Application of acellular bovine pericardium patch in implant based immediate breast reconstruction / 中华外科杂志

Objective: To examine the clinical effect of acellular bovine pericardium patch in implant based immediate breast reconstruction. Methods: The clinicopathological information of 141 breast cancer patients, who admitted to Department of Breast Reconstruction and Oncoplastic Surgery, Tianjin Medical University Cancer Hospital, underwent immediate mammoplasty with implants combined with acellular bovine pericardium patches were analyzed from June 2016 to October 2019. All patients were female, with the age of (38.8±8.5) years (range: 13 to 60 years). The body mass index was (21.9±2.5) kg/m2 (range: 16.0 to 32.3 kg/m2). There were 39 cases of duct carcinoma in situ, 46 cases of stage Ⅰ, 40 cases of stage Ⅱ and 16 cases of stage Ⅲ. All patients received nipple-areola-sparing mastectomy or skin-sparing mastectomy with sentinel lymph node biopsy or axillary lymph node dissection, and prosthesis implantation with sub-pectoralis combined with breast patch. The correlation of clinicopathological characters and complications was assessed by t test, χ2 test, Fisher's exact probability method and Logistic regression. Pre-and post-operative aesthetic, quality of life scores were recorded. Results: The operation time (M(IQR)) was 3.6(1.5) hours (range: 3.0 to 6.5 hours). The early postoperative complication rate was 22.0% (31/141), prosthesis removal was the main postoperative complication, accounting for 64.5% (20/31) of the total complications, of which 15 cases occurred in the first 30 patients. The follow-up time was 28(8) months (range: 20 to 53 months), The most frequent long-term complications were capsular contracture and implant displacement, with the incidence of 11.2% (14/125) and 10.4% (13/125), respectively. Multivariate analysis showed that prosthesis volume ≥300 ml (OR=8.173, 95%CI: 1.302 to 51.315, P=0.021) and peri-areolar incision (OR=7.809, 95%CI: 2.162 to 28.211, P<0.01) were independent relative factors for the occurrence of short-term postoperative local complications. After 2 years of operation, the score of breast appearance satisfaction was 71.7±15.5, postoperative effect satisfaction was 90.4±9.5, psychological satisfaction was 90.7±17.1, sexual satisfaction was 70.1±25.1. The immediate postoperative satisfaction rate at discharge was 95.4% (134/141), and 17.6% (22/125) of patients had the intention to received revision surgery. Conclusions: Prosthesis volume ≥300 ml and peri-areolar incision were independent realtive factors for short-term local complications after bovine pericardium patch combined with prosthesis implantation in the immediate breast reconstruction. After completing the learning curve, the postoperative complications of the procedure could be decreased.

A case report of hyponatremia complicated with cerebral infarction characterized by apathetic onset / 天津医药

Hyponatremia(serum sodium<135 mmol/L)is one of the most common electrolyte disorders in the clinic, which is often secondary to a variety of diseases.Its clinical manifestations are lack of specificity,and severe cases can cause brain edema,neurological and psychiatric symptoms.There was also a correlation between hyponatremia and fracture.This paper summarizes a case of hyponatremia complicated with cerebral infarction and fracture.

Expression of indoleamine 2, 3-dioxygenase and its correlation with prognosis in breast cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expression of indoleamine 2, 3-dioxygenase (IDO) in breast cancer and its correlation with clinicopathologic factors and prognosis.</p><p><b>METHODS</b>The expression of IDO, CD31, CD105 proteins in 40 specimens of breast cancer were assessed by immunohistochemistry.</p><p><b>RESULTS</b>The overexpression rate of IDO in breast cancer was 67.5% (27/40), and expression of IDO was closely associated with clinical stage and lymph nodes metastasis. The disease-free survival rate in patients with IDO overexpression was not significantly lower than that in patients with negative or low expression of IDO (P > 0.05). Moreover, the expression of IDO was positively correlated with CD105-labeled microvessel density (r = 0.659, P < 0.05).</p><p><b>CONCLUSIONS</b>Expression of IDO is associated with clinical stage and lymph nodes metastasis, and microvessel densitty. IDO expression may promote the growth and metastasis of breast cancer, probably via the increased agiogenesis. A larger sample study is needed to verify whether the prognosis of beast cancer is significantly correlated with IDO expression.</p>

Axillary skip metastases in breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinicopathologic characteristics and the prognostic factors of breast cancer patients with skip metastases in the axilla.</p><p><b>METHODS</b>The clinical data of 1502 breast cancer patients who underwent complete axillary lymph node dissection were retrospectively reviewed. The patterns of skip metastases, clinical features and prognostic factors were analyzed.</p><p><b>RESULTS</b>Of the 1502 patients, lymph node metastases were found in 814, of whom skip metastases in 119 (14.6%, 119/814). The Clinicopathologic factors such as age, tumor size, tumor location, clinical stage, hormonal receptor status and involved interpectoral lymph nodes were not correlated with skip metastases (P > 0.05). The disease free survival rate was lower in clinical stage I and II patients with skip metastases than that in those without (P = 0.003), while no significant difference was observed in clinical stage III patients (P = 0.457). Multivariate analysis showed that the tumor size, number of metastatic lymph nodes, extracapsular invasion of the lymph nodes and skip metastases in the axilla were significantly correlated with survival rate.</p><p><b>CONCLUSION</b>Skip metastasis in the axilla cannot be accurately predicted by clinicopathologic factors. Early breast cancer patients with skip metastases should be treated properly due to poor prognosis.</p>