Objective:To explore the risk factors analysis and validation of anemia after triple-negative breast cancer (TNBC) and risk prediction model, to provide reference for reducing the incidence of anemia after TNBC-NAC.Methods:Retrospectively, 316 female TNBC-NAC patients in the breast department of our hospital from January 2016 to July 2021 were selected as the study subjects (modeling set), and the condition of anemia after the last chemotherapy was set as the observation group. In addition, 98 breast cancer patients in 2022 were selected for validation. Multivariate Logistic regression was used to analyze the effect of Fukangning capsule on TNBC-NAC anemia. We established the risk nomogram prediction model and calibration curve of anemia after chemotherapy by using R software and conducted internal and external verification. Hosmer-Lemeshow test was used to evaluate the prediction deviation between the risk prediction value of the nomogram model and the actual observed value, and the ROC curve was used to evaluate the prediction effect of the model.Results:A total of 75 (23.73%) among 316 patients developed anemia. The results of multivariate Logistic regression analysis showed that menopause [ OR (95% CI)=26.739 (5.063-141.227)], RBC [ OR (95% CI)=0.168 (0.098-0.286)], Hb level [ OR (95% CI)=0.952 (0.929-0.976)], and pathological stage Ⅲ[ OR (95% CI)=4.182 (1.759-9.946)] were independent risk factors for anemia after TNBC-NAC ( P<0.05). The nomogram prediction model established based on the above factors. Hosmer-Lemeshow test results showed that the difference between the risk prediction value and the actual observed value is ( χ2=3.68, P=0.885). The correction curve approaches to the ideal curve and the average absolute error was 0.012. The area under the ROC curve was 0.945, 95% CI was 0.918-0.972, sensitivity was 0.921 and specificity was 0.853, suggesting that the model has good differentiation and calibration degree. The external validation results showed that the nomogram predicted anemia with sensitivity of 88.7%, spectificity of 85.45% and accuracy of 86.73%. Conclusion:Menopausal status, RBC, Hb level before chemotherapy and pathological stage are independent risk factors for anemia after taking TNBC-NAC. The nomogram prediction model based on the above indicators had good discrimination and calibration, and accurately predicted the possibility of anemia after TNBC-NAC.

Multiple plant lineages have independently evolved sex chromosomes and variable kary-otypes to maintain their sessile lifestyles through constant biological innovation.Morus notabilis,a dioecious mulberry species,has the fewest chromosomes among Morus spp.,but the genetic basis of sex determination and karyotype evolution in this species has not been identified.In this study,three high-quality genome assemblies were generated for Morus spp.[including dioecious M.notabilis(male and female)and Morus yunnanensis(female)]with genome sizes of 301-329 Mb and were grouped into six pseudochromosomes.Using a combination of genomic approaches,we found that the putative ancestral karyotype of Morus species was close to 14 protochromosomes,and that sev-eral chromosome fusion events resulted in descending dysploidy(2n=2x=12).We also charac-terized a～6.2-Mb sex-determining region on chromosome 3.Four potential male-specific genes,a partially duplicated DNA helicase gene(named MSDH)and three Ty3_Gypsy long terminal repeat retrotransposons(named MSTG1/2/3),were identified in the Y-linked area and considered to be strong candidate genes for sex determination or differentiation.Population genomic analysis showed that Guangdong accessions in China were genetically similar to Japanese accessions of mul-berry.In addition,genomic areas containing selective sweeps that distinguish domesticated mul-berry from wild populations in terms of flowering and disease resistance were identified.Our study provides an important genetic resource for sex identification research and molecular breeding in mulberry.

Objective:To investigate the relationship between peritoneal thickness and baseline solute transport function in peritoneal dialysis (PD) patients, and analyze the factors affecting the function of peritoneal transport.Methods:Non-diabetic end-stage renal disease (ESRD) patients admitted to the Second Hospital of Longyan City from January 2017 to June 2019 were enrolled in this study. The thickness of the peritoneal membrane was measured by color ultrasound instrument before the peritoneal catheterization. Standard peritoneal equilibration test (PET) was performed after one month of peritoneal dialysis. The ratio of corrected creatine in 4 h dialysate to 2 h serum creatine (D/Pcr) was used as a solute baseline transport index, and according to the D/Pcr evaluation results, the patients were divided into high/high average transfer (H) group (D/Pcr≥0.65) and low/low average transfer (L) group (D/Pcr<0.65). The clinical data, peritoneal thickness and peritoneal dialysis related indicators between the two groups of patients were compared. Binary logistic regression was used to analyze the factors affecting the function of peritoneal transport.Results:The amount of peritoneal ultrafiltration in H group was significantly lower than that in L group, intraperitoneal creatinine clearance (Ccr) and peritoneal thickness were significantly higher than those in L group (both P<0.05). Pearson and Spearman correlation results showed that the thickness of peritoneal membrane positively correlated with D/Pcr ( r=0.673, P<0.05), peritoneal Ccr ( r=0.261, P<0.05), and negatively correlated with ultrafiltration of peritoneal dialysis ( r=-0.365, P<0.05). Partial correlation analysis showed that the peritoneal thickness was positively correlated with the solute transport index D/Pcr ( r=0.539, P<0.05) and the peritoneal Ccr ( r=0.338, P<0.05). Binary logistic regression results showed that peritoneal thickening was a risk factor affecting peritoneal transport function ( OR=1.175, 95% CI 1.009-1.369, P<0.05). Conclusions:There is a positive correlation between the peritoneal membrane thickness and the baseline solute transport index in patients with non-diabetic peritoneal dialysis. Peritoneal thickening is a risk factor affecting peritoneal transport function.

Objective:To investigate the social function in young and middle-aged coronary disease patients after percutaneous coronary intervention (PCI) and to analyze its influencing factors so as to provide a basis for making clinical intervention.Methods:From February 2019 to September 2019, this study selected 240 young and middle-aged coronary disease patients after PCI reexamined in Cardiovascular Medicine of a ClassⅢ Grade A general hospital in Nanning as subjects by convenience sampling. All of patients were investigated with the General Information Questionnaire, Social Dysfunction Screening Scale (SDSS) , Brief Illness Perception Questionnaire (BIPQ) and Event Related Rumination Inventory (ERRI) . Binary Logistic regression was used to analyze the influencing factors.Results:Among 240 young and middle-aged coronary disease patients after PCI, the total score of SDSS was (3.98±2.58) . The incidence of social dysfunction was 72.9% (175/240) . Binary Logistic regression analysis showed that the influencing factors of social dysfunction in young and middle-aged coronary disease patients after PCI included the average monthly income per person in family ( OR=0.383) , illness perception ( OR=1.558) , objective rumination ( OR=0.643) with statistical differences ( P<0.01) . Conclusions:Social function in young and middle-aged coronary disease patients after PCI needs to be improved. Effective intervention based on influencing factors should be taken to reduce the incidence of social dysfunction in young and middle-aged coronary disease patients after PCI.

Objective: To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods: Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC-Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm, ≥1.0 cm, serum level of SCC-Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high-risk factors of common iliac lymph node (CILN) and para-aortic lymph node (PALN) metastases were also analyzed. Results: The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3% (48/81). The CILN and/or PALN metastasis rate was 24.7%(20/81), and among them, the MAD of CILN and/or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC-Ag for evaluating lymph node metastasis was 4.8 ng/ml. The accuracy, specificity and Youden index of SCC-Ag≥4.8+ MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC-Ag≥4.8 ng/ml group and 68.3%, 65.4% and 0.4 of SCC-Ag≥4.8 ng/ml+ MAD≥0.5 cm group (P<0.05). All of the 21 patients in SCC-Ag≥4.8 ng/ml+ MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and/or PALN was 38.1%. While only 4 cases of 17 patients in SCC-Ag<4.8 ng/ml+ MAD<1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P<0.001). The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and/or MAD of CILN and/or PALN was 0.5~1.0 cm were associated with the CILN and/or PALN metastases (all P<0.05). Conclusions Those patients with MAD≥1.0 cm+ SCC-Ag≥4.8 ng/ml and with high-risk factors of CILN and/or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC-Ag<4.8 ng/ml combined with MAD<1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

Objective To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC?Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm,≥1.0 cm, serum level of SCC?Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high?risk factors of common iliac lymph node (CILN) and para?aortic lymph node ( PALN) metastases were also analyzed. Results The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3%(48／81). The CILN and／or PALN metastasis rate was 24.7%(20／81), and among them, the MAD of CILN and／or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC?Ag for evaluating lymph node metastasis was 4.8 ng／ml. The accuracy, specificity and Youden index of SCC?Ag≥4.8+MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC?Ag≥4.8 ng／ml group and 68.3%, 65.4% and 0.4 of SCC?Ag≥4.8 ng／ml+MAD≥0.5 cm group ( P＜0.05). All of the 21 patients in SCC?Ag≥4.8 ng／ml+MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and／or PALN was 38.1%. While only 4 cases of 17 patients in SCC?Ag＜4.8 ng／ml+MAD＜1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P＜0.001).The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and／or MAD of CILN and／or PALN was 0.5～1.0 cm were associated with the CILN and／or PALN metastases ( all P＜0.05). Conclusions Those patients with MAD≥1.0 cm+SCC?Ag≥4.8 ng／ml and with high?risk factors of CILN and／or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC?Ag＜4.8 ng／ml combined with MAD＜1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

Objective To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC?Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm,≥1.0 cm, serum level of SCC?Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high?risk factors of common iliac lymph node (CILN) and para?aortic lymph node ( PALN) metastases were also analyzed. Results The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3%(48／81). The CILN and／or PALN metastasis rate was 24.7%(20／81), and among them, the MAD of CILN and／or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC?Ag for evaluating lymph node metastasis was 4.8 ng／ml. The accuracy, specificity and Youden index of SCC?Ag≥4.8+MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC?Ag≥4.8 ng／ml group and 68.3%, 65.4% and 0.4 of SCC?Ag≥4.8 ng／ml+MAD≥0.5 cm group ( P＜0.05). All of the 21 patients in SCC?Ag≥4.8 ng／ml+MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and／or PALN was 38.1%. While only 4 cases of 17 patients in SCC?Ag＜4.8 ng／ml+MAD＜1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P＜0.001).The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and／or MAD of CILN and／or PALN was 0.5～1.0 cm were associated with the CILN and／or PALN metastases ( all P＜0.05). Conclusions Those patients with MAD≥1.0 cm+SCC?Ag≥4.8 ng／ml and with high?risk factors of CILN and／or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC?Ag＜4.8 ng／ml combined with MAD＜1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

Objective: To introduce the laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branched and to evaluate its feasibility and safety for cervical cancer and its effect to bladder function and to provide some reference to simplify the surgical procedures of laparoscopic type C1 hysterectomy. Methods: The clinicopathologic data of the patients with stage ⅠA2~ⅡB cervical cancer and who underwent the laparoscopic C1 hysterectomy based on anatomic landmark of the uterus deep vein and its branches between March 2010 and December 2015 was retrospectively analysed. Results: A total of 99 patients received laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches, in which 93 patients reserved unilateral or bilateral pelvic autonomic nerve successfully, the other 6 patients were transfered to receive type C2 hysterectomy due to adhesions, bleeding or the low possibility of curative resection. The failure rate of the surgery was 6.1% (6/99). The average age of these 93 patients was 44.4±8.2 years (range 25~61 years) and there was one case of stage ⅠA2, 84 stage ⅠB1, 2 stage ⅠB2, 5 stage ⅡA1 and 1 stage ⅡB. The number of patients with squamous cell carcinoma was 67, adenocarcinoma was 19, adenosquamous carcinoma was 3, small cell neuroendocrine carcinoma was 3 and mixed type was 1. The average operation time was 4.1±0.5 h, the average amount of intraoperative blood loss was 103.8±84.0 ml and the mean number of excisional pelvic lymph nodes was 29.7±8.9. There was no patient with positive parametrial margin, positive vaginal margin or intraoperative ureteral injury. The postoperative catheter extraction time was 20.3±8.4 d. The median follow-up time was 20 months (rang 5~44 months), the long-term bladder dysfunction rate was 8.6% (8/93). The numbers of locally uncontrolled and distantly metastasis case were both one and both patients died. The fatality rate were 2.2% (2/93). The two-year disease-free survival and overall survival rate were 97.6% and 96.2%, respectively. Conclusion Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches is a safe and feasible treatment method for cervical cancer and it provides a new approach for simplifying the surgical procedures of laparoscopic type C1 hysterectomy.

Hypoxia,a salient feature of solid tumors,is often associated with invasiveness,metastasis and resistance to anticancer drugs.The strategies including the use of oxygen-carriers based on hyperbaric oxygen and blood substitutes to transport oxygen into tumors or in situ generation of O2from the tumor microenvironment endogenous H2O2have been explored to relieve the tumor hypoxia and to improve therapeutic efficiency.In addi-tion,it is potential to design hypoxia-responsive nanocarriers based on tumor hypoxia microenvironment to deliver anticancer drugs to the targeted tumor site,thereby improve drug concentrations in targeted site,significantly increase the antitumor efficiency and reduce the side-effects of drugs.This review gives an overview of the advances in relieving tumor hypoxia and hypoxia-responsive nanocarriers for tumor to provide a reference for the research and development of new antitumor drugs.

Objective To investigate the relationship between adhesion molecule CD44v6,intercellular adhesion molecule-1 (ICAM-1) and lymph node metastasis in early stage of cervical squamous cell carcinoma.Methods Seventy-four specimens of cervical cancer stage Ⅰ b1,20 specimens of normal cervical tissue and 20 specimens of cervical squamous cell in situ carcinoma were collected from Jiangxi Provincial Maternal and Child Health Care Hospital.The expression of CD44v6 and ICAM-1 in cervical tissue was detected by real-time PCR and immunohistochemistry.The lymphatic vessel density (LVD) labeled by D2-40 was detected by immunohistochemistry.The relationship of CD44v6,ICAM-1 and LVD with the differentiation degree and lymph mode metastasis was investigated.Results The positive expression rate of CD44v6 and ICAM-1 in normal cervix,cervical squamous cell carcinoma in situ,and cervical carcinoma tissues was gradually increased,which were 0,75.00％,87.84％ and 10.00％,45.00％,81.08％ respectively.Their mRNA expression amount was gradually increased,which were 0,0.24±0.02,1.02±0.11 and 0.10 ± 0.00,0.19±0.02,1.03 ± 0.10 respectively,the differences were statistically significant (P＜0.01).LVD was gradually increased in normal cervix,cervical squamous cell carcinoma in situ,and cervical carcinoma (P＜0.01).The expression of CD44v6,ICAM-1 and LVD in low differentiated cervical carcinoma tissue was higher than that in high and middle differentiated cervical carcinoma (P＜0.01).The expression of CD44v6,ICAM-1and LVD in lymph node metastasis was higher than that in non-lymph node metastasis (P＜0.01).The expression of CD44v6,ICAM-1 and LVD in cervical cancer tissue had each two positive correlation (P＜0.01).Conclusion CD44v6 plays a promoting role in the progression of cervical cancer,which with ICAM-1 and LVD synergically promote the cervical cancer development,and could be used as an effective indicator for judging lymph node metastasis and diagnosis of cervical cancer.