The clinical data of 23 patients undergoing real-time echocardiography-guided infusion port implantation in the Breast Center of Tsinghua Changgung Hospital in Beijing from January to July 2021 were analyzed. The length of catheter insertion L1 was initially estimated using surface measurement method in all patients. Intraoperatively, transthoracic echocardiography was applied using the parasternal four-chamber view to visualize the catheter image within the right atrium, and the length of catheter insertion L2 was recorded under the guidance of echocardiography. Postoperatively, chest radiographs were taken in the upright position to observe the position of the catheter tip. According to chest CT scans, the ideal length (L) for catheter tip placement was calculated when it was located at the junction of superior vena cava and right atrium. Bland-Altman scatter plot analysis and linear regression fitting test were used on L1 and L2 respectively with L to evaluate the consistency. A total of 23 patients were included in this study, among which one case of left breast cancer patient undergoing breast-conserving surgery had difficulty in identifying the catheter tip position due to residual pleural effusion obscuring the imaging of the cardiac apex four-chamber view. In 22 patients, the results of intraoperative ultrasound imaging were good, including 1 case of catheter ectopic to azygos vein, and 21 cases of right atrial catheter could be detected by ultrasound. Statistical analysis showed that there was a good consistency between L1 and L, L2 and L, and the difference between them was d=0.28 cm (95%CI:-1.76-2.31 cm) and d=0.20 cm(95%CI:-0.84-1.23 cm), respectively, with no statistical significance (P>0.05). In the linear regression model, L2 and L had a higher fit than L1, and the difference was statistically significant (R²=0.954, P<0.001). This study found that real-time echocardiographic localization technique can be applied in adult port surgery to replace X-ray-guided real-time catheter tip detection and adjustment to the optimal position.

Objective:To preliminarily evaluate the efficacy and safety of Surpass Streamline flow diverting device (FD) in the treatment of intracranial aneurysms.Methods:A retrospective analysis was conducted on the clinical data of 46 patients with intracranial aneurysms treated with Surpass Streamline FD at the Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University from November 2020 to March 2021. There were 57 aneurysms in 46 patients. Among them, there were 28 ophthalmic segment aneurysms, 8 communicating segment aneurysms, 19 cavernous sinus segment aneurysms, 1 carotid segment aneurysm and 1 vertebral V4 segment aneurysm. The O′Kelly-Marotta (OKM) grading scale was used to assess the degree of embolization of aneurysms immediately after surgery and during follow-up. The modified Rankin scale (mRS) was used to evaluate the neurological function of patients during the perioperative period and during follow-up. At 6 months after surgery, digital subtraction angiography (DSA) or CT angiography (CTA) was performed to review the occlusion of the aneurysm.Results:A total of 46 FDs were implanted in 57 intracranial aneurysms in 46 patients. Among them, 42 FDs (91.3%) were successfully released at one time; the other 4 FDs were not successfully released at one time, but after bridging, overlapping and balloon dilation, satisfactory release effects were achieved. Forty-three patients were treated with FD implantation alone, and three patients were treated with FD combined with coiling. The DSA of 57 aneurysms immediately after the operation showed that the contrast agent was well filled in the aneurysm, and the OKM grades were grade A in 30 cases, grade B in 19, grade C in 5, and grade D in 3. After the operation, 43 patients (93.5%) had a good outcome (mRS ≤2 points); the remaining 3 patients (6.5%) had various degrees of ischemic complications. A total of 32 patients (37 aneurysms) underwent DSA or CTA follow-up, the follow-up time was 6.6±1.8 months (3-10 months), and 32 aneurysms (86.5%) were completely occluded (OKM grade D in all). At the last follow-up, 32 patients had no new ischemic or bleeding complications, and their mRS were all ≤2 points.Conclusions:The immediate effect of Surpass Streamline FD in the treatment of intracranial aneurysms is satisfactory. The aneurysm occlusion rate in the mid-term follow-up seems high and the incidence of complications is low. However, the long-term efficacy and safety need to be further observed.

乳腺癌是女性最常见的恶性肿瘤,在女性癌症死亡原因中排名第二.约20％的乳腺癌为HER-2阳性乳腺癌.自从曲妥珠单抗、帕妥珠单抗、拉帕替尼、T-DM1等抗HER-2靶向治疗药物陆续问世后,HER-2阳性乳腺癌的预后显著提升,7年无疾病生存(DFS)提升可达95％.然而很多患者,特别是晚期患者在接受抗HER-2治疗的过程中最终都会产生耐药,导致疾病进展.本文主要从分子机制方面来解释抗HER-2治疗的耐药情况,包括HER-2的结合障碍、HER-2信号通路的改变及免疫逃逸等方面,并介绍了可能解决耐药途径的研究进展.

碘剂用于甲状腺功能亢进术前准备已有近百年的历史，但其最初的应用是基于错误的理论。抗甲状腺药物出现后替代碘剂成为了预防围手术期甲状腺危象的主要药物。如今，术前应用碘剂的目的是减少术中出血及术后并发症，但该作用尚缺乏循证医学证据。本文就术前碘准备的应用起源、作用机制、循证医学证据及应用现况等方面进行阐述，说明原发性甲状腺功能亢进患者术前准备并非必须使用碘剂。

Objective:The purpose of this study is to study the safety and efficacy of TEP repair in elderly patients.Methods:The data of elderly patients who received TEP repair in Beijing Tsinghua Changgung Hospital from January 2019 to December 2020 were retrospectively analyzed. Patients were divided into 2 groups, group 1 (n=50 cases, 70 years or older ) and group 2 (n=50 cases, 60 to 69 years old). Follow up duration was 1-92 weeks. Patient demographics, operation time, postoperative pain-NRS, length of hospital stay (LOS), intraoperative injury, antibiotic prophylaxis and postoperative complications were compared between the two groups.Results:Only LOS was significantly decreased in group 2 [(5.2±1.7) days vs (4.3±1.4) days, P=0.004]. Operation time, postoperative pain, intraoperative injury, antibiotic prophylaxis and postoperative complications were comparable between groups.Conclusion:With thorough assessment, preparing and precise technique, TEP repair in elderly patients is safe and efficacious.

错配修复(MMR)基因主要对DNA复制过程中的碱基错配进行修复,发生突变则会使DNA稳定性下降,造成微卫星不稳定,进而突变累积,导致恶性肿瘤发生.此类型肿瘤主要表现在结直肠癌及子宫内膜癌中.近年来,多项研究表明,MMR基因在乳腺癌中也有一定程度的表达缺失,结合微卫星不稳定及肿瘤突变负荷可对特定分子分型的乳腺癌预后有预测价值,对免疫治疗及内分泌耐药的晚期乳腺癌解救治疗均有一定的指导意义.目前,MMR基因与乳腺癌发生、发展的相关性研究较少.笔者对MMR基因、微卫星不稳定与乳腺癌发病、临床特点、免疫治疗及预后等的关系进行综述.

目的 探讨医院内高钙血症的流行病学情况.方法 从首都医科大学宣武医院信息中心获取2011年全年住院患者信息,31 018例住院患者中,18 388例(59.3％)检测血钙;其中56例血钙值＞2.67 mmol/L,进一步分析高钙血症原因,从中筛出可疑原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者,对其进行随访,并复查血钙及血甲状旁腺素(parathyroid hormone,PTH),两次及以上高钙血症及高PTH(＞65 ng/L)者确诊为PtPT.结果 该院2011年住院患者高钙血症患病率为0.3％,56例高钙血症患者中,死亡6例(10.7％),拒绝复查及失访6例(10.7％),复查血钙和PTH结果正常9例(16.1％),实验室误差7例(12.5％),医源性高钙血症l例(1.8％),原因不明4例(7.1％),恶性肿瘤导致高钙血症13例(23.2％),PHPT7例(12.5％),慢性肾衰竭3例(5.4％).恶性肿瘤所致高钙血症中,肺癌所占比例最高[6例(46.1％)].该院住院患者中PHPT的患病率为38.1/10万.结论 该院住院患者高钙血症的最常见原因为恶性肿瘤,其次是PHPT.该院的住院患者高钙血症患病率与欧美的研究数据相近,而PHPT患病率却低于欧美报道,应重视PHPT的筛查.

目的 三阴性乳腺癌(triple-negative breast cancer,TNBC)是一种异质性疾病,恶性度高、预后差,目前缺乏有效的靶向治疗手段.本研究探讨基于基因表达谱、蛋白组学、免疫学和免疫组织化学等不同方法学的TNBC亚分型,旨在明确TNBC亚分型研究现状以及每种亚型潜在的靶向治疗方法.方法 应用PubMed及CNKI检索系统,以"三阴性乳腺癌、分型、亚型"为关键词,检索2009-2019相关文献.纳入标准:TNBC的亚分型研究.最终分析符合纳入标准的文献23篇.结果 基于基因表达谱、蛋白组学、免疫学、标志物的免疫组织化学分析等信息,TNBC被分为不同的亚型,包括管腔雄激素受体型(luminal androgen receptor,LAR)、基底样型(basal-like,BL)、间充质型(mesenchymal,MES)以及免疫调节型/免疫激活型(immunomodulatory/basal-like immune-activated,IM/BLIA)等,这些亚型表现出不同的生物学及临床特征,提示不同亚型可能对不同的靶向治疗敏感.如LAR对AR拮抗剂敏感,BL可能对铂类化疗药及PARP抑制剂敏感,MES可能对抑制上皮-间质转化相关通路以及抑制肿瘤干细胞相关通路的药物敏感,而IM/BLIA可能会获益于免疫检查点治疗.结论 TNBC具有很大的异质性,明确其亚分型对于理解TNBC的肿瘤生物学特征和临床行为具有重要意义,为将来TNBC患者分层和个体化治疗研究提供了重要依据.

Objective:To investigate the effect of actin related protein 2/3 complex subunit 2 (ARPC2) gene silencing on the biological characteristics of papillary thyroid carcinoma (PTC) TPC-1 cells through lentivirus-mediated RNA interference.Methods:TPC-1 cells infected with nonsense short hairpin RNA (shRNA) sequence lentivirus (shCtrl) was used as the control group. TPC-1 cells infected with ARPC2 shRNA interference sequence lentivirus (shARPC2) was used as the experimental group, in which the expression of ARPC2 gene was specifically interfered. The effects of silencing the expression of ARPC2 gene on the proliferation of TPC-1 cells were detected by using methyl thiazolyl tetrazolium (MTT) assay, flow cytometry, Western blot and colony formation test. Flow cytometry and Western blot were conducted to detect the effect of silencing ARPC2 gene on TPC-1 cells apoptosis and related proteins.Results:shARPC2 could efficiently infect TPC-1 cells, and the expression efficiency of green fluorescent protein was over 85%. Compared with the control group, TPC-1 proliferation was inhibited in the experimental group. The ratio of S-phase cells in the experimental group was reduced compared with that in the control group [(14.79±0.21)% vs. (21.13±0.33)%, t = 27.77, P < 0.05]. The ratio of G 1 and G 2/M-phase cells in the experimental group was increased compared with that in the control group [G 1 phase: (67.57±0.08)% vs. (62.06±0.36)%, t=25.56, P < 0.05; G 2/M phase: (17.64±0.12)% vs. (16.91±0.17)%, t=6.154, P < 0.05]. Meanwhile, the expressions of cell cycle-related proteins CDK2, CyclinE and CyclinD were reduced in the experimental group. The number of clone formation in the experimental group was less than that in the control group, the difference was statistically significant [(10±2) vs. (161±6), t=9.011, P < 0.05]. In addition, the apoptotic ratio of cells in the experimental group was higher than that in the control group [(8.60±0.77)% vs. (4.08±0.40)%, t=9.011, P < 0.05]. Western blot showed that the expressions of anti-apoptotic factors p21 and bcl-2 were reduced in the experimental group, while the expression of pro-apoptotic factor bax was increased. Conclusion:The interference with the expression of ARPC2 regulated by shRNA can inhibit the proliferation, and promote the apoptosis of PTC TPC-1 cells, indicating that ARPC2 may be a possible biological new target for the treatment of PTC.

目的 分析中、低危分化型甲状腺癌行甲状腺全切除术后接受放射性碘(131I)治疗对短期临床转归的影响.方法 选取2015年1月至2018年12月在清华大学附属北京清华长庚医院/清华大学临床医学院行甲状腺全切除术且术后静态评估为中、低危的分化型甲状腺癌患者92例,按术后是否接受放射性131I治疗分为接受131I治疗组和未接受131I治疗组,其中接受131I治疗组29例,未接受131I治疗组63例.动态随访至少2次,包括术后早期(基线)随访1次,临近研究截止时(2019年2月)再随访1次.根据2次随访时的血清甲状腺球蛋白水平及影像学等资料进行治疗效果评价和动态复发风险评估.结果 中位随访时间为12(2～48)个月.基线随访时接受131I治疗组病情较重,两组间静态复发风险、肿瘤大小及淋巴结转移数有显著差异(P<0.05).经过治疗后,近期随访时的接受和未接受131I治疗组完全缓解率分别为69.0％(20/29)、76.2％(48/63),组间差异无显著性(P=0.463).近期随访时的动态复发风险分层评估显示,两组的良好反应率、不确定反应率、生化不完全反应率和结构不完全反应率差异无显著性(P=0.160).基线状态下未达到良好反应的患者接受131I治疗后,其动态复发风险评估获得的改善较未接受131I治疗者明显提升(P=0.004).在接受131I治疗组内,与治疗前相比,131I治疗后完全缓解率显著升高(P=0.004),动态风险分层显著降低(P=0.015),血清甲状腺球蛋白水平显著降低(P=0.001).92例患者在甲状腺全切除术后,基线状态下即达到完全缓解的比例为56.5％(52/92),且肿瘤较小或转移淋巴结数目较少的亚组完全缓解率较高.结论 甲状腺全切除术后静态评估为中、低危的分化型甲状腺癌患者中,符合131I治疗适应证者虽然其基线状态下病情较重,但接受131I治疗后其短期临床转归与未接受131I治疗的患者趋于一致.肿瘤大小及转移淋巴结数目是影响甲状腺全切除手术疗效的因素.

Objective To explore the differences of brain cognitive function and behavior in children with craniopharyngioma during perioperative period. Methods The clinical data of 19 patients with craniopharyngioma were retrospectively enrolled who underwent craniotomy at Department of Neurosurgery, Tsinghua University Yuquan Hospital from February 2015 to February 2017. The mean age of patients was 9. 10 ± 3. 53 (6 -15) years old. Twelve cases were primary tumors and 7 were recurrent tumors. Craniotomy was conducted for tumor resection in all patients. Fourteen cases were treated through frontal coronal incision approach, 3 through corpus callosum-transparent compartment-dome approach and 2 through small incision of pterional approach. The intelligence test was performed using the fourth edition of the Wechsler Intelligence Test Scale before and after surgery. The Conners Child Behavior Scale ( for parents) was used for behavioral testing. The cognitive function and behavioral changes of the brain in 19 children with craniopharyngioma before and 2 weeks after operation were compared. Results Among the 19 children with craniopharyngiomas, total tumor resection was achieved in 17 cases and subtotal resection in 2. There was no operative death. The preoperative and postoperative total IQ (intelligence quotient) scores (101.68 ±18. 50 vs. 103. 05 ± 15. 67), verbal comprehension indexes(98. 00 ± 13. 51 vs. 101. 00 ± 17. 07), perceptual reasoning indexes (94. 11 ± 12. 60 vs. 95. 26 ± 15. 05), working memory indexes (87. 00 ± 14. 15 vs. 92. 16 ± 19. 12), processing speed indexes (92. 95 ± 17. 17 vs. 95. 47 ± 16. 91) had no significant difference (all P >0. 05). There were no significant differences in behavior scores of the children before and 2 weeks after operation (all P>0. 05). Conclusion There seems to be no significant decrease in postoperative intelligence and behavioral level in children with craniopharyngioma. It shows that the surgical resection itself would not cause damage to the cognitive function of the child.

目的 分析影响乳腺内病灶Marker放置和取出的影像学因素.方法 选择我科2018年1月-2019年2月收治的乳腺癌行新辅助治疗且乳腺病灶内放置标记夹并最终接受手术治疗的患者,根据其影像学资料及标记夹放置和取出的手术记录,比较单独及联合应用超声、X线摄影及磁共振对标记夹的放置、识别和取出的成功率的影响.结果 共11例患者入组,新辅助治疗开始前乳腺内病灶在超声、X线和磁共振检查上的检出率分别为100.0％(11/11)、72.7％(8/11)和100.0％(11/11),组间无统计学差异(P>0.05);治疗过程中,超声、X线和磁共振至少有1次识别出标记夹的检出率为0.0％(0/11)、100.0％(11/11)和45.5％(5/11),各组间均有统计学差异(P<0.05);1例在术中仅凭超声检出标记夹并导丝定位(仅凭超声定位成功率9.1％);5例拟行保乳手术者在通过X线立体定位植入导丝(X线定位成功率为100.0％);所有标本离体后X线下证实标记夹包含在标本内.结论 乳腺癌新辅助治疗乳腺病灶内标记夹放置选用超声引导下穿刺成功率高,时机在第2周期治疗开始前为宜,治疗后肿瘤接近或达到临床完全缓解且拟行保乳手术者,可优先选用X线引导定位标记夹.

Objective To investigate the fornix of patients undergoing resection of third ventricle tumor through transcallosal interforniceal approach.Methods The clinical data of 5 patients with third ventricle tumor were retrospectively analyzed who were admitted to Department of Neurosurgery,Tsinghua University Yuquan Hospital from December 2015 to June 2016.All patients received operation through transcallosal interforniceal approach.DTI (diffusion tensor imaging) was performed before and after operation.The fractional anisotropy (FA),apparent diffusion coefficient (ADC) values and length of fornix were measured.Results Total resection was achieved in 5 cases.At 1 month post operation,the DTI functional analysis showed that the FA value of fornix decreased slightly in 3 patients,the ADC value decreased slightly in 1 patient and the length of fornix decreased in 4 patients,compared with those before operation.Those parameters returned to preoperative levels at 3 months after operation.Conclusions The effects of operation on fornix were slight and temporary.After proficient operation,there was no significant change in the value of FA,ADC or the length of the fornix.DTI could be an effective method to evaluate the safety of operation.

OBJECTIVE:Perlecan, which is also called heparan sulfate proteoglycan 2 (HSPG2), is a protein encoded by the HSPG2 gene that maps to 1p36.12 in the human genome. In this study, we assessed the independent prognostic value of HSPG2 in terms of overall survival (OS) and recurrence-free survival (RFS) in patients with LGG.PATIENTS AND METHODS:A retrospective study was conducted by using data in the Cancer Genome Atlas-Low Grade Glioma (TCGA-LGG).RESULTS:Increased HSPG2 expression was an independent prognostic indicator of poor OS in oligoastrocytoma (HR: 1.644, 95% CI: 1.116-2.423, p = 0.012) and in oligodendroglioma (HR: 1.459, 95% CI: 1.138-1.871, p = 0.003). In addition, increased HSPG2 expression independently predicted poor RFS in oligodendroglioma (HR: 1.402, 95% CI: 1.110-1.770, p = 0.005). Furthermore, we observed that high HSPG2 expression was associated with significantly shorter OS and RFS in oligodendroglioma, no matter the patients received radiotherapy or not. Using copy number alterations (CNAs) and DNA methylation data in TCGA-LGG, we found that DNA copy deletion was generally associated with decreased HSPG2 expression. Regression analysis suggested a weak negative correlation between HSPG2 expression and HSPG2 DNA methylation (Pearson's r = -0.388).CONCLUSIONS:Increased HSPG2 expression could independently predict poor OS in oligoastrocytoma and oligodendroglioma and also independently predicted poor RFS in oligodendroglioma. Its expression is modulated by both DNA copy number and DNA methylation in oligodendroglioma.

Objective To investigate changes of hippoeampus-related brain functions in children following resection of the third ventricle tumors through transcallosal intefforniceal approach.Methods Nine children with the third ventricle tumors were randomly selected at Department of Neurosurgery,Tsinghua University Yuquan Hospital.Resting state functional MRI (rs-fMRI) was scanned for all patients before and after operation.Multiple aspects,including regional homogeneity (ReHo),ALFF (amplitude of low frequency fluctuations),fALFF (fractional ALFF) and changes of function connectivity [DMN (default mode network) and hippocampus as ROI (region of interest)] were compared before pre-and post-operative states.Results (1) At 1 month post operation,the decreased ReHo was observed in the left superior frontal cortex,while the elevated ReHo was seen in the right middle occipital gyrus,middle temporal gyrus and left central gyrus compared with pre-operative conditions.The elevated ReHo was in the left superior temporal gyrus and right central frontal gyrus at 2 months post operation compared with that at 1 month after operation.There was no difference of ReHo between 2 months after operation and preoperative state.(2) At 1 month post operation,decreased ALFF was in occipital lobe,while increased ALFF was observed in regions around surgical pathway.ALFF restored to preoperative state at 3 months post operation.(3) Decreased fALFF was shown in frontal lobe and occipital lobe after operation.At 3 months post operation,the fALFF restored to preoperative state.(4) The contact between bilateral frontal gyri and other brain areas was elevated at 1 month post operation and recovered to preoperative state at 3 months.Surgery had an effect on the connections between hippocampus and the whole brain.Conclusions The short-term effect of transcallosal interforniceal operations on ReHo,ALFF and fALFF in the brain regions of patients could recover to preoperative state with time.The operation may not interrupt the connections between DMN and hippocampus-related brain areas.

目的 探索成人甲状旁腺细胞培养方法的可行性.方法 采用胶原酶消化成人甲状旁腺组织,进行原代和传代细胞培养,隔日观察细胞的形态变化.取传代一代细胞,一部分通过电子显微镜观察细胞形态并检测培养液中甲状旁腺激素(parathyroid hormone,PTH)含量,另一部分采用聚合酶链反应(polymerase chain reaction,PCR)方法检测甲状旁腺细胞特异性标志物的RNA:钙敏感性受体(calcium-sensing receptor,CaSR)、PTH和神经胶质细胞缺失转录因子(glial cells missing-2,GCM-2).结果 电子显微镜下观察传代至第7d的细胞,发现细胞质丰富,含有丰富的线粒体、内质网和高尔基体,细胞质和细胞间可见分泌囊泡;细胞培养液上清中可检测出PTH;甲状旁腺细胞特异性标志物CaSR、PTH及GCM2呈阳性.结论 经胶原酶消化法消化成人甲状旁腺细胞并培养,所得甲状旁腺细胞具有良好的形态和分泌功能,并保持甲状旁腺细胞的特异表型,可作为永久性甲状旁腺功能低下时同种异体细胞移植的来源.

目的 比较乳腺癌保留乳房和乳房全切手术患者的生活质量.方法 回顾性收集首都医科大学宣武医院普通外科2006年1月至2013年12月间,由同一组手术医师连续完成的保留乳房或乳房切除手术的乳腺癌患者资料,按照入组和排除标准筛选出符合入组条件患者232例,使用欧洲癌症治疗研究组织(EORTC)制定的测量癌症患者生活质量量表(QLQ)-C30和QLQ-BR23对其生活质量进行评价.于2014年2月至2015年4月调查期间,发放并回收生活质量调查问卷207份,分为保留乳房组(101例)和乳房全切组(106例).两组患者腋窝手术方式、化疗、放射治疗、内分泌治疗、文化程度等计数资料的比较采用x2检验,肿瘤分期差异采用Z检验,生活质量数据差异采用t检验比较.结果 问卷回收率为89％(207/232).对比两组患者一般资料,结果显示,保留乳房组和乳房全切组在肿瘤分期、腋窝淋巴结手术情况、化疗、内分泌治疗情况等差异均无统计学意义(Z=-1.925,x2=5.129、0.121、1.943,P均＞0.050),但保留乳房组的放射治疗比例明显高于乳房全切组[91.1％(92/101)比28.3％(30/106),x2=84.248,P＜0.001],且文化程度高者(高中及以上学历)占80.2％(81/101),显著高于乳房全切组的60.3％ (64/106)(x2=9.684,P=0.017).QLQ-C30结果显示,两组患者在总体生活质量、躯体功能、角色功能、情绪功能、认知功能、社会功能领域及疲乏、恶心与呕吐、疼痛、呼吸困难、睡眠障碍、食欲、便秘、腹泻、经济困难等子量表的评分差异均无统计学意义(t=0.456、2.297、2.106、-1.529、-0.400、0.689、-1.050、0.354、-1.219、-0.473、1.027、-0.118、0.623、0.179、-1.066,P均＞0.050).QLQ-BR23结果显示,保留乳房组患者的体象评分(83.2±19.6)显著高于全切组(66.2±20.1)(t=4.854,P＜0.001),在性功能、性欲、对未来的憧憬、系统治疗不良反应、乳房症状、上肢症状和对脱发的担忧方面评分组间差异均无统计学意义(t=-0.628、-0.874、-0.418、0.000、-0.193、-0.457、0.774,P均＞0.050).结论 保留乳房手术患者总体生活质量与乳房全切组没有差异,但保留乳房手术能很好的维护患者的体象,即患者体形满意度明显高于乳房切除组,所以保留乳房手术仍值得进一步推广.

Objective To summarize the clinical and pathological features of breast carcinoma in situ with minimal invasion, and to achieve the purpose of early diagnosis and early treatment. Methods To summarize and analyze the clinical data, pathologic features, treatment and follow-up results of 18 patients with DCIS-MI who were diagnosed during January 2009~December 2015. Results 18 cases of patients were in line with the diagnosis criteria of micro invasive carcinoma in situ, 15 of them can touch the tumor, and 11 cases had malignant calcification (61.1%). 4 cases underwent modified radical mastectomy, 3 cases underwent breast conserving surgery, and 17 patients underwent sentinel lymph node biopsy. All patients had no lymph node metastasis. 1 patient had the ipsilateral invasive breast cancer after 6 months, the rest of the patients were followed up for 48 months without tumor recurrence or metastasis. Conclusion Breast DCIS-MI is considered to be the interim stage in the progression from DCIS to IDC and the prognosis is good. Sentinel lymph node biopsy is the best choice for this type of patients, if the Sentinel lymph nodes are negative, the patients can be avoid axillary dissection.

Objective To explore the feasibility of the hydrogel as a cell carrier for parathyroid cells.Methods Cryopreserved parathyroid cells were recovered and cultured until sufficient,then the cells were digested、centrifuged and pipetted to single-cell suspension.The chitosan solution,crosslinking agents and cell suspension were mixed to hydrogels by some ratio.After that,hydrogels covered by complete medium were incubated at 37 ℃ in constant temperature incubator.Meanwhile,the supernatant were collected for measuring the PTH level every other day and the viability and shape of cells in hydrogels was also evaluated by fluorescopy.Results Parathyroid cells were recovered and cultured successfully and the adherent cells were spindle-like.The hydrogel could be prepared at room temperature in less than 1 minutes.The fluorescent confocal microscopy showed that more than 90％ of the cells in the hydrogel kept viable after 24 hours and the proportion had no significant change after 3 days.Furthermore,PTH was detected in the supernatants.Conclusion The facilely prepared inexpensive hydrogel,which can maintain normal morphlology and function of cells,is of potential application to cell transplantation therapy for hypopatathyroidism.

[A bstrca t] Objective To explore the effects of paclitaxel , epirubicin and cyclophosphamide , which are widely used in breast cancer chemotherapy , on the cognition function of mice .Methods Totally 80 Balb/c mice were randomized into four groups , 20 mice in each group .The mice in 3 experimental groups were intraperitoneally injected with paclitaxel ( 30 mg/kg ) , epirubicin ( 10 mg/kg ) , or cyclophosphamide alone (200 mg/kg) respectively.The mice in control group were injected with isovolumic saline .At 4 weeks after injection, all groups were given Morris water maze test , including place navigation and spatial probe test , to record the time the mice spent on underwater platform ( escape latency ) , the ratio of time in every quadrant to total swimming time and the times of crossing the platforma .The escape latencies of mice were compared among groups using repeated measurement analysis of variance , the ratio of time in every quadrant to total swimming time was compared using univariate analysis of variance and the times of crossing the platform among groups were compared using Kruskal-Wallis rank sum test .Results In place navigation test , the escape latencies at 5 time points (on days 1,2,3,4,5 after injection) in four groups were decreased with training time , which showed a trend of decline ( F=11.25 , P=0.001 ) .There was no statistically significant difference in escape latency between paclitaxel/epirubicin/cyclophosphamide-treated group and control group , while escape latencies were significantly different at 5 time points ( comparison between groups: F=1.23 , P=0.251;comparison at different time points: F=5.94 , P<0.001; interaction between grouping and different time points:F=0.77 , P=0.676 ) .In spatial probe test , the ratio of time spent in every quadrant to the total swimming time in 4 groups presented a significant difference ( F=3.26 , P=0.027 );it was significantly lower in cyclophosphamide-treated group than that in control group (13.6%±8.9%vs 23.9%±13.9 %;t=-3.05, P=0.009 ) .The difference was not statistically significant between experimental groups and control group in the times of crossing the platform on the sixth day after injection (χ2 =1.86, P=0.602 ).Conclusions Cyclophosphamide can affect the memory maintenance of mice . There is a possibility that chemotherapy medication can affect the ability of spatial cognition and learning in mice .