Lymph node metastasis is a significant indicator of recurrence and mortality in thyroid carcinoma and often guides treatment decisions. However, the characteristics and specific mechanisms of various cancer cells that metastasize to lymph nodes are not clear. This study aims to characterize the cellular heterogeneity and transcriptomic dynamics of thyroid cancer. We further seek to elucidate the role of the key transcription factor FOXA2 in orchestrating a pro-metastatic and immunosuppressive program, specifically its regulation of T-cell activity and apoptosis. Our ultimate goal is to identify potential therapeutic strategies for thyroid cancer with lymph node metastasis. Using single-cell RNA-seq analyses, we investigated the dynamic of cellular heterogeneity transcriptome regulation and microenvironmental factors in 15,591 single cells from paired samples of primary and lymph node-metastasized tumors. The function of key factor was further investigated using data from public database and in vitro expriments. We found that among all the six subclusters identified, the cancer cells (cluster 3) with higher tumor different ability (tumor different score) evolved into metastatic clusters infiltrating into lymph nodes. We also showed that the immune response-activating cell surface receptor signaling pathway is enriched in malignant cells of the metastatic lymph node. The interactions between T cells and other cells were weakened, and CCLs-mediated signals out/income T-cells are more likely to affect the interactions. Tumor-intrinsic forkhead box A2 (FOXA2) orchestrated the thyroid cancer cell immunologic/metastatic signature and its expression is related to prognosis. FOXA2 knockdown promoted thyroid cancer cell migration, proliferation, and T-cell apoptosis. Moreover, its expression significantly influenced T-cell activity by the CCL2/LCN2-mediated signal pathway. These findings reveal that FOXA2 regulates cancer cell immunity by influencing T-cell apoptosis in thyroid cancer. Our results provide a potential pharmacological strategy for immune therapy in thyroid cancer with lymph node metastasis.

The non-invasive detection of cancer via exhaled breath condensate (EBC) represents a promising frontier in oncology. This study explores the metabolic profiles of EBC to identify biomarkers for the early detection of thyroid cancer (TC) and breast cancer (BC), and to investigate potential metabolic interrelationships between them. We conducted gas chromatography-mass spectrometry (GC-MS) analysis of EBC samples from 74 individuals, including 65 cancer patients (TC and BC) and 9 non-cancer controls. Comparative statistical analyses and machine learning were employed to identify discriminant metabolites. 305 metabolites were identified in total. Comparative analysis revealed 16 differential metabolites in cancer patients versus controls, with 14 specific to TC and 7 to BC. Notably, five metabolites were common to both cancers: 1,2-Bis(trimethylsilyl)benzene, 1,4-Phthalazinedione,2,3-dihydro-6-nitro-, Eicosane, Methyltris (trimethylsiloxy) silane, and Octadecane, highlighting metabolites that were commonly altered in both cancer types. ROC analysis demonstrated strong diagnostic potential: 1,2-Bis(trimethylsilyl)benzene effectively discriminated cancer from controls (AUC = 0.822) and identified TC (AUC = 0.866), while 1,4-Phthalazinedione,2,3-dihydro-6-nitro- detected BC (AUC = 0.783). Combinations of metabolites yielded AUCs > 0.7 for both cancers. However, limited discriminatory power was observed between TC and BC (maximum AUC = 0.663), indicating significant metabolic similarity. Furthermore, specific metabolite abundances correlated with conventional serum biomarkers, thyroid hormone levels, and lymphatic metastasis. Our findings establish EBC metabolomics as a powerful, non-invasive tool for early cancer detection and monitoring. The identification of shared metabolic alterations between TC and BC suggests common metabolic features that warrant further investigation and paves the way for developing breath-based diagnostic assays.

Background Lymph node metastasis is a significant indicator of recurrence and mortality in thyroid carcinoma and often guides treatment decisions. However, the characteristics and specific mechanisms of various cancer cells that metastasize to lymph nodes are not clear. This study aims to characterize the cellular heterogeneity and transcriptomic dynamics of thyroid cancer. We further seek to elucidate the role of the key transcription factor FOXA2 in orchestrating a prou2010metastatic and immunosuppressive program, specifically its regulation of Tu2010cell activity and apoptosis. Our ultimate goal is to identify potential therapeutic strategies for thyroid cancer with lymph node metastasis. Methods Using singleu2010cell RNAu2010seq analyses, we investigated the dynamic of cellular heterogeneity transcriptome regulation and microenvironmental factors in 15,591 single cells from paired samples of primary and lymph nodeu2010metastasized tumors. The function of key factor was further investigated using data from public database and in vitro experiments. Results We found that among all the six subclusters identified, the cancer cells (cluster 3) with higher tumor different ability (tumor different score) evolved into metastatic clusters infiltrating into lymph nodes. We also showed that the immune responseu2010activating cell surface receptor signaling pathway is enriched in malignant cells of the metastatic lymph node. The interactions between T cells and other cells were weakened, and CCLsu2010mediated signals out/income Tu2010cells are more likely to affect the interactions. Tumoru2010intrinsic forkhead box A2 (FOXA2) orchestrated the thyroid cancer cell immunologic/metastatic signature and its expression is related to prognosis. FOXA2 knockdown promoted thyroid cancer cell migration, proliferation, and Tu2010cell apoptosis. Moreover, its expression significantly influenced Tu2010cell activity by the CCL2/LCN2u2010mediated signal pathway. Conclusions These findings reveal that FOXA2 regulates cancer cell immunity by influencing Tu2010cell apoptosis in thyroid cancer. Our results provide a potential pharmacological strategy for immune therapy in thyroid cancer with lymph node metastasis.

The advancement of single-port laparoscopic cholecystectomy (SPLC) in primary hospitals in China continues to be impeded by formidable technical obstacles, including insufficient triangular relationships and suboptimal ergonomics. Therefore, a novel magnetically controlled separable forceps system was developed to improve the performance of SPLC. The objective of this study was to provide a comprehensive account of the initial experience with the separable magnetically-controlled forceps system. Animals Experiments and a 52-year-old male (body mass index, 21.82) presented by the authors. Underwent a pure SPLC procedure using a subumbilical approach without additional trocars or sutures. The surgical procedure was facilitated using a novel separable magnetically controlled forceps system, that improved the surgical field of vision during dissection with less instrument coming from and being controlled from the same port of entry. No adverse events occurred during the animal experiments. Meanwhile, the procedure on the human body was completed within 45 min. Notably, there were no recorded instances of pre- or postoperative complications, and the use of postoperative drains was unnecessary. Furthermore, the patient was discharged 8 h after the surgical intervention, and subsequent follow-up was uneventful for 30 days postoperatively. This innovative magnet-retracting forceps system allows portless access to the peritoneal cavity, providing surgeons with superior endoscopic views and the ease of maneuverability of retraction. The feasibility and safety of utilizing the novel separable magnetically controlled forceps for gallbladder retraction have been demonstrated using SPLC. A novel separable magnetically-controlled forceps system assisted single-port laparoscopic cholecystectomy technique was developed. The feasibility and safety of utilizing the novel separable magnetically-controlled forceps the gallbladder retraction have been demonstrated using SPLC. This innovative magnet-retracting forceps system allows portless access to the peritoneal cavity, providing surgeons with superior endoscopic views and the ease of maneuverability of retraction, as the retraction force is supplied without the need for a shaft device in the abdomen.

BACKGROUND:Discriminating the epigenetic landscapes of coincidental benign thyroid nodules (particularly follicular adenoma subtypes) from papillary thyroid carcinoma (PTC) remains a critical unresolved challenge, impeding mechanistic insights into their divergent pathogenic trajectories. METHODS:To address this knowledge gap, we performed integrative multi-omics profiling of histologically paired benign thyroid nodules and PTC lesions from the same patients, synergizing chromatin accessibility mapping (ATAC-seq), whole-exome sequencing, transcriptomics, and ATAC-seq-derived extrachromosomal circular DNA (eccDNA) detection. RESULTS:Three pivotal mechanisms emerged from our cross-omics analyses to delineate the benign-malignant dichotomy. First, chromatin architecture interrogation revealed spatially colocalized PTC-specific accessible regions with somatic mutation hotspots, suggesting coordinated interplay between epigenetic remodeling and genomic instability in malignant transformation. Second, we uncovered ARHGEF28 and ARHGEF24 as novel potential benign-specific master regulators, where TEAD4-binding motif enrichment in benign-hyperaccessible chromatin drives their coordinated overexpression, forming a self-reinforcing regulatory loop unique to benign thyroid nodules. Third, eccDNA-centric profiling delineated a different regulatory paradigm: benign thyroid noduless exhibited preferential enrichment of T-cell signaling related elements on eccDNA scaffolds, whereas PTCs eccDNA were enriched in the DNA replication signaling pathways. This multidimensional atlas not only maps lineage-specific regulatory topologies of thyroid neoplasms but also establishes the ARHGEF28/24-TEAD4 axis as potential association with benign lineage. CONCLUSIONS:By elucidating chromatin-based thresholds of malignant progression, our findings provide a molecular framework for differential diagnosis and mechanistic dissection of transformation checkpoints.

BackgroundPapillary thyroid cancer (PTC) is prevalent among younger populations and has a favorable survival rate. However, a significant number of patients experience psychosocial stress and a reduced quality of life (QoL) after surgical treatment. Therefore, comprehensive evaluations of the patients are essential to improve their recovery.MethodsThe present study enrolled 512 young and middle-aged patients diagnosed with PTC who underwent surgery at our institution between September 2020 and August 2021. Each participant completed a series of questionnaires: Generalized Anxiety Disorder 7 (GAD-7), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL), and Readiness to Return-to-Work Scale (RRTW).ResultsGAD-7 data showed that almost half of the study subjects were experiencing anxiety. Regarding health-related quality of life (HRQoL), participants reported the highest levels of fatigue, insomnia, voice problems, and scarring, with patients in anxious states reporting worse symptoms. Based on RRTW, more than half of the subjects had returned to work and had better HRQoL compared to the others who were evaluating a possible return to work. Age, gender, BMI, education, diet, residence, health insurance, months since surgery, monthly income, and caregiver status were significantly correlated with return to work. Additionally, having a caregiver, higher monthly income, more time since surgery, and living in a city or village were positively associated with return to work.ConclusionYoung and middle-aged patients with PTC commonly experience a range of health-related issues and disease-specific symptoms following surgery, accompanied by inferior psychological well-being, HRQoL, and work readiness. It is crucial to prioritize timely interventions targeting postoperative psychological support, HRQoL improvement, and the restoration of working ability in PTC patients.

Despite the approval of several therapeutic agents for HER2-positive breast cancer, drug resistance remains a significant challenge, hindering the patient's prognosis. Thus, our study aimed to establish a risk model to predict the prognosis of patients and identify key genes regulating drug resistance in HER2-positive breast cancer. Utilizing data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), a predictive model was constructed based on 5 drug resistance-related genes, which demonstrated a notable capacity to indicate the survival rates of patients. Besides, through eccDNA and transcriptome sequencing of drug-sensitive and resistant cancer cells, 3 significant DEGs were identified: MED1, MED24, and NMD3. Among them, MED1 showed the most significant elevation in drug-resistance cells, highlighting its crucial role in mediating drug resistance. MED1 may serve as a valuable target for alleviating drug resistance in HER2-positive breast cancer.

目的:探讨ER、PR、HER-2 及Ki-67 在乳腺癌患者原发灶及复发转移灶中的表达差异,并分析其对乳腺癌患者预后的影响.方法:统计2012 年01 月01 日2021 年12 月31 日我院肿瘤科收治的复发转移性乳腺癌患者,除外病理及临床资料缺失的患者后,共计89 例患者纳入本研究.采用回顾性队列研究方法,比较乳腺癌原发灶及复发转移灶中ER、PR、HER-2 及Ki-67 的表达差异.结果:本研究纳入患者的平均年龄为53.14 岁(20～84 岁).其中有34 例患者接受术前新辅助治疗,所有患者均行乳腺癌根治术或改良根治术,并进行了相应的术后辅助治疗.乳腺癌原发灶中ER及PR阳性表达率均高于转移灶;而HER-2 阳性及Ki-67 高表达的情况在转移灶中更常见.乳腺癌原发灶与复发转移灶中ER、PR、HER-2、Ki-67 表达差异比例分别为:24.72％、42.70％、11.24％、13.48％.乳腺癌原发灶及转移灶中ER、PR表达的异质性与患者无病生存期相关.结论:乳腺癌患者的ER、PR、HER-2 和Ki-67 表达状态在原发灶与复发转移灶中存在一定的异质性,进而影响患者的治疗策略及预后.

Background:Cervical lymph node enlargement caused by coronavirus disease 2019 (COVID-19) vaccination has been reported, but little is known on whether the vaccination would influence preoperative cervical lymph node evaluation and its risk of lymph node metastasis in thyroid cancer.Methods:We retrospectively analyzed data of patients who underwent thyroid cancer surgery in Tangdu Hospital, China, from 1 March 2021 to 30 June 2021. A total of 182 patients were included in the cohort study. All patients with suspected malignant tumors underwent ultrasound (US)-guided fine needle aspiration (FNA) of thyroid lesions before surgery to confirm the diagnosis. Cervical lymph nodes were evaluated by preoperative physical examination and imaging. Wilcoxon rank-sum test and Fisher's exact test were used to evaluate the effect of vaccination on cervical lymph nodes in patients with thyroid cancer. Statistical significance was defined at P<0.05.Results:The patients were divided into two groups according to whether they had been vaccinated or not. Our results showed that there were no significant differences between the two groups in the brand of the vaccine, operation method, and the extent of surgery. Moreover, there was no significant difference in the evaluation of US characteristics of cervical lymph nodes between the two groups regardless of having the vaccination or not. Interestingly, US evaluation found that the experimental group's proportion of cervical lymph node enlargement increased significantly within 14 days after vaccination, which was statistically significant.Conclusions:This study found that vaccination against COVID-19 did not increase the number of cervical lymph node metastases, but inaccurate assessment of cervical lymph nodes in thyroid cancer patients within 14 days of vaccination (due to temporary lymph node enlargement) may lead to more extensive surgery.

Background:It has been established that clusterin is involved in the invasion of immune cells in the tumor microenvironment, but it remains unknown how it promotes immune invasion in breast cancer.Methods:We used Tumor Immune Estimation Resource (TIMER) and Gene Expression Profiling Interactive Analysis (GEPIA) databases to assess the relation between expression of clusterin and immunoinfiltration-related marker genes. TIMER database was used to evaluate the expression of clusterin, and its relation to tumor immune invasion was examined. Based on Kaplan-Meier plotter database, we investigated the association between clusterin expression and prognosis in patients with cancer, and the impact of clinicopathological factors and cancer-related outcomes.Results:Clusterin expression was markedly associated with prognosis of a variety of tumors, specifically breast cancer. Enhanced clusterin expression was markedly associated with molecular typing of breast cancer and expression of multiple markers related to specific immune cell subsets.Conclusions:These results indicate that clusterin is connected to prognosis of breast cancer patients and tumor immune cell infiltration. This demonstrates that clusterin may be a biomarker of immune cell recruitment into breast tumors and an important biomarker for immune cell infiltration; consequently being a valuable prognostic factor in breast cancer patients.

Additional file 8: Table S1. Showing the detailed clinical information and follow-up data of the enrolled TNBC population.

Ferroptosis, being classified as a form of regulated cell death, was driven by the oxidative injury induced by lipid peroxidation (LPO). Recently, ferroptosis has been confirmed to exert a critical effect in the pathogenesis and treatment of various tumors, including gastric cancer (GC). Erastin, as a frequently used ferroptosis inducer, caused ferroptosis by downregulating the xCT expression resulting in increasing reactive oxygen species (ROS) and aggravating the LPO. However, the mechanisms of Erastin in ferroptosis regulation, especially in GC, remain largely elusive. This work firstly demonstrated that Erastin inhibited cell growth and promoted apoptosis and ferroptosis in AGS and BGC823 cells. Then, based on Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of Erastin-related targets screened by using PharmMapper Web, the P38MAPK signaling was explored and validated in AGS and BGC-823 cells. Besides, the Fer-1 and P38 inhibitor were performed to investigate the mechanisms of ferroptosis induced by Erastin in depth. This work revealed a feedback mode among xCT, ROS and the P38MAPK pathway, which affected each other. It meant that Erastin regulated ferroptosis through the xCT-mediated ROS/P38MAPK signaling feedback loop. In addition, it was noticed that in co-operation with Erastin, the cytotoxic effects of Afatinib on cells were aggravated by further strengthening ferroptosis with activation of the P38MAPK pathway. In summary, those works provided evidence that Erastin plays an important role in increasing the cytotoxic effect on GC cells treated with Afitinib. Furthermore, the Erastin-induced ferroptosis via the xCT-mediated ROS/P38MAPK pathway feedback loop provides new strategies for GC comprehensive treatment.

Abstract Background HER2-low could be found in some patients with triple-negative breast cancer (TNBC). However, its potential impacts on clinical features and tumor biological characteristics in TNBC remain unclear. Methods We enrolled 251 consecutive TNBC patients retrospectively, including 157 HER2-low (HER2low) and 94 HER2-negtive (HER2neg) patients to investigate the clinical and prognostic features. Then, we performed single-cell RNA sequencing (scRNA-seq) with another seven TNBC samples (HER2negvs. HER2low, 4 vs. 3) prospectively to further explore the differences of tumor biological properties between the two TNBC phenotypes. The underlying molecular distinctions were also explored and then verified in the additional TNBC samples. Results Compared with HER2neg TNBC, HER2low TNBC patients exhibited malignant clinical features with larger tumor size (P = 0.04), more lymph nodes involvement (P = 0.02), higher histological grade of lesions (P < 0.001), higher Ki67 status (P < 0.01), and a worse prognosis (P < 0.001; HR [CI 95%] = 3.44 [2.10–5.62]). Cox proportional hazards analysis showed that neoadjuvant systemic therapy, lymph nodes involvement and Ki67 levels were prognostic factors in HER2low TNBC but not in HER2neg TNBC patients. ScRNA-seq revealed that HER2low TNBC which showed more metabolically active and aggressive hallmarks, while HER2neg TNBC exhibited signatures more involved in immune activities with higher expressions of immunoglobulin-related genes (IGHG1, IGHG4, IGKC, IGLC2); this was further confirmed by immunofluorescence in clinical TNBC samples. Furthermore, HER2low and HER2neg TNBC exhibited distinct tumor evolutionary characteristics. Moreover, HER2neg TNBC revealed a potentially more active immune microenvironment than HER2low TNBC, as evidenced by positively active regulation of macrophage polarization, abundant CD8+ effector T cells, enriched diversity of T-cell receptors and higher levels of immunotherapy-targeted markers, which contributed to achieve immunotherapeutic response. Conclusions This study suggests that HER2low TNBC patients harbor more malignant clinical behavior and aggressive tumor biological properties than the HER2neg phenotype. The heterogeneity of HER2 may be a non-negligible factor in the clinical management of TNBC patients. Our data provide new insights into the development of a more refined classification and tailored therapeutic strategies for TNBC patients.

Simulation-based medical education (SBME) and three-dimensional printed (3DP) models are increasingly used in continuing medical education and clinical training. However, our understanding of their role and value in improving trainees’ understanding of the anatomical and surgical procedures associated with liver surgery remains limited. Furthermore, gender bias is also a potential factor in the evaluation of medical education. Therefore, the aim of this study was to evaluate the educational benefits trainees receive from the use of novel 3DP liver models while considering trainees’ experience and gender. Full-sized 3DP liver models were developed and printed using transparent material based on anonymous CT scans. We used printed 3D models and conventional 2D CT scans of the liver to investigate thirty trainees with various levels of experience and different genders in the context of both small group teaching and formative assessment. We adopted a mixed methods approach involving both questionnaires and focus groups to collect the views of different trainees and monitors to assess trainees’ educational benefits and perceptions after progressing through different training programs. We used Objective Structured Clinical Examination (OSCE) and Likert scales to support thematic analysis of the responses to the questionnaires by trainees and monitors, respectively. Descriptive analyses were conducted using SPSS statistical software version 21.0. Overall, a 3DP model of the liver is of great significance for improving trainees’ understanding of surgical procedures and cooperation during operation. After viewing the personalized full-sized 3DP liver model, all trainees at the various levels exhibited significant improvements in their understanding of the key points of surgery (p < 0.05), especially regarding the planned surgical procedure and key details of the surgical procedures. More importantly, the trainees exhibited higher levels of satisfaction and self-confidence during the operation regardless of gender. However, with regard to gender, the results showed that the improvement of male trainees after training with the 3DP liver model was more significant than that of female trainees in understanding and cooperation during the surgical procedure, while no such trend was found with regard to their understanding of the base knowledge. Trainees and monitors agreed that the use of 3DP liver models was acceptable. The improvement of the learning effect for practical skills and theoretical understanding after training with the 3DP liver models was significant. This study also indicated that training with personalized 3DP liver models can improve all trainees’ presurgical understanding of liver tumours and surgery and males show more advantage in understanding and cooperation during the surgical procedure as compared to females. Full-sized realistic 3DP models of the liver are an effective auxiliary teaching tool for SBME teaching in Chinese continuing medical education.

e12565 Background: HER2-low could be found in some patients with triple-negative breast cancer (TNBC). However, its potential impacts on clinical features and tumor biological characteristics in TNBC remain unclear. Methods: We enrolled 251 consecutive TNBC patients retrospectively, including 157 HER2-low (HER2 low ) and 94 HER2-negtive (HER2 neg ) patients to investigate the clinical and prognostic features. Then, we performed single-cell RNA sequencing (scRNA-seq) with another seven TNBC samples (HER2 neg vs. HER2 low , 4 vs. 3) prospectively to further explore the differences of tumor biological properties between the two TNBC phenotypes. The underlying molecular distinctions were also explored and then verified in the additional TNBC samples. Results: Compared with HER2 neg TNBC, HER2 low TNBC patients exhibited malignant clinical features with larger tumor size ( P = 0.04), more lymph nodes involvement ( P = 0.02), higher histological grade of lesions ( P < 0.001), higher Ki67 status ( P < 0.01), and a worse prognosis ( P < 0.001; HR [CI 95%] = 3.44 [2.10-5.62]). Cox proportional hazards analysis showed that neoadjuvant systemic therapy, lymph nodes involvement and Ki67 levels were prognostic factors in HER2 low TNBC but not in HER2 neg TNBC patients. scRNA-seq revealed that HER2 low TNBC which showed more metabolically active and aggressive hallmarks, while HER2 neg TNBC exhibited signatures more involved in immune activities with higher expressions of immunoglobulin-related genes ( IGHG1, IGHG4, IGKC, IGLC2); this was further confirmed by immunofluorescence in clinical TNBC samples. Furthermore, HER2 low and HER2 neg TNBC exhibited distinct tumor evolutionary characteristics. Moreover, HER2 neg TNBC revealed a potentially more active immune microenvironment than HER2 low TNBC, as evidenced by positively active regulation of macrophage polarization, abundant CD8 + effector T cells, enriched diversity of T-cell receptors and higher levels of immunotherapy-targeted markers, which contributed to achieve immunotherapeutic response. Conclusions: This study suggests that HER2 low TNBC patients harbor more malignant clinical behavior and aggressive tumor biological properties than the HER2 neg phenotype. The heterogeneity of HER2 may be a non-negligible factor in the clinical management of TNBC patients. Our data provides new insights into the development of a more refined classification and tailored therapeutic strategies for TNBC patients.

Objective:To compare the efficacy and prognosis of three kinds of operation for stage Ⅰ-Ⅱ breast cancer.Methods:The data of 127 patients with breast cancer who underwent surgical treatment from March 2013 to March 2018 were retrospectively analyzed. They were divided into three groups according to the operation types：endoscopic group（40 cases underwent single hole endoscopic breast conserving surgery），traditional group（44 cases underwent traditional open breast conserving surgery），and radical resection group（43 cases underwent open total mastectomy）. SPSS 23.0 statistical analysis software was used，and the operation-related indicators were expressed as（xˉ±s），and single-factor analysis of variance was used among multiple groups；the count data such as complications and metastasis rate were expressed as rates，and χ2 test was used for comparison；P < 0.05 was considered statistically significant.Results:Operation time：traditional group < radical group < endoscopic group（P < 0.05）；Intraoperative bleeding，number of lymph node dissections，length of hospital stay and total incidence of complications：endoscopic group < traditional group < radical group（P < 0.05）；The excellent and good rate of breast beauty：endoscopic group > traditional group > radical mastectomy group（P < 0.05）；There was no significant difference in local recurrence rate and metastasis rate among the three groups（P > 0.05）.Conclusion:Endoscopic breast-conserving surgery，traditional open breast-conserving surgery and modified radical mastectomy have similar efficacy in the treatment of stage Ⅰ to Ⅱ breast cancer，and there is no significant difference in the risk of mid and long term recurrence and metastasis. However，endoscopic breast-conserving surgery has certain advantages in breast aesthetics and postoperative recovery.

目的 探讨乳腺癌术后接受ac-T方案化疗患者放疗开始时间对预后的影响.方法 研究纳入2019年1月至2020年1月间本院收治的乳腺癌患者120例,所有患者均采用手术治疗,术后均行ac-T方案化疗和辅助放疗,回顾性分析患者的临床资料,依据患者手术治疗到放疗的间隔时间(SRI)将120例患者分为对照组和研究组,其中对照组患者54例,SRI在3个月以上,研究组患者66例SRI在3个月以内,比较2组局部复发、远处转移和预后的差异.结果 研究组并发症发生率22.73％、局部复发率10.61％、远处转移发生率9.09％,分别与对照组18.52％、9.26％和7.41％对比差异均无统计学意义(P＞0.05);研究组无进展生存期时长(24.05±5.37)个月明显长于对照组(18.69±5.13)个月;对照组和研究组手术前生活质量评分差异无统计学意义(P＞0.05);术后6个月,研究组5个领域的生活质量评分均高于对照组,差异有统计学意义(P＜0.05).结论 乳腺癌术后接受ac-T方案化疗的患者越早行术后放疗越有助于延长患者的无进展生存期,提高患者的生活质量,临床效果更加显著.

Background:Extrachromosomal circular DNA (eccDNA) is omnipresent in cancers and related to the progression of tumors and oncogene amplification. However, its function in breast cancer (BC) is unclear.Methods:After constructing the DNA library, CLeavage Effects by Circularization for In vitro Reporting of sequencing was performed for eccDNA detection using 1 BC tissue sample. Fastqc was used to evaluate the quality of the original data. Burrows-Wheeler-Alignment Tool was used to compare the original data to the reference genome. A Circle-MAP was subsequently performed to detect eccDNA, and Bedtools was used to annotate the eccDNA genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted by ClusterProfiler. The Genotype-Tissue Expression and the Cancer Genome Atlas databases were used to collect the ribonucleic acid-sequencing data of the BC and normal samples. A Gene Expression Profiling Interactive Analysis, the University of Alabama at Birmingham CANcer data analysis Portal, and Kaplan-Meier survival curves were used to analyze the Cancer Genome Atlas data.Results:A total of 200 eccDNA genes, including IGTB7, were obtained. About the biological processes (BPs), these 200 genes were mainly enriched in actin cytoskeleton reorganization and axon guidance. Concerning the molecular functions (MFs), these 200 genes were mainly enriched in sodium ion transmembrane transporter activity and metal ion transmembrane transporter activity. As for cellular components (CCs), these 200 genes were mainly enriched in the transcription regulator complex and focal adhesion. ITGB7 was significantly enriched in cell-matrix adhesion and localization within the membrane in the BPs, integrin binding in the MFs, and cell-substrate junction and focal adhesion in the CCs. The 200 eccDNA genes were mainly enriched in the PI3K-Akt signaling pathway and focal adhesion. Notably, ITGB7 was enriched in focal adhesion, ECM-receptor interaction, the PI3K-Akt signaling pathway, and human papillomavirus infection. Besides, ITGB7 was significantly upregulated in BC patients and was associated with the menopause status of the BC patients.Conclusions:ITGB7 might serve as a prognostic marker for BC patients. ITGB7 has important implications for the individualized clinical treatment of BC patients.

目的:探究Ⅲ期结直肠癌手术患者接受奥沙利铂联合卡培他滨治疗后血清粒细胞集落刺激因子(G-CSF)、人脂联素(ADPN)水平的变化,分析血清G-CSF、ADPN水平与肠道菌群失调的相关性.方法:选择2021年1月至2021年12月于我院接受手术治疗的220例Ⅲ期结直肠癌患者为研究对象,均对其联合应用奥沙利铂与卡培他滨进行治疗,分析治疗前后患者血清G-CSF、ADPN水平变化,将入组患者按照肠道菌群情况分为肠道正常组(n=80)、菌群失调Ⅰ度组(n=90)、菌群失调Ⅱ度组(n=50),分析肠道菌群失调对入组患者治疗前后血清G-CSF、ADPN水平的影响,最后评估血清G-CSF、ADPN水平与肠道菌群失调的相关性.结果:(1)治疗后入组患者血清G-CSF、ADPN水平均较治疗前出现了明显的降低,前后比较有差异(P＜0.05);(2)治疗后菌群正常组患者血清G-CSF、ADPN水平明显低于菌群失调Ⅰ度组,菌群失调Ⅰ度组明显低于菌群失调Ⅱ度组,各组间血清G-CSF、ADPN水平有差异(P＜0.05);(3)不同肠道菌群失调组患者肠道菌群数量存在差异,患者肠道菌群失调情况越严重,其肠球菌数量越高,乳杆菌数量越低(P＜0.05);(4)血清G-CSF、ADPN水平与乳杆菌数量呈现负相关(r=-0.872、-0.781,P＜0.05),与肠球菌数量呈现正相关(r=0.772、0.819,P＜0.05).结论:Ⅲ期结直肠癌行手术治疗患者术后联用奥沙利铂与卡培他滨可以显著降低其血清G-CSF、ADPN水平,且其降低程度与患者肠道菌群失调情况相关,提示可以考虑将调节结直肠癌患者肠道菌群作为降低患者化疗后炎性反应措施之一推广于临床.

目的 探讨影响经皮肝穿刺胆道引流(PTBD)治疗胆总管结石(CBDS)患者引流持续时间的因素.方法 2019年4月～2021年3月我院收治的112例CBDS患者均接受PTBD治疗.收集临床资料,以PTBD平均引流时间加标准差之和为截断点,将患者分为PTBD持续时间延长组和正常组,应用多因素Logistic回归分析影响引流延长的因素.结果 在112例CBDS患者中,109例(97.3％)患者成功取出结石,其中81例胆道引流时间短于17天,另28例超过17天;PTBD持续时间延长组血清总胆红素[(38.1±7.3)μmol/L对(24.2±6.2)μmol/L]、淀粉酶[(403.7±15.6)U/L对(92.7±13.2)U/L]、ALP[(302.3±52.1)U/L 对(180.7±50.2)U/L]、GGT[(176.6±16.7)U/L对(93.3±15.6)U/L]、C 反应蛋白[(75.1±12.2)mg/L对(56.9±10.3)mg/L]和结石直径[(16.9±2.5)mm对(11.3±2.1)mm]等均显著高于PTBD持续时间正常组,差异有统计学意义(P＜0.05);多因素Logistic回归分析显示血清总胆红素(OR:4.092,95％CI:1.684～9.944)和淀粉酶水平(OR:3.277,95％CI:1.348～7.965)及结石直径(OR:3.651,95％CI:1.502～8.873)是影响 CBDS 患者 PTBD持续时间的独立因素(P＜0.05).结论 采用PTBD治疗CBDS患者成功率高,了解一些容易导致引流时间延长的因素有助于做好术前准备和术后管理.