Therapeutic resistance remains a major cause of treatment failure and disease recurrence across cancer types, considerably limiting the long-term efficacy of chemotherapies, targeted therapies, and immunotherapies. Growing evidence indicates that resistance cannot be fully explained by static genetic alterations but rather arises from dynamic and reversible adaptive processes. Epigenetic regulation governs transcriptional plasticity, cellular state transitions, and tumor heterogeneity under therapeutic stress. Alterations in DNA methylation, histone modifications, chromatin accessibility, and non-coding RNA networks enable cancer cells to silence tumor suppressor programs, activate compensatory survival pathways, acquire stem cell-like drug-tolerant persister states, and remodel the tumor immune microenvironment. These mechanisms often act in a coordinated manner to form a dynamic regulatory system that supports adaptive resistance. However, current studies have frequently focused on individual epigenetic regulators and have lacked an integrated framework to explain how epigenetic plasticity collectively drives therapeutic resistance. In this review, we deconstruct cancer therapy resistance using the conceptual framework of the “epigenetic landscape.” We summarize the molecular functions and crosstalk among the major epigenetic layers and describe how this integrated network sustains key resistance-associated phenotypes. We also discuss emerging therapeutic strategies that target epigenetic plasticity, including epigenetic drugs, targeted protein degradation, epigenetic editing, and rational combination therapies. Overall, this review provides a systematic framework for understanding epigenetically mediated therapy resistance and highlights epigenetic plasticity as a therapeutic vulnerability for developing durable cancer treatments.

BACKGROUND:Epidemiological data show that approximately 80% of cancer patients experience pain of varying degrees throughout the course of their disease, with nearly one-third experiencing severe pain, significantly impacting their quality of life and the effectiveness of antitumor treatment. Triple-negative (TN) breast cancer tissues typically exhibit increased stromal stiffness and abnormally elevated mechanical stress; these biomechanical alterations may amplify pain signals by activating mechanosensitive channels. Utilizing single-cell RNA sequencing analysis, this study aims to elucidate the potential biological links between fibroblast mechanotransduction and cancer-associated pain, thereby providing a theoretical basis for clinical diagnosis and treatment. METHODS:Dimensionality reduction and unsupervised clustering were used to identify cell types in TN breast cancer single-cell RNA sequencing data. To assess the association between pain and mechanical stimulation, we constructed a set of gene signatures associated with mechanical stimulation and pain and calculated scores using the Area Under the Curve Cell (AUCell). CellChat and SCENIC were used to reveal the communication networks and transcription factor regulatory mechanisms of fibroblast subtypes. RESULTS:COL3A1+ fibroblasts derived from TN breast cancer are highly involved in biological processes such as extracellular matrix remodeling, collagen fiber formation, and mechanotransduction. To assess the association between pain and mechanical stimulation, we constructed a gene signature set related to mechanical stimuli and pain and calculated corresponding scores using the AUCell tool. Cell communication studies showed that COL3A1+ fibroblasts interact extensively with epithelial cells and other cells through laminin and collagen signaling pathways, potentially leading to mechanotransduction remodeling of the TN breast cancer microenvironment. CONCLUSION:COL3A1+ fibroblasts demonstrate enhanced transcriptional profiles pertinent to collagen deposition and cytoskeletal reorganization, which are correlated with mechanotransduction signaling and may be connected with mechanical sensitivity in cancer-related pain. This study systematically characterizes the potential relationship between fibroblast-associated mechanotransduction characteristics and pain-related gene signatures at the single-cell level in TN breast cancer. These findings offer hypothesis-generating insights into the molecular landscape of tumor-associated pain, although additional experimental and clinical validation is necessary.

Immune checkpoint blockade has shown benefit in some Triple-negative breast cancer (TNBC) patients, but responses are variable. BRCA1-mutated TNBC represents a biologically distinct subgroup, potentially differing in immunogenicity and immunotherapy responsiveness. However, immune microenvironment differences between BRCA1-mutated and sporadic TNBC remain incompletely understood. By performing single-cell RNA sequencing analysis on sporadic TNBC and BRCA1 mutant TNBC, we assessed immune cell composition, transcriptional program, pathways, stemness, differentiation, and transcription factor regulatory networks. B cell and plasma cell subtypes were further explored using AUCell, CytoTRACE, Monocle2, and Slingshot. Compared to sporadic TNBC, BRCA1-mutated TNBC exhibited a distinct immune landscape with enriched naïve and memory B cells, while sporadic TNBC was dominated by terminally differentiated plasma cells, including IgA plasma cells. Functional enrichment analyses showed enhanced adaptive immune signaling, antigen presentation, and B cell receptor pathways in BRCA1-mutated TNBC, while sporadic TNBC had humoral effector and immunoregulatory programs. Trajectory and stemness analyses indicated enhanced cellular plasticity and decreased differentiation in B cells derived from BRCA1-mutated triple-negative breast cancer. Analysis of transcription factors revealed JUND and ETV1 in BRCA1-mutated TNBC, and MEIS1 and CEBPB in sporadic TNBC. Our findings underscore disparities in the immune ecosystem between BRCA1-mutated and spontaneous TNBC, indicating that the B cell-centric immunological milieu in BRCA1-mutated TNBC may offer a more advantageous setting for immunotherapy. Sporadic TNBC, by contrast, exhibits an immunological state characterized by plasma cells, which may restrict immune reactivation. These data indicate that B cell-based immunological stratification may guide precision immunotherapy approaches.

Tumor-associated macrophages (TAMs) play a critical role in the immunosuppressive tumor microenvironment (TME). Although the biochemical signaling pathways regulating TAMs have been extensively elucidated, how these cells persistently sense physical properties of the tumor stroma—such as matrix stiffness, tension, and compression—and translate them into sustained immunosuppressive programs remains to be systematically addressed. Unlike other infiltrating immune cell populations that primarily engage in transient adhesive interactions, TAMs utilize integrins for stable spatial anchoring and continuous mechanotransduction. In this review, we synthesize current evidence on the integrin-TAM mechanosensing axis. We first distinguish the persistent mechanobiological features of TAMs from those of structural stromal cells and other transiently infiltrating lymphocytes. Subsequently, we delineate how force-dependent signaling shapes TAM phenotypic plasticity, metabolic reprogramming, and spatial organization. Crucially, we define a self-amplifying biomechanical-immune feedback framework, demonstrating how mechanically remodeled TAMs actively exacerbate extracellular matrix stiffening to consolidate the immunosuppressive niche. Furthermore, we critically evaluate the translational relevance of this axis, analyzing the limitations of past single-target integrin inhibitors and highlighting the emerging potential of multidimensional combination therapeutic strategies. Targeting integrin-dependent mechanotransduction provides a rational, system-level strategy to dismantle mechanically reinforced immune barriers. Breaking this interlocking feedback framework offers new insights for remodeling the TME and enhancing the efficacy of current immunotherapies. Highlights integrin-mediated mechanotransduction linking biomechanics to immunity. Illustrates how mechanical cues reshape macrophage immunoregulatory programs. Discusses integrin-macrophage-ECM interactions in immunosuppressive niches. Outlines therapeutic strategies targeting integrin-dependent mechanotransduction.

Antigen-presenting cancer-associated fibroblasts (apCAFs) are a recently identified stromal cell subset in the tumor microenvironment, playing a significant role in tumor immune regulation through their unique antigen-presenting function. This study aimed to elucidate the biological significance of apCAFs in triple-negative breast cancer (TNBC) by analyzing single-cell transcriptomic data from nine TNBC patients in public databases and integrating TCGA data. Three major CAF subpopulations were identified, with apCAFs primarily establishing functional connections with various cell types, including T cells, via the MIF signaling pathway. Based on genes significantly associated with overall survival, TNBC patients were stratified into two subgroups (C1 and C2), with the C1 group exhibiting stronger immune response activity. A prognostic risk model was constructed using four key genes (CXCL13, LOXL1, PLOD2, and CIR1), demonstrating that the low-risk group had higher levels of immune cell infiltration and immune function activity. Among these genes, CXCL13 showed the most significant correlation with patient overall survival, and its significant upregulation in apCAFs was experimentally validated, suggesting its crucial role in TNBC prognosis and immune regulation. The survival prediction model based on these four apCAF-related prognostic genes has shown significant potential in evaluating TNBC patient prognosis and predicting immunotherapy efficacy. Furthermore, this study provides important theoretical evidence for a deeper understanding of the role of apCAFs in the classification of breast cancer subtypes.

Background:Five-year treatment with tamoxifen (TAM) has been the traditional standard of care for breast cancer. Organising pneumonia (OP) is a rare but significant complication of radiation therapy for breast cancer. The effect of TAM leading to OP has not yet been clearly documented.Case Description:This report describes the case of a 38-year-old female who developed progressive aggravation of round-like patchy bilateral pulmonary infiltrated with a reverse halo sign but without any clinical symptoms 5 months after TAM therapy, following breast-conserving surgery and radiotherapy (RT) for breast carcinoma. A lung biopsy was performed and revealed a histological pattern of OP. TAM therapy was discontinued, and subsequent gradual radiological improvement was observed. As there was no proof for TAM had caused the incident, TAM was re-administrated. Eight months after reinstitution of TAM, the same patchy migratory bilateral pulmonary infiltrated with reverse halo sign was found on chest CT with the patient claiming no discomforts nor any clinical symptoms. The diagnosis of TAM-related OP was made based on the exclusion of other causes and recurrence with the re-administration of TAM. The multidisciplinary team (MDT) concluded that TAM should be withdrawn and a "wait-and-see" approach was taken after a comprehensive assessment, instead of altering the medication or performing prophylactic mastectomy.Conclusions:The withdrawal and rechallenge of TAM strongly suggest that it may play a role as a cofactor in the occurrence of OP after RT for breast cancer, and RT may also be a cofactor in the occurrence of OP. It is extremely important to be alerted to the possibility of OP after concurrent or sequential hormonal therapy and RT.

Tumor-associated macrophages (TAMs) are the most critical effector cells of innate immunity and the most abundant tumor-infiltrating immune cells. They play a key role in the clearance of apoptotic bodies, regulation of inflammation, and tissue repair to maintain homeostasis in vivo. With the progression of triple-negative breast cancer（TNBC）, TAMs are "subverted" from tumor-promoting immune cells to tumor-promoting immune suppressor cells, which play a significant role in tumor development and are considered potential targets for cancer therapy. Here, we explored how macrophages, as the most important part of the TNBC ecosystem, are "subverted" to drive cancer evolution and the uniqueness of TAMs in TNBC progression and metastasis. Similarly, we discuss the rationale and available evidence for TAMs as potential targets for TNBC therapy.

Background The breast imaging reporting and data system (BI-RADS) lexicon provides a standardized terminology for describing leision characteristics but does not provide defined rules for converting specific imaging features into diagnostic categories. The inter-reader agreement of the BI-RADS is moderate. In this study, we explored the use of a simplified protocol and scoring system for BI-RADS categorization which integrates the morphologic features (MF), kinetic time-intensity curve (TIC), and apparent diffusion coefficient (ADC) values with equal weights, with a view to providing a convenient and practical method for breast magnetic resonance imaging (MRI) and improving the inter-reader agreement and diagnostic performance of BI-RADS. Methods This cross-sectional, retrospective, single-center study included 879 patients with 898 histopathologically verified lesions who underwent an MRI scan on a 3.0 Tesla GE Discovery 750 MRI scanner between January 1, 2017, and June 30, 2020. The BI-RADS categorization of the studied lesions was assessed according to the sum of the assigned scores (the presence of malignant MF, lower ADC, and suspicious TIC each warranted a score of +1). Total scores of +2 and +3 were classified as category 5, scores of +1 were classified as category 4, and scores of +0 but with other lesions of interest were classified as category 3. The receiver operating characteristic (ROC) curves were plotted, and the sensitivity, specificity, and accuracy of this categorization were investigated to assess its efficacy and its consistency with pathology. Results There were 472 malignant, 104 risk, and 322 benign lesions. Our simplified scoring protocol had high diagnostic accuracy, with an area under curve (AUC) value of 0.896. In terms of the borderline effect of pathological risk and category 4 lesions, our results showed that when risk lesions were classified together with malignant ones, the AUC value improved (0.876 vs. 0.844 and 0.909 vs. 0.900). When category 4 and 5 lesions were classified as malignant, the specificity, accuracy, and AUC value decreased (82.3% vs. 93.2%, 89.3% vs. 90.2%, and 0.876 vs. 0.909, respectively). Therefore, to improve the diagnostic accuracy of the protocol for BI-RADS categorization, only category 5 lesions should be considered to be malignant. Conclusions Our simplified scoring protocol that integrates MF, TIC, and ADC values with equal weights for BI-RADS categorization could improve both the diagnostic performance of the protocol for BI-RADS categorization in clinical practice and the understanding of the benign-risk-malignant breast diseases.

Hepatocellular carcinoma (HCC), a common malignant tumor, is one of the main causes of cancer-related deaths worldwide. Circular RNAs (circRNAs), a novel class of non-coding RNA, have been reported to be involved in the etiology of various malignancy. However, the functions of circRNAs in HCC remain unclear. In this study, through mining the RNA sequencing databases from GEO datasets and subsequent experimental verification, we identified that hsa_circ_0000384 (circMRPS35) was highly expressed in HCC. Knockdown of circMRPS35 suppressed the proliferation, migration, invasion, clone formation and cell cycle of HCC cell lines both in vitro and in a xenograft mouse model. Mechanically, circMRPS35 sponged microRNA-148a-3p (miR-148a), which in turn regulated STX3-PTEN axis. Surprisingly, we detected a peptide encoded by circMRPS35 (circMRPS35-168aa), which was significantly induced by chemotherapeutic drugs and promoted cisplatin resistance in HCC cells. These results demonstrated that circMRPS35 might be a novel factor in HCC progress, and has a great potential as a new diagnosis and therapeutic target for treatment of HCC.

Background: To assess the efficacy, safety, and cosmetic effects of breast-conserving surgery (BCS) combined with intraoperative radiotherapy (IORT) in Chinese people. Methods: A retrospective analysis was performed on 451 patients who received IORT at four hospitals in China. The endpoints were ipsilateral breast tumor recurrence (IBTR), locoregional recurrence (LRR), overall survival (OS), disease-free survival (DFS), IORT-related toxicities, and cosmetic outcomes. Findings: The median follow-up was 5.4 years (with a range of 1.0 to 11.9 years). The overall IBRT was 1.5%, LRR was 2.8%, and the OS rate and DFS rate were 96.2% and 99.1%, respectively. Only one (0.2%) breast cancer-related death was recorded. The cancer-related distant metastasis rate was 0.6%. There was no intraoperative or postoperative radiation-related acute hematological toxicity or other complications. Overall, 74.3% of patients graded the cosmetic effect as excellent or good. The pre-excision IORT is non-inferior to post-IORT The LRR was 2.4%, whereas the OS rate was 99.5% after adjusting for the age of patients according to the recommended criteria by the American Society of Therapeutic Radiation Oncology (ASTRO), and the DFS rate was 98.1%. Interpretation: IORT significantly reduced the treatment time while preserving a high degree of locoregional control and cosmetic effects. The outcomes of pre-excision IORT were similar to those of post--excision IORT. Patients older than 40 years old are legible for IORT. Funding: This work was supported by the Beijing Municipal Science & Technology Commission (D161100000816003), National Natural Science Foundation of China (Grant No. 82072097), National Key Research and Development Project (Grant No. 2019YFE0110000), Clinical and Translational Medicine Research Foundation of Chinese Academy of Medical Sciences(Grant No. 2020-I2M-C&T-B-069), the CAMS Initiative Fund for Medical Sciences (Grant No. 2017-I2M-3-004), the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No. 2018PT32013, 2017PT32001 and 2016ZX310178), the Beijing Hope Run Special Fund (Grant No. LC2017B15 and LC2020A18). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This study was approved by the Ethics Committee of the Cancer Hospital Chinese Academy of Medical Sciences, the First Affiliated Hospital of Zhengzhou University, the Peking University Cancer Hospital, and 301 hospital.

Background: The incidence of bilateral breast cancer (BBC) is low, accounting for 5% of patients with breast cancer. This study aimed to investigate the clinicopathological features and prognosis of synchronous bilateral breast cancer (SBBC) and metachronous bilateral breast cancer (MBBC) in the Chinese population. Methods: Patients with BBC, including SBBC and MBBC, were selected from 6,162 breast cancer patients who underwent surgery at the Chinese People's Liberation Army (PLA) General Hospital between January 2007 and December 2019. Furthermore, patients with unilateral breast cancer (UBC) who underwent surgery at the same time were randomly selected at a ratio of 1:2 as the control group. Clinicopathological features and prognosis were compared between the groups. Results: In all, 123 (2.0%) patients with BBC were enrolled in this study, including 98 (1.6%) SBBC and 25 (0.4%) MBBC patients. A total of 280 patients with UBC were selected for the control group. Compared with patients with UBC, patients with SBBC were more likely to be older and have a family history of breast cancer, non-infiltrative carcinoma, lower pathological tumor-node-metastasis (pTNM) stage, and luminal A type breast cancer as their first tumor. Patients with MBBC were more likely to be postmenopausal and have hormone receptor [estrogen receptor (ER)/progesterone receptor (PR)] negativity, a higher pTNM stage, and a triple-negative first tumor. Patients with UBC with ER/PR (-) were more likely to develop contralateral breast cancer (CBC) than those with ER/PR (+). There was no significant difference in overall survival (OS) and disease-free survival (DFS) between patients with SBBC and patients with UBC. Patients with MBBC had worse DFS than those with UBC, but OS was similar for both types of patients. Patients with MBBC <55 years at first diagnosis had significantly shorter DFS compared to those with SBBC and UBC. A multivariate Cox proportional hazards model revealed that age >= 55 years and ER/PR negativity of the first tumor were independent risk factors for OS. Independent risk factors for DFS included MBBC, age <55 years, family history of other malignant tumors, ER/PR (-), lymphovascular invasion, and N stage >= 2 of the first tumor. Conclusions: The OS and DFS of patients with SBBC and UBC were similar. The MBBC patients, especially those <55 years old at first diagnosis, had shorter DFS than patients with UBC.

Background Information is still controversial in the studies regarding the current optimal surgical management of phyllodes tumors (PTs) of the breast. Local recurrence (LR) may occur with an upgraded in the pathological grade, influencing the prognosis of patients with PT. This systematic review and meta-analysis aimed to investigate the association of LR risk with margin status and margin width which could have significant implications on the surgical management of PT. Methods Independent and comprehensive searches were performed by two authors through five databases including PubMed, Medline, Embase, ScienceDirect and Cochrane Library from January 1990 to October 2021. Studies investigating the association between margin width, margin status and LR rates were considered for inclusion. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan5.3 software, and statistical heterogeneity was assessed using the Chi-square test and quantified using the I2 statistic. Visual inspection of funnel plots was used to judge publication bias. Results A total of 34 articles were included in this article, all of which with NOS scores above 5. Regardless of the PT grade, positive margin significantly increased the risk of LR [odds ratio (OR) 3.64, 95% confidence interval (CI): 2.60-5.12]. No significant difference was found in the risk of LR between the margins <1 and ≥1 cm (OR 1.39, 95% CI: 0.67-2.92). For benign and borderline PTs, there were no significant differences of the LR risk between breast-conserving surgery (BCS) and mastectomy (benign OR 0.68, 95% CI: 0.12-3.78; borderline OR 1.14, 95% CI: 0.29-4.51). While the LR risk was significantly increased by BCS for malignant PT (OR 2.77, 95% CI: 1.33-5.74). Discussion Different surgical management strategies should be considered for different PT grades. BCS was a feasible option and margins <1 cm was not significantly associated with LR risk for all grade of PT. After BCS, benign PT with positive margin could adopt the "wait and watch" strategy with regular follow-up, while borderline and malignant PTs were expected to underwent re-excision to ensure negative margins. More studies are still needed to clarify and update the existing conclusions and improve the prognosis of PT patients.

Background:Regardless of histological grade, phyllodes tumors (PTs) exhibit the potential of local recurrence. The National Comprehensive Cancer Network (NCCN) recommends wide local excision (WLE) with a 1 cm margin or more for borderline/malignant PTs but excisional biopsy for benign PTs. However, the treatment of benign PTs remains controversial and the clinicopathologic risk factors for the local recurrence is still unclear.Methods:We retrospectively analyzed 238 patients with PTs who underwent surgery at the Chinese PLA General Hospital from January 1, 2006 and April 30, 2020. We stratified our analysis according to histologic grade and explored the clinicopathologic factors to influence local recurrence (LR), including age, histologic grade, history of fibroadenoma, type of surgery [vacuum-assisted biopsy system (VABS), local excision (LE), wide local excision (WLE) and mastectomy].Results:All 238 cases were categorized as benign (171, 71.8%), borderline (38, 16.0%), or malignant (29, 12.2%). The median follow-up was 50.2 months. In multivariate analysis, histologic grade (P<0.01) and history of fibroadenoma (P<0.01) were independent prognostic factors for LR. No difference existed in the recurrence rate of BPT treated with different surgical procedures (P=0.397), whereas a higher recurrence rate was found in VABS and LE subgroups than in WLE and mastectomy subgroups for borderline/malignant tumors (P<0.01).Conclusions:No association found between surgical modalities and LR rate for BPT. We suggested a "wait-and-watch" policy for patients with unexpected benign subtypes, instead of unnecessary re-excision. In addition, VABS or LE can be treated for BPT with small mass, whereas WLE or even mastectomy should be conducted for borderline/malignant PTs with large mass.

详细阐述了电外科设备(electrosurgical unit,ESU)的定义、特点以及亟待解决和优化的问题,介绍了动物切割凝血模型、血管封闭模型及神经损伤模型等ESU临床评价用动物模型的构建方法以及评估ESU有效性和安全性的指标,分析了各种动物模型构建方法的优势和不足,展望了未来ESU临床评价用动物模型应与人工智能、计算机信息自动化等技术相结合的发展趋势.

BACKGROUND:Triple-negative breast cancer (TNBC) is a malignant subtype of breast cancer, the main treatments for which are chemotherapy and surgery. PIK3CA is an oncogene that encodes the p110α subunit of class IA PI3K to regulate cell proliferation and apoptosis. Some reports have observed neoadjuvant chemotherapy (NAC) to have poor pathological complete response (pCR) rates in TNBC with PIK3CA mutation. This study aimed to explore the mechanism of how mutant PIK3CA alters chemotherapeutic susceptibility in TNBC.METHODS:TNBC cell lines (MDA-MB-231 and MDA-MB-468) with PIK3CA gene mutations (E545K and H1047R regions) and overexpression were established by transfection. NOD/SCID mice were used for in vivo experiments. Epirubicin was used as the chemotherapeutic agent. Cell viability, cell cycle, apoptosis, and Transwell assays were conducted for phenotype analysis. Western blot, quantitative reverse transcription-polymerase chain reaction, and immunohistochemistry were used to detect gene and protein expression levels. A clinical analysis of 50 patients with TNBC was also performed.RESULTS:Cell viability and Transwell assays showed that PIK3CA mutation promoted TNBC cell growth and conferred an enhanced migratory phenotype. Cell cycle and apoptosis assays showed that PIK3CA mutation moderately improved the proliferation ability of TNBC cells and remarkably inhibited their apoptosis. After epirubicin therapy, the proportion of early apoptotic cells decreased among cells with PIK3CA mutation. Further, xenograft tumors grew faster in NOD/SCID mice injected with mutated cell lines than in control group, suggesting that PIK3CA mutation caused chemotherapy resistance. Importantly, western blot and immunohistochemical analysis showed that cells and mouse tumors in the PIK3CA mutation groups exhibited different expression levels of apoptosis-related markers (Xiap, Bcl-2, and Caspase 3) and proteins associated with the PI3K/AKT/mTOR pathway (p110α, AKT, p-AKT, mTOR, p-mTOR, p-4E-BP1, p-p70S6K, and Pten). Moreover, prognostic analysis of 50 patients with TNBC indicated that PIK3CA mutation might be linked with relapse and death.CONCLUSIONS:PIK3CA mutation confers resistance to chemotherapy in TNBC by inhibiting apoptosis and activating the PI3K/AKT/mTOR signaling pathway.

Background Electrosurgical technology is widely used in surgical dissection and hemostasis, but the generated heat creates thermal injury to adjacent tissues and delays wound healing. The plasma blade (PB) applies pulsed radiofrequency (RF) to generate electrical plasma along the edge of a thin, flat, insulated electrode, minimizing collateral tissue damage. This study aimed to evaluate wound healing in swine skin following incision with a new surgical system that applies low-temperature plasma (NTS-100), a foreign PB, conventional electrosurgery (ES), and a scalpel blade. Methods In vitro porcine skin and an in vivo porcine skin model were used in this study. Full-thickness skin incisions 3 cm in length were made on the dorsum of each animal for each of the 5 surgical procedures at 0, 21, 28, 35, and 42 days. The timing of the surgical procedures allowed for wound-healing data points at 1, 2, 3, and 6 weeks accordingly. Local operating temperature and blood loss were quantified. Wounds were harvested at designated time points, tested for wound tensile strength, and examined histologically for scar formation and tissue damage. Results Local operating temperature was reduced significantly with NTS-100 (cut mode 83.12±23.55 °C; coagulation mode 90.07±10.6 °C) compared with PB (cut mode 94.46±11.48 °C; coagulation mode 100.23±6.58 °C, P<0.05) and ES (cut mode 208.99±34.33 °C, P<0.01; coagulation mode 233.37±28.69 °C, P<0.01) in vitro. Acute thermal damage from NTS-100 was significantly less than ES incisions (cut mode: 247.345±42.274 versus 495.295±103.525 µm, P<0.01; coagulation mode: 351.419±127.948 versus 584.516±31.708 µm, P<0.05). Bleeding, histological scoring of injury, and wound strength were equivalent for the NTS-100 and PB incisions. Conclusions The local operating temperature of NTS-100 was lower than PB, and NTS-100 had similarly reliable safety and efficacy.

目的 评价一种新型低温等离子手术系统(NTS-100)对猪皮肤切割愈合的影响.方法 选择6头巴马小型猪的背部脊柱两侧皮肤,获取愈合时间分别为1、2、3和6周的皮肤标本,比较手术刀、新型低温等离子手术系统(NTS-100)、高频电刀、低温等离子手术刀(Pulsed-Electron Avalanche Knife,PEAK)对皮肤切口愈合的影响,评价指标包括出血量、疤痕宽度、炎性细胞浸润程度和疤痕拉力强度等.结果 新型低温等离子手术系统(NTS-100)止血效果优于手术刀(P<0.01),各时间点的疤痕宽度均小于高频电刀(P<0.05),愈合时间为3周和6周时的T淋巴细胞和巨噬细胞浸润显著少于高频电刀(P<0.01),愈合时间为3周时的瘢痕拉力强度高于高频电刀(P<0.05),各评价指标与PEAK比较,无统计学差异(P>0.05).结论 新型低温等离子手术系统(NTS-100)减少术后伤口瘢痕形成,提高伤口愈合强度,具有可靠的安全性,可以满足微创精细手术的要求.

Bleeding complications can cause significant morbidities and mortalities in both civilian and military conditions. The formation of stable blood clots or hemostasis is essential to prevent major blood loss and death from excessive bleeding. However, the body's self-coagulation process cannot accomplish timely hemostasis without the assistance of hemostatic agents under some conditions. In the past two decades, topical hemostatic materials and devices containing platelets, fibrin, and polysaccharides have been gradually developed and introduced to induce faster or more stable blood clot formation, updating or iterating traditional hemostatic materials. Despite the various forms and functions of topical hemostatic materials that have been developed for different clinical conditions, uncontrolled hemorrhage still causes over 30% of trauma deaths across the world. Therefore, it is important to fabricate fast, efficient, safe, and ready-to-use novel hemostatic materials. It is necessary to understand the coagulation process and the hemostatic mechanism of different materials to develop novel topical hemostatic agents, such as tissue adhesives and sealants from various natural and synthetic materials. This review discusses the structural features of topical hemostatic materials related to the stimulation of hemostasis, summarizes the commercially available products and their applications, and reviews the ongoing clinical trials and recent studies concerning the development of different hemostatic materials.

Background: Breast ptosis is directly caused by Cooper's ligament laxity, with the decline of nipple areola complex (NAC) and mammary parenchyma. Breast cancer with ptosis is always a knotty problem that can hardly be repaired by classic breast conservation surgery (BCS) ending up with a pleasing appearance. We analyzed our 12 years' experience of performing inverted-T pattern techniques to treat bilateral breast ptosis, with or without breast cancer. Methods: One hundred forty-eight breasts in 74 patients undergoing inverted-T pattern reduction mammoplasty were included in this study. Information about patients' clinical and surgical characteristics, complications, NAC sensitivity, cosmetic and oncological outcomes were collected and retrospectively analyzed. Results: In the cohort of 57 patients with pure breast ptosis, the mean body mass index (BMI) was 25.2 kg/m2, and the mean weight of resected tissue from the left and right breast reductions were 744.9 and 756.7 g. In the cohort of 17 patients diagnosed as breast cancer with ptosis, the mean BMI was 25.1 kg/m2, and the mean weight of resected tissue were 504.1 g for left and 535.6 g for right side. The majority of repairs were performed for tumors located in the upper outer (58.8%), mostly with inferior or superomedial pedicles (90%). All the upper inner tumors were repaired with inferior pedicles. Minor complications such as seroma (8.1%), NAC epidermolysis (8.1%), delayed wound healing (4.1%) were detected postoperatively. Partial NAC necrosis occurred in one patient (1.4%). 82.4% of all the patients rated "very satisfied" or "satisfied" as the final cosmetic outcomes. NAC sensitivity was "very high" and "high" in 82.4% patients. No local occurrence, distant metastasis and mortality occurred in tumor patients. Conclusions: The inverted-T pattern reduction mammoplasty is a reliable technique to treat bilateral breast ptosis with a low complication rate. For cases with breast cancer, this technique can achieve both satisfying cosmetic outcomes and oncological safety.

预防性乳腺切除术是近年来兴起的一种针对乳腺癌高危女性的降低发病风险的手段,美国女性在过去20多年接受该手术的比例大幅增加,且单侧乳腺癌患者选择对侧乳房预防性切除比高风险健康女性选择双侧乳房预防性切除的接受度更高.高危人群选择手术多基于对癌症的恐惧、对乳房对称性的担忧、随访筛查的负担等多重因素.对于健康高危女性,行双侧预防性乳腺切除术可显著降低患乳腺癌的风险,降低死亡率,延长预期寿命,显示出生存获益;对于单侧乳腺癌患者,行对侧预防性乳腺切除术明显降低对侧乳腺癌的发生风险.预防性乳腺切除术结合乳房重建具有良好的美容学效果且显著缓解高危女性心理压力,术后女性的整体满意度高;但术后组织坏死、感染、出血等并发症的风险增加,并可能影响未达预期女性的生活质量.临床上外科医生需充分平衡高危人群的获益与风险,采用多学科、个体化的方法辅助女性决策.