ObjectiveTo compare the clinicopathological characteristics and prognosis of young early breast cancer patients with different human epidermal growth factor receptor 2 (HER2) expression levels, and to analyze the clinicopathological characteristics and prognosis of young early breast cancer patients with low HER2 expression. MethodsA total of 1 723 breast cancer patients who were treated in the Department of Breast Surgery of the First Affiliated Hospital of Xi’an Jiaotong University between June 2016 and June 2018 were collected and divided into three groups: HER2-negative, low-expression, and high-expression. The clinicopathological characteristics of the three groups were compared, and the relationship between HER2 expression and patients’ prognosis was analyzed. ResultsThere were 512 HER2-negative patients, 748 HER2-low expression patients, and 463 HER2-high expression patients. The results of the clinical pathological characteristics analysis of the three groups of patients showed that there were no statistical differences in marital status, menopausal status, family history, single T stage (tumor size), single M stage (distant metastasis), affected side, vascular tumor thrombus, and radiotherapy in the three groups of breast cancer patients with different HER2 expression levels (P>0.05). However, there were statistical differences in age, Ki-67 expression level, N stage, TNM stage, surgical method, estrogen receptor and progesterone receptor status, histological type, histological grade, whether to receive neoadjuvant therapy and adjuvant chemotherapy in breast cancer patients with different HER2 expression levels (P<0.05). The results of survival analysis showed that the prognosis of early breast cancer patients may not be significantly correlated with the HER2 expression level, and the prognosis of young early breast cancer patients may also not be statistically correlated with the HER2 expression status. ConclusionsBreast cancer patients with different HER2 expression levels differ in multiple clinicopathological characteristics, but these differences do not significantly affect the prognosis of the patients. Especially for early-stage breast cancer, HER2 expression levels do not seem to have a significant impact on prognosis. This suggests that HER2 status may not be a decisive factor in treatment and prognosis assessment, and other pathological characteristics and treatment methods need to be considered comprehensively. The prognosis of young breast cancer patients in early stage may also not be statistically correlated with HER2 expression status.
ObjectiveTo review the pathological effects of cellular senescence in the occurrence and development of osteoarthritis (OA) and potential therapeutic targets.MethodsThe role of chondrocyte senescence, synovial cell senescence, mesenchymal stem cells senescence in OA, and the biological mechanism and progress of chondrocyte senescence were summarized by consulting relevant domestic and abroad literature.ResultsThe existing evidence has basically made clear that chondrocyte senescence, mesenchymal stem cells senescence, and cartilage repair abnormalities, and the occurrence and development of OA have a certain causal relationship, and the role of the senescence of synovial cells, especially synovial macrophages in OA is still unclear. Transcription factors and epigenetics are the main mechanisms that regulate the upstream pathways of cellular senescence. Signal communication between cells can promote the appearance of senescent phenotypes in healthy cells. Targeted elimination of senescent cells and promotion of mesenchymal stem cells rejuvenation can effectively delay the progress of OA.ConclusionCellular senescence is an important biological phenomenon and potential therapeutic target in the occurrence and development of OA. In-depth study of its biological mechanism is helpful to the early prevention and treatment of OA.
ObjectiveTo investigate the clinicopathological characteristics and prognosis of young patients with non-small cell lung cancer (NSCLC).MethodsA total of 5320 patients with primary NSCLC from 2008 to 2014 were included and then divided into four groups according to their age, ie. a young group (≤ 45 years), a middle-young group (46 - 60 years), a middle-old group (61 - 75 years) and an old group (≥76 years). The clinicopathological manifestation and overall survival (OS) of the patients among the different age groups were compared.ResultsThe patients aged 45 years or younger accounted for 12.1% of all NSCLC cases. The proportions of females, never-smokers and adenocarcinoma were 49.9%, 65.9% and 74.0% in the young group, higher than those in the other three age groups (P<0.001 for all). And the proportion of Ⅲ/Ⅳ stage tumor was 84.3% in the young group, just less than that in the old group (87.9%; P<0.001). Patients in the young group were more likely to receive surgery (30.5%) and chemotherapy (38.9%), and got comparatively favorable OS compared with the patients in other age groups (P>0.05 for all).ConclusionsNSCLC occurring in young population is not rare. Young patients with NSCLC have unique clinicopathological characteristics, with more females, never-smokers and adenocarcinomas. Young patients with NSCLC may choose aggressive treatment approaches, such as surgery and chemotherapy, thus get a comparatively favorable prognosis.
ObjectiveTo review the research progress of the application of autologous fat grafting in perioral and lower face rejuvenation. Methods By extensively reviewing related articles and combining the clinical experiences, the anatomic features (fat compartments and blood supply), aging features of the perioral and lower face, and the application advancement and related complications of autologous fat grafting in this area were generally summarized. Results The aesthetic features of perioral and lower face include the lip, chin, and so on, and the anatomic structures relating autologous fat grafting include the mandibular fat compartments, chin fat compartments, and other fat compartments. Meanwhile, the facial artery passes through this area and spreads out several important branches. The aging features of perioral and lower face include the depening of nasolabial fold, the aging lip, perioral wrinkles, “marionette lines”, and so on. Autologous fat grafting can improve perioral and lower face rejuvenation by restoring volume loss of facial fat compartments, correcting aging malformation, and improving skin quality. But there are neurovascular injuries, facial aesthetic problems, and other related complications. ConclusionAutologous fat grafting can be applied in perioral and lower face rejuvenation, and it can effectively improve related aging features. There are several aspects developing aggressively, including the research of facial asthetics features of Chinese people, combining autologous fat grafting with surgery as well as other methods to comprehensively treat facial aging, and the application of fat tissue related derivatives in perioral and lower face rejuvenation. However, the resorption rate of facial grafted fat tissue is still too high, and the long-term effectiveness can not be assured. In the future, the solutions related to improving the survival rate of grafted fat tissue need to be explored in the future.
Facial aging is caused by several aspects involving skin, its deep soft tissue (fat, muscles, fascia ligaments, etc), and bones. The skin presents deepen wrinkles, darker, drying, and roughness. Volume loss and sag caused by gravity can be seen in deep soft tissue. And selective absorption can be seen in bones. At present, to combat facial aging caused by different causes, we have adopted comprehensive treatment methods such as facial rhytidectomy, embedded wire ascension, autogenous fat graft, hyaluronic acid or botulinum toxin injection, and optoelectronic techniques, etc.
Objective To analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.
Objective To explore the axillary lymph node dissection (ALND) could be safely exempted in younger breast cancer patients (≤40 years of age) who receiving breast-conserving surgery combined with radiotherapy in metastasis of 1–2 sentinel lymph node (SLN) and T1–T2 stage. Methods The data of pathological diagnosis of invasive breast cancer from 2004 to 2015 in SEER database were extracted. Patients were divided into SLN biopsy group (SLNB group) and ALND group according to axillary treatment. Propensity matching score (PSM) method was used to match and equalize the clinicopathological features between two groups at 1∶1. Multivariate Cox proportional risk model was used to analyze the relationship between axillary management and breast cancer specific survival (BCSS), and stratified analysis was performed according to clinicopathological features. Results A total of 1 236 patients with a median age of 37 years (quartile: 34, 39 years) were included in the analysis, including 418 patients (33.8%) in the SLNB group and 818 patients (66.2%) in the ALND group. The median follow-up period was 82 months (quartile: 44, 121 months), and 111 cases (9.0%) died of breast cancer, including 33 cases (7.9%) in the SLNB group and 78 cases (9.5%) in the ALND group. The cumulative 5-year BCSS of the SLNB group and the ALND group were 90.8% and 93.4%, respectively, and the log-rank test showed no significant difference (χ2=0.70, P=0.401). After PSM, there were 406 cases in both the SLNB group and the ALND group. The cumulative 5-year BCSS rate in the ALND group was 4.1% higher than that in the SLNB group (94.8% vs. 90.7%). Multivariate Cox proportional hazard analysis showed that ALND could further improve BCSS rate in younger breast cancer patients [HR=0.578, 95%CI (0.335, 0.998), P=0.049]. Stratified analyses showed that ALND improved BCSS in patients diagnosed before 2012 or with a character of lymph node macrometastases, histological grade G3/4, ER negative or PR negative. Conclusions It should be cautious to consider the elimination of ALND in the stage T1–T2 younger patients receiving breast-conserving surgery combined with radiotherapy when 1–2 SLNs positive, especially in patients with high degree of malignant tumor biological behavior or high lymph node tumor burden. Further prospective trials are needed to verify the question.
ObjectiveTo review the current situation of total knee arthroplasty (TKA) used in young patients with osteoarthritis. MethodsThe recent literature in the treatment of osteoarthritis with TKA in young patients was extensively reviewed. The characteristics, curative effect, and postoperative satisfaction degree of TKA in young patients were analyzed and summarized. ResultsYoung patients have longer life expectancy and higher activity, which may lead to much higher expectation of the TKA. Comparing with elderly patients, young patients obtain equal or better effectiveness after TKA, but they are likely to not be satisfied with the effects because of low survival rate of the prosthesis. At present, continuous development of implant design, prosthesis material, and operation technique are in progress to reduce wear, hence to prolong the implant survivorship so as to meet the desire of young patients. However, the studies of the big samples and long-term follow-up are required to confirm the clinical advantages of such developments. ConclusionWith the trend of TKA in young patients, surgeons should have a good understanding of the patients' demands, select suitable prosthesis and give appropriate preoperative counseling to build up an objective expectation of curative effect, which will lead to a better doctor-patient relationship.
ObjectiveTo study the effectiveness of facial meticulous fat grafting by fat granules injection asistor. MethodsBetween January and August 2015, 46 patients received facial autologous fat grafting for rejuvenation. There were 7 males and 39 females, aged 21-65 years (mean, 34 years). Firstly, the faces were divided into 10 cosmetic zonations according to facial aesthetic criteria, then autologous fat grafting was carried out by fat granules injection asistor. The autologous fat was filled into 1, 2, 3, 4, 5, 6, 7, 8, and 9 cosmetic zonations in 3, 7, 5, 3, 8, 4, 2, 10, and 4 cases respectively; the injected fat amount was 2-110 mL (mean, 47 mL). ResultsThe swelling period was from 5 to 15 days after operation (mean, 7 days), and there were no complications of infection, cyst, introvascular thrombogenesis, and so on. They were followed up 1-7 months (mean, 3 months). The effect of face rejuvenation was satisfactory. ConclusionCosmetic zonation of face is helpful for preoperative evaluation of autologous fat grafting, and the fat granules injection asistor is beneficial to reach better effect of face rejuvenation.