Table of Content

20 April 2022, Volume 22 Issue 02

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Several focus issues of conversion therapies for intermediate-advanced hepatocellular carcinoma

LONG Yin, SONG Xing-dong, ZHANG Lei

2022, 22(02):  115-119.  DOI: 10.3969/j.issn.1009-976X.2022.02.001

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Most patients with hepatocellular carcinoma are diagnosed at intermediate-advanced stage in China, losing the chance of long-term survival through surgical resection. In recent years, locoregional therapy and systemic therapies of hepatocellular carcinoma have achieved great progress and more patients with intermediate-advanced unresectable hepatocellular carcinoma are expected to benefit from conversion therapies. After preliminary exploration, the multi-mode and high-intensity conversion therapies through combining locoregional therapy and system therapy has shown a gratifying success rate. However, there is still no consensus on the target population, regimen options and operation opportunity of conversion therapies. The paper reviews the domestic and foreign research progress and discusses several focus issues of conversion therapies for intermediate-advanced hepatocellular carcinoma.



Original Articles and Clinical Research

Comparative study on the safety and efficacy of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy

DENG Jing, CHEN Huan-wei

2022, 22(02):  120-125.  DOI: 10.3969/j.issn.1009-976X.2022.02.002

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Objective To compare the safety and efficacy of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Methods The clinical data of patients who underwent pancreaticoduodenectomy from January 2016 to August 2021 were analyzed retrospectively. Forty-nine patients who met the criteria after PD were divided into LPD group （n=23） and OPD group （n=26）. The operation time, intraoperative blood loss, postoperative complications, postoperative hospital stay, postoperative oncology results and prognosis were compared between the two groups. Results In terms of surgical safety, the intraoperative blood transfusion rate, incidence of postoperative pancreatic fistula, biliary fistula, postoperative bleeding, delayed gastric emptying, abdominal infection and complication rate in LPD group were similar to that in OPD group, and the differences were not statistically significant （P>0.05）.Compared with OPD, LPD had a longer operation time, but less intraoperative blood loss（P<0.05）. In terms of surgical efficacy, the number of patients admitted to ICU, the number of unplanned reoperations, the length of tumor specimens, the number of intraoperative lymph node dissection, the number of patients with positive lymph nodes, the rate of R0 resection, the degree of tumor differentiation, postoperative pathological stage, tumor origin, readmission rate within 30 days after discharge, postoperative recurrence rate, postoperative 90-day mortality, postoperative 1-year,2-year and 3-year survival rates of LPD were similar to that of OPD,and the differences were not statistically significant （P>0.05）. Compared with OPD, the first time of getting out of bed and anal exhaust after LPD were earlier, the postoperative hospital stay was shorter, the postoperative pain score was lower, and the basic daily living ability score was higher（P<0.05）. Conclusion Compared with OPD, LPD is safe and reliable, and can obtain the same radical effect of oncology. The curative effect of LPD is worth affirming, and it is feasible in clinic

Studying the effect of Pin1-interacting lncPIL-1 on the malignant phenotypes of breast cancer cells

ZHAO Wei, LUO Man-Li

2022, 22(02):  126-133.  DOI: 10.3969/j.issn.1009-976X.2022.02.003

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Objective To explore the effect of Pin1-interacting long non-coding RNA lncPIL-1 on the proliferation, migration and stem cell phenotype of breast cancer cells. Methods RNA immunoprecipitation combined with high-throughput sequencing （RIP-seq） was used to obtain lncRNAs specifically bound to Pin1. RNA immunoprecipitation （RIP） and crosslinking-immunoprecipitation （CLIP） were used for validation. The expression of lncPIL-1 was knocked down by small interfering RNA （siRNA）, and the lncPIL-1 overexpressed breast cancer cell lines were obtained by lentivirus infection. The knockdown and overexpression efficiency were detected by qRT-PCR. The effect of lncPIL-1 on the proliferation of breast cancer cells was detected by plate cloning assay. Transwell assay was used to detect the effect of lncPIL-1 on the migration of breast cancer cells. ALDEFLUOR assay was used to detect the effect of lncPIL-1 on the stem cell phenotype of breast cancer cells. Results RIP-seq and validation experiments showed that lncPIL-1 was enriched in Pin1 immunoprecipitates. LncPIL-1 overexpression in breast cancer patients correlated with worse overall survival. Colony formation assay showed that lncPIL-1 didn′t affect breast cancer cell growth. Transwell assay showed that overexpression of lncPIL-1 enhanced the migration capabilities of breast cancer cells, and knockdown of lncPIL-1 reduced the capabilities. ALDEFLUOR assay showed that knockdown of lncPIL-1 significantly inhibited the stem cell phenotype of breast cancer cells. Conclusion lncPIL-1 specifically binds to Pin1 and is highly associated with poor prognosis of breast cancer patients. LncPIL-1 promotes the migration and cancer stem cell phenotypes of breast cancer cells, which suggests that lncPIL-1 may be a new therapeutic target for breast cancer.

Relationship between BRAF mutation and clinicopathological characteristics in papillary thyroid carcinoma

WANG Pei-shun, LI Shu-qin, WANG Yan, WANG Rui, GAO Xi-tao, WANG Zhao-xin, ZHOU Jun

2022, 22(02):  134-137.  DOI: 10.3969/j.issn.1009-976X.2022.02.004

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Objective To investigate the incidence of BRAF mutation and its relationships with clinicopathological characteristics in patients with PTC. Methods 253 patients with papillary thyroid carcinoma who underwent surgery in the department of thyroid and breast surgery of the First People′s Hospital of Lianyungang from January 2018 to December 2019 were selected. The relation between the mutation of BRAF and clinicopathological features of papillary thyroid carcinoma patients was analyzed. Results The BRAF mutation was present in 81% of patients （205 of 253）. The frequency of BRAF mutation increased with age. There were significant correlations between BRAF mutation and lymph node metastasis, and between BRAF mutation and the clinical stage of papillary thyroid cancer （P<0.05）. Multivariate Logistic regression analysis showed that ≥45 years older, high clinical stage and lymph node metastasis were independent factors for BRAF mutation. Conclusion The mutation of BRAF is associated with the lymph node metastasis, and clinical stage of PTC, and may have a positive predictive value for diagnosing thyroid tumors.

Evaluation of three kinds of flap treatments after mastectomy

HE Wen-jun, HONG Hong, LIANG Su-qiong, HUANG Li-fang

2022, 22(02):  138-142.  DOI: 10.3969/j.issn.1009-976X.2022.02.005

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Objective To evaluate the results of three kinds of flap treatments after breast cancer mastectomy. Methods 108 patients with breast cancer from February 2019 to April 2021 were were allocated to one of the three following groups according to flap fixation： conventional wound closure （A group, n=30）, flap fixation using sutures （B group,n=42） or flap fixation using tissue glue （C group, n=36）. And all patients underwent total mastectomy or modified radical mastectomy and followed up for at least 6 months after surgery. The basic information, the formation and treatment of seromas, and other complications associated with seromas were recorded and analyzed among patients. Also, the secondary outcomes were observed such as drainage, surgical site infections, outpatient visits, flap necrosis, reoperations, postoperative pain score, cosmetic effects and further treatment after surgery. Results A total of 20 patients had seromas that required puncture treatment, all of which occurred in patients receiving axillary lymph node dissection, including 7 cases in group A （23.3%）, 7 cases in group B （7.3%）, and 6 cases in group C （16.6%）. Although the proportion of group A was higher than that of group B and group C, the number of cases among the three groups was not statistically significant. There were no significant differences in postoperative drainage, postoperative pain, surgical site infection, rehospitalization, and postoperative outpatient visits for additional treatment of incision wounds, and no differences in shoulder function were observed; no significant difference in skin beauty between the three methods was observed in six month follow-up. Conclusion In th present study, there was no obvious difference between conventional closed incisions, suture flap fixation and the use of medical tissue glue to prevent the formation of seromas, which may be related to adequate postoperative axillary drainage and good flap compression.

Tumor microenvironment for effective bladder cancer immunotherapy and its composition in human and mouse tumors: a preliminary report

ZHOU Bing-kun, WANG Bo, HE Qing-qing, HUANG Xiao-dong, CHEN Jun-yu, HUANG Jian

2022, 22(02):  143-153.  DOI: 10.3969/j.issn.1009-976X.2022.02.006

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Objective To identify the composition of the tumor microenvironment （TME） for the efficacy of bladder cancer immunotherapy in public databases and to evaluate their expression and distribution in human bladder cancers and N-butyl-N-（4-hydroxybutyl）-nitrosamine （BBN）-driven spontaneous mouse bladder tumors. Methods IMvigor210 database is a clinical trial for PD-L1 blockade treatment in advanced bladder cancer. We used DESeq2 to screen out differentially expressing genes （DEGs） that are associated with immunotherapy efficacy in IMvigor210 database. The differentially enriched pathways were further identified by GO and KEGG pathway enrichment analysis. IOBR R package was utilized to identify the cell composition in the TME. The clinical significance of differential cells gene signatures or associated gene expression were evaluated in TCGA bladder cancer database. By using 32 bladder cancer specimens from Sun Yat-sen Memorial Hospital, these cell infiltrations were confirmed by immunohistochemistry and associated with tumor stage. Furthermore, we established a BBN-driven spontaneous mouse bladder tumor model. H&E staining and immunohistochemistry were applied to compare the similarity of tumor progression and major composition of TME between mouse bladder tumor and human bladder cancer. Results In the IMvigor210 database, 521 DEGs were identified to be associated with efficacy of immunotherapy. Forty-four DEGs of them were enriched in collagen-containing extracellular matrix, suggesting that fibroblasts were engaged in the efficacy of immunotherapy. TME analysis showed that gene sets of histones or cell cycle, NK cells and CD8⁺ T cells gene signatures were enriched in the effective group, while gene signatures of inflammatory cancer-associated fibroblasts were enriched in the ineffective group. In the TCGA bladder cancer database, NK cells and CD8⁺ T cells gene signatures were positively associated with good prognosis of patients, while CD56 expression was positively associated with tumor stage. By contrast, PDGFRB expression was positively associated with poor prognosis and tumor stage. Moreover, PDGFRB⁺ cancer-associated fibroblasts were heavily infiltrated in high-stage bladder cancer tissues. In the BBN mouse model, increasing proportion of mice developed bladder tumors and ultimately into muscle-invasive bladder cancer （MIBC） in a time-dependent manner. BBN-driven mouse tumor recapitulated the histology and manifested similar disease progression to human bladder cancer. There were similar infiltration patterns of NK cells, CD8⁺ T cells and cancer-associated fibroblasts in mouse tumor and human bladder cancer. Conclusion Bioinformatics analysis showed that NK cells, CD8⁺ T cells and caner-associated fibroblasts are associated with the efficacy of immunotherapy and have clinical significance in human bladder cancer. The infiltration patterns of these cells were similar in human cancer and a spontaneous mouse tumor model. These results provide potential targets and a rational mouse model for further research on immunotherapy of bladder cancer.

Immune cell abundance model to predict survival prognosis of patients with sepsis：a deep learning study

GU Yang, LIU Xun, OU Qi-yun, ZHANG Na, LI Han, QIN Wei-qiang, YU Tao, LI Li

2022, 22(02):  154-162.  DOI: 10.3969/j.issn.1009-976X.2022.02.007

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Objective To development of a deep learning immune cell abundance model to predict 28-day survival in patients with sepsis. Methods In this study, a total of 479 sepsis patients were included and patients were randomly divided into training and validation groups in a 9：1 ratio. We built the DeepSurv in TensorFlow, a deep learning survival neural network-based model on 431 sepsis patients′ data with 28 immune cells in training cohort from prospective cohort study （MARS study）. The algorithm was internally validated on 48 sepsis patients from validation group. The primary end point was 28-day survival, and the area under curve （AUC） were used for model evaluation. Results In the training group, we established a deep learning survival neural network model showed promising results to predict 28-day survival in sepsis patients, patients with low vs high risk score had statistically significantly longer 28-day survival （HR=0.022, 95%CI： 0.013~0.038, P<0.005）. The immune cell abundance risk score was associated with 28-day survival （AUCs for 14- and 28-day survival were 0.912 and 0.936, respectively）. Similarly, in the test group, patients with low vs high risk score had statistically significantly longer 28-day survival （HR=0.07, 95%CI： 0.008~0.63, P<0.005）, the AUCs for 14- and 28-day survival were 0.822 and 0.777 respectively. Further, this study identified that model obviously related to immune microenvironment characteristics. Conclusion This study developed and validated novel deep learning survival neural network model showed reliable individual 28-day survival information in prognostic evaluation and treatment recommendation in patients with sepsis.

Research on intracranial spatial distribution of NSCLC brain metastatic based on TFCE

LI Wei, YANG Song-ran

2022, 22(02):  163-167.  DOI: 10.3969/j.issn.1009-976X.2022.02.008

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Objective By acquring spatial distribution of incidence rate of non-small cell lung cancer brain metastases based on MRI data, to determine the true signal area in brain metastatic areas. Methods According to the inclusion and exclusion criteria, patients with non-small cell lung cancer brain metastatic lesions were screened and included. We obtained their MRI data and segmented tumor area manually. After registration, we overlapped tumor regions together to calculate frequency of brain metastatic lesions. Using TFCE non-parametric analyses and permutation test to determine the true signal area. Results A total of 35 patients with non-small cell lung cancer brain metastases were included in this study. Frequency map showed highest frequency of non-small cell lung cancer was 22.86% and the highest metastatic number invoxel level was 8, which located in posterior midline of junction of parietal lobe and occipital lobe. The significant cluster of non-small cell lung cancer brain metastases was in grey-white matter border adjacent to ventricle and basal ganglia. Conclusion Non-small cell lung cancer brain metastases tend to locate in basal ganglia and posterior fossa and homogeneity exists between metastatic locations of different genders. Analyzing brain MRI data can provideassistance during the treatment process.

Feasibility of low-radiation-dose and low-contrast-dose scanning in triad of chest pain by dual-phase helical CT

YAN Zhuo-heng, LU Guo-xiong, JIANG Yu-song, CHEN Xiao-hong, WU Yi-wen

2022, 22(02):  168-172.  DOI: 10.3969/j.issn.1009-976X.2022.02.009

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Objective To evaluate the feasibility of low-radiation-dose and low-contrast-dose （double low-dose） scanning during the pulmonary artery phase and thoracic aorta phase（dual-phase） in acute myocardial infarction, pulmonary embolism and aortic dissection （triad of chest pain） by spiral CT. Methods 156 patients collected from Sun Yat-sen Memorial Hospital were included in our study. And they were divided into two groups. The observation group consisted of 39 patients with acute chest pain, and 117 ordinary patients composed the control group. Patients of observation group received double low-dose CT scanning of dual phase （pulmonary artery phase and thoracic aorta phase）, including CT pulmonary angiography （CTPA） （CTPA1 group）, coronary artery CT angiography （CCTA） （CCTA1 group） and thoracic aorta CT angiography （TCTA） （TCTA1 group）. And the three kinds of images were acquired at one scanning. According to the needs of different imaging sites, patients of control group were again divided three groups, including CTPA2 group （n=39）, CCTA2 group （n=39） and TCTA2 group （n=39）. And the images were acquired in a routine scanning mode. All of the images were reconstructed and analyzed by two radiologists. Qualitative evaluation of image quality was made.The dose length product （DLP） and average volume CT dose index （CTDI） were recorded, and the effective radiation dose was calculated accordingly. CT value and SD value of the center point of each trunk vessel cavity were measured to calculate and compare the noise ratio （CNR）. Results The K values of the scores of pulmonary artery, coronary artery and thoracic aorta between observation and control group were 0.60, 0.68 and 0.61, respectively, indicating good consistency. There were no statistical differences in CNR and average CT value between observation and control groups （P>0.05）. No significant differences existed in the effective radiation dose of CCTA between two groups （P>0.05）. However,the effective radiation dose of CTPA and TCTA in observation group was significantly lower than that in control group （P<0.05）. Conclusion The double-low-dose spiral CT scanning of dual phase has lower effective radiation dose and its image quality meets the clinical requirements.

The effect of different contrast agent injection rates on the image quality of cervical enhanced MRA

XIE Ding-xiang, LI Zhu-hao, WU Jia-le, ZHAO Jing, LAI Zhi-man

2022, 22(02):  173-177.  DOI: 10.3969/j.issn.1009-976X.2022.02.010

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Objective The effects of different contrast agent injection rate on the quality of 3D enhanced MRA images were analyzed, and the optimal contrast agent injection rate on high-quality cervical enhanced MRA images was discussed. Methods Patients with suspected cervical vascular lesions who underwent enhanced cervical MRA were randomly divided into 3 groups according to the injection rate. There were 22 cases in group A（1 mL/s）, 25 cases in group B（2 mL/s）, and 20 cases in group C（3 mL/s）. The quality of arterial images and the degree of venous contamination from raw data were graded by two attending physicians, and the mean scores of the whole artery and venous contamination were calculated. The brachiocephalic trunk, left common carotid artery, left subclavian artery, 1 cm below the bifurcation of bilateral common carotid artery and bilateral same-level vertebral artery, bilateral internal carotid cavernous sinus segment （C4） and basilar artery signal intensity （SI） were measured by another attending physician. Results The average arterial signal of groups A, B and C were 584, 720 and 690 respectively. The mean value of arterial contrast noise ratio （CNR） are 222.50, 272.94 and 280.22 respectively. The above three groups are statistically significant （SI H=8.29, P=0.016, CNR H=7.56, P=0.023, P<0.05）. There was statistical difference in arterial, venous and overall scores （P<0.05）. There was statistical difference not only between groups A and B, but also group A and C in arterial scoring （P<0.017）, but there was no statistical difference between groups B and C （P>0.017）. There was statistical difference between groups A and C in venous contamination score. There was no statistical difference between Group A and Group B as well as that Group B and Group C （P>0.017）, there was no statistical difference between Group A and Group B and Group C （P<0.017）, and there was no statistical difference between Group B and Group C （P>0.017）. Conclusion With the increase of injection rate, the signal intensity of carotid artery increased, the image signal-to-noise ratio increased, but the venous contamination did not increase. Therefore, injection rate of 3 mL/s was recommended for cervical enhanced MRA.

Retrospective analysis of the influence of four multi-mode analgesia schemes on the rehabilitation after total knee arthroplasty

TANG Yong-nan, HOU Da-biao, LUO Dong-bin, LUO Si-min

2022, 22(02):  178-182.  DOI: 10.3969/j.issn.1009-976X.2022.02.011

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Objective To analyze the effects of four kinds of multi-mode analgesia on the rehabilitation of patients after total knee replacement. Methods Based on the data extracted from the electronic medical record system of our hospital, 537 patients with osteoarthritis who underwent the first unilateral total knee arthroplasty from April 2015 to April 2020 were analyzed retrospectively. Four kinds of multi-mode analgesia schemes were adopted, including auricular point sticking combined with femoral nerve block in group A, auricular point sticking combined with saphenous nerve block in group B, celecoxib combined with femoral nerve block in group C, celecoxib combined with saphenous nerve block in Group D Stagnation. The general data before operation, VAS score, quadriceps muscle strength, Pittsburgh sleep quality index （PSQI） score and knee joint active activity were analyzed. Results No statistically differences were determined in baseline among four groups. The VAS scores of group A and group B were lower than those of group C and group D on the 3rd and 7th day after operation. The muscle strength of quadriceps femoris in group A and group C was significantly worse than that in group B and group D on the first and third days after operation. The PSQI scores of group A and group B were lower than those of group C and group D at the same time. In group A and B, the active range of motion of knee joint was higher on the 1st and 3rd day after operation than in group C and D. Conclusion Auricular point sticking combined with single time adductor canal block is more effective in relieving postoperative pain, improving sleep, promoting early functional exercise and achieving rapid recovery.

Effects of different doses of dexmedetomidine on median effective concentration of sufentanil in inhabiting cardiovascular responses totracheal intubation in elderly patients

CHEN Zhi-yi, LIU Jian, YANG Yang, WU Lun

2022, 22(02):  183-186.  DOI: 10.3969/j.issn.1009-976X.2022.02.012

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Objective To evaluate the effects of different doses of dexmedetomidine on the median effective concentration of sufentanil in inhabiting cardiovascular response to tracheal intubation with the probability of 50%（EC50） in the elderly patients. Methods Ninety-six elderly patients who were undergoing elective abdominal operation under general anesthesia,with ASA physical statusⅠ-Ⅱ, were randomly divided into four groups：the control group（Group C） which were injected saline 10 ml before anesthesia induction;the dexmedetomidine group （Group D1, Group D2 and Group D3, 0.1, 0.3 and 0.5 μg/kg of dexmedetomidine were respectively injected before anesthesia induction for 5-15 min）. All the patients were received propofol with a target concentration of 2.5 μg/ml and total intravenous anesthesia of sufentanil with a target concentration of preset dose through target-controlled infusion pump. Dixon′s up-and-down method was used to determine the dose of sufentanil. The number of patients with sinus bradycardia, hypotension and cough before intubation was recorded, as well as the number of patients with agitation and pain in the PACU and the Ramsay sedation score at 2 hours after surgery. Results The EC50 of sufentanil in inhibiting the hemodynamic response to tracheal intubation in the elderly patients with different doses of dexmedetomidine administered intravenously before general anesthesia induction with the target concentration of propofol at 2.5 μg/mL were 0.246 ng/mL in group C, 0.238 ng/mL in group D1, 0.215 ng/mL in group D2, and 0.199 ng/mL in group D3, respectively. Compared with group C, the incidence of bradycardia before tracheal intubation was higher in group D3, and the incidence of agitation during extubation was lower in groups D2 and D3（P<0.05）. There were no significant differences in the incidence of hypotension and cough before tracheal intubation, as well as the incidence of pain in the PACU, and the Ramsay sedation score at 2 hours after surgery（P>0.05）. Conclusion As the dose of dexmedetomidine increased, the target concentration of sufentanil required for tracheal intubation in elderly patients decreased, and 0.3 and 0.5 μg/kg dexmedetomidine before induction of general anesthesia reduced agitation in the PACU in elderly patients.

A prospective study of skin location assisted endoscopic band ligation for grade Ⅱ-Ⅲ internal hemorrhoids

LI Shu-ling, LIU Jun-jie

2022, 22(02):  187-190.  DOI: 10.3969/j.issn.1009-976X.2022.02.013

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Objective This study accessed the clinical efficacy of skin location assisted endoscopic band ligation for grade Ⅱ-Ⅲ internal hemorrhoids. Methods A total of 70 consecutive patients diagnosed grate Ⅱ-Ⅲ internal hemorrhoids were enrolled in this study. The observation group（n=35） performed skin location assisted endoscopic band ligation and the control group（n=35） performed tradition hemorrhoids ligation. The age, gender and the classification of hemorrhoids for both groups were of no significant differences. The post operational pain, bleeding, other complications and effectiveness were observed and compared. Results The operative time and postoperative bleeding rate for both groups were of no significant difference. The post operational pain of the observation group was significantly lower than that of the control group, and the life quality for the observation group was significantly greater than that of the control group. The observation group had greater effective rate （97.14% vs 85.71%, P>0.05）, and fewer complication rate than the control group （5.71% vs 17.14%, P>0.05）but had no significant difference. Conclusions Skin location assisted EBL causes less postoperative pain and less complication than the traditional ligation group and is expected to be safe and effective for grade Ⅱ-Ⅲ internal hemorrhoids.

Case Report

Laparoscopic excision combined with immediate self-fixation mesh abdominal wall reconstruction of abdominal wall aggressive fibromatosis

ZHONG Jia-jian, MA Dong-heng, CHEN Si-cong, ZHAO Yong-ling

2022, 22(02):  191-193.  DOI: 10.3969/j.issn.1009-976X.2022.02.014

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This paper retrospectively analyzed a case of laparoscopic excision combined with immediate self-fixation mesh abdominal wall reconstruction of abdominal wall aggressive fibromatosis with the review of literature to explore the clinical features, diagnosis and treatment of abdominal wall aggressive fibromatosis and to provide reference for medical staff.

Review

Research progress of intraductal papillary neoplasm of the bile duct

CHEN Dong, LIANG Yi-hua, LIAO Bing, CAI Mu-yan

2022, 22(02):  194-198.  DOI: 10.3969/j.issn.1009-976X.2022.02.015

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Intraductal papillary neoplasm of the bile duct （IPNB） is a rare type of tumor, characterized by dilated bile ducts filled with a papillary or villous biliary neoplasms and secretion with a large amount of mucins in some cases. It is difficult to obtain a positive and correct diagnosis before surgery and the most common presenting symptoms are abdominal pain, jaundice and cholangitis. It is likely to make a definite diagnosis based on the accumulated knowledge of the specific clinical features of IPNB. Currently the definition of IPNB remains controversial and the differential diagnosis of papillary cholangiocarcinoma and IPNB remain challenging. Other pathological features include multifocality and different proportion of invasive components. Patients with pancreaticobiliary subtype have worse prognosis and mucin core protein （MUC）-1 is the most important immunohistochemical marker related to the survival. IPNB have a variant of distinctive imaging characteristics and it is possible to determine whether an associated invasive carcinoma exist before surgery according to CT combined with MRCP imaging finding. Surgery is the primary treatment and the overall postoperative survival is better than general cholangiocarcinoma.

Research progress on metabolic syndrome and its prevention and treatment after liver transplantation

YE Shao-wei, QIAN Jun-lin, HU Ze-min

2022, 22(02):  199-204.  DOI: 10.3969/j.issn.1009-976X.2022.02.016

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Liver transplantation （LT） is considered to be the only radical option for patients with end-stage liver disease, severe hepatitis and advanced liver malignant tumor （primary）. Due to the improvement of perioperative nursing, infection control and immunosuppressive drugs in recent decades, the early survival rate of liver transplant recipients has made great progress, but the survival rate in the late stage after transplantation （more than 5 years after transplantation） has not improved. The main causes of late death are malignant tumors and cardiovascular complications. Metabolic syndrome, defined as obesity, hypertension, dyslipidemia and hyperglycemia, is diagnosed as LTMS （liver transplantation metabolic syndrome） after liver transplantation in transplant recipients, affecting long-term survival. Many aspects of metabolic syndrome can be changed. The purpose of this review is to summarize the current knowledge about LTMS and its related components and to explore its prevention and management strategies, in order to provide practical step-by-step guidance.

Current situation of neoadjuvant therapy for triple negative breast cancer

ZENG Zhi-hao, HE Shen

2022, 22(02):  205-209.  DOI: 10.3969/j.issn.1009-976X.2022.02.017

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Objective Triple negative breast cancer has high invasion, high recurrence, high metastasis and poor prognosis,and it has poor effect on endocrine therapy and anti-HER-2 targeted therapy.This study summarized the progress of neoadjuvant therapy for triple negative breast cancer in recent years. Methods PubMed, CNKI, Wanfang and other databases were used to search relevant literatures in recent years with “TNBC, neoadjuvant therapy, pathological complete response” as search keywords. Results Pathological complete response rate is considered to be one of the important criteria for the prognosis of neoadjuvant therapy. Anthracycline combined with paclitaxel is still the preferred neoadjuvant chemotherapy regimen for TNBC patients. Platinum-based drugs provide a better neoadjuvant chemotherapy regimen for TNBC patients with BRCA gene mutation, but hematological and digestive adverse reactions need to be paid attention to. Drugs related to immune check point inhibitors have been proved to enhance pCR and improve long-term survival prognosis in TNBC neoadjuvant therapy, and discontinuation due to adverse drug reactions has a lower incidence than platinum drugs. In addition, the tumor microenvironment targeting drugs, poly ADP ribose polymerase inhibitors, PI3K/AKT/mTOR pathway inhibitors and other related drugs have positive therapeutic effects in clinical studies on multi-drug combination. Conclusion In the neoadjuvant therapy of TNBC, chemotherapy is the basis, and immunotherapy has achieved relevant clinical trial results. Tumor microenvironment targeting drugs, PARP inhibitors, and PI3K/AKT/mTOR pathway inhibitors have great research prospects.

New progress in the study of Asprosin

XUE Jia-jing, GUO Wei, ZHAO Bing-bing, ZHAO Ling-fei

2022, 22(02):  210-213.  DOI: 10.3969/j.issn.1009-976X.2022.02.018

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Asprosin is a new kind of glycogen adipokines, which is synthesized and released by white adipose tissue mainly in fasting. Asprosin plays a complex role in the central nervous system, peripheral tissues and organs. It is associated with appetite, glucose metabolism, insulin resistance （IR）, apoptosis and so on. Recent studies have found that Asprosin plays an important and complex role in metabolic and metabolic diseases. Metabolic diseases mainly include diabetes mellitus （DM）, nonalcoholic fatty liver disease （NAFLD）, polycystic ovarian syndrome （PCOS）, and cardiovascular diseases. It is mainly due to the destruction of normal metabolic processes. At present, such diseases bring a great threat to human health and the quality of life. In this paper, we reviewed the progress of asprosin in metabolic diseases in recent years, and provided new ideas for clinical diagnosis and treatment in the future.