Application of 3D visualization technique in breast cancer surgery with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the value of 3D visualization technique in breast-preserving surgery for breast cancer with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap.</p><p><b>METHODS</b>From January, 2015 to May, 2016, 30 patients with breast cancer underwent breast-preserving surgery with immediate breast reconstruction using pedicled latissimus dorsi muscle flap. The CT data of the arterial phase and venous phase were collected preoperatively and imported into the self-developed medical image 3D visualization system for image segmentation and 3D reconstruction. The 3D models were imported into the simulation surgery platform for virtual surgery to prepare for subsequent surgeries. The cosmetic outcomes of the patients were evaluated 6 months after the surgery. Another 18 patients with breast cancer who underwent laparoscopic latissimus dorsi muscle breast reconstruction without using 3D visualization technique from January to December, 2014 served as the control group. The data of the operative time, intraoperative blood loss and postoperative appearance of the breasts were analyzed.</p><p><b>RESULTS</b>The reconstructed 3D model clearly displayed the anatomical structures of the breast, armpit, latissimus dorsi muscle and vessels and their anatomical relationship in all the 30 cases. Immediate breast reconstruction was performed successfully in all the cases with median operation time of 226 min (range, 210 to 420 min), a median blood loss of 95 mL (range, 73 to 132 mL). Evaluation of the appearance of the breast showed excellent results in 22 cases, good appearance in 6 cases and acceptable appearance in 2 cases. In the control group, the median operation time was 283 min (range, 256 to 313 min) and the median blood loss was 107 mL (range, 79 to 147 mL) with excellent appearance of the breasts in 10 cases, good appearance in 4 cases and acceptable appearance in 4 cases.</p><p><b>CONCLUSION</b>3D reconstruction technique can clearly display the morphology of the latissimus dorsi and the thoracic dorsal artery, allows calculation of the volume of the breast and the latissimus dorsi, and helps in defining the scope of resection of the latissimus dorsi to avoid injuries of the pedicled vessels. This technique also helps to shorten the operation time, reduce intraoperative bleeding, and improve the appearance of the reconstructed breast using pedicled latissimus dorsi muscle flap.</p>

Application of digital 3D technique combined with nanocarbon-aided navigation in endoscopic sentinel lymph node biopsy for breast cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the clinical value of digital 3D technique combined with nanocarbon-aided navigation in endoscopic sentinel lymph node biopsy for breast cancer.</p><p><b>METHODS</b>Thirty-nine female patients with stage I/II breast cancer admitted in our hospital between September 2014 and September 2015 were recruited. CT lymphography data of the patients were segmented to reconstruct digital 3D models, which were imported into FreeForm Modeling Surgical System Platform for visual simulation surgery before operation. Endoscopic sentinel lymph node biopsy and endoscopic axillary lymph node dissection were then carried out, and the accuracy and clinical value of digital 3D technique in endoscopic sentinel lymph node biopsy were analyzed.</p><p><b>RESULTS</b>s The 3D models faithfully represented the surgical anatomy of the patients and clearly displayed the 3D relationship among the sentinel lymph nodes, axillary lymph nodes, axillary vein, pectoralis major, pectoralis minor muscle and latissimus dorsi. In the biopsy, the detection rate of sentinel lymph nodes was 100% in the patients with a coincidence rate of 87.18% (34/39), a sensitivity of 91.67% (11/12), and a false negative rate of 8.33% (1/12). Complications such as limb pain, swelling, wound infection, and subcutaneouseroma were not found in these patients 6 months after the operation.</p><p><b>CONCLUSION</b>Endoscopic sentinel lymph node biopsy assisted by digital 3D technique and nanocarbon-aided navigation allows a high detection rate of sentinel lymph nodes with a high sensitivity and a low false negative rate and can serve as a new method for sentinel lymph node biopsy for breast cancer.</p>

Studies on sexual dysfunction in male patients with chronic renal insufficiency / 中华男科学杂志

<p><b>OBJECTIVES</b>To investigate the prevalence, main manifestation and related factors of sexual dysfunction in male patients with chronic renal insufficiency (CRI).</p><p><b>METHODS</b>A cross-section study was conducted by six hospitals in Sichuan Province. The prevalence and severity of sexual dysfunction were assessed by SCASF microsoft among patients with chronic renal disease. Logistic regression was used to examine and test the association between sexual dysfunction and other medical conditions.</p><p><b>RESULTS</b>The prevalence of sexual dysfunction was wider in patients with CRI than in those without. The main manifestations in male patients were decreased libido, erectile dysfunction and premature ejaculation. Stratified analysis in uremia showed that the prevalence and severity of sexual dysfunction were similar between patients on haemodialysis(HD) and those on peritoneal dialysis(PD). The patients receiving no replacement treatment suffered more decreased libido and performance anxiety than dialyzed patients (HD and PD) and transplantation patients(Tx). The patients receiving no replacement treatment and dialysis suffered more erectile dysfunction than Tx men. A multivariable analysis demonstrated that the duration, creatinine clearance(Ccr), parathyroid hormone (PTH), albumin(Alb) were not associated with sexual dysfunction. The use of beta-blocker, anemia and depression were risky factors for decreased libido, and increasing age was a risky factor for erectile dysfunction. The use of angiotensin-converting-enzyme inhibitor(ACEI)/angiotention receptor antagonist (ARB) and recombinant human erythropoietin(r-HuEpo) were protective factors for erectile dysfunction.</p><p><b>CONCLUSIONS</b>The main manifestations of sexual dysfunction in male patients with CRI are decreased libido, erectile dysfunction and premature ejaculation. The replacement therapy, especially transplantation, can decrease the prevalence or severity of sexual dysfunction. The genesis of sexual dysfunction is multifactorial, including age, physiological factors, psychological factors and medical conditions.</p>