This study explores the idea of constructing a comprehensive and life-cycle Chinese medicine chronic disease management mode for breast cancer. It is believed that the comprehensive and life-cycle Chinese medicine chronic disease management for breast cancer should be guided by the essence of Chinese medicine theory,i.e.,the holistic view of the correspondence between man and universe,the life view of the integration of physique and spirit, the movement view of the coordination of motion and stillness, and the dynamic balanced view of the equilibrium of yin and yang. The management can be fulfilled with the prevention and treatment measures of Chinese medicine emotional guidance,popularization of Chinese medicine health preservation science,Chinese medicinal food therapy,exercise therapy and Chinese medicine music therapy. The comprehensive and life-cycle Chinese medicine chronic disease management of breast cancer can be divided into 4 stages of peri-operative stage,peri-chemotherapy and peri-targeted therapy stage,peri-radiotherapy stage and consolidation stage. At each stage,Chinese medicine therapy of the combination of internal and external treatment can be adopted,and the emphasis on the simultaneous rehabilitation of the spirit and emotions should be stressed. Meanwhile, the“Internet Plus”information network technology can be used to establish a breast cancer chronic disease management system,which will provide breast cancer patients with the best available management and care,and increase the compliance of the patients, thus to ultimately achieve the purpose of improving the quality and efficacy of medical services.

目的 本文旨在评价国内真实世界中以帕妥珠单抗为基础的联合方案用于人表皮生长因子受体2(HER?2)阳性乳腺癌患者的新辅助治疗的疗效和安全性.方法 自2019年3月至2022年1月,于广东省中医院乳腺科完成含帕妥珠单抗方案新辅助治疗及手术的60例HER?2阳性Ⅱ?Ⅲ乳腺癌患者,采用MRI或CT及Miler?Payne标准行临床疗效评价与手术后病理评价.分析含帕妥珠单抗的新辅助方案在HER?2阳性乳腺癌患者中的疗效和不良反应.结果 60例患者中,临床总缓解率(ORR)为82％,病理有效率(G3+G4+G5)为90％,病理完全缓解率(pCR/G5)为53％(32/60),其中表柔比星(E)联合环磷酰胺(C)序贯多西他赛(T)化疗方案组pCR率最高,为56％(18/32).所有患者均未出现影响治疗的严重不良反应.结论 在真实世界中,应用含帕妥珠单抗方案新辅助治疗HER?2阳性乳腺癌患者疗效确切,联合含蒽环类化疗有更好获益可能,且安全性良好.

Background: Hair loss is one of the most common side effects of chemotherapy, which can cause persistent negative emotions, further affecting therapeutic effects and reducing the quality of life. However, there is no clinically safe and effective methods to solve the problem at present. Our previous clinical and animal studies showed that a medicinal and edible decoction YH0618 could significantly promote hair growth in cancer patients after chemotherapy, without interfering with the anti-tumor effect of chemotherapy. Besides, the theory of Chinese Medicine believes “Essence of the kidney is reflected on the hair”. Therefore, this study will further explore the efficacy of YH0618 granule on chemotherapy-induced hair loss in patients with breast cancer by a randomized, double-blind, multi-center clinical trial and elucidate the potential mechanism from the aspect of kidney deficiency or renal dysfunction.Methods/Design: Eligible breast cancer patients who will start chemotherapy will be randomly divided into group A (YH0618 granule) and group B (placebo). The chemotherapeutic agents contains Taxanes or/and Anthracyclines, and chemotherapy regimen will last at least 6 cycles with every three weeks a cycle. Subjects assigned to group A will receive YH0618 granules two times a day (6 g each time), 6 days a week, mixing with 300 ml warm water from the first to the fourth chemotherapy cycle. Subjects in group B will receive the placebo granule in the same manner. The primary outcome is the time point of occurrence of hair loss reaching grade II assessed by WHO Toxicity Grading Scale, and objective indexes of hair quality and hair follicle recorded by a hair and scalp detector before the fifth chemotherapy. Secondary outcomes include changes of facial color and thumbnails color, grading of thumbnails ridging, assessment of quality life, fatigue, routine blood test, hepatic and renal function, and some medical indicators which can reflect kidney deficiency in Chinese Medicine.Discussion: This research is of great significance for the treatment of cancer and improving the quality of life of patients. The study may provide the most direct evidence for meeting clinical needs and lay a solid scientific foundation for later product development.Trial registration: The trial was registered on 14 December 2018 at Chinese Clinical Trial Registry: ChiCTR1800020107.

Accumulating evidence has suggested that cancer stem cells (CSCs) are at the root of drug resistance, and recent studies have indicated that caveolin-1, a membrane transporter protein, is involved in the regulation of cancer chemoresistance and stem cell signaling. However, the current understanding of the role of caveolin-1 in breast cancer development remains controversial. Herein, we demonstrate that caveolin-1 expression was upregulated after breast cancer chemotherapy in vitro and in vivo, accompanied by co-overexpression of β-catenin and ATP-binding cassette subfamily G member 2 (ABCG2) signaling. Additionally, breast CSCs were enriched for caveolin-1 expression. Caveolin-1 silencing sensitized breast CSCs by limiting their self-renewal ability but promoting the differentiation process. β-catenin silencing prevented the enhanced chemoresistance of CSCs induced by caveolin-1 overexpression, indicating that β-catenin is an essential molecule responsible for caveolin-1-mediated action. Further mechanistic investigation revealed that caveolin-1 silencing could downregulate the β-catenin/ABCG2 pathway through glycogen synthase kinase 3 beta activation and Akt inhibition, resulting in increased β-catenin phosphorylation and proteasomal degradation. Clinical investigation also revealed a close correlation between caveolin-1 and β-catenin/ABCG2 signaling in breast cancer samples. Notably, caveolin-1 was highly elevated in triple-negative breast cancer, and caveolin-1 silencing significantly impaired the tumorigenicity and chemoresistance of breast CSCs in in vivo models. Overall, our study not only highlights the role of caveolin-1 in mediating the chemoresistance of breast CSCs via β-catenin/ABCG2 regulation but also provides novel approaches for future therapies targeting CSCs.

目的:探讨乳管内乳头状病变的临床病理特征及诊断方法.方法:采用回顾性方法,对1 211例不同类型乳管内乳头状病变的年龄分布、乳头溢液与乳房肿块情况、病理及影像学检查结果进行分析.结果:1211例患者中,乳头状瘤874例,乳头状瘤病231例,乳头状癌106例;恶性病变患者平均年龄大于良性病变患者(P＜0.01),31～50岁为乳头状瘤及乳头状瘤病的高发年龄;16.0％患者有乳腺疾病手术史,乳头状瘤病患者中先后多次手术及同时双侧手术者明显多于乳头状瘤与乳头状癌患者(P＜0.05);67.8％患者有不同性质的乳头溢液,乳头状癌患者中溢液病例少于良性病变患者,但血性溢液明显多于良性病变患者(P＜0.05);约80％的良性病变术中可见肿块,恶性者术中均可见肿块,乳头状瘤病患者中伴有中-重不典型增生者明显多于乳头状瘤(p＜0.05),肿块＞1.0 cm时常伴有中-重不典型增生,乳头状癌患者肿块平均最大径(1.93±0.78) cm;导管造影及导管镜检查对良性病变诊断的准确率高于彩色B超和钼靶(P＜0.05).结论:不同类型乳管内乳头状病变有一些共同表现,也有各自特征,掌握这些特征有利于临床正确诊断及合理的治疗.

Objective: To explore the syndrome differentiation patterns of breast cancer,indentify the main four diagnostic method information of the syndrome types,and establish foundation for setting up standards for syndrome differentiation types of consolidate period in patients with breast cancer after surgeries. Methods: Questionnaires were given to 1102 patients admitted to breast department of Guangdong province Hospital of TCM from June 2009 to June 2012 who were on the consolidate period of breast cancer. Methods of category analysis and frequency normalization were used. Results: Four patterns were concluded to be clinically practical by the confirmation of experts,including spleen-kidney deficiency pattern( 34. 8% ) ,kidney deficiency with blood stasis pattern( 27. 9% ) ,deficiency of liver-kidney yin pattern ( 4. 7% ) and disease without syndrome pattern ( 32. 5% ) . Conclusion: epidemiology investigation and statistical analysis are used to establish the syndrome differentiation patterns and indexes for consolidate period of breast cancer,which provides theoretical evidence for treating patients in this phase.

目的探讨3.0T核磁共振成像(MRI)LAVA动态增强序列在乳腺良恶性病变鉴别诊断中的价值。方法回顾性分析经手术或穿刺病理证实的47例乳腺病变患者的MRI资料,分析病变信号、形态、时间—信号强度增强曲线,计算LAVA动态增强序列诊断良恶性病变的灵敏度、特异度、准确度。结果 3.0T MRI平扫示乳腺良恶性病变T1WI多呈等、低信号影,T2WI多呈等、高信号影,二者信号差异无统计学意义;LAVA动态增强序列示恶性病变形态不规则、边缘模糊、不均匀强化,与良性病变差异均有统计学意义,分别以形态不规则、边缘不清作为诊断乳腺恶性病变的标准,LAVA动态增强扫描的灵敏度、特异度及准确度均>76.1%。良性病变多表现为Ⅰ型曲线,恶性病变多表现为Ⅲ型曲线;Ⅱ型曲线在良恶性病变中均可见到。以Ⅰ型曲线作为诊断良性病变的标准,LAVA动态增强扫描的特异度可达96.1%;以Ⅲ型曲线作为诊断乳腺恶性病变的标准,LAVA动态增强扫描的准确度可达87.2%。结论 3.0T MRI LAVA动态增强扫描有助于乳腺良恶性病变的鉴别诊断,且特异性、敏感性、准确性较高。

Objective:To explore the relationship of Blood lipid and recrudescence and metastasis of breast cancer.Methods:Following-up ER negative and PR negative breast cancer in consolidate period,and do logistic regression analysis of correlation factors of recrudescence and metastasis of breast cancer.Results:The relationship of triglyceride and recrudescence and metastasis of breast cancer is positive correlation;triglyceride,high density lipoprotein and recrudescence and metastasis of breast cancer are negative correlation.Conclusions:The steping up of triglyceride and depressing ofhigh density lipoprotein are related recrudescence and metastasis of breast cancer.

Objective:To explore the relationship of blood lipid Metabolism and recrudescence and metastasis of breast cancer.Methods:Researching blood lipid of ER negative and PR negative breast cancer in preoperative,consolidate period(afteroperation 1 year)and recrudescence and metastasis period,and do statistics analyze.Results:The difference of TG,LDL-C,Apo-A,Apo-B have statistical significance in three periods,The difference of preoperative TC and consolidate period TC has no statistical significance,but The difference of preoperative TC and recrudescence and metastasis period TC,consolidate period TC and recrudescence and metastasis period TC have statistical significance.The difference of HDL-C in three periods have no statistical significance.Conclusions:TG,LDL-C,Apo-A,Apo-B and TC of recrudescence and metastasis of breast cancer are gradual advance with pathogenetic condition progression.blood lipid level is subcardinal laboratories manifest in recrudescence and metastasis of breast cancer.

Objective:To probe the distribution pattern of TCM Syntromes of breast cancer patieints in perioperative period,and estabilsh a foundation for developing Symdrome Differentiated standard for it.Methods:Reasearching on 501 patients with breast cancer in periopreative period by clustering analysis on clinical Syntromes,then come to the diagnosiic basis.Results:The Syntromes are most practical to be clustered into 3 classes: in the day before surgery,they are liver Qi depression and phlegm stasis with kidney difciency,liver Qi depression with blood stasis,and disproportion of Chu and Ren meridian with liver Qi depression;in the day after surgery,they are hypofunctioning of spleen and stomach,deficiency of both Qi and blood and dampness disturbing spleen and stomach;in third day after surgery,they are hypofunctioning of spleen and stomach,deficiency of both Qi and Yin,or dampness disturbing spleen and stomach.Conclusion:The symdrome differentiated standard for perioperative period of breast cancer patients was primarily established and the preoperatively symdrome is suffiency mostly while the postoperatively symdrome is deficiency mostly.This result can be referenced in clinical diagnosis and therapeutic evaluation.

Objective To explore the relationship of blood lipid level and body mass index(BMI) with prognosis of breast cancer patients with both estrogen receptor(ER) and progesterone receptor(PR) negative.Methods A follow-up was carried out in breast cancer patients with both ER and PR negative during the period of consolidating the therapeutic effect.The recrudescence and metastasis rate and the fatality rate in patients with normal blood lipid level and BMI before operation were compared with those in patients with abnormal blood lipid level and BMI.Results The recrudescence and metastasis rate and the fatality rate in patients with abnormal blood lipid level and BMI were higher than those in the patients with normal blood lipid level and BMI(P0.05),and were the highest in patients with BMI≥25(P0.05 compared with those patients with BMI25).Conclusion The correlation is shown between the prognosis of breast cancer patients and the increase of blood lipid level and BMI.

Objective:To probe the distribution pattern of TCM Syntromes of breast cancer patieints in perioperative period,and estabilsh a foundation for developing Symdrome Differentiated standard for it.Methods:Reasearching on 501 patients with breast cancer in periopreative period by clustering analysis on clinical Syntromes,then come to the diagnosiic basis.Results:The Syntromes are most practical to be clustered into 3 classes: in the day before surgery,they are liver Qi depression and phlegm stasis with kidney difciency,liver Qi depression with blood stasis,and disproportion of Chu and Ren meridian with liver Qi depression;in the day after surgery,they are hypofunctioning of spleen and stomach,deficiency of both Qi and blood and dampness disturbing spleen and stomach;in third day after surgery,they are hypofunctioning of spleen and stomach,deficiency of both Qi and Yin,or dampness disturbing spleen and stomach.Conclusion:The symdrome differentiated standard for perioperative period of breast cancer patients was primarily established and the preoperatively symdrome is suffiency mostly while the postoperatively symdrome is deficiency mostly.This result can be referenced in clinical diagnosis and therapeutic evaluation.

Objective and Methods: The method and Conclusions of the type of syndrome study of breast cancer patients in consolidation are different.We discuss the differentiation to explore the type of syndrome disposition characteristic and essence of breast cancer patients in consolidation.Results: The type of syndrome of breast cancer patients in consolidation is divided 4 types through clustering method and 6 types through Improved Delphi Method.Conclusions: The two different method is additional each other,and have significance to study etiological factor and pathogenesis of breast cancer patients in consolidation.

目的:观察梗阻性肾病围手术期中医辨证规律的变化。方法:应用临床流行病学及数理统计分析技术对梗阻性肾病住院手术患者进行样本定群病例的前瞻性研究,建立信息数据库,进行聚类统计分析。结果:梗阻性肾病术前分为脾肾气(阳)虚兼湿浊型、脾肾气虚兼湿热型、脾肾阳虚兼血瘀型、脾肾气虚兼血瘀型、湿热蕴结型、肝肾阴虚型6大证型,术后则分为气阴两虚兼湿浊型、脾肾气虚兼湿浊型、气阴两虚兼湿热型、脾肾阳虚兼血瘀型、脾肾气虚兼血瘀型、湿热蕴结型6大证型。结论:脾肾阳虚兼血瘀、脾肾气虚兼血瘀型和脾肾气(阳)虚兼湿浊型的病人多数延续术前的证候。术后呈现气阴两虚的病例明显增加,术前表现为肝肾阴虚和湿热蕴结型的病人,术后也有很多转为气阴两虚型。术前脾肾气虚兼湿热型病人很多转为术后的脾肾气虚兼湿浊型。

女性患者因某种疾病卧床不起时,都有一个共同的忧患:排尿时接尿困难,易弄脏床铺.医院现使用的便器有两种:①大便器,呈扁平状,上有一椭圆开口,使用时垫于患者臀下,排大便很适用,女患排尿时一旦尿急或用力,就会尿到床铺上,且有许多患者因病情不允许搬动使用.

Objective:To conclude the rules of syndrome differentiation of consolidate period patients of breast cancer after their operations.Methods:We colleced syndrome communications of 486 patients in consolidate period of breast cancer after their operations.And we filled in the forms and founded data-base of syndrome differentiation factors.And gathered ideas and experiences of 5 famous and old herbalist doctors,and packed up and analysed the forms and data-base to got the conclusion.Results:We concluded 5 clinical familiar syndrome differentiation were Qi and Yin deficiency syndrome,disorder of chong ren syndrome,dual Yang vacuity of spleen and kidney syndrome,dual Yin vacuity of liver and kidney syndrome and with disease and no syndrome syndrome.Conclusion:The deficiency syndromes are the main types in patients in consolidate period of breast cancer after their operations,and the patients of Qi and Yin deficiency syndrome are the most proportion.

Objective To explore the technique of breast reconstruction after mastectomy. Methods 30 cases of patients with breast cancer who were not suitable for breast conservative surgery were sum-marized. Among them, immediate breast reconstruction with prosthetic implants after mastectomy was used in 16 patients, transverse rectus abdominis musculocutaneous flap (TRAM flap) in 10 patients, and latissimus dorsi musculocutaneous flap in 4 patients. There were 27 patients who underwent immediate breast reconstruction, while 3 patients underwent delayed breast construction. Results The appearance was good in 16 cases of breast reconstruction with prosthetic implants and no complications were found. Two out of the ten patients who had the transevarse rectus abdominis musculocutaneous flap (TRAM flap) breast reconstruction had partly necrosis of skin flap, and one lateral ventral syndrome. The appear-ance of the 7 cases after the TRAM flap breast reconstruction evaluated well, 2 cases moderate, and one case less satisfactory. The appearance of 4 patients who had breast reconstruction with latissimus dorsi musculocutaneous flap evaluated well. Conclusion Breast reconstruction is an important part of combined therapy for the breast cancer, especially for the patients who have strong desire to conserve breast, while incompetence for breast conserving surgery. In such a case breast reconstruction is a good choice. Imme-diate breast reconstruction is better than delayed breast construction. The appropriate method of breast reconstruction depends on each individual patient. Patients with locally advanced breast carcinoma can se-lectively choose immediate breast reconstruction.

Objective To investigate the safety and effectiveness of TURP for treating prostatic hyperplasia associated with obstructicve nephropathy. Methods 57 cases with prostatic hyperplasia associated with obstructicve nephropathy were treated by TURP after improvement of kidney's function by indwelling urinary catheter or cystostomy in suprapubic region. Results The effective rate operative treatment was 100% and no death was found in this group. The postoperative average IPSS was 8.1 while the QQL was 1.4.Conlusion TURP is a safe and effective method for treating prostatic hyperplasia associated with obstructicve nephyropath through preoperative urinary drainage to improve renal function.

成人Still's病(adult onset still's disease,AOSD)是原因未明的以高峰热、一过性多形性皮疹、关节炎或关节痛为主要临床表现,并伴有周围血粒细胞升高,肝脾及淋巴结肿大等系统受累的一种临床综合征,属中医学热痹、暑温、湿温、内伤发热等范畴.