A modified tricuspid valve annuloplasty technique for functional tricuspid regurgitation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Functional tricuspid regurgitation often occurs in patients with concomitant left sided, valve disease. Several types of tricuspid valve annuloplasty have been described, but there is no consensus on the management of functional tricuspid regurgitation. We report a modified annuloplasty technique and compare its efficacy with the conventional Kay technique.</p><p><b>METHODS</b>A retrospective review was made of 60 patients who received tricuspid valve annuloplasty (group A, modified method; group B, Kay technique) and the early and midterm outcomes of modified method and Kay technique were compared.</p><p><b>RESULTS</b>Three patients underwent ring annuloplasty using a semirigid Carpentier-Edwards ring due to failing suture annuloplasty. All patients were completely cured when they left the hospital. The follow-up time was (32 ± 7) months in group A and (30 ± 7) months in group B. After three years, tricuspid regurgitation decreased by more than two grades in 13 patients in group A and 11 in group B. The mean postoperative regurgitation grade in group A was lower than group B at 12, 24 and 36 months but not significantly. Three of 28 patients developed recurrent tricuspid regurgitation in group A and five of 26 patients in group B during the follow-up period (three deaths and three ring annuloplasties excluded). Freedom from recurrent tricuspid regurgitation in group A was higher than that group B at all follow-up points. Postoperative right atrium diameter, right ventricle endodiastolic dimension and tricuspid regurgitation area decreased obviously in both groups. The right ventricle endodiastolic dimension and tricuspid regurgitation area improved more significantly in group A than group B over three years of follow-up,</p><p><b>CONCLUSIONS</b>The modified annuloplasty technique achieved the same outcomes as the conventional Kay annuloplasty over the first three years postoperation. As this modified technique is simple and less expensive, it is another option for correction of functional tricuspid regurgitation.</p>

Clinical observation of the immediate breast reconstruction following breast-conserving surgery for centrally located breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of the immediate breast reconstruction following breast-conserving surgery for centrally located breast cancer.</p><p><b>METHODS</b>From January of 2006 through December of 2011, 30 women with centrally located breast cancer of stage I or II was treated by breast-conserving surgery removing or not removing the nipple-areola complex. All the patients received immediate breast reconstruction with adjacent gland tissue flap or latissimus dorsi myocutaneous flap. The breast shape and complication were observed. All the patients were followed up.</p><p><b>RESULTS</b>The thirty women underwent the breast-conserving surgery successfully, in which 12 cases received immediate breast reconstruction with adjacent gland tissue flap and 18 cases received immediate breast reconstruction with latissimus dorsi myocutaneous flap. The superior rate of the aesthetic effect was 90% (27/30) according to JCRT in one week or six months after surgery. No recurrence and metastasis were observed after a median follow-up of 38 months ( range 4-72 months).</p><p><b>CONCLUSION</b>The immediate breast reconstruction following breast-conserving surgery for centrally located breast cancer at early stage is satisfactory for the aesthetic result and clinical efficacy, and deserves further clinical application.</p>

Lesion localization and surgical resection for non-palpable breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the methods of lesion localization and surgical treatment for non-palpable breast cancer, presented with only small calcification lesion on the images.</p><p><b>METHODS</b>From November 2003 to August 2007, 61 patients with non-palpable lesion were finally pathologically diagnosed as early breast cancer (T1-2N0M0), based on the small calcification lesions shown by full field digital mammography (FFDM) through molybdenum target, and the rich blood supply shown by type-B ultrasonic examination. Accurate lesion-localization prior to surgical resection was conducted, and sample re-examination by FFDM was done after resection. Patients with single lesion underwent breast-conserving surgery, precise excision with the aid of image-guided wire localization, and stage I breast reconstruction was performed simultaneously using wide-based gland-tissue flap. Patients with multiple lesions received modified radical mastectomy.</p><p><b>RESULTS</b>Among the 50 patients treated with breast-conserving surgery, the accuracy of localization for lesions was 100% (50/50), and all lesions were excised completely with a negative margin proven by FFDM re-examination and pathological examination. The superior rate of mammaplasty was 86.0% (43/50) according to JCRT criteria, with a compliance difference of 1.5 cm. Modified radical mastectomy was performed in 11 patients. The follow-up period in this series was from 6 to 58 months with a mean follow-up time of 39 months. Distant metastases were detected in only one patient and local recurrence was not observed yet.</p><p><b>CONCLUSION</b>Lesion localization by FFDM in patients with non-palpable breast cancer is accurate and practical. In patients with single lesion, breast-conserving resection followed by synchronous stage I breast reconstruction with wide-based gland-tissue flap is appropriate.</p>

Effects of chemotherapy on circulating angiogenic factor levels in patients with breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the changes in circulating VEGF and endostatin (ES) levels during chemotherapy for patients with breast cancer, and their correlation with efficacy of chemotherapy.</p><p><b>METHODS</b>40 breast cancer patients with metastases were included in this study. They received TAC/TEC, CAF/CEF, NP, CAP, CMF, TFP, TA or TC regime chemotherapy, respectively. Totally 120 serum samples were collected from the patients at three time points: before chemotherapy, the end of 1 and 5-6 chemotherapy cycles, and analyzed for VEGF and ES levels using ELISA. Tumor agiogenesis activity was evaluated by serum soluble vascular cell adhesion molecule (VCAM - 1) measured by ELISA as a surrogate marker.</p><p><b>RESULTS</b>(1) Before chemotherapy, the median level of VEGF in patients with breast cancer was 496.6 pg/ml, 4.7 times higher than that of healthy controls (P <0.001). The median level of ES was 95.5 ng/ml, 18.3% lower than that of healthy controls (P = 0.183). VCAM-1 was 1077.1 ng/ml and higher than that of controls (P <0.001). The serum VEGF levels correlated with VCAM-1 levels, tumor staging and metastatic sites (P <0.05). (2) At the end of 1 cycle of chemotherapy, the serum VEGF level (median 524.8 pg/ml) was higher than the pretreatment values (P = 0.047), whereas the levels of ES and VCAM-1 were not significantly altered (110.5 ng/ml, P = 0.055; and 975.6 ng/ml, P = 0.27). (3) At the end of 5-6 cycles, the changes in VEGF correlated with the response to chemotherapy. Serum VEGF levels in 27 patients with chemotherapy-responsive and stable disease showed a significant decrease (median 287.4 pg/ml) , but not observed in 13 patients with progressive disease. VCAM-1 also showed a treatment-related change like VEGF. However, chemotherapy might only have a minor effect on ES, because there was no significant difference in the ES levels among 5-6 cycle patients, 1 cycle patients and healthy controls, and neither between therapy-responsive patients.</p><p><b>CONCLUSION</b>Intensive chemotherapy for breast cancer results in a significant decrease of serum VEGF level, which might be an indicator of the controlled disease status, and following the treatment-induced response or stabilization, the tumor angiogenesis seems to change into an anti-angiogenesis direction.</p>

The association of polymorphisms of CDT1 and GMNN gene with the risk of breast cancer in Chinese women: a case-control analysis / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the association of polymorphisms of CDT1 and GMNN gene, two important genes participating in DNA replication, with the risk of sporadic breast cancer.</p><p><b>METHODS</b>Using polymerase chain reaction-restriction fragment length polymorphism (PCR - RFLP) and the primer-introduced restriction analysis (PIRA)-PCR assay to genotype the CDT1 838G/A and GMNN 387C/A polymorphisms in a case-control study of 427 breast cancer cases and 477 cancer-free controls in a Chinese population.</p><p><b>RESULTS</b>No significant association of the CDT1 838G/A and GMNN 387C/A polymorphisms with the risk of breast cancer was found (adjusted OR:1.16, 95% CI:0.88-1.54 for CDT1 GA+AA genotypes and adjusted OR:0.90, 95% CI:0.67-1.21 for GMNN CA+AA genotypes). However, in the stratified analyses, a significant association of CDT1 GA+AA genotypes with breast cancer risk among subjects with family history of cancer was found (adjusted OR:2.21, 95% CI:1.20-4.09).</p><p><b>CONCLUSION</b>These findings suggest that the CDT1 838G/A and GMNN 387C/A polymorphisms may not play a major role in the etiology of breast cancer, but CDT1 variant may have a potential role only in genetically susceptible women.</p>

Hemodynamic changes during piggyback liver transplantation of different Child class / 第三军医大学学报

Objective To describe the hemodynamic changes during piggyback liver transplantation (PBLT), and to analyze the hemodynamic correlation with various degrees of cirrhosis according to Childpugh classification. Methods Between March 1999 and June 2004, 180 patients underwent PBLT procedure in our institution, and 95 cases were selected and divided according to Child classification. The intraoperative hemodynamics of different time points were retrospectively analyzed, including mean artery pressure (MAP), heart rate (HR), central vein pressure (CVP) and mean pulmonary artery pressure (MPAP). Results Hemodynamic changes were minimal before and during anhepatic phase in all the patients. At reperfusion, a hemodynamic disturbance occurred featured by decrease of MAP and increase of MPAP. Comparison between different Child class showed that in the Child C group, MAP were lower and HR were higher before new liver phase, while CVP and MPAP were higher during new liver phase. Conclusion Hemodynamic changes were minimal before and during anhepatic phase for PBLT, while they were more severe during reperfusion, and they also correlates with the different Child class before transplantation. The more severe of the cirrhosis before transplantation according to Child classification, the greater hemodynamic changes during the operation.