ObjectiveTo review the current situation of total knee arthroplasty (TKA) used in young patients with osteoarthritis. MethodsThe recent literature in the treatment of osteoarthritis with TKA in young patients was extensively reviewed. The characteristics, curative effect, and postoperative satisfaction degree of TKA in young patients were analyzed and summarized. ResultsYoung patients have longer life expectancy and higher activity, which may lead to much higher expectation of the TKA. Comparing with elderly patients, young patients obtain equal or better effectiveness after TKA, but they are likely to not be satisfied with the effects because of low survival rate of the prosthesis. At present, continuous development of implant design, prosthesis material, and operation technique are in progress to reduce wear, hence to prolong the implant survivorship so as to meet the desire of young patients. However, the studies of the big samples and long-term follow-up are required to confirm the clinical advantages of such developments. ConclusionWith the trend of TKA in young patients, surgeons should have a good understanding of the patients' demands, select suitable prosthesis and give appropriate preoperative counseling to build up an objective expectation of curative effect, which will lead to a better doctor-patient relationship.
ObjectiveTo study the effectiveness of facial meticulous fat grafting by fat granules injection asistor. MethodsBetween January and August 2015, 46 patients received facial autologous fat grafting for rejuvenation. There were 7 males and 39 females, aged 21-65 years (mean, 34 years). Firstly, the faces were divided into 10 cosmetic zonations according to facial aesthetic criteria, then autologous fat grafting was carried out by fat granules injection asistor. The autologous fat was filled into 1, 2, 3, 4, 5, 6, 7, 8, and 9 cosmetic zonations in 3, 7, 5, 3, 8, 4, 2, 10, and 4 cases respectively; the injected fat amount was 2-110 mL (mean, 47 mL). ResultsThe swelling period was from 5 to 15 days after operation (mean, 7 days), and there were no complications of infection, cyst, introvascular thrombogenesis, and so on. They were followed up 1-7 months (mean, 3 months). The effect of face rejuvenation was satisfactory. ConclusionCosmetic zonation of face is helpful for preoperative evaluation of autologous fat grafting, and the fat granules injection asistor is beneficial to reach better effect of face rejuvenation.
Objective To summarize the progress of effect of gonadotropin-releasing hormone agonist on protecting ovarian function of young breast cancer patients who received chemotherapy, and to provide reference for clinical work. Methods Through searching of PubMed, CNKI, WanFang database, and other databases, we mainly collected relevant literatures in nearly five years, which concerning the effect of gonadotropin-releasing hormone agonist on protecting the ovarian function of young breast cancer patients who received chemotherapy. Results Young breast cancer patients faced with problems about long-term survival, quality of life, social psychological pressure, and other related problems. Chemotherapy caused irreversible damage to the ovarian function. Chemotherapy combind with gonadotropin-releasing hormone agonist could prevent premature ovarian failure and improve patients’ quality of life. Conclusions Gonadotropin-releasing hormone agonist combines with chemotherapy can protect the ovarian function of young breast cancer patients, and reduce premature ovarian failure and retain reproductive function with no serious adverse effect. In addition, it shall not affect the curative effect of chemotherapy itself, but this conclusion still needs further randomized controlled clinical trial to confirm.
Facial aging is caused by several aspects involving skin, its deep soft tissue (fat, muscles, fascia ligaments, etc), and bones. The skin presents deepen wrinkles, darker, drying, and roughness. Volume loss and sag caused by gravity can be seen in deep soft tissue. And selective absorption can be seen in bones. At present, to combat facial aging caused by different causes, we have adopted comprehensive treatment methods such as facial rhytidectomy, embedded wire ascension, autogenous fat graft, hyaluronic acid or botulinum toxin injection, and optoelectronic techniques, etc.
ObjectiveTo investigate the clinicopathological characteristics and prognosis of young patients with non-small cell lung cancer (NSCLC).MethodsA total of 5320 patients with primary NSCLC from 2008 to 2014 were included and then divided into four groups according to their age, ie. a young group (≤ 45 years), a middle-young group (46 - 60 years), a middle-old group (61 - 75 years) and an old group (≥76 years). The clinicopathological manifestation and overall survival (OS) of the patients among the different age groups were compared.ResultsThe patients aged 45 years or younger accounted for 12.1% of all NSCLC cases. The proportions of females, never-smokers and adenocarcinoma were 49.9%, 65.9% and 74.0% in the young group, higher than those in the other three age groups (P<0.001 for all). And the proportion of Ⅲ/Ⅳ stage tumor was 84.3% in the young group, just less than that in the old group (87.9%; P<0.001). Patients in the young group were more likely to receive surgery (30.5%) and chemotherapy (38.9%), and got comparatively favorable OS compared with the patients in other age groups (P>0.05 for all).ConclusionsNSCLC occurring in young population is not rare. Young patients with NSCLC have unique clinicopathological characteristics, with more females, never-smokers and adenocarcinomas. Young patients with NSCLC may choose aggressive treatment approaches, such as surgery and chemotherapy, thus get a comparatively favorable prognosis.
ObjectiveTo review the pathological effects of cellular senescence in the occurrence and development of osteoarthritis (OA) and potential therapeutic targets.MethodsThe role of chondrocyte senescence, synovial cell senescence, mesenchymal stem cells senescence in OA, and the biological mechanism and progress of chondrocyte senescence were summarized by consulting relevant domestic and abroad literature.ResultsThe existing evidence has basically made clear that chondrocyte senescence, mesenchymal stem cells senescence, and cartilage repair abnormalities, and the occurrence and development of OA have a certain causal relationship, and the role of the senescence of synovial cells, especially synovial macrophages in OA is still unclear. Transcription factors and epigenetics are the main mechanisms that regulate the upstream pathways of cellular senescence. Signal communication between cells can promote the appearance of senescent phenotypes in healthy cells. Targeted elimination of senescent cells and promotion of mesenchymal stem cells rejuvenation can effectively delay the progress of OA.ConclusionCellular senescence is an important biological phenomenon and potential therapeutic target in the occurrence and development of OA. In-depth study of its biological mechanism is helpful to the early prevention and treatment of OA.
Objective To explore the axillary lymph node dissection (ALND) could be safely exempted in younger breast cancer patients (≤40 years of age) who receiving breast-conserving surgery combined with radiotherapy in metastasis of 1–2 sentinel lymph node (SLN) and T1–T2 stage. Methods The data of pathological diagnosis of invasive breast cancer from 2004 to 2015 in SEER database were extracted. Patients were divided into SLN biopsy group (SLNB group) and ALND group according to axillary treatment. Propensity matching score (PSM) method was used to match and equalize the clinicopathological features between two groups at 1∶1. Multivariate Cox proportional risk model was used to analyze the relationship between axillary management and breast cancer specific survival (BCSS), and stratified analysis was performed according to clinicopathological features. Results A total of 1 236 patients with a median age of 37 years (quartile: 34, 39 years) were included in the analysis, including 418 patients (33.8%) in the SLNB group and 818 patients (66.2%) in the ALND group. The median follow-up period was 82 months (quartile: 44, 121 months), and 111 cases (9.0%) died of breast cancer, including 33 cases (7.9%) in the SLNB group and 78 cases (9.5%) in the ALND group. The cumulative 5-year BCSS of the SLNB group and the ALND group were 90.8% and 93.4%, respectively, and the log-rank test showed no significant difference (χ2=0.70, P=0.401). After PSM, there were 406 cases in both the SLNB group and the ALND group. The cumulative 5-year BCSS rate in the ALND group was 4.1% higher than that in the SLNB group (94.8% vs. 90.7%). Multivariate Cox proportional hazard analysis showed that ALND could further improve BCSS rate in younger breast cancer patients [HR=0.578, 95%CI (0.335, 0.998), P=0.049]. Stratified analyses showed that ALND improved BCSS in patients diagnosed before 2012 or with a character of lymph node macrometastases, histological grade G3/4, ER negative or PR negative. Conclusions It should be cautious to consider the elimination of ALND in the stage T1–T2 younger patients receiving breast-conserving surgery combined with radiotherapy when 1–2 SLNs positive, especially in patients with high degree of malignant tumor biological behavior or high lymph node tumor burden. Further prospective trials are needed to verify the question.
Objective To explore the clinicopathological features of bilateral primary breast cancer (BPBC) at different ages. Methods Clinical data of 105 BPBC patients admitted to the Department of Breast Surgery in The First Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were collected and divided into young group (≤40 years old) and middle-old group (>40 years old) according to age. The characteristics and differences of bilateral tumor lesions in pathological type, molecular type, tumor diameter, histological grade, clinical stage, lymph node metastasis, recurrence or distant metastasis, immunohistochemical indexes expression characteristics, consistency and difference, and overall prognosis between the two groups were retrospectively analyzed. Results There were statistically significant differences between the two groups in the size of the first primary cancer, lymph node metastasis, the high expression rate of Ki-67 in the second primary cancer, clinical stage of double primary cancer and recurrence or distant metastasis (P<0.05). In the young group, the proportion of the first primary cancer with T3–T4 stage was higher, the incidence of lymph node metastasis was higher, the proportion of high expression of Ki-67 in the second primary cancer was higher, and the proportion of patients with double primary cancer at first diagnosed as stage Ⅳ were higher than those in the middle-old group, and were prone to recurrence or distant metastasis. The expression of immunohistochemical indexes in bilateral cancer foci was consistent between the two groups (P<0.05). The expression consistency of ER and Ki-67 in the young group was better, and the expression consistency of PR and HER-2 in the middle-old group was better. The histological grade of the first primary cancer, TNM stage of bilateral primary cancer and recurrence or metastasis were independent factors affecting the prognosis of patients (P<0.05). Conclusions The BPBC patients of different ages have different clinicopathological features, and the expression of immunohistochemical indexes in bilateral cancer foci is consistent. Tumor histological grade of the first primary cancer may affect the prognosis of patients with BPBC, and the prognosis of patients with early bilateral TNM stage is better.
ObjectiveTo review the research progress of the application of autologous fat grafting in perioral and lower face rejuvenation. Methods By extensively reviewing related articles and combining the clinical experiences, the anatomic features (fat compartments and blood supply), aging features of the perioral and lower face, and the application advancement and related complications of autologous fat grafting in this area were generally summarized. Results The aesthetic features of perioral and lower face include the lip, chin, and so on, and the anatomic structures relating autologous fat grafting include the mandibular fat compartments, chin fat compartments, and other fat compartments. Meanwhile, the facial artery passes through this area and spreads out several important branches. The aging features of perioral and lower face include the depening of nasolabial fold, the aging lip, perioral wrinkles, “marionette lines”, and so on. Autologous fat grafting can improve perioral and lower face rejuvenation by restoring volume loss of facial fat compartments, correcting aging malformation, and improving skin quality. But there are neurovascular injuries, facial aesthetic problems, and other related complications. ConclusionAutologous fat grafting can be applied in perioral and lower face rejuvenation, and it can effectively improve related aging features. There are several aspects developing aggressively, including the research of facial asthetics features of Chinese people, combining autologous fat grafting with surgery as well as other methods to comprehensively treat facial aging, and the application of fat tissue related derivatives in perioral and lower face rejuvenation. However, the resorption rate of facial grafted fat tissue is still too high, and the long-term effectiveness can not be assured. In the future, the solutions related to improving the survival rate of grafted fat tissue need to be explored in the future.