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Objective:To investigate the clinical efficacy of redo rectal resection and coloanal anastomosis.Methods:The retrospective and descriptive study was conducted. The clinicopatholo-gical data of 49 patients who underwent redo rectal resection and coloanal anastomosis for the treatment of local recurrence of tumors and failure of colorectal or coloanal anastomosis after rectal resection in the Sixth Affiliated Hospital of Sun Yat-sen University from November 2012 to December 2021 were collected. There were 32 males and 17 females, aged 57(range,31-87)years. Redo rectal resection and coloanal anastomosis was performed according to the patient′s situations. Observa-tion indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers or percentages. Results:(1) Surgical situations. All 49 patients underwent redo rectal resection and coloanal anastomosis successfully, with the interval between the initial surgery and the reopera-tion as 14.2(7.1,24.3)months. The operation time and volume of intraoperative bold loss of 49 patients in the redo rectal resection and coloanal anastomosis was 313(251,398)minutes and 125(50,400)mL, respectively. Of the 49 patients, there were 38 cases receiving laparoscopic surgery including 12 cases with transanoscopic laparoscopic assisted surgery, 11 cases receiving open surgery including 2 cases as conversion to open surgery, there were 20 cases undergoing Bacon surgery, 14 cases undergoing Dixon surgery, 12 cases undergoing Parks surgery, 2 cases undergoing intersphincter resection and 1 case undergoing Kraske surgery, there were 20 cases undergoing rectum dragging out excision and secondary colonic anastomosis, 13 cases undergoing dragging out excision single anastomosis, 12 cases undergoing rectum dragging out excision double anastomosis, 4 cases undergoing first-stage manual anastomosis, there were 21 cases with enterostomy before surgery, 16 cases with prophylactic enterostomy after surgery, 12 cases without prophylactic enterostomy after surgery. The duration of postoperative hospital stay of 49 patients was (14±7)days. (2) Postoperative situations. Fifteen of 49 patients underwent postoperative complications, including 8 cases with grade Ⅱ Clevien-Dindo complications and 7 cases with ≥grade Ⅲ Clevien-Dindo complications. None of 49 patient underwent postoperative transferring to intensive care unit and no patient died during hospitalization. Results of postoperative histopathological examination in 23 patients with tumor local recurrence showed negative incision margin of the surgical specimen. (3) Follow-up. All 49 patients underwent post-operative follow-up of 90 days. There were 42 cases undergoing redo rectal resection and coloanal anastomosis successfully and 7 cases failed. Of the 37 patients with enterostomy, 20 cases failed in closing fistula, and 17 cases succeed. There were 46 patients receiving follow-up with the median time as 16.1(7.5,34.6)months. The questionnaire response rate for low anterior resection syndrome (LARS) score was 48.3%(14/29). Of the patients who underwent redo coloanal anastomosis and closure of stoma successfully, there were 9 cases with mild-to-moderate LARS.Conclusion:Redo rectal resection and coloanal anastomosis is safe and feasible for patients undergoing local recurr-ence of tumors and failure of colorectal or coloanal anastomosis after rectal resection, which can successfully restore intestinal continuity in patients and avoid permanent enterostomy.
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Objective:To investigate the correlation between the lipocalin-2 (LCN-2) level and white matter hyperintensities (WMHs) in patients with ischemic stroke.Methods:Consecutive patients with ischemic stroke admitted to the Department of Neurology, Jinling Hospital, Medical School of Nanjing University from September 2021 to November 2021 and whose duration from onset to hospitalization <14 d were prospectively enrolled. Enzyme-linked immunosorbent assay was used to detect the serum LCN-2. Fazekas scale was used to assess the severity of periventricular and subcortical WMHs. A total WMHs score ≥3 was defined as severe WMHs. Multivariate logistic regression analysis was used to determine the correlation between serum LCN-2 level and WMHs. Results:A total of 179 patients were enrolled, including 122 males (68.2%), aged 64.7±11.6 years. The median serum LCN-2 level was 387.1 g/L, and 86 patients (48.0%) had severe WMHs. Serum LCN-2 in the severe WMH group was significantly higher than that in the non-severe WMH group (505.3±342.4 g/L vs. 367.8±224.5 g/L; t=3.110, P=0.002). Multivariable logistic regression analysis showed that after adjusting for the relevant confounding factors, there was a significant correlation between higher serum LCN-2 and severe WMHs (odds ratio 2.32, 95% confidence interval 1.17-4.63; P=0.017) and higher total WMHs score (odds ratio 1.62, 95% confidence interval 1.12-2.35; P=0.011). Conclusion:Higher serum LCN-2 level is associated with severe WMHs in patients with ischemic stroke.
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Objective:To analyze the pathogenesis and clinical characteristics of appendiceal neoplasms and its prognosis.Methods:In recent 14 years, 94 appendiceal neoplasms were found among 6 334 patients undergoing appendectomy in a single center of Ordos Central Hospital.The initial symptoms, clinical features, auxiliary examinations, pathology, surgical methods, and clinical outcomes of 94 patients diagnosed with appendix tumors were recorded.Results:Appendiceal neoplasms accounted for 1.48% for all undergoing appendectomy. Among these 94 cases, 49 cases were female and 45 cases were male. The median age was 59.5 years. 80 cases were followed up with a follow-up rate of 85.1%, and the follow-up period was 2-175 months.The 5-year overall survival rate was 91.9% and the 10-year overall survival rate was 88.9%.The results of univariate analysis of prognosis showed that the prognosis of patients with WBC count>10.0×10 9/L (χ 2 =8.884, P=0.003) and lymph node metastasis(χ 2 =17.216, P=0.001) was relatively poor. The prognosis of appendiceal adenocarcinoma is relatively poor compared with mucinous tumors(χ 2=13.857 , P=0.001 ). Conclusions:The incidence of appendiceal neoplasms is very low; Chronic lower right abdominal pain accounted for a large proportion of the manifestations; Classification of appendiceal neoplasms, leukocyte count and lymph node metastasis predict the prognosis of patients with appendiceal neoplasms.
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Objective@#To investigate the safety and efficacy of surgical treatment for chronic radiation intestinal injury.@*Methods@#A descriptive cohort study was performed. Clinical data of 73 patients with definite radiation history and diagnosed clinically as chronic radiation intestinal injury, undergoing operation at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 1, 2012 to February 28, 2019, were reviewed and analyzed retrospectively. Patients did not undergo operation or only received adhesiolysis were excluded. All the patients had preoperative examination and overall evaluation of the disease. According to severity of intestinal obstruction and patients′ diet, corresponding nutritional support and conservative treatment were given. Surgical methods: The one-stage bowel resection and anastomosis was the first choice for surgical treatment of chronic radiation intestinal injury. Patients with poor nutritional condition were given enterostomy and postoperative enteral nutrition and second-stage stoma closure and intestinal anastomosis if nutritional condition improved. For those who were unable to perform stoma closure, a permanent stoma should be performed. Patients with severe abdominal adhesion which was difficult to separate, enterostomy or bypass surgery after adhesiolysis would be the surgical choice. For patients with tumor metastasis or recurrence, enterostomy or bypass surgery should be selected. Observation parameters: the overall and major (Clavien-Dindo grades III to V) postoperative complication within 30 days after surgery or during hospitalization; mortality within postoperative 30 days; postoperative hospital stay; time to postoperative recovery of enteral nutrition; time to removal of drainage tube.@*Results@#Of the 73 patients who had been enrolled in this study, 10 were male and 63 were female with median age of 54 (range, 34-80) years. Preoperative evaluation showed that 61 patients had intestinal stenosis, 63 had intestinal obstruction, 11 had intestinal perforation, 20 had intestinal fistula, 3 had intestinal bleeding, and 6 had abdominal abscess, of whom 64(87.7%) patients had multiple complications. Tumor recurrence or metastasis was found in 15 patients. A total of 65(89.0%) patients received preoperative nutritional support, of whom 35 received total parenteral nutrition and 30 received partial parenteral nutrition. The median preoperative nutritional support duration was 8.5 (range, 6.0-16.2) days. The rate of one-stage intestine resection was 69.9% (51/73), and one-stage enterostomy was 23.3% (17/73). In the 51 patients undergoing bowel resection, the average length of resected bowel was (50.3±49.1) cm. Among the 45 patients with intestinal anastomosis, 4 underwent manual anastomosis and 41 underwent stapled anastomosis; 36 underwent side-to-side anastomosis, 5 underwent end-to-side anastomosis, and 4 underwent end-to-end anastomosis. Eighty postoperative complications occurred in 39 patients and the overall postoperative complication rate was 53.4% (39/73), including 39 moderate to severe complications (Clavien-Dindo grade III-V) in 20 patients (27.4%, 20/73) and postoperative anastomotic leakage in 2 patients (2.7%, 2/73). The mortality within postoperative 30 days was 2.7% (2/73); both patients died of abdominal infection, septic shock, and multiple organ failure caused by anastomotic leakage. The median postoperative hospital stay was 13 (11, 23) days, the postoperative enteral nutrition time was (7.2±6.9) days and the postoperative drainage tube removal time was (6.3±4.2) days.@*Conclusions@#Surgical treatment, especially one-stage anastomosis, is safe and feasible for chronic radiation intestine injury. Defining the extent of bowel resection, rational selection of the anatomic position of the anastomosis and perioperative nutritional support treatment are the key to reduce postoperative complications.
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Objective@#To analyze the status of domestic surgical treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China.@*Methods@#Clinicopathological data of patients who underwent surgery from October 2003 to October 2018 in 16 domestic medical centers was retrospectively analyzed. Excel database was created which covered 77 fields of 7 parts: baseline information of patients, laboratory tests, imaging tests, chemoradiotherapy information, intra-operative findings, postoperative pathology and follow-up data. The Wilcoxon rank-sum test was used for comparison of the measurement data between groups. The χ2 test was used for comparison of the categorical data between groups. The survival curve was calculated by the Kaplan-Meier method.@*Results@#Of the 1 003 patients, there were 575 male and 428 female patients with the age of (58.5±14.1) years (range: 18 to 92 years). In a total of 920 patients, the carcinoma of sigmoid colon was performed in 292 cases (31.8%) with the highest ratio. The proportion of patients with liver metastasis and lung metastasis were 27.9% (219/784) and 8.3% (64/769). Preoperative detection of carcino-embryonic antigen level was the most common method in China (87.74%, 880/1 003), and the positive rate was 64.5% (568/880). The correct rate of preoperative imaging tests was 40.7% (280/688). The ratio of peritoneal carcinomatosis index (PCI) scores between 0 and 10 was the highest (59.6%, 170/285). Two hundred and sixty-two (27.0%) patients were performed by totally laparoscopic operation in 971 patients. The resection of primary tumor was performed in 588 of the 817 patients (72.0%). In a total of 457 cases, 253 (55.4%) patients were performed cytoreduction which group scored completeness of cytoreduction (CCR) 0. The postoperative hyperthermic intraperitoneal chemotherapy was implemented in 70 of the 334 cases (21.0%). Among 1 003 cases, 562 cases (56.03%) had complete follow-up data and the median overall survival was 15 months. The primary tumor resection and the CCR scores were affected by the PCI scores. The patients underwent primary tumor resection (187/205 vs. 26/80, χ2=105.085, P=0.000) and the patients were performed cytoreduction which scored CCR 0 or CCR 1 (162/204 vs. 8/78, Z=-10.465, P=0.000) had significant difference between the groups of PCI<20 and ≥20. There was a close correlation between the surgical method and the CCR scores (Z=-3.246,P=0.001).When the maximum degree of tumor reduction was planned, most surgeons would choose laparotomy. The overall survival time was longer in patients with primary tumor resection (P=0.000). The median survival time was 18.6 months in the group of primary tumor resection.@*Conclusions@#It is difficult to diagnose the synchronous peritoneal carcinomatosis from colorectal cancer before the operation. Primary tumor resection has an obvious effect to prolong the survival time. It is necessary to standardize the treatment of peritoneal metastasis.
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<p><b>OBJECTIVE</b>To evaluate the feasibility and efficacy of Zhu's trocar placement (ZTP) in laparoscopic appendectomy (LA) in the treatment of complicated appendicitis.</p><p><b>METHODS</b>Clinical data of 139 complicated appendicitis patients undergoing LA at the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2017 were retrospectively analyzed. ZTP-LA group comprised 59 cases and its procedure was as follows: 10 mm umbilical trocar was used as lens port; 12 mm trocar at crossing point of umbilical hole horizontal line and right midclavicular line was used as main operating port; 5 mm trocar at the crossing point of horizontal line 0-3 cm below umbilicus and right anterior axillary line was used as assist operating port with the drainage function for Douglas fossa and right iliac fossa; The operator and the assistant stood on the right side and the left side of the patient respectively. Traditional three-port group comprised 80 cases (8 cases converted to laparotomy, 72 cases enrolled finally) and its procedure was as follows: 10 mm lens port below umbilicus; 10-12 mm main operating port at lateral border of left lower rectus abdominis; 5 mm assist operating port above pubis; The operator and the assistant stood on left side of the patient. The operative time, time to oral semi-fluid, postoperative hospital stay, cost during hospitalization, and postoperative morbidity of complication were compared between two groups.</p><p><b>RESULTS</b>Baseline data such as gender, age, WBC count, percentage of leukocyte, pathological finding and type were not significantly different between two groups(all P>0.05). The conversion rate in ZTP-LA was significantly lower than that in traditional three-port group [0%(0/59) vs. 10.0%(8/80),χ²=4.552,P=0.033]. Compared with traditional three-port group, ZTP-LA group showed shorter operative time [(47.8±20.1) minutes vs. (66.0±27.3) minutes, t=4.383,P<0.001], shorter time to oral semi-fluid [(35.0±20.7) hours vs. (59.3±32.8) hours, t=5.158,P<0.001], shorter postoperative hospital stay [(4.1±1.6) days vs. (5.5±2.2) days, t=4.162, P<0.001], lower postoperative morbidity of complication [3.4% (2/59) vs. 18.1%(13/72), χ²=6.879, P=0.009], lower incidence of postoperative intra-abdominal abscess [0%(0/59) vs. 11.1%(8/72), χ²=5.179, P=0.023], lower incidence of paralytic ileus [1.7%(1/59) vs. 12.5%(9/72), χ²=3.946, P=0.047] and less cost during hospitalization[(13 585±2909) yuan vs.(16 861±5334) yuan, t=4.463, P<0.001].</p><p><b>CONCLUSION</b>ZTP-LA is safe, feasible and effective with advantages of faster recovery and less cost in the treatment of complicated appendicitis.</p>
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Humans , Appendectomy , Methods , Appendicitis , General Surgery , Laparoscopy , Methods , Length of Stay , Postoperative Complications , Retrospective Studies , Surgical Instruments , Treatment OutcomeABSTRACT
Objective@#To explore clinical features and prognosis factors of surgical complications after intersphincteric resection (ISR) for low rectal cancer following neoadjuvant chemoradiotherapy.@*Methods@#The clinical data of 132 patients with low rectal cancer who underwent ISR following neoadjuvant chemoradiotherapy from September 2010 to June 2017 at Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University were retrospectively reviewed. There were 100 males and 32 females, with the age of (52.9±11.4) years and distance to anal verge of 3.9 cm. Records of perioperative complication (POC) within 30 days after surgery, anastomotic leakage (AL), and anastomotic stenosis (AS) were analyzed. POC was recorded according to the Clavien-Dindo classification. AL was graded by ISREC system and classified into the early AL within 30 days after surgery and delayed AL beyond 30 days. AS was defined as narrowing of the bowel lumen at the anastomosis that prevented passage through a colonoscope with a 12 mm diameter. According to the shape of narrowing, AS was recorded as the stenosis in situ or stenosis with long-segment bowel above. Univariate and multivariate analysis were used to identify risk factors of anastomotic complications.@*Results@#Among the 132 patients, full-dose radiotherapy and diverting stoma were performed in 128 (97.0%) patients, respectively. In entire cohort, AL was found in 41 (31.1%) patients, including 32 patients with clinical leakage (24.2%). The median time for diagnosis of AL was 37 days (2 to 214 days) after surgery. There were 25 patients (18.9%) who were diagnosed with delayed AL beyond 30 days. Chronic presacral sinus formation was detected in 22 of 129 (17.1%) patients at 12 months from surgery. Among the 128 eligible patients, 36 (28.1%) were diagnosed as AS, including 24 (18.8%) patients with stenosis in situ and 12 (9.4%) patients with bowel stenosis above. After a median follow-up of 26 months, 7(5.3%) patients received permanent colostomy and the other 20(15.2%) patients retained a persistent ileostomy, owing to anastomotic complications. Results of multivariate analysis showed that radiation colitis was an independent prognosis factor of AL after ISR (OR=5.04, 95% CI: 2.05 to 12.43, P=0.000); male gender (OR=5.19, 95% CI: 1.24 to 21.75, P=0.024) and AL (OR=8.49, 95% CI: 3.32 to 21.70, P=0.000) were independent prognosis factors of AS after ISR.@*Conclusions@#Surgical complications are common after ISR for low rectal cancer patients with neoadjuvant chemoradiotherapy. A high rate of AL is observed after long-term follow-up, which is associated with AS. Increasing awareness of anastomotic complications after ISR should be raised, especially for male patients with radiation colitis.
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Objective To evaluate the safety and efficacy of low-dose platelet glycoprotein Ⅱb/Ⅲa antagonist tirofiban on preventing reocclusion during mechanical thrombectomy (MT) for in situ thrombosis(IST).Methods It is a retrospective cohort study, and 112 patients treated with MT, from the Nanjing Prospective Stroke Registration, were enrolled from February 2014 to October 2014. During MT, if angiography after a successful recanalization(defined as Thrombolysis In Cerebral Infarction(TICI) 2b/3) showed residual stenosis at the site of occlusion, additional angiographies were made every 10 min for 30 min.Then, if angiography displayed reocclusion in the corresponding vessels, a repeat recanalization was operated, followed by a low dose intra-arterial tirofiban infusion. MRA or CT angiography (CTA) was implemented to identify intracranial atherosclerosis (ICAS) 5-7 days after the procedure. The patients with confirmed ICAS were enrolled in the IST group. The rest were enrolled in the non-in situ thrombosis (NIST) group.Results A total of 80 patients with acute cerebral infarction were enrolled in the study. IST rate was 32.5%(26/80).All IST patients were confirmed ICAS by follow-up vascular imaging. Instant reocclusion after successful recanalization was significantly more common in the IST group(57.7%(15/26) vs 3.7%(2/54);χ2=30.568, P=0.000) than in the NIST group.In the case of the efficacy and safety of low-dose intra-arterial tirofiban infusion, 82.6%(19/23) of the reocclusion patients eventually accomplished TICI 2b/3, the rest 17.4%(4/23) of the cases were intractable to the procedure and needed rescue stent implantation.The modified Rankin Scale scores in patients infusing tirofiban were superior to the unused patients in 90 days. There was no patient with symptomatic intracranial hemorrhage after the procedure. Conclusions Patients with IST have higher cerebrovascular reocclusion rate during MT. After MT, low-dose intra-arterial tirofiban infusion may prevent reocclusion, and the prognosis is better.
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Objective@#To investigate the effect of irradiation to anastomosis from preoperative radiotherapy for patients with rectal cancer by studying the pathological changes.@*Methods@#In this retrospective study, patients enrolled in the FOWARC study from January 2011 to July 2014 in the Sixth Affiliated Hospital of Sun Yat-Sen University were included. In the FOWARC study, enrolled patients with local advanced rectal cancer were randomly assigned to receive either neoadjuvant chemo-radiotherapy or chemotherapy. Among these patients, 23 patients were selected as radiation proctitis (RP)group, who fulfilled these conditions: (1) received neoadjuvant chemo-radiotherapy followed by sphincter-preserving surgery; (2) developed radiation proctitis as confirmed by preoperative imaging diagnosis; (3) had intact clinical samples of surgical margins. Twenty-three patients who had received neoadjuvant chemo-radiotherapy but without development of radiation proctitis were selected as non-radiation proctitis (nRP) group. Meanwhile, 23 patients received neoadjuvant chemotherapy only were selected as neoadjuvant chemotherapy (CT) group. Both nRP and CT cases were selected by ensuring the basic characteristics such as sex, age, tumor site, lengths of proximal margin and distal margin all maximally matched to the RP group. Both proximal and distal margins were collected for further analysis for all selected cases. Microscopy slices were prepared for hematoxylin & eosin staining and Masson staining to show general pathological changes, and also for immunohistochemistry with anti-CD-34 as primary antibody to reveal the microvessel. Microvessel counting in submucosal layer and proportion of macrovessel with stenosis were used to evaluate the blood supply of the proximal and distal end of anastomosis. A modified semi-quantitative grading approach was used to evaluate the severity of radiation-induced injury. Either ANOVA analysis, Kruskal-Wallis rank-sum test or χ2 test was used for comparison among three groups, and Mann-Whitney U test was used for comparison between two groups.@*Results@#Compared to group of neoadjuvant chemotherapy only, patients receiving neoadjuvant chemo-radiotherapy had lower microvessel count in both proximal and distal margins (M(QR): proximal, 25.5 (19.6) vs. 50.0 (25.0), Z=3.915, P=0.000; distal, 20.5 (17.5) vs. 49.0 (28.0), Z=3.558, P=0.000), higher proportions of macrovessel with stenosis (proximal, 9.5% (23.8%) vs. 0, Z=3.993, P=0.000; distal, 11.5%(37.3%) vs. 0 (2.0%), Z=2.893, P=0.004), higher histopathologic score (proximal, 4.0 (2.0) vs. 1.0 (2.0), Z=6.123, P=0.000; distal, 5.0 (3.0) vs. 2.0 (1.0), Z=4.849, P=0.000). In patients receiving neoadjuvant chemo-radiotherapy, compared to nRP group, RP group had lower microvessel count in both proximal and distal margins (proximal, 19.0 (23.0) vs. 30.4 (38.0), Z=2.845, P=0.004; distal, 19.0 (13.0) vs. 30.0(29.1), Z=2.022, P=0.043), higher proportions of macrovessel with stenosis (proximal, 23.0% (40.0%) vs. 0(11.0%), Z=3.248, P=0.001; distal, 27.0% (45.0%) vs. 3.0% (19.0%), Z=2.164, P=0.030). Rate of anastomotic leakage for CT, nRP and RP group were 8.7% (2/23), 30.4% (7/23), and 52.2% (12/23), and the differences among three groups were statistically significant (χ2=10.268, P=0.007).@*Conclusion@#Radiation-induced injury existed on both margins of the resected rectal site after preoperative radiotherapy, and those diagnosed as radiation proctitis had more severe microvascular injury.
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Objective To investigate the risk difference of early neurological deterioration (END) in minor stroke patients with large artery atherosclerosis (LAA) and small vessel occlusion (SVO). Methods From January 2012 to August 2016, consecutive patients with first-ever acute ischemic stroke registered in the Nanjing Stroke Registration System were enrolled. The patients with minor stroke whose National Institutes of Health Stroke Scale (NIHSS) ≤3 on admission were screened. Propensity score matching analysis and McNemar's test were used to analyze the risk difference of END in minor stroke patients with LAA and SVO. Results A total of 778 patients with minor stroke were included, including 249 with LAA, 183 with SAO, and 145 matched pairs with propensity score matching method. The proportion of patients with END in the LAA group was significantly higher than that in the SVO group (6.2% vs. 1.4%; P<0.001). Conclusion Minor stroke due to LAA is more prone to have END than that due to SVO.
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<p><b>OBJECTIVE</b>To evaluate the short-term outcomes and perioperative safety of proximally extended resection for locally advanced rectal cancer after neoadjuvant chemoradiotherapy.</p><p><b>METHODS</b>From colorectal cancer database in The Sixth Affiliated Hospital of Sun Yat-sen University, a cohort of patients who underwent neoadjuvant chemoradiotherapy(1.8-2.0 Gy per day, 25-28 fractions, concurrent fluorouracil-based chemotherapy) followed by curative sphincter-preserving surgery for locally advanced rectal cancer between May 2016 and June 2017 were retrospectively identified. Exclusion criteria were synchronous colon cancer, intraoperatively confirmed distal metastasis, multiple visceral resection, and emergency operation. Thirty-one patients underwent proximal extended resection and two were excluded for incomplete extended resection, then 29 patients were enrolled as the extended group. Using propensity scores matching with 1/1 ration, 29 locally advanced rectal cancer patients who underwent conventional resection after neoadjuvant chemoradiotherapy at the same time were matched as the conventional group. Clinical data of two groups were analyzed, and the baseline characteristics and short-term outcomes were compared using the t test, χtest, or Mann-Whitney U test.</p><p><b>RESULTS</b>Two groups were well balanced with respect to the baseline characteristics after propensity score matching. As compared with conventional group, patients in extended group had longer surgical specimen [(18.8±5.1) cm vs.(11.6±3.4) cm, t=6.314, P=0.000] and longer proximal resection margin [(14.8±5.5) cm vs.(8.2±3.0) cm, t=5.725, P=0.000], but also had longer total operating time [(322.4±100.7) min vs.(254.6±70.3) min, t=2.975, P=0.004] and more intraoperative blood loss [100(225) ml vs. 100(50) ml, Z=-2.403, P=0.016]. No significant differences were observed in the length of distal resection margin, ratio of positive resection margin, number of retrieved lymph node, time of analgesic use, time of draining tube use, time to first flatus, time to first oral diet, and postoperative hospital stay. During the perioperative period of 30 days, the morbidity of complication in extended group and conventional group was 17.2%(5/29) and 34.5% (10/29), respectively (P=0.134).</p><p><b>CONCLUSION</b>Proximally extended resection is a radical and safe surgical alternative for locally advanced rectal cancer after neoadjuvant chemoradiotherapy, which can potentially reduce the risk of anastomosis complication.</p>
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<p><b>OBJECTIVE</b>To study the correlation between adipocytokines levels and metabolic syndrome (MS) in patients with newly diagnosed type 2 diabetes mellitus (T2DM).</p><p><b>METHODS</b>Sixty-eight patients with newly diagnosed T2DM, including 51 cases with MS and 17 without MS, were examined for blood pressure (BP), fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (IRI), waist to hip ratio (W/H), body mass index (BMI), and serum adipocytokine levels (IL-6, vaspin, and adiponectin).</p><p><b>RESULTS</b>The diabetic patients with MS had higher BMI, HbA1c, FBG, FINS, IRI, TG, TC, and SBP than those without MS. Serum IL-6 level was higher but adiponectin level was lower in patients with MS than in those without MS. There was no significant difference in vaspin level between the two groups. Adiponectin level was positively correlated with TG (r=-0.30, P=0.02) and inversely with BMI (r=-0.47, P=0.39) and HOMA-IR (r=-0.30, P=0.03); vaspin level was positively correlated with HOMA-IR (r=0.347, P=0.02) and inversely with HDL-L (r=-0.45, P=0.01); IL-6 level was positively correlated with LDL-L (r=0.18, P=0.25) and inversely with HDL-L (r=-0.45, P=0.01).</p><p><b>CONCLUSION</b>Adiponectin and IL-6 levels are closely related to MS, but the relationship between vaspin and MS needs further investigation.</p>
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Adult , Female , Humans , Male , Middle Aged , Adipokines , Blood , Adiponectin , Blood , Adipose Tissue , Metabolism , Diabetes Mellitus, Type 2 , Blood , Interleukin-6 , Blood , Metabolic Syndrome , Serpins , BloodABSTRACT
Objective To compare the clinical outcome of procedure for prolapse and hemorrhoids (PPH) and PPH + selective Milligan-Morgan hemorrhoidectomy(MMH) in surgical treatment of Ⅲ ～ Ⅳ stage hemorrhoids and research the best surgical procedures.Methods Retrospective analysis was made on the clinical data of 125 cases with Ⅲ ～ Ⅳ stage mixed hemorrhoids,they were non-randomized-controlled divided into PPH group (group 1) and PPH + selective MMH group(group 2),comparing the data of recurrence,complication and symptoms relief including anal prolapse,bleeding,anus fall feeling,wet anus and pruritus ani.Results While observing 3 years after operation,group 1 and group 2 both relieved symptoms of anal prolapse,bleeding,anus fall feeling,wet anus and pruritus ani.The relief rate of these symptoms in the two group were all high than 92%.There was one cases relapsed in the group 2 (the recurrence rate of 2%) was better than the group 1 (the recurrence rate of 13%) which were 8 case,there was a significant statistical significance (x2 =4.629,P ＜ 0.05) in the recurrence and clinical outcome.Conclusion Radical choose of PPH and selective MMH to treat Ⅲ ～ Ⅳ stage mixed hemorrhoids patients,which could relieve postoperative symptoms and acquire better long-term clinic outcomes.
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Objective To investigate the method of surgical treatment of acute intestinal obstruction caused by colorectal cancer,and affirm the feasibility and validity of the new way ofearly precolonic postoperative enteral nutritionafter operation of acute intestinal obstruction caused by colorectal cancer.Methods Retrospective analized the clinical data of 78 cases of acute intestinal obstruction caused by colorectal caner from September 2007 to September 2012 and the incidence of complications (incision infection,intra-abdominal abscess,anastomotic leakage,and pneumonia) was observed.Results Sixty-two patients received radical resection and primary anastomosis.All of them were cured and no death occurred.Two patients had complication of postoperative infection and none suffered from anastomotic or drainage leakage.Conclusion Radical resection and primary anastomosis using Intra-operative colonic lavage are safe and effective methods for patients with colorectal cancer associated with acute intestinal obstruction,and early precolonic postoperative enteral nutritioncould better eliminate perioperative malnourished patients more,reduce operation complication,prevent anastomotic leakage,and increase the success rate of the operation.
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Under low temperature conditions, the hapten carboxyl-norketamine was synthesized by reacting norketamine and succinaldehyde acid.Identification result using electrospray ionization mass showed the hap ten was successfully synthesized.The artificial antigen confirmed by infrared spectroscopy was developed by conjugating hapten to carrier proteins with carbodiimide(EDC) method.Matrix-assisted laser desorption ioni zation time of flight mass spectrometry(MALDI-TOF-MS) showed that the ratio of hapten to BSA was 11:1.The antibody with high titer(5.12 × 10~4) was produced after immuning to rabbits.
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Objective To observe the expression of ? APP and SS in the hippocampus of the rat mode ls with the deficits of learning and memory function, and investigate its mechanism.Methods Using immunohistochemistry (IHC), we detected the expressions of ? amyloid precursorprotein(? APP) and somatostatin(SS) in the hippocampus of the rat brains,using HE staining method, we observed the shapes and structures of pyramidal cell layer neurons in hippocampus of the rats in the experimental group and the controls.Results The learning and memory functions were lower significantly in the experimental group than in the controls ( P