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Objective To detect the level of peripheral blood UL16 binding protein 2 (ULBP2) in patients with colorectal cancer,and study its value on early diagnosis and prognosis evaluation.Methods Eighty patients with colorectal cancer (colorectal cancer group) and 60 healthy subjects (healthy control group) from May 2016 to May 2019 in Affiliated Dongfeng Hospital,Hubei University of Medicine were selected.Serum expression level of ULBP2 was detected by enzyme-linked immunosorbent assay.The diagnostic efficacy of serum ULBP2 in colorectal cancer was evaluated by receiver operating characteristic (ROC) curve.The influencing factors of survival in patients with colorectal cancer were analyzed by Cox regression model.Kaplan-Meier method was used for drawing the survival curve,and log-rank test method was used for comparison.Results The serum ULBP2 level in colorectal cancer group was significantly higher than that in healthy control group:(85.52 ± 12.18) ng/L vs.(66.20 ± 8.28) ng/L,and the serum ULBP2 level of stage Ⅰ to Ⅱ in colorectal cancer group was also significantly higher than that in healthy control group:(76.44 ± 7.56) ng/L vs.(66.20 ± 8.28) ng/L,and there were statistical differences (P ＜ 0.05).ROC curve analysis result showed that the optimal cut off value of serum ULBP2 for colorectal cancer diagnosis was 79.53 ng/L,and area under curve (AUC) was 0.869,with a sensitivity of 73.75％ and a specificity of 91.67％;the optimal cut off value of serum ULBP2 for stage Ⅰ to Ⅱ colorectal cancer diagnosis was 71.86 ng/L,and AUC was 0.827,with a sensitivity of 78.57％,and a specificity of 78.33％.According to the median serum ULBP2 level,the patients were divided into ULBP2 high expression (ULBP2 ＞ 85.52 ng/L,38 cases) and ULBP2 low expression (42 cases).The serum expression level of ULBP2 was related to lymph node metastasis and tissue differentiation (P ＜ 0.05).Univariate Cox regression analysis result showed that lymph node metastasis,distant metastasis,tissue differentiation and serum ULBP2 were risk factors of poor prognosis in patients with colorectal cancer (P ＜ 0.01 or ＜ 0.05);multivariate Cox regression analysis result showed that serum ULBP2 was the independent risk factor of poor prognosis in patients with colorectal cancer (HR =0.194,95％ CI 0.077 to 0.490,P =0.001).The median survival time in patients with serum ULBP2 high expression was significantly shorter than that in patients with serum ULBP2 low expression (28 months vs.50 months),and there was statistical difference (P ＜ 0.05).Conclusions Serum ULBP2 can be used as an indicator for early diagnosis and prognostic evaluation in patients with colorectal cancer.
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Objective@#To detect the level of peripheral blood UL16 binding protein 2 (ULBP2) in patients with colorectal cancer, and study its value on early diagnosis and prognosis evaluation.@*Methods@#Eighty patients with colorectal cancer (colorectal cancer group) and 60 healthy subjects (healthy control group) from May 2016 to May 2019 in Affiliated Dongfeng Hospital, Hubei University of Medicine were selected. Serum expression level of ULBP2 was detected by enzyme-linked immunosorbent assay. The diagnostic efficacy of serum ULBP2 in colorectal cancer was evaluated by receiver operating characteristic (ROC) curve. The influencing factors of survival in patients with colorectal cancer were analyzed by Cox regression model. Kaplan-Meier method was used for drawing the survival curve, and log-rank test method was used for comparison.@*Results@#The serum ULBP2 level in colorectal cancer group was significantly higher than that in healthy control group: (85.52 ± 12.18) ng/L vs. (66.20 ± 8.28) ng/L, and the serum ULBP2 level of stage Ⅰ to Ⅱ in colorectal cancer group was also significantly higher than that in healthy control group: (76.44 ± 7.56) ng/L vs. (66.20 ± 8.28) ng/L, and there were statistical differences (P<0.05). ROC curve analysis result showed that the optimal cut off value of serum ULBP2 for colorectal cancer diagnosis was 79.53 ng/L, and area under curve (AUC) was 0.869, with a sensitivity of 73.75% and a specificity of 91.67%; the optimal cut off value of serum ULBP2 for stage Ⅰ to Ⅱ colorectal cancer diagnosis was 71.86 ng/L, and AUC was 0.827, with a sensitivity of 78.57%, and a specificity of 78.33%. According to the median serum ULBP2 level, the patients were divided into ULBP2 high expression (ULBP2>85.52 ng/L, 38 cases) and ULBP2 low expression (42 cases). The serum expression level of ULBP2 was related to lymph node metastasis and tissue differentiation (P < 0.05). Univariate Cox regression analysis result showed that lymph node metastasis, distant metastasis, tissue differentiation and serum ULBP2 were risk factors of poor prognosis in patients with colorectal cancer (P<0.01 or <0.05); multivariate Cox regression analysis result showed that serum ULBP2 was the independent risk factor of poor prognosis in patients with colorectal cancer (HR = 0.194, 95% CI 0.077 to 0.490, P = 0.001). The median survival time in patients with serum ULBP2 high expression was significantly shorter than that in patients with serum ULBP2 low expression (28 months vs. 50 months), and there was statistical difference (P<0.05).@*Conclusions@#Serum ULBP2 can be used as an indicator for early diagnosis and prognostic evaluation in patients with colorectal cancer.
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Objective@#To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.@*Methods@#The retrospective cohort study was conducted. The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected. There were 51 males and 111 females, aged (35±8)years, with a range from 12 to 47 years. Of 162 patients, 72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group. Observation indicators: (1) surgical situations; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination, telephone interview, and WeChat was performed to detect the postoperative complications at 1, 3, 6 months and 1, 2, 5 years postoperatively up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and the t test was used for comparison between groups. Count data were represented as absolute numbers, and were analyzed by the chi-square test or fisher exact probability. Ordinal data were analyzed by the Wilcoxon rank sum test.@*Results@#(1) Surgical situations: patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy, without conversion to open surgery, reoperation, or perioperative death. (2) Intraoperative situations: the operation time and volume of intraoperative blood loss of the concealed incision group were (102±17)minutes and (11±4)mL, respectively, versus (105±19)minutes and (11±4)mL of the traditional incision group (t=-1.232, -0.676, P>0.05). There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group, respectively, with a significant difference between the two groups (χ2=6.280, P<0.05). (3) Postoperative situations: in the concealed incision group, 56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance. In the traditional incision group, 42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance. There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z=-4.012, P<0.05). Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9)days and (64 408±5 123)yuan, versus (5.2±1.5)days and (64 953±3 477)yuan of the traditional incision group (t=-1.788, -0.804, P>0.05). There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group, respectively, with no significant difference between the two groups (χ2=2.894, P>0.05). There was no postoperative complication such as infection, hemorrhage or anastomotic leakage in either group. (4) Follow-up: 32 of 162 patients were lost to follow-up, including 10 in the concealed incision group and 22 in the traditional incision group; other 130 patients were followed up for 1-14 months, with a median follow-up time of 7 months. During the follow-up, 1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding, and was cured after symptomatic supportive treatment. One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment. Other patients had no readmission due to postoperative complications.@*Conclusion@#Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible, with good cosmetic effects.
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Objective To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.Methods The retrospective cohort study was conducted.The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected.There were 51 males and 111 females,aged (35± 8)years,with a range from 12 to 47 years.Of 162 patients,72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group.Observation indicators:(1) surgical situations;(2) intraoperative situations;(3) postoperative situations;(4) follow-up.Follow-up using outpatient examination,telephone interview,and WeChat was performed to detect the postoperative complications at 1,3,6 months and 1,2,5 years postoperatively up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and the t test was used for comparison between groups.Count data were represented as absolute numbers,and were analyzed by the chisquare test or fisher exact probability.Ordinal data were analyzed by the Wilcoxon rank sum test.Results (1) Surgical situations:patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy,without conversion to open surgery,reoperation,or perioperative death.(2) Intmoperative situations:the operation time and volume of intraoperative blood loss of the concealed incision group were (102± 17) minutes and (11±4) mL,respectively,versus (105± 19) minutes and (11 ±.4) mL of the traditional incision group (t=-1.232,-0.676,P＞0.05).There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group,respectively,with a significant difference between the two groups (x2=6.280,P＜0.05).(3) Postoperative situations:in the concealed incision group,56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance.In the traditional incision group,42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance.There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z =-4.012,P＜0.05).Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9) days and (64 408±5 123) yuan,versus (5.2± 1.5) days and (64 953± 3 477)yuan of the traditional incision group (t =-1.788,-0.804,P＞0.05).There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group,respectively,with no significant difference between the two groups (x2=2.894,P＞0.05).There was no postoperative complication such as infection,hemorrhage or anastomotic leakage in either group.(4) Follow-up:32 of 162 patients were lost to follow-up,including 10 in the concealed incision group and 22 in the traditional incision group;other 130 patients were followed up for 1-14 months,with a median follow-up time of 7 months.During the follow-up,1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding,and was cured after symptomatic supportive treatment.One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment.Other patients had no readmission due to postoperative complications.Conclusion Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible,with good cosmetic effects.
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Objective To compare the clinical effects of RPH combined with Milligan and PPH in the treatment of severe mixed hemorrhoids. Methods 168 patients with severe mixed hemorrhoids were assigned to a study group or a control group,84 patients for each group. The control group received PPH therapy,while the study group received RPH combined with Milligan procedure. Results The procedures were completed successfully in all the patients. The postoperative hospital stay and surgical duration were shorter and the amount of bleeding was smaller in the study group than in the control group(P<0.05). Three months after surgery,the rate of compli-cations including urinary retention,anal incontinence,anorectal stenosis,and secondary anal fissure was lower in the study group than in the control group(P < 0.05). The total effective rate was 97.6% in the study group and 85.7% in the control group,with a higher rate in the study group(P<0.05). Anal PSV and EDV values were lower in both groups three months after the procedures as compared with one day before the procedures(P<0.05),and the values were smaller in the study group than in the control group(P<0.05). Conclusions Milligan combined with RPH in the treatment of severe mixed hemorrhoids can reduce hemorrhoids blood flow. This procedure is mini-mally invasive and it can reduce the development of postoperative complications and improve efficacy.