Tamoxifen (TAM) is employed to treat premenopausal ER-positive breast cancer patients, but TAM resistance is the main reason affecting its efficacy. Thus, addressing TAM resistance is crucial for improving therapeutic outcomes. This study explored the potential role of Tinagl1, a secreted extracellular matrix protein, whose expression is compromised in TAM-resistant MCF-7 breast cancer cells (MCF-7R). We discovered that Tinagl1 plays a pivotal role in countering TAM resistance by inhibiting the EGFR and β1-integrin/focal adhesion kinase (FAK) signaling pathways, both of which are abnormally activated in MCF-7R cells and contribute to the resistance mechanism. Our data showed that the expression level of Tinagl1 in MCF-7R cells was lower compared to their wild-type counterparts, and TAM could further reduce Tinagl1 expression in MCF-7R cells, which was consistent with our microarray results. Moreover, Tinagl1 could restore the sensitivity of MCF-7R cells to TAM and inhibit the motility of MCF-7R cells by regulating epithelial-mesenchymal transition (EMT) in vitro and in vivo experiments. In addition, the level of Tinagl1 in TAM-resistant breast cancer samples was significantly lower than that in their matched primary tumors. Analysis of an online database further indicated that high Tinagl1 expression correlates with better recurrence-free survival (RFS), particularly in patients with ER-positive, HER2-negative breast cancer. Overall, this study positions Tinagl1 not only as a potential prognostic marker but also as a promising therapeutic target.

BACKGROUND:The roles of long non-coding RNAs (lncRNAs) in the progression of various human tumors have been extensively studied. However, their specific mechanisms and therapeutic potential in Triple-Negative Breast Cancer (TNBC) remain to be fully elucidated. MATERIALS AND METHODS:The qRT-PCR assay was utilized to assess the relative mRNA levels of TFAP2A-AS1, PHGDH, and miR-6892. To investigate the impact of TFAP2A-AS1, we conducted various assays, including CCK-8, Transwell, flow cytometry, and clonal formation assays, to analyze cell viability, invasion, apoptosis, and proliferation capabilities of TNBC cells. Additionally, the effects of TFAP2A-AS1 on tumor growth were evaluated through in vivo xenograft models. To explore and confirm the interactions between TFAP2A-AS1 and miR-6892, as well as between miR-6892 and PHGDH, we employed bioinformatics analysis and dual-luciferase reporter assays. Lastly, Western blot analysis and immunohistochemistry (IHC) were performed to determine the protein expression levels of PHGDH and EMT-related markers in treated TNBC cells and xenograft tissues. RESULTS:Our study revealed that TFAP2A-AS1 was notably downregulated in TNBC cell lines, whereas PHGDH was upregulated. High PHGDH expression correlated with poorer survival outcomes, suggesting its oncogenic role in TNBC. Functional assays demonstrated that overexpression of TFAP2A-AS1 suppressed proliferation, clonal formation, migration, and invasion, while promoting apoptosis in TNBC cells. Conversely, overexpression of PHGDH had the opposite effects, promoting tumorigenic traits. Mechanistically, TFAP2A-AS1 was found to act as a sponge for miR-6892, thereby upregulating its expression and subsequently inhibiting the target gene PHGDH. In vivo experiments confirmed that TFAP2A-AS1 overexpression inhibited tumor growth, an effect that was partially reversed by the inhibition of miR-6892 or overexpression of PHGDH. CONCLUSION:Our study demonstrates that lncRNA TFAP2A-AS1 inhibits TNBC progression by modulating the miR-6892/PHGDH axis. These findings reveal that TFAP2A-AS1 suppresses key malignant characteristics of TNBC, such as proliferation, migration, and invasion. These insights suggest that targeting this pathway could offer a potential therapeutic strategy for TNBC, a subtype known for its limited targeted treatment options.

BACKGROUND:To summarize the experiences on the mastoscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal and standardize this operation. PATIENTS AND METHODS:Between January 1, 2002, and October 31, 2021, a total of 2035 breasts of 1082 male patients with gynecomastia, of which 129 patients with one side, were underwent mastoscopic subcutaneous mastectomy. The follow-up endpoint was 3 months after surgery. RESULTS:All patients were successfully completed the operation, and none of them was transferred to open operation. The operation time for unilateral breast was 12-28 min, and the average time was 17.7 ± 6.2 min. The amount of bleeding during unilateral operation was very small, about 5-10 ml. The total drainage volume was 5-50 ml after the operation, and the drainage tube was removed in 3-5 days. The epidermal necrosis occurred in 0.3% nipple. 0.2% chest wall had a little ecchymosis in the supero-medial region of the breast. All patients had the normal feeling of nipples and areola, the smoothing and symmetrical chest wall, and the natural contour. There was no recurrence during the follow-up period. CONCLUSIONS:The mastoscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal has a short operation time, few surgical complications and good esthetics. It achieves the "5S" goals on the complete removal of glandular tissue (sweeping), small and scar-hidden incision are small (scarless), good symmetry of bilateral chest wall (symmetry), normal chest shape (shape), and smoothing chest wall (smoothing). LEVEL OF EVIDENCE III:The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

Abstract Background: To summarize the experiences on the mastopscopic subcutaneous mastectomyfor gynecomastia by "nine-step method"based on the "5S" goal ，and standardize this operation . Patients and methods： Between January 1st 2002 and October 31st 2021，a total of 2035 breasts of 1082 male patients with gynecomastia, of which 129 patients with one side, were underwent mastopscopic subcutaneous mastectomy. Results： All patients were successfully completed the operation, and none of them was transferred to open operation. The operation time for unilateral breast was 12-28 min, and the average time was 17.7±6.2 min. The amount of bleeding during unilateral operation was very small, about 5-10ml. The total drainage volume was 5ml~50ml after the operation, and the drainage tube was removed in 3~5 days. The epidermal necrosis occurred in 0.3% nipple. 0.2% chest wall had a little ecchymosis in the upper- inner region of the breast. All patients had the normal feeling of nipples and areola, the smoothing and symmetrical chest wall, and the natural contour. There was no recurrence during the follow-up period. Conclusions： The mastopscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal has a short operation time, few surgical complications and good esthetics. It achieving the "5S" goals on the complete removal of glandular tissue（sweeping）, small and scar-hidden incision are small（scarless）,good symmetry of bilateral chest wall (symmetry), normal chest shape (shape), and smoothing chest wall（smoothing）.

目的 探讨乳腺癌组织的HNF1α 反义RNA 1(HNF1α-AS1)和HNF4α反义RNA 1(HNF4α-AS1)水平及临床意义.方法 采用实时定量PCR检测 2020 年 1 月至 2021 年 12 月手术切除的 106 对乳腺癌组织和癌旁组织的HNF1α-AS1、HNF4α-AS1 水平,分析组织两者水平与乳腺癌临床病理特征的关系,Kaplan-Meier Plotter数据库在线分析乳腺癌RNAseq数据中 2976 例患者的HNF1α-AS1、HNF4α-AS1 水平与预后的关系.结果 HNF1α-AS1 水平为 5.245±0.202,高于癌旁组织的 1.436±0.044,而HNF4α-AS1 水平为 0.836±0.035,低于癌旁组织的 1.337±0.048,差异有统计学意义(P＜0.05),进一步分析显示乳腺癌组织的HNF1α-AS1 和HNF4α-AS1 水平呈负相关(r=-0.453,P＜0.001).组织HNF1α-AS1 水平与TNM分期、组织学分级和Nottingham预后指数(NPI)有关(P＜0.05),而组织HNF4α-AS1 水平与肿瘤大小、淋巴结转移、TNM分期、组织学分级、HER-2表达和NPI有关(P＜0.05).Kaplan-Meier Plotter在线分析显示,HNF1α-AS1 水平与乳腺癌的总生存期(OS)无关(HR=1.28,95％CI:0.99～1.64,P=0.056),而HNF4α-AS1 水平与乳腺癌的OS有关,其中高水平者的中位OS优于低水平组(HR=0.75,95％CI:0.59～0.96,P=0.020).结论 HNF1α-AS1 在乳腺癌中高表达而HNF4α-AS1 为低表达,两者异常表达在乳腺癌恶性进展发挥作用,有望成为乳腺癌防治的靶点.

Objective:To investigate the feasibility and clinical value of indocyanine green emulsion duct fluoresceography in nipple discharge surgery to locate the nipple discharge duct and mark the diseased glands.Methods:Retrospective analysis was performed on the clinical data of 178 patients with pathological nipple discharge who underwent surgical treatment from May 2018 to May 2021. Molybdenum target lactography and indocyanine green lactography were performed intraoperatively. SPSS 25.0 software was used to analyze the data. The measurement data were expressed by（xˉ±s），and independent sample t test was performed. The count data were represented by［n（%）］and χ2 or Fisher test was used. P<0.05 was considered statistically significant.Results:There were 193 overflowing milk ducts in 178 patients，including 133 benign lesions（68.9%），40 malignant lesions（20.7%），and 20 borderline lesions（10.4%）. Unilateral and single-hole overflow is more common，with yellow serous overflow. Mammography showed that 84（43.5%）of the milk ducts with discharge showed “trunk sign” and 109（56.5%）showed “tree sign”. The most common types of glands were inhomogeneous and dense，and mostly located in the inner and lower quadrant. Indocyanine green lactigraphy showed that 132（68.4%）of the discharge lactis were fluorescined directly through the skin，55（28.5%）were not fluorescined through the skin，and 6（3.1%）of the subcutaneous lymphatic lactis were fluorescined. There were significant differences in the development of indocyanine green in different age，pathological quadrants and molybdenum target imaging signs of discharge milk duct（P<0.05）. There was no statistically significant difference in the diameter of overflow milk duct in different fluorescein imaging（P>0.05），but there was statistically significant difference in the distance between overflow milk duct and skin（P<0.05）.Conclusion:The results of indocyanine green emulsion duct fluoroscopy were related to the age of the patient，the quadrant location of the discharge duct，molybdenum target imaging signs and the distance from the discharge duct to the skin. Indocyanine green lactigraphy can accurately locate the diseased lactis，reasonably design surgical incisions，and completely remove the diseased glandular system during nipple discharge surgery，which has clinical application value.

Objective:To investigate the prognostic value of circulating tumor cells（CTCs）in patients with stage T1-2 breast cancer with 1~3 positive axillary lymph nodes（ALNS）.Methods:Clinical data of 120 patients with breast cancer who met the standards from January 2016 to December 2019 were retrospectively analyzed. SPSS24.0 statistical software. was used for analysis. Univariate and multivariate analysis of patient prognosis was performed by COX risk regression model. ROC curve is drawn to determine the optimal critical value of CTCS. Kaplan-Meier method was used to draw disease-free survival curves of patients with different CTCS levels，and log-rank test was used to analyze the difference in survival rates. P<0.05 was considered statistically significant.Results:The follow-up period was 27~63 months，with a median of 49 months. No patient died during the follow-up period，a total of 10 patients had local recurrence，5 patients had distant metastasis，and 1 of them had local recurrence with distant metastasis. The 5-year DFS was 88.3%.Cox univariate survival analysis showed that age，PT2 stage，triple negative molecular typing and CTCS number were the influential factors for postoperative prognosis（P<0.05）. ROC curve analysis of CTCS showed that the AUC was 0.807（95%CI：0.739-0.875），the optimal cut-off value was 3，the Youden index was 0.683，the sensitivity was 0.908，and the specificity was 0.775.During the follow-up period，10 of the 71 patients in the CTCS≥3 group had recurrence and metastasis，the 5-year disease-free survival rate was 85.9%，and 4 of the 49 patients in the CTCS<3 group had recurrence and metastasis，the 5-year DFS was 91.8%. The difference in DFS between the two groups was statistically significant（χ2=4.006，P=0.045）.Conclusion:CTCS can predict the prognosis of breast cancer patients with stage T1-2 and 1~3 p ALNs positive patients. When patients have CTCs≥3，PMRT should be considered in combination with other clinicopathological characteristics such as age，PT stage，molecular typing to improve the prognosis of patients.

目的 观察肾性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)患者行甲状旁腺全切除术(total parathyroidectomy,TPTX)或 TPTX 联合自体移植术(total parathyroidectomy with autotransplantation,TPTX+AT)后血钙、血磷及血清全段甲状旁腺激素(intact parathyroid hormones,iPTH)、碱性磷酸酶(alkaline phosphatase,ALP)水平变化,探讨其治疗效果和安全性.方法 肾性SHPT患者62例,行TPTX或TPTX+AT治疗.记录手术成功率及术后并发症发生情况;比较术前及术后1、3、6个月时血钙、血磷及血清iPTH、ALP水平;比较术前及术后6个月时骨痛视觉模拟评分(visual analogue scale,VAS)、皮肤瘙痒及睡眠障碍发生率;随访至2020年4月,记录术后SHPT复发及持续性甲状旁腺功能低下发生情况.结果 62例患者中24例行TPTX,38例行TPTX+AT,手术成功率100％,行TPTX+AT者移植物存活率为86.8％,术后均未发生切口感染、喉部感觉神经丧失、失音等并发症,无围术期死亡.血钙、血磷及血清iPTH、ALP水平在术后1个月[(2.26±0.20)mmol/L、(1.09±0.29)mmol/L、73.74(64.50,86.26)ng/L、223.18(44.87,318.86)u/L]、3 个月[(2.26±0.21)mmol/L、(1.28±0.25)mmol/L、72.37(64.13,84.40)ng/L、131.98(43.52,199.61)u/L]、6 个月[(2.27±0.22)mmol/L、(1.33±0.24)mmol/L、71.11(60.06,83.04)ng/L、104.78(35.36,154.91)u/L]时均低于术前[(2.66±0.15)mmol/L、(2.89±0.70)mmol/L、1 277.32(1 012.35,1 423.85)ng/L、567.68(445.10,741.50)u/L](P＜0.05);术后 3、6 个月时血磷水平均高于术后 1个月时(P＜0.05),血清ALP水平均低于术后1个月时(P＜0.05);术后6个月时血磷水平高于术后3个月时(P＜0.05),血清iPTH、ALP水平均低于术后3个月时(P＜0.05).术后6个月时皮肤瘙痒(4.84％)、睡眠障碍(3.23％)发生率及骨痛 VAS 评分[(1.96±0.91)分]均低于术前[80.65％、69.35％、(5.12±2.29)分](P＜0.05).随访至2020年4月,SHPT复发9例,出现持续性甲状旁腺功能低下5例.结论 肾性SHPT患者行TPTX或TPTX+AT可有效缓解临床症状,降低血钙、血磷及血清iPTH、ALP水平,且围术期并发症、持续性甲状旁腺功能低下发生率及SHPT复发率低.

目的 探讨经环乳晕切口联合乳腔镜腋窝淋巴结清扫实施乳腺癌保乳手术(breast conserving surgery,BCS)及腋窝淋巴结清扫的治疗效果和美容结果.方法 2016年1月至2019年1月,98例早期乳腺癌患者实施BCS,其中46例行环乳晕切口加乳腔镜腋窝淋巴结清扫术,并与同期52例经肿块表面切口联合传统腋窝淋巴结清扫的保乳手术比较,2组手术时间、术中出血、放置引流管时间、住院天数等手术观察指标;根据术后6个月以上乳房外观评价不同手术方式的乳房美容效果.结果 2组病例的肿瘤直径、肿瘤位置、肿瘤与乳头乳晕复合体(nipple-areola complex,NAC)距离、淋巴结转移、病理类型、临床分期、分子分型的比较,差异无统计学意义(P>0.05),肿瘤表面切口组手术时间较短(P<0.05),术中出血、放置引流管时间、住院天数比较,差异无统计学意义(P>0.05).美容效果比较,环乳晕切口组在质地与弹性、对称性、患侧乳房凹陷程度、皮肤颜色、手术瘢痕及乳房顺应性差值得分高于肿瘤表面切口组,差异有统计学意义(P<0.05).总分>24分的优良率在环乳晕切口组(78.3％,36/46)明显高于肿瘤表面切口组(51.9％,27/52),差异有统计学意义(P<0.05).结论 环乳晕切口切除肿瘤,能够达到与肿瘤表面切口相同的保乳治疗效果,结合乳腔镜腋窝淋巴结清扫技术,提高了早期乳腺癌保乳手术效果和患者术后生活质量,获得了最佳的美容效果.

目的 探讨局部晚期乳腺癌(LABC)根治切除联合自体全厚邮票植皮术一期创面修复的疗效.方法 回顾性分析2018年3月至2020年3月首都医科大学附属北京安贞医院收治的10例LABC女性患者的临床资料.9例原发肿瘤直径＞5 cm,在切除肿瘤后取下腹部皮肤行一期全厚邮票植皮术;1例为右侧改良根治术后2年局部复发4个月伴随对侧原发乳腺癌,切除右侧胸壁复发病灶后,取左侧改良根治术所切除乳房的正常皮肤行一期全厚邮票植皮术.记录术后7d植皮区成活、皮下积液情况.术后随访6～24个月,记录植皮区皮肤状态及复发情况.结果 10例患者行乳腺癌根治手术联合一期全厚邮票植皮术修复胸壁缺损创面,手术效果满意,供皮区无张力缝合,愈合良好,术后7d植皮区95％以上成活.随访6～24个月,植皮区皮肤弹性好,瘢痕轻,耐摩擦;9例患者无局部复发及远处转移;1例术后拒绝辅助化疗及放疗,术后1年同侧胸壁出现局部复发,未发现其他转移.术后患者生活质量明显改善.结论 乳腺癌根治术联合全厚邮票植皮术一期创面修复治疗LABC手术效果满意,并可有效地降低皮瓣坏死风险,促进切口I期愈合,为需要植皮治疗的LABC患者提供了安全、可靠的手术方法.

Background Breast cancer is one of the most frequently diagnosed cancers among women worldwide. Alterations in the tumor microenvironment (TME) have been increasingly recognized as key in the development and progression of breast cancer in recent years. To deeply comprehend the gene expression profiling of the TME and identify immunological targets, as well as determine the relationship between gene expression and different prognoses is highly critical. Methods The stromal/immune scores of breast cancer patients from The Cancer Genome Atlas (TCGA) were employed to comprehensively evaluate the TME. Then, TME characteristics were assessed, overlapping genes of the top 3 Gene Ontology (GO) terms and upregulated differentially expressed genes (DEGs) were analyzed. Finally, through combined analyses of overall survival, time-dependent receiver operating characteristic (ROC), and protein-protein interaction (PPI) network, novel immune related genes with good prognosis were screened and validated in both TCGA and GEO database. Results Although the TME did not correlate with the stages of breast cancer, it was closely associated with the subtypes of breast cancer and gene mutations (CDH1, TP53 and PTEN), and had immunological characteristics. Based on GO functional enrichment analysis, the upregulated genes from the high vs low immune score groups were mainly involved in T cell activation, the external side of the plasma membrane, and receptor ligand activity. The top GO terms of the upregulated DEGs from the high vs low immune score groups exhibited better prognosis in breast cancer; 15 of them were related to good prognosis in breast cancer, especially CD226 and KLRC4-KLRK1. Conclusions High CD226 and KLRC4-KLRK1 expression levels were identified and validated to correlate with better overall survival in specific stages or subtypes of breast cancer. CD226, KLRC4-KLRK1 and other new targets seem to be promising avenues for promoting antitumor targeted immunotherapy in breast cancer.

乳腺癌患者行乳腺切除术后的总体生存率与保乳手术后辅助放疗的总体生存率相似,术后辅助放疗可使乳腺癌患者总体生存率升高.影响乳腺癌术后放疗效果的主要因素有放疗方法、放疗体位、放疗呼吸方式、患者年龄、乳腺的体积及形态、肿瘤分期和分型等.本文对乳腺癌保乳手术后放疗的研究进展进行综述,分析影响放疗效果的因素.

目的 探讨介入支架置入(percutaneous coronary intervention,PCI)术后4～6周实施乳腺癌手术的可行性和安全性.方法 2014年1月～2019年1月我们对18例乳腺癌合并重度冠状动脉狭窄先行PCI,PCI术后4～6周实施乳腺癌手术(3例完成PCI术后1个月确诊乳腺癌,15例乳腺癌术前准备发现冠状动脉重度狭窄,无法耐受手术及麻醉,先行冠状动脉PCI),重视围手术期管理,术前5 d开始停用阿司匹林及氯吡格雷,使用低分子肝素钙桥接抗凝,术中及术后使用心肌保护药物.结果 12例置入药物洗脱支架(drug eluting stent,DES),6例置入金属裸支架(bare metal stent,BMS).PCI术中支架置入后即刻血管造影显示血流通畅.乳腺癌手术包括改良根治术7例,乳腺全切术+前哨淋巴结活检4例,单纯乳房切除5例,保乳乳腺区段切除+前哨淋巴结活检2例,均顺利完成乳腺癌手术.手术时间50～145 min,(89.9±27.4)min;术中出血量30～200 ml,(98.3±59.5)ml.术中、术后血压、心率及血流动力学平稳,术前与术后3 d血小板、高敏C反应蛋白、脑钠肽、心肌肌钙蛋白Ⅰ及左心室射血分数差异无显著性(P>0.05),乳腺癌手术后无心脏相关事件发生.3例乳腺癌改良根治术后恢复抗凝后出现皮瓣下出血,通过加强负压引流及加压包扎控制,效果满意.住院时间5～8 d,(6.1±1.1)d.18例术后随访12～24个月,中位随访时间15个月,均无心脏相关事件发生,无肿瘤复发及转移.结论 通过加强围术期的管理,改善术中、术后心肌供血,选择恰当的手术方式,BMS与DES置入术后4周以上实施乳腺癌手术是安全的.

主动脉球囊反搏(intra-aortic balloon counter pulsation, IABP)是心脏外科常用的机械辅助装置,是治疗心肌缺血的最好方法之一[1],目前广泛应用于急性心肌梗死合并心源性休克的救治[2].但目前IABP应用于非心脏手术中的报道较少.本文报道1例胃贲门癌手术术前预防性置入IABP鞘管,术中发生血压急剧降低,心跳骤停后时快速置入球囊,使用IABP支持后患者血流动力学恢复稳定的案例,并分析IABP应用于非心脏手术的可行性及应用价值.

Objective: This paper aims to provide some experimental basis for unveiling the role of PDRG1 (P53 And DNA Damage-Regulated Gene 1) gene silencing in the growth and development of gastric cancer. Methods: PDRG1 levels in gastric cancer tissues and cell lines were measured by Western blotting. Then, gastric cancer BGC-823 cells, divided into Control, PDRG1 siRNA, NC siRNA and PDRG1 siRNA + KU55933 (ATM inhibitor) groups, were used to conduct a series of in vitro experiments including MTF, Flow cytometry, Wound-healing and Transwell assays. Expression of PDRG1 and ATM/p53 pathway-related proteins were determined by Western blot. Eventually, experiment in vivo was carried out to verify the control of PDRG1 on gastric cancer cells after establishing the tumor xenograft model in nude mice. Results: PDRG1 was significantly elevated in gastric cancer tissues and was associated with lower cell differentiation degree, more severe lymph node metastasis and higher tumor stage of gastric cancer patients. The growth of BGC-823 cells were significantly retarded and the cell apoptosis was increased in the PDRG1 siRNA group; besides, cell cycle was arrested in G2/M phase, and the expressions of p-ATM, p53, p21, p-cdc2 and cleaved caspase-3 were up-regulated with the reduced PDRG1. However, KU55933 could reverse the anti-tumor effect of PDRG1 siRNA on BGC-823 cells. The in-vivo experiment confirmed PDRG1 siRNA can inhibit tumor xenograft growth in nude mice. Conclusion: Specific PDRG1 gene silencing may inhibit the growth and metastasis of gastric cancer cells through the activation of ATM/p53 pathway.

目的 首都医科大学拥有全英文授课模式的国际医学院,招收全世界范围内医学生.由于种族、语言和学习习惯等问题常在临床见习课中,学生与患者、学生与教师间不能充分沟通.此研究目的是为了在临床见习中国际学生能与教师、患者沟通,实施对患者查体,并切实做到理论联系实际,掌握临床诊疗思路,达到见习课教学效果.方法 总结构建CBL与PPT总结加随堂小测验结合教学模式,在一次见普外科习课程中3种方式教学依次进行,并借鉴TBL、LBL、翻转课堂等概念,强调见习真实病人的重要性.结果 在学生中反响热烈,使本届留学生外科学学习积极性高涨,参与感强烈;减轻了教师的备课负担,口语提升明显,从而带动其他外科科室逐步参与进来;留学生外科学考试成绩明显优于往届.结论 教学效果满意度上升,提高了教学质量和教师队伍的英语教学水平.

目的 探讨腹腔镜直肠癌根治术和直肠癌常规开腹根治性手术治疗不同年龄段直肠癌患者的疗效.方法 将200例直肠癌患者,根据年龄和手术方式的不同分为高龄(≥80岁)腹腔镜组(n=30)、高龄开腹组(n=30)、老年(≥60岁,且﹤80岁)腹腔镜组(n=34)、老年开腹组(n=32)、中年(≥40岁,且﹤60岁)腹腔镜组(n=38)、中年开腹组(n=36).比较不同组别患者的术中、术后相关指标及不良反应发生情况.结果 不同年龄段腹腔镜组患者的手术时间、术后排气时间、术后进食时间、术后住院时间均短于相同年龄段开腹组患者,术中出血量、创口大小均小于相同年龄段开腹组患者,差异均有统计学意义(P﹤0.05).中年腹腔镜组患者的手术时间短于老年腹腔镜组和高龄腹腔镜组患者,术后进食时间短于高龄腹腔镜组患者,差异均有统计学意义(P﹤0.05);中年开腹组患者的手术时间短于老年开腹组和高龄开腹组患者,术后排气时间、术后进食时间均短于高龄开腹组患者,差异均有统计学意义(P﹤0.05).腹腔镜组与开腹组患者的并发症发生情况比较,差异无统计学意义(P﹥0.05).结论 腹腔镜直肠癌根治术治疗不同年龄段直肠癌患者的疗效相当,且与开腹手术比较,腹腔镜手术有着明显的优势,值得临床广泛应用.

早在1881年,俄国医师首先发现了胆囊与心脏之间存在某种神经联系.此后,不断有研究人员在临床发现相关病例.1986年,Krasna领导的小组报道了由于急性胆道疾病所导致的ECG变化,让更多的临床医生关注到了急性胆道疾病的心血管系统表现对临床诊断的影响[1].时至今日,急性胆道疾病引发的心血管系统临床表现,仍是误导临床诊断的重要原因之一,很容易延误治疗,增加患者的痛苦和经济负担.据最新数据统计,在美国,约有15％的人患有胆结石,而这些人中约有10％～ 25％出现了相关症状,这其中就包括胆心综合征[2].

Objective To investigate the effect of microsatellite instability (MSI) and hepatocyte growth factor (HGF) on the survival of patients with colorectal cancer . Methods A total of 82 patients with colorectal cancer were enrolled in our hospital from January 2012 to May 2014.The expression of MSI and HGF was detected by immunohistochemistry. Results 38 cases of patients were MSI positive , accounting for 39.02%;HGF expression was positive in 58 cases, accounting for 70.73%.MSI was associated with differentiation (P <0.05), but without age, sex, tumor location, tumor size, histological type, gross type and lymphatic metastasis (P >0.05).HGF expression was not associated with the above indicators (P >0.05). There was a significant negative correlation between MSI and HGF expression (r =-0.6531, P =0.032). Age, lymphatic metastasis, positive expression of MSI and HGF were independent prognostic factors in patients with colorectal cancer (P <0.05).Conclusion HGF expression in colorectal cancer is more obvious , MSI and HGF expression levels is related to the survival of colorectal cancer patients .

目的:通过分析两例老年阑尾炎病人术后并发急性肠系膜静脉血栓形成,探讨其病因及可能的预防措施。方法:今年诊治的两例急性化脓性阑尾炎患者,术后并发肠系膜静脉血栓形成,分析其发生特点。结果:两例均为老年、病情重、合并症多患者,诊断明确时均已经发生部分小肠坏死,行一期肠切除及吻合术,并抗凝治疗。结论:阑尾炎症严重的老年病人,围手术期应警惕腹腔内静脉血栓形成的危险。