目的 评价凋亡相关基因bcl-2、p53的表达与乳腺癌新辅助化学疗法（化疗）疗效的关系。 方法 计算机检索Cochrane、Pubmed、Embase、中国知网、万方、维普等数据库，2003年4月－2013年4月bcl-2、p53蛋白与乳腺癌新辅助化疗的病例对照研究，应用RevMan 4.2统计软件进行定量分析。 结果 共纳入15篇病例对照研究，bcl-2与乳腺癌新辅助化疗6篇，治疗有效279例，其中bcl-2表达阳性159例；治疗无效115例，其中bcl-2表达阳性57例。p53与乳腺癌新辅助化疗13篇，治疗有效679例，其中p53表达阳性249例；治疗无效341例，其中p53表达阳性195例。Meta分析结果显示，bcl-2表达的阳性率与乳腺癌新辅助化疗疗效无统计学意义[OR=1.40，95%CI（0.89，2.18），P=0.14]，而p53表达的阳性率与乳腺癌新辅助化疗疗效有统计学意义[OR=0.46，95%CI（0.26，0.80），P=0.007]。 结论 p53可以作为乳腺癌新辅助化疗疗效敏感性的一个指标，对乳腺癌新辅助化疗有提示作用。
ObjectiveTo compare the effects of piriformis muscle release versus preservation in total hip arthroplasty (THA) via supercapsular percutaneously-assisted total hip (SuperPATH) approach on muscle injury. MethodsForty-nine patients undergoing initial THA via SuperPATH approach between June 2022 and June 2023 were randomly divided into two groups, with 24 patients in trial group and 25 patients in control group. The trial group received piriformis muscle release intraoperatively, whereas the control group underwent muscle preservation. There was no significant difference in baseline data such as gender, age, body mass index, disease type, American Society of Anesthesiologists (ASA) grading, and preoperative muscle infiltration, muscle atrophy, muscle injury serological indicators, Harris score, etc. (P>0.05). The incision length, operation time, intraoperative blood loss, total blood loss, hospital stay, preoperative and postoperative 1-day muscle injury serological indicators [including creatine kinase (CK) and lactic dehydrogenase (LDH)], and incidence of complications between two groups were recorded. Harris score was used to evaluate the recovery of hip joint function. MRI was used to evaluate the extent of hip muscle injuries (gluteus minimus, gluteus medius, piriformis, obturator internus, quadratus femoris), including tendon integrity, degree of muscle fat infiltration, and degree of muscle atrophy preoperative and 1 year postoperatively. ResultsThe operation time, intraoperative blood loss, and total blood loss in the trial group were significantly shorter than those in the control group (P<0.05). There was no significant difference in the incision length and length of hospital stay between the two groups (P>0.05). Both groups showed a significant increase in serum CK and LDH levels on postoperative day 1 compared to preoperative levels (P<0.05), but there was no significant difference between the two groups (P>0.05). All patients were followed up, the follow-up time for the trial group and the control group was (14.8±2.8) and (15.1±3.0) months, respectively, with no significant difference (t=−0.400, P=0.691). Incisions healed by first intention in both groups, with 1 case in the trial group and 2 cases in the control group experiencing venous thrombosis in the calf muscle space. There was no complication such as deep vein thrombosis, pulmonary embolism, hip dislocation, prosthesis loosening, or periprosthetic infection in the lower limbs. There was no significant difference in the incidence of complications between the two groups (P>0.05). At 1 year after operation, both groups of patients showed a significant increase in Harris scores compared to preoperative levels (P<0.05), but there was no significant difference between the two groups (P>0.05). Compared with preoperative results, both groups showed significant fat infiltration in the piriformis and obturator muscles at 1 year after operation (P<0.05), while there was no significant fat infiltration in the gluteus minimus, gluteus medius, and quadratus femoris muscles (P>0.05). At 1 year after operation, except for the higher incidence of piriformis muscle fat infiltration in the control group compared to the trial group (P<0.05), there was no significant difference in the incidence of other muscle infiltrations between the two groups (P>0.05). At 1 year after operation, both groups of piriformis and obturator muscles showed significant muscle atrophy compared to preoperative levels (P<0.05). The gluteus minimus and gluteus medius showed mild atrophy compared to preoperative levels, while the maximum transverse diameter of the quadriceps muscle slightly increased, but the differences were not significant (P>0.05). There was no significant difference in the maximum cross-sectional diameter or cross-sectional area changes of each muscle between the two groups (P>0.05). At 1 year after operation, the continuity of the gluteus medius and quadratus femoris muscles in both groups was intact. Both groups had some patients with incomplete continuity of the piriformis muscle, obturator internus, and gluteus minimus, but the difference was not significant (P>0.05). ConclusionThe SuperPATH approach THA may cause injury to the piriformis, gluteus minimus, and obturator internus. The piriformis muscle release does not increase muscle injury, but it can shorten the operation time and reduce bleeding.
Uveitis is a group of inflammatory diseases affecting the uveal tract, retina, retinal blood vessels and vitreous. Due to its complex etiology, various entities, diverse and lack of constancy in treatment, some patients can experience visual impairment and even loss. In view of the fact that blindness caused by uveitis is mostly incurable and occurs usually in young and middle-aged people, it accounts for an important part of blinding eye diseases and has attracted worldwide attention. With the continuous development of precision medicine, clinicians will face new problems and challenges in disease diagnosis, and further in-depth research is needed to explore more optimized and efficient diagnostic processes and examinations to improve the diagnosis of uveitis in China.
目的 探讨应用负压辅助愈合治疗系统（V.A.C. Therapy）在胸、腹、背部断层皮片游离移植术后加压固定的有效性。 方法 2010年10月－2011年10月，应用V.A.C. Therapy加压固定游离断层皮片修复21例胸、腹、背部皮肤软组织缺损患者。男15例，女6例；年龄21～63岁，平均43岁。其中瘢痕切除后创面13例，皮瓣切取后供瓣区形成的创面8例。创面位于胸部7例，腹部9例，背部5例。皮肤及软组织缺损范围12 cm×10 cm～18 cm×15 cm。游离移植的断层皮片厚度为0.6 mm，在缺损部位移植断层皮片后，使用V.A.C. Therapy固定皮片，压力范围100～125 mm Hg （1 mm Hg=0.133 kPa）。 结果 住院时间19～32 d，平均24 d。21例植皮均成活，受区创面Ⅰ期愈合；供皮区创面Ⅰ期愈合。随访时间6～12个月，平均8个月。游离移植皮肤色泽与周围皮肤色泽相似，无破溃，无明显凹陷。 结论 应用V.A.C. Therapy加压固定的游离断层皮片，成活率高，效果可靠，是一种安全实用的固定方法。
Objective To systematically evaluate the difference in leg length discrepancy (LLD) between robot-assisted total hip arthroplasty (THA) and traditional THA. Methods The Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP, and CBM databases were searched by computer to collect cohort studies of robot-assisted and traditional THAs from inception to August 11th, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 high-quality cohort studies were included. The results of Meta-analysis showed that compared with traditional THA, LLD after robot-assisted THA was smaller [MD=−1.64, 95%CI (−2.25, −1.04), P<0.001], Harris scores at 3 and 12 months after operation were higher [MD=1.50, 95%CI (0.44, 2.57), P=0.006; MD=7.60, 95%CI (2.51, 12.68), P=0.003]. However, the operative time was longer [MD=8.36, 95%CI (4.56, 12.17), P<0.000 1], and the postoperative acetabular anteversion angle was larger [MD=1.91, 95%CI (1.43, 2.40), P<0.001]. There was no significant difference in Harris score at 6 months, amnesia index (Forgotten joint score, FJS), postoperative acetabular abduction angle, and incidence of complication between the two groups (P>0.05). Conclusion Robot-assisted THA is superior to traditional THA in postoperative LLD.
Quantitatively analyzing hematoxylin & eosin (H&E) histopathology images is an emerging field attracting increasing attentions in recent years. This paper reviews the application of computer-aided image analysis in breast cancer prognosis. The traditional prognosis based on H&E histopathology image for breast cancer is firstly sketched, followed by a detailed description of the workflow of computer-aided prognosis including image acquisition, image preprocessing, regions of interest detection and object segmentation, feature extraction, and computer-aided prognosis. In the end, major technical challenges and future directions in this field are summarized.
Early screening is an important means to reduce breast cancer mortality. In order to solve the problem of low breast cancer screening rates caused by limited medical resources in remote and impoverished areas, this paper designs a breast cancer screening system aided with portable ultrasound Clarius. The system automatically segments the tumor area of the B-ultrasound image on the mobile terminal and uses the ultrasound radio frequency data on the cloud server to automatically classify the benign and malignant tumors. Experimental results in this study show that the accuracy of breast tumor segmentation reaches 98%, and the accuracy of benign and malignant classification reaches 82%, and the system is accurate and reliable. The system is easy to set up and operate, which is convenient for patients in remote and poor areas to carry out early breast cancer screening. It is beneficial to objectively diagnose disease, and it is the first time for the domestic breast cancer auxiliary screening system on the mobile terminal.
【 Abstract 】 Objective To discuss incidence of the complications in the rectal cancer patients ’ early postoperative being treated with neoadjuvant chemotherapy combined with surgical intervention. Methods The rectal cancer patients under surgical therapy being diagnosed definitely, with neoadjuvant chemotherapy under multi-disciplinary team (MDT) or without and firstly being discovered from April to October of 2007 were studied. The complication conditions of these patients 1 month after operation were studied and observed, and the differences between MDT group and non-MDT group were compared. Results According to the condition, 189 rectal cancer patients were internalized. Among all the patients, the distance of tumor to the dentate line were lt;3 cm 38 cases, 3 ～ 7 cm 86 cases, ≥ 7 cm 65 cases; pathological stage were Ⅰ stage 5 cases ， Ⅱstage 122 cases， Ⅲstage 50 cases， Ⅳstage 12 cases. There were 181 cases laparotomy, 8 cases laparoscopic operation; 33 cases stoma operation, 156 cases non-stoma operation. The total incidence of postoperative complication was 27.0% （51/189）. Of all, incision bleeding was 1 case, abdominal (deep) bleeding were 4 cases, anastomosis bleeding were 5 cases, pulmonary infection was 1 case, wound infection were 7 cases, urinary tract infection were 3 cases, abdominal (deep) infection was 1 case, unknown fever were 19 cases, superficial layer wound dehiscence was 1 case, wound co-liquation were 15 cases, anastomosis leakage were 3 cases, rectovaginal fistula were 2 cases; intestinal obstruction were 7 cases, urinary retention were 7 cases, stress ulcer were 2 cases. Follow-up in 2-10 months after operation, there was no death case. The baseline between MDT group and non-MDT group was equal. The ratio of postoperative blood transfusion of MDT group was obviously less than that of non-MDT group （P＜0.05）. Moreover, the operation time of MDT group was obviously shorter than that of non-MDT group, and the difference was statistically significant （P＜0.05）. But the ratio of laparotomy and laparoscopic operation, of stoma operation and non-stoma operation, as well as the types of radical excision operation of rectal cancer didn’t show any statistical difference between two groups (Pgt;0.05). The postoperative venting time, defecation time, intake time didn’t show any statistical difference between two groups too. But the postoperative out-of-bed activity time and the postoperative in-hospital days of MDT group was obviously shorter than that of non-MDT group, and the difference was statistically significant （P＜0.05）. In MDT group the postoperative total complication rate was less than non-MDT group, and the difference was statistically significant （P＜0.05）. Among all the complications, the MDT group had a lower rate of wound infection, wound co-liquation and urinary retention （P＜0.05）. Using multifactorial logistic regression analysis, the risk factor which influenced the postoperative complication rate in MDT group were: postoperative intake time and postoperative hospitalization time. But the risk factor in non-MDT group was only according to postoperative hospitalization time. Conclusion The patients who were treated by MDT, definite operative method combining neoadjuvant chemotherapy or not didn’t increase the postoperative complication rate and risk. So it could be believed that such a composite treatment was feasible and safe in early postoperative stage. But it needs further studies to evaluate the medium- and long-term clinical effect.