Objective To compare the dosimetric difference between volumetric are modulation with RapidArc and fixed field dynamic IMRT for breast cancer radiotherapy after breast-conserving surgery.Methods Twenty patients with early left-sided breast cancer received radiotherapy after breast-conserving surgery.After target definition,treatment planning was performed by RapidAre and two fixed fields dynamic IMRT respectively on the same CT scan.The target dose distribution,homogeneity of the breast,and the irradiation dose and volume for the lungs,heart,and eontralateral breast were read in the dosevolume histogram (DVH) and compared between RapidAre and IMRT.The treatment delivery time and monitor units were also compared.Results In comparison with the IMRT planning,the homogeneity of clinical target volume (CTV) ,the volume proportion of 95% prescribed dose (V95%) was significantly higher by 0.65% in RapidAre (t =5.16,P = 0.001) ,and the V105% and V110% were lower by 10.96% and 1.48 % respectively,however,without statistical significance (t =-2.05 ,P =0.055 and t =-1.33 ,P =0.197).The conformal index of planning target volume (PTV) by the Rap~dAre planning was (0.88±0.02),significantly higher than that by the IMRT planning [(0.74±0.03),t = 18.54,P < 0.001].The homogeneity index (HI) of PTV by the RapidArc planning was 1.11±0.01,significantly lower than that by the IMRT planning (1.12±0.02,t =-2.44,P =0.02).There were no significant differences in the maximum dose (Dmax) and V20 for the ipsilateral lung between the RapidArc and IMRT planning,but the values of V10,V5 ,Dmin and Dmean by RapidArc planning were all significantly higher than those by the IMRT planning (all P < 0.01).The values of max dose and V30 for the heart were similar by both techniques,but the values of V10 and V5 by the RapidArc planning were significantly higher (by 18% and 50% ,respectively).The V5 of the contralateral breast and lung by the RapidArc planning were increased by 9.33% and 3.04% respectively compared to the IMRT planning.The mean MU of the RapidArc was 608 MU,significantly higher than that by the IMRT planning (437 MU,t = 10.86,P < 0.001).The treatment time by the RapidArc planning was 111.3 s,significantly longer than that by IMRT planning (103.6 s,t = 3.57,P = 0.002).Conclusions The RapidArc planning improves the dose distribution of CTV and homogeneity of PTV for breast cancer radiotherapy after breast-conserving surgery.However,it significantly enlarges the volume of normal tissues irradiated in low dose areas,prolongs the treatment delivery time,and increases the MU value in comparison with IMRT.

Objective:To investigate the associations between the hormone receptors,Ki67 expression and response to neoadjuvant anthracycline-based chemotherapy in breast cancer patients.Methods:One hundred sixty-eight primary breast cancer patients received anthracycline-based neoadjuvant chemotherapy.The expression of estrogen receptor(ER),progesterone receptor(PR),and Ki67 were determined by immunohistochemistry assay in core-needle biopsy specimens prior to the chemotherapy,and pathologic response was assessed by Miller & Payne grade(G1 to G5).Results:40%(67/168)of the patients had a good pathologic response,defined as complete pathologic response(pCR or G5)and minimal residual disease(G4).Among the patients,20%(33/168)had a complete pathologic response(G5).ER or PR status was significantly associated with pathological response.Patients with PR-negative tumors had a higher pathological response rate or pCR than those with PR-positive tumors(17/67 vs 45/90,P=0.002;6/67 vs 25/90,P=0.003,respectively),whereas patients with ER-negative tumors had a higher pathological response rate than those with ER-positive tumors.Moreover,Patients with both ER-and PR-negative tumors exhibited a remarkable pathological response as compared with those with any single factor(36/17 vs 26/86,P=0.009).No association between Ki67 expression and pathological was found in this cohort of patients.There was a linear correlation between the expression of Ki-67,ER or PR status and pathologic response.Conclusion:There is a significant association between the hormone receptors and pathological response to neoadjvant anthracycline-based chemotherapy in breast cancer patients,and patients with PR-negative tumors are more likely to respond to chemotherapy.

OBJECTIVETo discuss diagnosis and treatment of iatrogenic purulent lumbar spinal infection.

METHODSFrom December 2006 to January 2010, 4 patients with iatrogenic purulent lumbar spinal infection were treated with posterior debridement. There were 2 males and 2 females, ranging in age from 50 to 66 years (respectively in 52, 66, 58, 50 years); in course of disease from 2 weeks to 2.5 months (respectively in 21, 14, 60, 75 days ). All patients had fever, lumbago, local tenderness and limited lumbar activity before operation. White blood cell count (WBC), erythrocyte sedimentation rate (ESR) were abnormal. The clinical effects were evaluated by symptoms and laboratory examination.

RESULTSSymptoms of lumbago and fever vanished in 4 patients, of which wounds were primary healing without complications. The patients were followed up for 3 months, no infection (WBC, C-reactive protein and ESR were normal) and lumbar instability were found.

CONCLUSIONIatrogenic purulent lumbar spinal infection can be diagnosed according to course of disease, clinical symptoms and signs, imaging finding. In the items, magnetic resonance imaging finding have necessarily specificity, once finding abscess-formation, will promptly operate.

Aged ; Debridement ; methods ; Diagnosis, Differential ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spondylitis ; diagnosis ; surgery ; Suppuration

OBJECTIVETo investigate the prognostic significance of Her-2 expression in node-positive and node-negative breast cancer in Chinese women.

METHODSThe Her-2 expression in breast cancers from 981 patients was detected by immunohistochemistry with anti-Her-2 (CB11) monoclonal antibody. The survival curves were analyzed by Kaplan-Meier method, and Cox regression model was applied to determine whether this factor is an independent predictor of survival in multivariate analysis.

RESULTSNineteen point seven percent of the patients showed positive Her-2 expression in their tumors. Patients with Her-2-positive tumors tended to be younger. The high level Her-2 expression was significantly associated with negative estrogen receptor and progesterone receptor status in their tumors (P < 0.05). Among 387 patients with node-positive disease, the 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate were significantly lower in patients with Her-2-positive tumors than in patients with Her-2-negative tumors (DFS: 48.8% vs. 66.9%, P = 0.009; OS: 55.2% vs. 76.4%, P = 0.001), and Her-2 expression was an independent unfavorable prognostic factor for OS, but not for DFS in patients with node-positive disease. Among 591 patients with node-negative disease, Her-2 expression was not significantly associated with DFS and OS (P > 0.05).

CONCLUSIONHer-2 expression is an important prognostic factor in patients with node-positive disease, but not for patients with node-negative disease in Chinese women.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Breast Neoplasms ; metabolism ; pathology ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gene Expression Regulation, Neoplastic ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Staging ; Proportional Hazards Models ; Receptor, ErbB-2 ; metabolism ; Receptors, Progesterone ; metabolism ; Survival Rate

OBJECTIVETo investigate the correlations between Fas-1377 and -670 polymorphisms and survival in Chinese women with breast cancer.

METHODSPolymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP) was used to detect the polymorphism of Fas gene in 310 breast cancer patients with a long-term follow-up (median 10.5 years, range 0.2 - 16.1 years). Survival curves were analyzed by Kaplan-Meier method.

RESULTSThe polymorphism of neither Fas-1377 nor Fas-670 was significantly correlated with the overall survival in this series of 310 cases (P > 0.05). However, among 146 patients without lymph node metastasis, the 5-year overall survival (OS) rate was significantly lower in the patients with Fas-1377 AA genotype than that in the patients with Fas-1377 GA or GG genotype (OS: 66.7% vs. 95.4%, P = 0.03). Among 117 patients with lymph node metastasis, both the Fas-1377 and Fas-670 polymorphisms were not significantly correlated with OS (P = 0.42).

CONCLUSIONAmong breast cancer patients without lymph node metastasis, patients with Fas-1377 AA genotype may have a worse survival, while patients with Fas-1377 GA or GG genotype may not be so.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Apoptosis ; Breast Neoplasms ; genetics ; metabolism ; pathology ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Middle Aged ; Polymorphism, Genetic ; Prognosis ; Survival Rate ; Young Adult ; fas Receptor ; genetics ; metabolism

BACKGROUNDGastric varices (GV) are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate (BC), the mainstay of the therapy for GV, has been reported to be effective for hemostasis of bleeding varices, but its efficacy in the obliteration of GV and impact on the survival of patients still needs clarification. Here we summarized our experience of 10 years' practice to evaluate the efficacy and safety of endoscopic therapy using BC for GV patients.

METHODSFrom January 1997 to April 2006, GV cases treated with endoscopic injection using BC were collected. The "sandwich method" and the "modified sandwich method" were used to inject BC intravascularly. Retrograde analysis was made on the data of treatment and follow-up.

RESULTSA total of 635 GV cases treated with endoscopic injection using BC were collected, most of them (90.2%) suffered from post-hepatitis cirrhosis. Emergency hemostasis was achieved in 139 out of 146 sessions (95.2%). Complications occurred in 32 cases (5.2%), including hemorrhage due to early expulsion of tissue glue (3.1%), septicemia (1%) and ectopic thrombosis (0.5%), such as spleen infarction. Endoscopic follow-up in 503 patients showed complete disappearance (76.9%), collapse (17.3%) or remnants (5.8%) of gastric varices. A total of 550 patients were followed up clinically for 3 to 115 months. Of these patients, 44 had recurrent bleeding (8.0%) and 44 died from hepatic failure, recurrent bleeding, hepatic carcinoma or other causes. The longest survival was 115 months, with a median survival of 25 months. Survival rates at 1, 2, 3, 4 and 5 year were 95%, 92%, 90%, 83% and 81%, respectively.

CONCLUSIONSEndoscopic sclerotherapy with BC is effective for the hemostasis of bleeding GV, as well as obliteration of GV which contributes to less rebleeding and better survival. The modified sandwich method may be useful to minimize ectopic embolism, which we speculated to result from excess iodized oil.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Enbucrilate ; therapeutic use ; Endoscopy, Gastrointestinal ; methods ; Esophageal and Gastric Varices ; mortality ; therapy ; Female ; Humans ; Male ; Middle Aged ; Sclerotherapy ; adverse effects ; methods ; Tissue Adhesives ; therapeutic use

OBJECTIVESTo explore the frequency, clinical features and risk factors of venous thromboembolism (VTE) in hospitalized patients.

METHODSThe frequency, demographic features, and acquired and inherited factors of in-patient cases of VTE in Peking union medical college hospital from 1994 to 2004 were analyzed retrospectively.

RESULTSSix hundred and seventy-two patients were enrolled. Among them, male to female ratio was 1.2 and the median age was 53 (14 - 92). Five hundred and eighty (86.3%) patients were at their first diagnosis with the peak ages between 40 and 50 for men and 50 and 60 for women. More common acquired risk factors were antiphospholipid antibody syndrome (APS) (32.0%), trauma / surgery (31.1%) and malignancies (17.1%). 35.7% of the patients had multiple acquired risk factors. Before the initiation of anticoagulation therapy, the activities of protein C (PC), protein S (PS) and antithrombin (AT) were measured in 94 patients. The deficiency of these three natural anticoagulants was 44.7%. Among the anticoagulant deficiencies, PC deficiency was the commonest one (13.8%). Combined deficiency of PC and AT accounted for 10.6%. 31.6% of the 94 patients had inherited plus acquired risk factors.

CONCLUSIONSAge for the first event of VTE in the men was about 10 years ahead of that in the women. The major acquired risk factors were APS, trauma/surgery and malignancies, and inherited risk factors were PC deficiency and PC + AT combined deficiencies. It seems that the coexistence of multiple risk factors plays an important role in triggering VTE.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Venous Thromboembolism ; etiology

Objective To investigate the differences in biomechanical properties of 3 internal fixation patterns(the lateral plate and screw group, the rear plate and screw group, and the front and rear lag screw group) for treating posterolateral tibial plateau fracture under different axial loads. Methods Based on CT data of the tibial plateau, the entity model of 1/2 and 1/4 posterolateral tibial plateau fracture with 3 internal fixations were established and meshed to analyze force status of the fracture models with 3 internal fixations under different axial loads. ResultsUnder the axial load of 1 kN, for the 1/2 posterolateral tibial plateau fracture model, the displacements of the fracture fragments in the lateral plate and screw group, the rear plate and screw group, and the front and rear lag screw were 552.082, 67.964, 54.085 μm, respectively, and the stresses on the fixation device were 306.745, 231.844, 73.047 MPa, respectively. For the 1/4 posterolateral tibial plateau fracture model, the displacements in the three groups above were 416.072, 302.107, 150.639 μm, respectively, and the stresses on the fixation device were 306.673, 208.467, 73.607 MPa, respectively. Both the displacements of the fracture fragments and the stresses on the fixation device increased correspondingly under the axial load of 1.5 kN, and the trend of the data was similar to that under the axial load of 1 kN. Conclusions The results from the fracture models with 3 internal fixation patterns show that the front and rear lag screw group has a superior biomechanical stability under two different axial loads, and the similar mechanical properties can be achieved in the rear plate and screw group. Therefore, the front and rear lag screws will be preferred to treat posterolateral tibial plateau fracture with less obvious displacement in clinic.

Objective: To understand the incidence trend of liver cancer in China from 2005 to 2016, and explore the correlation between the incidence trend of liver cancer and the incidence trend of hepatitis B. Methods: The incidence data of liver cancer in China from 2005 to 2016 were collected from the Annual Report of Cancer Registry in China. The incidence data of hepatitis B were collected from China Public Health Science Data Center. World standardized incidence rate (WSR) was calculated according to the World Segi's population. Joinpoint regression model was used to analyze the trend of WSR of liver cancer [measured by average annual percentage change (AAPC)]. The age-period-cohort model was fitted to analyze the age, period and cohort effects in people aged 20- years and above. Pearson correlation coefficient was used to explore the correlation between the incidence of liver cancer and the incidence of hepatitis B. Results: The crude incidence of liver cancer in China showed a trend of first increase before 2009 and then relatively stable. The world standardized morbidity rate of liver cancer in China decreased from 19.11 per 100 000 in 2005 to 17.74 per 100 000 in 2016 (AAPC=-0.5%, 95%CI: -1.3%-0.3%, P=0.240). The incidence of liver cancer in male decreased significantly (AAPC=-1.0%, 95%CI: -1.5%--0.5%, P=0.001). The incidence of liver cancer in women increased from 2005 to 2010 [annual percentage change (APC)=1.7%, 95%CI: -0.1%-3.4%, P=0.059] but showed a significant decrease trend from 2010 to 2016 (APC=-1.6%, 95%CI: -2.3%--1.0%, P=0.001). From 2005 to 2016, the incidence of liver cancer showed a decreasing trend in urban areas (AAPC=-0.3%, 95%CI: -0.8%-0.3%, P=0.316) and rural areas (AAPC=-3.9%, 95%CI: -4.4%--3.3%, P<0.001). Risk for liver cancer increased with age, while the period effect showed a trend of first increase then decrease and cohort effect showed a decrease trend. The morbidity rates of both hepatitis B and liver cancer showed decrease trends from 2009 to 2016, and there was a significant correlation (r=0.71, 95%CI: 0.01-0.94, P=0.048). Conclusions: From 2005 to 2016, the morbidity rate of liver cancer in China showed a decrease trend, and there were significant gender and urban-rural area specific differences. Age effect had a great impact on the risk for liver cancer. With the progress of population aging in China, liver cancer is still a public health problem, to which close attention needs to be paid.
Adult ; China/epidemiology* ; Female ; Humans ; Incidence ; Liver Neoplasms/epidemiology* ; Male ; Rural Population ; Urban Population ; Young Adult

Objective To investigate a reasonable and effective internal fixation method for posterolateral fracture of the tibial plateau. Methods Specimens of the tibial plateau with posterolateral fracture made from 12 adult male cadavers were randomly and evenly divided into 3 groups, and fixed by anterior 6.5 mm lag screw, lateral 4.5 mm L-shape plate, posterior 3.5 mm T-shape plate, respectively. All the specimens were loaded in turn by stress of 250, 500, 750, 1 000 N, and the corresponding axial displacement and stress were measured. Results Under the same stress, the Y-axial displacement of the anterior lag screw group was the smallest, showing a significant difference with the lateral plate group and the posterior plate group, while there was no significant difference between the lateral plate group and the posterior plate group in the Y-axial displacement. The stresses on marked points in the anterior lag screw group were evenly distributed. Conclusions For fixation of isolated posterolateral fractures of the tibial plateau, the anterior 6.5 mm lag screw can effectively increase the axial stability and balance the stress distribution around the fracture block, indicating it is an effective method for mechanical fixation. The lateral plate has certain advantage in lateral stability control, while the posterior plate has certain value to reduction of the posterior tibia plateau fracture.