Objective To analyze the correlation among the clinicopathologic features, ultrasound imaging features, and axillary lymph node metastasis in breast cancer patients with negative clinical evaluation of axillary lymph nodes (cN0), and to establish a logistic regression model to predict axillary lymph node metastasis, so as to provide a reference for more accurate evaluation of axillary lymph node status in cN0 breast cancer patients. Methods The data of 501 female patients with cN0 breast cancer who were hospitalized and operated in the Affiliated Hospital of Wuhan University of Science and Technology (Xiaogan Central Hospital) from December 2013 to October 2020 were collected. Among them, 376 patients from December 2013 to December 2019 were selected to establish a prediction model for axillary lymph node metastasis of cN0 breast cancer. In the modeling group, the basic information, clinical pathological characteristics, and ultrasound imaging features of patients were analyzed by single factor analysis. The factors with statistical significance were included in the multivariate logistic regression analysis, and the logistic regression prediction model was established. The model was evaluated by the correction curve and Hosmer-Lemeshow test goodness of fit. The model was validated in the validation group (125 patients from January to October 2020), and the receiver operation characteristic (ROC) curve was drawn. Results The probability of positive axillary lymph nodes in 501 patients with cN0 breast cancer was 28.14% (141/501). The univariate analysis results of the modeling group showed that the histological grade, vascular invasion, progesterone receptor (PR), Ki-67, age, molecular typing, ultrasound breast imaging-reporting and data system (BI-RADS) grade were associated with axillary lymph node metastasis. Multivariate logistic regression analysis showed that the vascular infiltration, positive estrogen receptor (ER) , ultrasound BI-RADS grade 4C and Ki-67≥14% increased the probability of axillary lymph node metastasis (P<0.05). Using the above prediction factors to establish the prediction nomogram, the area under the ROC curve (AUC) of the modeling group was 0.72 [95%CI (0.66, 0.78)], the cut-off value was 0.30, the sensitivity was 61.00%, and the specificity was 71.20%. The newly established axillary lymph node transfer logistic regression model was applied to the validation group (n=125), and the AUC was 0.72 [95%CI (0.53, 0.76)]. The truncation value was 0.40, and the total coincidence rate was 69.60% (87/125), positive predictive value was 47.37% (18/38), and negative predictive value was 91.95% (80/87). Conclusions Vascular invasion, positive ER , ultrasound BI-RADS grade 4C, and Ki-67≥14% are risk predictors of axillary lymph node metastasis in cN0 breast cancer patients. The negative predictive value of the model is 91.95%, which has a higher value in predicting axillary lymph node metastasis in early breast cancer patients, and can provide a reference for screening exempt sentinel lymph node biopsy population.
ObjectiveTo evaluate the effect of pre-infusion of allogeneic lymphoyctes treated with 5-FU on the rat liver graft. MethodsRat liver transplant models from Wistar to SD were established. Four groups were designed as following: control group: only liver transplantation without any other intervention; lymphocytes group: 1 ml of untreated lymphocytes (5×106/ml) from Wistar rats were preinfused into SD rats on day 7 and 4 separately before transplantation; lymphocytes with low concentration of 5-FU group: low concentration 5-FU (7.5 μg) treated lymphocytes were preinfused as above; lymphocytes with high concentration of 5-FU group: high concentration 5-FU (15 μg) treated lymphocytes were preinfused as above. Fas-L and CD8 expression were detected by immunohistochemistry method on day 7 after transplantation. ResultsThe integral opticaldensity (IOD) of Fas-L positive lymphocytes in the lobules of liver and portal areas were higher in lymphocytes with low concentration of 5-FU group than in the other groups （Plt;0.05）. There was no difference between lymphocyte group and lymphocytes with high concentration of 5-FU group （Pgt;0.05）. The IOD of CD8+ expression in lobules of liver was not different among all the three lymphocytes treated groups （Pgt;0.05）. But in portal areas, CD8+ expression was lower in the lymphocytes with low concentration of 5-FU group than in the other groups （Plt;0.05）. ConclusionPreinfusion of lymphocytes treated with low concentration 5-FU can induce graft immune tolerance, the probable mecanism of which is the increasing Fas-L expression in graft.
ObjectiveTo evaluate therapeutic effect of the targeting recombinant adenovirus Ad-EAFP-PALB/r-Caspase-3 on primary hepatocellular carcinoma cells (HepG2) and subcutaneous implanted tumors of nude mice. MethodsHepG 2 cells, breast cancer MDA-MB-231 cells， and normal hepatic L-02 cells were infected with the previously constructed targeting recombinant adenovirus Ad-EAFP-PALB/r-Caspase-3, then morphological change was observed and apoptosis index was detected by cell morphologic assay. Tumor growth and pathological changes were observed after the implanted tumors model of nude mice were injected with the recombinant adenovirus. Results Both apoptosis and obvious apoptotic peak of cells were observed by flow cytometry (FCM) in HepG 2 cell group. The apoptosis index of MDA-MB-231 and L-02 cells was 0 and 7.3%, respectively, which were significantly lower than that of HepG2 cells (48.2%), Plt;0.01. The volume of subcutaneous tumor of nude mice was (0.26±0.31) cm 3 in HepG2 cell group, (0.25±0.15) cm 3 in MDA-MB-231 cell group， and (0.26±0.28) cm 3 in control group on two weeks after implantation of cancer cells, and no statistical difference was found among them (Pgt;0.05). The volume of subcutaneous tumor of nude mice was (0.53±0.12) cm 3 in HepG 2 cell group, (0.49±0.22) cm 3 in MDA-MB-231 cell group， and (0.54±0.13) cm 3 in control group on four weeks after implantation of cancer cells, and the difference was not significant among them (Pgt;0.05). But on eight weeks after implantation of cancer cells, the volume of tumor was (0.65±0.13) cm 3 in HepG 2 cell group, (1.27±0.32) cm 3 in MDA-MB-231 cell group， and (1.43±1.09) cm 3 in control group, which suggested that the growth of tumor in HepG 2 cell group slowed down significantly when compared with MDA-MB-231 cell group and control group (Plt;0.01), although the difference in the latter two groups was not significant (Pgt;0.05). The necrosis regions were found with lymphocytic infiltration and apoptosis cells in HepG2 cell group after injection of recombinant adenovirus Ad-EAFP-PALB/r-Caspase-3, but no pathological change of cells was found in control group after injection. It was found that the cells in MDA-MB-231 cell group were solidly arranged with small glandular lumenlike structure, marked cellular atypia, multinucleated tumor cells and megakaryocytic tumor cells, which was not different from that before injection. ConclusionThe targeting recombinant adenovirus Ad-EAFP-PALB/r-Caspase-3 induces the apoptosis of primary hepatocellular carcinoma in vivo and in vitro, which may provide new ways of targeted gene therapy.
ObjectiveTo investigate the influencing factors of cervical lymph node metastasis of papillary thyroid carcinoma (PTC) and provide more accurate guidance for the cleaning strategy of PTC cervical lymph node.MethodsRetrospectively analyzed the case data of pathological diagnosis of PTC patients from June 2013 to June 2019 in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, and explored the influencing factors of lymph node metastasis in central region and lymph node metastasis in lateral cervical region.ResultsThe results of multivariate analysis showed that patients aged ≤55 years old, tumor diameter >1 cm, peripheral invasion, bilateral cancer, and multifocal cancer had a higher lymph node metastasis rate in the central region (P<0.05). When the number of risk factors mentioned above was 0, 1, 2, 3, 4, 5 and 6, the lymph node metastasis rate in the central region was respectively: 3.5% (4/113), 25.2% (72/286), 30.0% (70/233), 38.6% (76/197), 52.5% (53/101), 76.9% (20/26), and 100% (13/13). With the increase of the number of risk factors, the lymph node metastasis rate in central region increased (χ2=236.894, P<0.001). In the lymph node metastasis in lateral cervical region, multivariate analysis showed that patients with tumor diameter >1 cm, membranous invasion, and lymph node metastasis in the central region ≥2 had a higher lymph node metastasis rate (P<0.05), while lymph node metastasis in the lateral cervical region was not related to age, gender, peripheral invasion, and multifocal carcinoma (P>0.05). When the cumulative number of risk factors in patients was 0, 1, 2, 3, 4, 5, and 6, the lymph node metastasis rate in the lateral cervical region was respectively: 11.1% (1/9), 29.4% (5/17), 79.2% (19/24), 89.6% (43/48), 96.4% (27/28), 100% (21/21), and 100% (3/3). With the increase in the number of risk factors, lymph node metastasis in the lateral cervical region increased (χ2=101.094, P<0.001).ConclusionsThe cervical lymph node metastasis is positively correlated with the number of corresponding risk factors. With the increase of risk factors, cervical lymph node metastasis rate also increases. The number of risk factors provides a simple and intuitive indicator for cervical lymph node metastasis, which is more conducive to the formulation of individualized and accurate surgical program.
ObjectiveTo explore the surgical techniques of rat orthotopic liver transplantation (OLT) model in rats using modified technique by single operator. MethodsA total of two hundreds cases of rats (one hundred pairs) were used to establish OLT model including eighty cases of rats (forty pairs) used in formal study by using modified Kamada “two-cuff” method, of which the key surgical procedures were further modified. Intraoperative results and postoperative recovery were analyzed. ResultsAll eighty cases of rats successfully operated. Operative time in donors was (28.5±2.4) min and reparative time of donor liver was (10.2±1.8) min. Anastomosis time for suprahepatic inferior vena cava and portal vein (15.3±1.9) min and (3.4±1.2) min, respectively. Anhepatic phase of transplant recipients was (23.8±1.9) min, anastomosis time for infrahepatic inferior vena cava was (5.1±2.1) min, and biliary reconstruction time was (3.1±0.9) min. Blood loss of donor and recipients during the operation was blew 0.5 ml. No recipient died for operation. The 2 d survival rate of recipients was 90% (36/40), three rats died of bleeding at the seam in hepatic inferior vena cava and one rat died of longer anhepatic phase. The 7 d survival rate of recipients was 82.5% (33/40), three rats died of intra-abdominal infections. ConclusionThe modification in en bloc separation of abdominal aorta and interior vena cava for abdominal aortic perfusion of donor liver, careful dissection of left subphrenic vein triangle and the hemostasis by heat coagulating can reduce operative complications, guarantee the quality of donor liver and improve the survival rate of rats in establishment of OLT model in rats using modified technique by single operator.
Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.