Comparison of clinical outcomes between patellar resurfacing and nonresurfacing in total knee arthroplasty: retrospective study of 130 cases

OBJECTIVE

To compare clinical outcomes between patellar resurfacing and nonresurfacing in total knee arthroplasty (TKA).

METHODS

Data from osteoarthritis patients who underwent TKA and were followed up for ≥ 9 years were analysed retrospectively. Patients were divided into two groups: patellar nonresurfacing group and patellar resurfacing group. In the nonresurfacing group, the partial lateral facet of the patella was removed, the patella was reshaped to match the trochlea of the femoral prosthesis and circumpatellar denervation was performed. In the resurfacing group, the patella was resurfaced with a cemented component. Clinical outcomes included incidence of anterior knee pain, Knee Society Score, patient satisfaction, revision rate and radiographic findings.

RESULTS

Of the 130 patients included, 71 were assigned to the nonresurfacing group and 59 to the resurfacing group. No significant between-group differences were observed for any clinical outcomes measured. The incidence of anterior knee pain was 14.1% (nonresurfacing group) and 5.1% (resurfacing group). The revision rate was 9.89% (nonresurfacing group) and 3.4% (resurfacing group).

CONCLUSION

Clinical outcomes for patellar nonresurfacing, including patelloplasty and circumpatellar denervation, are similar to those for patellar resurfacing, in TKA.

Observation of a charged charmoniumlike structure in e+ e- → π+ π- J/ψ at sqrt[s] = 4.26 GeV

We study the process ee+ e- → π+ π- J/ψ at a center-of-mass energy of 4.260 GeV using a 525  pb(-1) data sample collected with the BESIII detector operating at the Beijing Electron Positron Collider. The Born cross section is measured to be (62.9±1.9±3.7)  pb, consistent with the production of the Y(4260). We observe a structure at around 3.9  GeV/c2 in the π(±)J/ψ mass spectrum, which we refer to as the Z(c)(3900). If interpreted as a new particle, it is unusual in that it carries an electric charge and couples to charmonium. A fit to the π(±)J/ψ invariant mass spectrum, neglecting interference, results in a mass of (3899.0±3.6±4.9)  MeV/c2 and a width of (46±10±20)  MeV. Its production ratio is measured to be R = (σ(e+ e- → π(±)Z(c)(3900)(∓) → π+ π- J/ψ)/σ(e+ e- → π+ π- J/ψ)) = (21.5±3.3±7.5)%. In all measurements the first errors are statistical and the second are systematic.

Exposure to bisphenol A disrupts meiotic progression during spermatogenesis in adult rats through estrogen-like activity

The effect of bisphenol A (BPA) on the reproductive system is highly debated but has been associated with meiotic abnormalities. However, evidence is lacking with regard to the mechanisms involved. In order to explore the underlying mechanisms of BPA-induced meiotic abnormalities in adult male rats, we exposed 9-week-old male Wistar rats to BPA by gavage at 0, 2, 20 or 200 μg/kg body weight (bw)/day for 60 consecutive days. 17β-Estradiol (E2) was administered at 10 μg/kg bw/day as the estrogenic positive control. Treatments with 200 μg/kg bw/day of BPA and E2 significantly decreased sperm counts and inhibited spermiation, characterized by an increase in stage VII and decrease in stage VIII in the seminiferous epithelium. This was concomitant with a disruption in the progression of meiosis I and the persistence of meiotic DNA strand breaks in pachytene spermatocytes,and the ataxia-telangiectasia-mutated and checkpoint kinase 2 signal pathway was also activated; Eventually, germ cell apoptosis was triggered as evaluated by terminal dUTP nick-end labeling assay and western blot for caspase 3. Using the estrogen receptor (ER) antagonist ICI 182780, we determined that ER signaling mediated BPA-induced meiotic disruption and reproductive impairment. Our results suggest that ER signaling-mediated meiotic disruption may be a major contributor to the molecular events leading to BPA-related male reproductive disorders. These rodent data support the growing association between BPA exposure and the rapid increase in the incidence of male reproductive disorders.

Morphological and Molecular Identification of Cytospora germanica Causing Canker on Populus spp. in China

Species of Cytospora Ehrenb. cause canker and dieback on many genera of hardwoods. During surveys of forest trees in 2004 and 2008, some hardwoods such as Populus spp. with symptoms of canker and dieback were found in Liaoning and Xinjiang provinces, respectively. In these trees, the canker pathogen discolored the sapwood. During wet weather, the conidia were exuded from the fruiting bodies in gelatinous matrices, usually as yellow or orange tendrils. In the spring, the affected trees were wilting and the diffuse cankers spread rapidly and extensively during the period when trees began active spring growth. For saplings, sometimes the death rate of the pathogen has exceeded 50%. Conidiomatal stromata immersed in bark, prominent, circular to ovoid, 1.10 ± 0.23 mm in diameter (n = 10). Discs were white, nearly flat, circular, 0.44 ± 0.04 mm in diameter (n = 10), with one or two ostioles per disc. Ostioles were gray. Locules were subdivided by invaginations into chambers. Conidia were hyaline and lelongate-allantoid shaped, 4 to 5.4 μm long and 1 to 1.4 μm wide. Pieces (5 × 5 mm²) of the junction of affected and healthy tissues were surface sterilized with 1% NaOCl for 30 s and then rinsed twice in sterile distilled water. The fragments were placed on potato dextrose agar (PDA) plates incubated at 25°C for 7 days. The obtained isolates were cultured on PDA at 25°C in diffuse fluorescent light for 30 days, and then were deposited in the culture collection of the Chinese Academy of Forestry. According to these morphological features we initially thought that this pathogen was Cytospora chrysosperma (Pers.) Fr. However, BLAST analysis showed 98% and 99% homology with ITS sequence of isolate CBS118560 (GenBank Accession No. DQ243793), 99% and 100% homology with LSU gene of isolate AR3427 (AF362561) when we amplified ITS-rDNA gene and LSU gene of the isolates. The sequences were submitted to GenBank with the following accession numbers: JQ086563, JQ086564, JX524617, and JX524618. Pathogenicity tests were conducted in the greenhouse by inoculating 20 disinfected (70% ethanol) Populus tomentosa cuttings. Another two cuttings were treated with water agar as controls. The cuttings were incubated at 25°C for 30 days. In 18 of the 20 cuttings, the cambium became brown and appeared water soaked 20 days later, whereas controls did not show any symptoms. C. germanica was reisolated from symptomatic tissues. Inoculations were later repeated two times with similar results. Hubbes (1) and Spielman (2) considered V. germanica (teleomorph of C. germanica) a synonym of V. sordida (teleomorph of C. chrysosperma) based on morphological studies. We almost regarded these isolates as C. chrysosperma too. Morphological identification has been a weak and often inadequate means of identifying Cytospora species (1,2); the present study based on ITS-rDNA gene and LSU gene has substantially elevated identifications. To our knowledge, this is the first report of C. germanica on Populus spp. in China. Populus species are economically important trees in forests of North China and C. germanica has the potential to cause significant economic losses. References: (1) M. Hubbes. Phytopathol. Z. 39:65, 1960. (2) L. J. Spielman. Can. J. Bot. 63:1355, 1985.

17β-estradiol suppresses the macrophage foam cell formation associated with SOCS3

Evidence from clinical trials and animal experiments has shown that estrogen has anti-atherosclerotic effects when administered to young women or experimental animals. The mechanisms involve the modulation of vascular inflammation, growth factor expression, and oxidative stress injured arteries. However, whether estrogen modulates the foam cell formation in plaque remains unknown. Here, we investigated the effects of 17β-estradiol (E2) on cholesterol efflux in vivo and in vitro. ApoE null mice underwent an ovariectomy at 5(th) week of age and then were treated with E2 or vehicle for the following 8 weeks. Compared with the vehicle-treated mice, the serum total cholesterol level, atherosclerotic plaque size, and lipid deposits were decreased and meanwhile ATP-binding cassette transporter A1 (ABCA1) expression in the plaque was increased in mice with E2 treatment. E2 also increased suppressor of cytokine signaling 3 (SOCS3) expression in the atherosclerotic plaques and in RAW264.7 cells. In vitro, E2 treatment reversed janus kinase/signal transducers and activators of transcription (JAK/STAT)-inhibited ABCA1 expression in RAW264.7 cells but had no effect on ABCA1 expression in SOCS3 knockdown cells. SOCS3 overexpression elevated ABCA1 expression through the inhibition of JAK2/STAT3 phosphorylation. Finally, we also found that E2 enhanced the cholesterol efflux to apoA I in RAW264.7 cells. In summary, E2 reduces atherosclerosis in ApoE null mice associated with upregulating ABCA1 expression and modulating the cholesterol efflux, which are dependent on SOCS3 upregulation. These results provide new insight into the athero-protective effects of estrogen.

Screening of condensed tannins from Canadian prairie forages for anti-Escherichia coli O157:H7 with an emphasis on purple prairie clover (Dalea purpurea Vent)

Tannins from forages grown (n = 10) on the Canadian prairie, as well as from Quebracho, Rhus semialata, and brown seaweed (Ascophyllum nodosum), were screened for anti-Escherichia coli O157:H7 activity against E. coli O157:H7 strain 3081 at a concentration of 400 μg/ml for each tannin type, except for brown seaweed, which was at 50 μg/ml. Growth of the bacteria was assessed by measuring the optical density at 600 nm over 24 h. Tannin from seaweed at a concentration of 50 μg/ml inhibited growth of strain 3081. Among the terrestrial forages, only condensed tannins (CT) from purple prairie clover (Dalea purpurea Vent; PPC) increased (P < 0.05) the lag time and reduced (P < 0.05) the growth rate of E. coli O157:H7. The anti-E. coli O157:H7 activity of PPC CT was further assessed by culturing E. coli strain ATCC 25922 and eight strains of E. coli O157:H7 with PPC CT at 0, 25, 50, 100, or 200 μg/ml. Selected strains were enumerated after 0, 6, and 24 h of incubation, and fatty acid composition was determined after 24 h of incubation. E. coli strain 25922 was cultured with 0, 50, or 200 μg of CT per ml and harvested during the exponential growth phase for examination by transmission electron microscopy. Increasing CT concentration linearly increased (P < 0.001) the lag times of seven strains and linearly reduced (P < 0.001) the growth rates of eight E. coli O157:H7 strains. Proportions of unsaturated fatty acids in the total fatty acids were decreased (P < 0.01) by CT at 50 μg/ml. Transmission electron microscopy showed that CT disrupted the outer membrane structure. Anti-E. coli O157:H7 activity of PPC CT at levels of up to 200 μg/ml was bacteriostatic rather than bactericidal, and the mechanism of anti-E. coli activity may involve alteration in the fatty acid composition and disruption of the outer membrane of the cell.

Jet energy resolution in proton-proton collisions at [Formula: see text] recorded in 2010 with the ATLAS detector

The measurement of the jet energy resolution is presented using data recorded with the ATLAS detector in proton-proton collisions at [Formula: see text]. The sample corresponds to an integrated luminosity of 35 pb-1. Jets are reconstructed from energy deposits measured by the calorimeters and calibrated using different jet calibration schemes. The jet energy resolution is measured with two different in situ methods which are found to be in agreement within uncertainties. The total uncertainties on these measurements range from 20 % to 10 % for jets within |y|<2.8 and with transverse momenta increasing from 30 GeV to 500 GeV. Overall, the Monte Carlo simulation of the jet energy resolution agrees with the data within 10 %.

Osteocalcin, glucose metabolism, lipid profile and chronic low-grade inflammation in middle-aged and elderly Chinese

AIM

To assess the relationship between serum total osteocalcin and measurements of adiposity, glucose tolerance, lipid profile, adipokine and chronic low-grade inflammation in middle-aged and elderly Chinese subjects.

METHODS

We performed a cross-sectional community-based study in central Shanghai. Serum total osteocalcin was measured by radioimmunoassay in 783 men and 946 post-menopausal women. Their associations with measurements of adiposity, glucose tolerance, lipid profile and chronic low-grade inflammation were examined.

RESULTS

Serum total osteocalcin levels revealed a sexual dimorphism, with post-menopausal women having significantly higher levels than men (P < 0.001). Serum osteocalcin levels of participants with self-reported cardiovascular disease were significantly lower (P = 0.044) than those without. In men, serum osteocalcin levels of participants with the metabolic syndrome were significantly lower than those without the metabolic syndrome (P = 0.036). Serum osteocalcin correlated negatively with fasting serum insulin, homeostasis model assessment of insulin resistance, alanine aminotransferase, triglycerides and total cholesterol, and positively with homeostasis model assessment of β-cell function in both men and post-menopausal women (all P < 0.05). In men, serum osteocalcin correlated negatively with BMI, diastolic blood pressure, fasting plasma glucose and 2-h oral glucose tolerance test glucose after adjustment for age (all P < 0.05). In post-menopausal women, serum osteocalcin correlated negatively with waist-hip ratio, LDL cholesterol and C-reactive protein, and positively with adiponectin (all P < 0.05). Serum osteocalcin was not associated with CXC chemokine ligand 5 level (P > 0.05). Alanine aminotransferase was an independent predictor of serum osteocalcin in both men and post-menopausal women (both P < 0.001). Adiponectin was an independent predictor of serum osteocalcin in post-menopausal women (P = 0.011). Serum osteocalcin was an independent predictor of homeostasis model assessment of β-cell function in both genders (both P < 0.05).

CONCLUSIONS

Serum total osteocalcin was closely associated with glucose and lipid metabolism in both Chinese men and post-menopausal women.

Anomalous exchange bias at collinear/noncollinear spin interface

We report on the interfacial magnetic coupling in manganite bilayers of collinear ferromagnetic La_0.7Sr_0.3MnO₃ and noncollinear multiferroic TbMnO₃. Exchange bias is observed at the Néel temperature of TbMnO₃ (~41 K) due to the onset of long-range antiferromagnetic ordering in the Mn spin sublattice. Interestingly, an anomalous plateau of exchange bias emerges at the ordering temperature of Tb spins (~10 K), and we ascribe this unique feature to the strong coupling between Tb and Mn spin sublattices in TbMnO₃, which in turn influences the magnetic coupling across the interface. On the other hand, the enhancement of coercivity in La_0.7Sr_0.3MnO₃/TbMnO₃ shows monotonous temperature dependence. Our results illustrate a strong interfacial magnetic interaction at the La_0.7Sr_0.3MnO₃/TbMnO₃ interface, highlighting the roles of competing spin orders, magnetic frustration, and coupling between multiple spin sublattices in artificial collinear/noncollinear spin heterostructures.

Observation of two new N* resonances in the decay ψ(3686)→ppπ0

Based on 106×10(6)ψ(3686) events collected with the BESIII detector at the BEPCII facility, a partial wave analysis of ψ(3686)→ppπ0 is performed. The branching fraction of this channel has been determined to be B(ψ(3686)→ppπ0)=(1.65±0.03±0.15)×10(-4). In this decay, 7 N* intermediate resonances are observed. Among these, two new resonances, N(2300) and N(2570) are significant, one 1/2+ resonance with a mass of 2300(-30-0)(+40+109)  MeV/c2 and width of 340(-30-58)(+30+110)  MeV/c2, and one 5/2- resonance with a mass of 2570(-10-10)(+19+34)  MeV/c2 and width of 250(-24-21)(+14+69)  MeV/c2. For the remaining 5 N* intermediate resonances [N(1440), N(1520), N(1535), N(1650) and N(1720)], the analysis yields mass and width values that are consistent with those from established resonances.

High intensity focused ultrasound ablation of goat liver in vivo: Pathologic changes of portal vein and the "heat-sink" effect

The purpose of this study was to evaluate pathological changes of the portal vein (PV) and the effects on main branches of the hepatic PV during HIFU (high-intensity focused ultrasound) sonication when liver tissue adjacent to the main branches of hepatic PV was ablated. Normal liver tissue at 0mm, 5mm, 10mm away from the hepatic portal vein in 50 healthy goats was ablated with magnetic resonance image-guided HIFU (MRgHIFU). MRI showed a non-perfusion region at the target area but did not show any significant changes of the PV immediately after HIFU. The histological examination 1 day after HIFU showed coagulative necrosis at the target area, revealed deep-dyed swelling collagen (CS) fibers and vessel wall fracture (VWF) in the PV adjacent to the target area; however, no CS or VWF was observed in the PV 1 week after HIFU ablation. The energy required to ablate the foci at 0mm was 21% more than that at 10mm from the PV (p<0.05); the energy needed to ablate foci 5mm away from the PV was 10% more than that at 10mm from the PV (p<0.05). We concluded that minor injury of the hepatic portal vein may occur when ablating the adjacent liver tissue, and the acoustic energy deposition is related to the distance to the portal vein.

Search for magnetic monopoles in sqrt[s]=7 TeV pp collisions with the ATLAS detector

This Letter presents a search for magnetic monopoles with the ATLAS detector at the CERN Large Hadron Collider using an integrated luminosity of 2.0  fb(-1) of pp collisions recorded at a center-of-mass energy of sqrt[s]=7  TeV. No event is found in the signal region, leading to an upper limit on the production cross section at 95% confidence level of 1.6/ϵ  fb for Dirac magnetic monopoles with the minimum unit magnetic charge and with mass between 200 GeV and 1500 GeV, where ϵ is the monopole reconstruction efficiency. The efficiency ϵ is high and uniform in the fiducial region given by pseudorapidity |η|<1.37 and transverse kinetic energy 600-700<E(kin)sinθ<1400  GeV. The minimum value of 700 GeV is for monopoles of mass 200 GeV, whereas the minimum value of 600 GeV is applicable for higher mass monopoles. Therefore, the upper limit on the production cross section at 95% confidence level is 2 fb in this fiducial region. Assuming the kinematic distributions from Drell-Yan pair production of spin-1/2 Dirac magnetic monopoles, the efficiency is in the range 1%-10%, leading to an upper limit on the cross section at 95% confidence level that varies from 145 fb to 16 fb for monopoles with mass between 200 GeV and 1200 GeV. This limit is weaker than the fiducial limit because most of these monopoles lie outside the fiducial region.

Evidence for the direct two-photon transition from ψ(3686) to J/ψ

The two-photon transition ψ(3686)→γγJ/ψ is studied in a sample of 1.06×10(8) ψ(3686) decays collected by the BESIII detector. The branching fraction is measured to be (3.1±0.6(stat)(-1.0)(+0.8)(syst))×10(-4) using J/ψ→e(+)e(-) and J/ψ→μ(+)μ(-) decays, and its upper limit is estimated to be 4.5×10(-4) at the 90% confidence level. This work represents the first measurement of a two-photon transition among charmonium states. The orientation of the ψ(3686) decay plane and the J/ψ polarization in this decay are also studied. In addition, the product branching fractions of sequential E1 transitions ψ(3686)→γχ(cJ) and χ(cJ)→γJ/ψ(J=0,1,2) are reported.

HIF-1α downregulates miR-17/20a directly targeting p21 and STAT3: a role in myeloid leukemic cell differentiation

Hypoxia-inducible factor 1 (HIF-1) is a crucial transcription factor for the cellular adaptive response to hypoxia, which contributes to multiple events in cancer biology. MicroRNAs (miRNAs) are involved in almost all cellular activities such as differentiation, proliferation, and apoptosis. In this work, we use miRNA microarrays to profile miRNA expression in acute myeloid leukemia (AML) cells with inducible HIF-1α expression, and identify 19 differentially expressed miRNAs. Our study shows that HIF-1α represses the expression of miR-17 and miR-20a by downregulating c-Myc expression. These two miRNAs alleviate hypoxia and HIF-1α-induced differentiation of AML cells. More intriguingly, miR-17 and miR-20a directly inhibit the p21 and STAT3 (signal transducer and activator of transcription 3) expression, both of which can reverse miR-17/miR-20a-mediated abrogation of HIF-1α-induced differentiation. Moreover, we show in vivo that miR-20a contributes to HIF-1α-induced differentiation of leukemic cells. Taken together, our results suggest that HIF-1α regulates the miRNA network to interfere with AML cell differentiation, representing a novel molecular mechanism for HIF-1-mediated anti-leukemic action.

Clinical manifestations of obstructive sleep apnoea in pregnancy: more than snoring and witnessed apnoeas

Sleep disordered breathing and its symptoms have been associated with a multitude of fetal and maternal complications including gestational hypertensive disorders, gestational diabetes and possibly pre-term labour and other markers of alterations in fetal wellbeing. The disease remains underdiagnosed in the general population but likely also in pregnancy, mostly because providers do not appropriately screen for the disorder. Sleep disordered breathing may manifest differently in women, since women report more fatigue and less snoring than men do. This paper discusses typical presentations of sleep disordered breathing but also reports some less obvious presentations to help providers recognise those manifestations and screen for the disorder when warranted. Our case series describes patients with diagnoses such as chronic hypertension, pre-eclampsia, pulmonary hypertension, nocturnal asthma and panic attacks, who were diagnosed with sleep disordered breathing and offered treatment with CPAP during pregnancy.

Canker on Bark of Populus spp. Caused by Cytospora tritici, a New Disease in China

Species of Cytospora Ehrenb. and associated teleomorphs cause dieback and canker on over 85 species of angiosperm and gymnosperm plants throughout the world (2). Cytospora tritici Punith. was first observed on Triticum asetivum in Germany in 1980 but may also affect many hardwoods (3). During a survey of landscape trees in 2007, Populus spp. with cankers were found in Fushun, Baoxing, and Luding counties and Chengdu city in Sichuan Province. In these trees, bark canker pathogens discolored the sapwood. During damp weather, conidia were pushed out and formed orange spore horns. Conidiomatal stromata were immersed in bark, prominent, and 1.53 ± 0.33 mm in diameter (n = 10). Discs were white to grey, circular, oval, and 0.59 ± 0.14 mm in diameter (n = 10), with one ostiole per disc. Ostioles were dark grey. Locules were multi-chambered, chambers irregular. Conidia were lelongate-allantoid shaped, hyaline, aseptate, 5.04 ± 0.65 μm long (n = 50), and 1.22 ± 0.13 μm wide (n = 50). Fragments (5 × 5 mm²) of the junction of diseased and healthy tissues were surface sterilized with 1% NaOCl for 30 s and then rinsed twice in sterile distilled water. The pieces were placed on potato dextrose agar (PDA) plates and incubated at 25°C for 7 days. The obtained isolates were cultured on PDA at 25°C in diffuse fluorescent light for 30 days. Upon isolation, the mycelium grew at a rate of 3 to 5 mm per day at 25°C, forming pale white-to-pure white flat colonies. Conidiomata never formed on PDA. ITS1-5.8S-ITS2 sequences were amplified via PCR from genomic DNA obtained from mycelia using universal primers ITS1 and ITS4 (4). The amplification products showed 100% sequence homology with C. tritici isolate DQ243812 from the GenBank database. The ITS sequences were submitted to GenBank (Accession No. JQ277333 to JQ277336). Pathogenicity was confirmed by inoculating 20 disinfected (70% ethanol) Populus tomentosa cuttings. Cuttings were incubated at 25°C for 30 days. Another two cuttings were treated with water agar as controls. In 18 of the 20 cuttings, the cambium developed a brown color and appeared water soaked 15 days later, whereas controls did not develop any symptoms. C. tritici was reisolated from symptomatic tissues. To our knowledge, this is the first report of C. tritici in China causing canker on Populus spp. Cytospora canker is common in practically all countries where poplar are grown. Canker expansion increases when tree defenses are compromised, usually by seasonal dormancy but also by drought, cold injury of wood, sun scald of bark, flooding of root, hail, freezing, or other stress (1). Future spread of C. tritici to western China is considered highly likely. References: (1) G. C. Adams et al. Stud. Mycol. 52:1, 2005. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ March 25, 2012. (3) E. Punithalingam. Nova Hedwigia 32:585, 1980. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, San Diego, 1990.

Treatment outcomes and unfavorable prognostic factors in patients with occult breast cancer

AIMS

The purpose of this study was to evaluate the treatment outcomes and prognostic factors in patients with occult breast cancer (OBC).

METHODS

We retrospectively analyzed 95 patients with OBC who were treated at our facility between January 1998 and June 2010. Of the 95 patients, 64 underwent mastectomy plus axillary lymph node dissection (ALND) with or without post-mastectomy radiation (Mast + ALND group), 13 underwent ALND followed by ipsilateral breast radiotherapy (BR + ALND group) and the remaining 18 were treated with ALND (ALND group).

RESULTS

Patients who underwent Mast + ALND or BR + ALND had significantly improved rates of locoregional recurrence-free survival (LRFS) and recurrence/metastasis-free survival (RFS) than patients who only underwent ALND (p < 0.05). There were no significant differences in the LRFS (p = 0.718), RFS (p = 0.935) and breast cancer-specific survival (BCSS) (p = 0.991) rates between the patients who underwent Mast + ALND compared with those who received BR + ALND. Multivariate analysis revealed that patients with four or more involved lymph nodes had significantly worse outcomes (p = 0.042, HR = 4.63, 95% CI = 1.66-32.47 for BCSS and p = 0.038, HR = 3.62, 95% CI = 1.08-20.77 for RFS).

CONCLUSIONS

Patients with OBC who received ALND and subsequent breast radiotherapy had similar outcomes to patients who underwent mastectomy. The presence of four or more involved lymph nodes may independently predict poor outcomes of OBC.