Axillary management based on American college of surgeons oncology group Z0011 criteria makes it possible to omit intraoperative diagnosis of sentinel lymph nodes in early breast cancer patients

The ACOSOG Z0011 trial has resulted in the omission of axillary lymph node dissection (ALND) in early breast cancer patients with one or two metastatic sentinel lymph nodes (SLNs). There has been increasing interest in the necessity of intraoperative assessment of SLNs in patients treated based on the Z0011 criteria. We evaluated the utility of intraoperative assessment in these eligible patients. A total of 1396 patients were treated following the Z0011 criteria from April 2012 to December 2019. We examined the proportion and clinicopathological features of patients who underwent ALND due to three or more metastatic SLNs and the sensitivity of intraoperative assessment. Only 16 (1.1%) patients had three or more metastatic SLNs diagnosed by intraoperative assessment, and they immediately underwent ALND. Of the clinicopathological factors, high clinical tumor stage (p = 0.002) and high Ki-67 labeling index value (p = 0.056) were more likely to be associated with the presence of three or more metastatic SLNs. The major independent risk factor for three or more metastatic SLNs was high clinical tumor stage (OR 3.94 [95% CI 1.42–11.0]; p = 0.009). Intraoperative assessment had low sensitivity (70.5%) and a high false-negative rate (29.5%) in detecting SLN metastases. The main finding of our study was the small proportion of patients who required ALND due to three or more metastatic SLNs according to the Z0011 criteria. The Z0011 strategy enables intraoperative assessment of SLNs to be omitted in early breast cancer patients.     

进展期低位直肠癌新辅助放化疗后侧方淋巴结清扫的选择和意义

侧方淋巴引流是低位直肠癌3个重要的淋巴引流方向之一。沿引流途径清扫淋巴结是直肠癌根治术基本要求,也决定淋巴结清扫范围。但侧方淋巴结是区域淋巴结还是远处淋巴结,一直存在争议。这带来新辅助放化疗和侧方淋巴结清扫、以及新辅助放化疗对侧方淋巴结转移疗效的争议。笔者综合分析国内外研究进展,对直肠癌侧方淋巴结转移规律、影响侧方淋巴结转移复发危险因素以及放化疗前后MRI检查对侧方淋巴结评估等进行深入阐述,并结合临床实践,探讨进展期低位直肠癌新辅助放化疗后侧方淋巴结清扫的选择和意义。     

食管癌早癌内镜黏膜下剥离术后发生食管狭窄的危险因素分析及预测模型建立

目的 分析食管癌早癌内镜黏膜下剥离术(ESD)后发生食管狭窄的危险因素并建立相应的预测模型。方法 回顾性分析六安市人民医院消化内科于2018年6月至2021年12月收治的52例符合标准的早期食管癌患者病理和临床资料,根据患者术后是否发生食管狭窄分为狭窄组(n=15例)与非狭窄组(n=37例)。比较两组患者基线资料,分析筛选获得与术后发生食管狭窄有关的指标,再将有关指标纳入多因素logistic回归分析中得出影响术后发生食管狭窄的独立因素,并基于上述因素对应系数构建线性回归模型,采取受试者工作特征(ROC)曲线评估模型的预测价值,选择拟合优度检验评判预测值与实际值的一致性情况。结果 两组患者固有肌层损伤、病变环周范围、肿瘤浸润深度、剥离的纵径长度比较,差异有统计学意义(均P<0.05)。多因素logistic回归分析结果提示有固有肌层损伤(OR=4.310,95%CI:2.307～8.055)、病变环周范围>3/4环周(OR=12.820,95%CI:3.781～43.470)、肿瘤浸润深度进展至M3～SM1期(OR=6.482,95%CI:2.747～15.294)、长剥离...     

黄体酮对兔离体主动脉平滑肌张力的影响

目的　观察黄体酮对KCl去极化引起的兔离体主动脉肌条收缩作用的影响 ,并探讨其作用与内皮细胞的关系。方法　制备家兔离体主动脉平滑肌条 ,置于灌流肌槽中 ,记录肌条的张力变化。结果　黄体酮 (5、5 0和 10 0 μmol·L- 1)使KCl量效曲线明显右移 ,最大反应压低 ,KCl的EC50 由对照 (36.4± 19.7)mmol·L- 1依次变为 (4 0 .3± 19.6)、(4 3.4± 2 0 .9)和 (5 9.0± 2 0 .1)mmol·L- 1(r =0 .94 ,P <0 .0 5 ) ;83.3μmol·L- 1黄体酮使KCl 2 5 .1mmol·L- 1预收缩胸主动脉肌条明显舒张 (P <0 .0 0 1) ;去内皮后 ,此舒张作用明显减弱。结论　黄体酮可使兔胸主动脉血管平滑肌条舒张 ,其作用可能是通过抑制血管平滑肌细胞膜上的电压依赖性钙通道 ,并与内皮细胞存在有关     

Role of lateral neck dissection in cancers of the larynx and hypopharynx with No neck

Radical neck dissection is a standard procedure carried out for the teatment of palpable nodes in the neck but if carried out electively in cases where there are no palpable nodes in the neck it is considered to be an overtreatment with its associated morbity. Lateral neck dissection was carried out on twenty patients who had T31 T4 lesion of the larynx and hypophar-vnx with NO neck. The dissection entails removal of Level II. III and IV nodes. Occult metastasis 80% and 85% respectively. The mean follow up was 13 monts. It appears from our study that elective lateral neck dissection is a promising and safe procedure and may be useful as an important prognostic tool in sampling the lymph nodes and predicting recurrences in the neck.     

Ionic and haemodynamic changes influence the release of the excitatory amino acid glutamate in the posterior hypothalamus

The push-pull technique was used to investigate the release of the excitatory amino acid glutamate in the posterior hypothalamic area of the conscious rat. The hypothalamus was superfused through the pushpull cannula with artificial cerebrospinal fluid (CSF), and the superfusate was collected in time periods of 10 min when ionic conditions in the CSF were changed, or in short periods of 3 min when blood pressure changes were evoked. The mean glutamate release rate was 2.8 + 0.7 pmol/min. Depolarization by hypothalamic superfusion with CSF containing 50 mM K⁺ enhanced the release of glutamate in the presence of Ca²⁺. The K⁺-induced release was attenuated by 40% when the hypothalamus was superfused with Ca²⁺-free CSF. Replacement of Ca²⁺ by Mg²⁺ abolished the K⁺-induced release of glutamate. Hypovolaemia elicited by haemorrhage enhanced the release rate of glutamate. Similarly, a hypotension elicited by i.v. injection of chlorisondamine (3 mg/kg) led to a pronounced and permanent enhancement in glutamate release. The effects of hypovolaemia and chlorisondamine on glutamate release were abolished in aortic denervated rats, indicating that this response is due to a decrease of impulse generation in baroreceptors. A hypovolaemia elicited by blood infusion did not affect the release of glutamate. Similarly, a pronounced pressor response to phenylephrine (15 /kg per minute) infused intravenously for 9 min was ineffective.The results show that the K⁺-induced release of glutamate in the hypothalamus is dependent on the presence of Ca²⁺. The increase in glutamate release rate by hypovolaemia or chlorisondamine suggests that the glutamatergic neurons in the posterior hypothalamic area respond to unloading of aortic baroreceptors and possess a counteracting, hypertensive function.