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Objective:To study the risk factors of axillary lymph node metastasis by analyzing the acoustic image characteristics of the automated breast volume scanner (ABVS) of breast cancer masses.Methods:The imaging features of ABVS of 212 patients with breast cancer, unilaterally and singly, confirmed by pathological examination admitted in Hangzhou First People’s Hospital from Jan. 2016 to Dec. 2018 were retrospectively analyzed. There were 83 cases with axillary lymph node metastasis (metastatic group) and 129 cases without (non-metastatic group) . The correlation of clinical and the imaging features of ABVS with axillary lymph node metastasis was analyzed using univariate analysis and multivariate logistic regression. ROC curve was used to analyze the cut-off value of the maximum diameter of the mass in predicting the breast cancer axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, and negative predictive value of each risk factor were analyzed for predicting breast cancer axillary lymph node metastasis.Results:The retraction phenomenon and micro-calcification of breast cancer in the metastatic group (60.2%, 65.1%) were higher than those in the non-metastatic group (43.4%,37.2%) ( P=0.017 vs P<0.001) . The maximum diameter of the breast cancer in the metastatic group was bigger than in the non-metastatic group ( Z=2.18, P=0.029) . Multivariate logistic regression analysis showed that the micro-calcification of breast cancer ( OR=2.522, P=0.003) was an independent predictor of lymph node metastasis in breast cancer. The area under the curves and the cut-off value of the maximum diameter of the mass in predicting the breast cancer axillary lymph node metastasis were 0.589 and 2.85 cm. The sensitivity was 34.9%, the specificity was 82.9%, the positive predictive value was 56.9%, and the negative predictive value was 66.5%. The sensitivities of micro-calcification and retraction phenomenon to predict the occurrence of axillary lymph node metastasis in breast cancer patients were 65.1% and 60.2%, specificities were 62.8% and 56.6%, positive predictive values were 52.9% and 47.2%, and negative predictive values were 73.6% and 68.9%. Conclusion:The study suggests that the maximum diameter, micro-calcification, and retraction phenomenon of masses are associated with the occurrence of the axillary lymph node metastasis in breast cancer.
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Objective To investigate the risk factors for postoperative cognitive dysfunction (POCD) and nursing intervention in patients undergoing laparoscopic radical hysterectomy. Methods One hundred patients undergoing laparoscopic radical hysterectomy were included, surgical history, general anesthetics way, education, family factors(alone), body mass index, age, duration of anesthesia, dose of sufentanyl, hematocrit, the time for regaining orientation, dysphoria, postoperative pain degree were recorded. The occurrence of POCD was observed at 7 days (early period) and 3 months (later period) after surgery. Logistic regression analysis was used to examine the risk factors for POCD at early period and later period. Results The incidence of POCD at early period was 29.0%(29/100). Logistic regression analysis of surgical history, general anesthetics way, body mass index, age, hematocrit, the time for regaining orientation, postoperative pain degree in patients, general anesthetics way (OR=2.821, 95%CI 1.099-7.240) and postoperative pain degree(OR=2.292, 95%CI 1.129-4.654) were the significant risk factors for POCD at early period. The incidence of POCD at later period was 7.0%(7/100). Logistic regression analysis of education and family factors(alone) in patients, family factors(alone) was the significant risk factor for POCD at later period (OR=5.517, 95%CI 1.010-30.126). Conclusions General anesthetics way and postoperative pain degree are the significant predictors for POCD in patients undergoing laparoscopic radical hysterectomy during hospitalization, and family factors(alone) is the risk factor for POCD at 3 months after surgery, and active nursing intervention could reduce the occurrence of POCD.
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Objective To investigate the influence of two general anesthestic modes on postoperative cognitive dysfunction (POCD) in the patients undergoing laparoscopic radical hysterectomy .Methods One hundred ASA Ⅰ‐Ⅱ patients undergoing lapa‐roscopic radical hysterectomy were randomly allocated to the propofol group (group P) and sevoflurane group (group S) ,50 cases in each group .The anaesthesia time ,total dose of sufentanil ,total dose of vecuronium ,recovery time ,recovery time for regaining ori‐entation and complications during anesthetic recovery period were recorded .The cognitive function was assessed by the mini‐mental state examination (MMSE) on preoperative 1 d (T0 ) ,postoperative 1 d (T1 ) ,postoperative 3 d ,(T2 ) ,postoperative 7 d (T3 ) ,post‐operative 1 month (T4 )、postoperative 3 months (T5 ) and the POCD occurrence situation was evaluated by adopting the Z scoring . Results The total dose of sufentanil and vecuronium in the group S was lower than that in the group P (P<0 .05) ,the recovery time and time for regaining orientation in the group S was longer than that in the group P (P<0 .05);the incidence rates of shive‐ring ,dysphoria and upper respiratory tract obstruction in the group S were higher than those in the group P (P<0 .05) .There were no statistically significant difference in the MMSE scores between the two groups (F=0 .14 ,P=0 .709);the MMSE scores in each group had statistical differences among different time points (F=74 .46 ,P<0 .01) .The interaction effect existed between the gen‐eral anesthetic mode and time with MMSE score (F=7 .99 ,P<0 .01);the MMSE scores at T1 ,T2 in the group S were lower than those in the group P (P<0 .05) .The incidence rate of POCD at T1 ,T2 、T3 ,T4 in the group S was higher than that in the group P (P<0 .05) .Conclusion The incidence rate of POCD in the patients undergoing laparoscopic radical hysterectomy by adopting sevoflurane inhalation general anaesthesia is higher than that by adopting propofol anesthesia ,but which has no difference after postoperative 3 months .
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Objective To evaluate the effects of propofol on TREM-1 expression in THP-1 cells stimulated by lipo-polysaccharide (LPS). Methods Cells were divided into 7 groups: (1) control group; (2) LPS group that was exposed to LPS in final concentration of 100μg/L;(3) Progroup that was incubated with 100μmol/L propofol;(4-7) groups combined 100μg/L LPS with propofol at different dose of 12.5μmol/L (P1 group), 25μmol/L (P2 group), 50μmol/L (P3 group), 100μmol/L (P4 group) respectively. After 16 hours of incubation, the TNF-α concentration in supernatants were measured by ELISA. TREM-1 expression were examined by FACS and TREM-1 mRNA were detected using qRT-PCR. Results TREM-1 on THP-1 increased significantly in group P3 and group P4 compared with LPS group (P<0.05). The concentra-tions of TNF-αin P3 and P4 (P<0.05) decreased substantially in supernatant compared with LPS group. TREM-1 mRNA transcription level in group LPS rise considerably (P < 0.05) compared to that in control group, and it dropped greatly in group P4 (P <0.05) compared with that in group LPS. Conclusion Propofol could enhance TREM-1 expression on sur-face of THP-1 stimulated by LPS. Propofol reduces TNF-αlevel in culture supernatant. And propofol may restrain TREM-1 mRNA expression.