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Objective:To investigate the safety and feasibility of the CHESS endoscpic ruler (CHESS ruler), and the consistency between the measured values and the interpretation values by endoscopic physician experience.Methods:From January 2021 to January 2022, a total of 105 liver cirrhosis patients with portal hypertension were prospectively enrolled from General Hospital, Xixia Branch Hospital, Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region (29 cases), and the First People′s Hospital of Yinchuan (25 cases), General Hospital of Ningxia Medical University (18 cases), Wuzhong People′s Hospital (10 cases), the Fifth People′s Hospital of Ningxia Hui Autonomous Region (10 cases), Shizuishan Second People′s Hospital (6 cases), Yinchuan Second People′s Hospital (5 cases), and Zhongwei People′s Hospital (2 cases) 8 hospitals. The clinical characteristics of all the patients, including gender, age, nationality, etiolog of liver cirrhosis, and Child-Pugh classification of liver function were recorded. A big gastroesophageal varices was defined as diameter of varices ≥5 mm. Endoscopist (associated chief physician) performed gastroscopy according to the routine gastroscopy procedures, and the diameter of the biggest esophageal varices was measured by experience and images were collected, and then objective measurement was with the CHESS ruler and images were collected. The diameter of esophageal varices of 10 randomly selected patients (random number table method) was determined by 6 endoscopists (attending physician or associated chief physician) with experience or measured by CHESS ruler. Kappa test was used to test the consistency in the diameter of esophageal varices between measured values by CHESS ruler and the interpretation values by endoscopic physician experience.Results:Among 105 liver cirrhosis patients with portal hypertension, male 65 cases and female 40 cases, aged (54.8±12.2) years old, Han nationality 82 cases, Hui nationality 21 cases and Mongolian nationality 2 cases. The etiology of liver cirrhosis included chronic hepatitis B (79 cases), alcoholic liver disease (7 cases), autoimmune hepatitis (7 cases), chronic hepatitis C (2 cases), and other etiology (10 cases). Liver function of 32 cases was Child-Pugh A, Child-Pugh B 57 cases, and Child-Pugh C 16 cases. All 105 liver cirrhosis patients with cirrhotic portal hypertension were successfully measured the diameter of gastroesophageal varices by CHESS ruler, and the success rate of application of CHESS ruler was 100.0% (105/105). The procedure time from the CHESS ruler into the body to the exit of the body after measurement was (3.50±2.55) min. No complications happened in all the patients during measurement. Among 105 liver cirrhosis patients with cirrhotic portal hypertension, 96 cases (91.4%) were recognized as big gastroesophageal varices by the endoscopists. Totally 93 cases (88.6%) were considered as big gastroesophageal varices by CHESS ruler. Eight cases were recognized as big gastroesophageal varices by the endoscopist, however not by the CHESS ruler; 5 cases were recognized as big gastroesophageal varices by the CHESS ruler, but not by the endoscopists; 4 cases were not recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler; 88 cases were recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler. The missed diagnostic rate of big gastroesophageal varices by the endoscopists experience was 5.4% (5/93), and the Kappa value of consistency coefficient between the measurement by the CHESS ruler and the interpretation by endoscopists experience was 0.31 (95% confidence interval 0.03 to 0.60). The overall Kappa value of consistency coefficient by 6 endoscopists measured by CHESS ruler in big gastroesophageal varices diagnosis was 0.77 (95% confidence interval 0.61 to 0.93).Conclusion:As an objective measurement tool, CHESS ruler can make up for the deficiency of subjective judgment by endoscopists, accurately measure the diameter of gastroesophageal varices, and is highly feasible and safe.
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Objective:To investigate the antibiotics resistance of patients with Helicobacter pylori ( H. pylori) infection of different age in Ningxia. Methods:From July to December 2021, a total of 1 040 patients with H. pylori infection confirmed by 14C-urea breath test who had no history of H. pylori treatment and underwent gastroscopy were selected from the H. pylori special outpatient clinics from Ningxia Hui Autonomous Region People′s Hospital, Ningxia Hospital of Integrated Traditional Chinese and Western Medicine, Yuanzhou District People′s Hospital of Guyuan, Wuzhong People′s Hospital, the Second People′s Hospital of Shizuishan, People′s Hospital of Zhongwei, Yinchuan First People′s Hospital. Gastric mucosa specimens were obtained under gastroscopy and cultured for H. pylori in vitro. Harvested H. pylori were detected for H. pylori drug resistance phenotype. Kirby-Bauer disk diffusion method was used to detect antibiotic sensitivity. Previous use of antibiotics of patients were recorded. The characteristics of primary drug resistance of people≤44, 45 to 59, and ≥60 years old were analyzed. Chi-square test was used for statistical analysis. Results:A total of 538 H. pylori strains were obtained from 1 040 gastric mucosa specimens cultured in vitro, with a positive rate of 51.7%. A total of 187 patients could provide information on history of antibiotics usage. The primary drug resistance rates of metronidazole, clarithromycin and levofloxacin were high, which were 95.5% (514/538), 44.6% (240/538) and 45.4% (244/538), respectively; however drug resistance of amoxicillin, furazolidone and tetracycline were not found. The double drug resistance rate was 36.4% (196/538), mainly resistant to metronidazole and clarithromycin or metronidazole and levofloxacin, the drug resistance rates were 17.8% (96/538), 18.2% (98/538), respecitively. The triple drug resistance rate was 25.5% (137/538), all of the strains were metronidazole, clarithromycin and levofloxacin resistant strains. The primary drug resistance rates to levofloxacin and clarithromycin in patients with H. pylori infection who had previous history of quinolones and macrolides were 60.9% (28/46) and 63.4% (83/131), respectively; which were higher than those of patients who had not used corresponding drugs (41.8%, 59/141 and 39.3%, 22/56), and the differences were statistically significant ( χ2=5.05 and 9.23, P=0.023, 0.002). The drug resistance rates of metronidazole of ≤44, 45 to 59, and ≥60 years old group were 94.2% (163/173), 95.5% (231/242) and 97.6% (120/123), respectively, and the differences were not significant ( P>0.05). The single drug resistance rates of levofloxacin of ≤44, 45 to 59, and ≥60 years old group were 34.7% (60/173), 48.3% (117/242) and 54.5% (67/123), respectively, and the differences were statistically significant ( χ2=12.95, P=0.002). The levofloxacin resistance rate of ≤44 years old group was lower than that of 45 to 59, and ≥60 years old group, and the differences were statistically significant ( χ2=7.70 and 11.49, P=0.006, 0.001). The single drug resistance rates of clarithromycin of ≤44, 45 to 59, and ≥60 years old group were 36.4% (63/173), 50.4% (122/242) and 44.7% (55/123), respectively, and the differences were statistically significant ( χ2=8.00, P=0.018). The clarithromycin resistance rate of ≤44 years old group was lower than 45 to 59 years old group, and the difference was statistically significant ( χ2=8.00, P=0.005). Dual drug resistance rates of levofloxacin and clarithromycin of ≤44, 45 to 59 and ≥60 years old group were 49.7%(86/173), 70.2%(170/242), 45.5%(56/123), and the difference was statistically significant( χ2=27.63, P<0.001). The resistance rate of clarithromycin and levofloxacin in 45 to 59 years old group was higher than that in ≤44 and ≥60 years old group, and the difference was statistically significant ( χ2=18.00 and 21.13, both P<0.001). Conclusions:Primary drug resistance rates to metronidazole, levofloxacin and clarithromycin are high in patients with H. pylori infection of different ages in Ningxia. Individualized eradication therapy guided by drug resistance test is recommended.
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Objective@#To explore the effect of enterostomy on analgesic pattern in advanced digestive tract cancer.@*Methods@#A retrospective cohort study was carried out, which was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University (E2018026). Inclusion criteria were as follows: (1)age and gender were not limited; (2) all the gastrointestinal malignancies were confirmed histologically, and local recurrence or metastasis were confirmed by CT or MR; (3) numerical rating scale (NRS) ≥4 points, opioid analgesic drugs were required; (4) informed consents were signed by patients of their own. Exclusion criteria were as follows: (1) malignancies of early stage; (2) suspicious adverse mental states which might lead to poor administration compliance; (3) hypersensitivity or allergic reactions to opioids. Clinical data of patients with advanced gastrointestinal cancer receiving comprehensive treatment at the Medical Oncology Department of the Sixth Affiliated Hospital of Sun Yat-sen University from September 2016 to April 2017 were retrospectively collected. The patients were divided into the stoma group and the non-stoma group. The clinical findings of two groups were analyzed, including age, sex, ostomy status, pain location, presence or absence of intestinal obstruction, pain characteristics, selection of opioid analgesic agents, treatment of side effects of analgesics. Pain was assessed using brief pain inventory(BPI) table and NRS score. Strong opioids were prescribed for patients of NRS ≥4. Patients who were intolerant to opioids required opioid titration. The titration drugs included oral or IV morphine and oxycodone. After achievement of adequate pain control, long-acting opioids were administered, which included sustained-release morphine tablets, controlled release oxycodone and transdermal fentanyl. Criteria for pain relief included NRS≤3, breakthrough pain <3 times/day and duration of adequate pain control >3 days. The χ2 test and the Wilcoxon signed rank sum test (nonparametric test) were used to analyze the clinical features of patients in the stoma and non-stomach groups. In order to find the factors associated with maintenance therapy and the use of laxatives, the variables were compared as well as in multivariate analysis with multiple regression models. For all the statistical tests, a value of P<0.05 in a two-tailed test was established as the alpha significance level.@*Result@#A total of 123 patients were enrolled in this study, including 79 males (64.2%) and 44 females (35.8%) with a median age of 51 years. Fifty-two patients were in stoma group, including 30 (24.4%) of ileostomy and 22 (17.9%) of colostomy, and 71 patients were in non-stoma group. Pain of 40 (76.9%) patients in stoma group located in abdomenopelvic site while the pain of 44 (62.0%) patients in non-stoma group located in other sites. Compared with non-stoma group, cases in stoma group complained more abdominopelvic pain (73% vs. 62.0%, P<0.001).The median NRS pain score before treatment in the stoma group and the non-stoma group was 5.7 and 5.6, respectively, without statistically significant difference (P=0.741). After analgesic management, the above scores reduced to 2.1 and 2.3, respectively, without statistically significant difference as well (P=0.092). Analgesic treatment was effective in 111 cases (90.2%), including 49 cases (94.2%) in the stoma group, and 62 cases (87.3%) in the non-stoma group, and there was no statistically significant difference between the two groups (P=0.202). There was more application of fentanyl transdermal patch [34.6%(18/52) vs. 9.8%(7/71)] in the stoma group, while more application of lactulose laxative [78.9%(56/71) vs. 61.5%(32/52)](χ2=10.023, P=0.002) in the non-stoma group. Multivariate analysis revealed that ostomy (OR=0.290, 95%CI: 0.102-0.824, P=0.009) and pain site (OR=5.691, 95%CI:1.709-18.948, P=0.005) were independent factors affecting the choice of the first line opioid sustained release agent. Of the 123 patients with maintaining analgesia, 98 had available data of laxative use, of whom 46 used laxatives to prevent or treat constipation, and the proportion of laxatives in stoma group (21.2%, 11/52) was significantly lower than that in non-stoma group (49.3%, 35/71) (χ2=6.957, P=0.008). Multivariate analysis of the application of laxative use showed that age (OR=0.281, 95% CI: 0.123-0.684, P=0.010) and ostomy (OR=2.621, 95% CI: 1.033-6.687, P=0.045) were independent factors affecting the use of lactulose laxatives.@*Conclusions@#Enterostomy may affect the analgesic pattern in advanced digestive tract cancer. Patients with stoma are more likely to use fentanyl transdermal patches and younger patients with stoma do not need prophylactic use of laxatives.
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Rectal cancer is one of the most common malignancies in China. Total mesorectal excision (TME) plus neoadjuvant therapy is the standard treatment for locally advanced rectal cancer. After a development of over 20 years, neoadjuvant synchronous chemoradiotherapy has become the standard treatment and cornerstone of neoadjuvant therapy for rectal cancer. However, radiotherapy does not really increase the overall survival and is associated with long-term impact on the functions of anus, sex, urinary system and fertility, so the application of simple neoadjuvant chemotherapy rises gradually and becomes a potentially better treatment option. This paper elaborates the reason, present research status and future trend of the rising neoadjuvant chemotherapy.
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Humans , Chemoradiotherapy , China , Neoadjuvant Therapy , Neoplasm Staging , Rectal Neoplasms , Therapeutics , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the safety and preliminary efficacy of dose-modified regimen of 5-fluorouracil plus oxaliplatin and irinotecan (mFOLFOXIRI) for patients with advanced colorectal cancer (CRC).</p><p><b>METHODS</b>Data of 312 CRC patients confirmed by pathology receiving triplet drug alone or combined with target therapy between October 2012 and December 2016 at the Sixth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. CRC patients who had previously completed adjuvant therapy (or neoadjuvant therapy) within 6 months or palliative chemotherapy were excluded, meanwhile those with poor general condition (ECOG score > 2) or grade 2 neuropathy and allergy to oxaliplatin were excluded as well. Regimen of mFOLFOXIRI: oxaliplatin 85 mg/m² dissolved in 5% glucose solution 500 ml by intravenous infusion for 2 h; irinotecan 150 to 165 mg/m² dissolved in 0.9% sodium chloride 250 ml by intravenous infusion for 90 min; following intravenous infusion of leucovorin 400 mg/m² for 2 h, day 1; 5-FU 2800 mg/m², 48-h continuous intravenous infusion; once every 2 weeks. Therapy could be combined with a targeted drug, bevacizumab 5 mg/kg every two weeks; cetuximab 500 mg/m² every two weeks. Side effect was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE 4.0.3). The objective response rate was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) after administering at least four cycles of chemotherapy.</p><p><b>RESULTS</b>The median age was 52 years (range 16-73) in the whole group; 113 patients (36.2%) had locally advanced CRC, and 199 (63.8%) had metastatic CRC. Most patients (274/312, 87.8%) did not receive any treatment earlier. There were a total of 1651 chemotherapy cycles in the whole group, with a median of 6(1-19) cycles. Of these 1651 cycles, 124 cycles of chemotherapy(7.5%) were dose-adjusted; 176 cycles of chemotherapy(10.7%) were delayed for median 5(3-13) days; 124 cycles(7.5%) required dose decrease. The overall relative dose intensity was >90%; the specific drug dose intensity was 93.6%(2620 mg×m⁻²×d⁻¹) for fluorouracil, 97.8%(83 mg×m⁻²×d⁻¹) for oxaliplatin, and 94.2%(155 mg×m⁻²×d⁻¹) for irinotecan. Twenty-three patients (7 of intestinal perforation, 7 of intestinal obstruction, 1 of grade 4 hematologic toxicity, and 8 of grade 3 fatigue) refused subsequent chemotherapy due to intolerable toxicity. Main grade 3 or 4 adverse events in patients were neutropenia in 69 cases (22.1%), fatigue in 35 cases (11.2%), and anemia in 28 cases (8.9%). Twenty serious adverse events (6.4%) occurred, including 13 patients of febrile neutropenia (4.2%), 7 patients of intestinal perforation (2.2%, 4 patients in upper rectum, 2 in sigmoid colon, and 1 in transverse colon cancer), and 9 of them had subsequent sepsis (2.9%). All the patients with intestinal perforation underwent emergency operation. No treatment-related deaths occurred. In 199 patients with metastatic CRC, because 22 patients did not receive image evaluation, the preliminary efficacy of 177 patients was actually evaluated. A total of 113 objective response events were observed. The overall response rate was 63.8%(113/177), partial response rate was 61.6%(109/177), clinically complete response rate was 2.3%(4/177), stable disease was 29.9% (53/177), progressive disease was 6.2%(11/177), and the disease control rate was 93.8%(166/177). In 127 patients receiving triplet drug, objective response rate was 40.9% for those with less than four cycles and 81.1% for those with more than four cycles (P<0.001).</p><p><b>CONCLUSION</b>The mFOLFOXIRI regimen with reduced dose can be safely used in advanced CRC and has achieved promising results in terms of short-term efficacy.</p>
Subject(s)
Adolescent , Adult , Aged , Humans , Middle Aged , Young Adult , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Camptothecin , Colorectal Neoplasms , Drug Therapy , Fluorouracil , Leucovorin , Organoplatinum Compounds , Retrospective Studies , Treatment OutcomeABSTRACT
Liver metastasis is the most common cause of death for patients with colorectal cancer.Surgical resection is the first choice for colorectal cancer liver metastasis (CRLMs),but only 10％-25％ of them are resectable.Patients with unresectable CRLMs are usually treated with systemic chemotherapy and/or local ablative therapies as alternative options.The safety and efficiency of thermal ablation therapies have been improved in recent years.The 5-year survival rate of patients underwent thermal ablation is higher than that of patients underwent chemotherapy for treating CRLMs.A consensus for thermal ablation of colorectal liver metastasis was provided by international experts panel on 2013.The recommendations and indications of thermal ablation for CRLMs were considered and documented according to the literature review based on radiofrequency ablation with long-term follow-up.The main content of the consensus from international experts for thermal ablation of colorectal liver metastasis were reviewed in this article.
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Objective To construct the core competence evaluation index system for intravenous therapy specialized nurses.Methods Using literature research,group discussion,and two-round Delphi expert consultation,the core competence evaluation index system for intravenous therapy specialized nurses was constructed.Results The response rates for two rounds of expert consultation were both 100％,authority coefficients were 0.93 and 0.94,and coordination coefficients at all levels ranged from 0.252 to 0.418.The core competence evaluation index system for intravenous therapy specialized nurses consisted of 8 first-class indexes,35 second-class indexes and 93 third-class indexes.Conclusion The enthusiasm,authority,concentration degree and coordination degree of experts were comparatively high.It can provide references for training,assessment,certification,utilization and management of intravenous therapy specialized nurses.
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<p><b>OBJECTIVE</b>To investigate the value of MRI with CUBE sequence in early evaluation of the efficacy of neoadjuvant therapy (NAT) for locally advanced rectal cancer.</p><p><b>METHODS</b>Inclusion criteria: (1) rectal cancer proven by biopsy; (2) locally advanced rectal cancer (T3-4 or positive lymph nodes) with distance from lower edge of tumor to anal verge within 12 cm diagnosed by MRI before NAT; (3) acceptance of NAT treatment regulations and completion of NAT; (4) completion of routine MRI scan and CUBE scan before and after 2-course NAT chemotherapy (including new neoadjuvant chemotherapy and chemoradiotherapy); (5) completion of surgery 6-8 weeks after NAT; (6) exclusion of any previous NAT due to rectal malignant tumor or other tumors; (7) exclusion of poor image quality of preoperative routine MRI insufficient for rectal cancer staging or of CUBE image insufficient for tumor volume measurement. Fifty patients with advanced local rectal cancer were recruited in our hospital from February 2014 to January 2016. All the patients underwent MRI before and after 2-course neoadjuvent therapy. Tumor volume on CUBE were measured and the volume changes were calculated: volume difference= pre-treatment volume-post-treatment volume, volume change rate= (pre-treatment volume-post-treatment volume)/ pre-treatment volume. All the patients were categorized into sensitive and non-sensitive group according to postsurgical pathology. Comparisons were made between both groups before and after therapy. ROC curve was used to evaluate the value of CUBE-associated parameters in predicting the efficacy of rectal cancer.</p><p><b>RESULTS</b>Among enrolled 50 patients with rectal cancer, 31 were male and 19 were female, with mean age of 49.1 years (range 21 to 70 years). T-staging by MRI before NAT was T2N1-2 in 1 case, T3 in 43 cases, T4 in 6 cases. The number of patients after NAT from tumor regression grading (TRG) 0 to TRG3 was 14, 13, 18, 5, respectively. The sensitive group and insensitive group were 45 cases and 5 cases. Mean tumor volume before and after preoperative 2-course NAT was 18.70 (4.14 to 91.77) cmand 9.26 (1.02 to 52.58) cm, respectively, whose difference was significant (U=-5.826, P<0.001). Both measure values of overall tumor volume before and after preoperative NAT between sensitive group and insensitive group did not show significant differences(all P>0.05). While sensitivity group had significantly higher volume difference and change rate compared to insensitive group [ (11.90±10.01) cmvs. (0.65±3.93) cm, P=0.005; 0.45±0.28 vs. 0.09±0.36, P=0.010]. ROC curve revealed that the optimal cutoff value of accurate identification of patients with NAT sensitive was 1.96 cmfor volume difference with sensitivity 86.7% and specificity 80%, and 0.06 for volume change rate with sensitivity 93.3% and specificity 60%.</p><p><b>CONCLUSION</b>MRI CUBE can predict the efficacy of NAT for early rectal cancer patients accurately and sensitively through the detection of tumor volume change before and after NAT.</p>
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Objective To study the effects of anti -cancer drug NSC319726 on the gene expression of ovarian cancer.Methods The data that NSC319726 acted on the ovarian cancer cell lines TOV112D was down-loaded from the GEO database and then the bioinformatical analysis was conducted .Results NSC319726 in-creased 246 genes including MMP3,CXCR4 et al and decreased 198 genes such as PBX1 in ovarian cancer cell lines.GO analysis indicated that six GO items were related to metabolism .Pathway analysis revealed that NSC319726 could affect the circadian clock and MMP signaling pathway .Conclusion NSC319726 could affect the expression of multiple functional genes in ovarian cancer cell lines and might be a potential drug targeting to the precursor-B cell acute lymphoblastic leukemia .Meanwhile , it should be noted that NSC 319726 may have effects on the tumor metastasis and human sleep .Therefore,further research needs to be conducted before the clinical use .
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<p><b>OBJECTIVE</b>To study the impact of neoadjuvant radiochemotherapy on erectile and urinary functions in mid-low rectal cancer patients.</p><p><b>METHODS</b>Seventy mid-low rectal cancer patients from January 2012 to May 2013 in The Sixth Affiliated Hospital, Sun Yat-sen University were prospectively enrolled. According to tumor staging and patient decision, patients received neoadjuvant radiochemotherapy(50 Grays administered over a six-week period and four cycles of concomitant mFOLFOX6 chemotherapy followed by operation (study group) or surgery alone(control group). Dropouts, loss to follow up and relapse during follow-up were removed from the analysis. A total of 30 patients stayed in study group and 29 patients in control group. To assess erectile and urination functions, the five-item version of the international index of erectile function (IIEF-5) and the international prostate symptom score (IPSS) questionnaires were used before therapy and 12 months after surgery.</p><p><b>RESULTS</b>In both study and control groups, total IIEF-5 score was decreased significantly at postoperative 12-month compared to initial assessment(P<0.01). Compared with control group, IIEF-5 score change was significantly higher in study group (9.6 ± 6.1 vs. 5.3 ± 5.3; P<0.01). Total IPSS score in both groups was increased significantly at postoperative 12-month compared to initial assessment(P<0.05). No significant difference was found in IPSS score change between the two groups (3.0 ± 3.4 vs. 1.5 ± 3.0, P>0.05). Univariate analysis on study group showed that age, tumor location and maximal diameter were associated with erectile dysfunction. Age was associated with urination dysfunction (all P<0.05).</p><p><b>CONCLUSION</b>Neoadjuvant radiochemotherapy has significant impact on erectile dysfunction after surgery in mid-low rectal cancer patients.</p>
Subject(s)
Humans , Male , Chemoradiotherapy , Erectile Dysfunction , Neoadjuvant Therapy , Neoplasm Staging , Prospective Studies , Rectal Neoplasms , Surveys and Questionnaires , Urinary IncontinenceABSTRACT
<p><b>OBJECTIVE</b>To evaluate the influences of inferior mesenteric artery (IMA) types and Riolan artery arcade absence on the incidence of anastomotic leakage(AL) after laparoscopic resection of rectal cancer.</p><p><b>METHODS</b>Clinical data of 116 local advanced rectal cancer patients who underwent laparoscopic resection in The Sixth Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2014 were analyzed retrospectively. IMA and Riolan artery arcade were examined by preoperative computed tomography angiography (CTA) reconstruction. The influences of IMA type, Riolan artery arcade absence and ligation site (high or low) on AL were analyzed by Logistic regression.</p><p><b>RESULTS</b>The proportion of IMA types(I(-IIII() was 57.8%(67/116), 10.3%(12/116), 31.0%(36/116) and 0.9%(1/116), respectively. Riolan artery arcade absence was found in 60.3%(70/116). Eight (6.9%) patients suffered from AL. IMA type III( had significantly higher AL incidence as compared to other IMA types [19.4%(7/36) vs. 1.2%(1/80), P=0.001]. Meanwhile, patients with Riolan artery arcade absence also had significantly higher AL incidence[11.4%(8/70) vs. 0.0%(0/46), P=0.030]. However, the difference in AL incidence between high and Low IMA ligation was not statistically significant [8.0%(7/87) vs. 3.4%(1/29), P=0.531]. Seven of these 8 AL patients were found in IMA type III( with Riolan artery arcade absence and high ligation. Multivariate analysis showed that IMA type III( (P=0.001) and Riolan artery arcade absence (P=0.002) were independent risk factors of AL.</p><p><b>CONCLUSIONS</b>IMA type III( with Riolan artery arcade absence increases AL incidence significantly in laparoscopic resection of rectal cancer. IMA type and Riolan aretry arcade absence or not contribute to the selection of IMA ligation site in the operation. For the colorectal cancer patients with IMA type III( and Riolan artery arcade absence, selective low IMA ligation with root lymph node dissection should be recommended.</p>
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Adult , Female , Humans , Male , Middle Aged , Anastomotic Leak , Arteries , Colorectal Neoplasms , General Surgery , Incidence , Laparoscopy , Ligation , Lymph Node Excision , Lymphatic Metastasis , Mesenteric Artery, Inferior , Rectal Neoplasms , General Surgery , Retrospective StudiesABSTRACT
Colorectal cancer (CRC) is not a single disease, but a group of wide spectrum of heterogeneous diseases, and tumors with similar clinicopathological features may react differently to treatments and have diverse prognosis. So complementary risk evaluation, or based on molecular biomarkers to further stratify colorectal cancer beyond TNM staging is necessary. Understanding mechanism of carcinogenesis is good for subtyping colorectal cancer as well as drug development. So far, 3 major pathways are thought to be related to CRC carcinogenesis, chromosome instability, microsatellite instability and CpG island hypermethylation. High throughput profiling enables to study the molecular basis for CRC more comprehensively and systemically. Several studies have defined 3-6 subtypes. Colorectal Cancer Subtype Consortium has made consensus to divide CRC into 5 subtypes based on pool analysis of available profiling data. Further validation is ongoing. There are only a few biomarkers which can be applied in daily practice, including MSI, RAS, BRAF, PI3KCA and HER2.
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<p><b>OBJECTIVE</b>To compare two different routes of totally implantable venous access ports (TIVPs) from the upper arm vein and the subclavian vein in terms of complications for patients with gastrointestinal malignancy.</p><p><b>METHODS</b>Patients who underwent implantations of TIVPs from September 2013 to January 2015 were retrospectively evaluated. The outcome measurements were rates and types of postprocedural early-stage and long-term complications.</p><p><b>RESULTS</b>A total of 208 patients(upper arm vein group, 86; subclavian vein group, 122) were included in this study. All TIVPs were implanted successfully. The rate of catheter displacement was higher in upper arm vein group(14.0% vs 5.7%, P=0.04), while other postprocedural early-stage complications had no significant difference between the two groups. The occurrence of transfusion obstacle and rates of overall postprocedural long-term complications were significantly lower in upper arm vein group than that in subclavian vein group(1.2% vs. 9.8%, P=0.02; 7.0% vs. 27.0%, P=0.01, respectively).</p><p><b>CONCLUSION</b>Compared with subclavian vein group, upper arm vein group has lower postprocedural long-term complication rates and is recommended as a safe and comfortable choice for port implantation.</p>
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ObjectiveTo explore the correlations of simple bladder capacity measurement and urodynamic examination used for assessing the bladder function of patients with spinal cord injury.Methods From December 2011 to September 2013,a total of 37 patients with spinal cord injury were recruited.Their bladder functions were examined by both simple bladder capacity measurement and urodynamics in the first week after admission.The type of neurogenic bladder,residue urine,bladder capacity and the changes of bladder pressure were documented and compared.Results The simple bladder capacity measurement and urodynamics showed no significant differences in the parameters including residual urine,and bladder pressures when inputting 50mL,100mL,300mL and 400mL water(P>0.05). But there were significant differences in the results of bladder capacity and bladder pressure when inputting 200mL water(P<0.05). The intra-class coefficients between the results by the two methods were 0.606~0.919(P<0.01).The Kappa coefficient of the health professionals’judgments according to the two methods was 0.825(P<0.001).Conclusions The results of simple bladder capacity measurement are reliable.It can be used as the supplement for urodynamics to monitor the bladder function of patients with spinal cord injury.
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<p><b>OBJECTIVE</b>To evaluate the erectile function of male patients treated by neoadjuvant radiochemotherapy and neoadjuvant chemotherapy alone for mid-low rectal cancer.</p><p><b>METHODS</b>The clinical data of 66 patients with rectal cancer from March 2011 to March 2013 were prospectively analyzed. Of all the patients, 56 cases were finally included in the study and were randomly allocated to two groups. Thirty patients were treated by neoadjuvant radiochemotherapy followed by surgery (RCS group), and 26 were treated by neoadjuvant chemotherapy followed by surgery (NCS group). The five-item version of the international index of erectile function (IIEF-5) questionnaire were used to determine erectile function before therapy and at least 12 months after surgery. The impacts of age, location, size of tumor, and body mass index on erectile function were analyzed.</p><p><b>RESULTS</b>Total score was decreased significantly at follow-up compared to initial assessment in both RCS and NCS groups (23.4 ± 1.30 vs. 11.7 ± 5.8, t = 10.748, P < 0.01; 23.1 ± 1.3 vs. 15.2 ± 6.7, t = 5.910, P < 0.01, respectively). Score difference was statistically higher in RCS group compared with NCS group (11.7 ± 5.6 vs. 8.0 ± 6.0, t = 2.394, P = 0.020). In terms of tumor location for RCS group, difference was statistically higher in the patients with low rectal cancer compared with those with middle rectal cancer (14.5 ± 3.5 vs. 9.5 ± 6.0, t = 2.894, P = 0.008).</p><p><b>CONCLUSIONS</b>The erectile functions of patients treated by neoadjuvant radiochemotherapy followed by surgery are more affected than that of patients treated by neoadjuvant chemotherapy followed by surgery in mid-low rectal cancer. Also low rectal cancer are significantly associated with erectile dysfunction in the patients treated by neoadjuvant radiochemotherapy followed by surgery.</p>
Subject(s)
Humans , Male , Chemoradiotherapy , Follow-Up Studies , Neoadjuvant Therapy , Penile Erection , Physiology , Prospective Studies , Rectal Neoplasms , General Surgery , Therapeutics , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the safety and preliminary efficacy of modified FOLFOXIRI (combination of reducing dosage irinotecan, oxaliplatin and fluorouracil) in first-line treatment for patients with metastatic colorectal cancer.</p><p><b>METHOD</b>A total of 53 patients with advanced colorectal cancer receiving modified FOLFOXIRI regimen were recruited continuously from January 2010 to January 2014. Safety profile was recorded based on NCI Common Terminology Criteria for Adverse Events version 3.0 (NCI-CTCAE v3.0). Objective response was evaluated by Response Evaluation Criteria in Solid Tumors version1.1 (RECIST 1.1) after administration of at least 4 cycles chemotherapy. Kras and Braf gene sequencing was tested by dideoxy chain-termination method. Relation between efficacy and two genes was examined.</p><p><b>RESULTS</b>Among 53 patients, no treatment-related mortality was presented. The rate of grade 3 to 4 adverse event was 32.1% (17/53), including neutropenia 13.2%(7/53), anemia 11.3% (6/53) and fatigue 9.4% (5/53). Overall response rate (ORR) and disease control rate (DCR) were respectively 65.9% (29/44) and 90.0% (40/44). Radical resection rate (R0) was 29.5% (13/44). Efficacy of mFOLFOXIRI regimen plus targeting therapy was assessed in 44 patients. mFOLFOXIRI regimen plus targeting therapy achieved an ORR of 72.7% (8/11), which was higher than the ORR 65.9% (21/33) of triplet regimen alone, but the difference was not statistically significant (P=0.198). Paraffin specimens of 48 colorectal cancer cases were tested. Twenty-one cases were Kras mutant (43.75%), 3 cases were Braf mutant (6.25%). There were no significant differences between two groups (P>0.05).</p><p><b>CONCLUSION</b>Reducing dosage mFOLFOXIRI can be safely used in advanced colorectal cancer and can achieve promising results in terms of short term efficacy.</p>
Subject(s)
Humans , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , China , Colorectal Neoplasms , Drug Therapy , Proto-Oncogene Proteins B-rafABSTRACT
Objective To investigate the feasibility of using problem-based learning in nursing clinical teaching in the obstetrics and gynecology department.Methods Sixty-six nursing students were randomly divided into PBL group and lecture-based learning(LBL)group .At the end of their internship,the two groups were compared in terms of examination performance,learning attitude and aptitude,and their feedback on the two learning modes.Results The students in the PBL group were significantly better than those in the control group in terms of examination performance,learning attitude and aptitude,and their feedback on the learning mode(P<0.001).Conclusions PBL may be effective in the improvement of their attitude to learning and aptitude,the comprehensive ability.It can provide an environment to promote internal learning motivation for students.
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AIM: To investigate the effect of 5 - fluorouracil ( 5 - FU ) on the expression of the stem cell marker CD133 on colon cancer stem cells. METHODS:CD133 expression on several colon cancer cell lines was detected by flow cytometry. The CD133 positive cells from DLD1 cells were separated by the method of magnetic activated cell separation. Colony assay was used to measure self - renew ability and MTS assay was used to detect the sensitivity to 5 - FU after separation. After 5 - FU treatment, the change of CD133 mRNA level was measured by qPCR. RESULTS: CD133 expression on the surface of colon cacner cell lines DLD1, HT29, SW480, HCT116, Lovo, RKO was 30.20% , 82.00% , 0.34% , 91.80% , 85.30% , 0.28% respectively. DLD1 cells had two obvious populations according to CD133 expression. CD133 positive cells were separated from DLD1 cells, the positive purity was 87.21% ±5.33% and the negative purity was 84.30% ±4.65%. CD133 positive cells formed more colonies with limited dilution colony assay (46.33% ±4.44% vs 31.00% ±2.00% , P <0.05). CD133 positive cells were less sensitive to 5 - FU compared to CD133 negative cells(20% less, P <0.01). 5 - FU at concentration of 1 mg/L upregulated CD133 mRNA expression in both DLD1 and HT29 cells, the relative quantity was increased from 1 to 1.684 ±0.012(P <0.01 )and 30.702 ±0.280 to 49.379 ±0.460(P <0.01) in HT29 and DLD1, respectively. CONCLUSION: Compared to CD133 negative cells, CD133 positive cells show more ability to form colonies in vitro, and are less sensitive to 5 - FU. 5 - FU upregulats the mRNA expression of CD133, resulting in the CD133 colon cancer stem cells enrichment during 5 - FU treatment.
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Objective To investigate the prevention and management of anastomotic leakage in patients with middle and lower rectal cancer after neoadjuvant therapy.Methods In this study,50 cases of middle or lower rectal carcinoma underwent anus preserving radical resection and anastomosis after a 4 cycles of chemotherapy with FOLFOX and 46 Gy(2 Gy×23)radiotherapy.Anastomotic leakage,the prevention and management of this complication were analyzed retrospectively.Results All these 50 patients received low anterior resection after chemoradiotherapy,among the 19 cases receiving prophylactic ileac stoma simultaneously,there was no anastomotic leakage,whereas anastomotic leakage developed in 4 out of the 31 patients who did not receive prophylactic ileac stoma,including concomitant rectovaginal fistula in 2 cases.All these fistulae were cured conservatively.Conclusion Concomitant treatment of FOLFOX regimen and RT in neoadjuvant setting of rectal cancer could increase the rate of anal interior sphincter reservation,prophylactic ileac stoma helps to reduce the rate of anastomotic leakage after a anus-preserving low anterior resection of the cancer.