Table of Content

17 March 2022, Volume 22 Issue 01

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New Surgical Approach

Application of intra-operative navigation in endoscopic breast conserving surgery：a case report

OU Xin-yu, LU Yi-wen, LIU Zhi-han, SU Shi-cheng

2022, 22(01):  1-5.  DOI: 10.3969/j.issn.1009-976X.2022.01.001

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Background A growing number of Chinese breast cancer patients are diagnosed at a young age. The quality of life of young breast cancer patients has been a critical issue. Breast-conserving surgery （BCS） not only removes the tumor but also maintains the appearance of breast. The Breast Tumor Center of Sun Yat-sen Memorial Hospital is one of the first departments in China to perform breast-conserving surgeries. Endoscopic breast surgery has emerged as a promising surgical approach. However, it is hard to delineate the tumor margins in endoscopic BCS, which restrains its development. In traditional BCS, surgeons determine the tumor border by palpation, which is impossible in endoscopic BCS. For the first time, we performed the intra-operative navigation system-assisted endoscopic breast-conserving surgery, in which the tumor border was accurately delineated using the navigation system. Patient A 46-year-old woman was diagnosed with left breast cancer with the stage of cT2N1M0 IIB. She asked the surgeons to maintain the breast appearance to the greatest extent. Methods Breast MR was performed to acquire the three-dimensional images. At the start of surgery, the spatial position of breast was acquired by scanning with O-arm device after skin preparation and draping. Then, we integrated the images and breast position in a real-time 3-dimensional model of Medtronic Stealth Station S7 Navigation System with the “3D Fusion” function. Finally, we used the probe to precisely mark the tumor border and excised the lump. Results The margins of the tumor were all negative in pathological assessment. The breasts looked basically symmetrical and the wound was invisible when viewed from the front. The patient was pleased with the appearance. Discussion Intra-operative navigation system-assisted endoscopic breast-conserving surgery achieves an easier operative procedure and a lower positive rate of surgical margin, which may vigorously promote the endoscopic BCS.



Original Articles and Clinical Research

Chemotherapy combined with gonadotropin-releasing hormone agonist in early breast cancer patients： a single-centre, double-blind, randomized controlled trial

LIN Wei-wei, LIN Que-ran, HE Zuan-yu, SU Feng-xi, PAN Ping, CHEN Kai, YANG Dong-zi

2022, 22(01):  7-13.  DOI: 10.3969/j.issn.1009-976X.2022.01.002

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Objective To analyze the effect of chemotherapy combined with gonadotropin-releasing hormone （GnRHa） on the menstrual recovery of breast cancer patients after chemotherapy and explore the potential side effects of GnRHa on patients. Methods This is a single-centre, double-blind, randomized clinical trial. A total of 141 early- or middle-stage breast cancer patients aged 14 ~ 45 years were included. The patients were randomly assigned to the intervention group （n=69） and control group （n=72） using random digits generated by SPSS. The follow-up was conducted in Sun Yat-sen Memorial Hospital, Sun Yat-sen University from August 2008 to December 2021. Logistic regression was used to study the effect of GnRHa on menstrual recovery after chemotherapy, linear regression was used to study the relationship between GnRHa and liver function indicator and antral follicle count （AFC）, and Cox regression was used to analyze the impact of menstrual recovery on the prognosis of patients. Results At six months after chemotherapy, 69.2% of the patients in the intervention group recovered menstruation compared with 75.9% in the control group, with no statistically significant difference （P>0.05）. Multivariate logistic regression showed that the use of GnRHa had no significant effect on menstrual recovery （OR=0.19, 95% CI： 0.03~1.14）; no significant side effects on alanine aminotransferase and AFC （P> 0.05）. There were no significant associations between menstrual recovery with death, metastasis, and relapse （P>0.05）. The average volume of the right ovarian was significantly negatively associated with metastasis （HR=0.76; P=0.046）. The Log-rank test indicated no significant difference in metastasis-free survival （MFS） and relapse-free survival （RFS） between the intervention group and the control group （P>0.05）. Conclusion The use of GnRHa in chemotherapy among breast cancer patients had no significant effect on the menstrual recovery after chemotherapy. The safety of using GnRHa was high and there was no significant hepatotoxicity.

Screening of ferroptosis-related genes and construction of prognostic prediction model in pancreatic cancer

HE Chong, ZHOU Shu-rui, LI Ya-qing, CHEN Shao-jie, LIAN Guo-da, CHEN Shang-xiang, HUANG Kai-hong

2022, 22(01):  14-23.  DOI: 10.3969/j.issn.1009-976X.2022.01.003

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Objective To explore the value of ferroptosis-related genes in predicting the prognosis of patients with pancreatic cancer, and further explore the potential molecular mechanism. Methods Gene expression and corresponding clinicopathological data of pancreatic cancer patients were downloaded from the public database. The differentially expressed genes in pancreatic cancer tissues were screened by R software “limma” package. Differentially expressed genes in pancreatic cancer tissues were verified by univariate COX regression analysis, and a prognostic model was established by LASSO COX regression analysis. We performed Kaplan-Meier survival analysis to examine the significance of the model in the prognosis of prediction pancreatic cancer. The accuracy of the model in the prognosis of prediction pancreatic cancer was analyzed by the ROC curve. In the ICGC verification queue, the predictive value of the model was evaluated by Kaplan-Meier survival analysis and ROC curve. Then we divided the TCGA-PAAD cohort into two groups according to the risk value, compared the differences in gene expression and gene enrichment pathways, and evaluated the abundance of immune cells in the tumor microenvironment. Results Thirty-seven ferroptosis related genes were identified as prognostic genes by univariate COX regression analysis. We constructed a prognostic model based on 15 iron death-related genes using LASSO COX regression analysis. According to the model calculation, all patients in the cohort were divided into the high-risk group and the low-risk group. Kaplan-Meier survival analysis suggested that the survival time of pancreatic cancer patients in the high-risk group was shorter than that in the low-risk group （HR=2.16, P<0.05）. ROC curve analysis proved the accuracy of the predictive model in predicting the prognosis of pancreatic cancer （the area under the ROC curve were 0.74 （1 year）, 0.82 （3 years）, and 0.88 （5 years）, respectively）. Functional enrichment analysis of differentially expressed genes in the high-risk and low-risk groups showed that there were significant differences in immune microenvironment between the two groups. The infiltration degrees of B naive cells, plasma cells, and CD8⁺T cells in the high-risk group were lower than that in the low-risk group, but the infiltration degrees of M0 and M1 macrophages were higher in the high-risk group than in the low-risk group（P<0.05）. In addition, we also studied the expression of PD-1 and CTLA4 in the low-risk group and high-risk group of the TCGA-PAAD cohort and found that the expression levels of PD-1 and CTLA4 in the low-risk group of the TCGA-PAAD cohort were higher than those in the high-risk group. Conclusion We have constructed a prognostic model of ferroptosis-related genes in pancreatic cancer, which can predict the prognosis of pancreatic cancer patients, and found that there are differences in immune microenvironment between the high-risk group and the low-risk group in the TCGA cohort, which can provide a reference for immunotherapy.

Methionine deficiency increase the drug sensitivity of regorafenibfor hepatocellular carcinoma cells

WU Ye, LIU Xiao-di, XU Yan-ni, LUO Bao-ming

2022, 22(01):  24-29.  DOI: 10.3969/j.issn.1009-976X.2022.01.004

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Objective To investigate the effects of methionine （Met） deficiency on human hepatocellular carcinoma （HCC） cell lines HepG2 and Huh7 growth, and whether Met deficiency synergizes with regorafenib in tumor growth. Methods IC50 of regorafenib in normal complete medium and methionine-deficient complete medium were detected by CCK8 assay. Apoptosis and cycle flow experiment were employed to identify the apoptosis induction and cell cycle effect of regorafenib on these two cell lines under different medium conditions. Clone formation assay was conducted to explore HCC cell proliferation. Changes of mitochondrial membrane potential were detected by JC-1 fluorescence probe. Liposome peroxidation assay was used to measure lipid peroxidation levels. Results This research revealed that methionine deficiency decreased the IC50 of regorafenib in human hepatocellular carcinoma （HCC） cell lines HepG2 and Huh7. Methionine deficiency synergized with regorafenib in inhibiting tumor proliferation,inducing apoptosis and decreasing mitochondrial membrane potential; while HepG2 cell cycle had no significant effect. Both of them increased but had no synergistic effect on the lipid peroxidation level in HepG2. Conclusion Methionine restriction and regorafenib played a synergistic role in inhibiting cell proliferation, which provided a theoretical basis for clinical treatment on reducing the dose of regorafenib, increasing drug sensitivity and improving patients' quality of life in clinic practice.

Sevoflurane induces neuronal apoptosis by affecting the energy metabolism and oxidative stress

ZHANG Yang-fan, WEN Jin-bei, YAN Ying-zhe, HUANG Xiao-yan, TAN Zi-cong, YANG Hao-jie, JI Feng-tao

2022, 22(01):  30-33.  DOI: 10.3969/j.issn.1009-976X.2022.01.005

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Objective This paper investigates the neurotoxic effect of the anesthetic sevoflurane, and explores the influence of the energy metabolism and oxidative stress induced by sevoflurane. Methods Primary neurons were cultured in vitro and assigned into a control group and an experimental group. The experimental group was treated with 4.1% sevoflurane for 6 hours. Western blot was used to detect the change of Cleaved caspase-3 apoptotic protein, flow cytometry was used to detect the apoptotic rates of neurons, the DCFH-DA method was used to detect the change of ROS, and ATP is also detected by test kits. Results Compared with the control group, the cleaved caspase-3 apoptotic protein in experimental group increased （P<0.01）, the ROS also increased （P<0.05） but the ATP decreased （P<0.05）. Conclusion The sevoflurane-induced apoptosis may be caused by mitochondrial energy metabolism.

Metabolic pathways and key gene analysis of circulating tumor cells in pancreatic cancer based on GEO database

LIN Xing-yi, TIAN Zhen-feng, PAN Le-le, SU Ming-xin, CHEN Yin-ting

2022, 22(01):  34-41.  DOI: 10.3969/j.issn.1009-976X.2022.01.006

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Objective To explore the critical metabolic pathway and gene of circulating tumor cells （CTCs） in pancreatic cancer. Methods CTCs related datasets were screened out from GEO database. To find out metabolism related differentially expressed genes （DEGs）, DEGs from datasets and metabolic genes from KEGG database were compared using R studio. KEGG pathway enrichment was performed by R while protein-protein interaction （PPI） network constructed by STRING and visualized by Cytoscape. Enriched KEGG pathway comparison was made between two CTCs datasets to obtain the key pathway and gene. Then, we analyzed the relationship between key gene and clinical characters and immune infiltration through TCGA and TIMER database. Results 834 and 1119 DEGs were selected from GSE118556 and GSE18670 separately. DEGs from the former were mainly enriched in cysteine and methionine metabolism, carbon metabolism and biosynthesis of cofactors. DEGs from the latter were mainly enriched in carbon metabolism, purine metabolism and glycerophospholipid metabolism. Among them, TKT （transketolase） upregulated significantly in carbon metabolism in both datasets. TKT was significantly associated with overall survival, neoplasm stage, and histological grade （P<0.05）. TKTL1 and TKTL2, which also encode transketolase isoenzymes, were associated with immune infiltration（P<0.05）. Conclusion Through bioinformatic analysis of pancreatic cancer CTCs datasets, carbon metabolism and TKT were found to be significant in the process of CTCs formation and maintaining, which provides the basis for further metastasis metabolic mechanism studies of pancreatic cancer.

High-throughput interaction proteome mapping revealed that U6 snRNA multi-dimensionally regulates mRNA processing and maturation in tumor cells

YANG Zhi-Zhi, YANG Bing, TIAN Bin, LIAO Jian-you

2022, 22(01):  42-50.  DOI: 10.3969/j.issn.1009-976X.2022.01.007

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Objective We purified endogenous U6 snRNA （U6 for short） interaction protein from tumor cells by ChIRP technique, and identified the interaction proteome by high sensitivity liquid chromatography-mass spectrometry, systematically revealing the new biological function and molecular regulation mechanism of U6 in tumor cells. Methods A biotin-labeled U6-specific probe was synthesized, and the complex formed by formaldehyde crosslinking U6 and interacting protein was captured by molecular hybridization, and the U6 interacting proteome was identified by high sensitivity mass spectrometry. Bioinformatics analysis was used to analyze the function of U6 in tumor cells. Results 135 specific endogenous U6 interacting proteins were identified through rigorous screening. GO, KEGG, protein complex enrichment analysis and PPI analysis showed that U6 was involved in a series of biological processes from mRNA production to post-transcriptional regulation in addition to interacting with related proteins such as mRNA precursor splicing processing. U6 was also involved in the transcription regulation of mRNA, vesicle transport, nucleation transport of mature mRNA, mRNA degradation, RNA localization, post-transcriptional regulation and other processes. Conclusion Our study systematically revealed the interaction proteome map of U6 in tumor cells for the first time in the world, and the analysis of the map showed that U6 was multidimensional in the whole process of mRNA biological regulation, providing a new direction and idea for the study of the function and mechanism of U6 in tumor development.

CT/MR features of xanthogranulomatous cholecystitis

LUO Yuan, LIU Yu-xiang, WANG Ming-mei, LI Yong

2022, 22(01):  51-55.  DOI: 10.3969/j.issn.1009-976X.2022.01.008

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Objective To investigate the CT and MR features of xanthogranulomatous cholecystitis（XGC）. Methods Twenty-one patients which were pathologically as xanthogranulomatous cholecystitis from Sun Yat-Sen Memorial Hospital of Sun Yat-sen University in January 2017 to August 2021, and their CT and MR images were analyzed retrospectively. Results Gallbladder wall thickening occurred in 18 cases （86.00%）, including diffuse and uniform thickening in nine cases （50.00%）, diffuse and heterogeneous thickening in four cases （22.22%）, localized thickening in five cases （27.78%）, and no thickening of gallbladder wall in three cases （14.29%）. There were 13 cases （72.22%） with uniform enhancement of muscularis and three cases （16.67%） with uneven enhancement of muscularis. Nodules in gallbladder wall were found in eight cases （38.10%）. The gallbladder mucosal line was continuous in 18 cases （85.71%） and interrupted in three cases （14.29%）. The adjacent structures were infiltrated in nine cases （42.86%）, and the boundary was clear in 12 cases （57.15%）. Enlarged lymph nodes were seen in four cases （19.05%）. Fifteen cases （71.43%） were complicated with gallbladder or bile duct stones, of which nine cases （60.00%） were complicated with bile duct obstruction. Conclusion Thickening of gallbladder wall, uniform mucosal line enhancement, nodules in gallbladder wall and complete gallbladder mucosal line are characteristics of XGC.

Diagnosis and treatment of five cases of hepatic angiomyolipoma

LI Shuo, LIN Jie, WANG Wei-dong

2022, 22(01):  56-60.  DOI: 10.3969/j.issn.1009-976X.2022.01.009

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Objective To analyze the clinical, imaging, pathological features and treatment of hepatic angiomyolipoma （HAML）. Methods Five cases of hepatic angiomyolipoma admitted to our hospital from January 2016 to October 2020 were retrospectively analyzed, and the disease was discussed in combination with relevant literature. Results All the 5 patients with hepatic angiomyolipoma received surgical treatment with good prognosis. During the postoperative follow-up, no tumor recurrence or metastasis was observed in all the patients, and no cases died. Conclusion Hepatic angiomyolipoma is rare in clinical practice, often lack of characteristic clinical manifestations, and early diagnosis is difficult.The diagnosis depends on postoperative pathological and immunohistochemical results. Surgical treatment is the first choice of treatment, which has definite curative effect and good prognosis.

Clinical study on the ratio of standardized residual liver volume to liver hardness to predict liver dysfunction after hepatectomy

ZUO Chao-hai, QIN Zhi-rong, YU Jie-xiong, PAN De-sheng, KUANG Nai-le, HUANG Hao-chuan

2022, 22(01):  61-65.  DOI: 10.3969/j.issn.1009-976X.2022.01.010

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Objective To explore the clinical value of the ratio of standardized residual liver volume to liver hardness in predicting liver dysfunction after hepatectomy. Methods The clinical data of 61 patients who underwent hepatectomy in our hospital from January 2015 to June 2021 were analyzed retrospectively. Before operation, CT or MR were used for liver enhancement scanning, and the images were examined for three-dimensional reconstruction. Anatomical left or right hepatectomy is planned according to the location of liver tumor. The whole liver volume and the remaining liver volume were calculated according to the proposed surgical scheme. At the same time, 61 patients were examined by liver ultrasound and transient elastic imaging to detect the liver hardness value （KPA） of each patient, calculate the ratio of standardized remaining liver volume to liver hardness value （SFLV/KPA）, and observe whether 61 patients had postoperative liver insufficiency. The possible related factors causing postoperative liver insufficiency were analyzed by univariate analysis, and the factors related to postoperative liver insufficiency were obtained. Then the correlation between these factors and postoperative liver insufficiency was analyzed by binary logistic regression analysis, and the role of standardized ratio of residual liver volume to liver stiffness value （SFLV/KPA） in predicting liver insufficiency after hepatectomy was discussed. The relationship between SFLV/KPA and postoperative liver dysfunction was determined by receiver operating characteristic curve and ROC curve. Results All 61 patients were operated successfully. Seven patients had liver dysfunction, no patient had liver failure and no patient died after operation. The results of logistic regression analysis showed that intraoperative bleeding, hilar blocking time, SFLV/KPA and operation method were the influencing factors of postoperative liver dysfunction. Conclusion According to the receiver operating characteristic curve ROC curve, when the ratio of SFLV/KPA （standardized residual liver volume/liver hardness） is greater than 30.6, patients generally do not have liver dysfunction after operation, and the operation safety is higher.

Clinical study of tracer method on sentinel lymph node biopsy for early breast cancer

WANG Min, WEI Jian-nan, ZENG Sheng-guang, YANG Yong, WANG Yuan, SHI Jian, ZHENG Ai-qiu

2022, 22(01):  66-70.  DOI: 10.3969/j.issn.1009-976X.2022.01.011

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Objective To compare and analyze the effect of radiosotope combined with methylene blue and methylene blue single tracer in sentinel lymph node biopsy of early breast cancer. Methods The clinical data of 385 breast cancer patients who underwent sentinel lymph node biopsy in our hospital were collected. Among them, 109 cases were performed with methylene blue single tracer by senior doctors. And 276 cases were performed with radiosotope combined with methylene blue by senior and junior doctors. The differences of sentinel lymph node biopsy results were analyzed and compared between double tracer and single tracer, so did sentinel lymph node biopsy with double tracer between senior and junior surgeons. Results There was no significant difference in detection rate, false negative rate, accuracy rate and sensitivity between double tracer and methylene blue single tracer in sentinel lymph node biopsy （P>0.05）. There was no significant difference in detection rate, false negative rate and accuracy rate between senior surgeons and junior surgeons under double tracer method （P>0.05）. Conclusion It is safe, reliable and economical for senior doctors to perform sentinel lymph node biopsy with methylene blue single tracer method. The double tracer method can help junior breast doctors master sentinel lymph node biopsy quickly.

Comparison of the effect of MIS-TLIF and TLIF surgery in the treatment of single-segment lumbar spinal stenosis

HUANG Yong-feng, OU Rong-tong, PAN Ying-song

2022, 22(01):  71-74.  DOI: 10.3969/j.issn.1009-976X.2022.01.012

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Objective To study and compare the clinical efficacy of minimally invasive surgery transforaminal lumbar interbody fusion （MIS-TLIF） and transforaminal lumbar interbody fusion （TLIF） in the treatment of single-segment lumbar spinal stenosis. Methods Sixty patients with single-segment lumbar spinal stenosis admitted to our hospital between January 2016 and December 2020 were selected as the research subjects, and they were divided into study group （n=30） and control group （n=30） by using the randomized control method. Study group received MIS-TLIF surgery, and control group was given TLIF surgery. The differences in the perioperative related indicators and scores of lumbar Oswestry Dysfunction Index （ODI） and Visual Analogue Scale （VAS） before surgery and at different time points after surgery were compared between the two groups of patients. Blood was collected to determine the changes in laboratory indicators such as serum interleukin-6 （IL-6）, interleukin-10 （IL-10）, creatine kinase （CK） and C-reactive protein （CRP） before and after surgery. Results The duration of surgery in study group was longer than that in control group （P<0.05）, and the intraoperative blood loss, postoperative drainage volume, postoperative ambulation time and discharge time were all less or shorter than those in control group （P<0.05）. The ODI scores of patients in study group at different time points after surgery were lower than those in control group （P<0.05）. The VAS scores of study group were lower than those of control group at different time points after surgery （P<0.05）. The expression levels of serum IL-6, IL-10, CK and CRP of study group after treatment were lower than those of control group （P<0.05）. Conclusion MIS-TLIF has a high safety in the treatment of patients with single-segment lumbar spinal stenosis, and can shorten the postoperative recovery time, improve lumbar function and pain symptoms, relieve the degree of postoperative muscle injury and promote the recovery of inflammatory indicators.

Application of enhanced recovery after surgery（ERAS）in the treatment of annular mixed hemorrhoids during perioperative period

CHEN Hai-ming, XU Ling-ling, LI Jian-guang, LUO Hui-ming

2022, 22(01):  75-78.  DOI: 10.3969/j.issn.1009-976X.2022.01.013

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Objective To investigate the application effect of enhanced recovery after surgery （ERAS） in the perioperative period of annular mixed hemorrhoids. Methods 280 patients with annular mixed hemorrhoids admitted to our hospital from January 2020 to December 2020 were selected and divided into ERAS group （n=144） and control group （n=136） respectively. A retrospective study was conducted to compare the perioperative evaluation indicators of the two groups of patients. Results The operation was successfully completed in both groups. The postoperative perianal pain score, the use rate of strong analgesia, and the rate of acute urinary retention in the ERAS group were significantly lower than those in the control group （P<0.05）. There was no significant difference between the two groups in the incidence of postoperative secondary bleeding, bleeding reoperation and anastomotic stenosis （P>0.05）. The ERAS group did not increase the operation time, and the postoperative hospitalization days and hospitalization expenses were significantly less than those in the control group （P<0.05）. Conclusion ERAS can relieve postoperative perianal pain, reduce acute urinary retention, shorten postoperative hospitalization time, and save medical expenses in patients with annular mixed hemorrhoids. Therefore, its clinical application is safe and feasible.

Anatomical study and clinical practice of anterior pelvic ring section based on CT

XU Guo-hua, YANG Ming-ming, LIANG Guan-bao

2022, 22(01):  79-83.  DOI: 10.3969/j.issn.1009-976X.2022.01.014

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Objective To explore the anatomical features of the common anterior pelvic ring sections and to provide reference for the treatment of clinical pelvic disorders. Methods The image data of 107 patients who underwent pelvic CT examination in our hospital from January 2017 to March 2021 were selected, including 53 males and 54 females. The maximum linear depth, the width of the channel, the minimum inclination angle and the distance between the iliac crests were measured at the 2 cm and 4.5 cm cross-sections behind the anterior superior iliac spine. The maximum linear depth and oblique angle, the width of the channel, the minimum oblique angle and the distance between the anterior inferior iliac spine were measured at the transverse section of the anterior inferior iliac spine. The differences between the male and female groups were compared. Results There were no statistically significant differences between the male and female groups in the maximum straight-line depth, channel width and minimum inclination angle at 2 cm behind the anterior superior iliac spine （P>0.05）, while there were statistically significant differences in the distance between the iliac crest between the male and female groups （P<0.05）. There were statistical differences in the maximum straight-line depth, channel width, minimum inclination angle and the distance between the level of inter-iliac-crest line at 4.5 cm behind the anterior superior iliac spine between the male and female groups （P<0.05）. There were statistically significant differences in the maximum straight-line depth at the anterior inferior iliac spine, and the width of the channel between the male and female groups （P<0.05）, while there were no statistically significant differences in the inclination angle and the minimum inclination angle when obtaining the maximum depth and the distance between the anterior inferior iliac spine （P>0.05）. There was no statistical difference in parameters between left and right sides （P>0.05）. Conclusion Understanding the anatomical features of the common sections of the anterior pelvic ring can improve the safety of clinical operation and reduce the incidence of complications.

Retrospective analysis of pathogenic bacteria results of hospital-acquired infection in neurosurgery inpatients

HUANG Sai-lin, XU Shao-qiang, FAN Yan-li, LI Lian, ZHENG Tao, SHI Hong-zhi

2022, 22(01):  84-88.  DOI: 10.3969/j.issn.1009-976X.2022.01.015

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Objective By reviewing the pathogenic bacteria results of hospital-acquired infections from inpatients in our neurosurgery department, we analyzed their distribution characteristics and drug resistance in order to provide more supportive ideas for clinical infection prevention, diagnosis and treatments. Methods The pathogenic bacteria of 738 hospital-acquired infections from 639 inpatients in neurosurgery department from June, 2016 to June, 2019 were collected. We used statistical methods to analyze the characteristics and drug resistance of these pathogens. Results There were 738 hospital-acquired infectious cases, including hospital-acquired pneumonia （377 cases）, urinary system infections （130 cases）, bloodstream infections （109 cases）, central nervous system infections （106 cases）, and other infections （16 cases）. Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus are the main pathogens. In the clinical use of important antibacterial drugs, Escherichia coli and Klebsiella pneumoniae showed high rates of drug resistance to ceftriaxone （62.1% and 56.25%）. And their resistance rates to imipenem were 2.01% and 16.4% respectively. Pseudomonas aeruginosa was below 30%. Acinetobacter baumannii was beyond 50% （except for minocycline）. Staphylococcus aureus was 61.29%, and Coagulase-negative Staphylococci was 79.23%. Staphylococcus was not found to be resistant to vancomycin, linezolid and tigecycline. The resistance rate of Candida was below 10%. Conclusion Hospital-acquired infections of inpatients in neurosurgery department are mainly Gram-negative bacteria and Staphylococcus, and we also found the drug resistance is extremely serious. In clinical daily diagnosis and treatments, we suggest antibiotics be used rationally according to the characteristics of pathogens and the drug resistance situations monitoring in this hospital.

Five-year follow-up analysis of clinical efficacy of radiotherapy alone and radiochemotherapy in malignant glioma

Liu Wei

2022, 22(01):  89-93.  DOI: 10.3969/j.issn.1009-976X.2022.01.016

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Objective To analysis the clinical efficacy of radiotherapy alone and concurrent chemoradiotherapy of malignant glioma after operation. Methods The retrospective study included 99 cases of malignant glioma after operation were performed in Neurosurgery Departments of Huanhu Hospital from Oct 2015 to Sept 2016. All the 99 cases of patients weredivided into two groups： radiotherapy alone group （48 cases） and concurrent chemoradiotherapy group （51 cases）. All patients began routine postoperative radiation therapy in 20 days or so, make 2 Gy/day, divided 30 times, totaling 60 Gy of radiotherapy, sustained 42 days （except Saturday and Sunday）. The concurrent chemoradiotherapy group perform the program for temozolomide 75 mg/m²·day for 42 days simultaneously; then after four weeks, the groupaccept 6 cycles of temozolomide adjuvant therapy, the program is 200 mg/m²·day, once daily for 5 days, then 23 days withdrawal, treatment may continue until disease progression, up to 2 years. The 1, 3 and 5-year survival rates of all cases were counted, and the clinical effects of radiotherapy alone and concurrent chemoradiotherapy of malignant glioma after operation were analyzed. Results 1, 3, 5-year survival rate of the radiotherapy alone group were 54.2%, 29.2%, 10.4%, and the concurrent chemoradiotherapy group were 74.5, 51.0%, 31.4%. The concurrent chemoradiotherapy group was higher than the radiotherapy alone group （P < 0.05）. The concurrent chemoradiotherapy group had higher acute reaction such asnausea and vomiting, but bone marrow suppression, hearing loss, memory loss and other long-term damages were similar in the two groups. Conclusion The concurrent chemoradiotherapy after malignant glioma operation may improve the outcome.

Expression and significance of immunehisto chemical levels of ESM-1 in recurrent pituitary adenoma

ZHAO Zhao, YAN Xiao-ling

2022, 22(01):  94-97.  DOI: 10.3969/j.issn.1009-976X.2022.01.017

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Objective To explore the correlation of ESM-1 expression at the immunohistochemical level and the recurrence of pituitary adenoma. Methods Immunohistochemical staining of ESM-1 antibody was performed on 33 pituitary adenoma patients attending our hospital from February 2018 to April 2021. Results The relapse group had higher ESM-1 expression （P=0.004）, while age, sex and tumor maximum diameter had no significant correlation with ESM-1 expression, no significant difference in ESM-1 expression before and after relapse, and no obvious correlation between ki-67-positive protein expression index and ESM-1 expression. Conclusions The expression of ESM-1 is clearly correlated with tumor recurrence, and it guides the treatment and prognosis of pituitary adenoma.

Implication of enhanced recovery after surgery （ERAS） in anterior cervical discectomy and fusion surgery

HE Xu-hui, ZHENG Chao-shun, GUO Yue-yue, ZHANG Long-sheng, XING Ze-hua, LIN ben-dan

2022, 22(01):  98-102.  DOI: 10.3969/j.issn.1009-976X.2022.01.018

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Objective To evaluate the clinical effect of ERAS protocol in anterior cervical discectomy and fusion surgery. Methods We retrospectively analyze the clinical data of 42 patients with cervical Spondylosis underwent surgical treatment from July 2019 to June 2021. The patients were distributed to observation group and control group by whether their perioperative management were ERAS protocol. The perioperative data （operation time, estimated blood loss, drainage time, postoperative bed time, postoperative hospital staying time）, clinical effect score and swallowing function were compared between two groups. Results The baseline data were comparable between two groups （P>0.05）. For perioperative clinical data, the operation time and estimated blood loss were comparable between two groups, while the drainage time, postoperative bed time and postoperative hospital staying time in the ERAS group were shorter （P<0.05）. For clinical effect score, the VAS scores of one day, one month, six months postoperative and the JOA score of one month, six months postoperative were better than the scores preoperative （P<0.05）. Only the VAS scores one day postoperative of the ERAS group were better, the other time VAS and JOA scores were comparable between two groups （P>0.05）. For swallowing function, the ERAS groups has better score one day, one month postoperative （P<0.05）, while the score 6 months postoperative were not statistically different （P>0.05. For postoperative complications, one pulmonary infection and two urinary retention happened in the ERAS group and one skin infection in the conventional group which could be cured conservatively. No patients required reoperation or had other severe complication. Conclusion Implication of ERAS in anterior cervical discectomy and fusion surgery can improve clinical effect, shorter hospital staying time and improve satisfaction rates.

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Advances of the conversion therapy of immune checkpoint inhibitors combined antiangiogenic targeted drugs for advanced hepatocellular carcinoma

HUANG Zhan-ren, NING Jin-yue, LI Han-qin, CHEN Nian-ping

2022, 22(01):  110-114.  DOI: 10.3969/j.issn.1009-976X.2022.01.021

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With the in-depth research on the pathogenesis of hepatocellular carcinoma （HCC）, advanced liver cancer has entered the era of comprehensive treatment with multiple methods and combinations of multiple drugs. In particular, immunotherapy, immune checkpoint inhibitors combined with antiangiogenic targeted drugs and hepatic arterial infusion chemotherapy（HAIC） and other down-stage conversion therapy have achieved remarkable efficacy, bringing hope to patients with advanced liver cancer. At present, immunization combined with targeted drugs for the treatment of advanced liver cancer has become one of the research hotspots at home and abroad, and the plan of atezolizumab plus bevacizumab（T+A） has been officially written into several guidelines as the first-line therapy for the advanced liver cancer. This article discusses the research progress, applicable population, and efficacy monitoring of immune combined targeted therapy.