Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study

ObjectiveTo investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial.MethodsSurvivors (aged 35–68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors’ HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors.ResultsThe decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference −0.017, 95% CI: −0.031 to −0.004). The older survivors’ mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference −0.019, 95% CI: −0.031 to −0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up.ConclusionsHRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.     

Fertility preservation in patients of childbearing age treated for breast cancer: A nationwide cohort study

BackgroundApproximately 7% of breast cancers are diagnosed in women under 40. Question of subsequent fertility has become fundamental. We aimed to evaluate the rate of fertility preservation (FP) by oocyte retrieval (OR) after ovarian stimulation in patients of childbearing age, managed for breast cancer with adjuvant chemotherapy in France, reuse rate of frozen gametes and live births rate (LBR) after treatment.MethodsWe included 15,774 women between 18 and 40 years old, managed by surgery and adjuvant chemotherapy for breast cancer, between January 2011 and December 2020 from a French health registry. Patients with OR after breast surgery and before chemotherapy were considered as FP group; those with no OR as no FP group. To compare LBR with French population independently of age, we calculated Standardized Incidence Rates (SIR) of live births using indirect standardization method.ResultsFP rate increased gradually since 2011, reaching 17% in 2019. A decrease in use was observed in 2020 (13,9%). Among patients with at least 2 years of follow-up, gamete reuse rate was 5,6%. Births after cancer were mostly from spontaneous pregnancies. Among patients with at least 3 years of follow-up, LBR was 19,6% in FP group, 3,9% in second group. SIR of live births was of 1,05 (95% CI = 0.91–1.19) and 0.33 (95% CI = 0.30–0.36) in FP and no FP group respectively.ConclusionOncofertility activity increased until 2019 in France, reaching 17%. Gamete reuse rate was low. Births resulted mainly from spontaneous pregnancies. SIR of live births was lower in no FP group.     

缺氧对乳腺癌细胞E-cadherin、cytokeratin、vimentin表达的影响

目的:研究体外缺氧对乳腺癌细胞系MCF7浸润能力及其细胞表面黏附分子E-cadherin和细胞骨架蛋白犤细胞角蛋白(cytokeratin)、波形蛋白(vimentin)犦表达的影响。方法:模拟体外缺氧环境,观察缺氧对乳腺癌细胞MCF7浸润穿透Matrigel的能力;以及采用半定量RT-PCR检测细胞表面黏附分子E-cadherin和cytokeratin、vimentin表达情况。结果:缺氧状态下MCF7细胞的浸润能力明显增强;且在缺氧条件下E-cadherin基因表达下降、cytokeratin、vimentin基因表达升高。结论:缺氧状态下MCF7细胞转移能力和其表面的E-cadherin基因、cytokeratin、vimentin基因表达存在一定关系。     

颗粒松质骨压紧植骨全髋关节置换术治疗创伤性髋关节炎的疗效

目的探讨颗粒松质骨压紧植骨全髋关节置换术(THA)治疗髋臼骨折继发创伤性髋关节炎的疗效。方法1998年12月-2005年5月,对15例髋臼骨折继发创伤性髋关节炎患者行颗粒松质骨压紧植骨THA,所有患者髋臼假体均采用骨水泥固定,颗粒骨均取自体骨,术后24h后开始被动活动,3个月后开始全负重锻炼。临床随访采用Harris髋关节评分(HSS)系统评分,对任何原因引起髋臼假体翻修均视为临床失败。根据Conn等影像学评价法观察颗粒骨长人情况,根据DeLee的三区法测量臼杯、骨水泥与移植骨间的界面宽度,臼杯的移位程度则依据其相对于泪点间线的距离而定。结果14例患者获得平均4．3年(1．0-7．5年)随访,HHS评分由术前平均42分(10-62分)提高到随访结束时平均84分(58-98分)。1例髋部有轻度疼痛,无患者行翻修手术。大部分髋部恢复了其正常的旋转中心,仅有2例高出对侧0．8 mm。大多数患者影像学表现稳定,2例在Ⅰ区和Ⅲ区出现进行性增宽的透亮带,1例在Ⅲ区出现非进行性增宽的透亮带。1例臼杯假体在术后7年出现明显移位(6 mm),但并没有行翻修手术。结论颗粒骨压紧植骨技术作为一种生物学髋臼重建方法,其联合THA治疗髋臼骨折后继发创伤性关节炎伴髋臼缺损的疗效令人满意,能够恢复髋关节的正常解剖和功能活动。     

颈前入路相关结构三维可视化研究

目的：建立颈前入路相关结构的三维可视化模型。方法：选取首例中国数字化可视人体数据集中第3颈椎上缘至第7颈椎下缘的连续薄层断面图像。运用3D—DOCTOR软件，在计算机上分割重建该手术入路相关的解剖结构并立体显示。结果：成功重建并立体显示第3～7颈椎、椎间盘、脊髓、颈神经、椎动脉、颈长肌、喉（气管）、咽（食管）、颈总动脉（颈内、外动脉）、颈内静脉、迷走神经和胸锁乳突肌等解剖结构的位置关系，建立了颈前入路相关结构的三维可视化模型。结论：在颈部三维可视化模型基础上，参照颈前入路手术步骤可逐层显示该手术相关的重要结构．为该手术的术前训练和模拟提供形态学依据。     

骶骨肿瘤切除ISOLA重建骨盆环稳定

目的探讨骶骨肿瘤切除术后应用ISOLA重建骨盆环稳定的疗效。方法手术治疗32例骶骨肿瘤患者。肿瘤切除后均应用ISOLA行腰骶部内固定植骨融合,其中24例行前后联合入路,结扎双侧髂内动脉;8例行单纯后路肿瘤切除植骨融合内固定。结果术后经过6个月～5年的随访,术后感染去除内固定1例,因肿瘤复发死亡3例,再手术3例,失访5例,余患者术后症状均明显改善,植骨融合好,骨盆环稳定,内固定物无松动,未发现断钉断棒现象。结论骶骨肿瘤切除术后应用ISOLA重建下腰椎及骨盆环稳定,疗效满意。     

假体隆乳术后形态不佳的矫治

目的探讨假体置入隆乳术后形态不佳的原因和矫治方法。方法根据临床表现将乳房不佳分为5种类型：圆球型、上部膨隆型、下坠型、单侧双乳型及不规则型。通过松解纤维囊、纤维囊折叠缝合、重新分离隆乳腔隙、更换假体、乳房悬吊术等方法，进行矫治再次隆乳术。结果经过至少6个月随访观察，本组106例均获得了满意的手术效果。结论隆乳术后乳房形态不佳主要与假体体积过大、腔隙分离不到位、假体移位、乳房下皱襞过度分离、纤维囊挛缩及引流、包扎位置不当等因素有关，针对不同原因实施相应的手术方法矫治，能够获得满意的手术效果。     

股骨重建钉在股骨粗隆下骨折手术中的应用

[目的]探讨股骨重建钉（RIN）治疗股骨粗隆下骨折（SFF）的手术方法及临床疗效。[方法]1998年6月-2005年5月，采用RIN技术对4JD例SFF患者进行固定，其中男27例，女13例；年龄22．．75岁。平均43．5岁。依据Seinsheimer分类：Ⅱ型5例，Ⅲ型13例，Ⅳ型21例，Ⅴ型1例。高能量损伤33例，低能量损伤7例。开放性骨折3例。[结果]4JD例随访8个月-2a6个月，平均1a8个月。X线片观察骨折愈合时间4．2月（3．2-6．5月）。按照韩一生评分标准，优26例，良12例，可2例，优良率95％。无感染、内固定失效、畸形愈合及股骨头缺血性坏死等并发症。[结论]RIN技术是治疗SFF的一种有效方法，具有固定可靠、并发症少、骨折愈合率高等优点。精细的手术操作是手术成功的关键。     

弹性绷带在乳腺癌术后应用的效果观察

目的　观察弹性绷带在乳腺癌术后应用效果。方法　 4 8例乳腺癌根治术后应用弹性绷带包扎为实验组 ,4 5例用普通宽绷带包扎为对照组。然后 ,对两组患者术后并发症进行观察。结果　实验组患者的并发症明显低于对照组 ,两组比较有显著性差异 ,P <0 .0 5。结论　应用弹性绷带包扎 ,能明显减少并发症的发生 ,促进切口愈合 ,使患者术后术侧上肢功能锻炼可以提早进行。