower margin of the tumors to the distal resection site,lymphadenectomy and operation on the tumor itself.

Objectives:To study effects of TPN on postoperative patients with colon or rectum cancer,including gut function recovery,wound healing and immune function.　Medthods:42 elder patients with colon or rectum cancer were divided into two groups at randomization,TPN group and control group.From POD+1 to POD+8,TPN group was given TNA daily and control group was given solutions of glucose and electrolyte.Gut function recovery and wound healing were observed and albumin,pre-albumin,IgG,IgA,IgM,CD3+,CD4+ and CD8+ were determined on POD+1 and POD+8.　Results:The recovery of gut function and wound healing in TPN group were better than those in control group,and levels of pre-albumin,IgG,IgA were higher than those in control group.　Conclusions:TPN has positive effects in gut function recovery,wound healing and immune function in postoperative patients with colon or rectum cancer.

s: Objectives:To study effects of TPN on postoperative patients with colon or rectum cancer,including gut function recovery,wound healing and immune function. Medthods:42 elder patients with colon or rectum cancer were divided into two groups at randomization,TPN group and control group.From POD+1 to POD+8,TPN group was given TNA daily and control group was given solutions of glucose and electrolyte.Gut function recovery and wound healing were observed and albumin,pre albumin,IgG,IgA,IgM,CD3 +,CD4 + and CD8 + were determined on POD+1 and POD+8. Results:The recovery of gut function and wound healing in TPN group were better than those in control group,and levels of pre albumin,IgG,IgA were higher than those in control group. Conclusions:TPN has positive effects in gut function recovery,wound healing and immune function in postoperative patients with colon or rectum cancer.

Objectives: To evaluate the effect of TPN plus argine on nutrition status, immune function and postoperative complications in radical treatment of gastro intestinal cancer patients. Methods: 88 cases undertaking radical treatment were randomized into TPN group (normal group)(30 cases), argine group (plus argine)(30 cases) and control group (28 cases). Since POD+1, the former two groups were given intravenous nutrition support continuously for 7 days and argine 80～100ml/day in argine group.Controlled group was given glucose, amino acid solution and electrolytes first, then transited to normal oral food intake. On AOD-1 and POD+8, albumin, pre albumin, transferrin and immune parameters were analyzed; postoperative complications were observed as well. Results: On POD+8, pre albumin and transferrin were improved in normal and argine group. In argine group, IgG?IgE?CD3?CD4?CD4/CD8?NKC activity and IL 2 concentration were obviously higher than that in other two groups( P