Multimodal prehabilitation before major abdominal surgery: A retrospective study

INTRODUCTION@#Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme.@*METHODS@#Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation.@*RESULTS@#There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay (@*CONCLUSION@#The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.

Obstructive Ileocolitis in Patients With Obstructed Colorectal Cancer – A Matched Case Control Study

PURPOSE: Obstructive ileocolitis is an ulcero-inflammatory condition which typically occurs in the ileum or colon proximal to an obstructing colorectal lesion. If left unresolved, it often leads to intestinal perforation. We present a matched case control study of patients with obstructive ileocolitis caused by colorectal cancer to determine if any factors can predict this condition. METHODS: This is a retrospective review of 21 patients with obstructive colorectal cancer and histologically proven obstructive ileocolitis from 2005 to 2015 matched for age and sex with 21 controls with obstructing colorectal cancer without obstructive ileocolitis. RESULTS: The 21 patients with obstructive ileocolitis had a median age of 71 years (range, 52–86 years). The most common presenting symptom was abdominal pain (n = 16, 76.2%), followed by vomiting/nausea (n = 14, 66.7%) and abdominal distension (n = 12, 57.1%). Interestingly, the radiological feature of pneumatosis intestinalis was noted in only 1 case. No significant differences were observed in baseline comorbidities, clinical presentations, or tumor characteristics between the 2 groups. Patients with obstructive ileocolitis were found to have a significantly higher total leucocyte count (17.1 ± 9.4×109/L vs. 12.0 ± 6.8×109/L, P = 0.016), lower pCO2 (32.3 ± 8.2 mmHg vs. 34.8 ± 4.9 mmHg, P = 0.013), lower HCO3 (18.8 ± 4.5 mmol/L vs. 23.6 ± 2.7 mmol/L, P < 0.001), lower base excess (-6.53 ± 5.32 mmol/L vs. -0.57 ± 2.99 mmol/L, P < 0.001) and higher serum lactate levels (3.14 ± 2.19 mmol/L vs. 1.19 ± 0.91 mmol/L, P = 0.007) compared to controls. No radiological features were predictive of obstructive ileocolitis. CONCLUSION: Patients with obstructive ileocolitis tend to present with metabolic acidosis with respiratory compensation, raised lactate, and worse leucocytosis. Radiological features are not useful for predicting this condition.

Efficacy and Safety of MSC Infusion in Treatment of Children with Refractory LOHC: A Clinical Study / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To study the curative effect and safety of menchymal stem cell infusion in treatment of children with refractory late-onset hemorrhagic cystitis(LOHC) after allogeneic HSCT.</p><p><b>METHODS</b>Thirty cases of children with refractory LOHC after allo-HSCT in our department between December 2010 and July 2016 were analyzed retrospectively, out of 30 cases 7 received MSC treatment. The used MSC of all were four-to-five generation MSC from bone marrows of third party donors, and were infused into patients with (1.87±0.456)×10/kg MSCs once a week (1-4 times in total) until the hematuria and odynuria symptoms being improved. To observe whether unfavorable reactions occurred after MSC treatment, the patients accepted daily physical examination and regular assistant examination. The cytokine levels were also measured and dynamically detected in 2 cases before and after MSC treatment.</p><p><b>RESULTS</b>In 30 children with refractory LOHC, the hematuria difficultly reached the remission after routine hydration, alkalizing and antiviral therapy, Among 25 cases who were received methylprednisolone, MTX and CTX therapy, 7 cases received MSC infusion for 1-4 times with dose of (1.87±0.456)×10/(kg·time) as a result, 7 cases of LOHC were cured. The TNF-α and IL-2R levels in 2 cases progressively decreased after MSC infusion, no occurence of fever, rash, embolism and so on were found in 7 cases received MSC infusion; the BKV detection showed that the viral load did not increase; the leukemia relapse or secondary cancer did not occure.</p><p><b>CONCLUSION</b>The MSC treatment is safe and effective for refractory LOHC after allo-HSCT.</p>

Single segment fixation with atlantoaxial pedicle screwsin the treatment of Jefferson fracture combined with unstable odontoid fracture / 中国组织工程研究

BACKGROUND: Jefferson fracture associated with unstable odontoid fracture is rare, and little reported.Occipito-cervical fusion is the commonly used treatment method, but it causes a severe loss of the motion of cervical vertebrae, which affects the patients' quality of life, so the curative effect is poor.OBJECTIVE: To evaluate the feasibility and therapeutic efficacy of atlantoaxial transpedicular screw fixation for Jefferson fracture associated with unstable odontoid fracture, so as to avoid occipito-cervical fusion and preserve the motion of the atlanto-occipital joint.METHODS: Fifteen patients with Jefferson fracture associated with unstable odontoid fracture from March 2010 to August 2015, were treated with atlantoaxial transpedicular screw fixation. There were 13 cases of Anderson type II and 2 cases of Anderson shallow type lll odontoid fracture, as well as 5 cases combined with transverse atlantal ligament rupture. All patients underwent skull traction after admission, as well as three-dimensional CT was applied preoperatively to determine the atlas pedicle screw trajectory and chose suitable screws. Atlantoaxial transpedicular screw was placed and atlantoaxial joint was reduced under general anesthesia. Bone graft fusion of atlantoaxial joint was applied only for the transverse atlantal ligament.The pain and neurologic function were evaluated by the Visual Analog Scale and the American Spinal Injury Association Impairment Scale before and after operation. The range of motion of the atlanto-occipital joint was observed during follow-up.RESULTS AND CONCLUSION: (1) The mean operation time was (150±41) minutes (120-270 minutes). The mean blood loss was (246±95) mL (160-500 mL). (2) Atlantoaxial transpedicular screws were successfully placed in all patients. No spinal and nerve root injury, or vertebral artery injury occurred intraoperatively. The atlantoaxial achieved good reduction. (3) The follow-up time was 12-36 months. There were nine cases of incomplete spinal cord injury, and 7 cases of obviously improved neurologic function. The visual analog scale scores were significantly improved at 1 year postoperatively, from preoperative (8.15±0.62) to postoperative (1.2±1.4) (P < 0.05). (4) All fractures and bone grafts were healed without loosening or rupture of the screws. The range of motion of the atlanto-occipital joint was (14.6±2.8)° postoperatively. (5) To conclude, atlantoaxial transpedicular screw fixation is effective for Jefferson fracture combined with unstable odontoid fracture, which not only exhibits a high rate of bone healing and stable fixation, but also avoids the occipital-cervical fusion and preserves occipito-atlantal motion.

Clinical significance of CD39 CD73 subsets and both of them positive subgroups of regulatory T cells in the microenvironment of colorectal cancer / 实用肿瘤学杂志

Objective The objectives of this study were to investigate the clinical significance of CD39,CD73,double positive subgroups for CD39 and CD73,and other lymphocytes with clinicopathological parameters in the microenvironment of colorectal cancer.Methods Tumor infiltrating lymphocyte(TIL)was collected from 24 patients with colorectal cancer after radical resection.The expression of CD39+,CD73+ or CD39+ with CD73+ in T cells were measured by flow cytometry.The association between these subgroups and clinicopathologic parameters was analyzed.Results The CD73+ and CD39+ with CD73+ subgroups were associated with lymph node metastasis and poor degree of differentiation,and this mechanism was closely related to tumor-associated inflammation.Conclusion CD39+ with CD73+ colorectal tumor infiltration Treg has a more unique biological activity than other Treg group.This study provides a new idea and theoretical basis for predicting the prognosis of colorectal cancer.