Effect of breast invasive ductal carcinoma with extensive intraductal components on local recurrence after breast conserving surgery / 中华普通外科杂志

Objective To analyze the clinicopathological features and prognostic factors of patients with breast invasive ductal carcinoma with extensive intraductal components (EIC).Methods The clinical data of 182 patients of early breast invasive ductal carcinoma undergoing breast-conserving surgery were analyzed retrospectively in the Second Affiliated Hospital of Soochow University,and the clinicopathological features and prognosis of two groups of breast cancer patients with EIC positive (n =23) and EIC negative (n =159) were compared.Results In the EIC positive group,ipsilateral breast tumor recurrence (IBTR) was 21.7％ (5/23) and the distant metastasis rate was 4.3％ (1/23);in the EIC negative group,ipsilateral breast tumor recurrence (IBTR) was 1.9％ (3/159) and the distant metastasis rate was 3.8％ (6/159).The Kaplan-Meier curve showed that the 5-year local recurrence-free survival rates in the EIC positive group was lower than that of the EIC negative group (78％ vs.97.7％) (P ＜ 0.001),and the difference was statistically significant,but the 5-year distant metastasis-free survival rates in the two groups was similar (95.7％ vs.96.2％) (P =0.892).COX multivariate analysis showed that EIC was an independent risk factor for local recurrence after breast-conserving surgery in breast invasive ductal carcinoma patients.Conclusions EIC increases the local recurrence rate in patients with breast invasive ductal carcinoma undergoing breast-conserving surgery.

Thyroid structure and function changes in end stage renal failure patients:an clinical control study / 中华内分泌外科杂志

Objective To investigate the thyroid structure changes using a high-frequency sonography and thyroid dysfunction in end-stage renal failure(ESRF) patients.Methods From Jan.2012 to Apr.2012,50 ESRF patients and 55 consecutive outpatients(nonthyroid diseases visitors)as normal controls were included in the study.The size of thyroid gland was measured with ultrasonography and the volume was calculated.The internal echo changes and status of nodules were observed.Measurement such as thyroid hormones,parathyroid hormones and renal function were performed all patients.Results The serum level of T3,FT3 in ESRF patients were significantly lower than those of the control patients(1.05 ±0.23 mg/ml vs 1.14 ±0.25 pg/ml,P =0.038;3.1 ± 0.41 pg/ml vs 3.31 ±0.57 pg/ml,P =0.029),while the serum level of TSH was significandy higher in ESRF group than in the control group (3.29 ± 1.77 mIU/L vs 2.37 ± 0.67 mIU/L,P =0.001).Ultrasonography showed that 32％ (16/50) of ESRF patients and 3.6％ (2/55) of the controls had thyroid goiter (P ＜ 0.001).Compared to ESRF patients without nodules,the average age was significantly higher in patients with nodules (52.94 ± 14.21 vs 42.32 ± 11.37,P =0.006).Conclusion ESRF patients tend to have a higher incidence of alteration of thyroid function and nodular goiter which can be effectively assessed by ultrasonography.

Clinical anatomy for external branch of the superior laryngeal nerve during thyroid surgery by intraoperative neuromonitoring / 中华普通外科杂志

Objective To evaluate the mechanism of external branch of the superior laryngeal nerve (EBSLN) injury during thyroid surgery as showed by intraoperative neuromonitoring.Methods 70 patients with 109 nerves at risk were enrolled in this study from March 2011 to October 2011.A positive signal is determined by observing contractions of the cricothyroid muscle.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.Results 108 nerves (99.1％) were located successfully,42 of which were visualized (38.9％).55 nerves (50.9％) crossed the superior thyroid artery more than 1 cm apart,while the other 53 nerves (49.1％) went less than 1 cm including 24 nerves(more than 0.5 cm,less than 1 cm) and 29 nerves (less than 0.5 cm) or coursed below the superior pole of the thyroid.The rate of the latter type was significantly elevated in patients with the top to botton diameter of the gland more than 5 cm.One patient suffered from impairing in the production of high tones postoperatively.Conclusions Intraoperative neuromonitoring is useful and helpful in providing instructive information for operations by locating EBSLN.

The neuromonitoring of the external branch of the superior laryngeal nerve in Micooli's endoscopic thyroidectomy / 中华普通外科杂志

ObjectiveTo evaluate the intraoperative neuromonitoring of the external branch of the superior laryngeal nerve (EBSLN) during Micooli's endoscopic thyroidectomy in order to avoid nerve injury.MethodsIn this study,36 patients with 56 nerves at risk were enrolled from February 2011 to September 2011.A positive signal is determined by observing contractions of the cricothyroid muscle to locate the EBSLN.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.The VHI-10 table was used for evaluation pre- and postoperatively. ResultsAll 56 nerves were located successfully,26 nerves(46.4％ ) crossed the superior thyroid artery more than 1 cm apart from the upper pole of the thyroid gland,while the other 30 nerves(53.6％ ) did less than 1 cm.In cases where the diameter was longer than 5 cm,the nerves crossed the artery at less than 1.0 cm from the upper pole in 73％ cases(P =0.006).There was no significant difference between VHI-10 results before and after surgery (P ＞ 0.05). ConclusionsIntraoperative neuromonitoring is useful and helpful in avoiding nerve injury by locating EBSLN.

Mutation-sensitive molecular switch in rapidly detecting the mutation of the DBC2 gene 7776C ＞ T / 中华内分泌外科杂志

ObjectiveTo rapidly detect the mutation frequency of DBC2 gene 7776C ＞ T in breast cancer and breast fibroadenoma by applying the mutation-sensitive molecular switch ( comprised of high-fidelity DNA polymerase and phosphorothioate-modified allele-specific primers) and agarose gel electrophoresis.Methods Allelic specific primers targeting mutation type and wild type were designed with the primers'3'terminal phosphorothioate modification.When the primers matched with the tissue DNA,the primers could be extended with highfidelity polymerase; when they mismatched with the tissue DNA,the primers could not be extended.DNA samples from 85 cases of breast cancer and 10 cases of breast fibroadenoma tissues were chosen and analyzed by PCR amplifications mediated by high-fidelity DNA polymerase.Gel imaging system was employed to make analysis of PCT products.ResultsThe mutation-sensitive molecular switch system showed that the mutation rate of 7776C ＞ T was 2.4％ ( 2/85 ) in the 85 cases of breast cancer,and no mutation was found in the 10 cases of breast fibroadenoma.ConclusionsThe mutation-sensitive molecular switch combined with agarose gel electrophoresis can rapidly detect the mutation of breast cancer DBC2 gene 7776C ＞ T.It is applicable in single nucleotide polymorphisms assay and has enormous application value in detecting gene mutation.