Objective To investigate the risk factors associated with surgical site infection (SSI) in patients with breast cancer,and provide the basis for preventing SSI.Methods Case-control study was used to investigate the clinical data of 630 patients of breast cancer retrospectively by single factor and multiple factors regressive analysis.Results The incidence rate of SSI was 3.65％ (23/630),the main pathogenic bacteria was staphylococcus aureus (14/20),single factor regressive analysis showed that granulocytopenia associated with chemotherapy,diabetes mellitus,time of drainage were the risk factors of SSI (P ＜ 0.05).Multiple factors regressive analysis showed that granulocytopenia associated with chemotherapy,time of drainage were the independent risk factors of SSI (P ＜ 0.05).Conclusion Granulocytopenia associated with chemotherapy,time of drainage are the independent risk factors of SSI and comprehensive preventive measures should be taken to control the incidence rate of SSI.

Objective To study the value of sentinel lymph node (SLN) for forecasting axillary lymph node metastasis in breast cancer. Methods Fifty-six patients with breast cancer underwent SLN methylene blue mapping and biopsy,as well as axillary lymph node dissection.All lymph nodes received routine HE staining and immunohistochemical examination. Results SLN was successfully identified in 52 cases (52/56,92.8%).Routine pathological examination demonstrated metastasis of SLN in 22 cases and metastasis of non-SLN in 1 case,the false negative rate being 4 3% (1/23).In the remaining 29 cases without pathologically verified metastasis,immunohistochemical staining showed 1 case of CK-19 (+) with EMA (+) and another 1 case of CK-19 (+) with CEA (+),without metastasis of non-SLN. Conclusions SLN methylene blue mapping and biopsy may forecast axillary lymph node metastasis in breast cancer.

Objective To investigate the feasibility of breast conservative surgery for large breast carcinoma(over 3 cm in diameter)after neoadjuvant chemotherapy.Methods A total of 24 patients with breast carcinoma larger than 3 cm in diameter underwent core needle biopsy and neoadjuvant chemotherapy with paclitaxel and/or epirubicin in our hospital from June 2003 to September 2006.The chemotherapy was carried out for 2 to 4 cycles,and then breast conservative surgery was performed in 7 to 10 days.Results After the neoadjuvant chemotherapy,3(12.5%)patients achieved CR,and 21(87.5%)had PR.Pathological CR was detected in 2(8.3%)of the patients.The breast conservative surgery was completed in 14 cases(58.3%),10 patients were converted to modified radical resection.The patients was followed up for 5 to 44 months with a median of 24,during which none of them had recurrence or distant metastasis.Conclusions For patients with large breast carcinoma,breast conservative surgery is feasible after neoadjuvant chemotherapy.

Objective To analyze the clinical pathologic features and prognosis of triple negative breast cancer. Method A total of 570 cases of breast cancer between January 2005 and June 2007 were analyzed,113 cases were negative for estrogen receptor(ER), progesterone receptor(PR) and HER-2 as the triple negative group, 48 cases were negative for ER, PR and positive for HER-2 as the control group. The clinical pathologic features, recurrence and survival of the patients were compared. Results The median age was 46 years old, 15 cases (13.3%) had a breast cancer family history or oophoroma family history,86.7%(98/113) of pathological types were invasive ductal carcinoma,lymph node metastases were detected in 31.0%(35/113 ) in the triple negative group. No significant difference was found for p53 staining between the triple negative group[58.4%(66/113)positive] and the control group [41.7%(20/48) positive] (P＞0.05).The median time of follow-up was 24 months,the loss was 5 cases, 10 cases (9.3%, 10/108) had local recurrence and metastasis,and 8 cases (7.4%,8/108) died from breast cancer metastases,2-year survival rate was 96.2% in the triple negative group.There was no significant difference in local recurrence and survival time between the triple negative group and the control group (P＞0.05). Conclusions The incidence of triple negative breast cancer is higher than other data reported. Triple negative breast cancer exhibits the same clinical pathological features compared with ER-/PR-/HER-2 + subtypes,and the prognosis is similar to the controls.

Objective To investigate the expression of cyclooxygenase-2(COX-2)in breast cancer tissues,as well as the relationship between COX-2 and the clinicopathological features.Method The expression of COX-2 was detected in 60 cases of breast cancer tissues and 20 cases of breast normal tissues by using immunohistochemistry,and combined with clinicopathological information for analysis.Results The COX-2 expression rate was 65.0%(39/60)in breast cancer tissues and 10.0%(2/20)in breast normal tissues respectively.There was statistic difference between the two(P<0.01).The over expression of COX-2 was significantly correlated with TNM stages,lymphatic metastasis and the expression of epidermal growuth factor receptor-2(C-erbB-2)(P<0.05 or<0.01).Conclusion The expression of COX-2 in breast cancer tissues is significantly higher,which might play a fairly important role in tumorigenesis and progression of breast cancer.

Objective To explore the method and management of pre-hospital care and raise the level of traffic injuries in pre-hospital care by summarizing the clinical features of death patients with severe tragic accident trauma Methods The basic data of 62 death patients with severe traffic accident trauma was analyzed according to death report statistics of severe traffic accident trauma from January 1st,2005 to December 31th,2008 Results Brain injury death accounted for most of traffic accident trauma death.The mortality rate of brain injury in the wounded wag 8.28%(13/157),but of asphyxia and hemorrhagic shock was 2.55%(4/157),3.18%(5/157)respectively in 2005.With the development of treatment and rescued in time, the mortality rate reduced to 6.11%(11/180),0,0.56%(1/180)in 2008.Conclesions It should be trying to shorten the time of pre-hospital care for pafients with trsffic accident trauma,especially in patients combined with hemorrhagic shock,asphyxia,severe brain injury.It is concluded that rapid and effective pre-hospital care can significantly reduce death rate and self-help or each other rescue training would also be effective to reduce mortality.

Objective To explore the clinical efficacy and safety of hyper-early embolotherapy in treatment of intracranial ruptured aneurysm.Methods A retrospective analysis was made on 33 patients with intracranial ruptured aneurysm.Preoperative Hunt-Hess grade:grade Ⅰ-Ⅱ in 16 patients,gradeⅢin 5 patients,grade Ⅳ in 9 patients,grade Ⅴ in 3 patients.All patients were confirmed with subarachnoid hemorrhage (SAH) by angiography and then underwent embolization under general anesthesia by detachable coils within 6 h from onset.Results After operation,25 patients (75.8％) recovered well,4 patients (12.1％) were with mild disability with paralysis and aphasia,4 patients (12.1％) were dead (1 patient for intraoperative aneurysm rupture,1 patient for postoperative pneumonia,1 patient for infection of hematoma at puncture site and 1 patient for postoperative gastrointestinal bleeding).Followed up 1-6 months,no rebleeding occurred.Conclusions Hyper-early embolotherapy could avoid rebleeding of the aneurysm,and relieve the vasespasm,without increasing the intra-operative rebleeding rate.Moreover hyper-early embolotherapy could greatly decrease the mortality of poor-grade SAH patients.

OBJECTIVETo evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB device in recanalization of patients with acute ischemic stroke of posterior circulation.

METHODSThe clinical data of 17 consecutive patients with acute ischemic stroke of posterior circulation, treated with the Solitaire AB device from August 2011 to August 2015 in Department of Neurosurgery, the Military General Hospital of Beijing People's Liberation Army, were extracted and then retrospectively analyzed. There were 12 male and 5 female patients with a median age of 60 years (ranging from 44 to 75 years). Among them, 8 cases occluded in basilar artery, 4 cases occluded in vertebral artery and 5 cases occluded in vertebral plus basilar artery. Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after treatment, measured by National Institute of Health stroke scale (NIHSS) score, were compared via t test and the clinical outcomes were assessed by modified Rankin score (mRS) at 90 days after treatment.

RESULTSFifteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath time were above 7.5 hours. The NIHSS score at 7 days was 11±10, which was significantly decreased compared to the admission NIHSS score 17±5 (t=2.949, P=0.009). No symptomatic intracranial hemorrhage case was found after thrombectomy. At 90 days, one patient died(mRS 6), one patient seriously disabled (mRS 5), two patients moderately seriously disabled (mRS 4), four patients resulted in moderate outcome (mRS 3) and the other 9 patients achieved good outcome (mRS 0 to 2). The dead and seriously disabled cases were both due to failure in recanalization. Two moderately seriously disabled cases were probably attributed to their severe admission condition (NIHSS >20) and prolonged time (onset to sheath time >6 hours).

CONCLUSIONMechanical thrombectomy with the Solitaire AB device contributes to a high rate of recanalization with a low probability of complication and improves functional outcome in patients with acute ischemic stroke of posterior circulation.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; surgery ; Thrombectomy ; Treatment Outcome

Intracranial venous sinus thrombosis is a special type of cerebral vascular disease. It usually originates from the later period of wasting disease, brain trauma, puerperium, blood disease, heart disease, eye/nasal/facial infection, meningitis and septicemia. It occurs in different age and sex. Infants, young children, frail elderly people, postpartum women, chronic disease patients are prone to be affected.Because of lacking of typical clinical manifestations, the clinical diagnosis and treatment of this disease is difficult and easily leading to misdiagnosis and mistreatment, which affects the prognosis of the patients.Because of lacking of standardized diagnosis and treatment strategy, different methods are needed. According to the proceeding reports, we reviewed the current progress of the diagnosis and treatment of intracranial venous sinus thrombosis.

Objective To explore the intra-arterial therapies and prognostic predictors of anterior circulation stroke patients.Methods Fifty-nine anterior circulation stroke patients,admitted to our hospital from May 2011 to June 2014,were divided into two groups:intra-arterial therapy (IAT) group (n=25,thrombolysis in myocardial infarction [TIMI] grade Ⅱ～Ⅲ after IAT) and multi-modal therapy (MMT) group (n=34,onset time longer than 6 h or achieving no good effect afterIAT);their clinical data and follow up data were reviewed and summarized.National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity;and modified Rankin scale (mRS) was performed three months after the stroke to reveal the clinical outcomes.The t test,chi-square test and multivariable Logistic regression analysis were performed to analyze the related prognosis factors.Results The mean age of the patients was 59.8±1.3 years.MMT patients had significantly higher baseline admission NIHSS scores as compared with those inIAT patients (18.3±4.2 vs.12.6±4.3,t=l 1.88,P=0.000);MMT patients had a significantly higher patent flow rate as compared withIAT patients (82.4％ vs.56.0％,x2=4.878,P=0.027).Besides,the MMT patients had a significantly longer time till accepting treatment (5.8±1.4 vs.5.3±0.9,t=4.735,P=0.000);In multivariate analysis,age,time getting treatment,NIHSS scores at discharge are predictors for poor outcomes,while perfect recanalization was associated with favorable outcome.Conclusions MMT can be used for patients with severe admission NIHSS scores,and it may enjoy higher patency rate than IAT.Good vessel recanalization is the only predictor for favorable outcome.