ObjectiveTo analyze the clinicopathologic features of elderly patients with triple-negative breast cancer (TNBC) and explore the influencing factors of postoperative prognosis.MethodsThe TNBC patients who were pathologically confirmed in the Affiliated Hospital of Southwest Medical University from January 1st, 2013 to January 1st, 2014 were retrospectively collected. The differences of clinicopathologic characteristics bwteeen elderly and young and middle-aged patients (according to the standard of 65 years old) were analyzed. At the same time, Cox risk regression model was used to analyze the prognostic factors of elderly patients with TNBC.ResultsA total of 142 patients with TNBC were collected, including 53 elderly patients and 89 young and middle-aged patients. There were no significant differences in terms of family history, histological grade, clinical TNM stage, T stage, axillary lymph node status, and postoperative chemotherapy between the elderly patients and young and middle-aged patients (P>0.05). The rate of breast conserving surgery in the young and middle-aged patients was higher than that in the elderly patients (χ2=4.665, P=0.031). All patients were followed up to 60 months, the recurrence and metastasis rate and the mortality of the elderly patients were lower than those of the young and middle-aged patients (recurrence and metastasis rate: 30.2% versus 47.2%, χ2=3.974, P=0.046; mortality: 11.3% versus 28.1%, χ2=5.474, P=0.019), and the 5-year disease-free survival rate and 5-year overall survival rate of the elderly patients were higher than those of the young and middle-aged patients (5-year disease-free survival rate: 69.8% versus 52.8%, χ2=4.106, P=0.037; 5-year overall survival rate: 88.7% versus 71.9%, χ2=5.209, P=0.022). The tumor T stage (χ2=14.806, P=0.001) and status of axillary lymph node metastasis (χ2=8.149, P=0.043) were associated with postoperative recurrence and metastasis in the elderly patients with TNBC by univariate analysis, and which were the independent risk factors for the recurrence and metastasis in the elderly patients with TNBC by multivariate analysis.ConclusionsPrognosis of elderly patients with TNBC is better than that of young and middle-aged patients. Tumor T stage and axillary lymph node status are independent risk factors affecting prognosis of elderly patients with TNBC.
Objective To determine the effects of controlled hypotension (CH) on cerebra1 blood flow, cerebra1metabolism, and cognitive functions. Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to 2008), EMbase (1974 to 2008), The Cochrane Library (Issue 2, 2008), CBM (1978 to 2008), and CNKI (1994 to 2008). The quality of included trials was assessed by two reviewers independently. RevMan 4.2.7 software provided by The Cochrane Collaboration was used for statistical analysis. Results Nine RCTs involving a total of 295 patients were included. Most of the studies were of poor methodological quality. Meta-analysis was performed because the outcomes were the comparisons of the means of several repeated measures, and so a descriptive analysis was conducted. There were no significant differences in cerebral blood flow velocity, hypoxia-induced metabolites, and cognitive function between the CH group and the control group (Plt;0.05). But the S100B protein level in cerebrospinal fluid or blood was significantly higher in the CH group than that in the control group (Plt;0.02). Conclusion CH has no adverse effects on cerebra1 blood flow, cerebra1 metabolism, or cognitive functions. But isoflurane-induced hypotension may increase the release of S100B, indicating worse brain injury. The above conclusions were made from the limited evidence, and more rigorous RCTs are needed.
Objective To systematically assess the effectiveness and safety of ProSeal laryngeal mask (PLMA) compared to endotracheal tube (TT) for airway management in the patients undergoing laparoscopic biliary tract surgery.Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers (CCTR) of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneitystudies. Results Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that: ① Side effects: none of the patients experienced regurgitation or hypoventilation. ② PLMA was superior to TT in terms of less postoperative sore throat (OR=0.27, 95%CI 0.13 to 0.53, P=0.0002) and response during extubation (OR=0.01, 95%CI 0.00 to 0.03, Plt;0.00001). ③ PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation (Ppeak: WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; PetCO2: WMD=0.01, 95%CI -0.58 to 0.59, P=0.99) and ease of insertion (OR=0.58, 95%CI 0.23 to 1.47, P=0.25). ④ Hemodymatics changed during the procedure: PLMA was more stable than TT. Conclusion It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.
Objective To assess the efficacy and safety of nerve-stimulator-guide needle placement in the peripheral nerve blockade. Methods The Cochrane Library, MEDLINE, OVID, VIP, CNKI and CBM were searched. The quality of the included studies was evaluated by three reviewers, and meta-analysis was performed. Results Twenty studies involving 1 287 participants related to needle placement in the peripheral nerve blockade were included. There were only 2 studies that described a detailed randomization method and allocation concealment and blinding, and the others were inadequate. Meta-analysis based on the included studies showed that: ① Absolute success ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR= 4.05, 95%CI 2.57 to 6.36, Plt;0.00001) and anatomy localization (OR=30.3, 95%CI 1.73 to 532.74, P=0.02), but lower than ultrasound-guide-localization (OR=0.27, 95%CI 0.10 to 0.74, P=0.01). ② Onset time of the block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD= –1.70, 95%CI –?4.50 to 0.95, P=0.08), faster than arteriopalmus localization (WMD= 8.38, 95%CI 0.72 to 16.04, Plt;0.000 01), but slower than ultrasound-guide-localization (WMD= 8.38, 95%CI 0.72 to 16.04, P=0.04). ③ Ratio of complication associated to block: nerve-stimulator-guide was similar to eliciting paraesthesia (OR= 1.01, 95%CI 0.55 to 1.86, P=0.97), anatomy localization (WMD= 0.06, 95%CI 0.00 to 1.21, P=0.07) and arteriopalmus localization (WMD= 8.82, 95%CI 0.10 to 4.11, P=0.65), but higher than ultrasound-guide-localization (OR= 5.03, 95%CI 1.74 to 14.49, P=0.003). ④ Time to block: nerve-stimulator-guide was similar to eliciting paraesthesia (WMD=0.02, 95%CI –0.46 to 0.51, P=0.92), shorter than arteriopalmus localization (WMD= –4.00, 95%CI –5.58 to –2.42, Plt;0.000 01) and longer than ultrasound-guide-localization (WMD= 1.90, 95%CI 0.47 to 3.33, P=0.009). ⑤ Patient-accepted ratio: nerve-stimulator-guide was higher than eliciting paraesthesia (OR=2.32, 95%CI 1.02 to 5.30, P=0.05), and similar to arteriopalmus localization (OR=8.14, 95%CI 0.88 to 75.48, P=0.06). Conclusion Nerve-stimulator-guide location is a precise, effective and safe localization method. Due to moderate risk of selection bias and detection bias of included studies, the evidence is not b. Our results suggest that well-designed double-blind randomized controlled and larger-scale trials on the use of nerve stimulator in the peripheral nerve block are needed.
ObjectiveTo compare the clinicopathological features of Luminal A breast cancer patients in early and middle stage, and locally advanced Luminal A breast cancer, then the influencing factors of disease-free survival (DFS) in locally advanced Luminal A breast cancer patients were further discussed.MethodsFrom January 2010 to December 2012, 295 Luminal A breast cancer patients who completed diagnosis, treatment, and follow-up in our hospital were retrospectively collected. According to TNM stage, 227 cases of early and middle breast cancer and 68 cases of locally advanced breast cancer were divided into two groups. Chi-square test or rank sum test was used to compare the clinicopathological characteristics of patients between the two groups, and log-rank test and Cox proportional risk regression model were used to explore the influencing factors of 5-year DFS situation in patients with locally advanced Luminal A breast cancer.ResultsT stage and N stage were later in locally advanced Luminal A breast cancer patients than that of the early and middle breast cancer patients (P<0.05), and the tumor grade was higher in locally advanced Luminal A breast cancer patients (P<0.05). The 5-year DFS rate was 87.8% (259/295). In this study, there were5 comprehensive treatment schemes as follows: neoadjuvant chemotherapy + surgery + radiotherapy + endocrine therapy, neoadjuvant chemotherapy + surgery + endocrine therapy, surgery + chemotherapy + radiotherapy + endocrine therapy, surgery + chemotherapy + endocrine therapy, and surgery + radiotherapy + endocrine therapy. The 5-year DFS rate of locally advanced Luminal A breast cancer patients was lower than that of the early and middle Luminal A breast cancer patients (76.5% vs. 91.2%, P=0.001). Univariate analysis showed that T stage (χ2=8.248, P=0.040), N stage (χ2=9.470, P=0.024), vascular invasion (χ2=4.211, P=0.031), and tumor grade (χ2=6.985, P=0.030) were the factors influencing the5-year DFS situation of locally advanced Luminal A breast cancer patients. Multivariate analysis showed that T staging (HR=5.062, P<0.001) and N staging (HR=7.075, P<0.001) were the influencing factors for 5-year DFS situation in locally advanced Luminal A breast cancer patients. The later the T stage and N stage, the worse the 5-year DFS situation.ConclusionsT stage and N stage are independent risk factors for prognosis of patients with locally advanced Luminal A breast cancer. Individualized comprehensive treatment program is an important guarantee for improving the 5-year DFS rate of this kind of patients.