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Contralateral prophylactic mastectomy rate stable at major Canadian breast cancer center

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World Journal of Clinical Oncology 2016年第3期7卷 302-307页

作者： Amanda Roberts Lakhbir Sandhu Tulin D Cil stefan O P hofer Toni Zhong Department of Surgery University of Toronto Division of General Surgery University Health Network and Women’s College Hospital Division of Plastic and Reconstructive Surgery University Health Network Toronto General Hospital

AIM: To examine trends of contralateral prophylactic mastectomy(CPM) rates at a Canadian academic breast cancer ***: A single-institution retrospective cohort study was completed. Women of any age who underwent at least a unilateral mastectomy(UM) for primary unilateral breast carcinoma between January 1, 2004 and December 31, 2010 were included. Patients who underwent CPM on the same day as UM were isolated to create two distinct cohorts. Patient and procedure characteristics were compared across groups using R software(version 3.1.0). The percentage of CPMs per year was determined. The Cochrane-Armitage test was used to assess the trend of CPMs over time. A P value of < 0.05 was considered ***: A total of 811 women met the inclusions/exclusion criteria; 759(93.6%) underwent UM alone and 52(6.4%) underwent UM with immediate CPM. The absolute number of procedures(UM and UM + CPM) increased over time, from 83 in 2004 to 147 in 2010 reflecting an increase in mastectomy volume. Annual CPM rates did not increase over time(P = 0.7) and varied between 2.6% to 10.7%. Family history of breast cancer [OR 3.6(1.8-7.3)] and immediate reconstruction [10.0(5.2-19.3)] were both significantly associated with CPM. Women who underwent CPM were younger(median age CPM 49 years vs UM 52 years, P < 0.0001) but age less than 50 years was not statistically associated with increased rates of CPM. CONCLUSION: CPM rates from 2004 to 2010 at a high-volume Canadian breast cancer center did not increase over time, in contrast to trends observed in the United States.

关键词： Breast Oncology Prophylactic Mastectomy Surgery

AME证据系列001--转化医学协会:脓毒症诊断和早期识别的临床实践指南

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临床与病理杂志 2016年第10期36卷 1467-1476页

作者： Zhongheng Zhang Nathan J.Smischney Haibo Zhang Sven Van Poucke Panagiotis Tsirigotis Jordi Rello Patrick M.Honore Win Sen Kuan Juliet June Ray Jiancang Zhou You Shang Yuetian Yu Christian Jung Chiara Robba Fabio Silvio Taccone Pietro Caironi David Grimaldi stefan hofer George Dimopoulos Marc Leone Sang-Bum Hong Mabrouk Bahloul Laurent Argaud Won Young Kim Herbert D.Spapen Jose Rodolfo Rocco 张建成(译) 尚游(译) 钟鸣(校) Department of Emergency Medicine Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016 Department of Critical Care Medicine Jinhua Hospital of Zhejiang UniversityJinhua Zhejiang 321000 Department of Anesthesiology Mayo ClinicRochesterMNUSA Keenan Research Center for Biomedical Science of St.Michael's Hospital Departments of Anesthesia and PhysiologyInterdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoONCanada Departments of Anesthesiology Critical CareEmergency Medicine and Pain TherapyZiekenhuis Oost-Limburgy GenkBelgium 2nd Department of Internal Medicine Attikcon University HospitalMedical SchoolNational and Kapodistrian University of AthensAthensGreece CIBERES Vall d'Hebron Institut of ResearchUniversitat Autonoma de BarcelonaSpain Universitair Ziekenhuis Brussely Vrije Universiteit Brussel Brussels BrusselsBelgium Emergency Medicine Department National University HospitalNational University Health SystemSingapore and the Department of SurgeryYong Loo Lin School of MedicineNational University of SingaporeSingapore DeWitt Daughtry Family Department of Surgery Jackson Memorial HospitalUniversity of Miami Leonard M.Miller School of MedicineMiamiFLUSA Department of Critical Care Medicine Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016 Department of Critical Care Medicine Union HospitalTongji Medical CollegueHuazhong University of Science and TechnologyWuhan 430022 Department of Critical Care Medicine Renji HospitalShanghai Jiao Tong University School of MedicineShanghai 200001 University Hospital Dusseldorf Heinrich-Heine-University DusseldorfMedical FacultyDivision of CardiologyPulmonology and Vascular MedicineDusseldorfGermany Neurosciences Critical Care Unit Addenbrooke's HospitalCambridgeUK Department of Intensive Care Hopital ErasmeUniversite Libre de Bruxelles(ULB)BrusselsBelgium Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti Fondazione IRCCS Ca'Granda-Ospedale

脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊... 详细信息

脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。

关键词：脓毒症早期识别诊断

Self-Sensing and –Actuating Probes for Tapping Mode AFM Measurements of Soft Polymers at a Wide Range of Temperatures

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Journal of Modern Physics 2011年第2期2卷 72-78页

作者： Nadejda B. Matsko Julian Wagner Anton Efimov Ines Haynl stefan Mitsche Wolfgang Czapek Boris Matsko Werner Grogger Ferdinand hofer 不详

Self-sensing and –actuating probes optimized for conventional tapping mode atomic force microscopy (AFM) are described. 32-kHz quartz tuning forks with a chemically etched and focus ion beam (FIB) sharpened (curvature radii are 5-10 nm) tungsten tip are stable at air and liquid nitrogen atmosphere and at a wide range of temperatures. If driven at constant frequency, the scan speed of such sensors can be up to 3 Hz. AFM was performed on polymer samples in order to study the stability and applicability of these sensor for investigation of soft materials with high dynamical tendencies.

关键词： Tuning Fork Sharp Tungsten Tip AFM Tapping Mode Soft Materials

无细胞真皮基质在腹壁重建中的应用：对当前证据的系统回顾

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中国美容整形外科杂志 2013年第3期24卷 I0005-I0005页

作者： Jeffrey E.Janis. AnneC.0’Neill. Jamil Ahmad ToniZhong stefan 0.P.hofer 美国德克萨斯州达拉斯德克萨斯大学西南医学中心整形外科加拿大安大略州多伦多多伦多大学外科部整形与再造外科中心大学医疗网络外科与肿瘤外科部整形外科中心

背景与目的前腹壁再造手术是一个复杂的过程，其可因污染而使创面复杂，以及区域组织缺损、之前形成的瘢痕或放射治疗、局部组织可用性差。临床中引入无细胞真皮基质的应用，与之前的合成材料联合可以解决上述多种问题。无细胞真皮基质... 详细信息

背景与目的前腹壁再造手术是一个复杂的过程，其可因污染而使创面复杂，以及区域组织缺损、之前形成的瘢痕或放射治疗、局部组织可用性差。临床中引入无细胞真皮基质的应用，与之前的合成材料联合可以解决上述多种问题。无细胞真皮基质较强的生物相容性使其可与周围组织融合，以对抗感染、挤压、腐蚀和黏附。方法以“真皮基质（dermalmatrix）”或“人源性真皮（humandermis）”或“猪源性真皮（porcineder-mis）”或“牛源性真皮（bovinedermis）”为检索词，检索MEDLINE数据库自2011年12月31日起的所有文献，限定检索为“人类（human）”和“英语语言（Englishlanguage）”。选取前瞻I生及回顾性的临床研究文献。结果检出40篇合格文献作为本次回顾研究对象。35篇文献的证据等级为Ⅳ级，其余5篇为Ⅲ级。无细胞真皮基质用于腹壁再造的多个临床方面，包括创伤、肿瘤切除、脓毒血症以及疝修复。各个临床研究中包含多种手术方法。然而，由于患者群组的多样性和技术说明的相关数据的有限性，所以关注于对应用无细胞真皮基质修复后疝复发的高发生率。结论我们尚需要取自证据水平I、Ⅱ、Ⅲ级研究的高质量数据来明确无细胞真皮基质的适应证，为腹壁重建提供理想的外科手术方法，以最大程度地提高疗效。（循证医学证据等级：疗法，Ⅳ级）

关键词：无细胞真皮基质证据等级前腹壁 MEDLINE数据库系统回顾应用重建临床研究文献

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面动脉穿支皮瓣修复口周缺损

中国美容整形外科杂志 2013年第5期24卷 I0018-I0018页

作者： stefan O. P. hofer Nicole A. Posch Xander Smit 朱利娜(译) 魏峰(译) 高景恒(译) 伊拉斯谟大学鹿特丹医学中心整形再造和手外科荷兰鹿特丹港市《中国美容整形外科杂志》编辑部

背景面动脉穿支皮瓣概念的发展，让口周缺损的修复术有更多的自由性。面动脉的单个穿支可以为面部皮肤较大面积的带蒂穿支皮瓣供血。方法对5个新鲜尸体的10个面动脉注射填充液，并解剖，研究面动脉穿支的分布、数量、长度和直径。对5例... 详细信息

背景面动脉穿支皮瓣概念的发展，让口周缺损的修复术有更多的自由性。面动脉的单个穿支可以为面部皮肤较大面积的带蒂穿支皮瓣供血。方法对5个新鲜尸体的10个面动脉注射填充液，并解剖，研究面动脉穿支的分布、数量、长度和直径。对5例肿瘤相关的口周缺损患者实施面动脉穿支皮瓣修复术。其中2例额外使用局部皮瓣。外科技术以美学单位原则和多普勒超声识别的面动脉为依据，面动脉作为识别相应面动脉穿支的标志。结果尸体解剖发现大量的均匀分布的面动脉穿支（平均5．7；范围3～9）。平均穿支长度为25．2mm（13．0～51．0mm）。平均穿支直径为1．2mm（0．6～1．8mm）。所有临床病例中，相应的面动脉穿支符合再造术的需求。皮瓣旋转180°。4例皮瓣全部存活。1例皮瓣显示较小的远端坏死。结论因为面动脉穿支皮瓣具有穿支较恒定、较大幅度旋转和供体位点美观等优点，其可提供通用的特制皮瓣。因其蒂较薄，其也是Ⅰ期再造术的理想皮瓣，而不需要Ⅱ期修整。

关键词：皮瓣修复术动脉穿支缺损穿支皮瓣尸体解剖面动脉多普勒超声面部皮肤