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.

OBJECTIVETo evaluate the association between perioperative bleeding post percutaneous coronary intervention (PCI) and 1 year adverse cardiovascular events in elderly patients.

METHODSFrom June 2006 to August 2011, 1 105 elderly ( ≥ 75 years) patients undergoing PCI in Fuwai Hospital were prospectively included. Patients were divided into peri-procedure bleeding group (n = 153) and no bleeding group (n = 952). Cox proportional hazards model was performed to evaluate the independent effect of bleeding on the composite endpoint of death and myocardial infarction.

RESULTSBARC 2 grade bleeding occurred in 9.5% (105/1 105) patients. The rate of BARC ≥ 2 grade bleeding was 11.8% (130/1 105) , and the access site-related bleeding accounted for 62.7% (96/153) of all bleeding. The composite endpoint of 1 year death and myocardial infarction was higher in bleeding group (9.2% (14/153) vs. 4.2% (40/952), P = 0.008) . The 1 year cardiac death was higher in bleeding group (3.9% (6/153) vs. 0.8% (8/952), P = 0.007), but the rate of non-cardiac death was similar between bleeding group and no bleeding group (P = 0.360). Cox proportional hazards model analysis showed that HR of 1 year death and myocardial infarction in BARC ≥ 2 grade bleeding patients was 2.368 (95%CI:1.201-4.669, P = 0.013) compared with no bleeding patients.

CONCLUSIONPerioperative bleeding post PCI is an independent predictor of 1 year adverse outcomes in elderly patients( ≥ 75 years).

Aged ; Hemorrhage ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Proportional Hazards Models ; Risk Factors ; Treatment Outcome