Objective:To compare the therapeutic effects between immediate breast reconstruction (IBR) after skin-sparing mastecto-my and modified radical mastectomy (MRM) in young breast cancer patients (≤35 years), as well as to analyze the prognostic factors of IBR in these patients. Methods:The clinicopathological data of young breast cancer patients who had undergone IBR after skin-spar-ing mastectomy (60 cases) and MRM (68 cases) in Liuzhou People's Hospital from July 2008 to June 2014 were retrospectively ana-lyzed. Local recurrence, disease-free survival, and overall survival of the patients between the two groups were compared. The influ-encing factors for survival of the IBR group patients, such as age, tumor size, and nipple-areolar complex preservation, were analyzed. Results:All patients were followed-up for a period ranging from 15 to 88 months with a median of 51. In the IBR group, local recur-rence, distant metastasis, and death occurred in 3, 8, and 5 cases, respectively. The 3-and 5-year disease-free survival rates (DFSR) were 91.7%and 81.7%, respectively, whereas the overall survival rate (OSR) was 91.7%. In the MRM group, local recurrence, distant metastasis, and death occurred in 2, 9, and 5 cases, respectively. The 3-and 5-year DFSRs were 94.1%and 83.8%, respectively, where-as the OSR was 92.6%. No statistical difference was noted between the two groups (P>0.05). The analysis of prognostic correlation fac-tors in the IBR group patients shows that lymph node metastasis and estrogen and progesterone receptor-negative correlated with the tumor-free survival and overall survival rates (P<0.05). Conclusion:No apparent statistical difference in the comparison of the local re-currence and long-term survival rate was observed between the two groups' young breast cancer patients who underwent IBR after skin-sparing mastectomy and MRM. IBR after skin-sparing mastectomy is safe for young breast cancer patients with early-stage, and nipple-areolar complex preservation does not increase the risk of recurrence in the IBR group patients. Lymph node metastasis and es-trogen and progesterone receptor-negative are the major prognostic factors of IBR after skin-sparing mastectomy in young breast can-cer patients.

Objective To investigate the surgical method and therapeutic effects of immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-sparing mastectomy.Methods From January 2008 to July 2014,61 patients with breast cancer were given immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-sparing mastectomy.Results All of the 61 patients obtained successful breast reconstruction without flap necrosis and serious complications.Followed-up from 12 to 78 months,all patients were no local recurrence,but distant metastasis was occurred in 4 cases and death in 1 case.The morphology of reconstructed breast was excellent in 93.4 ％ (57/61) cases.Conclusion Immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipplesparing mastectomy is safe,easy to master and has few serious complications.The reconstructed breast has a natural and beautiful appearance and improves the quality of life.It does not affect postoperative adjuvant therapy.Most Chinese patients can obtain breast reconstruction without implant.This method is worth to spread.

Objective:To investigate the safety and effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and sorafenib on large hepatocellular carcinoma (HCC) patients treatment.Methods:From Jan 2012 to Dec 2017, 36 patients (Male: 33, Female: 3, average age: 51.8) with large HCC lesions(5-7 cm) received TACE plus with RFA and sorafenib in the Third Affiliated Hospital of Sun Yat-sen University. Efficacy was evaluated after TACE. Each patient was received follow-up after RFA procedure. The occurrence rate of complications and overall survival (OS) were recorded. Log-rank univariate analysis was used to analyze the OS data.Results:The median TACE time was 4, and the RFA time was (1.7±0.7) . Mean duration time of sorafenib administration was (37.7±28.8) months. Adverse events of sorafenib: 26(72.2%) hand-foot skin reaction, 6(16.7%) hypertension, 22(61.1%) diarrhea, 17(47.2%) alopecia, 3(8.3%) oral ulcer and 1(2.8%) gastrointestinal hemorrhage. Median OS was 63.0 months, and 1-year, 3-year and 5-year survival rate was 100%, 72.7% and 52.6%. The cumulative survival rate of patients taking whole course of sorafenib ( n=21) was better than that of patients taking remedial ( n=15); the cumulative survival rate of patients with alpha fetal protein (AFP) <200 μg/L ( n=26) before treatment was better than ≥200 μg/L ( n=10); the cumulative survival rate of patients with good TACE response ( n=19) was better than that of patients with no response ( n=17), and the differences were statistically significant (all P<0.05). Conclusions:TACE plus with RFA and sorafenib are safe and effective for large HCC patients with 5-7 cm lesions and this treatment might improve OS. The whole-course sorafenib, lower base AFP value (<200 μg/L) and good TACE response were considered as the good factors for the combination therapy in large HCC patients.

Objective To evaluate combination multiple interventional therapies for acute lower extremity deep venous thrombosis (DVT).Methods From January 2008 to October 2014,96 patients with acute unilateral proximal or mixed DVT received interventional treatments including 74 DVT cases of the left lower extremity,and 22 patients in the right.Procedures undertaken included catheter-directed thrombolysis (CDT) only (n =7),CDT combined with thrombolysis (n =89),balloon angioplasty (n =32),and stent implantation (n =6).Results The mean circumference difference between the normal and affected thighs dicreased from (6.7 ± 1.8) cm to (0.8 ± 0.3) cm,t =13.48,P ＜ 0.001.That between the normal and affected calves decreased from (5.9 ± 1.6)cm to (0.7 ±0.4)cm,t =12.84,P ＜0.001.After intervention the Porter's score reduced from (9.7 ± 2.4) points to (1.1 ± 0.6) points,t =15.46,P ＜0.001,and the venous patency rate was (90 ± 8)％.Conclusion CDT combined with thrombolysis through dorsal vein,PTA,and stent implantation is a safe and effective therapeutic modality for acute lower extremity DVT.

Objective To investigate the technique,efficacy,and safety of percutaneous interventional treatments for biliary complications (BC) after liver transplantation (LT).Methods The clinical and imaging data of 127 patients with BC after LT,who received percutaneous interventional treatments in the Third Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2015,were analyzed retrospectively.On the basis of the cholangiographic appearance,patients were classified into 5 groups:biliary leakage group (n =11),anastomotic biliary strictures group (n=28),hilar biliary strictures group (n =30),multifocal biliary strictures group (n =51),and bilomas group (n =7).The modality of interventional treatments was percutanous transhepatic biliary drainage (PTBD),PTBD combined with balloon dilation,PTBD combined with balloon dilation and stent implantation.The methods of biliary drainage included external drainage and external-internal drainage.All the patients were followed up after treatment.The curative effect and operation-correlated complications were observed.Results The first successful rate of PTBD was 97.6％ (124/ 127).The total curative rate,improvement rate and inefficacy rate of interventional treatments were 37.8％ (48/127),44.9％ (57/127) and 17.3％ (22/127) respectively.In biliary leakage group,all the patients were cured by percutaneous interventional treatments with the curative rate being 100％.In anastomotic biliary strictures group,the cure and improvement rates were 64.3％ (18/28) and 35.7％ (10/28) respectively.The efficacy rate was 100％ (28/28).In hilar biliary strictures group,the cure,improvement and inefficacy rates were 40％ (12/30),53.3％ (16/30) and 6.7％ (2/30) respectively.The efficacy rate was 93.3％ (28/30).In multifocal biliary strictures group,the cure,improvement and inefficacy rates were 13.7％ (7/51),54.9％ (28/51) and 31.4％ (16/51) respectively.The efficacy rate was 68.6％ (35/51).In bilomas group,3 cases (3/7) obtained improvement and treatment of 4 cases was inefficative.The efficacy was the best for the patients with bilary leakage,and it was the worst for the patient with bilomas (P＜0.001).The main operation-correlated complication was bile tract infection during drainage.The rates of bile tract infection were 32.4％ (34/105) and 81.8％ (18/22) in patients with external drainage and external-internal drainage,respectively.There was statistically significant difference between these two items (P＜ 0.001).Conclusion PTBD combined with balloon dilation and biliary stent implantation is a safe and effective therapeutic modality for BC after LT,which can improve patients' clinical symptoms,improve patients' quality of life.The patients with bilomas should be treated by retransplantation as soon as possible.The biliary external drainage can decrease the rate of biliary tract infection significantly.

Objective To study the feasibility and efficacy of percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS) in patients with portal hypertension due to chronic portal vein occlusion after splenectomy.Methods 27 patients who had portal hypertension due to chronic portal vein occlusion after splenectomy underwent PTIPS between December 2010 and March 2015.These patients were enrolled in this retrospective study.The success rates,efficacy,and complications were evaluated.Significance in the differences in the portosystemic pressure gradient (PPG) as measured before and after PTIPS procedure was assessed.Results PTIPS was successfully carried out in 25 patients but failed in 2.No fatal procedural complications were observed.The mean PPG dropped from (22.3 ± 5.7) mmHg to (12.4 ± 3.1) mmHg after successful PTIPS (1 mmHg =0.133 kPa,P ＜0.05).The median follow-up in the 25 patients with successful PTIPS were 22 months and there were 3 (12.0％) deaths from liver failure due to severe cirrhosis,and 1 death (4.0％) from stroke during the follow-up period.Shunt dysfunction happened in 4 (16.0％) patients.The original symptoms reoccurred in 2 patients (8.0％) and the remaining patients were diagnosed by routine CT or US examination.Three patients recovered after shunt revision with stent implantation or balloon angioplasty,while one patient refused any further therapy except oral medication.This patient suffered from the first episode of rebleeding 36 months after PTIPS.Hepatic encephalopathy developed in 2 (8.0％) patients,1 patient recovered after medical treatment,while the other who developed Grade 3 hepatic encephalopathy recovered after implanting a smaller cover stent.The remaining patients were asymptomatic with patent shunts.Conclusion PTIPS was a feasible,safe,and efficacious treatment for portal hypertension due to chronic portal vein occlusion after splenectomy.

Objective:To investigate the value of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in predicting the pathological grade and early recurrence rate of hepatocellular carcinoma.Methods:The imaging data, pathological data, and follow-up data of 90 patients with hepatocellular carcinoma who underwent Gd-EOB-DTPA-enhanced MRI examination and surgical treatment in People's Hospital of Baise from January 2016 to October 2017 were retrospectively analyzed. The correlation between the signal intensity of contrast-enhanced MRI and postoperative pathological grade was analyzed. Kaplan-Meier survival analysis was performed to investigate the effects of the signal characteristics of hepatobiliary lesions on the early recurrence rate of hepatocellular carcinoma.Results:A total of 59 (65.56%) patients showed low-intensity signals and 31 (34.44%) patients showed mixed-intensity signals. High-intensity signal was not found in any patients. The signal intensity of the hepatobiliary phase was significantly correlated with the pathological grade of the tumor ( χ2 = 2.26, P = 0.040) and tumor size ( t = 3.10, P = 0.033). The early recurrence rate of hepatocellular carcinoma was significantly higher in patients exhibiting mixed-intensity signals than that in patients exhibiting low-intensity signals ( χ2 = 2.25, P = 0.041). Conclusion:Gd-EOB-DTPA-enhanced MRI in the hepatobiliary phase with different signal intensities has the potential to predict the pathological grade and early recurrence rate of hepatocellular carcinoma.

Objective:The medical-related patent transformation level is relatively low in China for a long time. However, with the support and advancement of a series of national policies, domestic patents and other medical intellectual property projects are increasing year by year, and medical transformation is also receiving more and more attention. Zhongshan Hospital affiliated to Fudan University actively promotes the transformation of hospital patents through various channels, and actively explores how to carry out patent transformation and how to improve the success rate of transformation. This article aims to analyze and explore the feasibility of multi-channel promotion of patents, and to open up a new path for the use of new media to promote patent conversion.Methods:Through Excel analysis of " Zhongshan Patent Hero Post" WeChat public account and official Weibo platform weekly page views data and patent salon project data, as well as the patent application and transformation of Zhongshan Hospital in the past 6 years, and analyze the effect of patent promotion.Results:Through multiple channels and various links of effective promotion methods, the patent application and conversion situation of Zhongshan Hospital has doubled in the past 6 years.Conclusions:The hospital will further actively explore the patent application and transformation process, the full-cycle promotion method of each link, and provide a transfer and transformation consulting docking and promotion platform for the scientific research results or patent technologies related to hospitals and enterprises, and help the transformation of medical patents.

OBJECTIVETo observe the treatment and prognosis of optic nerve invasion in retinoblastoma (RB).

METHODThe children who had been diagnosed with unilateral RB and had received enucleation from January 2006 to December 2013 in our hospital were recruited. Tumor extension into the optic nerve were disclosed. Optic nerve involvement was classified into four grades according to the degree of invasion. Grade I is superficial invasion of the optic nerve head only, grade II is involvement up to and including the lamina cribrosa, grade III is involvement beyond the lamina cribrosa, and grade IV is involvement up to and including the surgical margin. Grade I and II are called invasion of the optic nerve before the sieve plate. Grade III and IV are called invasion of the optic nerve after the sieve plate. Other high-risk factors included extensive invasions of the choroid, sclera, anterior chamber, iris, and ciliary body. They were divided into two groups according to whether the merger of other high histopathologic risk factors. Treatment was delivered accordingly, and the prognosis of different degrees of optic nerve invasion was observed. The subjects were followed up for 6 months to 7 years (average: 43 months).

RESULTThere were 465 subjects in this study, including 279 boys and 186 girls. The right eye was affected in 260 patients and the left eye in 205 patients. The average time from onset of symptoms to visit was 2.7 months (range 1 day-24 months). Twenty-five patients died, resulting in an overall survival rate of 94.6%. The mortality rate of patients with optic nerve involvement with grade I was 0.4%, grade II was 1.0%, grade III was 8.7% was and grade IV was 60.9%. Of the 338 with invasion of the optic nerve before the sieve plate, two died of recurrence, with a survival rates of 99.4% (336/338). Of the 127 patients who had invasion of the optic nerve after the sieve plate, twenty-three died of recurrence, with a survival rate of 81.9% (104/127) , the difference was statistically significant (χ² = 52.299, P = 0.000). A total of 379 patients did not have any other merged pathology high-risk factors, 8 died, the mortality rate was 2.1%. Of the 86 patients who had complicated with other high-risk factors, 17 died, the mortality rate was 19.8%, the difference was statistically significant (χ² = 42.955, P = 0.000). Of the 338 patients, 304 had invasion of the optic nerve before the sieve plate had not merged other pathology high-risk factors, none died, of the 34 patients who had complicated with other pathology high-risk factors, 2 had died, the mortality rate was 5.9%, the difference was statistically significant (P = 0.010). Of the 127 patients with invasion of the optic nerve after the sieve plate, 76 had not complicated with other pathological high-risk factors, 9 of whom had died, the mortality rate was 11.8%, 51 had complicated with other pathological high-risk factors, 14 of whom had died, the mortality rate was 27.5%, outcomes did significantly differ between the two subgroups (χ² = 5.014, P = 0.025). Cox multivariate analysis showed that invasion of the retrolaminar optic nerve, surgical margin of the optic nerve and sclera were influential factors of colorectal cancer.

CONCLUSIONPatients with optic nerve invasion have an excellent outcome with current therapy. But for those whose resection margin was invaded, which has a high incidence of recurrence, chemotherapy is recommended for patients with postlaminar optic nerve involvement.

Child ; Female ; Humans ; Male ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Optic Nerve Neoplasms ; pathology ; surgery ; Prognosis ; Retinoblastoma ; pathology ; surgery ; Retrospective Studies ; Survival Rate

Objective To investigate the efficacy and safety of percutanous transhepatic intrahepatic portosystemic shunt(PTIPS)for chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension.Methods The clinical and imaging data of 38 patients with chronic portal vein occlusion and cavernous transformation with symptomatic portal hypertension, who received PTIPS in our hospital from November 2009 to June 2016,were analyzed retrospectively.The differences of the portosystemic pressure gradient(PPG)measured before and after PTIPS procedure was analyzed by a paired samples t-test. All the patients were followed up and the curative effect and operation-correlated complications were observed.Results The PTIPS procedure was technically successful in 36 patients.The other two patients with unsuccessful PTIPS underwent medical treatment,and one of them died of recurrent variceal bleeding 25 months later. Effective portal decompression and free antegrade shunt flow were achieved in 36 patients with successful PTIPS.And the mean PPG was decreased from(25.2±2.9)to(13.2± 1.3) mmHg (1 mmHg=0.133 kPa) before and after PTIPS respectively and the difference was statistically significant(P<0.05).During the procedure,arterial hemorrhage occurred in two patients who subsequently underwent embolization. Biliary injury occurred in one case and percutanous transhepatic biliary drainage (PTBD)was then performed.The mean follow-up period of the 36 patients was(26.7±10.4)months(range from 3.0 to 74.0 months).Hepatic encephalopathy appeared in 4 cases,among which,3 patients recovered after receiving medical treatment, while 1 patient experienced Grade 3 hepatic encephalopathy and recovered after implanting a smaller cover-stent.Shunt dysfunction occurred in 10 cases,of which 8 cases recovered after shunt revision with stent implantation or ballon angioplasty, while 2 cases underwent anticoagulation by warfarin only. During follow-up period, 7 patients died of liver failure(n=4), hepatic cellular carcinoma(n=1), recurrent varicose vein bleeding(n=1), and renal failure(n=1). The other patients remained asymptomatic and shunt patency. Conclusions PTIPS is both safe and effective for the treatment of symptomatic portal hypertension caused by chronic portal vein occlusion and cavernous transformation.The technical success rate is high,and the short-term curative effect is satisfied.