Objective:This study aimed to develop and validate a predictive model for postoperative seroma resolution in patients with breast cancer, thereby providing an evidence-based tool for individualized postoperative management. Methods:This was a dual-center retrospective cohort study. A total of 373 patients who underwent surgery for breast cancer were included and an independent validation cohort(n=84)according to study center. Candidate predictors were screened using univariable and multivariable Cox proportional hazards regression analyses, and a nomogram was subsequently constructed. Internal validation was performed using bootstrap resampling, and model performance was evaluated in terms of discrimination (C-index and time-dependent area under the receiver operating characteristic curve [AUC]), calibration, and clinical utility (decision curve analysis). Validation was conducted in an independent cohort. Results:Multivariable Cox regression identified four independent predictors: body mass index (BMI), concomitant diabetes mellitus, modified radical mastectomy, and the number of lymph nodes dissected. A nomogram incorporating these variables was established. Following 1, 000 bootstrap resamples in the training cohort, the model yielded a concordance index (C-index) of 0.76 (95% CI, 0.73-0.80). The model demonstrated good discriminatory ability in both the training and validation cohorts. In the training cohort, the AUC was 0.79 (95% CI, 0.75-0.83) on postoperative day 7 and 0.78 (95% CI, 0.74-0.82) on postoperative day 10. In the independent validation cohort, the corresponding AUCs were 0.90 (95% CI, 0.82-0.97) and 0.86 (95% CI, 0.75-0.96), respectively. Calibration plots showed good agreement between predicted and observed probabilities of complete seroma resolution on postoperative days 7 and 10 in both cohorts. Decision curve analysis further demonstrated that the model provided a meaningful net clinical benefit across a broad range of threshold probabilities at both time points, indicating favorable clinical applicability. Conclusions:We developed a prognostic model for postoperative seroma resolution that may serve as an effective clinical tool to identify high-risk patients, guide early intervention, and reduce the risk of delayed or refractory seroma resolution.

Background Gastric cancer (GC) is a leading cause of cancer-related deaths worldwide. Understanding the molecular mechanisms of GC metastasis is crucial for improving patient survival outcomes. Methods RNA sequencing and analysis were performed on tissue samples from primary and lymph node metastatic lesions of gastric cancer. Differential gene analysis and functional pathway analysis were conducted. Immune infiltrating environment and protein expression levels were evaluated using immunohistochemistry. Cell experiments were conducted to investigate the role of CCL21 in GC metastasis. Results ACTG2, CNN1, DES, MUC6, and PGC were significantly upregulated in primary tumor cells, while CCL21, MS4A1, CR2, CLDN11, and FDCSP were significantly upregulated in metastatic tumor cells. Functional pathway analysis revealed enrichment in pathways related to immune response. CLDN11 and CCL21 were found to play important roles in promoting gastric cancer metastasis. Cell experiments confirmed the role of CCL21 in promoting GC cell growth and metastasis. CCL21 is highly expressed in GC tissues and binds to CCR7, leading to upregulation of CLDN11. This results in GC-lymph node metastasis and abnormal activation of immune cells (B cells and CD4 + T cells). Conclusion Inhibition of CCL21 and CLDN11 proteins may be a promising strategy for treating GC and preventing lymph node metastasis. These findings provide specific molecular markers for early lymph node metastases of GC, which can aid in developing treatment strategies and predicting patient prognosis.

Background: Thyroidectomy is commonly performed for benign or malignant thyroid tumors, often resulting in hypothyroidism. Levothyroxine (LT4) supplementation is crucial to maintain hormone levels within the normal range and suppress TSH for cancer control. However, determining the optimal dosage remains challenging, leading to uncertain outcomes and potential side effects. Methods: We analyzed clinical examination data from 510 total thyroidectomy patients, including demographic information, blood tests, and thyroid function. Using R, we applied data preprocessing techniques and identified 274 samples with 98 variables. Principal Component Analysis, correlation analysis, and regression analysis were conducted to identify factors associated with optimal LT4 dosage. Results: The analysis revealed that only eight variables significantly influenced the final satisfactory dosage of LT4 in tablets: Benign0/ Malignant1 (benign or malignant), BQB (electrophoretic albumin ratio), TP (total protein), FDP (fibrin degradation products), TRAB_1 (thyroid -stimulating hormone receptor antibody), PT (prothrombin time), MONO# (monocyte count), and HCV0C (hepatitis C antibody). The resulting predictive model was: Dose = -0.2656189 + 0.2543759 * Benign0/Malignant1 + 0.0727776 * BQB + 0.0143673 * TP + 0 .0102303 * FDP + 0.0074896 * TRAB 1 + 0.0310039 * PT - 0.3862136 * MONO# + 0.0011970 * HCV0C. Conclusion: Parameters such as benign/malignant status, TRAB_1, and BQB ratio during medication can serve as observational indicators for postoperative LT4 dosage. The calculated linear model can predict the LT4 dosage for patients after thyroidectomy, leading to improved treatment effectiveness and conserving medical resources.

PURPOSE:Ubiquitin-specific peptidase 10 (USP10) has been found to have oncogenic activity in several human tumors. This study first revealed the exact function of USP10 on the progression of thyroid cancer (THCA) by researching its effect on the ferroptosis.METHODS:USP10 expression in THCA patients was analyzed by online data analysis and in 75 THCA cases was scrutinized by real-time quantitative reverse transcription-polymerase chain reaction and Western blot. Influence of USP10 on the viability, colony formation, migration and invasion of THCA cells was demonstrated by cell counting kit-8, colony formation, wound healing and Transwell invasion assays. Effect of USP10 on the Erastin-induced ferroptosis in THCA cells was evaluated by detecting the ferroptosis-related indicators. Intrinsic mechanism of USP10, glutathione peroxidase 4 (GPX4) and sirtuin 6 (SIRT6) in regulating THCA progression was identified. In vivo xenograft experiment was implemented.RESULTS:USP10 was abundantly expressed in THCA patients, linking to poor outcome. USP10 overexpression enhanced the viability, colony formation, migration and invasion of THCA cells. USP10 mitigated the Erastin-induced ferroptosis in THCA cells, decreased the levels of iron, Fe2+ , malondialdehyde, lipid reactive oxygen species, reduced mitochondrial superoxide level, and increased mitochondrial membrane potential. USP10 facilitated the expression of ferroptosis suppressor GPX4 by elevating SIRT6. Loss of USP10 repressed the in vivo growth of THCA cells.CONCLUSION:USP10 might attenuate the ferroptosis to promote thyroid cancer malignancy by facilitating GPX4 via elevating SIRT6. It might be novel target for the treatment of THCA.

颈动脉体瘤（carotid body tumor，CBT）是一种相对罕见的疾病，大部分起源自颈动脉分叉处的化学细胞感受器，临床少见。目前CBT的治疗以手术切除为主，但其解剖位置特殊，病灶血供丰富，导致手术难度大，放化疗等治疗方法亦有报道。本综述从CBT的发病机制、临床表现、临床分型、治疗等方面予以总结。

BackgroundCarotid body tumor (CBT) is the most common head and neck paraganglioma. Whether preoperative embolization benefits CBT patients who will receive surgical resection is still controversial.MethodsIn this multi-center retrospective study, we collected data from patients with CBT who received surgical treatment without (group A) or with preoperative embolization (group B) from 2011 to 2019. The primary outcome was the rate of death or stroke after 3 years of follow-up. The secondary outcomes of the study were length of operation (LOO), intraoperative blood loss (IBL), length of stay (LOS), rate of recurrence, and rate of cranial nerve (CN) injuries. Descriptive statistics were used to analyze the demographics, clinical characteristics, complications, and follow-up results of the patients.ResultsBetween January 2011 and October 2019, 261 consecutive patients (107 male and 154 female) entered analysis. After 3 years of follow-up, no patient died in both groups. Only three patients with stroke were detected: 2/226 (0.9%) in group A vs. 1/35 (2.9%) in group B (p = .308). The LOO in group A was 132.6 ± 64.6 min compared with 152.9 ± 40.4 min in group B (p = .072). IBL in group A was 375.4 ± 497.8 ml compared with 448.0 ± 270.8 ml in group B (p = .400). LOS in group A was 8.3 ± 2.0 days compared with 7.4 ± 1.7 days in group B (p = .016). Seventy-two CN injuries were detected: 65/226 (28.8%) in group A vs. 7/35 (20.0%) in group B (p = .281). There were 65 temporary CN injuries (59 in group A vs. 6 in group B) (p = .254) and seven permanent CN injuries (6 in group A vs. 1 in group B) (p = .945). Three most frequently injured cranial nerves were the pharyngeal branch and superior laryngeal nerve (12.3%), recurrent laryngeal nerve (7.7%) and vagus nerve (7.3%).ConclusionThere was insufficient evidence to support the efficacy of preoperative embolization. CBT resection alone had a similar rate of stoke, recurrence, and CN injuries when compared with CBT resection with preoperative arterial embolization. Meanwhile, CBT resection alone did not increase LOO and IBL.

Purpose SOX12 is overexpressed in many cancers, and we aimed to explore the biological function and mechanism of SOX12 in thyroid cancer. Materials and Methods We first analyzed the expression of SOX12 in thyroid cancer using data in The Cancer Genome Atlas. Immunohistochemistry and qRT-PCR were performed to identify SOX12 expression in thyroid cancer tissue and cells. Thyroid cancer cells were transfected with small interfering RNA targeting SOX12, and cellular functional experiments, including CCK8, wound healing, and Transwell assays, were performed. Protein expression was examined by Western blot analysis. A xenograft model was developed to evaluate the effect of SOX12 on tumor growth in vivo. Results SOX12 expression was increased in thyroid cancer tissue and cells. SOX12 promoted cell proliferation, migration, and invasion and accelerated tumor growth in vivo. The expression of PCNA, Cyclin D1, E-cadherin, Snail, MMP-2, and MMP-9 was affected by SOX12 knockdown. Bioinformatic analysis showed that SOX12 could interact with the POU family. SOX12 knockdown inhibited the expression of POU2F1, POU2F2, POU3F1 and POU3F2, and SOX12 expression showed a positive correlation with POU2F1, POU3F1, and POU3F2 expression in clinical data. POU2F1 and POU3F1 were able to reverse the effect of SOX12 knockdown on thyroid cancer cells. Conclusion SOX12 affects the progression of thyroid cancer by regulating epithelial-mesenchymal transition and interacting with POU2F1 and POU3F1, which may be novel targets for thyroid cancer molecular therapy.

Objective To evaluate arterial covered stent used in the resection of complex carotid body tumor (CBT) and postoperative adverse events. Methods Twelve patients with CBT Shamblin type Ⅱ 3 cases and type Ⅲ 9 cases from 2018 to 2020 who underwent intraoperative combined arterial covered stent reconstruction (4 cases) or prereconstruction of internal carotid artery (8 cases) were included in this study. Statistics and analysis were done for general clinical data, intraoperative evaluation and postoperative adverse events. Results The operation was successful for all 12 cases. Average operative time was (160±55) min and blocking time was (25±6) min during carotid artery reconstruction. There was without need to block during internal carotid artery prereconstruction. Intraoperative bleeding was (342±101) mL. It was shown by follow-up one year later that there were 2 cases of temporary nerve injury and 1 case of postoperative covered stent obstruction. Both permanent nerve injury and transient ischemic attack were not found. Conclusions Stent graft used to reconstruct during operation or prereconstruction of internal carotid artery in CBT Shamblin type Ⅱ and type Ⅲ could reduce vascular injury, shorten blocking time of carotid artery, and lower adverse events. However, the treatment remained to be studied with large-sample controlled trial.

Gallbladder cancer (GBC) is the most aggressive cancer type in the biliary tract, and our previous studies observed that microRNA (miR)-135a-5p expression was downregulated in GBC tissues. However, few studies have focused on the mechanism of action of the miR-135a-5p target genes in GBC. The present study aimed to investigate the regulatory role of miR-135a-5p signaling in GBC. The present study found that miR-135a-5p expression was downregulated in GBC tissue, as detected by immunohistochemistry and reverse transcription-quantitative PCR. In addition, overexpression of miR-135a-5p significantly inhibited the proliferation and migration of GBC-SD cells. Using a luciferase activity assay, it was identified that angiopoietin-2 (ANGPT2) was a potential target gene of miR-135a-5p in GBC. Knockdown of ANGPT2 expression significantly inhibited the proliferation and invasion of GBC-SD cells. In conclusion, the present results suggested that miR-135a-5p affected GBC cell proliferation and invasion by targeting ANGPT2. Moreover, miR-135a-5p may be a potential biomarker for GBC progression and a potential target for GBC therapeutic intervention.

2019年12月新型冠状病毒肺炎疫情暴发以来,全国的疫情防控工作虽已初见成效,但由于部分新型冠状病毒肺炎患者的临床表现不典型,潜伏期长且传染性强,疫情的未来发展仍存在不确定性.在目前的疫情形势下,对限期手术患者的收治时机、原则及手术相关防护准则等还未形成共识.在结合相关文献及临床实践的基础上,探讨普外科医生如何安全开展限期手术患者的诊疗工作,避免聚集性疫情的出现.

目的 探讨参芪扶正注射液对乳腺癌术后化疗患者生活质量及免疫功能的影响.方法 选取2016年4月至2017年10月上海中医药大学附属第七人民医院收治的94例女性乳腺癌术后患者,按随机数表法分为对照组和观察组,各47例.对照组患者接受单纯FEC方案化疗,在此基础上,观察组患者接受参芪扶正注射液.比较两组患者的临床疗效、生活质量、免疫功能及淋巴细胞亚群.结果 对照组和观察组患者治疗总有效率分别为65. 96%(31／47)、89. 36%(42／47),观察组患者治疗总有效率高于对照组,差异有统计学意义(P＜0. 05).治疗后,两组患者总体健康状况评分高于治疗前,乳腺癌特异性评分及症状评分低于治疗前,差异有统计学意义(P＜0. 05).治疗后,观察组患者总体健康状况评分高于对照组,乳腺癌特异性评分及症状评分低于对照组,差异有统计学意义(P＜0. 05).治疗后,两组患者IgG、IgM、C3及C4水平低于治疗前,差异有统计学意义(P＜0. 05).治疗后,观察组IgG、IgM水平高于对照组,观察组C3、C4水平低于对照组,差异有统计学意义(P＜0. 05).治疗后,两组患者CD3 +、CD4 +、CD4 +／CD8 +水平高于治疗前,观察组CD3 +、CD4 +、CD4 +／CD8 +水平高于对照组,差异有统计学意义(P＜0. 05).治疗后,两组患者CD8 +、NK水平低于治疗前,观察组CD8 +、NK水平高于对照组,差异有统计学意义(P＜0. 05).结论 参芪扶正注射液可有效提升乳腺癌患者术后化疗的临床疗效,改善患者的生活质量,提升机体免疫功能.

许多食管裂孔疝伴胃食管反流病（ gastroesophageal reflux disease，GERD）患者，临床表现为胸痛及类似心脏病的症状群，并且常有心电图改变，故极易误诊为冠心病、心绞痛。这是一个常见的临床问题，因患者和医生都认为疼痛为心源性，但实际难治性胸痛患者部分为非心脏起源。故胸痛的鉴别诊断往往很困难，评估症状本身是不够的，对于基础疾病的诊断更为重要。远端食管和心脏有一个共同的传入迷走神经供应，机械和／或化学刺激食管可以诱发心肌缺血，导致胸痛［1－4］。所以以胸痛为主诉的冠心病患者，很大一部分合并 GERD 及食管裂孔疝［5］。许多医生忽视这种疾病的可能性，尤其是当他们确认患者原有冠心病，只考虑到去积极地寻找原来的心脏问题。此外，最常见的用于治疗冠心病的心脏药物，特别是硝酸盐类、钙通道阻滞剂和抗血小板药物，可以加重原有的 GERD ［6－8］，进而使得胸痛症状加重。以往的研究已经提供的证据表明，使用质子泵抑制剂、抗酸治疗及促进胃动力治疗可使 GERD 患者减少疼痛症状，并改善心电图的心肌缺血表现［9－10］，但是对于食管裂孔疝患者术后心电图的变化及其与冠心病的鉴别还不清楚，为此，本文对1例食管裂孔疝合并心电图心肌缺血改变的患者术后心电图进行分析，资料如下。