Analysis of metastatic patterns after curative colorectal cancer surgery based on primary tumor location / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate metastatic patterns of colorectal cancer following curative surgery based on primary tumor location in order to provide evidence for the decision of individualized adjuvant therapy and postoperative follow-up.</p><p><b>METHODS</b>Clinical and follow-up data of 904 patients who underwent curative colorectal cancer in The Affiliated Tumor Hospital of Zhengzhou University from October 2004 to October 2012 with complete follow-up data were analyzed retrospectively. A total 274 patients belonged to right-sided colon cancer group (cecum, ascending, hepatic flexure, and transverse colon), 243 belonged to left-sided colon cancer group(splenic flexure, descending, and sigmoid colon), and 387 belonged to rectal cancer group. The overall rate of distal metastasis and site-specific metastasis rates (liver, lung, and peritoneum) were compared among these 3 groups.</p><p><b>RESULTS</b>The cohort patients had a median follow-up of 37(4-122) months, and the median follow-up duration was similar in right-sided, left-sided, and rectal cancer groups with 39(5-119), 39(6-122) and 36(5-121) months(P=0.513). During the follow-up period, 44 patients (4.9%) had local recurrence alone, 137 (15.2%) distal metastasis alone, and 30(3.3%) local recurrence combined with distal metastasis. Compared to right-sided colon cancer group, rectal and left-sided cancer groups had significantly higher overall metastasis rates [23.5% (91/387), 17.3% (42/243) vs. 12.0% (33/274), P=0.000). With respect to specific regions, lung metastasis rate in rectal cancer group was 9.3%, which was significantly higher than that in left-sided(4.5%) and right-sided colon cancer group(2.6%)(P=0.001). Other sites of metastasis did not yield significant differences, including liver(P=0.130) and peritoneum(P=0.858).</p><p><b>CONCLUSIONS</b>Cancer location may be used as a reference of personalized adjuvant therapy and postoperative follow-up surveillance programs. Lower threshold for adjuvant therapy in rectal and left-sided colon cancers, and more aggressive surveillance for lung metastasis by chest X-ray or CT should be considered.</p>

Association of serum albumin level with clinicopathologic features and prognosis in colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical significance of preoperative serum albumin level and its association with survival in colon cancer patients.</p><p><b>METHODS</b>Clinicopathological data of 621 consecutive patients with colon cancer admitted in Henan Cancer Hospital between January 2000 and December 2008 were retrospectively analyzed. These patients were divided into hypoalbuminemic and normal groups according to the definition of hypoalbuminemia (serum albumin < 35 g/L). Clinicopathological features were compared between two groups. The association of preoperative serum albumin level and the prognosis was analyzed by Kaplan-Meier and Log-rank test. Multivariate Cox model was used to evaluate the survival.</p><p><b>RESULTS</b>Sixty-seven(10.8%) patients were defined as preoperative hypoalbuminemia and were mostly found in those with right hemicolon cancer. Preoperative serum albumin level was associated with depth of tumor (χ(2)=35.609, P=0.000), lymph node metastasis (χ(2)=8.110, P=0.004), distant metastasis (χ(2)=9.064, P=0.003), advanced TNM T staging (χ(2)=23.070, P=0.000), and not associated with age, gender, tumor gross type, histological type, and degree of tumor differentiation (all P>0.05). 5-year survival rate of hypoalbuminemia group and normal group was 55.2% and 66.1% respectively (P=0.032). Univariate analysis revealed age (P=0.000), tumor gross type (P=0.014), degree of tumor differentiation (P=0.014), depth of tumor (P=0.000), lymph node metastasis (P=0.001), distant metastasis (P=0.000), advanced TNM T staging (P=0.000), operative method (P=0.000) and preoperative serum albumin level (P=0.032) were associated with survival. Cox multivariate analysis revealed the albumin level was the independent prognostic factor of the 5-year overall survival (HR:0.694, 95% CI: 0.492-0.980, P=0.038). The patients with higher albumin level had better survival outcome.</p><p><b>CONCLUSIONS</b>Preoperative serum albumin level is an independent prognostic factor for colon cancer. Colon cancer patients with hypoalbuminemia have worse clinicopathological manifestation and poorer overall survival.</p>

Clinical application of operation procedure improvement and process optimization in pancreatoduodenectomy / 中国综合临床

Objective To explore the safety and feasibility of operation procedure improvement and process optimization for pancreatoduodenectomy.Methods The effect of the duation time of opertion and postoperative complications of operation procedure improvement and process optimization for pancreatoduodenectomy in 98 patients in the Tumour Hospital Affiliated to Zhengzhou University from August 2008 to May 2015 were retrospective analyzed.Results The duation time of opertion was 145-205 min,average time was 175 min.There were 5 cases (5.1％) of bile leakage,6 case (6.12％) of pancreatic fistula and 4 cases (4.08％) of hemorrhage,and laparotomy revealed that one of them with pancreas-intestinal anastomotic hemorrhage,the haemorrhage stop after sufficient drainage,but due to infection,organ failure,this case was dead half a year after the operation.The remaining patients recovered uneventfully through open drainage,partial flush,somatostatin application,and other conservative treatment.Conclusion The improved pancreatoduodenectomy can shorten operation time and reduce operation complication,is a safe and feasible method,and worthy of clinical popularization.

Pain analgesic efficacy of diclofenac sodium and lidocaine hydrochloride combined with anisodamine in treatment of patients with bone fractures and evaluation of its safety / 中国生化药物杂志

Objective To analyse the pain analgesic efficacy and safety evaluation of diclofenac sodium and lidocaine hydrochloride combined with anisodamine in patients with bone fractures.Methods 54 patients who were diagnosed with acute fracture in the hospital were collected and randomly divided into experimental group and control group, 27 cases in each group, control group was treated with diclofenac sodium and lidocaine hydrochloride, and experimental group was treated with anisodamine on the basis of control group.Before 30 min and 2 h after treatment, the effect of 5-hydroxytryptamine ( 5-HT ), prostaglandin E2 ( PGE2 ), analgesic effect, tolerability and adverse reactions were detected in all patients. ResuIts Compared with control group post treatment, the plasma 5-HT content was significantly lower in experimental group ( P<0.05 ); the plasma PGE2 content in experimental group was significantly lower (P<0.05); the pain rating index (PRI) total score,PRI feel score, PRI emotion score, present pain intensity (PPI) and visual analogue scale (VAS) in experimental group was significantly lower (P<0.05).The tolerance of experimental group was 92.59%, which was significantly higher than 66.67% of control group (χ2 =5.59,P<0.05).ConcIusion Diclofenac sodium and lidocaine hydrochloride combined with anisodamine could significantly decrease 5-HT and PGE2 in patients with fracture pain, enhance the analgesic effect, reduce the incidence of adverse reactions, with a good tolerance, which have the guiding significance on clinical therapy.

Surgical management of huge pelvic tumor: a report of 56 cases / 中华消化外科杂志

Objective To investigate the surgical management of huge pelvic tumor.Methods The clinical data of 56 patients with huge pelvic tumor who were admitted to the Cancer Hospital of Henan Province from February 2005 to January 2012 were retrospectively analyzed.Tumor resectability was assessed via enhanced computed tomography or three-dimensional reconstruction,and the tumors were freed and resected by combination of muliiple surgical approaches.All the patients were followed up via telephone or re-examination at the out-patient department to learn the recurrence and metastasis of tumor.The survival rate was calculated using the life table.Results Fifty patients received preoperative computed tomography examination,and the imaging data of 6 patients were three-dimensionally reconstructed.Preoperative evaluation showed that 49 patients needed combined multivisceral resection,5 needed tumor resection,and the tumors of 2 patients were unresectable.Fourteen patients were diagnosed preoperatively,and 8 patients were diagnosed by intraoperative rapid frozen section examination,and the rest 34 patients were diagnosed by postoperative pathological examination.The surgical approaches including anterior median sacral approach combined with transperineal coccyx anterior approach (21 patients),anterior median sacral approach (11 patients),obturator approach (8 patients),retropubic approach (8 patients) and obturator approach combined with transperineal approach of coccyx (8 patients).Tumor and rectum resection was carried out on 18 patients,tumor and partial bladder resection on 12 patients,tumor,uterus and ovariectomization on 12 patients,tumor,part of the small intestine and colorectal resection on 10 patients,tumor and total pelvic exenteration on 4 patients.In all the 56 patients,53 achieved R0 resection,2 cases reached naked eye clean,1 case had residual tumor.The mean operation time was 100 minutes.Fifty patients recovered uneventfully.Six patients had postoperative complications,including 3 patients with intestinal obstruction (2 patients were cured by conservative treatment,and 1 patient was cured by surgery),2 patients with pelvic infection and 1 patient with colostomy hernia,and they were cured by drainage and nutritional support.One patient died of postoperative myocardial infarction.The results of postoperative pathologic study showed that 25 patients were with adenocarcinoma,16 with sarcoma and 15 with gastrointestinal stromal tumor.Forty-seven patients were followup to December 2012,and the 5-year survival rate was 26.7％ for patients with adenocarcinoma,18.9％ for patients with sarcoma,and 52.6％ for patients with gastrointestinal stromal tumor.Conclusion Preoperative assessment of resectability of huge pelvic tumor can reduce unnecessary laparotomy and improve the safety of operation.

Effects of Electroacupuncture on Depressive Disorder Recovery and Serum Cytokines / 中国康复理论与实践

@#Objective To explore the effect and mechanism of electroacupuncture at Baihui(GV20) and Zusanli(ST36) of patients with depression.Methods90 patients were randomly divided into group A electroacupunctured at Baihui(GV20) and Zusanli(ST36), group B electroacupunctured at Taichong(LR3), Sanyinjiao(SP6), Neiguan(PC6), and Shenmen(H7) and group C treated with Fluoxetine (20 mg/d, 6 weeks). The therapeutic effect was assessed by the Hamilton Depression Rating Scale (HAMD) before and after treatment. Serum cytokine levels (IL-2, IL-4, and IFN-γ) were measured by ELISA assay at admission and after treatment (6 weeks).ResultsCompared to pre-treatment, the mean levels of HAMD ( P<0.01)and IL-4 (P <0.01) decreased significantly in all groups after treatment. Rank distribution of HAMD scores had obvious difference between all groups. The mean levels of IL-2 and IFN-γ had no significant difference in group C after treatment (P>0.05). And the mean levels of IL-2 and IFN-γ increased significantly in groups A and B after treatment(P<0.01, P<0.05).ConclusionElectroacupuncture takes effect earlier than fluoxetine for depression. Electroacupuncture at Baihui(GV20) and Zusanli(ST36) was more effective than the other two methods. The three types of treatments can restore three types of cytokines and improve depressive syndrome.

Effect of Electro-acupuncture on Expression of Transforming Growth Factor-β1 in the Cartilage of Experimental Rats with Knee Osteoarthritis / 中国康复理论与实践

@#Objective To investigate the effect of electro-acupuncture on cartilage renovation of knee osteoarthritis.Methods 40 female SD rats were randomly divided into the normal group,model group,electro-acupuncture treatment group and control group.The left knees of the treatment group and right ones of the control group were treated by electro-acupuncture for two weeks from the fifth week since operation.Collected left knees' cartilage of all rats at the seventh week since the beginning of experiment.HE and immunohistochemical staining were used to observe the expression characteristic of transforming growth factor-β1(TGF-β1)in cartilage.Results The expression of TGF-β1 in the treatment group was very significantly stronger than all other groups(P<0.01).Conclusion Electro-acupuncture can obviously up-regulate the level of TGF-β1 in cartilage of experimental rats with knee osteoarthritis,and promote the repair of cartilage.

Effect of Acupuncture on Different Traditional Chinese Medicine Syndrome Types in Patients with Apoplectic Hemiplegia / 中国康复理论与实践

@#Objective To observe effects of acupuncture on different traditional Chinese medicine(TCM) syndrome types in patients with apoplectic hemiplegia.Methods 57 cases of apoplectic hemiplegia were divided into the Qi deficiency with blood stagnation group(35 cases) and blockage of the meridians and collaterals by phlegm and blood group(22 cases).All patients were treated by scalp acupuncture combined with body acupuncture.The clinical therapeutic effect was evaluated according to the scores of manner,speech,motor function of limbs,and so on.Results In the Qi deficiency and blood stagnation group,2 cases were basically cured,17 were remarkably effective,12 were effective,with a total effective rate of 88.6%;while,in the blockage of the meridians and collaterals by phlegm and blood group,3 cases were basically cured,14 were remarkably effective,3 were effective,with a total effective rate of 90.9%.There was a significant difference between the two groups in clinical remarkably effective rate(P<0.01),but no difference in total effective rate( P>0.05).Conclusion Acupuncture can obviously improve the consciousness,language and limb function of patients with apoplectic hemiplegia.The effective rate of type of blockage of the meridians and collaterals by phlegm and blood is superior to type of Qi deficiency with blood stagnation.