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ObjectiveTo evaluate the clinical efficacy and safety of Tongluo Mingmu capsules in the treatment of diabetic retinopathy with blood stasis， collateral obstruction， and Qi and Yin deficiency syndrome. MethodA randomized， double-blind， positive-control， and multi-center clinical trial design method was used. 416 patients with diabetic retinopathy with blood stasis， collateral obstruction， and Qi and Yin deficiency syndrome in four test centers were included （the ratio of the treatment group to the control group was 3∶1）. On the basis of standardized hypoglycemic treatment， the treatment group was given both four Tongluo Mingmu capsules and two Calcium Dobesilate capsule agents three times a day， while the control group were given both two Calcium Dobesilate capsules and four Tongluo Mingmu capsule agents three times a day. The course of treatment was 12 weeks. The curative effect of Tongluo Mingmu capsules was evaluated by comparing the comprehensive curative effect of diabetic retinopathy， traditional Chinese medicine（TCM） syndrome score， corrected visual acuity， fundus changes， fundus fluorescence angiography， and other curative effect indexes before and after treatment in the two groups. At the same time， general examination， laboratory examination， and adverse events were performed to evaluate the safety of the drug. ResultThe baseline demographic data and disease characteristics of the treatment group and the control group were balanced and comparable， with the difference not statistically significant. After 12 weeks of treatment， the total effective rate of the comprehensive curative effect of diabetic retinopathy in the treatment group （61.0%， 189/310） was better than that in the control group （44.1%， 45/102）， and the difference was statistically significant （χ2=8.880， P<0.01）. The total effective rate of TCM syndromes in the treatment group （88.4%， 259/293） was better than that in the control group （69.9%， 65/93）， and the difference was statistically significant （χ2=17.927， P<0.01）. The disappearance rate of dry eyes （χ2=8.305）， dull complexion （χ2=4.053）， lassitude （χ2=10.267）， shortness of breath （χ2=8.494）， and dry stool （χ2=8.657） in the treatment group was higher than that in the control group， and the difference between the groups was statistically significant （P<0.05， P<0.01）. In terms of improving corrected visual acuity （χ2=8.382）， fundus changes （χ2=6.026） ， the treatment group was significantly better than the control group （P<0.05）. During the trial， the incidence of adverse events in the treatment group and the control group was 1.3% and 2.9%， respectively. There was no significant difference between the two groups. In addition， there were no serious adverse events and adverse events leading to withdrawal in both groups. ConclusionTongluo Mingmu capsules can improve the comprehensive curative effect of diabetic retinopathy and enhance the efficacy of TCM syndromes， visual acuity， fundus changes， and fundus fluorescein angiography， with great safety. Therefore， it can provide a new alternative therapeutic drug for patients with diabetic retinopathy.
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Objective:To investigate the predictive value of enhanced CT-based radiomics for brain metastasis (BM) and selective use of prophylactic cranial irradiation (PCI) in limited-stage small cell lung cancer (LS-SCLC).Methods:Clinical data of 97 patients diagnosed with LS-SCLC confirmed by pathological and imaging examination in Shanxi Provincial Cancer Hospital from January 2012 to December 2018 were retrospectively analyzed. The least absolute shrinkage and selection operator (LASSO) Cox and Spearman correlation tests were used to select the radiomics features significantly associated with the incidence of BM and calculate the radiomics score. The calibration curve, the area under the receiver operating characteristic (ROC) curve (AUC), 5-fold cross-validation, decision curve analysis (DCA), and integrated Brier score (IBS) were employed to evaluate the predictive power and clinical benefits of the radiomics score. Kaplan-Meier method and log-rank test were adopted to draw survival curves and assess differences between two groups.Results:A total of 1272 radiomics features were extracted from enhanced CT. After the LASSO Cox regression and Spearman correlation tests, 8 radiomics features associated with the incidence of BM were used to calculate the radiomics score. The AUCs of radiomics scores to predict 1-year and 2-year BM were 0.845 (95% CI=0.746-0.943) and 0.878 (95% CI=0.774-0.983), respectively. The 5-fold cross validation, calibration curve, DCA and IBS also demonstrated that the radiomics model yielded good predictive performance and net clinical benefit. Patients were divided into the high-risk and low-risk cohorts based on the radiomics score. For patients at high risk, the 1-year and 2-year cumulative incidence rates of BM were 0% and 18.2% in the PCI group, and 61.8% and 75.4% in the non-PCI group, respectively ( P<0.001). In the PCI group, the 1-year and 2-year overall survival rates were 92.9% and 78.6%, and 85.3% and 36.8% in the non-PCI group, respectively ( P=0.023). For patients at low risk, the 1-year and 2-year cumulative incidence rates of BM were 0% and 0% in the PCI group, and 10.0% and 20.2% in the non-PCI group, respectively ( P=0.062). In the PCI group, the 1-year and 2-year overall survival rates were 100% and 77.0%, and 96.7% and 79.3% in the non-PCI group, respectively ( P=0.670). Conclusion:The radiomics model based on enhanced CT images yields excellent performance for predicting BM and individualized PCI.
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Objective:To investigate clinicopathological and magnetic resonance imaging (MRI) characteristics of pediatric cardiac tumors.Methods:The clinical, pathological and MRI data of 7 patients with pediatric cardiac tumors confirmed by pathological examination in Children's Hospital of Chongqing Medical University from February 2012 to December 2016 were retrospectively analyzed.Results:There were 3 males and 4 females with first diagnosis age ranging from 1 month to 3 years. As for clinical presentation, most cases were featured with cardiac murmur and enlarged cardiac boundary; only 1 case had acute cerebral infarction, and 1 case did not show any abnormal performance. Pathological findings showed that 6 cases of benign tumors (including 2 cases of fibroma, 1 case of rhabdomyoma, 1 case of myxoma, 1 case of lipoma and 1 case of hemangioma), 1 case of malignant tumor (primitive neuroectodermal tumor of pericardium). MRI results showed that the signal intensity of malignant tumor was higher than that of normal myocardium in each sequence; significant differences were found in benign tumors; first-pass perfusion, cardiac cine image and late gadolinium enhancement were the most obvious.Conclusions:The clinical presentations of pediatric cardiac neoplasms are atypical. Each tumor type has pathognomonic pathological features. MRI has great advantages in the diagnosis and differential diagnosis of cardiac tumors especially for benign tumors.
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Breast cancer screening can significantly reduce the death rate of patients. Although the domestic screening programs have certain health economic value, the high-cost ones need to be weighed. The incidence rate of interval breast cancer is one of important indicators to measure the sensitivity of breast cancer screening program. This paper reviews the epidemiology, clinical features, pathological features and prognosis of interval breast cancer patients, with emphasis on the risk factors and prevention strategies of interval breast cancer.
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Objective:To investigate the etiology, pathogenesis, clinical manifestations, and treatment of acute pancreatitis (AP) complicated with spleen infarction.Methods:A case of AP combined with splenic infarction was retrospectively analyzed and the literature was reviewed.Results:AP complicated with splenic infarction suggested that the patient′s condition was serious. The impairment of splenic immune function caused by splenic infarction may be an important cause of severe acute pancreatitis (SAP). Early detection and active treatment can obtain a good prognosis, and anticoagulant or antiplatelet aggregation treatment was not the key treatment.Conclusions:AP combined with splenic infarction may be an risk factor for SAP.
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Objective:The aim of this study was to analyze the relationship between the changes of pre- and post-operation PET/CT metabolic parameters and prognosis for liver cancer patients.Methods:A retrospective study was carried out among 92 patients with liver cancer who received liver transplantation and PET/CT examination in our hospital from October 2013 to May 2017.According to Deauville criteria, the lesions were classified into PET negative, weak positive, and strong positive. The metabolic parameters including SUV max, SUL, MTV, TMR, TLR, TLG, UVP of normal liver parenchyma, liver cancer lesions and mediastinum were measured or calculated. The relationship between metabolic parameters and recurrence was analyzed. The relationship of Deauville score and metabolic parameters and the changing characters of metabolic parameters between the PET/CT of pre and post transplantation were analyzed. Results:Thirty cases did not relapse after LT, among which 16, 7 and 7 cases had Deauville score of 3, 4 and 5 respectively in pre-operation PET/CT. The recurrence time of 62 patients in recurrence group was (10.90±10.30) months. MTV, TLG, UVP-M, UVP-LB in recurrence group were significant higher( P<0.05). Patients with low metabolic parameters show better prognosis than patients with high metabolic parameters. Metabolic parameters of 5 score group were higher than that of 4score. The metabolic parameters of recurrence group were higher than those in non-recurrence group. MTV, TLG, UVP-M, UVP-LB in post-operation PET/CT were lower than those in pre-operation PET/CT, however, SUV max, TMR, TLR, SUL had no significantly difference. Conclusions:PET/CT metabolic burden parameters should be evaluated before LT to select patients with better prognosis. For liver transplantation patients with high metabolic parameters, PET/CT examination should be performed early after surgery to improve the detection of recurrence and metastasis, and relevant treatment should be timely conducted.
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Objective:To explore the effects and value of implementing clinical pathway refinement on the rational use of antimicrobial drugs in elderly inpatients with community-acquired pneumonia(CAP)in secondary care hospitals.Methods:A total of 122 elderly patients with CAP admitted to the respiratory department of our hospital from April 1, 2018 to October 31, 2019 were enrolled as the subjects, and they were randomly divided into two groups: the study group(n=61, receiving management of refined clinical pathways)and the control group(n=61, the selection of management types and duration determined by clinical experience). The rates of sample submission and positive sputum pathogens, the intensity of antibiotic use, course of treatment, drug costs, combined drug use, length of stay and costs of hospitalization were analyzed and compared between the two groups.Results:The sample submission rate and the positive rate of sputum pathogens were higher in the study group than in the control group(95.1% or 58/61 vs.73.8% or 45/61, 27.6% or 16/58 vs.13.3% or 6/45, χ2=10.536 and 5.545, P=0.001 and 0.019). There was no significance in the cumulative defined daily use(DDD), duration of all antibiotic administration and cumulative administration time between the study and control groups(41.8 or 46.5 vs.78.3 or 111.0, 41 d or 61 d vs.50 d or 131 d, 6 or 7 vs.9 or 15, Z=-0.526, -0.559 and-0.429, all P>0.05). The rate of combined antibiotic therapy was lower in the study group than in the control group(16.4% or 10/61 vs.65.5% or 40/61, χ2=30.500, P=0.000). The duration of antibiotic use, drug costs, length of stay and hospitalization expenses were lower in the study group than in the control group[(8.98±2.05)d vs.(11.75±3.16)d, (1 928.03±1 156.47)yuan vs.(2 335.92±1 038.56)yuan, (11.00±3.16)d vs.(13.90±3.72)d, (12 172.94±3 934.52)yuan vs.(14 036.85±5 591.11)yuan, t=5.748, 2.050, 4.643 and 2.129, P<0.05]. There was no significant difference in the cure rate and 30-day mortality between the study and control groups(95.1% or 58/61 vs.88.5% or 54/61, 4.9% or 3/61 vs.8.2% or 5/61, χ2=1.743 and 0.535, both P>0.05). Conclusions:The application of refinement of clinical pathways in elderly patients with CAP can effectively improve sample submission and detection rates of pathogenic bacteria in sputum, reduce the intensity of antibiotic use, duration, cost and rates of combined antibiotic therapy, decrease the in-hospital time and hospitalization expenses, and help promote rational use of antimicrobial drugs and control of medical expenses.
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Objective@#To evaluate the application of clinical pathway for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) undergoing antibiotic administration.@*Methods@#One hundred and twenty six patients with AECOPD admitted from April 2017 to December 2018 were randomly divided into two groups: 63 patients in study group (63) received antibiotics treatment according to the clinical pathway and other 63 patients in control group received antibiotics according to clinical experience. The rates of sample submission and positive sputum pathogens, the rates of antibiotic use and its intensity, course of treatment, drug cost and combined medication, length of stay and costs of hospitalization were analyzed and compared between two groups.@*Results@#The sample submission rate and the positive rate of sputum pathogens in study group were significantly higher than those in control group [100.0% (63/63) vs. 90.5% (57/63), χ2=6.300; 44.4% (28/63) vs. 22.8% (13/57), χ2=6.229, P<0.05, respectively]. The positive rate of fungi in sputum in study group was not different from that in control group [15.9% (10/63) vs.14.0% (8/57), χ2=0.079, P>0.05]. Types and rate of antibiotic usage in study group were lower than those in control group [9 vs. 12; 85.7% (54/63) vs. 96.8% (61/63), χ2=4.881, P<0.05]. The administration time, defined daily use (DDD) and duration of single antibacterial drugs in study group were lower than those in control group. There were no significant differences in accumulate administration time [4.50 (0.25, 14.75) vs. 7.00 (2.25, 16.0)], accumulative DDD [(33.42 (0.66, 96.00) vs. 52.86 (25.90, 137.7)] and length of all antibiotics administration [(35.00 (1.25,100.00)d vs. 59.50 (24.50,139.00)d] between study group and control group (Z=-1.072, -1.387, -1.375, respectively; all P>0.05). In study group, the combined antibiotics use rate was lower than that in control group [(41.3% (28/63) vs. (63.5% (40/63) , P=0.03]; the length [(7.63±3.95)d vs. (12.84±4.45) d, t=-6.939, P<0.01] and costs of antibiotics use [1 157 (745,2 002) Yuan vs. 2 063 (1 534, 2 811)Yuan, Z=-4.480, P<0.01], length of hospital stay [(11.43±3.53)d vs. (16.65±3.99)d, t=-7.785, P<0.01] and hospitalization expenses [(13 020±5 511) Yuan vs. (19 621±4 824) Yuan, t=-7.121, P<0.01] in study group were all significantly lower than those in control group. Acute exacerbation rate within 30 days in study group was not different from that in control group [9.5% (4/63) vs.6.3% (6/63), χ2=0.434, P=0.51].@*Conclusion@#Application of clinical pathway management provides basis for rational use of antimicrobial drugs and for control of medical expenses for COPD patients with acute exacerbation.
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Objective To evaluate the application of clinical pathway for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) undergoing antibiotic administration.Methods One hundred and twenty six patients with AECOPD admitted from April 2017 to December 2018 were randomly divided into two groups:63 patients in study group (63) received antibiotics treatment according to the clinical pathway and other 63 patients in control group received antibiotics according to clinical experience.The rates of sample submission and positive sputum pathogens,the rates of antibiotic use and its intensity,course of treatment,drug cost and combined medication,length of stay and costs of hospitalization were analyzed and compared between two groups.Results The sample submission rate and the positive rate of sputum pathogens in study group were significantly higher than those in control group [100.0％ (63/63) vs.90.5％ (57/63),x2=6.300;44.4％ (28/63) vs.22.8％ (13/57),x2=6.229,P＜0.05,respectively].The positive rate of fungi in sputum in study group was not different from that in control group [15.9％ (10/63) vs.14.0％ (8/57),x2=0.079,P＞0.05].Types and rate of antibiotic usage in study group were lower than those in control group [9 vs.12;85.7％ (54/63) vs.96.8％ (61/63),x2=4.881,P＜0.05].The administration time,defined daily use (DDD) and duration of single antibacterial drugs in study group were lower than those in control group.There were no significant differences in accumulate administration time [4.50 (0.25,14.75) vs.7.00 (2.25,16.0)],accumulative DDD [(33.42 (0.66,96.00) vs.52.86 (25.90,137.7)]and length of all antibiotics administration [(35.00 (1.25,100.00)d vs.59.50 (24.50,139.00)d] between study group and control group (Z=-1.072,-1.387,-1.375,respectively;all P＞0.05).In study group,the combined antibiotics use rate was lower than that in control group [(41.3％(28/63) vs.(63.5％(40/63),P=0.03];the length [(7.63±3.95)d vs.(12.84±4.45) d,t=-6.939,P＜0.01] and costs of antibiotics use [1 157 (745,2 002) Yuan vs.2 063 (1 534,2 811)Yuan,Z=-4.480,P＜0.01],length of hospital stay [(11.43±3.53)d vs.(16.65±3.99)d,t=-7.785,P＜0.01] and hospitalization expenses [(13 020±5 511) Yuan vs.(19 621±4 824) Yuan,t=-7.121,P＜0,01] in study group were all significantly lower than those in control group.Acute exacerbation rate within 30 days in study group was not different from that in control group [9.5％(4/63) vs.6.3％(6/63),x2=0.434,P=0.51].Conclusion Application of clinical pathway management provides basis for rational use of antimicrobial drugs and for control of medical expenses for COPD patients with acute exacerbation.
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Objective To evaluate the application of clinical pathway in management of patients with bronchial asthma in the community.Methods One hundred and ten patients with bronchial asthma were enrolled from Xinzhong community in Beijing Dongcheng district during January 2015 to December 2016.Patients were randomly assigned in two groups:53 patients were managed with conventional method (control group) and 57 patients received clinical pathway management (study group).The asthma control test (ACT),degree of airflow limitation (FEV1 ％),annual acute attack times and annual medical expenses were compared between the two groups.Results There was no significant difference in the ACT(16.72 ± 3.90vs.16.82±4.81 points,t =-0.13) and FEV1％(66.8± 17.43 vs.68.57±19.79,t =-0.44) between two groups before management (P ＞ 0.05).After treatments,the ACT(16.72 ± 3.90 vs.17.23 ± 3.47 points,t =-1.19) and FEV1％ (66.8 ± 17.43 vs.70.35 ± 9.78,t =-1.84) in control group were unchanged (P ＞ 0.05),while the ACT (16.82 ± 4.81 vs.19.40 ± 3.64 points,t =-6.10) and FEV 1 ％ (68.57 ± 19.79 vs.77.03 ± 14.04,t =-4.83) in study group were improved significantly (P ＜ 0.05).After one year of clinical pathway management,the ACT (19.40 ± 3.64 vs.17.23 ± 3.47 points,t =-3.20)and FEV1％ (77.03 ± 14.04 vs.70.35 ±9.78,t =-2.88)in study group were significantly higher than those in control group (P ＜ 0.05).The annual acute attack times (1.23 ± 0.42 vs.1.85 ± 1.39 times,t =3.21) and annual medical cxpenses [16 966(3 130,61 869)vs.23 400(7 864,237 028) Yuan,Z =-3.47] of study group were significantly lower than those of control group (P ＜ 0.05).Conclusions Clinical pathway management can improve ACT and FEV1 ％ in patients with bronchial asthma,and reduce the risk of acute attack and medical expenses.
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Objective To observe the changes of mechanical pain thresholds and autophagy related proteins microtubule-associated protein 1 light chain 3 (LC3) and sequestosome 1 (SQSTM1 also known as p62) expression levels in the C57BL/6 mouse models of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS),and provide animal experimental evidence for CP/CPPS pain and autophagy study.Methods 36 male C57BL/6 mice were randomly divided into three groups: the model group,control group and na(i)ve group.The CP/CPPS model was established by subcutaneous injection in the lower abdomen region with suspension liquid,containing protein extract of male SD rat prostate gland and complete Freund adjuvant.At 1month and 6 months after modeling,the mice were sacrificed and prostate tissues were harvested for histological examination using HE staining.Mechanical tactile hyperalgesia was measured with von Frey filaments.The autophagy-related proteins LC3 and p62 expression levels were detected by immunohistochemistry,respectively.The average IOD was measured by Image Pro Plus 6.0,and the statistical analysis was performed with GraphPad Prism 5 software.Results The histopathology showed the appearance of chronic prostatitis in the model group,representing hyperplasia and lymphocytic infiltration to a different degree and lasted for 6 months after modeling.Moreover,prostate intraepithelial neoplasia (PIN) appeared in the model group at 6 months after modeling,characterized by the disappearence of basement membrane and obvious nuclear abnormality,while the control and na(i)ve groups showed normal histology during the 1-6 months.Compared with the control and na(i)ve groups,the mechanical pain threshold in the model group was significantly decreased along with the time from (0.353±0.154) g at 0 week to (0.008±0.00) g at 22 weeks (P<0.05).The average IOD of LC3 and p62 expression in the model group was significantly increased with timing from [(2.767±0.464)%,(2.872±1.642)%] at 1month to [(13.501±1.900)%,(9.07±0.49)%] at 6 month,P<0.05.Conclusions A CP/CPPS model is successfully established in C57BL/6 mice.For the model group,the mechanical pain threshold is decreased and autophagy levels are increased gradually with time.These phenomena show that chronic inflammation microenvironment may promote pain and autophagy activity in the prostate,which is closely related with the occurrence and development of prostatic intraepithelial neoplasia.
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This paper aimed to evaluate the clinical application value of vitrectomy combined with intraocular drug injection on treatment of severe endophthalmitis. Retrospective analyzed the 28 eyes for the 28 cases of patients suffering severe endophthalmitis, and with treatment of pars plana vitrectomy combined with intraocular drug injection, and foreign matter removal surgery. This study also analyzed the whole body and local application of antibiotics data, and clinical data of corticosteroid drug treatment. This study had followed up 6 to 12 monthes, 28 intraocular infected eyes of the 28 cases all had got controlled. The vision of 26 eyes improved to some degree, 2 eyes had eyeball atrophy. vitrectomy combined with intraocular drug injection was the most effective method to treatment the suppurative endophthalmitis
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Objective To investigate the effect of preoperative and postoperative inspiratory muscle training(IMT) on cardiopulmonary function and quality of life for patients undergoing esophagectomy.Methods Sixty patients who had received esophagectomy for esophageal cancer were randomly divided into an observation group (n =30) and a control group (n =30).All of the subjects were given conventional treatment (including preoperative health education,abdominal respiration training,pursed lip respiration training and expectoration training).On this basis,the patients in the treatment group were advised to do deep respiratory training using a breathing training device,four times a day,lasting 20 minutes each time,for 10 days (including five days before and five days after the operation).Respiratory muscle strength,blood gases,six minute walk test (6MWT) distances and Borg dyspnea scores were measured on admission,on the day prior to the operation and on the 1st,3rd and 5th day after the operation.And also on admission and on the 5th day after the operation their pulmonary function was tested,and their psychological status and quality of life were evaluated using the hospital anxiety and depression scale (HADS) and the Nottingham health profile (NHP) respectively.Results There was no significant difference in any index between the two groups on admission(P ＞ 0.05).Everyone's respiratory function and exercise capacity were sharply decreased,and Borg dyspnea score increased on the first postoperative day,and then gradually and significantly improved in both groups compared to that on admission(P ＜ 0.05).On the fifth postoperative day,the maximal inspiratory pressure of 67.41 ± 14.53 mmH2O,maximal ventilatory volume of 79.83 ± 5.37 L,6MWT of 427.19 ± 46.52 m,Borg score of 1.45 ± 0.48 points,postoperative anxiety score of 8.14 ±2.80 points,NHP total (128.91 ± 25.12 points),NHP pain score (24.66 ± 10.12 points),NHP sleeping score (25.18 ± 9.75 points),and NHP physical activity scores (22.81 ± 10.72 points) were significantly more improved in the observation group than those in the control group(P ＜ 0.05).Conclusion Preoperative and postoperative inspiratory muscle training can significantly reduce postoperative anxiety symptoms,improve postoperative cardiopulmonary function and the quality of life during perioperative period.Such therapy deserves further clinical research.
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<p><b>OBJECTIVE</b>To explore the clinical features, management approach and treatment outcomes for adenoid cystic carcinoma (ACC) of the breast.</p><p><b>METHODS</b>The clinicopathological data of 25 patients with breasts ACC treated in our hospital from years 1990 to 2012 were retrospectively reviewed and their prognosis was analyzed.</p><p><b>RESULTS</b>The median age of these 25 patients was 53 years (ranged from 31 to 81 years). With the exception of one male case, all patients were female including 17 cases of postmenopausal women. The most frequent presenting symptom is breast lumps, most (48.0%) were in the upper outer quadrant and areola area of the breast. Core needle biopsy was performed in five patients. The specimen finding were adenoids in three and invasive carcinoma in two cases. Axillary lymph node dissection was performed in 23 patients. Only two patients had histologically positive lymph nodes (3 of 14 and 2 of 20). Expression of ER and PR in 14 cases was detected by immunohistochemistry, showing one PR-positive and three ER-positive cases. The median follow-up of the 25 cases was 118 months (ranged from 12 to 244 months). Two patients died of lung metastases at 3 and 10 years after the surgery, respectively.</p><p><b>CONCLUSIONS</b>Due to the complexity of the histology of ACC, adequate sampling of specimens is essential for accurate diagnosis. ACC of the breast is a rare disease with a relatively good prognosis. The low incidence of axillary lymph node metastasis suggests that axillary node dissection is not recommended as a routine procedure. Breast ACC are often with negative ER and PR expression, and the value of adjuvant therapy needs to be further investigated.</p>
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Protocolos de Quimioterapia Combinada Antineoplásica , Usos Terapêuticos , Axila , Neoplasias da Mama , Tratamento Farmacológico , Metabolismo , Patologia , Cirurgia Geral , Neoplasias da Mama Masculina , Tratamento Farmacológico , Metabolismo , Patologia , Cirurgia Geral , Carcinoma Adenoide Cístico , Tratamento Farmacológico , Metabolismo , Patologia , Cirurgia Geral , Quimioterapia Adjuvante , Ciclofosfamida , Usos Terapêuticos , Fluoruracila , Usos Terapêuticos , Seguimentos , Neoplasias Pulmonares , Excisão de Linfonodo , Linfonodos , Patologia , Metástase Linfática , Mastectomia , Métodos , Metotrexato , Usos Terapêuticos , Pós-Menopausa , Receptores de Estrogênio , Metabolismo , Receptores de Progesterona , Metabolismo , Estudos RetrospectivosRESUMO
Objective To investigate the clinicopathologic features and prognosis of secretory carcinoma of the breast (SCB).Methods We enrolled 43 cases of secretory carcinoma of the breast out of invasive breast cancer patients according to the 2012 WHO Classification of Tumors of the Breast.Results The incidence of breast SCB was low,accounting for about 0.17％ of all breast cancer patients.The median age of onset was 49 years old.The diameter of tumor was 1.0-10.0 cm(mean size 3.2 cm).Pathology revealed large number of eosinophilic secretory material inside or outside the cancer cells positive for periodic acid-Schiff stains (PAS) and Alcian blue (AB).The positive rate of estrogen receptor (ER) was 34.9％ (15/43),progesterone receptor (PR) was 23.3％ (10/43),human epithelial growth factor receptor 2 (HER-2) was 25.6％ (11/43),S-100 was 97.7％ (42/43),and special PAS and AB diastase were tested and positive in 8 cases.The postoperative average follow-up time was 78 months,7 cases were found with distant metastasis.2 cases dying of distant metastasis.Conclusions SCB has a good prognosis despite of occasionally axillary lymph node metastasis,local recurrence or distant metastasis.
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Objective To investigate the correlation analysis of smoking on early outcomes in patients with coronary artery bypass graft surgery. Methods 489 patients undergoing CABG in our hospital from January 2010 to December 2012 were analyzed retrospectively. Subjects were divided into smoking group (n = 276), non-smoking group (n = 213). According to the condition of patients will quit smoking, smoking group was divided into two subgroups: quit-smoking group (n=81), not quit-smoking group (n=195). Results BMI, hypertension, hyperlipidemia, myocardial infarction, chronic obstructive pulmonary disease history were significantly higher than that of non-smoking group, the average age of left ventricular ejection fraction was significantly lower than that of the control group (P 0.05). If the COPD patients were excluded from the research, postoperative pulmonary complications, the time of mechanical ventilation of non-smoking groups was significantly lower than the smoking group; pulmonary complications , ventilation time of quit-smoking subgroups was significantly lower than not quit-smoking group (P < 0.05). Multivariate Logistic analysis showed that the period of hospitalization in patients with pulmonary complications is related with smoking status (P<0.05). Conclusions Smoking may increase the effect of pulmonary complications and postoperative mechanical ventilation period. Patients with CABG should be encouraged to stop smoking as soon as possible, so as to reduce the postoperative complications.
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Objective To explore the clinical characteristics,treatment and prognosis of ductal carcinoma in situ of the breast.Methods We retrospectively analysed 430 patients with a diagnosis of DCIS in Cancer Hospital of Tianjin Medical University from January 1991 to December 2005,to evaluate the clinical characteristics,treatment and prognosis.Results Overall survival rate of 430 patients was 94.9％ (408/430).10 cases died of breast cancer recurrence,7 for local recurrence,3 for metastsis.Tumor size,TNM stages and structural pattern of pathlogy were prognosis impacting factors (P ＜ 0.05).The 5-year survival rate for combination radiotherapy and breast-conserving surgery group was 100％,and 10-year survival rate was 97.1％,comparing traditional modified radical mastectomy 5-year survival rate of 98.3％and 10-year survival of 96.7％ (P ＞ 0.05).The overall survival rate of surgery alone group (89.9％) was lower than the post-operative comprehensive treatment group (96.8％),(P ＜ 0.05).Conclusions Treatment of DCIS should be based on primary tumor's clinical stage and histologic characters.Breast-conserving surgery enjoys the same outcome as traditional modified radical mastectomy.
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Objective To investigate the effect of dexmedetomidine on cognitive dysfunction after offpump coronary artery bypass grafting in patients.Methods Fifty-eight ASA physical status Ⅱt or Ⅲ patients,aged 51-63 yr,weighing 52-83 kg,undergoing off-pump coronary artery bypass grafting,were randomly divided into 2 groups (n =29 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with midazolam,etomidate,sufentanil and pipecuronium.The patients were thracheal intubated and mechanically ventilated.Anesthesia was maintained with propofol,sufentanil,isoflurane and pipecuronium.A loading dose of dexmedetomidine 1 μg/kg was infused over 15 min after tracheal intubation,followed by dexmedetomidine infusion at 0.5 μg· kg-1 · h-1 until the end of operation in group D,while the equal volume of normal saline was infused in group C.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 24 h before operation and 24,48 and 72 h after operation.The development of postoperative cognitive dysfunction was recorded within 72 h after operation.The consumption of sufentanil and extubation time after extubation was recorded.Results Compared with group C,MMSE scores at 24 and 48 h after operation were significantly increased and the incidence of postoperative cognitive dysfunction within 72 h after operation was decreased (P ＜ 0.05),and no significant change was found in the consumption of sufentanil and extubation time in group C (P ＞ 0.05).Conclusion Dexmedetomidine can decrease the development of postoperative cognitive dysfunction after off-pump coronary artery bypass grafting in patients.
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carcinoma (SRCC) of the breast.Methods The clinical and pathologic data of 17 SRCC of the breast were analyzed retrospectively.Results Breast SRCC accounted for 2-4.5％ of all breast cancer patients.I0 (58.8％) patients suffered from lymph node metastasis at admission,the positive rates of estrogen receptor(ER) and progesterone receptor (PR) were 71.4％ (10/14) and 64.9％ (9/14) respectively.With a follow-up time varying from 8 months to 11 years recurrence or metastasis were found in 7 patients,another 3 patients were found having distant metastasis at admission.Bone metastasis (8 patients) was most common.Treatments of breast SRCC were analogous to breast cancer at the same stage,sixteen cases were treated with surgery and 14 cases with chemotherapy.The 3' and 5' year disease-free survival rates were 50.3％ (7/17) and 23.0％ (5/17) respectively.With a mean follow-up time of 57 months,the mortality was41.2％ (7/17).Conclusions SRCC of the breast is highly invasive,with high rate of positive receptors and recurrence,and poor patients' survival.
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ObjectiveTo analyze the clinical features and prognostic factors of occult breast cancer. MethodsThe clinical features and prognostic factors of 62 occult breast cancer patients,who were treated in Tianjin Cancer Hospital from October 1997 to October 2011,were retrospectively analyzed.ResultsThe 3-year,5-year and 10-year overall survival rates of 62 cases were 87.4％,76.4％,73.2％ respectively,a median of 53 months.The 3-,5-,and 10-year overall survival rates of the patients with ＞4 positive lymph nodes are lower than that of patients with ≤4 nodes (77.8％,64.8％,38.9％ vs.90.7％,86.7％,86.7％,P =0.015 ) ;The 3-year and 5-year overall survival rates of patients with primary cancer found in removed breast tissue are lower than that in those primary tumor was not found (60.0％,40.0％,40.0％ vs.92.0％,83.6％,79.2％,P =0.023).The 3-year,5-year and 10-year overall survival rates in patients with recurrence and metastasis are lower than that of patients without (63.5％,28.6％,19.0％ vs.97.1％,97.1 ％,97.1％,P =0.000). ConclusionsThe prognosis of occult breast cancer is related with the number of positive lymph node,pathology,recurrence and metastasis.