Objective:To investigate the factors influencing recurrence and metastasis and prognosis of early breast cancer patients after surgery and the significance of all-foci radiotherapy after recurrence and metastasis.Methods:A retrospective cohort study was conducted. A total of 554 patients with stage T 1-2N 0M 0 breast cancer after surgery who were admitted to Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University from January 2006 to January 2019 were collected. The clinicopathological features were compared between patients with and without recurrence and metastasis after surgery. Kaplan-Meier method was used to analyze the overall survival (OS) and disease-free survival (DFS) of patients. The univariate analysis of prognostic factors was conducted using log rank test, while the multivariate analysis was conducted using Cox proportional hazards model. Patients with recurrence and metastasis are grouped according to whether the recurrence and metastasis lesions had received radiotherapy, patients with radiotherapy for all recurrence and metastasis lesions were classified as the all-foci radiotherapy group, patients with radiotherapy for partial recurrence and metastasis lesions were classified as non-all-foci radiotherapy group, and patients without radiotherapy for all recurrence and metastasis lesions were classified as non-radiotherapy group. The OS and progression free survival (PFS) were compared between groups. Results:The 554 patients were (49±10) years old, including 56 patients (10.1%) with recurrence and metastasis after surgery. There were statistically significant differences in menopausal status, pathological type, differentiation degree, estrogen receptor or progesterone receptor expression, pathological stage, postoperative adjuvant chemotherapy, postoperative adjuvant radiotherapy, and postoperative adjuvant endocrine therapy (all P < 0.05). The 5-year OS and DFS were 96.9% and 95.9%, respectively. The multivariate Cox regression analysis showed that the high differentiation ( HR = 0.300, P = 0.011), no postoperative adjuvant radiotherapy ( HR = 0.097, P < 0.001) and no postoperative endocrine therapy ( HR = 0.421, P = 0.040) were independent risk factors for DFS. The high differentiation ( HR = 0.266, P = 0.003) and no postoperative adjuvant radiotherapy ( HR = 0.225, P = 0.003) were independent risk factors for OS. OS in all-foci radiotherapy group was better than that in non-all-foci radiotherapy group, and the difference was statistically significant ( χ2 = 6.73, P = 0.010), but there was no significant difference in PFS between the two groups ( χ2 = 3.51, P = 0.061). There was no statistically significant difference in OS and PFS between the all-foci radiotherapy group and the non-radiotherapy group (both P > 0.05). Conclusions:Menopausal status, pathological classification, differentiation degree, estrogen receptor or progesterone receptor expression, pathological stage, postoperative adjuvant chemotherapy, postoperative adjuvant radiotherapy, and postoperative adjuvant endocrine therapy may affect the occurrence of postoperative recurrence and metastasis in stage T 1-2N 0M 0 breast cancer patients after surgery. The prognosis of stage T 1-2N 0M 0 breast cancer patient with high differentiation, no postoperative adjuvant radiotherapy and no postoperative endocrine therapy is poor. The OS of early breast cancer patients with recurrence and metastasis may be prolonged by all-foci radiotherapy compared with non-all-foci radiotherapy.

Objective:To investigate the factors influencing recurrence and metastasis and prognosis of early breast cancer patients after surgery and the significance of all-foci radiotherapy after recurrence and metastasis.Methods:A retrospective cohort study was conducted. A total of 554 patients with stage T 1-2N 0M 0 breast cancer after surgery who were admitted to Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University from January 2006 to January 2019 were collected. The clinicopathological features were compared between patients with and without recurrence and metastasis after surgery. Kaplan-Meier method was used to analyze the overall survival (OS) and disease-free survival (DFS) of patients. The univariate analysis of prognostic factors was conducted using log rank test, while the multivariate analysis was conducted using Cox proportional hazards model. Patients with recurrence and metastasis are grouped according to whether the recurrence and metastasis lesions had received radiotherapy, patients with radiotherapy for all recurrence and metastasis lesions were classified as the all-foci radiotherapy group, patients with radiotherapy for partial recurrence and metastasis lesions were classified as non-all-foci radiotherapy group, and patients without radiotherapy for all recurrence and metastasis lesions were classified as non-radiotherapy group. The OS and progression free survival (PFS) were compared between groups. Results:The 554 patients were (49±10) years old, including 56 patients (10.1%) with recurrence and metastasis after surgery. There were statistically significant differences in menopausal status, pathological type, differentiation degree, estrogen receptor or progesterone receptor expression, pathological stage, postoperative adjuvant chemotherapy, postoperative adjuvant radiotherapy, and postoperative adjuvant endocrine therapy (all P < 0.05). The 5-year OS and DFS were 96.9% and 95.9%, respectively. The multivariate Cox regression analysis showed that the high differentiation ( HR = 0.300, P = 0.011), no postoperative adjuvant radiotherapy ( HR = 0.097, P < 0.001) and no postoperative endocrine therapy ( HR = 0.421, P = 0.040) were independent risk factors for DFS. The high differentiation ( HR = 0.266, P = 0.003) and no postoperative adjuvant radiotherapy ( HR = 0.225, P = 0.003) were independent risk factors for OS. OS in all-foci radiotherapy group was better than that in non-all-foci radiotherapy group, and the difference was statistically significant ( χ2 = 6.73, P = 0.010), but there was no significant difference in PFS between the two groups ( χ2 = 3.51, P = 0.061). There was no statistically significant difference in OS and PFS between the all-foci radiotherapy group and the non-radiotherapy group (both P > 0.05). Conclusions:Menopausal status, pathological classification, differentiation degree, estrogen receptor or progesterone receptor expression, pathological stage, postoperative adjuvant chemotherapy, postoperative adjuvant radiotherapy, and postoperative adjuvant endocrine therapy may affect the occurrence of postoperative recurrence and metastasis in stage T 1-2N 0M 0 breast cancer patients after surgery. The prognosis of stage T 1-2N 0M 0 breast cancer patient with high differentiation, no postoperative adjuvant radiotherapy and no postoperative endocrine therapy is poor. The OS of early breast cancer patients with recurrence and metastasis may be prolonged by all-foci radiotherapy compared with non-all-foci radiotherapy.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To observe the effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability in critical ill patients with tracheostomy. Methods From January to June, 2021, a total of 84 critical ill patients with tracheostomy in the department of Critical Care Medicine, Zhongda Hospital, Southeast University, were randomly divided into control group (n = 28),experimental group A (n = 28) and experimental group B (n = 28). All the groups received routine therapy and early activities; while high-frequency chest wall oscillation was added to experimental group A, and abdominal electrical stimulation combined with high-frequency chest wall oscillation were added to experimental group B, for two weeks. Their involuntary cough peak flow (ICPF), Clinical Pulmonary Infection Score (CPIS), diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and thickness of abdominal muscle (Tab) were measured before and after treatment. Results The improvement of CPIS, ICPF and Tab were better in the experimental group B than in the other two groups (P < 0.05). The improvement of DE and DTF were slightly better in experimental group B, however, there was no significant difference among groups (FDE = 0.514, FDTF = 1.582, P > 0.05). The thickness d-values of rectus abdominis, musculi obliquus internus abdominis and musculus transversus abdominis were positively correlated with the d-value of ICPF in the exprimental group B (r > 0.415, P < 0.05). ICPF was highly negatively correlated with CPIS before treatment for all the patients (r = -0.702, P < 0.001). No adverse events occurred during the intervention period. Conclusion Abdominal electrical stimulation combined with high-frequency chest wall oscillation could improve airway clearance ability in critical ill patients with tracheostomy.

Objective:To explore the value of cardiovascular MR (CMR) T 1 mapping in evaluating myocardial injury in patients recovered from COVID-19. Methods:The clinical and image data of 15 patients with COVID-19 (9 with moderate clinical manifestation, 6 with severe clinical manifestation) who underwent CMR screening at 3 months after being discharged from the Second People′s Hospital of Fuyang City during May 2020 to June 2020 were prospective collected. Fifteen COVID-19 patients were selected as case group, and another 11 healthy volunteers were selected as control group. A standardized CMR protocol included cine, native and enhanced T 1 mapping, late gadolinium enhancement (LGE). Cardiac functional parameters, native T 1 value of left ventricular and extracellular volume fraction (ECV) were measured. One way ANOVA was used to assess the difference between CMR parameters among moderate and severe manifestation groups and control group, and LSD- t was used to assess the difference between the three groups. Results:LGE value was negative in all subjects. ECV values were higher in recovered COVID-19 patients with either moderate (27.9%±2.7%) or severe manifestation (30.0%±3.7%) than control group (23.2±1.9%) ( P<0.05); there was no significant difference of ECV values between recovered COVID-19 patients with moderate and severe manifestation ( P=0.100). There was no difference of native T 1 values and other functional and morphologic parameters of left ventricular and right ventricular among recovered COVID-19 patients with moderate and severe manifestation and control group ( P>0.05). Conclusion:CMR myocardial tissue ECV increase in patients who recovered from COVID-19, suggesting subclinical myocardial injury.

Objective: To explore the effect of hyperbaric oxygen preconditioning with different frequency on the survival rate of flap and ischemia-reperfusion injury in rats after transplantation, and to explore the best preconditioning conditions to improve the survival rate of rat flaps after transplantation. Methods: Thirty-six Sprague Dawley rats were randomly divided into four groups according to the random number table method, 9 groups in each group.Four groups of rats were pretreated with hyperbaric oxygen pretreatment for 0, 2, 4, and 6 days before the operation, control group, pretreatment 2 d group, pretreatment 4 d group, and pretreatment 6 d group. Taking the midline of the back of the rat as the axis, an ultra-long random flap with a pedicle at the tail end and about 1 cm from the superior iliac spine was designed and cut to a size of 10.0 cm×2.5 cm. The survival of the flaps in each group was observed and the final survival area and survival rate of the flaps were measured on the 7th day after surgery. On the 7th day after operation, the tissue was taken at a distance of 5 cm from the pedicle, and the histopathology was observed; The content of superoxide dismutase (SOD) and malondialdehyde (MDA) in flap tissue was detected by immunohistochemistry, and the expression rate of positive cells in each group was calculated. Immunofluorescence was used to detect the expression of interleukin-6 (IL-6) in the flap tissue. Results: On the 7th day after the operation, the survival area and survival rate of the transplanted flaps in the hyperbaric oxygen pretreatment group were significantly higher than those in the control group (P<0.05), and the pretreatment 4 d and 6 d groups were significantly higher than the pretreated 2 d group (P<0.05), but there was no significant difference between the pretreated 4 d group and the 6 d group (P=0.095). Pathological observation on the 7th day after operation showed that there was some necrosis in the control group, the vascular cells in the pretreated 2 d group had more vascular structures, and more neovascularization was observed in the pretreated 4 d group. The inflammatory cells were the least in the 6 d pretreatment group, and the neovascularization was the same as the pretreatment 4 d group. The absorbance A value of SOD in the control group was 0.009 7±0.000 3, and the positive expression rate was 20%, which was significantly lower than that in the hyperbaric oxygen pretreatment group. The difference was statistically significant (P<0.05). However, the absorbance A value of MDA in the control group was 0.055 1±0.003 0, and the positive expression rate was 55%, which was significantly higher than that in the hyperbaric oxygen pretreatment group. The difference was statistically significant (P<0.05). Among them, the SOD absorbance A value of the pretreated 2 d group was 0.023 8±0.003 0, and the positive expression rate was 30%, which was lower than the pretreatment 4 d group (absorbance A value 0.046 9±0.003 0, positive expression rate 35%) and 6 d group (absorbance A value 0.047 2±0.003 6, positive expression rate 40%), The MDA absorbance A value of the pretreated 2 d group was 0.037 2±0.003 2, and the positive expression rate was 30%, which was higher than the pretreatment 4 d group (absorbance A value 0.014 7±0.002 4, positive expression rate 5%) and 6 d group (absorbance A value 0.017 0±0.001 8, positive expression rate 10%), the difference was statistically significant (P<0.05). However, there was no significant difference in the expression of SOD and MDA between the pretreated 4 d group and the pretreated 6 d group (P>0.05). The expression of IL-6 in the hyperbaric oxygen pretreatment group was significantly lower than that in the control group (absorbance A value 44.937 0±0.594 0), the difference was statistically significant (P<0.05). The absorbance A value in the pretreated 2 d group was 41.698 0±0.724 0, which was significantly higher than the pretreatment 4 d group (absorbance A value 34.049 0±0.323 0) and 6 d group (absorbance A value 33.524 0±0.639 0). The difference was statistically significant (P<0.05). There was no significant difference in the expression of the pretreated 4 d group compared with the 6 d group (P=0.068). Conclusions Hyperbaric oxygen preconditioning can significantly promote the survival of rat flaps after transplantation. Preoperative hyperbaric oxygen preconditioning once daily for 4 consecutive days, can enhance the tolerance of flap tissue to ischemia and anoxia and reduce tissue ischemia-reperfusion injury.

BACKGROUND:Hyperbaric oxygen (HBO) therapy can aleviate the skin flap congestion by improving the angiogenesis and increasing the oxygen content of blood in skin flaps. Although the HBO therapy ability to increase flap survival has been wel described, the research on the application of HBO pretreatment in skin flap transplantation does not arouse adequate concern.
OBJECTIVE: To investigate the effect of HBO pretreatment on early-stage flap congestion in the rat model of over-length dorsal random skin flaps.
METHODS: Thirty-six SD rats were randomly divided into control group (n=12), HBO pretreatment group (n=12) and HBO treatment group (n=12). Rats in the HBO pretreatment group received 4 days of HBO therapy prior to transplantation, once a day. Rats in the HBO treatment group received 4 days of HBO therapy after transplantation. Rats in the control group were raised in the normal conditions after flap transplantation. At postoperative days 3 and 5, rats were sacrificed and the samples were colected. The inflammation of flap tissues was detected using hematoxylin-eosin staining. The expression of vascular endothelial growth factor and transforming growth factor-β was analyzed by immunohistochemistry staining. The flap survival rate was calculated at postoperative day 5.
RESULTS AND CONCLUSION:The flap survival area of the HBO pretreatment group and HBO treatment group was larger than that of the control group (P < 0.05). At postoperative days 3 and 5, the expression levels of vascular endothelial growth factor and transforming growth factor-β in the flap tissue were higher in the HBO pretreatment group and HBO treatment group than the control group (P < 0.05). However, there was no significant difference in the flap survival area and the expression of vascular endothelial growth factor and transforming growth factor-β between HBO pretreatment and HBO treatment groups (P > 0.05). HBO pretreatment can increase the expression of vascular endothelial growth factor and transforming growth factor-β and promotes angiogenesis in random pattern flaps,thereby improving skin flap survival.

BACKGROUND: A lot of researches have proved that polyglicolide acid (PGA), as a stent material, has been successfully used to construct engineered tissues, such as cartilage, bone and tendons, in nude mice or even big mammal. Whether the incubation of vascular endothelial cells and smooth muscle cells in the polyglicolide acid may subcutaneously construct vessel-like structure in nude mice needs a further study.OBJECTIVE: To verify the feasibility of forming vessel-like structure in the nude mice by subcutaneous implantation of polyglicolide acid cocultured with vascular endothelial cells and smooth muscle cells derived from newborn umbilical vein.DESIGN: Contrast study.SETTING: Tissue Engineering Key Laboratory, Medical College, Shanghai Jiao Tong University.MATERIALS: This study was performed at Tissue Engineering Key Laboratory, Medical College, Shanghai Jiao Tong University from January to June 2002. Belly band was derived from newborn babies in our department of obstetrics & gynecology. The parturien provided the informed consent, and this study was approved by the local research ethics committee. Twenty-six nude mice (3-4 weeks old, clean grade, irrespective of gender) were selected in this study. The animal experiment received confirmed consent from the local ethic committee. Polyglicolide acid was provided by Albany International Research Co.METHODS: Vascular endothelial cells and smooth muscle cells derived from newborn umbilical vein were incubated on a piece of polyglicolide acid to produce cell-material compound. In addition, the compound covered around the silicone tube to form a tube-like structural substance. Subsequently, the tube-like structural substance was subcutaneously implanted in 20 nude mice, which were regarded as an experimental group. And then, polyglicolide acid alone was subcutaneously transplanted in the rest 6 nude mice, which was regarded as a control group.MAIN OUTCOME MEASURES: Gross observations of cell-material compound by 2 and 6 weeks after transplantation;HE staining and immunohistochemical staining.detection; expression of factor Ⅷ and α-smooth muscle actin.RESULTS: Twenty-six nude mice were included in the final analysis. ① Gross observation: At 2 weeks after implantation,both the experimental and control groups formed tubular structures, however, at 6 weeks after implantation, the tubular structure still remained in experimental group but not in the controls. ② Histological observation and immunohistochemical detection: The histological examination of the engineered vessel showed that at 2 weeks, the vessels in both group contained mainly undegraded PGA fibers, while at 6 weeks, the PGA fibers were almost completely degraded in both groups and in the control group only fibrous-like tissue formed. Contrastly, in experimental group a typical vascular structure formed, Masson's trichrome stain, which stains collagen green, smooth muscle fibers red and cells purple, showed significant amounts of stainable collagen and smooth muscle fibers in the wall of the engineered vessel, furthermore,immunohistochemistry examination revealed that there were an endothelial cell layer formed in the inner surface of the engineered vessel which was confirmed by positive staining of yon Willebrand factor, meanwhile, the smooth muscle cells in the wall of the engineered vessel were confirmed by the positive staining of smooth muscle α-actin.CONCLUSION: The subcutaneous implantation of polyglicolide acid cocultured with vascular endothelial cells and smooth muscle cells may form vessels, which are similar to normal vascular histological structure.