No abstract

The impact of calcification in patients with breast carcinoma treated with breast-conserving surgery (BCS) is unclear. The present study aimed to determine the outcome of breast cancer patients with calcification treated with BCS. The records of 409 patients with breast carcinoma treated with BCS from January 2005 to December 2008 were reviewed. Patients were categorized as those with calcification (on mammography or ultrasonography), or those without calcification (neither on mammography nor ultrasonography). The local relapse free survival time (LRFS), disease free survival time (DFS) and overall survival time (OS) were compared, and subgroup analysis was performed based on morphological types and distribution patterns of mammographic calcification. Survival analysis demonstrated that patients with calcification had a significantly increased risk of local recurrence, distant metastasis and mortality compared with those without calcification [relative risk (RR) and 95% confidence interval (CI): local recurrence, 2.46 and 1.11–5.44; distant metastasis, 2.24 and 1.19–4.24; mortality, 2.50 and 1.06–5.86]. Subgroup analysis revealed that the distribution patterns (rather than morphological types of calcification) accounted for the increased risk of recurrence following BCS. Patients with mammographic calcification of liner/segmental distribution had significantly decreased LRFS (RR=6.20; 95% CI, 2.26–16.98), DFS (RR=6.81; 95% CI, 2.86–16.20) and OS (RR=9.14; 95% CI, 2.53–33.00), while patients with mammographic calcification of clustered distribution did not have significantly decreased LRFS, DFS and OS (P>0.05), compared with those without calcification. In addition, the mammographic calcification spreading along the ducts was more likely to be accompanied by an extensive intraductal component (P<0.001). Finally, the outcome of patients with calcification on breast ultrasound was as good as those without calcification. Patients with mammographic calcification, particularly those with calcification spreading along the ducts, have a higher risk of recurrence following BCS, which has a negative impact on long-term survival. Calcification identified on breast ultrasonography does not affect the survival of patients treated with BCS.

Background: To determine the safely and effectively of del Nido cardioplegia (DNC) in surgery for aortic root disease, with mild hypothermic cardiopulmonary bypass (CPB). Methods: From July to December 2017, all patients undergoing the surgery for aortic root disease (total aortic root replacement, valve-sparing aortic root replacement and replacement of aortic valve plus ascending aorta), with mild hypothermic CPB, were retrospectively reviewed at our institution. Patients were divided into two groups based on the type of cardioplegia: the classical blood cardioplegia (CBC group) and del Nido cardioplegia (DNC group). Demographics, operative details, perioperative data and postoperative complications were recorded and compared. A propensity score matching was performed in this study. Results: The preoperative data in DNC group were similar to CBC group. The volume of ultrafiltration was lower in DNC than CBC group (2,053.49±806.62 DNC vs. 2,666.00±967.14 CBC, P=0.001), when matched. The use of temporary pacemaker was more in DNC group (n=20, 46.5%, P=0.023), and the rate of automatic heart resuscitating was higher in the CBC group (92.0% vs. 72.1% DNC group, P=0.024, unmatched).There were no differences in in-hospital mortality, troponin T (mean 0.66 ng/mL for CBC group vs. 0.49 ng/mL for DNC group, P=0.152), left ventricular ejection fraction (mean 58.37% for CBC group vs. 60.07% for DNC group, P=0.395) or other postoperative complications between two groups, after matching. In subgroup analysis, the ultrafiltration volume was lower in DNC than CBC group (1,932.26±749.39 DNC vs. 2,640.00±996.24 CBC, P=0.004), when ACC time less than or equal to 90 minutes. The apache score was better in DNC group (4.75±3.41, P=0.041), when ACC time greater than 90 min. There were no statistical significances in other characteristics between groups.Conclusions: DNC is safe and effective for surgery for aortic root disease, not inferior to the CBC.