目的 通过数据挖掘分析不同Polo样激酶家族(PLKs)在人乳腺癌mRNA中的表达水平及与预后的关系.方法 采用 Oncomine、GEPIA2、cBioPortal、UALCAN,Linked Omics 及 Kaplan-Meier Plotter and DAVID 数据库分析乳腺癌患者mRNA中PLKs的表达、变异、临床病理相关性、预后意义和功能富集.结果 乳腺癌患者中PLK1、PLK4均显著高表达,PLK1、PLK4在乳腺癌分期、年龄、临床类型、淋巴结转移和TP53突变中均为高表达.PLK1、PLK4的高表达会影响乳腺癌患者的生存和预后.通过Linked Omics数据库发现PLK1、PLK4呈正相关(P＜0.05).结论 PLKs在乳腺癌的发生和病情进展中起着重要作用,由此为乳腺癌的分子机制研究和治疗药物研发提供了方向.特别是PLKl、PLK4,可能是乳腺癌治疗的相关靶点.

Objective To study the efficacy of oral administration of rifampicin combined with ultrasound-guided puncture for granulomatous lobular mastitis (GLM). Methods From January 2017 and January 2019，10 GLM patients with median age of 34 years confirmed by pathology were included in this study and treated with oral administration of rifampicin, 300 mg twice daily for a period of 9 months, combined with ultrasound-guided puncture. The symptoms and ultrasound manifestations of GLM patients were investigated at 3, 6, 9, 12 months, respectively. Results All patients had a history of breast feeding and manifestation of acute stages of breast infection, 5 cases with breast abscess. After 12 months therapy, the symptoms disappeared in all patients with normal ultrasonic manifestation and no patient relapsed. Conclusions Oral administration of rifampicin combined with ultrasound-guided puncture could be effective in the treatment of GLM patients.

Objective Postoperative delirium (POD) has rarely been investigated in breast cancer patients. Herein, we assessed the association between serum levels of the inflammatory biomarker translocator protein (TP) and the occurrence of POD in breast cancer patients. Methods In this prospective, observational study, TP levels were detected in preoperative and postoperative serum samples from 152 elderly breast cancer patients, samples from 152 healthy elderly women, and samples from 152 elderly women with benign breast diseases. The relationship between serum TP levels and POD was investigated using multivariate analysis. Results TP levels in postoperative patient serum samples were significantly higher than in preoperative patient serum samples and serum from women in the two control groups. Postoperative serum TP levels were independently correlated with serum C-reactive protein levels and the occurrence of POD. Postoperative serum TP levels had a high discriminatory ability for POD under the receiver operating characteristic curve. Conclusions Increased postoperative serum TP levels are independently associated with the degree of inflammatory response and the risk of POD in elderly breast cancer patients, substantializing TP as an inflammatory biomarker that can efficiently discriminate POD after breast cancer surgery.

Crohn's disease (CD) is a chronic non-specific intestinal inflammatory disease, and the incidence of perianal fistulizing CD (PFCD) is 17%-43%. Non-cutting setons is the first choice for surgical treatment of PFCD. Some new surgical methods are effective for specific types of PFCD, however, the efficacy of most new methods remains to be confirmed by further studies. The multidisciplinary team (MDT) mode has become a new direction of PFCD surgery. This article reviewed the advances in surgical treatment of PFCD.

Objective To compare the efficacy of laparoscopic complete mesocolic excision (CME) for right colon cancer with open CME. Methods The clinical data of the patients with right colon cancer in our department from January 2010 to December 2014 was retrospectively analyzed. There were 102 patients with laparoscopic CME as laparoscopic group and 116 patients with open CME as open group. Peri-operative outcomes and survival were compared between two groups. Rusults The baseline information was not significantly different between two groups (P>0. 05). Compared with open group, the patients in laparoscopic group had longer operating time [(155. 20±4. 17) min vs (140. 10±4. 00) min, P=0. 009 6], but less bleeding [(102. 60±7. 37) mL vs (145. 90±12. 23) mL, P=0. 003 7], more retrieved lymph nodes [(12. 17±0. 39) vs (10. 78±0. 42), P=0. 016 8], faster recovery course including shorter time to liquid diet [(2. 91±0. 47) day vs (3. 62±0. 41) day, P=0. 034] and shorter postoperative hospital stay [(10. 59±0. 57) day vs (14. 13±0. 52) day, P=0. 041]. No significant difference was observed in the postoperative complications between two groups. The period of follow-up had no significant difference between two groups [(38. 83±1. 73) month vs (30. 74±1. 60) month, P>0. 05]. Three-year survival rate of the patients in laparoscopic group was significantly higher than that in open group (89. 81％ vs 82. 22％, P=0. 048 2). Conclusions Laparoscopic CME provides the patients of right colon cancer with faster recovery and better overall survival.

Background: Studies have shown that Houpupaiqi mixture is beneficial to the recovery of postoperative gastrointestinal function in patients undergoing open gastrointestinal surgery. However, there is no randomized controlled trial focusing on the efficacy of Houpupaiqi mixture on laparoscopic colorectal cancer patients. Aims: To investigate the efficacy of perioperative administration of Houpupaiqi mixture on fast track surgery in patients with laparoscopic colorectal cancer. Methods: A total of 170 colorectal cancer patients at Renji Hospital from January 2016 to February 2017 were enrolled into the prospective randomized double-blind controlled clinical trial. The patients were randomly divided into experimental group and control group, and Houpupaiqi mixture (50 mL) or placebo (50 mL) were administered 6 hours before surgery, as well as 6 and 12 hours after surgery, respectively. The clinical efficacy and safety were compared between the two groups. Results: The patients in experimental and control groups were well balanced with respect to the baseline characteristics. Compared with the control group, time to first anal exhaust, time to recovery of regular bowel sounds and time of postoperative hospital stay were significantly decreased in experimental group (P< 0.05). However, no significant differences were observed in first time to defecation, first time to drink, first time to eat fluid diet and first time to eat solid food between the two groups (P> 0.05). One patient with anastomotic fistula was found in each group. Conclusions: Houpupaiqi mixture significantly promotes the recovery of gastrointestinal function of patients undergoing …

目的 探讨中间联合头侧入路在腹腔镜直肠癌手术的临床可行性和应用价值.方法 回顾性队列分析上海交通大学医学院附属仁济医院2016年10月至2017年6月间132例腹腔镜直肠癌根治术的临床资料(中间联合头侧组42例,头侧中间组35例,传统中间组55例),比较3组病人术中情况、术后恢复情况以及随访情况的变化.结果 在手术时间方面,头侧中间组用时最多[(146.90±5.92)min],其次为中间联合头侧组[(127.50±4.18)min],传统中间组花费时间最少[(122.90±3.97) min] (P=0.002);在清扫No.253淋巴结所需时间上传统中间组[(11.91±0.38)min]＞中间联合头侧组[(12.24±0.29) min]＞头侧中间组[(15.76±0.44)min](P＜ 0.001);No.253淋巴结清扫数目方面,头侧中间组[(2.686±0.220)枚]及中间联合头侧组[(2.929±0.190)枚]均大于传统中间组[(1.709±0.09)枚](P＜0.001);而在术中出血量、淋巴结清扫总数以及术后并发症等方面差异无统计学意义.所有病人随访期间无肿瘤复发和转移,无肿瘤相关死亡.结论 中间联合头侧入路的腹腔镜直肠癌手术不仅可获得传统中间入路相同的效果,不会增加手术时间和手术难度,而且可以获得和头侧中间入路相似的No.253淋巴结清扫效果.

Objective To explore the effects of low ligation of the inferior mesenteric artery (IMA) on the third station lymph node dissection in laparoscopic radical resection of rectal cancer (RC),and analyze the risk factors affecting the third station lymph node metastasis.Methods The retrospective cohort study was conducted.The clinical data of 380 RC patients who were admitted to Renji Hospital of Shanghai Jiaotong University School of Medicine from June 2014 to June 2016 were collected.Of 380 patients,177 with preservation of left colic artery (LCA) and 203 without preservation of LCA were respectively allocated into the low ligation group and high ligation group.All the patients received laparoscopic radical resection of RC based on the principle of total mesorectal excision (TME).Observation indicators:(1) intra-and post-operative recovery situations;(2) results of postoperative pathological examination;(3) follow-up and survival;(4) risk factors analysis affecting the third station lymph node metastasis.Follow-up using outpatient examination and telephone interview was performed to detect postoperative disease-free survival and tumor recurrence or metastasis up to May 31,2017.Measurement data with normal distribution were represented as x ± s,and comparisons between groups were evaluated with the t test.Comparisons of count data and ordinal data were respectively analyzed using the chisquare test and U test.The survival curve and survival rate were respectively drawn and analyzed using the KaplanMeier method,and the survival analysis was done by the Log-rank test.Results (1) Intra-and post-operative recovery situations:all the patients underwent successful surgery.The operation time,time to initial exsufflation and cases with anastomotic leakage were respectively (147.2±3.0) minutes,(72.8± 1.4)hours,20 in the low ligation group and (137.2±2.8) minutes,(76.6± 1.1) hours,38 in the high ligation group,with statistically significant differences between groups (t =2.463,2.073,x2 =4.025,P＜0.05).Volume of intraoperative blood loss,cases with temporary stoma,vascular injury (injury of inferior mesenteric vessels and presacral vein injury),urinary retention and duration of postoperative hospital stay were respectively (119±6)mL,25,29,24,(10.7± 0.5)days in the low ligation group and (108±5)mL,32,27,30,(9.6±0.4)days in the high ligation group,with no statistically significant difference between groups (t=1.524,x2 =0.235,0.716,1.115,t=1.780,P＞ 0.05).Of 58 patients with anastomotic leakage,31 received previously terminal loop ileostomy,13 received conservative treatment and 14 received postoperatively terminal loop ileostomy.Fifty-four patients with urinary retention received urethral catheterization.All the patients with complications were improved by treatment and then were discharged.(2) Results of postoperative pathological examination:number of lymph node dissected in the low ligation group and high ligation group was respectively 12.8±0.4 and 12.0±0.3;cases with depths of tumor invading to intestinal wall in stage pT1-T2 and pT3-T4,with tubular adenocarcinoma and non-tubular adenocarcinoma,with high-differentiated,moderate-differentiated and low-differentiated tumors,with lymph node metastasis in stage N0,N 1 and N2,with and without the third station lymph node metastasis,with TNM staging in stage Ⅰ,Ⅱ,Ⅲ,and Ⅳ were respectively 53,124,150,27,81,63,33,73,66,38,16,161,17,54,93,13 in the low ligation group and 59,144,176,27,99,59,45,79,78,46,24,179,32,47,105,19 in the high ligation group,with no statistically significant difference in above indicators between groups (t =1.556,x2 =0.035,0.296,U=2.002,0.220,x2 =0.778,U=5.557,P＞0.05).(3) Follow-up and survival:338 of 380 patients were followed up for 6-36 months,with an average time of 28 months,including 164 in the low ligation group and 174 in the high ligation group.The 1-and 3-year disease-free survival rates and cases with postoperative tumor recurrence or metastasis were respectively 93.9％,76.4％,39 in the low ligation group and 94.8％,79.3％,36 in the high ligation group,with no statistically significant difference between groups (x2=0.861,P＞0.05).(4) Risk factors analysis affecting the third station lymph node metastasis:results of univariate analysis showed that tumor location and diameter,depth of tumor invading to intestinal wall and tumor histopathological type were related factors affecting the third station lymph node metastasis of RC patients (x2 =9.957,9.921,6.196,6.576,P＜0.05).Results of multivariate analysis showed that tumor diameter ＞ 5 cm and non-tubular adenocarcinoma were independent risk factors affecting the third station lymph node metastasis of RC patients (Odds ratio=2.561,2.296,95％ confidence interval:1.280-5.123,1.037-5.083,P＜0.05).Conclusions The low ligation of the IMA is safe and feasible in laparoscopic radical resection of RC,meanwhile,it has the same radical effect in lymph node dissection and doesn't affect the third station lymph node metastasis and shortterm disease-free survival compared with high ligation of the IMA.Tumor diameter ＞ 5 cm and non-tubular adenocarcinoma are independent risk factors affecting the third station lymph node metastasis of RC.

Objective To analyze the clinical efficacy of anterior resection of rectal cancer using da Vinci robotic surgical system compared with laparoscopy.Methods A retrospective study was done on 40 patients with rectal cancer receiving da Vinci robotic assisted anterior resection comparing 60 patients of laparoscopic assisted anterior resection from June 2015 to June 2017.Perioperative results were collected to two groups.The clinical and pathological characteristics of two groups were similar.Results The amount of bleeding during operation in the da Vinci robotic group was less compared with laparoscopic group [(55.00±15.19) mL vs (81.25±74.84) mL,P＜0.05],more lymph node of detection [(13.68±1.83) vs (12.78±1.49),P＜0.05] and shorter time of postoperative urinary catheter [(3.63±0.87) d vs (4.17±0.69) d,P＜0.01].No significant difference between two groups was present postoperatively including anal exhaust time,feeding time,morbidity such as anastomotic leakage and hospital stay (P＞0.05).Conclusions Da Vinci robotic assisted anterior resection for rectal cancer has advantage in less bleeding,more lymph node detection and protection of bladder function and better postoperative recovery compared with laparoscopic assisted anterior resection.

Objective To evaluate the clinical significance and value of preserving left colic artery (LCA) when treating the inferior mesenteric artery (IMA) in laparoscopic resection for rectal cancer.Methods The clinical data of 523 cases of rectal cancer performed laparoscopic resection of rectal cancer in Renji Hospital,Shanghai Jiaotong University School of Medicine from Janua3y 2015 to December 2016 were analyzed retrospectively.All the cases include 203 cases with preservation of LCA (low ligation group) and 320 cases without preservation of LCA (high ligation group).The clinical conditions during operation and after operation were compared between two groups.Results The difference was not significant statistically in age,sex,tumor size,depth of tumor invasion,histopathologic type,tumor differentiation,blood loss and urinary retention rate between two groups (P ＞ 0.05).The postoperative exhaust time,anastomotic leakage rate and defecation frequency 3 months after operation in low ligation group were lower than those in high ligation group (P ＜ 0.05).What's more,the number of lymph node and operative time in low ligation group was more in high ligation group (P ＜ 0.05).Conclusion Preservation of left colic artery in laparoscopic resection of rectal cancer can achieve radical clearance of lymph nodes,increase the number of lymph node detection,reduce the incidence of anastomotic leakage rate and postoperative exhaust time,which is worth clinical promotion.