Clinical application of immediate prepectoral implant-based breast reconstruction with TiLoop Bra after skin-sparing or nipple-areola-complex-sparing mastectomy for breast cancer patients / 中国胸心血管外科临床杂志

@#Objective To explore the surgical technique and preliminary safety and aesthetics results of immediate prepectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) after skin-sparing mastectomy (SSM) or nipple-areola-complex-sparing mastectomy (NSM) for breast cancer patients. Methods The clinical data of consecutive patients who underwent immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM in West China Hospital from January to July 2022 were retrospectively analyzed. The operation time, intraoperative blood loss, early complication were collected. The preliminary aesthetics results were assessed with the Ueda score and Harris score. Results All the patients were female with a mean age of 39.0±6.8 years. One patient had bilateral breast malignant tumors, and the others had unilateral malignant tumors. Six patients received neoadjuvant chemotherapy before surgery. The mean diameter of the tumors was 24.4±11.9 mm under the color ultrasound before the neoadjuvant chemotherapy. The mean operation time was 153.9±49.4 min. The mean intraoperative blood loss was 29.2±18.3 mL. There were 3 patients with tumor stage 0, 10 patients with stage Ⅰ, 6 patients with stage Ⅱ, 3 patients with stage Ⅲ and 1 patient was found no residual cancer after neoadjuvant chemotherapy. All the patients were successfully followed up with a median follow-up time of 4.8 (3.0-9.2) months. There were 2 (8.3%) patients with major complications, including 1 wound dehiscence and 1 hematoma, and 4 (16.7%) minor complications, including 2 wound dehiscence and 2 infection. The patients with excellent and good Ueda score and Harris score accounted for 82.6% and 87.0%, respectively. None of the patients had animation deformity, capsular contracture, nipple-areola or skin flaps necrosis, or implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Conclusion For selected reliable patients, immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM for breast cancer patients is safe and has good aesthetics results in the early postoperative period. It has broad application space in patients with suitable indications, and can be promoted as a routine operation.

A multicenter study to develop and validate a novel C-GALAD Ⅱ HCC prediction model based on serological markers / 中华检验医学杂志

Objective:To establish a model C-GALAD for detecting hepatocellular carcinoma (HCC) from the chronic liver disease and healthy people based on the serum markers.Methods:A clinical cohort including 229 hepatocellular carcinoma patients, 2 317 patients with chronic liver disease and 982 healthy people, was retrospectively collected from eight hospitals or physical examination institutions from April 2018 to October 2020. The data were divided into a training set and a testing set by stratified sampling with a 6∶4 ratio. A predictive model was established on the training set using a logistic backward regression method and validated on the testing set. In addition, clinical data from March to July 2021 in Beijing You′ an Hospital affiliated to Capital Medical University, including 84 patients with liver cancer and 204 patients with chronic liver disease collected were used for external independent validation of the model. The receiver operating characteristic curve (ROC) area under curve (AUC), the sensitivity and the specificity were used to evaluate the effectiveness of the model.Results:Through the logistic backward regression method, the seven signatures including age, gender, alpha-fetoprotein (AFP), alpha-fetoprotein alloplasm-3 ratio (AFP-L3%), des-gamma-carboxyprothrombin(DCP), platelet (PLT) and total bilirubin (TBIL) were selected as risk factors in the detection model. The area under the ROC curve (AUC) of the model on the testing set was 0.954, with an 88.04% sensitivity and a 94.85% specificity, and the AUC of model on the external independent validation set was 0.943, with an 89.29% sensitivity and a 90.2% specificity, which were better than other published models.Conclusion:The C-GALAD Ⅱ model can accurately predict the risk of hepatocellular carcinoma occurrence, and thus provide a trustworthy diagnosis method of hepatocellular carcinoma.

Efficacy of plasma exchange in the treatment of autoimmune hemolytic anemia in children / 中国小儿急救医学

Objective:To investigate the efficacy and safety of plasma exchange(PE) in the treatment of autoimmune hemolytic anemia in children.Methods:The data from 8 hospitals in China during November 2014 to April 2017 were collected, and the clinical characteristics of PE in children with AHA were analyzed retrospectively.Results:A total of 21 children with AHA were included in the study, including 17 cases from PICU and 4 cases from pediatric kidney ward, with 11 boys and 10 girls, and the median age was 3.64(0.25, 11.10)years old, and median hospital stay was 12(4, 45)days.There were 15 cases(71.4%) with infection, 2 cases(9.5%)with autoimmune diseases, 4 cases(19.0%) with unknown.Consciousness disturbance occurred in 4 patients before replacement and recovered to normal after PE.The volume of blood decreased in two cases(9.5%) and completely relieved.There were 20 cases of anemia (95.2%), 15 cases were normal after PE, and 5 cases were improved.Jaundice occurred in 18 cases (85.7%), 12 cases were normal after PE, 6 cases were improved.Hepatosplenomegaly was found in 11 cases, 10 cases were normal after PE, 1 case was improved.After PE, the hemoglobin and red blood cell count increased, while the total bilirubin, indirect bilirubin, urea nitrogen and lactate dehydrogenase decreased, there were significant differences between pre-and post-replacement ( P<0.05). Only 1 case had allergic reaction, which was improved after symptomatic treatment, and PE was continued.After PE, 2 cases (9.5%) had complete remission, 16 cases (76.2%) had partial remission and 3 cases (14.3%) had been discharged. Conclusion:PE therapy can obviously improve the clinical symptoms and laboratory indexes of children with AHA who have failed to respond to conservative treatment.It can be used as a treatment measure for children with severe AHA and has a good safety.

Efficacy of plasma exchange in the treatment of autoimmune hemolytic anemia in children / 中国小儿急救医学

Objective:To investigate the efficacy and safety of plasma exchange(PE) in the treatment of autoimmune hemolytic anemia in children.Methods:The data from 8 hospitals in China during November 2014 to April 2017 were collected, and the clinical characteristics of PE in children with AHA were analyzed retrospectively.Results:A total of 21 children with AHA were included in the study, including 17 cases from PICU and 4 cases from pediatric kidney ward, with 11 boys and 10 girls, and the median age was 3.64(0.25, 11.10)years old, and median hospital stay was 12(4, 45)days.There were 15 cases(71.4%) with infection, 2 cases(9.5%)with autoimmune diseases, 4 cases(19.0%) with unknown.Consciousness disturbance occurred in 4 patients before replacement and recovered to normal after PE.The volume of blood decreased in two cases(9.5%) and completely relieved.There were 20 cases of anemia (95.2%), 15 cases were normal after PE, and 5 cases were improved.Jaundice occurred in 18 cases (85.7%), 12 cases were normal after PE, 6 cases were improved.Hepatosplenomegaly was found in 11 cases, 10 cases were normal after PE, 1 case was improved.After PE, the hemoglobin and red blood cell count increased, while the total bilirubin, indirect bilirubin, urea nitrogen and lactate dehydrogenase decreased, there were significant differences between pre-and post-replacement ( P<0.05). Only 1 case had allergic reaction, which was improved after symptomatic treatment, and PE was continued.After PE, 2 cases (9.5%) had complete remission, 16 cases (76.2%) had partial remission and 3 cases (14.3%) had been discharged. Conclusion:PE therapy can obviously improve the clinical symptoms and laboratory indexes of children with AHA who have failed to respond to conservative treatment.It can be used as a treatment measure for children with severe AHA and has a good safety.

High risk factors of the third level of lymphatic metastasis in breast cancer patients received radical/modified mastectomy: an analysis of 746 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the high risk factors of the third level of lymphatic metastasis in breast cancer patients to guide clinical practice.</p><p><b>METHODS</b>The clinical data of 746 breast cancer patients (all female, aged from 33 to 80 years with a median of 46 years) received radical or modified mastectomy between 2001 and 2011 was analyzed retrospectively. Eleven individual variables were selected to investigate high risk factors of the third level of lymphatic metastasis in different conditions.</p><p><b>RESULTS</b>Axillary nodes metastasis status (OR = 4.541, 95%CI:3.569-5.776), tumor site (OR = 1.437, 95%CI:1.029-2.007), external nodes involved (OR = 3.809, 95%CI:1.683-8.618) and estrogen receptor (OR = 0.740, 95%CI:0.569-0.964) were high risk factors of the third level of lymphatic metastasis. Further analysis found that it is prone to happen a metastasis, especially when the tumor with a size over 5 cm and located at the lateral quadrant. Negative estrogen receptor was a risk factor of the third level lymphatic metastasis along with the tumor stage.</p><p><b>CONCLUSION</b>For preoperative tumor biopsy shows Negative estrogen receptor of tumor stage T3 and over stage T3 when considering suspicious lymph node metastasis or external tissues metastasis intraoperatively should take in account into third level axillary lymph node dissection actively.</p>

STAT3, a Poor Survival Predicator, Is Associated with Lymph Node Metastasis from Breast Cancer / 한국유방암학회지

PURPOSE: The aim of this study is to explore signal transducer and activator of transcription 3 (STAT3) expression in breast cancer and to analyze the detailed mechanism that STAT3 contributes to the progression of breast cancer. METHODS: We retrospectively analyzed the clinicopathologic characteristics and overall survival (OS) of 140 breast cancer patients after curative surgery, and detected STAT3 expression, phosphorylated STAT3 (pSTAT3) expression, Ki-67 expression, vascular endothelial growth factor (VEGF)-C and -D expression in breast cancer tissues, and adjacent nontumor tissues. Survival analysis and relationship analysis were adopted for demonstrated the important mechanism of STAT3 contribution to progression of breast cancer. RESULTS: STAT3 expression, pSTAT3 expression, Ki-67 expression, VEGF-C expression, and VEGF-D expression in breast cancer tissues were significantly higher than those in adjacent nontumor tissues, respectively. With survival analysis, only number of lymph node metastasis (N stage) was identified as the independent predictors of the OS of breast cancer patients. Besides, we demonstrated there was the most prominent correlation between STAT3 expression and lymph node metastasis in breast cancer tissues by using the multinominal regression method. CONCLUSION: STAT3, a poor survival biomarker potential association with lymph node metastasis, was suitable for predication the OS of breast cancer patients after curative resection.

The value of digital subaction angiography in iagnosis and treatment of gastrointestional hemorrhage / 中国基层医药

Objective To evaluate the application value of DSA diagnosis and interventional therapy in gas-trointestinal hemorrhage. Methods 36 cases of gastrointestinal hemorrhage used DSA examination, according to the reason and position,26 cases of the patients that were positive of DSA opacification utilized interventional therapy with different embolic agents or vasopressin peffusion. Results 26 cases of patients in 36 had gastrointestinal hemorrhage, 12 cases of patients in 16 that have extravasation of contrast media were hemostasis by treating with embolization ther-apy and vasopressin peffusion, hemorrhage of eholecyst and biliary tract after operation,the patients of small intestinal hemorrhage, gastroduodenal hemorrhage after the operation of pancreatic carcinoma were embolized with gelfoam ,PVAand/or colis were done. The stopped bleeding immediately oceured in 84. 6% (22/26). Conclusion DSA are more valuable methods for the diagnosis of gastrointestinal hemorrhage. Arterial embolization and/or perfusion of vasoconl-rictor substance for treatment of hemorrhage of digestive tract is safe, effec is reliable.

Correlation Between Expression of Vascular Endothelial Growth Factor of Serum and Tumor Tissues and Clinical Prognosis in Patients with Breast Cancer / 中国普外基础与临床杂志

Objective To investigate the correlation between expression of vascular endothelial growth factor(VEGF) of serum and tumor tissues and the clinical prognosis in patients with breast cancer. Methods The expressions of VEGF level of serum and tumor tissues in 44 patients with invasive duct breast cancer, 13 with benign breast diseases and 40 healthy controls. Serum VEGF level was measured by ELISA method. The protein expression of tissue VEGF, ER and C-erbB-2 were evaluated by immunohistochemistry LSAB method. Results Serum VEGF level and tissue VEGF expression in breast cancer were higher than those in benign breast diseases (P0.05). VEGF expression was correlated with lymph node metastasis (P 0.05). Conclusion There is positively correlation between serum VEGF level and tissue VEGF expression, and between VEGF expression and clinic prognosis. Serum VEGF level may be one of important index of prognosis estimation in patients with breast cancer.

Clinical application value of ultrasonography in excising breast mass with Mammotome / 中华超声影像学杂志

Objective To investigate the clinical application value of ultrasonography in excising breast mass with Mammotome vacuum assisted biopsy device and a stereotactic unit(MMT).Methods Guided by ultrasonography,breast masses were biopsy and excised with MMT.The property of masses were identified by pathology.The effects were followed up with ultrasonography.Results Sixty one masses of breast in 34 cases were excised.Pathology showed that 54 were fibroadenoma and 7 were fibroadenosis.The patients had little discomfort in operation and few complications post operation.There were no relapses during short interviews.Conclusions MMT can biopsy and excise the breast mass guided by ultrasonography.The operation has little wound and few complications.It is a useful minimally invasive method which does not influence the appearance of breast.Ultrasonography can insure operation safety and precision.The effects are evaluated immediately.

Biopsy of needle stereotaction under mammography in nonpalpable breast lesion / 临床外科杂志

Objective To discuss the feasibility of diagnosis with needle stereotaction marking by steel wire under mammography and biopsy for nonpalpable early stage breast carcinoma.Methods Eighteen patients with doubtful nidus of breast only in X gram were performed needle stereotaction marking by steel wire under mammography, and removal freemartin biopsies of breast nidus were performed then.Results Localization and biopsy were very successful in all 18 patients. Seven patients were definited to have early stage breast carcinomas and eleven benign diseases.The diagnostic rate for nonpalpable early stage breast carcinoma was 100%.Conclusions Needle stereotaction marking by steel wire undermammography finish off the problem locating accurately breast nidus during operation.It was a credible and perfect technique for diagnoses of nonpalpable early stage breast carcinoma.

Analysis of 310 patients with benign breast tumor treated by mammotome minimally invasive stereotactic excision therapy / 中国普通外科杂志

Objective To evaluate the therapeutic value of minimally invasive excision of benign breast lesions using stereotactic mammotome minimally invasive surgery system.Methods Under ultrasonographic image monitoring,1160 breast masses of 310 patients were excised using mammotome minimally invasive stereotactic excision system and sent for pathologic examinations immediatly.Patients′condition was follow-ed up and recorded post-operative.Their clinical data were retrospectively analysed.Results Accurate and complete resection of all of the 1160 breast masses was achieved.The resected tissues were large enough to make pathologic diagnosis.The pathologic diagnoses were all found to be benign,and included: fibroadenoma(n=672),fibroadenosis(n=451),intraductal papilloma(n=12),cyst(n=6),cystic hyperplasia(n=17) and tubular adenoma(n=17).Regular follow up every 6-12 months was done.Postoperative surgical scars were unremarkable,the skin incisions were small and concealed,breast appearance and skin sensation were normal and ultrasonography did not reveal residual lesions or recurrences.Conclusions Complete resection of benign breast lesions can be done with mammotome technique.This technique is safe,accurate and effective.Moreover,there is little trauma,low complication rate,and the breast appearance is not affected.This minimally invasive excision technique for benign breast lesions is suitable for wide use.

Surgical treatment of breast carcinoma / 中国普通外科杂志

Objective To explore the strategy of surgical therapy for breast carcinoma . Methods The clinical data of 258 patients with breast carcinoma were analysed retrospectively. Results (1)136 patients with stage Ⅰ～Ⅱ breast carcinoma were subjected to modified radical mastectomy, overall survival(OS) was 100%, and relapse free survival(RFS)92.6%.(2)Partial mastectomy and axillary dissection were performed on two patients with stage Ⅱbreast carcinoma,one relapsed in 5 months after operation. (3)In patients with stage Ⅲ breast carcinoma,there was no statistical difference in OS and RFS between 88 patients subjected to modified radical mastectomy and 20 radical mastectomy.(4)The radical operation showed a better efficacy in 5 patients with stage Ⅳ breast carcinoma.(5)Using special breast cutter and electrotome,the rate of surgical blood transfusion was 3.5%,postoperative hematocele 2.7%,flap necrosis 7.4%, effusion under skin 18.6%,and edema of affected limb 4.3%. Conclusions (1)The modified radical mastectomy is the major operation for stage Ⅰ～Ⅲ breast carcinoma patients. (2)Using special breast cutter and electrotome could cut down surgical blood transfusion and operation time.(3)Rational axillary lymph node dissective could reduce postoperative complications.

Surgical therapy for breast intraductal papilloma / 中国普通外科杂志

Objective To study the effective therapy of breast intraductal papilloma . Method One hundred and thirty-two patients with breast intraductal papilloma (four patients with cancerization)were treated by resection of the tissue stained by methylene blue. The effect was evaluated. Results The pathological diagnosis were 91 patients with breast intraductal papilloma and 41 breast intraductal papillomatosis, and 4 of them were cancerization. One hundred and ninteen patients(90.1%) were followed up for 3～46 months, all patients were cured without recurrence after operation. Conclusions Resection of the tissue stained by methylene blue in treating breast intraductal papilloma is a reliable and effective method.

Diagnostic value of needle stereotaction marking by steel wire under mammography for nonpalpable breast carcinoma / 中国普通外科杂志

Objective To explore the diagnostic value of needle stereotaction marking by steel wire(NSMSW) under mammography for nonpalpable early stage breast carcinoma (BC). Methods 29 patients with nonpalpable breast lesions were performed NSMSW under mammography,and the lesions were removed for biopsy to make the diagnosis. Results Nine patients(31.0%) were definited as early stage BC and twenty(69.0%) benign disease.The pathologic results in freezing sections and in parafin sections were the same. Conclusions NSMSW under mammography can resolve the problem of accurate location of nonpalpable breast lesions during operation .It is a credible, useful and practical method for diagnosis of nonpalpable early stage BC.