Ближайшие и отдаленные результаты различных методов хирургической коррекции десценции передней стенки влагалища II–III степени

Objective. To conduct a comparative analysis of the efficacy of different surgical techniques for the correction of grade II–III anterior vaginal wall prolapse in sexually active patients of reproductive and perimenopausal ages. Patients and methods. The study included 79 patients of reproductive and perimenopausal ages with grade II–III anterior vaginal wall prolapse. All patients were divided into three groups depending on surgical technique: group 1 (n = 25) – surgical correction of prolapse using titanium mesh implants and 4 soft tissue fixators (“anchors”) according to the developed original technique; group 2 (n = 26) – surgical correction of prolapse using standard polypropylene implants; group 3 (n = 28) – correction with native tissues only. Results. At 1 month after surgery, about 50% of patients in each group reported irregular crampy pain in the inguinal and femoral region and/or perineum. Frequent urination was observed in 20% of patients in group 1, in 23% in group 2 and in 21.4% in group 3. At 6 and 12 months after surgery, 19.2% of patients in group 2 complained of bloody vaginal discharge, vaginal discomfort, painful intercourse, and partner’s negative reaction due to painful intercourse. Gynecological examination revealed erosion in the anterior vaginal wall and endoprosthesis extrusion, which required partial excision of the implant followed by restoration of the integrity of the anterior vaginal wall. Recurrence of grade II–III genital prolapse was diagnosed in 24–36 months in 25% of patients in group 3, in 7.7% in group 2, and in 1 (4%) in group 1, which did not require repeat surgical intervention. Conclusion. The use of individually sized titanium mesh implants together with titanium fixators (“anchors”) for the correction of grade II–III anterior vaginal wall prolapse is preferable to other surgical techniques. Key words: grade II–III anterior vaginal wall prolapse, surgical correction, titanium and polypropylene mesh implants, reproductive and perimenopausal period, mesh-related complications, disease recurrence

Smoking may affect adversely the response rate to interferon-alpha. Our objective was to verify this issue among chronic hepatitis C patients. Over the year 1998, 138 chronic hepatitis C male Egyptian patients presenting to Cairo Liver Center, were divided on the basis of smoking habit into: group I which comprised 38 smoker patients (>30 cigarettes/d) and group II which included 84 non-smoker patients. Irregular and mild smokers (16 patients) were excluded. Non eligible patients for interferon-alpha therapy were excluded from the study and comprised 3/38 (normal ALT) in group I and 22/84 in group II (normal ALT, advanced cirrhosis and thrombocytopenia). Group I was randomly allocated into 2 sub-groups: group Ia comprised 18 patients who were subjected to therapeutic phlebotomy while sub-group Ib consisted of 17 patients who had no phlebotomy. In sub-group Ia, 3 patients with normal ALT after repeated phlebotomies were excluded from the study. Interferon-alpha 2b 3 MU/TIW was given for 6 mo to 15 patients in group Ia, 17 patients in group Ib and 62 patients in group II. Biochemical, virological end-of- treatment and sustained responses were evaluated. At the end of interferon-alpha treatment, ALT was normalized in 3/15 patients (20%) in group Ia and 2/17 patients (11.8%) in group Ib compared to 17/62 patients (27.4%) in group II (P = 0.1). Whereas 2/15 patients (13.3%) in group Ia. and 2/17 patients (11.8%) in group Ib lost viraemia compared to 13/62 patients (26%) in group II (P = 0.3). Six months later, ALT was persistently normal in 2/15 patients (13.3%) in group 1a and 1/17 patients (5.9%) in group Ib compared to 9/62 patients (14.5%) in group II (P = 0.47). Viraemia was eliminated in 1/15 patients (6.7%) in group Ia and 1/17 patients (5.9%) in group Ib compared to 7/62 patients (11.3%) in group II, but the results did not mount to statistical significance (P = 0.4). Smokers suffering from chronic hepatitis C tend to have a lower response rate to interferon-alpha compared to non-smokers. Therapeutic phlebotomy improves the response rate to interferon-alpha therapy among this group.

Introduction. Pelvic organ prolapse is increasingly spreading around the world. Therefore, surgical interventions in this pathology are becoming more frequent. Non-mesh surgery for pelvic organ prolapse is reported to have a higher incidence of disease recurrence, and polypropylene mesh implants appear to cause implant-associated complications, thereby limiting their application in clinical practice. Materials and methods. When a patient with an apical prolapse and high risk of postoperative complications sought medical care in the Clinic, the specialists decided to perform promontofixation using a titanium mesh implant. Results and discussion. The present paper describes a clinical case of surgical treatment of genital prolapse using a titanium mesh implant. Since the patient who was admitted for surgical treatment had a family history of genital prolapse, an application of non-mesh technologies implied a high probability of genital prolapse recurrence, as well as a high risk of the vaginal erosion after surgery. Therefore, a promontofixation was performed using a titanium mesh implant, and the 6-month follow-up period showed no postoperative complications. Conclusion. Analysis of postoperative complications demonstrated a considerable potential of using titanium mesh implants for the prevention of implant-associated complications.

Objective. To study the efficacy and safety of the original surgical technique for the correction of grade 2 anterior vaginal wall prolapse using a combination of titanium mesh implants and non-absorbable anchor ligatures in reproductive-aged patients. Patients and methods. The results of examination and treatment of 12 reproductive-aged patients (35–43 years old) with grade 2 anterior vaginal wall prolapse, operated according to the original technique using a combination of titanium mesh implants and non-absorbable anchor ligatures, were analyzed. Results. Patients were followed up at 1, 3, 6, 12 months after surgery. Comparison of patient questionnaires in the pre- and postoperative periods showed improvement of quality of life and satisfaction with the results of surgical intervention. During the first month, 4 out of 12 patients reported mild cramping pain in the lower abdomen, 3 patients – frequent urination. Comprehensive clinical examination after 3, 6, 12 months revealed complete preservation of the results of surgical correction of anterior prolapse in all patients. Gynecological examination, transperineal and transvaginal ultrasound showed no displacement of pelvic organs and titanium implants. There were no Mesh-associated complications during the follow-up period. Conclusion. The efficacy and safety of the developed surgical technique for the correction of grade 2 anterior vaginal wall prolapse using a combination of titanium mesh implants and non-absorbable anchor ligatures in reproductive-aged patients were demonstrated. However, a small patient cohort indicates the need to continue research in this direction. Key words: grade 2 anterior vaginal wall prolapse, reproductive age, titanium mesh implants, non-absorbable anchor ligatures, trans-obturator Timesh-ligature correction

One hundred and seventeen consecutive patients (mean age 55 years) with Q wave acute inferior myocardial infarction (MI) were studied. Of these, 62 developed atrioventricular (AV) conduction disorders (group I) and 55 did not (group II). The AV block occurred early (within 24 h) in 38 (Ia) and later in 24 patients (Ib). We report the in-hospital morbidity and mortality of these acute MI patients. There were no significant differences between group Ia and Ib patients with respect to coronary artery disease risk factors. Right ventricular MI was diagnosed in 14 (36%) and 7 (29%) group Ia and Ib patients, respectively (p = NS), and in 5 (9%) of group II patients. Mean peak serum creatine kinase was highest in group Ia patients (2,403 IU/1) compared to 1,860 IU/1 in group Ib and 1,369 IU/1 in group II. There was cardiogenic shock in 11 patients with 10 deaths in group Ia, while in group II, 2 patients had cardiogenic shock and 3 died (p < 0.01). Only mortality was significantly higher in group Ia compared to group Ib (p < 0.05). Cardiogenic shock was twice the rate in group Ib (n = 4) compared to group II (n = 2; p < 0.05), but there was no difference in mortality. A complete AV block was present in 32 patients (84 %), with 25 (66 %) requiring a pacemaker in group Ia, compared to 9 (37%), with 8 (33%) requiring a pacemaker, in group Ib (p < 0.01). We conclude that prognosis is poor with the appearance of an AV block ≤ 24 h after Q wave acute inferior MI, although mortality in patients with late AV block ( > 24 h) remains similar to those without this complication. Cardiogenic shock may be higher in patients with AV block ≤ 24 h.

Virologic breakthrough (VBTH) during long-term lamivudine therapy is believed to be due to the emergence of rtYM204I/VDD mutants. We observed VBTH in 17 of 67 patients receiving long-term lamivudine therapy. The YMDD mutant at the onset of VBTH and/or subsequently was seen in eight (47%) of 17 such patients. We investigated other potential loci in the viral genome contributing to VBTH. Chronic hepatitis B (CHB) patients (n=17) on long-term (>or=12 months) lamivudine therapy who had at least one episode of VBTH were selected (group I). Age, sex, serology and baseline viral load matched patients on long-term lamivudine without VBTH (n=12) served as controls (group II). Hepatitis B virus (HBV) DNA sequences were analyzed for pre-S, surface, polymerase, core promoter, precore and core regions and were compared with sequences of respective genotypes. Group I patients with VBTH (n=17) either had rtYM204I/VDD mutations (n=8, group Ia YMDD) or no rtYM204I/VDD mutations (n=9, group Ib non-YMDD). Group Ia patients had median baseline HBV DNA of 2794 pg/mL (range 3-9166 pg/mL) and a mean alanine aminotransferase (ALT) level of 86+/-33 IU/L. In group Ib, the median baseline viral DNA was 916 pg/mL (range 8.3-5787 pg/mL) and the mean ALT was 61+/-38 IU/L. The first VBTH in group Ia and Ib patients was noted at 21+/-9 months and 15.2+/-5.9 months, respectively, with a rise in HBV DNA levels from undetectable limits to 952 pg/mL (range 4.3-4875 pg/mL) and 571 pg/mL (range 1.2-1970 pg/mL), respectively. Core promoter mutations were seen in five of eight (62.5%) and in six of nine (66.6%); classic double mutations (A1762T/G1764A) of core promoter region were detected in two and three patients and novel double mutations of core promoter (G1764T/C1766G) in one patient each of group Ia and Ib patients, respectively. Compared to 11 (68%) of 17 group I patients, only three (25%) of 12 patients in group II had core promoter mutations (P<0.05). No patient in group II had double mutations of the core promoter region. No significant difference in viral mutations was seen in any other region of the viral genome between group I and group II patients. In group I, none of the 15 patients (two died of hepatocellular carcinoma), but five (42%) group II patients achieved hepatitis B e antigen (HBeAg) seroconversion and sustained response by month 24 (P<0.05). Both core promoter and YMDD motif mutation(s) are associated with VBTH in patients on long-term lamivudine therapy. Whether or not these promoter mutations in the absence of YMDD mutations confer drug resistance needs to be studied in an in vitro cell culture system, as they could create novel and stronger binding sites for hepatocyte nuclear factors.

A retropective study was conducted to evaluate crystalluria in renal colic patients. There are 135 patients in the study group (renal colic) and 199 in the control group (without renal colic). Various kinds of urinary crystals were found in routine urinalysis, including calcium oxalate, amorphous phosphate, amorphous urate, triple phosphate and uric acid. In the patients with renal colic (Group 1), 31(23%) patients had crystalluria (Group IA), and the others had free crystal in urine (Group IB). In control patients (Group II), 18 (9%) patients had crystals in urine (Group IIA), and the others had free crystal in urine (Group IIB). After the follow-up period (20-37 months), all patients received secondary urinalysis in an asymptomatic condition. Twenty-three (19%) patients in Group I, and 20 (11%) patients in Group II had crystalluria. Individually, there were 13 (42%), 10 (9%), 9 (50%) and 11 (6%) patients in Group IA, Group IB, Group IIA and Group IIB had crystalluria. With mean follow-up of 23.6 months, 28 (21%) patients in Group I had recurrent renal colic, including 12 patients in Group IA and 16 patients in Group IB. Of these 12 patients in Group IA, 7 (58%) patients had crystalluria in both examinations. Of these 16 patients in Group IB, 4 (40%) patients had crystalluria in the secondary examination. In contrast, there was no patient in Group II developing renal colic during the follow-up period. From the results of our study, crystalluria were found more frequently in the patients with renal colic than in those without, even in the period of free of symptoms. Repeated crystalluria in patients with a history of renal colic may disclose a higher recurrent rate of renal colic attack. However, further investigation will be required to clarify the precise mechanism of the calcium crystalluria and urolithiasis or renal colic.

Impaired selective cytokine production by CD4+ T cells in Common Variable Immunodeficiency associated with the absence of memory B cells

Objective. To improve the efficacy and long-term outcomes of surgical treatment of grade II–III cervical elongation. Patients and methods. The study included 22 patients aged 30–74 years with grade II–III cervical elongation. All patients underwent surgical treatment based on the developed original technique with titanium implants (braid). Results. The results of the surgical intervention were evaluated on an outpatient basis at 1, 6, 12, and 24 months after surgery. A comparison of questionnaires before surgery and in the early and late postoperative periods showed improvement in the quality of life of patients, social and sexual activity. During the first postoperative month, 12 (54.5%) patients reported non-acute cramping pain in the perineum and/or inguinal/femoral region, 6 (27.3%) patients complained of frequent urination. A comprehensive clinical examination in the dynamics revealed the preservation of surgical correction, absence of pelvic organ prolapse in all patients in the early and last postoperative periods. Mesh-associated complications were not revealed during the follow-up period. Conclusion. The study demonstrated the efficacy and safety of the developed original technique of hysterosuspension using tape-like titanium (braid) mesh implants in patients with grade II–III cervical elongation of different age groups, as evidenced by a normal position of the uterus, absence of pelvic organ prolapse, and Mesh-associated complications during the follow‑up period. Key words: grade II–III cervical elongation, surgical correction, tape-like titanium mesh implants, hysterosuspension

Ovarian cancer ranks first among gynaecological cancers in terms of mortality, mainly due to late detection and high recurrence rates. The standard treatment for late stages remains cytoreductive surgery combined with systemic chemotherapy. However, survival and quality of life for patients receiving traditional treatment remain unsatisfactory. The aim of the study was to analyse the quality of life of patients with primary advanced ovarian cancer depending on the type of personalised management before the start of specialised treatment, after cytoreductive surgery in the early and late postoperative periods, during chemotherapy and after the end of specialised treatment. Materials and methods. A comparative analysis of the results of clinical examination and treatment of 74 patients with primary serous adenocarcinoma of the ovary, stages III–IV (FIGO 2015), was performed: Group IA – patients with primary ovarian cancer who underwent primary cytoreductive surgery (PDS) + adjuvant chemotherapy (ACT) – 43 patients; Group IB – patients with primary ovarian cancer who underwent neoadjuvant chemotherapy (NACT) + interval cytoreductive surgery (IDS) + adjuvant chemotherapy – 16 patients; IC group – patients with primary ovarian cancer who underwent primary cytoreductive surgery (PDS) + hyperthermic intraperitoneal chemotherapy (HIPEC) + adjuvant chemotherapy (ACT) – 15 patients. The quality of life of patients with advanced ovarian cancer was also assessed using special questionnaires EORTC QLQ-C30 and QLQ-OV28. Results and discussion. In the early postoperative period, when comparing patients in groups IA (PDS + ACT) and IC (PDS + HIPEC + ACT) using the Mann-Whitney test, a significant difference was obtained on the pain scales (Ukr. = 229, Uemp. = 208 Ukr.&gt; Uemp. at a significance level of p = 0.05), nausea and vomiting (Ukr. = 229, Uemp. = 137 Ukr. &gt; Uemp. at a significance level of p = 0.05), stool retention (Ukr. = 229, Uemp. = 189 Ukr. &gt; Uemp. at a significance level of p = 0.05) and gastrointestinal symptoms (Ukr. = 229, Uemp. = 191 Ukr. &amp;gt; Uemp. at a significance level of p = 0.05). A significant deterioration in the quality of life of patients who underwent hyperthermic intraperitoneal chemoperfusion due to an increase in pain, nausea and vomiting scores, stool retention and gastrointestinal symptoms among patients with primary ovarian cancer was observed only in the early postoperative period. In the subsequent stages of special treatment and after its completion, no significant deterioration in the quality of life among patients who underwent hyperthermic intraperitoneal chemoperfusion was observed compared with other groups. Conclusions. According to the authors, patients with primary ovarian cancer in the early postoperative period showed a marked decrease in physical functioning, pain intensity, general well-being and role functioning scales due to their physical condition. Subsequently, there was a tendency towards a gradual increase in physical health indicators in all groups of patients with primary ovarian cancer in the late postoperative period and after adjuvant chemotherapy. At the same time, there was a moderate decrease in the scores of the scales of life activity, role functioning due to emotional state, social functioning and mental health during special treatment and partial recovery of these scores after the end of special treatment. Hyperthermic intraperitoneal chemoperfusion was accompanied by a decrease in physical health scales in patients, most significantly in the early postoperative period. When assessing the quality of life of patients with primary ovarian cancer using the EORTC QLQ-C30 and QLQ-OV28 questionnaires, the results indicate no statistically significant negative effect of hyperthermic intraperitoneal chemoperfusion at all stages of treatment.

Objective. To study the effectiveness and safety of new surgical method for correcting the anterior vaginal wall prolapse using tissue-engineered constructs. Patients and methods. After preliminary experimental work on the creation and evaluation of the biocompatibility of tissueengineered constructs based on non-biodegradable (polypropylene and titanium endoprostheses) mesh implants with an autologous cellular component (rat and human dermal fibroblasts), 4 patients aged 44, 54, 70 and 75 years were examined. Inclusion criteria: anterior vaginal wall prolapse (stage II – III); consent to the installation of tissue-engineered construct. A fourstage surgical program providing for the correction of stage II-III anterior vaginal wall prolapse using tissue-engineered constructs of individual size was used. Results. In the early postoperative period, one patient was diagnosed with a small hematoma of the anterior vaginal wall. During the first month after surgery, one patient complained of gradual perineal pain, another patient – of frequent urination. Subsequently, these symptoms stopped. After 3, 6, 9, 12, 15 months after surgery, during the pelvic examination at rest, the Valsalva maneuver and transperineal ultrasound, no displacement of organs was detected, ultrasound clearly visualized a tissueengineered construct without displacement and deformation. Conclusion. We have developed an original method for correcting the prolapse of the anterior vaginal wall using tissueengineered constructs based on polypropylene and titanium with an autologous cellular component, which helps to optimize the results of surgical treatment, reduce the frequency of disease recurrence and the risk of developing mesh-related complications. Key words: pelvic organ prolapse, tissue-engineered constructs, surgical correction

The implantation of a non-absorbable polypropylene mesh during hernia repair causes chronic foreign body reaction involving the surrounding tissue. In case of inguinal hernia repair using mesh techniques, the spermatic cord is potentially affected by this chronic inflammatory tissue remodeling. This effect has been investigated using standardized animal models (pig and rabbit). Fifteen adult male pigs underwent transinguinal preperitoneal implantation of a polypropylene mesh. The contralateral side with a Shouldice repair served as control. After 7, 14, 21, 28, and 35 days, three animals were sacrificed. The spermatic cords were resected and analyzed histologically. In a second experiment Lichtenstein repair using the same polypropylene mesh and Shouldice repair on the contralateral side was done in eight chinchilla rabbits. Three animals served as controls. Three months after operation, the analysis included testicular size, testicular temperature, and testicular and spermatic cord perfusion. We added histological evaluation of the foreign body reaction and the spermatogenesis using the Johnsen score. In the pig, we observed a certain foreign body reaction with diffuse infiltrating inflammatory cells after mesh implantation. Venous thrombosis of the spermatic veins occurred in five of 15 cases. One animal presented focal fibrinoid necrosis of the deferent duct wall. The side of Shouldice repair showed only minor postoperative changes. In the rabbit, we also observed a typical foreign body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. The mesh repair led to a decrease of arterial perfusion, testicular temperature, and the rate of seminiferus tubules with regular spermatogenesis classified as Johnsen 10 (Lichtenstein: 48.1%, Shouldice: 63.8%, controls: 65.8%). Testicular volume increased about 10% after each operation. The implantation of a polypropylene mesh in the inguinal region induces major response of the structures of the spermatic cord. This may have an influence also on spermatogenesis. Due to this a strict indication for implantation of a prosthetic mesh during inguinal hernia repair is recommended.

Relation of Preprocedural Statin Therapy to In-Hospital Procedural Complications Following Percutaneous Coronary Interventions in Patients With Hyperlipidemia

The aim of the present study was to assess the safety and efficacy of anterior vaginal wall repair using polypropylene mesh for the correction of anterior vaginal wall prolapse. From May 2001 to March 2005, 38 patients with cystoceles or uterine prolapse underwent transvaginal repair with implantation of polypropylene mesh. In all 38 patients anterior vaginal wall repair was done concurrently with other procedures: vaginal hysterectomy, n = 18 (47.4%) and tension-free vaginal tapes n = 22 (57.9%). Preoperatively 26 patients (68.4%) had stage III/IV prolapse on pelvic organ prolapse quantification examination. After mean follow up of 23.4 months, the objective cure rate at 12 and 18 months was 94.5% and 94.3%, respectively. As for complications associated with placement of the polypropylene mesh, no tissue erosion or infection was found. Transvaginal implantation of polypropylene mesh is an effective and safe technique for the correction of anterior vaginal wall prolapse.

We studied the effect of the HLDF differentiation factor on production of cytokines by biopsy samples of nonmalignant breast diseases (ND) and invasive breast carcinoma of no special type (IBC-NST), in the absence and presence of lymphogenic metastasis: IBC-NST patients werw subdivided into groups on the prognostic protocol of the 8th edition of the AJCC committee. Group IA consisted of patients with T1-T2 tumor sizes, and predominantly with positive expression of estrogen and progesterone receptors (ER+/PR+/HER2-); it also included one patient with the HER2+ (ER-/PR-/HER2+) molecular subtype. The IB group was mainly composed of patients with T2 tumor size, with the presence of lymphogenic metastasis (in 8 out of 10) patients and with positive expression of estrogen and progesterone receptors (ER+/PR+/HER2-) and it also included three patients with the HER2+ (ER-/PR-/HER2+) molecular subtype. Group IIA consisted of patients with T1-T2 tumor sizes, mainly with no metastases in the lymph nodes (in 11 out of 12 patients) and with a triple negative molecular subtype. Group IIB included patients with T2 tumor size, the presence of nodal metastasis and the expression of markers of ER-/PR-/HER2 - and ER-/PR-/HER2+. Group IIIA consisted of patients with tumor size T1-T3, with the presence of nodal metastasis and the expression of markers of ER-/PR+/HER2+ and ER-/PR-/HER2+. Group IIIC consisted of patients with T3 tumor size, lymphogenic metastasis, and expression of ER-/PR-/HER2-markers (triple negative molecular subtype). Due to a limited number of patients in the groups IIB, IIIA and IIIC, as well as due to more severe clinical and pathological stages, according to the prognostic Protocol of the 8th edition of the AJCC Committee, they were pooled into group III. Concentrations of IL-2, IL-4, IL-6, IL-8, IL-10, IL-17, IL-18, IL-1β, IL-1Ra, TNF-α, IFN-γ, G-CSF, GM-CSF, VEGF and MCP-1 were assayed in supernatants of biopsy specimens of breast tissue. Results have shown that with IBC-NST, a statistically significantly higher level of spontaneous production (SP) by biopsy specimens of IL-17, IL-18, IFN-γ and VEGF, and a lower level of SP IL-6 as compared with ND. Patients of all clinical and pathological groups showed a high VEGF spontaneous production as compared with ND, while statistically significant differences from patients with ND were not found in IL-17 spontaneous production in group IB patients, and IL-18 spontaneous production were absent in group IA. Only in patients with IA and IB, the IL-6 spontaneous production was lower as compared to ND, and the IL-8 spontaneous production was lower in the IA group. IFN-γ spontaneous production was higher in patients with IBC-NST group IIA as compared with ND. Under the influence of the HLDF differentiation factor, it was found that the parameters of IBC-NST patients were statistically significantly higher in the production of IL-1Ra, IL-17, IL-18 and VEGF, and statistically significantly lower in the production of IL-6 as compared to ND. HLDF had a higher impact on the content of IL-18 in IBC-NST patients than in ND. After HDLF sublimation IL-6 values were lower in patients of groups IA and IB, and HLDF-induced IL-17 production was higher only in patients of group IA. Statistically significant differences in the index of influence of HLDF (IVHLDF), representing ratio of the cytokine concentration in the supernatants of a biopsy specimen stimulated by HLDF to spontaneous cytokine production, were found between ND and IBC-NST in the case of on IFN-γ production, and also in the case of IL-4 production (between patients in the absence and presence of lymphogenic metastasis). IVHLDF for production of IL-6, IL-8 and TNF-α was lower in group IIA patients compared to group IA, and IVHLDF for production of GM-CSF and MCP-1 was lower in group IIA as compared to group III, in addition IVHLDF for MCP-1 products was lower in group IIA as compared to ND. The HLDF effect on the cytokine production by the tumor and its microenvironment was different in ND patients and IBC-NST patients. HDLF suppressed IFN-γ production in the pooled group of IBC-NST patients; HLDF mainly had a suppressive effect on the production of IL-6, IL-8, TNF-α, GM-CSF and MCP-1 in IBC-NST patients of group IIA.