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BACKGROUND@#Postoperative chylous ascites is an infrequent condition after colorectal surgery and is easily treatable. However, its effect on the long-term oncological prognosis is not well established. This study aimed to investigate the short-term and long-term impact of chylous ascites treated with neoadjuvant therapy followed by rectal cancer surgery and to evaluate the incidence of chylous ascites after different surgical approaches.@*METHODS@#A total of 898 locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery between January 2010 and December 2018 were included. The clinicopathological data and outcomes of the patients with chylous ascites were compared with those of the patients without chylous ascites. The primary endpoint was recurrence-free survival (RFS). To balance baseline confounders between groups, propensity score matching (PSM) was performed for each patient with a logistic regression model.@*RESULTS@#Chylous ascites was detected in 3.8% (34/898) of the patients. The incidence of chylous ascites was highest after robotic surgery (6.9%, 6/86), followed by laparoscopic surgery (4.2%, 26/618) and open surgery (1.0%, 2/192, P = 0.021). The patients with chylous ascites had a significantly higher number of lymph nodes harvested (15.6 vs. 12.8, P = 0.009) and a 3-day longer postoperative hospital stay (P = 0.017). The 5-year RFS rate was 64.5% in the chylous ascites group, which was significantly lower than the rate in the no chylous ascites group (79.9%; P = 0.007). The results remained unchanged after PSM was performed. The chylous ascites group showed a nonsignificant trend towards a higher peritoneal metastasis risk (5.9% vs. 1.6%, P = 0.120). Univariate analysis and multivariate analysis confirmed chylous ascites (hazard ratio= 3.038, P < 0.001) as an independent negative prognostic factor for RFS.@*CONCLUSIONS@#Considering the higher incidence of chylous ascites after laparoscopic and robotic surgery and its adverse prognosis, we recommend sufficient coagulation of the lymphatic tissue near the vessel origins, especially during minimally invasive surgery.
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Humans , Chylous Ascites/etiology , Incidence , Laparoscopy , Rectal Neoplasms/surgery , Retrospective Studies , Risk Factors , Robotic Surgical Procedures/adverse effectsABSTRACT
Objective To explore the reasons and the best treatment options of facial mass complicated after exogenous growth factor injections.Methods 17 cases of postoperative complications caused by exogenous growth factor injections were retrospectively analyzed.15 patients with chin masses received mass resection and repairment with submental fat and fascial flap.Facial masses of the other 2 patients were located in cheek.Simple cheek mass resection was usually useful.All the patients had scar treatment.The postoperative satisfactory survey was investigated after 6 months.Results The incisions of 17 patients were healed well.An analysis through color Doppler ultrasound examination showed no residual or recurrent mass within half a year follow-up.One of the 17 patients had facial asymmetry and needed further treatment.Others were satisfied with the facial appearance of treatment.Conclusions The masses resulted from injection of exogenous growth factor should be cut off timely and reasonable reconstruction through fat and fascial flap and scar treatment are helpful to restore the original appearance of patients.
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Objective To establish the performance structure model of hospital knowledge team. Methods Proposing the hypothesized model on the basis of theoretical research,adopting a self-designed scale to carry out questionnaire investigation,using the method of statistical analysis to validate the fitting degree of the model.Results The performance structure of hospital knowledge team is composed of six dimensions,including patient service,quality management,medical quality,work efficiency,team growth,and team members feeling.The six dimensions can explain 76.92% of the variance.Conclusion With its special of hospital knowledge team performance,the performance structure is different from the existing research results.
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Objective To understand the various factors affecting hospital knowledge team performance.Methods Constructing the theoretical model of factors affecting team performance based on the WSR,adopting a self-designed scale to carry out questionnaire investigation,and using the method of statistical analysis to validate the rationality of the model. Results Hospital knowledge team performance is influenced by physical factors (4.38 ),Shi-Li factors (4.5 1 ),and Ren-Li factors (4.59),which Ren-Li factors influence is greater.Conclusion The WSR methodology provides a convenient and efficient way for understanding the determinants of hospital knowledge team performance.
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Objective To study the expression of ZNF217 and EF1α gene in the pathological scars and to investigate role and probable mechanism in the pathogenesis of abnormal scar.Methods Quantitative real-time PCR and Western blot were performed to detect the expression and distribution of mRNA and protein of ZNF217 and EF1α in hypertrophic scar (10 cases),keloid (10 cases),normal scar (10 cases),and normal skin (10 cases),and statistics was used to analyze the data.Results The expression of ZNF217 mRNA and protein in the normal skin,normal scar,hypertrophic scar and keloid were 1.46±0.397,1.45±0.265,4.49±0.999,5.47±0.808; 0.276±0.0211,0.299±0.0150,0.743t0.0509 and 0.747±0.0377,respectively.The expression of EF1α mRNA and prorein in the normal skin,normal scar,hypertrophic scar,and keloid were 1.47±0.469,1.47±0.218,5.10±1.68,5.74±1.92; 0.505±0.0371,0.518±0.0153,0.780±0.0369 and 0.792±0.0290,respectively.The positive rate of mRNA and protein of ZNF217 and EF1α was not statistically different between the hypertrophic scar and keloid (P＞0.05),while they were all remarkably significant in comparison between normal scar and abnormal scar (P＜0.01).In pathological scar mRNA and protein of ZNF217 and EF1α showed a strong positive correlation.Conclusions The expression of ZNF217 and EF1α is increased in pathological scar.Therefore,ZNF217 and EF1α overexpression may play an important role in the proliferation of fibroblasts and in the pathogenesis of pathological scar.
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Objective To study the expression of eukaryotic translation initiation factor 4E(eIF4E)in the pathological scars and its probable role in the pathogenesis of pathological scars.Methods Immunohistochemiscal technique was performed to detect the expression and distribution of eIF4E protein in hypertrophic scars(14 cases),keloids(25 cases),mature scars(20 cases)and normal skins(20 cases).Reverse transcription polymerase chain reaction(RT-PCR)was used to detect the eIF4E mRNA level in hypertrophic scars(7 cases),keloids(8 cases),mature scars(8 cases)and normal skins(8 cases).Results Thepositive rate of eIF4E protein expression was remarkably significant difference between normal scars and pathological scars(P＜0.05).The level of eIF4E mRNA in pathological scars 1.73±0.31was higher than that in control group 0.99±0.28.There was significant difference between two groups (P＜O.05).Conclusions The expression of eIF4E is increased in pathological scar.eIF4 E expression is closely associated with the development of pathological scar.Therefore,eIF4E overexpression may play an important role in the proliferation of fibroblasts and in the pathogenesis of pathological scar.