OBJECTIVE:To observe the effects and safety of different treatment courses of rivaroxaban in prevention and treatment of deep venous thrombosis(DVT)after total hip replacement. METHODS:The clinical data of 127 patients under-went selective total hip replacement in our hospital during Dec. 2014-Dec. 2015 were selected and analyzed retrospectively. They were divided into group A [83 cases,subdivided into group A1(40 cases)and A2(43 cases)by treatment course] and group B (44 cases) according to anticoagulant duration. Group A was given Rivaroxaban tablet 10 mg,po,qd,6-8 h after surgery;the treatment course of group A1 was 5 weeks(35 d)while that of group A2 was 2 weeks(14 d). Group B was giv-en Enoxaparin sodium injection 5000 AxaIU,sc,qd,12d before surgery;and then given Enoxaparin sodium injection 5000 AxaIU,sc,qd,after surgery;the treatment course lasted for 2 weeks. The incidence of DVT were compared among 3 groups as well as thrombin time(TT),activated partial thromboplastin time(APTT),hemoglobin(Hb)content,whole blood viscos-ity,plasma viscosity,platelet count and anticoagulant safety 3 days before surgery and after treatment. RESULTS:The inci-dence of DVT in group A1 was 0,which was significantly lower than that in group A2 (9.30%) and group B (11.36%), with statistical significance(P<0.05);there was no significant differences between group A2 and group B(P>0.05). Wheth-er 3 d before surgery or after treatment,there was no statistical significance in PT,APTT,Hb content,whole blood viscosi-ty,plasma viscosity and platelet count among 3 groups (P>0.05). No major bleeding events or pulmonary embolism was found in 3 groups. The incidence of mild bleeding events in group A was 5.00%,which was slightly higher than that in group A2 (2.33%) and group B (2.27%),without statistical significance (P>0.05);there was no statistical significance between group A2 and group B(P>0.05). CONCLUSIONS:Rivaroxiban long-term anticoagulation after total hip replacement has no significant effect on coagulation function and platelet,not only decrease the incidence of DVT,but also will not increase no bleeding with good safety.

OBJECTIVETo study the high risk factors of the third level of lymphatic metastasis in breast cancer patients to guide clinical practice.

METHODSThe clinical data of 746 breast cancer patients (all female, aged from 33 to 80 years with a median of 46 years) received radical or modified mastectomy between 2001 and 2011 was analyzed retrospectively. Eleven individual variables were selected to investigate high risk factors of the third level of lymphatic metastasis in different conditions.

RESULTSAxillary nodes metastasis status (OR = 4.541, 95%CI:3.569-5.776), tumor site (OR = 1.437, 95%CI:1.029-2.007), external nodes involved (OR = 3.809, 95%CI:1.683-8.618) and estrogen receptor (OR = 0.740, 95%CI:0.569-0.964) were high risk factors of the third level of lymphatic metastasis. Further analysis found that it is prone to happen a metastasis, especially when the tumor with a size over 5 cm and located at the lateral quadrant. Negative estrogen receptor was a risk factor of the third level lymphatic metastasis along with the tumor stage.

CONCLUSIONFor preoperative tumor biopsy shows Negative estrogen receptor of tumor stage T3 and over stage T3 when considering suspicious lymph node metastasis or external tissues metastasis intraoperatively should take in account into third level axillary lymph node dissection actively.

Adult ; Aged ; Aged, 80 and over ; Axilla ; pathology ; Breast Neoplasms ; pathology ; surgery ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mastectomy ; methods ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors