Objective  Screening the differential expression of circular RNA (circRNA) in the triple negative breast cancer (TNBC) with its tumor-adjacent tissues and to analyze the potentially downstream miRNAs and target genes associated circRNA candidates by bioinformatics analysis,then predict the potential regulatory pathways of circRNA in TNBC.
Methods  One paired triple negative breast cancer sample and adjacent non-cancerous tissues for RNA-Seq was collected from a patient received surgery at department of the thyroid and galactophore in Peking University Shenzhen Hospital.We obtained differential expression of circRNA and a total of ten circRNAs the five most significant up-regulated and down-regulated circRNA were selected.The RegRNA 2.0 website was used to predict the potential miRNAs corresponding to circRNA candidates,and three bioinformatics websites (miRDB,TargetScan,and RNAInter) were further utilized to predict the downstream mRNA of miRNAs.Gene ontology (GO) and Kyoto Encylopedia of Genes and Genomes (KEGG) analysis were performed for these target genes.The protein-protein interaction (PPI) network of the predicted target genes was analyzed by STRING online tools,and the data were exported before we imported them into the Cytoscape software.The key genes were screened out by MCODE plug-ins.Kaplan-Meier Plotter online database was used to analyze the relationship between the expression level of key genes and the prognosis of TNBC.
Results  There were 6547 differentially expressed circRNAs in the triple negative breast cancer tissues with its tumor-adjacent tissues,2311 of which were up-regulated and 4326 were down-regulated；a total of 1161 mRNAs were predicted in the downstream of 5 up-regulated circRNAs and 5 down-regulated circRNAs most significantly;the results of GO and KEGG analysis showed that these mRNA were mainly involved in negative regulation of transcription from RNA polymerase Ⅱ promoter,covalent chromatin modification,regulation of transcription and they are mainly involved in endocytosis,oxytocin signaling pathway,Wnt signaling pathway and cGMP-PKG signaling pathway;five key genes were screened out (UBOX5,UBE2G2,DTX3L,FZR1,RNF19A) among which the low expression of UBE2G2 and DTX3L indicated the poor overall survival of triple negative breast cancer patients;the corresponding miRNA and circRNA for UBE2G2 are hsa_miR-93-3p and hsa_circ_0001361,and hsa_miR-2115-5p and hsa_circ_0002874 for DTX3L respectively.
Conclusion  Among the downstream target genes of miRNA probably binding to circRNA candidates expressed differentially in triple negative breast cancer,the key genes are may be UBOX5,UBE2G2,DTX3L,FZR1 and RNF19A.UBE2G2 and DTX3L are related to the prognosis of TNBC patients,and their corresponding regulatory axes in TNBC are hsa_circ_0001361/miR-93-3p/ UBE2G2 and hsa_circ_0002874/miR-2115-5p/DTX3L respectively,which suggest that these two axes may participate in the occurrence and development of triple negative breast cancer.

Objective  To investigate the consistency of pathological results and immunohistochemical results between specimens obtained by Ultrasound-guided core needle biopsy(USCNB)and postoperative in the breast cancer and to analyze the influence of tumor size on it.To understand the accuracy of USCNB in the diagnosis of axillary lymph node(ALN)metastasis.
Methods  Retrospectively analyzed the clinicopathological data of 431 patients with breast cancer.Compared the pathological results of USCNB with postoperative pathology to understand the detection rate of breast cancer and the accuracy of ALN metastasis diagnosis by USCNB and to understand the consistency of immunohistochemistry(ER,PR,HER-2 and Ki-67) between USCNB and postoperative pathology.Analyzed of the influence of breast tumor size on the detection rate and immunohistochemistry consistency of breast cancer.
Results  417 cases were diagnosed of breast cancer by USCNB,the detection rate of breast cancer was 96.75%.The analysis indicated that there was no significantly difference of the detection rates of USCNB for breast cancer among groups with different tumor size(P>0.05).For the pathological diagnosis of abnormal ALN by USCNB,the accuracy was 90.34%(131/145),the sensitivity was 88.50%(100/113),the specificity was 96.88%(31/32),the false negative rate was 11.50%(13/113),and the false positive rate was 3.13%(1/32).The diagnostic coincidence rates of ER,PR,HER-2 and Ki-67 were 92.11%,90.49%,89.33%and 70.30%.The Kappa values were 0.780,0.752,0.743 and 0.290,AUC values of ER,PR and HER-2 were 0.719,0.700 and 0.479.The consistency between USCNB and ER,HER-2 decreased with the increase of tumor(P<0.05),but there was no significant difference in the coincidence rates of PR and Ki-67 among different tumor size groups(P>0.05).
Conclusion  USCNB is a reliable diagnostic method for breast cancer and ALN staging.The consistency of ER and PR between specimens obtained from USCNB and postoperative is good.The consistency of ER and HER-2 is related to the tumor size.

Objective  To investigate the current status of postoperative adjuvant endocrine therapy compliance in breast cancer patients attended the case management model,and to discuss the factors affecting their compliance.
Methods  From June 2013 to July 2017,this study enrolled 2072 breast cancer patients who received case management and accepted adjuvant endocrine therapy at Ruijin Hospital.Demographic characteristics and disease-related features were collected.Chi-square test was used to analyze the impact of these data on patients' compliance on the endocrine therapy designed by multi-disciplinary treatment(MDT).The statistically significant variables were further analyzed by logistic regression to fine out its corresponding impact level.
Results  The 5-year follow-up of adjuvant endocrine therapy,with a median time of (33.55±15.55)months,the compliance of 2 072 breast cancer patients was 99.61%,98.69%,97.38%,94.65% and 84.51%,respectively.The results of analysis showed that age,education,tumor stage(TNM stage) and the duration of endocrine therapy,all have statistically significant influence on therapy compliance(P<0.05).
Conclusion  The case management model is helpful to improve the adjuvant endocrine therapy compliance after breast cancer surgery.To further improve the therapy compliance,more attention should be paid to the patients older than 65,taking endocrine medicine over 3 years and early tumor stage.

Objective  To evaluate the outcome of the one-stage and two-stage implant-based breast reconstruction(IBBR) in terms of postoperative complications and patient satisfaction.
Methods  Clinical datawere retrospectively collected for patients who underwent one-stage and two-stage IBBR from 2013 to 2017.Postoperative complications,reoperations and patients' satisfaction were compared between the two groups.
Results  Biological patch resulted an increased risk of poor healing wound(OR:4.40,95%CI:1.27-15.29,P=0.02) and seroma(OR:9.30,95%CI:1.60-53.93,P=0.01).Radiotherapy resulted an increased risk of capsular contracture(OR:0.12,95%CI:0.03-0.49,P=0.003).The above complications appeared to be independent of operation mode.Two-stage IBBR only had more satisfactory aesthetic outcomes compared to one-stage IBBR(P<0.001),with no difference in complications and reoperations.
Conclusion  Both one-stage and two-stage IBBR could satisfy tumor safety and cosmetic effect.We recommend that the choice of techniquesshould be considered on a case-by-case basis.

Objective  To analyze the risk factors and prognosis of breast cancer patients with bone metastases.
Methods  Collected 2013-2015 U.S.Surveillance,Epidemiology,and End Results(SEER) database of patients with advanced breast cancer,and analyze the risk factors of bone metastasis,and multivariate Cox regression analysis was used to analyze the independent risk factors affecting the prognosis of patients with bone metastasis.
Results  Univariate analysis showed that in patients with advanced breast cancer,bone metastasis was related to gender,age,race,histological grade,pathological type,N stage,liver metastasis,lung metastasis,ER status,PR status and HER-2 status Relevant(P<0.05);the results of multivariate analysis showed that bone metastasis was related to the patient's age,gender,tissue grade,pathological type,N stage,ER status,PR status,and HER-2 status.The overall survival rate of patients with bone metastases in advanced breast cancer patients is higher;the multivariate Cox regression model shows that the patients are older at onset,black,high tissue grade,high T stage,no surgery and chemotherapy,accompanied by brain metastasis,accompanied by Lung metastasis,liver metastasis,ER negative,PR negative,and HER-2 negative are all independent risk factors affecting the survival of patients with bone metastases.
Conclusion  Among patients with advanced breast cancer,bone metastasis have a better prognosis than non-bone metastases.The age of onset,black people,high tissue grade,high T stage,brain metastasis,lung metastasis,liver metastasis,ER negative,PR negative and HER-2 negative are independent risk factors for poor prognosis.

Objective  To investigate the effect of miR-597 on the proliferation,migration and invasion of breast cancer cells,and its relationship with FOS related antigen 2(FOSL2).
Methods  Breast cancer cell lines T-47D,SK-BR-3,MDA-MB-231,MCF7,BT-474 and normal breast cell line MCF10A were selected as the study objects.According to the transfection,it was divided into:NC group(null plasmid) and miR-597 group(simulated sequence).Meanwhile,30 patients with breast cancer tissue and normal breast tissue adjacent to cancer were selected，rapid cryopreservation of liquid nitrogen to extract RNA for qRT-PCR.The expression level of miR-597 in cells and tissues was detected by real-time fluorescence quantitative PCR.The cell proliferation was detected by MTT and flow cytometry.The cell migration and invasion were detected by Transwell chamber.The expression of FOSL2 was detected by Western blot.The target effect of miR-597 and FOSL2 was confirmed by bioinformatics methodsand the luciferase reporter assay.
Results  The expression of miR-597 in breast cancer tissue was lower than that in normal breast tissue(P<0.01).The  cell proliferation ability of miR-597 in breast cancer cell line was lower than that in normal breast cell line(P<0.01).The percentage of G0G1 phase cells in miR-597 group was higher than that in NC group,and the percentage of S-phase cells was lower than that in NC group(t=10.215,10.336,P=0.000,0.000).The cell invasion ability of miR-597 group was lower than that of NC group(t=8.404,P=0.000).The cell migration ability of miR-597 group was lower than that of NC group(t=5.801,P=0.016).The expression level of FOSL2 in miR-597 group was lower than that of NC group(t=13.658,P=0.000).MiR-597 had a good targeting relationship with FOSL2.
Conclusion  miR-597 was low expressed in breast cancer tissue and cell lines.The high expression of miR-597 can inhibit the proliferation,migration and invasion of breast cancer cells,and which was related to the regulation of FOSL2.

Objective  To investigate the expression of chemokine ligand 12 / chemokine receptor 4(CXCL12 / CXCR4) axis in triple negative breast cancer and its relationship with lymph node metastasis.
Methods  From January 2017 to July 2019,the Department of Pathology of our hospital obtained 70 triple-negative breast cancer tissue samples and paired adjacent tissues,and 34 triple-negative breast cancer metastatic lymph node tissues.The expression of CXCL12 and CXCR4 in the samples were detected by immunohistochemistry,and their relationship with clinicopathological characteristics was analyzed.
Results  The proportion of CXCL12（+）,CXCR4（+）,CXCL12（+）/CXCR4（+） in cancer tissue was higher than that in adjacent tissues,the difference was statistically significant(P<0.05).The ratio of CXCL12（+）/CXCR4（+） in metastatic lymphoid tissue was higher than that in cancer tissue,the difference was statistically significant(P<0.05).Correlation analysis showed that CXCL12 and CXCR4 expression were positively correlated in cancer tissues(r=0.632,P=0.002).The lymph node metastasis rate and the proportion of stage Ⅲ-Ⅳ in CXCL12（+） patients were higher than those of CXCL12（-） patients(P<0.05),and the lymph node metastasis rate and the proportion of stage Ⅲ-Ⅳ in CXCR4（+） patients were higher than CXCR4（-） patients(P<0.05).The expression of CXCL12/CXCR4 biological axis was statistically significant with lymph node metastasis and clinical stage of triple negative breast cancer(P<0.05).
Conclusion  The expression of CXCL12/CXCR4 biological axis is closely related to the lymph node metastasis and clinical stage of triple negative breast cancer.The expression of CXCL12/CXCR4 may promote lymph node metastasis.

Objective  To investigate the expression of Atg5,Atg 9,Beclin 1,ULk1 and Mfn2 in peripheral blood monocytes of breast cancer patients,and its correlation with recurrence.
Method  100 patients with breast cancer treated by radical mastectomy were divided into recurrent group(37 cases),non-recurrence group(63 cases).The expression of Atg5、Atg9、Beclin 1、ULk1 and Mfn2 mRNA were detected by fluorescence quantitative RT-PCR.The relationship between each index and tumor recurrence was analyzed.
Results  The expression of Atg 9、Beclin 1、ULk1 and Mfn2 mRNA of recurrent group were lower than those of the non-recurrence group,and the expression of Atg5 mRNA was higher than that in the non-recurrence group(P=0.007,0.000,0.000,0.000).The clinical stage Ⅲ,histological grade Ⅲ,low expression of Atg9、Beclin 1、ULk1、Mfn2 were risk factors of recurrence.Low expression of Atg5 was protective factor for recurrence(P<0.05).
Conclusion  Low expression of Atg 9、Beclin 1、ULk1 and Mfn2 mRNA in breast cancer is a risk factor for breast cancer recurrence,and low expression of Atg5 gene is a protective factor for recurrence of breast cancer.The detection of its expression is of great significance to evaluate the prognosis of breast cancer after operation.

Objective  To investigate the effect and mechanism of low-frequency ultrasound microbubbles on paclitaxel-induced autophagy in triple negative breast cancer cells.
Methods  MDA-MB-468 cells were divided into control group(treatment),paclitaxel group(6 μg/ml paclitaxel),low-frequency ultrasound group(low-frequency ultrasound+6 μg/ml paclitaxel) and low-frequency ultrasound microbubbles group(low-frequency ultrasound+6 μg/ml paclitaxel+microbubbles),the proliferation,apoptosis,autophagy of MDA-MB-468 cells and the expression of Bcl-2,Bax,Beclin1,LC3Ⅰ and LC3Ⅱ in MDA-MB-468 cells.
Results  Compared with 0μg/ml,1,3,6,12,24μg/ml paclitaxel increased the proliferation inhibition rate of MDA-MB-468 cells(P<0.05).Compared with those in the control group,the proliferation inhibition rate and apoptosis rate of MDA-MB-468 cells,protein expression levels of Bax,Beclin1 and LC3Ⅱ in paclitaxel group were higher(P<0.05),the number of green dots was more,and the protein expression levels of Bcl-2 and LC3 were lower(P<0.05);compared with those in paclitaxel group,the proliferation inhibition rate and apoptosis rate of MDA-MB-468 cells,protein expression levels of Bax,Beclin1 and LC3Ⅱ in low-frequency ultrasound group were higher(P<0.05),the number of green dots was more,and the protein expression levels of Bcl-2 and LC3 were lower(P< 0.05);compared with the those in low-frequency ultrasound group,the proliferation inhibition rate and apoptosis rate of MDA-MB-468 cells,protein expression levels of Bax,Beclin1 and LC3Ⅱ in high-frequency ultrasound microbubbles group were higher(P<0.05),the number of green dots was more,and the protein expression levels of Bcl-2 and LC3 were lower(P<0.05).
Conclusion  Low-frequency ultrasound microbubbles can enhance the apoptosis and autophagy induced by paclitaxel in triple negative breast cancer cells by up-regulating the expression of Bax,Beclin1,LC3Ⅱ protein and down-regulating the expression of Bcl-2 and LC3Ⅰ protein.

Objective  To investigate the clinical effect of using mixed nucleoside tablets to prevent bone marrow suppression during AC adjuvant chemotherapy for breast cancer.
Methods  A total of 84 cases breast cancer patients who had received surgical treatment in our hospital from January 2018 to December 2019 were selected and all received adjuvant chemotherapy using AC regimen(21 days).The patients were randomly divided into the treatment group(42 patients) and the control group(42 patients).In the control group,if degree Ⅱ or above bone marrow suppression occurred during chemotherapy,recombinant human granulocyte colony stimulating factor injection(rh G-CSF) 5g/kg was administered subcutaneously.In the treatment group,mixed nucleoside tablets of 40mg/time were given orally,3 times/d,during chemotherapy.The blood routine examination was conducted on the 7th,9th and 11th day during 4 periods of chemotherapy.Changes of platelet,white blood cell and neutrophil count,degree of bone marrow suppression,occurrence time of bone marrow suppression and occurrence times of FN were compared and analyzed between 2 groups.
Results  Before treatment,there was no significant difference in the platelets,white blood cells and neutrophils between 2 groups(P>0.05).After chemotherapy,the counts of platelets,white blood cells and neutrophils of 2 groups decreased(P<0.05) Compared with the control group,the counts of platelets,white blood cells,and neutrophils in the treatment group increased to varying degrees in 4 periods of chemotherapy.Bone marrow suppression occurred in both groups after chemotherapy.The incidence of bone marrow suppression in the treatment group was 6.55%,and the control group was 13.10%.The incidence of bone marrow suppression in the treatment group was lower than the control group(P<0.05).The average response time of bone marrow suppression in the treatment group was later than that in the control group [(9.8±1.1)d vs.(7.5±1.4)d,t=8.372,P=0.000)].There were 2 people/period of FN in the treatment group,9 people/period in the control group,and fewer FNs in the treatment group than in the control group(P<0.05).
Conclusion  The mixed nucleoside tablets can effectively improve the myelosuppression of breast cancer patients with AC adjuvant chemotherapy and reduce the occurrence of FN.The use of mixed nucleoside tablets in AC adjuvant chemotherapy for low-risk breast cancer may become a new choice for FN low-risk adjuvant chemotherapy.

Objective  To explore the efficacy of 3D thoracoscopic lobectomy in the treatment of primary lung cancer.
Methods  A total of 120 cases of primary lung cancer admitted to our hospital from October 2018 to February 2020 were selected.According to different surgical methods,they were divided into observation group(67 cases) and control group(53 cases).The observation group was treated with 3D t,,horacoscopic lobectomy,and the control group was treated with 2D thoracoscopic lobectomy.The operation status,number of lymph node dissection,postoperative surgical pathological stage,lung function index,pain status,and complications were recorded in the two groups.
Results  The operation time,postoperative drainage tube indwelling time,and postoperative hospital stay in the observation group were shorter than those in the control group,and the intraoperative blood loss and the 24h postoperative drainage were lower than those in the control group(P＜0.05).There was no significant difference in the number of lymph node dissection and postoperative surgical pathological staging between the two groups(P>0.05).The forced expiratory vital capacity in 1 second(FEV1) in the observation group was better than that in the control group 3 months after operation(P＜0.05).The visual analog score(VAS) of the observation group was lower than that of the control group 3 months after operation(P＜0.05).The complication rate of the observation group was significantly lower than that of the control group(5.97% vs.18.87%,P＜0.05).
Conclusion  3D thoracoscopic lobectomy for primary lung cancer can shorten the operation time,postoperative drainage tube indwelling time,postoperative hospital stays,reduce intraoperative blood loss,24h postoperative drainage,improve lung function,reduce pain,and with less complications.

Objective  Evaluation of adhesion prevention efficacy of Sirolimus(SRL)-loaded hydrogel composite mesh under the condition of intraperitoneal onlay mesh(IPOM) in piglet model.
Methods  Laparoscopic technique was used to repair abdominal wall by IPOM method,then the SRL-loaded hydrogel was injected on the surface of the mesh to form the anti-adhesion composite mesh(SRL/gel/PP).The adhesion area,adhesion tenacity degree was evaluated.The virgin PP mesh and PROCEED mesh were used as control.Then the inflammation reaction and collagen disposition of surrounded monofilament was also evaluated.
Results  The hydrogel could fix on the surface of mesh and peritoneum.The SRL/gel/PP presented an excellent prevention abdominal adhesion property with a little few inflammation reaction and collagen disposition.SRL/gel/PP mesh could integrate with abdominal wall as well as no displacement and shrinking.
Conclusion  The SRL-loaded hydrogel composite mesh adapted to repair the abdominal defect with the IPOM method for prevention abdominal adhesion.

Objective  To summarize and share the clinical characteristics and surgical management of duodenal foreign bodies.
Methods  A retrospective analysis was performed on 27 cases from January 2008 to September 2020 of duodenal foreign bodies confirmed by preoperative plain abdominal X-ray,Computed Tomography and/or endoscopy.The cases underwent indicated surgery including duodenotomy,gastrotomy and jejunostomy.The operation time,blood loss,complications and length of hospital stay were documented as well.
Results  The types of duodenal foreign bodies mainly included vegetal digestive calculi in 10 cases(37%),toothpicks in 4 cases(15%),razor blades in 3 cases(12%).Among the 27 cases,16 cases were treated by duodenotomy,8 cases by gastrotomy and 3 cases by jejunostomy.Each type of surgery was suited for a specific location of duodenal foreign bodies.The mean operation time of duodenotomy was(144±57)min,with mean blood loss(112±105)ml and(13.4±19.0)d as length of hospital stay.Trends of decreasing were observed in both gastrotomy and jejunostomy with regard to either mean surgical duration,blood loss or length of hospital stay.The main complications were duodenal anastomotic leakage(1 case),pulmonary infection(2 cases),incision infection(2 cases),and re-laparotomy(1 case).
Conclusion  Duodenotomy is mainly used for foreign bodies in the horizontal part of duodenum,while gastrotomy and jejunostomy are suitable for foreign bodies in the segment from duodenal bulb to nearby descending part and ascending part of duodenum respectively.All three types of surgery are safe and reliable.In clinical practice,we should choose the operations according to the foreign body retention position.

Objective  To explore the clinical effect of arthroscopic double-row anchored suture bridge technique in treating simple humeral greater tuberosity avulsion fractures.
Methods  From January 2015 to December 2018, 68 patients with avulsion fracture of greater tuberosity of humerus were treated in the Department of Orthopedics of our hospital,they were divided into two groups according to the treatment methods.38 patients who underwent arthroscopic double-row anchor suture bridge technique were included in the arthroscopy group,thirty patients who underwent locking plate internal fixation were included in the plate group.Compare the perioperative indicators of the two groups of patients,record the American shoulder and elbow surgeon(ASES) score,visual analog scale(VAS),and the University of California Los Angeles(UCLA) functional score before and after the operation(last follow-up),and count the patients Postoperative joint range of motion,postoperative complications and patient satisfaction with treatment.
Results  The operation time in the arthroscopic group was significantly longer than that in the steel plate group(P<0.05),the intraoperative blood loss was significantly less than that in the steel plate group(P<0.05),and the hospitalization time was significantly shorter than that in the steel plate group(P<0.05);there was no significant difference in fracture healing time between the two groups(P>0.05);the ASES score and UCLA score of the two groups were higher than those before operation,but the postoperative ASES score and UCLA evaluation between the two groups showed no statistically significant difference(P> 0.05);while the VAS score was significantly lower in the arthroscopic group than in the plate group(P<0.05);The range of motion of shoulder joint(90 ° internal rotation,abduction and forward flexion) in arthroscopy group was significantly higher than that in steel plate group(P<0.05);There were significant differences in the incidence of postoperative complications(5.26% vs 23.33%) and patient satisfaction(97.37% vs 80.00%) between the arthroscopic group and the plate group(P<0.05).
Conclusion  Arthroscopic double row anchor nail suture bridge technique for the treatment of simple humeral greater tuberosity avulsion fracture has satisfactory effect,can significantly improve the postoperative joint function of patients,postoperative pain degree is light,postoperative complications are less,and patient satisfaction is high.

With the development of high-throughput gene detection technology and the concept of “precision medicine”, molecular diagnosis is more and more involved in the treatment strategy of breast cancer.Oncotype DX(21 gene), MammaPrint(70 gene) and PAM50 detection have been recommended by NCCN guideline to guide the decision-making of adjuvant therapy for breast cancer.We elaborate the most widely used and most accessible molecular diagnostic methods and their significance in breast cancer.Due to the confusion of related detection technology in China,molecular diagnosis could be used as a supplement to traditional clinicopathological factors under the evidence of evidence-based medicine,but it should be limited to specific patients.In the future,multi-gene detection of breast cancer should be standardized,so that patients could be benefit more from this technology.

Surgery is still one of the most important treatments for breast cancer patients. Da Vinci robot is the most advanced minimally invasive surgical system in the world, which has many advantages including small trauma, less bleeding, less complications, less pain and short hospitalization time. Da Vinci robot assisted breast surgery provides a new choice for breast cancer patients. This paper will focus on the application and future development of Da Vinci robot system assisted breast surgery, hoping to provide reference for clinical practice in breast cancer treatment.