A single-center retrospective study on axillary evaluation in 1 557 breast ductal carcinoma in situ patients between 2006 and 2016 / 中华外科杂志

Objectives@#To examine the influence factors on axillary evaluation in ductal carcinoma in situ (DCIS) patients, and the prognosis of different choices of axillary evaluation in a single-center retrospective study.@*Methods@#Totally 1 557 DCIS patients admitted in Department of Breast Surgery, Fudan University Shanghai Cancer Center from January 2006 to November 2016 were retrospectively enrolled. All patients were female. The median age was 49 years (range: 21 to 85 years). Surgical methods included modified radical mastectomy, simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation). Axillary evaluation included axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). T tests, χ2 test and Logistic regression analysis was used to analyze influence factors on axillary evaluation, respectively. Kaplan-Meier curve and Log-rank analysis were used to evaluate recurrence-free survival (RFS) and loco-regional recurrence-free survival (LRRFS) in patients with different surgical methods.@*Results@#Among the 1 557 DCIS patients, there were 1 226 cases received axillary evaluation, while 331 cases not received axillary evaluation. Patients were separated into 3 groups by different axillary evaluation choices: SLNB group (957 cases, 61.46%), ALND group (197 cases, 12.65%) and no evaluation group (403 cases, 25.88%). The patients in SLNB group increased significantly (P=0.000), from 3.85% (60/1 557) in 2006 to 75.19% (1 170/1 557) in 2016. The independent influence factors of receiving axillary evaluation were high nuclear grade (OR=3.191, 95%CI: 1.722 to 5.912, P=0.001) and tumor size>15 mm (OR=1.698, 95%CI: 1.120 to 2.573, P=0.012). Also, patients received breast conservation surgery were more likely to refuse axillary evaluation (OR=0.155, 95%CI: 0.103 to 0.233, P=0.000). There were no significant differences in RFS and LRRFS in patients with different axillary evaluation choices.@*Conclusions@#The investigation in trends and influence factors of different axillary evaluation choices provided basis on surgical precision medicine in DCIS patients. Patients received SLNB increased significantly. The independent influence factors of axillary evaluation were nuclear grade, tumor size and surgical methods. There was no significant differences in prognosis among the groups receiving different axillary evaluations.

A single-center retrospective study on influence factors on surgical methods in DCIS patients / 中华内分泌外科杂志

Objective To evaluate the influence factors on surgical methods in DCIS (Ductal carcinoma in situ) patients,and the prognosis of different surgical methods in a 10-year single-center retrospective study.Methods We retrospectively included 1557 DCIS patients who received treatments in our center from Jan.2006 to Nov.2016.T tests,Chi-square analysis and logistic regression analysis were used to analyze influence factors on surgical methods.Kaplan-Meier and Log-rank analysis were used to evaluate recurrence-free survival(RFS) and loco-regional recurrence-free survival (LRRFS) in patients with different surgical methods.Results Of the enrolled 1557 DCIS patients,surgical methods included modified radical mastectomy,simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation).The number of DCIS cases in our center increased (P＜0.001),so did the percentage of DCIS in annual malignant surgery cases (P=-0.026).Significant decrease was found in modified radical mastectomy (P=0.012).More than half of the patients received simple mastectomy after 2010,and more than one fifth of the patients received breast conservation surgery after 2008.About 13.99％ patients who received mastectomy had breast reconstruction.The independent influence factors of refusing breast conservation surgery were age ≥ 50(P＜0.001),medium nuclear grade (P=0.044),tumor size ＞ 15mm (P＜0.001) and spontaneous discharge (P＜0.001).Patients with smaller tumor size (≤ 15mm) and no spontaneous discharge had 4.18-fold and 7.04-fold greater preference for breast conservation surgery,respectively(OR=0.232,P＜0.001;OR=0.144,P＜0.001).There were no significant differences in RFS and LRRFS in patients with different surgical methods.Conclusion The evaluation in trends and influence factors of different surgical methods provides basis on surgical precision medicine in DCIS patients.

Current trends of breast reconstruction after mastectomy for breast cancer patients in China: a survey report / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the current trends of breast reconstruction (BR) for breast cancer patients in China.</p><p><b>METHODS</b>A questionnaire was designed for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy or chemotherapy, etc. All data were collected until December 2012. Questionnaires were sent to 52 members of the Committee of Breast Cancer Society by e-mail or mail.</p><p><b>RESULTS</b>By July 2013, 41 questionnaires had been returned. Among all, 5 were excluded for not performing BR. These 36 hospitals covered 22 provinces and municipalities in China. A total of 538 surgeons working in the general surgery or oncological surgery department, but only 123 (22.9%) were qualified to perform BR. In 2012, except for 4 missing data, 24, 763 mastectomies were performed in 32 hospitals; among them, 1120 (4.5%) received BR. According to these 36 respondents, 32 (88.9%) performed prosthetic (1, 843 cases in all) while 4 (11.1%) performed prosthetic BR with acellular dermal matrix (17 cases in all) from the time of their first BR operation to the end of 2012. During the same period, 965 latissimus dorsi myocutaneous flaps with implant were performed in 23 (63.9%) hospitals while 738 latissimus dorsi myocutaneous flaps without implant were performed in 32 (88.9%) hospitals. At the same time, 366 pedicled transverse rectus abdominis myocutaneous flap BRs were performed in 28 (77.8%) hospitals, while 155 abdominal free flap BRs were carried out in 9 (25.0%) hospitals. The overall complication rate was 18.2%. Postoperative radiotherapy had some effect on influencing the esthetic outcomes of BR, so the autologous BR was recommended, but the timing remained controversial. Regarding chemotherapy, most respondents concluded that it had no effect or only a mild effect. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.</p><p><b>CONCLUSIONS</b>With more attention paid to the quality of life after mastectomy, more and more BRs are needed, but the ratio is still low in China. To improve this situation, more efforts are needed, including the improvement of the intrahospital framework of multi-disciplinary service, the training for doctors and the educational program for patients, etc.</p>

Single-center report of 118 cases of free abdominal lfaps for breast reconstruction / 中国癌症杂志

Background and purpose:Along with the development of diagnosis and treatment technology, the disease free survival and overall survival of breast cancer have been extended. In order to improve the quality of life after mastectomy, more and more breast reconstructions were applied in breast cancer patients. We retrospectively reviewed 118 cases of free abdominal lfaps for breast reconstruction performed in Fudan University Shanghai Cancer Center. Clinical outcomes, reconstructive techniques and experiences are discussed. Methods:From November, 2006 to June, 2013, we used free abdominal lfaps to perform 118 cases of breast reconstruction on 117 female patients after mastectomy. We observed the surgery, complications and safety of this technic. Results:We performed 118 cases of lfaps based on deep inferior epigastric vessels. The average operation time was 7.72 h. The average time of ischemia was 78.74min. The average anastomosis time was 60.83min. The average number of perforators included in the lfap was 3. The internal thoracic vessels were preferred recipient vessels. Ten cases of vessel crisis occurred and 6 of them were venous thrombosis and 4 cases were venous kink. Seven of them were salvaged, and the other 3 failed, the success rate was 97.46%. Postoperative infection rate was 7.00%. Abdominal bulge occurred in 3.50%of patients. None of the patients developed abdominal hernia. The median interval between surgery and the ifrst cycle of adjuvant chemotherapy was 19 days. The median follow-up time was 12 months. One case of distant metastasis, but no local recurrence was observed. Conclusion: Although free abdominal flap breast reconstruction requires complicated microsurgical techniques, and the learning curve does exist, free abdominal lfap breast reconstruction has a high success rate with oncological safety and few complications.

Serum 1,5-anhydroglucitol in pregnant women with different glucose tolerance status / 中国医师进修杂志

Objective To explore the diagnosing value of serum 1,5-anhydroglucitol(1,5-AG)for gestational diabetes mellitus(GDM)by determining 1,5-AG in pregnant women with different glucose tolerance status.Methods The levels of serum 1,5-AG,fasting plasma glucose(FPG),1 hour plasma glucose(1hPG)and glycosylated hemoglobin(HbA1c)were determined in 30 cases GDM(GDM group),32 cases gestational impair glucose tolerance(GIGT group)and 43 cases gestational normal glucose tolerance (GNGT group).Results The level of serum 1,5-AG in GDM group[(11.69 ± 3.92)mg/L]was obviously lower than that in GIGT group[(20.93 ± 3.43)mg/L]and GNGT group[(27.83 ± 4.03)mg/L](P ＜ 0.01),GIGT group was obviously lower than that in GNGT group(P ＜0.05).The level of serum 1,5-AG had significantly negative correlation with FPG,1hPG and HbA1c respectively(P＜ 0.01).Conclusion The level of serum 1,5-AG has significantly correlation with glucose tolerance,1,5-AG can be used as useful indicator in the diagnosis of GDM.

The diagnostic efficiency of 1,5-anhydroglucitol for diabetes mellitus / 中国糖尿病杂志

Objective To explore the value of serum 1,5-AG in the diagnosis of diabetes mellitus by applying the method of pyranose oxidase (PROD). Methods 1,5-AG,FPG、2hPG and HbA_1c were determined in 50 case of DM,100 case of IGT and 30 control subject. ROC curve was applied to evaluate the diagnostic efficiency of 1,5-AG,FPG and HbA_1c for DM. Results Serum 1,5-AG was obviously lower in the diabetes than in IGT and controls(P＜0.01). Compared with controls, IGT patients had lower serum 1,5-AG(P＜0.05).1,5-AG level had significantly negative correlation with FPG,2hPG and HbA_1c respectively. The area under the ROC curve of 1,5-AG,FPG and HbA_1c are 0.948、0.921、0.817,respectively. Conclusions 1,5-AG level shows significantly correlation with glucose tolerance. Serum 1,5-AG measurement could be used as useful indicator in the screening of diabetes mellitus as well as in the monitoring of glycemic control.

Clinical significance of serum high-sensitivity C-reactive protein in impaired glucose tolerance and diabetes mellitus / 中国医师进修杂志

Objective To investigate,the significance of serum high-sensitivity C-reactive protein (hs-CRP) concentration in subjects with various glucose tolerance and study the role of hs-CRP in patients of impaired glucose tolerance (IGT) and diabetes mellitus.Method All subjects in the study underwent oral glucose tolerance test (OGTT).Determination of serum hs-CRP levels in normal glucose tolerance(NGT),IGT and type 2 diabetes mellitus (T2DM) patients were made by immunologic projective turbidimetry method.Results The levels of serum hs-CRP were (1.57 + 0.46) mg/L in NGT patients,(2.84 ±0.48) mg/L in IGT patients,and(4.18± 0.76) mg/L in T2DM patients.The levels of serum hs-CRP were positively correlated with body mass index,systolic blood pressure,diastolic blood pressure,fasting plasma glucose,OGTr 2 hPG,triglyceride,and total cholesterol.ConclusionsInflammation has already existed not only in T2DM patients but also in subjects with IGT.Inflammation might participate in the oeeurrance and development of T2DM.hs-CRP as an inflammator factor can be used to predict and monitor T2DM.

Detection and clinical significance of micrometastasis in sentinel lymph nodes from patients with breast cancer / 国际肿瘤学杂志

Sentinel lymph node biopsy(SLNB)can predict the status of axillary basin and precisely stage the patients with breast cancer.It can also release the patients whose sentinel lymph node(SLN)is negative from the unnecessary axillary lymph node dissection(ALND)and relieve the complication of the surgery.To standardize the pathologic examination and to make the best use of the molecular biology technique will help to diagnose the micrometastasis accurately.But the prognostic and therapeutic significance of the SLN microme tastasis of breast cancer remaias controversial.

Species Identification and Drug Resistance from Patients with Urogenital Candidiasis / 中华医院感染学杂志

OBJECTIVE To investigate species and drug resistance of pathogenic fungi from patients with urogenital candidiasis.METHODS The fungi were cultured with general method,isolated and identified with CHRO-Magar medium and API20C AUX stripes.Drug sensitive test was tested by M-27-A broth microdilution method recommendated.RESULTS In 331 pathogenic fungi,C.albicans was the most frequent species,followed by C.glabrata and C.parapsilosis.The resistant rate in the female patients was:to itraconazole 3.24%,fluconazole 4.32%,nystatin 4.86%, amphotericin B 6.49%,miconazole 16.76%,ketoconazole 17.84%,and to econazole 28.6%,and that in the male patients was:to nystatin 4.11%,itraconazole 5.48%,fluconazole 8.22%,amphotericin B 10.27%,ketoconazole 17.81%,econazole 23.29% and to miconazole 26.71%.CONCLUSIONS In order to guide clinically the selection of reasonable antifungals,species identification and sensitive test should also be stressed.