Objective:To summarize the serious complications and salvage methods and experience of breast reconstruction with free flap transplantation.Methods:Different techniques of free flap transplantation were used for breast reconstruction in 395 breast cancer patients who came to Hunan Cancer Hospital from September 2015 to December 2021. 45 complications occurred during and after surgery, including 21 serious complications. Corresponding salvage method was used for complications and flap failure. Salvage methods included free gracilis myocutaneous flap combined with adductor magnus perforator flap, free adductor magnus perforator flap transplantation, pedicled rectus abdominis flap transplantation, pedicled latissimus dorsi myocutaneous flap, prosthetic replacement, vascular grafting, vascular reanastomosis and release of vascular tension area.Results:The specific causes and salvage methods in 21 cases of reoperation included: 3 cases of excessive tension or compression of vascular pedicle, of which 1 case was successfully salvaged; in 2 cases flap failure was occurred, of which 1 case was replaced with prosthesis, and 1 case was salvaged with free gracilis myocutaneous flap combined with adductor magnus perforator flap; one case of vascular embolism caused by poor quality of vascular anastomosis was successfully salveged by vascular re anastomosis. One case had poor recipient vessels, and the flap failure was salvaged with pedicled latissimus dorsi flap. Three patients had poor compliance, of which one case was successfully salvaged, and the other two cases had total flap failure, which were repaired by free adductor magnus perforator flap and free gracilis myocutaneous flap combined with adductor magnus perforator flap respectively. Two patients had menstrual postoperatively, resulting in flap failure. Free gracilis myocutaneous flap combined with adductor magnus perforator flap and free adductor magnus perforator flap were used for breast reconstruction respectively. In 1 case, the blood supply was affected by excessive flap trimming, and the flap failure was salvaged by free adductor magnus perforator flap. 10 cases of subcutaneous hematoma were treated with debridement and exploration, and all were successfully salvaged.Conclusions:The complications and failure of free flap for breast reconstruction cannot be completely avoided. It is very important to master the corresponding salvage methods.

Gastric cancer is one of the major diseases threatening human health, with a high incidence and a low early diagnostic rate. There are many bottlenecks encountered during its treatment. Consequently, improving the early diagnostic rate and exploring new therapeutic targets are currently urgent challenges that need to be addressed. Telomerase is undetectable in normal tissues, but it exhibits high specificity and sensitivity in most cancers and has a definite correlation with prognosis. It may serve as a serum tumor marker and prognostic indicator. Human telomerase reverse transcriptase (hTERT) gene polymorphism can regulate the susceptibility of people to gastric cancer, and affect the occurrence, development, proliferation and apoptosis of gastric cancer through its target gene. Substances such as resistin, visfatin, G-quadruplex and methylenedioxyaniline can affect the occurrence and development of gastric cancer by regulating telomerase expression. The mechanism by which hTERT regulates tumor invasion and metastasis is currently unclear, so elucidating its mechanism is of great significance.This paper will review the research progress of this mechanism in recent years.

Objective To observe the expressions of endoplasmic reticulum chaperone (ERP57) and endoplasmic reticulum aminopep-tidase (ERAP1) in female breast cancer, and to explore their relationship with clinical pathological parameters of breast cancer. Methods A total of 124 samples of breast cancer and 24 samples of breast fibroadenoma were collected in the Affiliated Tumor Hospital of Xinjiang Medical University from January 2011 to December 2015. The expressions of ERP57 and ERAP1 were detected by immunohistochemistry SP method. The patients were divided into two groups according to the clinicopathological parameters. The differences of ERP57 and ERAP1 expression were analyzed between the groups. Results The positive expression rates of ERP57 were 58.8% (73/124) and 100% (24/24) in breast cancer and breast fibroadenoma samples, respectively. The difference was statistically significant (χ2=15.061, P<0.05). The positive expression rates of ERAP1 were 47.5%(59/124) and 83.3%(20/24), and there was a difference between them (χ2=10.328, P<0.05). The positive expression rates of ERP57 and ERAP1 in breast cancer samples were higher in patients without axillary lymph node metastasis than those in patients with axillary lymph node metastasis; which were higher in patients with histological gradeⅠcompared with those in patients with histological grade ⅡandⅢ;which were higher in patients with TNM stage Ⅰ-Ⅱ than those in patients with TNM stage Ⅲ-Ⅳ. There were significant differences between these groups (P<0.05). In addition, the positive expression rate of ERAP1 in breast cancer was higher in patients more than 35 years old than those in patients under 35 years old. The positive rate of Ki67 was higher in patients≤14%than that in patients >14%, and which was significantly higher in patient with non-triple negative than that in patients with the triple negative (P<0.05). Conclusion The low expression levels of ERP57 and ERAP1 may play an important role in the carcinogenesis of breast cancer, and which may be valuable in judging the malignant degree and prognosis of breast cancer.