Objective To study the risk factors for contralateral breast cancer(CBC) in women after regular treatment of the primary breast cancer.Methods Between January 1997 to December 2002,the clinical data of 340 breast cancer patients at our institution were retrospectively analyzed.In all the patients a detailed analysis was carried out with respect to age,operation type,radiation therapy technique and dose,the use of chemotherapy or hormone therapy,and other clinicopathologic characteristics.The Kaplan-Meier method was used to estimate the actuarial rate of CBC.The Cox proportional hazard regression model was used to estimate the relative risk factors of CBC.Results Fourteen cases were diagnosed to be CBC,thus overall incidence of CBC was 4.1%.Ten-year CBC incidence(2.7%) was higher than 5-year incidence of CBC(1.4%).Univariate analysis showed that the risk factors of CBC at 5-year and 10-year included: ≤45 years old,medullary carcinoma,family history of breast cancer and being taken without endocrine therapy(P0.05).Mutivariate analysis showed that ≤ 45 years old and being internal breast radiotherapy were independent risk factors of CBC at 5-year and 10-year(P

10.3969/j.issn.1000-3606.2013.06.007

Objective:To describe the surgical technique of direct anterior approach to total hip arthroplasty and to report the early clinical outcomes.Methods: A series of 100 consecutive,unselected patients who had 116 primary total hip arthroplasty surgeries (16 bilateral) done through direct anterior approach from March 11 2015 to June 21 2016 was reviewed.There were 50 male patients and 50 female patients.The average patient age was 51 years,and the average body mass index was 24.69 kg/m2.The preoperative diagnosis included avascular necrosis of femoral head,hip osteoarthritis,osteoarthritis se-condary to acetabular dysplasia,sequelae of hip old infection,ankylosing spondylitis,rheumatoid arthritis and avascular necrosis of femoral head after cannulated screws fixation of femoral neck fracture.There were 7 hips which had surgical history prior to the index hip arthroplasty,including 3 cases with bone graft treatment for avascular necrosis of femoral head through Smith-Peterson approach,2 cases with acetabular shelf procedures for acetabular dysplasia through Smith-Peterson approach,and 2 cases with cannulated screws fixation for femoral neck fracture (internal fixation residual).All were uncemented hips.The stems used in this study included 67 Triloc stems (DePuy company,USA),45 Corail stems (DePuy company,USA),2 Accolade stems (Stryker company,USA),1 Synergy stem (Smith-Nephew company,USA) and 1 Polarstem (Smith-Nephew company,USA).Results: The average follow up period was 8.5 months,the average incision scar length was 10 cm,and the average postoperative Harris score was 93.62.There was 95％ postoperative leg length discrepancy within 3 mm.The average cup inclination angle was 38.7°with 94.8％ in the range of 30° to 50°.The average cup anteversion angle was 14.3° with 94.2％ within the target range of 5° to 25°.The were 15 (12.9％) operative complications,including two femoral perforations (changing stem from Triloc to Corail),three calcar fractures (treated with cerclage wires),four greater trochanter fractures (2 were treated wire tension band,and 2 nondisplaced fractures untreated),one deep infection (debridement and retaining of the prothesis),one superficial infection (debridement),one hematoma and three wound healing complications (debridement).All the complications were successfully treated without any sequelae at the end of the latest follow-up.There was no postoperative dislocation.There was no major nerve and vascular injuries.There were 35 cases (30.2％) reporting symptoms of lateral femoral cutaneous nerve palsy.Conclusion: Direct anterior approach to total hip arthroplasty allows accurate and reproducible cup orientation positioning and leg length restoration and decreases the risk of postoperative dislocation,which is helpful for early rapid postoperative recovery.

Objective To explore the clinical diagnosis and management of focal nodular hyperplasia (FNH) of the liver. Methods Forty-two FNH cases treated in the past 9 years were studied retrospectively. The clinical and pathologic data were reviewed. Results Preoperative liver function test and AFP were normal. The preoperative radiography in FNH was usually not specific, with less than 50% cases were suggestive of FNH of the liver. Surgical resection resulted in a permanent cure with no significant postoperative complications. More than one year follow-up found recurrence in one case. Conclusion Clinical, laboratory and radiological findings when combined could help in establishing tentative diagnosis of FNH. Surgery is recommended in cases with equivocal diagnosis or in fear of hepatocellular carcinoma.

Objective To investigate the expressions of transforming growth factor beta receptors (TGF beta R), receptor-activated Smads and common-partner Smad in condylomata acuminata. Methods Tissue samples were collected from 20 patients with condylomata acuminata and 15 normal human controls.EliVisionTM plus immunohistochemical technique was used to detect the distribution and expression of TGF beta R Ⅰ , TGF beta R Ⅱ, Smad1/2/3, phosphorylated Smad2/3 and Smad4 in condylomata acuminata and normal control skin. Results Positive immunohistochemical staining for TGFbeta R Ⅰ , TGFbeta R Ⅱ,Smad1/2/3, p-Smad2/3 and Smad4 was detected in the epidermis of normal control skin. The intensity of im-munohistochemical staining was significantly lower for TGFbeta R Ⅰ , TGFbeta R Ⅱ, Smad1/2/3, p-Smad2/3and Smad4 in the epidermis of condylomata acuminata than in that of normal control skin (P < 0.05 or < 0.01). Conclusion The expressions of TGF beta R, receptor-activated Smads and common-partner Smad are decreased or absent in the epidermis of condylomata acuminata, which might interfere with TGF be-ta/Smad signaling and contribute to the development of epidermal hyperplasia in condylomata acuminata.

Background::Risk assessment and treatment stratification for three-vessel coronary disease (TVD) remain challenging. This study aimed to investigate the prognostic value of left atrial volume index (LAVI) with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score II, and its association with the long-term prognosis after three strategies (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], and medical therapy [MT]) in patients with TVD.Methods::This study was a post hoc analysis of a large, prospective cohort of patients with TVD in China, that aimed to determine the long-term outcomes after PCI, CABG, or optimal MT alone. A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital. A total of 7818 patients with available baseline LAVI data were included in the study. Baseline, procedural, and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which was a composite of all-cause death, myocardial infarction (MI), and stroke. Secondary endpoints included all-cause death, cardiac death, MI, revascularization, and stroke. Long-term outcomes were evaluated among LAVI quartile groups. Results::During a median follow-up of 6.6 years, a higher LAVI was strongly associated with increased risk of MACCE (Q3: hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.06-1.37, P = 0.005; Q4: HR 1.85, 95%CI 1.64-2.09, P <0.001), all-cause death (Q3: HR 1.41, 95% CI 1.17-1.69, P <0.001; Q4: HR 2.54, 95%CI 2.16-3.00, P <0.001), and cardiac death (Q3: HR 1.81, 95% CI 1.39-2.37, P <0.001; Q4: HR 3.47, 95%CI 2.71-4.43, P <0.001). Moreover, LAVI significantly improved discrimination and reclassification of the SYNTAX score II. Notably, there was a significant interaction between LAVI quartiles and treatment strategies for MACCE. CABG was associated with lower risk of MACCE than MT alone, regardless of LAVI quartiles. Among patients in the fourth quartile, PCI was associated with significantly increased risk of cardiac death compared with CABG (HR: 5.25, 95% CI: 1.97-14.03, P = 0.001). Conclusions::LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease. CABG is associated with improved long-term outcomes compared with MT alone, regardless of LAVI quartiles. When LAVI is severely elevated, PCI is associated with higher risk of cardiac death than CABG.

Objective:To investigate the factors affecting phenotypes in the patients of methylmalonic acidemia combined with homocysteinemia cblC type with MMACHC c. 609G>A homologous variant. Methods:A retrospective study on the clinical manifestations, complications, treatment, and outcome in 164patients of cblC type with MMACHC c. 609G>A homologous variant was conducted.The patients were diagnosed by biochemical and genetic analysisfrom January 1998 to December 2020. Results:Among the 164 patients, 2 cases were prenatally diagnosed and began treatment after birth. They are 3 and 12 years old with normal physical and mental development. Twenty-one cases were diagnosed by newborn screening. Among them, 15 cases had with normal development. They were treated fromthe age of two weeks at the asymptomatic period. Six cases began treatment aged 1 to 3 months after onset. Their development was delayed. One hundred and forty-one cases were clinically diagnosed. Their onset age ranges from a few minutes after birth to 6 years old. 110 cases had early-onset (78.0%). 31 cases had late-onset (22.0%). Five of them died. 24 patients lost to follow-up. Of the 141 clinically diagnosed patients, 130 (92.2%) with psychomotor retardation, 69 (48.9%) with epilepsy, 39 (27.7%) with anemia, 30 (21.3%) had visual impairment, 27 (19.1%) had hydrocephalus, 26 (18.4%) had feeding difficulties, 7 (5.0%) with liver damage, and 5 (3.5%) with metabolic syndrome. The frequency of hydrocephalus and seizures was significantly higher in the early-onset group. The urinary methylmalonic acid increased significantly in the patients with epilepsy. During the long-term follow-up, the level of plasma total homocysteine in the seizure-uncontrolled group was significantly higher than that in the seizure-controlled group, the difference had a statistical significance ( P<0.05). Conclusion:Most of the patients with MMACHC c. 609G>A homozygous variant had early-onset disease, with a high mortality and disability rate. If not treated in time, it will lead to neurological damage, resulting in epilepsy, mental retardation, hydrocephalus, and multiple organ damage. Pre-symptomatic diagnosis and treatment are crucial to prevent irreversible neurological damage. Neonatal screening and prenatal diagnosis are important to improve the outcome of the patients.