ObjectiveTo understand the application of acellular dermal matrix (ADM) in implant-based breast reconstruction. MethodLiteratures on application of ADM in the implant-based breast reconstruction were reviewed. ResultsADM was widely used in the implant-based breast reconstruction and revisionary breast surgery. ADM could help to achieve a better reconstruction outcome by precisely locating the inferior mammary fold and strengthening the local control of the implant. However, whether ADM might increase the postoperative complications was controversial. ConclusionADM assisted implant-based breast reconstruction could achieve a better cosmetic outcome, but the large sample randomized controlled trial is needed to evaluate the application effect and risk of ADM.
ObjectiveTo summarize the isolation procedures, molecular characterization, and differentiation and vascularization capacity of adipose-derived stem cells (ADSCs), in order to discuss the potential value of ADSCs for the repairment and regeneration of adipose tissues. MethodsRelated literatures about ADSCs were retrieved to summarize the potential value of ADSCs for the repairment and regeneration of adipose tissues. ResultsAs mesenchymal stem cells, ADSCs was rich in human adipose tissues. ADSCs possessed the potential to differentiate toward a variety of cell lineages, such as adipogenic, chondrogenic, osteogenic, cardiomyogenic, myogenic, and angiogenic. Besides, its capacity of adipogenic differentiation could maintain several passages. The most importantly, ADSCs could secrete significant amounts of angiogenesis-related cytokines, such as vascular endothelial growth factor (VEGF) and fibroblast growth factor-2 (FGF-2), which increased the angiogenesis of adipose tissue. ConclusionsADSCs play a key role in adipose tissue engineering, autologous adipose tissue grafting, and soft tissue wound repairing, which have important application prospect for breast reconstruction.
ObjectiveTo review the properties of bio-derived hydrogels and their application and research progress in tissue engineering. MethodsThe literature concerning the biol-derived hydrogels was extensively reviewed and analyzed. ResultsBio-derived hydrogels can be divided into single-component hydrogels (collagen,hyaluronic acid,chitosan,alginate,silk fibroin,etc.) and multi-component hydrogels[Matrigel,the extract of extracellular matrix (ECM),and decellularized ECM].They have favorable biocompatibility and bioactivity because they are mostly extracted from the ECM of biological tissue.Among them,hydrogels derived from decellularized ECM,whose composition and structure are more in line with the requirements of bionics,have incomparable advantages and prospects.This kind of scaffold is the closest to the natural environment of the cell growth. ConclusionBio-derived hydrogels have been widely used in tissue engineering research.Although there still exist many problems,such as the poor mechanical properties,rapid degradation,the immunogenicity or safety,vascularization,sterilization methods,and so on,with the deep-going study of optimization mechanism,desirable bio-derived hydrogels could be obtained,and thus be applied to clinical application.
ObjectiveTo review the application and research progress of autologous fat grafting in breast reconstruction. MethodThe recent literature concerning the technique, postoperative outcome, or limitations of autologous fat grafting in breast reconstruction was extensively consulted and reviewed. ResultsThere are several ways of breast reconstruction using autologous fat for patients who underwent mastectomy or breast conserving surgery. The complication incidence of fat grafting in breast reconstruction is low. Although the long-term outcome is unsteady, the aesthetic outcomes of autologous fat grafting can still reach a high satisfaction. However, the oncological safety of autologous fat grafting in women with breast cancer has not been fully proved. ConclusionsThe remarkable progress has been made in the researches of autologous fat grafting, and it is an effective method in breast reconstructive surgery. Studies with high quality and longer follow-up data are urgently required to assess the oncological safety of autologous fat grafting.
ObjectiveTo summarize the progress in mechanisms of resistance to trastuzumab in treating human epidermal growth factor receptor 2 (HER2)-positive breast cancer. MethodsBy searching Pubmed and CNKI, the literatures of mechanisms of resistance to trastuzumab in treating HER2-positive breast cancer were reviewed. ResultsThe possible mechanism of resistance to trastuzumab are thought to include HER2 gene amplification and high protein expression; impaired access of trastuzumab to HER2; bidirectional crosstalk between ER and HER2; HER2 downstream signal transduction pathway activation; expansion expression of other RTKs and membrane-associated receptors; alterations in apoptosis and cell cycle control as well as multi-gene mutation, etc. ConclusionsMechanisms of trastuzumab resistance in HER2-positive breast cancer is complicated, a better understanding will be achieved by comprehensive analysis of existing possible mechanisms. The outcome of HER2-positive breast cancer patients who developed resistance to trastuzumab will be improved by appropriate multi-target regime.
ObjectiveTo summarize the clinicopathological characteristics of 94 patients with pure mucinous breast carcinoma (PMBC), and to retrospectively analyze the prognosis and the prognostic factors. MethodsNinety four patients who were pathologically diagnosed with PMBC from November 1996 to October 2011 were retrieved from the database of breast cancer in West China Hospital. The clinicopathological and long term follow-up data of these patients were analyzed retrospectively. Results① Clinicopathological characteristics:These patients accounted for 1.48% (94/6 330) of all breast cancer patients who treated in our hospital during the same period. They were all female,with a median age of 45 years old (29-85 years)and median duration of 90 d (5-2920 d). A proportion of 63.83% (60/94) of these patients were premenopausal women. Ninety three patients had unilateral lesion, one patient had bilateral lesions, totally 95 lesions. A proportion of 85.29% (58/68) tumors were in T1-T2 staging, and 82.80% (77/93) tumors were node-negative. A proportion of 1.05% (1/95) tumors had metastasized at diagnosis. A proportion of 92.54% (62/67) tumors were in Ⅰ-Ⅱ staging, 84.34% (70/83) tumors were estrogen receptor (ER) positive, 74.70% (62/83) were progesterone receptor (PR) positive, and 20.25% (16/79) were human epidermal growth factor receptor 2 (HER-2/neu) positive. A proportion of 6.32% (6/95) of tumors had breast-conserving surgery. ② Preoperative diagnosis:The detection rate of malignance were 60.87% (14/23), 83.33% (40/48), and 100% (18/18), respectively for patients who were examined with mammography, ultrasonography, and mammography+ultrasonography, and there was significant difference between the three groups (P=0.006). ③ Prognosis and prognostic factors:The follow-up rate was 80.85% (76/94). Two cases had bone metastasis respectively in 14 and 26 months after operation, one of whom died. Both five-year and ten-year overall survival rate (OS) were 98.50%, both five-year and ten-year disease-free survival rate (DFS) were 95.80%. There was no lymph node involvement in patients of T1 phase, and no recurrence, metastasis or death occurred during the follow-up. The univariate analysis showed that the disease course, T staging, TNM staging, and HER-2/neu status were statistically significant prognostic factors for DFS situation (P<0.050). ConclusionsCases in this group displayed indolent behavior and favorable prognosis which are similar to western populations. The disease course, T staging, TNM staging, and HER-2/neu status appear to be significant predictors of worse prognosis. The combination of mammography and ultrasonography could largely improve the diagnostic accuracy, and breast-conserving therapy may be recommended for patients with no contraindications.
ObjectiveTo study the feasibility of human adipose-derived stem cells (hADSCs) combined with small intestinal submucosa powder (SISP)/chitosan chloride (CSCl)-β-glycerol phosphate disodium (GP)-hydroxyethyl cellulose (HEC) for adipose tissue engineering. MethodshADSCs were isolated from human breast fat with collagenase type I digestion, and the third passage hADSCs were mixed with SISP/CSCl-GP-HEC at a density of 1×106 cells/mL. Twenty-four healthy female nude mice of 5 weeks old were randomly divided into experimental group (n=12) and control group (n=12), and the mice were subcutaneously injected with 1 mL hADSCs+SISP/CSCl-GP-HEC or SISP/CSCl-GP-HEC respectively at the neck. The degradation rate was evaluated by implant volume measurement at 0, 1, 2, 4, and 8 weeks. Three mice were euthanized at 1, 2, 4, and 8 weeks respectively for general, histological, and immunohistochemical observations. The ability of adipogenesis (Oil O staining), angiopoiesis (CD31), and localized the hADSCs (immunostaining for human Vimentin) were identified. ResultsThe volume of implants of both groups decreased with time, but it was greater in experimental group than the control group, showing significant difference at 8 weeks (t=3.348, P=0.029). The general observation showed that the border of implants was clear with no adhesion at each time point;fat-liked new tissues were observed with capillaries on the surface at 8 weeks in 2 groups. The histological examinations showed that the structure of implants got compact gradually after injection, and SISP gradually degraded with slower degradation speed in experimental group;adipose tissue began to form, and some mature adipose tissue was observed at 8 weeks in the experimental group. The Oil O staining positive area of experimental group was greater than that of the control group at each time point, showing significant difference at 8 weeks (t=3.411, P=0.027). Immunohistochemical staining for Vemintin showed that hADSCs could survive at each time point in the experimental group;angiogenesis was most remarkable at 2 weeks, showing no significant differences in CD31 possitive area between 2 groups (P>0.05), but angiogenesis was more homogeneous in experimental group. ConclusionSISP/CSCl-GP-HEC can use as scaffolds for hADSCs to reconstruct tissue engineered adipose.
Objective To evaluate the effect of postmastectomy radiotherapy(PMRT)on the rate of loco-regional recurrence and survival for breast cancer patients undergoing radical mastectomy with one to three positive lymph nodes. Methods The database of Pubmed, Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, CBM, CNKI, VIP, and Chinese Cancer were searched. All randomized controlled trials about postmastectomy radiotherapy on breast cancer patients with 1-3 positive lymph nodes were considered for inclusion. Revman 5.3 was used in the meta analysis. Results Four trials enrolled 1 254 breast cancer women with 1-3 positive lymph nodes were included. The studies were high quality according to the evaluations of the quality criteria. After 10 to 20 years follow-up, the results showed that, 460 patients were analyzed in the result of loco-regional recurrence, the hazard ratio (HR) was 0.23, 95%CI (0.15, 0.37), the result showed statistical difference (P＜0.000 01), and the heterogeneity was existed (P=0.09,I2=59%). One thousand two hundred and fifty-four patients were analyzed in the result of overall survival, theHR was 0.82, 95%CI (0.71, 0.93), the result showed statistical difference (P=0.002 ), and there did not existed heterogeneity (P=0.65,I2=0%). Four hundred and sixty patients were analyzed in the result of metastasis-free survival, theHR was 0.71, 95%CI (0.56, 0.90), the result showed statistical difference (P=0.005), and there did not existed heterogeneity (P=0.63,I2=0%). Nine hundred and seventy-seven patients were analyzed in the result of disease free survival, theHR was 0.74, 95%CI (0.66, 0.85), the result showed statistical difference (P＜0.000 01), and there did not existed heterogeneity (P=0.49,I2=0%). Conclusion Through this systematic review, we consider that postmastectomy radiotherapy could reduce the loco-regional recurrence and increase the overall survival for long-term.
ObjectiveTo summarize the relevant studies of pharmacological mechanism of tamoxifen and its influence on ovary function in order to provide information and evidence for the therapy of breast cancer. MethodsPapers published from January 1950 to January 2014, were retrieved in MedLine, OVID, CBM, CNKI databases using the keywords on tamoxifen, drug metabolism, ovary, sex hormone, etc, 1286 papers were retrieved in English literatures, and 621 in Chinese literatures. Criteria of paper adoption:①The clinical and basic studies about metabolism of tamoxifen, metabolic effect of tamoxifen, and gene polymorphism of CYP2D6.②The role played by estrogen receptor and protein cofactors in tamoxifen effect.③The clinical and basic studies about tamoxifen induced ovulation, caused endometrial thickening, changed sex hormone levels. According to the above criteria, 152 papers were selected, and 77 papers out of them were finally analyzed and reviewed. Results①The tamoxifen metabolite 4-OH-N-tamoxifen was the main working component, the decreased levels could predict the poor prognosis.②The CYP2D6 gene polymorphism could affect the metabolic effect of tamoxifen and the therapeutic effect of patients with breast cancer.③The metabolic effect of tamoxifen needed the participation of the estrogen receptors and protein cofactors.④Tamoxifen could affect the reproductive system function through the estrogen receptor of H-P-O axis, ovary, and endometrium. ConclusionsMetabolic effect of tamoxifen is regulated by gene, it could affect reproductive system functions through estrogen receptor. the mechanism that tamoxifen cowld affect the hormone levels and wherther it could reflect the ovarian function by monitering the hormone levels continuously for patients with breast cancer need to be researched.
ObjectiveTo prepare human acellular adipose tissue matrix and to evaluate the cellular compatibility so as to explore a suitable bio-derived scaffold for adipose tissue engineering. MethodsThe adipose tissue was harvested from abdominal skin graft of breast cancer patients undergoing radical mastectomy or modified radical mastectomy, and then was treated with a series of decellularization processes including repeated freeze-thaw, enzyme digestion, and organic solvent extraction. The matrix was examined by histology, immunohistochemistry, DAPI fluorescence staining, and scanning electron microscopy to observe the the removal of cells and to analyze its composition of collagen type IV, laminin, and fibronectin, and microstructure. The 3rd passage human adipose-derived stem cells (hADSCs) were co-cultured with acellular adipose tissue matrix and different concentrations of extracted liquid (100%, 75%, 50%, and 25%). The cytotoxic effects of the matrix were tested by MTT. The biocompatibility of the matrix was detected by live/dead staining and scanning electron microscopy observation. ResultsThe acellular adipose tissue matrix basically maintains intrinsical morphology. The matrix after acellular treatment consisted of extracellular matrix without any cell components, but there were abundant collagen type I; neither DNA nor lipid residual was detected. Moreover, the collagen was the main component of the matrix which was rich in laminin and fibronectin. At 1, 3, and 5 days after co-cultured with hADSCs, the cytotoxic effect of matrix was grade 0-1. The matrix displayed good cell compatibility and proliferation. ConclusionThe acellular adipose tissue matrix prepared by repeated freeze-thaw, enzyme digestion, and organic solvent extraction method remains abundant extracellular matrix and has good cellular compatibility, so it is expected to be an ideal bio-derived scaffold for adipose tissue engineering.