Search

BACKGROUND: For patients with clinically node-positive (cN+) breast cancer undergoing neoadjuvant chemotherapy (NAC), retrieving previously clipped, biopsy-proven positive lymph nodes during sentinel lymph node biopsy [i.e., targeted axillary dissection (TAD)] may reduce false negative rates. However, the overall utilization and impact of clipping positive nodes remains uncertain. PATIENTS AND METHODS: We retrospectively analyzed cN+ ISPY-2 patients (2011-2022) undergoing axillary surgery after NAC. We evaluated trends in node clipping and associations with type of axillary surgery [sentinel lymph node (SLN) only, SLN and axillary lymph node dissection (ALND), or ALND only] and event-free survival (EFS) in patients that were cN+ on a NAC trial. RESULTS: Among 801 cN+ patients, 161 (20.1%) had pre-NAC clip placement in the positive node. The proportion of patients that were cN+ undergoing clip placement increased from 2.4 to 36.2% between 2011 and 2021. Multivariable logistic regression showed nodal clipping was independently associated with higher odds of SLN-only surgery [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.8-6.8, p < 0.001]. This was also true among patients with residual pathologically node-positive (pN+) disease. Completion ALND rate did not differ based on clip retrieval success. No significant differences in EFS were observed in those with or without clip placement, both with or without successful clip retrieval [hazard ratio (HR) 0.85, 95% CI 0.4-1.7, p = 0.7; HR 1.8, 95% CI 0.5-6.0, p = 0.3, respectively]. CONCLUSION: Clip placement in the positive lymph node before NAC is increasingly common. The significant association between clip placement and omission of axillary dissection, even among patients with pN+ disease, suggests a paradigm shift toward TAD as a definitive surgical management strategy in patients with pN+ disease after NAC.

[Objective] To establish a detection method for complement C3d-sensitized platelets. [Methods] Parallel detection of the same platelet sample under conditions of complement C3d sensitization and non-sensitization was conducted using microcolumn gel immunoagglutination inhibition assay technology. The supernatant obtained after the reaction between anti-C3d monoclonal antibodies and platelet samples was then reacted with C3d-sensitized red blood cells to observe whether agglutination occurs. Subsequently, this method was used to test samples from 22 clinical patients to determine whether their platelets were sensitized by complement C3d. [Results] The same platelet sample, after being sensitized with complement C3d, showed negative or weakened aggregation, which was determined as a positive result, whereas platelets that were not sensitized with complement C3d exhibited aggregation, which was determined as a negative result. A total of 22 clinical patient samples were tested, of which 16 were negative and 6 were positive. [Conclusion] A microcolumn gel immunoagglutination inhibition test was established to detect whether platelets are sensitized by complement C3d, which aids in the auxiliary diagnosis of complement-related immune diseases involving platelets.

BACKGROUND: Axillary surgery after neoadjuvant chemotherapy (NAC) is becoming less extensive. We evaluated the evolution of axillary surgery after NAC on the multi-institutional I-SPY2 prospective trial. METHODS: We examined annual rates of sentinel lymph node (SLN) surgery with resection of clipped node, if present), axillary lymph node dissection (ALND), and SLN and ALND in patients enrolled in I-SPY2 from January 1, 2011 to December 31, 2021 by clinical N status at diagnosis and pathologic N status at surgery. Cochran-Armitage trend tests were calculated to evaluate patterns over time. RESULTS: Of 1578 patients, 973 patients (61.7%) had SLN-only, 136 (8.6%) had SLN and ALND, and 469 (29.7%) had ALND-only. In the cN0 group, ALND-only decreased from 20% in 2011 to 6.25% in 2021 (p = 0.0078) and SLN-only increased from 70.0% to 87.5% (p = 0.0020). This was even more striking in patients with clinically node-positive (cN+) disease at diagnosis, where ALND-only decreased from 70.7% to 29.4% (p < 0.0001) and SLN-only significantly increased from 14.6% to 56.5% (p < 0.0001). This change was significant across subtypes (HR-/HER2-, HR+/HER2-, and HER2+). Among pathologically node-positive (pN+) patients after NAC (n = 525) ALND-only decreased from 69.0% to 39.2% (p < 0.0001) and SLN-only increased from 6.9% to 39.2% (p < 0.0001). CONCLUSIONS: Use of ALND after NAC has significantly decreased over the past decade. This is most pronounced in cN+ disease at diagnosis with an increase in the use of SLN surgery after NAC. Additionally, in pN+ disease after NAC, there has been a decrease in use of completion ALND, a practice pattern change that precedes results from clinical trials.

Background Malignant melanoma (MM) is caused by the malignant transformation of epidermal melanocytes with extremely high malignant degree, and its prevention and treatment is a key issue in the field of dermatology. Objective To investigate the prognosis of patients with MM, and influencing factors of the prognosis of patients with MM. Methods A total of 205 patients with malignant melanoma from the First Affiliated Hospital of Shanxi Medical University from January 2006 to December 2021 were selected as the subjects. The clinical data were obtained by collecting information from electronic medical records of patients, the overall survival (OS) was confirmed by telephone follow-up, and the last follow-up visit until 2022-12-31. The survival curve was plotted by the Kaplan-Meier method, and Log-rank test was used to compare the survival curves of different influencing factors. Multivariate Cox proportional hazard regression model was used to analyze the influencing factors of survival outcome in MM patients. Results The 1-year overall survival, 3-year overall survival, and 5-year overall survival rates of MM patients were 94.6% (194/205) , 81.9% (168/205) and 72.6% (149/205) , respectively, the mean OS was 71.77 months and the median OS was 66.83 months. The results of survival curve analysis showed statistically significant differences when comparing the OS of MM patients with different genders, ages, tumor thicknesses, tumor ulcers, lymph node metastases, and neutrophil-to-lymphocyte ratios (NLR) (P1.94 mm (HR=2.466, 95%CI=1.419-4.284) , tumor ulcer (HR=1.821, 95%CI=1.225-2.708) , lymph node metastasis (HR=1.999, 95%CI=1.305-2.892) , and NLR≥3 (HR=1.873, 95%CI=1.108-3.166) were the influencing factors of survival outcome in MM patients (P1.94 mm, tumor ulcer, lymph node metastasis and NLR≥3 are poor prognostic factors for MM patients. Medical workers can focus on MM patients with the above poor prognostic factors and enhance care to improve their survival rate, thus better guiding the clinic treatment.

A domestic cloud simulation software platform named CloudLPS(Cloud-Based Liquid Pipeline Simulator) with complete independent intellectual property rights is developed, aiming to eliminate the long-term reliance on foreign commercial simulation softwares for liquid pipeline simulation. The platform is built on a B/S cloud architecture and is designed with the goals of accuracy, speed, simple interfaces, and convenient interaction. In terms of models, in addition to conventional flow and heat transfer models, CloudLPS also introduces the advanced mathematical models such as the non-Newtonian fluid model and the cross-dimensional thermal model, which enables the software to have the capability of hydraulic and thermal simulations for condensable and high-viscosity crude oil pipelines. Furthermore, the software also introduces some efficient simulation methods,such as adaptive mesh, dynamic mesh, divide and conquer, and heterogeneous parallelization, to facilitate the rapid calculation of large and complex pipe network system. In terms of functionality, it primarily offers users a variety of business and composite business function support to crude oil and refined oil pipeline networks, such as steady-state and unsteady-state simulations of pipeline network system, logic control, water hammer analysis,batch tracking, shutdown and restart, energy consumption optimization, and more. Additionally, the software provides a user-friendly visual modeling and result data display and analysis environment. CloudLPS serves as a fundamental software tool that plays a supportive role in various aspects of pipeline network system, such as planning and designing, operation scheduling, risk decision-making, and other business scenarios. Its application holds significant importance in ensuring the safe and economic operation of liquid pipelines in China.

In this work, a novel In(iii) coordination polymer, i.e., {[In(L)(im)(H2O)](H2O)}n (1) was produced from the synthetic reactions in water and dimethylformamide mixed solvents and using methyl-3-hydroxy-5-carboxy-2-thiophenecarboxylic acid (H2L) and imidazole (Him) as the co-ligands, and then successfully loaded with dexamethasone. The injectable hydrogels were prepared from natural polysaccharide hyaluronic acid with good biocompatibility and successfully loaded with In(iii) complex. The suppressive inhibitory effect of hydrogels toward U251 human glioma cell line viability was assessed using the Cell Counting Kit-8 assay kit, and the relatively expressed levels of the vascular endothelial growth factor signaling pathway were determined by real-time RT-PCR.