OBJECTIVETo evaluate the oncologic safety of nipple-sparing mastectomy (NSM) for breast cancer patients based on current literature.

DATA SOURCESA comprehensive literature search of Medline, Embase databases was conducted for studies published through March 2014.

STUDY SELECTIONOur search criteria included English-language studies that focused on NSM at nipple-areola complex (NAC) involvement, patient selection, and recurrence. Prophylaxis NSM, case series or reports that based on very small population were excluded. In the end, 42 studies concerning NSM and oncological safety were included into the review.

RESULTSNSM is a surgical procedure that allows the preservation of the skin and NAC in breast cancer patients or in patients with prophylactic mastectomy. However, the oncologic safety and patient selection criteria associated with NSM are still under debate. The incidence of NAC involvement of breast cancer in recent studies ranges from 9.5% to 24.6%, which can be decreased through careful patient selection. Tumour-nipple distance, tumour size, lymph node involvement and molecular characteristics can be evaluated preoperatively by clinical examinations, imaging studies and biopsies to predict the risk of NAC involvement. Currently, there is no available standard protocol for surgical approaches to NSM or pathological examination of NSM specimens. The local recurrence (ranges from 0% to 24%) of NSM is not significantly higher than that of traditional mastectomy in selected patients based on long-term follow-up. The role of radiotherapy in NSM is still controversial and is not universally accepted.

CONCLUSIONSNSM appears to be oncologically safe following careful patient selection and assessment of margins.

Breast Neoplasms ; surgery ; Female ; Humans ; Mastectomy ; methods ; Nipples ; Patient Selection ; Risk Factors

OBJECTIVETo investigate the safety and efficacy of fast track surgery (FTS) management in gastric cancer undergoing D2 gastrectomy.

METHODSEighty gastric cancer patients undergoing D2 gastrectomy were recruited prospectively. Patients were assigned to receive FTS management (n = 40) or conventional perioperative care (n = 40). The FTS care included shorten preoperative fasting time, no nasogastric decompressing tubes and abdominal drainage placed, early postoperative oral feeding, multimodal analgesia, and early mobilisation. The length of postoperative hospital stay, medical cost, nutritional status, gut function, and postoperative complications in the two groups were recorded and compared.

RESULTSFTS group was associated with a significantly shorter postoperative hospital stay compared with conventional care group [(5.6 +/- 1.3) d vs. (9.4 +/- 1.9) d, P < 0.05]. Medical cost was less [(18 620 +/- 2360) Yuan vs. (20 370 +/- 2440) Yuan, P < 0.05] and duration of intravenous infusion [(3.5 +/- 1.4) d vs. (5.8 +/- 1.9) d, P < 0.05] was also shorter. First passage of flatus was earlier in FTS group than in conventional care group [(4.3 +/- 0.4) d vs. (5.5 +/- 0.9) d, P < 0.05]. Loss of body weight in the postoperative period was less in FTS group [(3.2 +/- 0.8) kg vs. (4.3 +/- 1.6) kg, P < 0.05]. There was no difference in morbidity or mortality between the two groups.

CONCLUSIONFTS in D2 gastrectomy is safe and efficient, and it can shorten postoperative hospital stay and hasten return of gut function.

Adult ; Aged ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Humans ; Length of Stay ; Male ; Middle Aged ; Perioperative Care ; Postoperative Complications ; prevention & control ; Prospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

Objective:To compare the efficacy and safety between propofol and sevoflurane in free flap breast reconstruction.Methods:The data of patients,who underwent free flap breast reconstruction with propofol(P group,n=16)or sevoflurane(S group,n=19),were collected.Postoperative complications of flap,postoperative nausea and vomiting(PONV)and intraoperative mean arterial blood pressure were retrospectively analyzed.Objective:No statistical significance of the baseline patient characteristics,duration of surgery and anesthesia was found between the two groups.The incidence of flap compromise was 6.3％in the P group while it was 10.5％in the S group.No statistical significance of the history of PONV,motion sickness and smoking was found between two groups.Also no statistical significance of intraoperative sufentanil and remifentanil administered,postoperative PCIA consumption was found between the two groups.The incidence of nausea(from 0 to 2 h)was significantly decreased in the P group(18.8％vs 68.4％,P=0.003).The incidences of vomiting(from 2 to 6 h,0 to 24 h)were significantly reduced in the P group(18.8％vs 52.6％,P=0.039;18.8％vs 57.9％,P=0.019).No statistical significance of preoperative mean arterial blood pressures was found between two groups([88.06±6.86] mmHg vs [88.10±8.13] mmHg,P=0.987).Significant decreases in intraoperative mean arterial blood pressures compared with preoperative mean arterial blood pressures were observed in both groups(P<0.05).Intraoperative mean arterial blood pressure was lower in the S group compared with the P group(P<0.05).More ephedrine was used in the S group(P<0.05).There was no intraoperative awareness in both groups.There were no significant differences in extubation time and 24 h quality of recovery score between the two groups.Conclusions:There was no difference in the outcome of flap between propofol and sevoflurane.Compared with sevoflurane,propofol improves postoperative nausea and vomiting with less intervention in mean arterial blood pressure.

OBJECTIVETo exam the effect and safety of conventional acupuncture (CA) on cardiac arrhythmia.

METHODSNine medical databases were searched until February 2016 for randomized controlled trials. Heterogeneity was measured by Cochran Q test. Meta-analysis was conducted if I was less than 85% and the characteristics of included trials were similar.

RESULTSNine qualified studies involving 638 patients were included. Only 1 study had definitely low risk of bias, while 7 trials were rated as unclear and 1 as high. Meta-analysis of CA alone did not have a significant benefit on response rate compared to amiodarone in patients with atrial fibrillation (Af) and atrial flutter (AF) [relative risk (RR): 1.09; 95% confidence interval (CI): 0.79-1.49; P=0.61; I=61%, P=0.11]. However, 1 study with higher methodological quality detected a lower recurrence rate of Af in CA alone as compared with sham acupuncture plus no treatment, and benefits on ventricular rate and time of conversion to normal sinus rhythm were found in CA alone group by 1 study, as well as the response rate in CA plus deslanoside group by another study. Meta-analysis of CA plus anti-arrhythmia drug (AAD) was associated with a significant benefit on the response rate when compared with AAD alone in ventricular premature beat (VPB) patients (RR, 1.19, 95% CI: 1.05-1.34; P=0.005; I=13%, P=0.32), and an improvement in quality-of-life score (QOLS) of VPB also showed in 1 individual study. Besides, a lower heart rate was detected in the CA alone group by 1 individual study when compared with no treatment in sinus tachycardia patients (MD-21.84 [-27.21,-16.47]) and lower adverse events of CA alone were reported than amiodarone.

CONCLUSIONSCA may be a useful and safe alternative or additive approach to AADs for cardiac arrhythmia, especially in VPB and Af patients, which mainly based on a pooled estimate and result from 1 study with higher methodological quality. However, we could not reach a robust conclusion due to low quality of overall evidence.

Acupuncture Therapy ; adverse effects ; Arrhythmias, Cardiac ; therapy ; Atrial Fibrillation ; therapy ; Atrial Flutter ; therapy ; Humans ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Ventricular Premature Complexes ; therapy