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Objective: The surgical indications, resection extent and management principle of lateral lymph node dissection (LLND) in lower rectal cancer have been controversial between Eastern and Western countries. This study aims to provide a theoretical basis for the rational implementation of LLND by reviewing the changes of LLND strategy over the past 30 years in a single-center, and analyzing prognostic factors for the survival outcomes of patients with lateral lymph node metastasis (LLNM). Methods: A retrospective observational study was performed. Clinical data of 289 patients with rectal cancer who received LLND at the Department of General Surgery of Peking University First Hospital from 1990 to 2019 were collected. Patients were divided into three groups based on decades. There were 89 cases in 1990-1999 group, 92 cases in the 2000-2009 group, and 108 cases in the 2010-2019 group. Data analyzed: (1) patient baseline data; (2) surgery and postoperative recovery; (3) lateral lymph node dissection; (4) postoperative survival and prognosis of patients with positive lateral lymph nodes. The surgical methods and pathological results of LLND were compared between groups, and the prognostic risk factors of patients with LLNM were analyzed. Results: A total of 289 patients underwent radical resection with LLND' accounting for 6.3% of the 4542 patients with rectal cancer during the same period in our hospital. Except decade-by-decade increase in tumors with distance from anal verge ≤ 7 cm, the proportion of ulcerated tumors, and the proportion of neoadjuvant radiochemotherapy, the differences in other baseline data were not statistically significant among 3 decade groups (all P>0.05). The proportion of LLND in the 3 groups decreased decade by decade [9.9% (89/898) vs. 8.0% (92/1154) vs. 4.3% (108/2490), χ(2)=40.159, P<0.001]. The proportion of laparoscopic surgery and unilateral LLND increased, while the mean operative time, intraoperative blood loss, surgical complications above grade III and postoperative hospital stay decreased decade by decade. These 289 patients completed a total of 483 lateral dissections, including 95 cases of the unilateral dissection and 194 cases of the bilateral dissection. The proportion of LLND in the 3 groups decreased decade by decade [9.9% (89/898) vs. 8.0% (92/1154) vs. 4.3% (108/2510), P<0.001]. The median number of dissected lymph nodes in the internal iliac artery and obturator regions increased (2 vs. 3 vs. 3, P<0.001), but those in the common iliac and external iliac regions decreased significantly (4 vs. 3 vs. 2, P=0.014). A total of 71 patients with LLNM were identified. The rate of LLNM in the 2010-2019 group was significantly higher than that in the previous two groups [37.0% (40/108) vs. 16.9% (15/89) vs. 17.4% (16/92), P=0.001]. The patients with LLNM showed a poorer overall survival (OS) and disease-free survival (DFS) compared with negative lateral lymph nodes (P<0.001). There were statistically significant differences in 5-year OS rate (30.9% vs. 27.2% vs. 0, P=0.028) and 5-year DFS rate (28.3% vs. 16.0% vs. 0, P=0.038) among patients with only internal iliac lymph node metastasis, patients with only obturator lymph node metastasis, and patients with external iliac or common iliac lymph node metastasis. Multivariate analysis of prognostic factors showed that external iliac or common iliac lymph node metastasis was an independent risk factor for OS (HR=1.649, 95%CI: 1.087-2.501) and DFS (HR=1.714, 95%CI: 1.173-2.504) in patients with LLNM (all P<0.05) . The OS and DFS were not significant different in patients with LLNM among 3 decade groups. Conclusions: In the past decade, the proportion of LLND in rectal cancer has decreased significantly. However, LLNM rate has been significantly increased due to preoperative imaging assessments focusing on suspicious LLNM without compromising the survival. Internal iliac artery and obturator lymph nodes can be regarded as regional lymph nodes with a satisfactory prognosis after LLND. For suspected external iliac or common iliac lymph node metastasis, the significance of LLND remains to be further evaluated.
Subject(s)
Humans , Dissection , Lymph Node Excision , Lymph Nodes , Prognosis , Rectal Neoplasms/surgery , Treatment OutcomeABSTRACT
To observe the effects of hypothermia on the repolarization duration and the expression of Kir2.1 protein of ventricular myocytes in isolated rat heart and explore the role of Kir2.1 protein. Eighteen healthy adult male Sprague-Dawley rats were randomly divided into three groups (n=6 per group): Control group (C group), 35℃ group (H group), 32℃ group (H group). Langendorff isolated heart models were established. After 15 min 37℃ K-H fluid banlanced perfusion, C group continued to perfuse the K-H solution at 37℃ for 30 minutes, H group continued to perfuse the K-H solution at 35℃ for 30 minutes, H group continued to perfuse the K-H solution at 32℃ for 30 minutes. At 15 min of balanced perfusion (T), and 30 min of continuous perfusion (T), the heart rate,and the MAP in the three layers of the left ventricular anterior wall were recorded, the action potential duration at 50% repolarization (MAPD), the action potential duration at 90% repolarization (MAPD) and transmural dispersion of repolarization(TDR) were calculated. At the same time, the occurrence of arrhythmia was recorded. The expression of Kir2.1 protein was measured by Western blot. The average optical density (AOD) and the distribution of Kir2.1 protein were measured by immunohistochemistry in the ventricular tissue measured by electrophysiology. Compared with T, the heart rate was decreased, MAPD and MAPD were prolonged significantly (P＜0.05), and TDR was increased significantly (P＜0.05) in H group, H group at T. Compared with C group, the HR was decreased, the MAPD was prolonged significantly (P＜0.05), TDR was increased significantly (P＜0.05),the expression and the AOD of Kir2.1 protein were decreased significantly (P＜0.05) in Hgroup, Hgroup at T. Compared with H group, the heart rate of H group was decreased significantly (P＜0.05), MAPD and MAPD were prolonged significantly (P＜0.05), and TDR was increased significantly (P＜0.05) at T. The distribution of Kir2.1 protein in group C was normal, while the distribution of Kir2.1 in H group and H group was disordered. Hypothermia prolonged the ventricular duration of repolarization and increased the dispersion of repolarization. The mechanism is related to the down-regulation the expression of Kir2.1 protein and the disorder of the distribution of Kir2.1 protein.
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Objective To investigate the clinical effect of amiodarone combined with psychological intervention on the treatment of the patients with arrhythmia and its influence on the serum high sensitive C reactive protein. Methods The control group were treated with amiodarone on the basis of routine treatment, the study group was given amiodarone combined with psychological intervention on the basis of routine treatment. The effect in the two groups before and after treatment and the hs-CRP level changes in the two groups were recorded. Results The total efficiency in the study group was 89.13%, which was higher than 71.74% in the control group(P<0.05). There was no significant difference in the level of hs-CRP between the two groups before treatment. After treatment, the hs-CRP in study group was better than that in control group (P<0.05). Conclusion On the basis of routine treatment, amiodarone combined with psychological intervention can significantly improve the clinical efficacy of arrhythmia patients, and significantly reduce the level of hs-CRP.
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Objective To investigate the clinical effect of amiodarone combined with psychological intervention on the treatment of the patients with arrhythmia and its influence on the serum high sensitive C reactive protein. Methods The control group were treated with amiodarone on the basis of routine treatment, the study group was given amiodarone combined with psychological intervention on the basis of routine treatment. The effect in the two groups before and after treatment and the hs-CRP level changes in the two groups were recorded. Results The total efficiency in the study group was 89.13%, which was higher than 71.74% in the control group(P<0.05). There was no significant difference in the level of hs-CRP between the two groups before treatment. After treatment, the hs-CRP in study group was better than that in control group (P<0.05). Conclusion On the basis of routine treatment, amiodarone combined with psychological intervention can significantly improve the clinical efficacy of arrhythmia patients, and significantly reduce the level of hs-CRP.
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<p><b>OBJECTIVE</b>To summarize multi-detector row CT (MDCT) and magnetic resonance imaging (MRI) features of retinal detachment and evaluate the diagnostic value of these two imaging modalities.</p><p><b>METHODS</b>The MDCT and MRI manifestations were reviewed in 45 cases (47 eyes) of retinal detachment, among which 16 cases (17 eyes) were examined by MDCT and 29 cases (30 eyes) by MRI. Thirty-two cases (33 eyes) were confirmed by operation, and the other 13 cases (14 eyes) were confirmed based on the clinical findings.</p><p><b>RESULTS</b>MDCT and MRI displayed signs of fluid retention between the detached retina and the posterior wall of the eyeball in the cases. Among all these cases, 21 eyes showed simple retinal detachment and 26 had also other pathologies (hemorrhage in 20 eyes and calcification in 6 eyes). Choroidal osteoma was identified in 3 eyes and melanoma of choroid in 5 eyes.</p><p><b>CONCLUSION</b>MDCT is sensitive in detecting calcification in the eyes and MRI with a minimal risk of radiation, and shows advantages in displaying hemorrhage and confined retinal detachment. Both MDCT and MR have high clinical value in the diagnosis of retinal detachment, and their choice depends on the individual condition of the patients.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Magnetic Resonance Imaging , Retinal Detachment , Diagnosis , Diagnostic Imaging , Retrospective Studies , Tomography, X-Ray Computed , MethodsABSTRACT
<p><b>OBJECTIVE</b>To investigate the magnetic resonance imaging (MRI) findings of capillary hemangioma in the brain to improve the diagnosis of capillary hemangioma.</p><p><b>METHODS</b>The MRI findings were analyzed in 6 patients with pathologically confirmed capillary hemangioma in the brain to define the characteristic MRI features of capillary hemangioma.</p><p><b>RESULTS</b>In the 6 patients, the capillary hemangiomas were located in the pons (n=1), bulbus medullae (n=1), bilateral cerebellar hemisphere (n=1), right temporal lobe (n=1) or left frontal lobe (n=1). Three patients had subacute hemorrhage, 2 had cystic degeneration and 1 had solid tumors, all shoeing heterogeneous MRI signals. Contrast-enhanced MR scans revealed marked heterogeneous enhancement with clear boundaries of the tumor parenchyma, where spots and thin strips without enhancement were seen in 5 cases; vascular network was seen in 1 case. Drainage vessels connected to the lesions were found in 3 cases.</p><p><b>CONCLUSION</b>MRI has a high diagnostic value for intracranial capillary hemangioma.</p>