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Objective:To investigate the characteristics, process, and prognosis of esophageal stricture after circumferential endoscopic submucosal dissection (ESD), and to preliminarily analyze the prevention and treatment effects of simple dilation, stent placement, mucosal transplantation, and glucocorticoid (hereinafter referred to as hormone) application in esophageal stricture.Methods:From August 2017 to March 2022, at the First Affiliated Hospital of Zhengzhou University, the clinical and follow-up data of 55 patients who underwent circumferential ESD for early esophageal cancer and precancerous lesions were retrospectively analyzed. According to the prevention and treatment methods for esophageal stricture, the patients were divided into two groups: simple dilation group (23 cases) and combined dilation group (32 cases). The combined dilation group was divided into mucosal transplantation subgroup (9 cases), stent placement subgroup (14 cases), hormone application subgroup (7 cases), and bleomycin subgroup (2 cases, excluded from comparative analysis due to limited cases). Overall prognosis of patients was observed. Treatment efficacy, prognosis, and adverse events were compared among the simple dilation group, mucosal transplantation subgroup, stent placement subgroup, and hormone application subgroup. Independent samples t-test, chi-square test, and Fisher′s exact test were used for statistical analysis. Results:Among the 55 patients, the follow-up time was (894.1±417.7) days. Refractory esophageal stricture (total dilation times ≥ 5) occurred in 33 patients (60.0%). Fifty-two patients (94.5%) achieved clinical remission of the stricture. The total number of dilations was 5.8±4.0, and the average dysphagia-free period was (52.3±37.1) days. The dysphagia-free period of mucosal transplantation subgroup was longer than that of the simple dilation group, stent placement subgroup, and hormone application subgroup ((114.5±50.0) days vs. (40.9±20.0), (39.7±10.0), and (40.9±25.5) days, respectively), and the differences were statistically significant ( t=4.82, 3.77 and 3.14, P<0.001, =0.011, =0.009). There were no statistically significant differences between the simple dilation group and the mucosal transplantation subgroup, stent placement subgroup, and hormone application subgroup in the total number of dilations (6.8±4.8 vs. 3.0±2.5, 5.8±2.2, and 5.7±5.0), stricture remission rate (95.7%, 22/23 vs. 8/9, 13/14, and 7/7), and incidence of adverse events (17.4%, 4/23 vs. 5/9, 5/14, and 2/7; all P>0.05). Conclusions:Esophageal stricture formed after circumferential ESD shows the characteristics of recurrence and intractability. The over all number of dilations is high, and the average dysphagia-free period is short. Most patients can achieve clinical remission of the stricture after multiple times of endoscopic dilation treatment. However mucosal transplantation, stent placement, and hormone application cannot well intervene the natural process of esophageal stricture.
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To investigate the effect of long-term indwelling gastric tube on the prevention and treatment of esophageal stenosis after endoscopic submucosal dissection (ESD) for esophageal circumferential superficial cancer, data of patients with esophageal circumferential superficial cancer who underwent ESD in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021 were retrospectively analyzed. There were 15 patients with gastric tube placement (GTP) after ESD (the GTP group ), and 23 patients without GTP (the non-GTP group). The general information, lesion location, pathological stage, postoperative complications, degree of esophageal stenosis (water intake), pain conditions, number of hospitalizations and medical expenses were compared between the two groups. The results showed that there was no significant difference in age, gender, lesion location or postoperative pathological stage between the two groups ( P>0.05). Compared with the non-GTP group, the rate of water intake in the GTP group was significantly higher (11/15 VS 6/23, P<0.05), the frequency of pain was less in the GTP group (7.3±3.1 times VS 10.7±3.6 times, t=3.00, P<0.05), and the number of hospitalizations and the medical expenses after ESD to before and after stent placement were significantly lower in the GTP group than those in the non-GTP group ( P<0.05). There were no significant differences in the incidence of delayed bleeding and perforation, or time of the first stenosis after ESD between the two groups ( P>0.05). The results of the study initially showed that long-term indwelling gastric tube after ESD can reduce the degree of esophageal stenosis with good safety for esophageal circumferential superficial lesions.
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Objective: To analyze clinicopathological features of circumferential superficial esophageal squamous cell carcinoma and precancerous lesions and investigate the risk factors for deep submucosal invasion and angiolymphatic invasion retrospectively. Methods: A total of 116 cases of esophageal squamous epithelial high-grade intraepithelial neoplasia or squamous cell carcinoma diagnosed by gastroscopy, biopsy pathology and endoscopic resection pathology during November 2013 to October 2021 were collected, and their clinicopathological features were analyzed. The independent risk factors of deep submucosal invasion and angiolymphatic invasion were analyzed by logistic regression model. Results: The multivariate logistic regression analysis showed that drinking history (OR=3.090, 95% CI: 1.165-8.200; P<0.05), The AB type of intrapapillary capillary loop (IPCL) (OR=11.215, 95% CI: 3.955-31.797; P<0.05) were the independent risk factors for the depth of invasion. The smoking history (OR=5.824, 95% CI: 1.704-19.899; P<0.05), the presence of avascular area (AVA) (OR=3.393, 95% CI: 1.285-12.072; P<0.05) were the independent factors for the angiolymphatic invasion. Conclusions: The risk of deep submucosal infiltration is greater for circumferential superficial esophageal squamous cell carcinoma patients with drinking history and IPCL type B2-B3 observed by magnifying endoscopy, while the risk of angiolymphatic invasion should be vigilant for circumferential superficial esophageal squamous cell carcinoma patients with smoking history and the presence of AVA observed by magnifying endoscopy. Ultrasound endoscopy combined with narrowband imagingand magnification endoscopy can improve the accuracy of preoperative assessment of the depth of infiltration of superficial squamous cell carcinoma and precancerous lesions and angiolymphaticinvasion in the whole perimeter of the esophagus, and help endoscopists to reasonably grasp the indications for endoscopic treatment.
Subject(s)
Humans , Esophageal Squamous Cell Carcinoma/pathology , Esophageal Neoplasms/pathology , Retrospective Studies , Esophagoscopy , Carcinoma, Squamous Cell/pathology , Precancerous Conditions/surgery , Margins of Excision , Risk FactorsABSTRACT
Objective: Few cases of Takotsubo cardiomyopathy with apical hypertrophic cardiomyopathy (APH)-like morphological changes during the recovery process have been reported.Patient: A 56-year-old woman diagnosed with Takotsubo cardiomyopathy showed a morphology similar to that of APH during recovery. We examined this patient using 2D speckle-tracking echocardiography based on the method used for hypertrophic cardiomyopathy, which suggested that the circumferential strain (CS) of the middle wall indicated myocardial function of the left ventricle, and the CS of the inner wall was associated with left ventricular chamber function.Results: We measured the CS of the endocardial, middle, and epicardial layers and found that the apical inner layer CS (CSinner), middle layer CS, and outer layer CS were all decreased at the onset. CSinner showed a strong tendency to recover on echocardiography performed when APH-like morphology was observed.Conclusion: The morphology of the apex in our case likely contributed to the maintenance of chamber function.
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OBJECTIVE@#To compare the retentions of different designs of cobalt-chromium (Co-Cr), pure titanium (CP Ti), and titanium alloy (Ti-6Al-4V) removable partial denture (RPD) circumferential clasps manufactured by selective laser melting (SLM) and to analyze the stress distribution of these clasps during the removal from abutment teeth.@*METHODS@#Clasps with clasp arm size A (1.9 mm width/1.1 mm thickness at the body and 0.8-taper) or B (1.2 times A) and 0.25 mm or 0.50 mm undercut engagement were modeled on a prepared first premolar die, named as designs A1, A2, A3, and A4, respectively. The density and elastic modulus of SLM-built Co-Cr, CP Ti, and Ti-6Al-4V were measured and given to different groups of clasps. The density, elastic modulus, and Poisson ' s ratio of enamel were given to the die. The control group was the cast Co-Cr clasp with design A1, to which the density and elastic modulus of cast Co-Cr alloy were given. The Poisson's ratio of all metals was 0.33. The initial 5 N dislodging force was applied, and the maximum displacement of the clasp along the insertion path was computed. The load was reapplied with an increment of 5 N than in the last simulation until the clasp was completely dislodged. The retentive force range of different groups of clasps was obtained. The retentive forces of the SLM-built Co-Cr, CP Ti, and Ti-6Al-4V clasps with equivalent computed retentive force range to the control group were validated through the insertion/removal experiment. The von Mises stress distributions of these three groups of SLM-built clasps under 15 N loads were analyzed.@*RESULTS@#SLM-built Co-Cr, CP Ti, and Ti-6Al-4V clasps with designs B1 or B2, and Co-Cr clasps with design A2 had higher retentive forces than those of the control group. SLM-built CP Ti and Ti-6Al-4V clasps with design A1 had lower retentive forces than those of the control group. SLM-built Co-Cr clasp with design A1 and SLM-built CP Ti and Ti-6Al-4V clasps with design A2 had equivalent retentive forces to those of the control group. The insertion/removal experiment showed that the measured retentive forces of these three groups of SLM-built clasps were (21.57±5.41) N, (19.75±4.47) N, and (19.32±2.04) N, respectively. No statistically significant measured retentive force difference was found among these three groups of SLM-built clasps (P>0.05). The maximum von Mises stress of these three groups of SLM-built clasps exceeded their responding yield strength except for the Ti-6Al-4V one.@*CONCLUSION@#SLM-built Co-Cr circumferential clasps had higher retention than CP Ti and Ti-6Al-4V ones with the same clasp arm size and undercut engagement. The retention of SLM-built circumferential clasps could be adjusted by changing the undercut engagement and clasp arm size. If SLM-built circumferential clasps are used in clinical practice, the Ti-6Al-4V clasp with clasp arm size A and 0.50 mm undercut engagement is recommended considering the long-term use of RPD in the patient's mouth.
Subject(s)
Humans , Chromium Alloys , Dental Clasps , Denture Retention , Denture, Partial, Removable , Finite Element Analysis , Lasers , TitaniumABSTRACT
The judgment of surgical resection margins is an important factor affecting local recurrence and distant metastasis of colorectal cancer, which is crucial to the prognosis of patients. How to select a standard and ideal surgical resection margin is a challenge for colorectal cancer surgeons. Surgical resection margins for colorectal cancer include longitudinal resection margin (LRM) and circumferential resection margin (CRM), and the distance of safe resection margins varies according to different guidelines. Surgical resection margins are mainly evaluated by preoperative imaging, operative experience, operative type, hyperspectral imaging (HPI) and fluorescence angiography (FA), and postoperative pathology. It is the constant pursuit of colorectal cancer surgeons to pay attention to the safe resection margins in colorectal cancer surgery to reduce local recurrence and distant metastasis.
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Humans , Colorectal Neoplasms/surgery , Digestive System Surgical Procedures , Margins of Excision , Neoplasm Recurrence, Local , Prognosis , Rectal NeoplasmsABSTRACT
Objective:To analyze the relationship between the circumferential resection margin status and prognosis and clinicopathological features of esophageal squamous cell carcinoma.Methods:The information of esophageal squamous cell carcinoma patients who underwent radical resection at the Fourth Hospital of Hebei Medical University from October 2017 to March 2019 were collected. All patients were diagnosed with advanced squamous cell carcinoma by postoperative pathology. Demographic data including sex, age, T stage, N stage, tumor location, lesion length, gross pathological type, vascular tumor embolization, nerve invasion and circumferential resection margin were collected and analyzed. The circumferential resection margins were evaluated using the College of American Pathologists(CAP) criteria. A total of 328 cases were included in this study according to the inclusion criteria. Using SPSS 20.0 statistical software, univariate survival analysis was assessed by Kaplan- Meier survival curves, survival curves were compared using Log- rank tests, and multivariate analysis was carried out by Cox regression. The Fisher exact and Chi- square tests were used to compare counting data. Results:As of the follow-up date, the 1-year and 2-year overall survival rates of 328 patients with esophageal squamous cell carcinoma were 91.9% and 84.8%, respectively. The median overall survival was 16 months(range 2-25 months). Univariate analysis showed that T stage, vascular embolism and nerve invasion were the influencing factors of overall survival, multivariate analysis showed that nerve invasion was an independent risk factor for overall survival, stratified analysis showed that the circumferential resection margin was related to overall survival in patients less than 60 years old( P=0.006), patients with ulcerative type of gross pathology( P=0.002) and patients with tumor length ≥4 cm( P=0.046). The 1-year and 2-year disease-free survival rates of the whole group were 89.7% and 67.8%, respectively. The median disease-free survival was 16 months(range 2-25 months). Univariate analysis showed that N stage was the influencing factor of disease-free survival in patients with esophageal squamous cell carcinoma, and stratified analysis showed that the disease-free survival rate of patients with ulcerative type( P=0.002), tumor length ≥4 cm( P=0.015) and circumferential resection margin negative group were better than that of circumferential resection margin positive group. There were 66 patients with positive circumferential resection margin in the whole group, and the positive rate of circumferential resection margin was 20.1%. Univariate analysis showed that T stage, N stage, vascular embolism, nerve invasion and gross pathological type were the influencing factors of circumferential resection margin, while multivariate logistic regression analysis showed that T stage, vascular embolism and gross pathological type were the influencing factors of circumferential resection margin. Conclusion:According to CAP criteria, circumferential resection margin is not related to the prognosis of patients with esophageal squamous cell carcinoma.Positive circumferential resection margins of esophageal squamous cell carcinoma correlate with T stage, vascular embolism, and gross pathologic type, but not with other clinicopathologic features.
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RESUMEN Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y la mayoría de los países desarrollados. La ecocardiografía con rastreo de marcas o speckle-tracking bidimensional (ST-2D) es una técnica reciente en la evaluación de la función cardíaca. Objetivo: Determinar la relación entre la deformación miocárdica (strain) circunferencial (GCS) medida por ST-2D y el estado de la circulación coronaria, en pacientes con cardiopatía isquémica. Método: Se realizó un estudio analítico, transversal, con 55 pacientes con indicación de coronariografía a los que se les realizó ecocardiograma para medir la GCS mediante ST-2D, en el Centro de Investigaciones Médico Quirúrgicas (CIMEQ, La Habana, Cuba), durante un año. Se crearon dos grupos: con enfermedad coronaria significativa (ECS=32) y no significativa (ECNS=23). Se utilizó SSPS para análisis de los resultados. Resultados: La edad promedio fue mayor en ECS (55,6 ±9,3 vs. 61,8±8,8; p=0,014). Predominaron los hombres con ECS (47,3%), los hipertensos (ECS=90,6% y ENCS=65,2%; p=0,02) y los fumadores (ECS=59,4% y ENCS=17,4%; p=0,002). El diagnóstico más frecuente fue la angina crónica estable (87%). En ECS predominó la enfermedad de tres vasos (75%). La GCS fue menor en ECS [(-19,5±3.8 vs. -25,2±5,7; p=0,033); área bajo la curva = 0,208]. No hubo diferencias en GCS, según el número de vasos significativamente enfermos. Conclusiones: Los resultados encontrados no justifican el empleo de la GCS por ST-2D para discriminar la presencia o no de ECS.
ABSTRACT Introduction: Cardiovascular diseases are the top cause of death in Cuba as well as in most developed countries. Two-dimensional speckle-tracking (2D-ST) echocardiography is a recent technique in the evaluation of cardiac function. Objective: To determine the relationship between global circumferential strain (GCS) measured through 2D-ST echocardiography and the state of coronary circulation in patients with ischemic heart disease. Method: An analytical, cross-sectional study was carried out on 55 patients with indication of coronary angiography, who underwent echocardiography to measure the GCS through 2D-ST at the Centro de Investigaciones Medico Quirúrgicas (CIMEQ, Havana, Cuba), during one year. Two groups were created: with significant coronary artery disease (SCAD = 32) and non-significant coronary artery disease (NSCAD = 23). The statistical package for the social sciences (SPSS) was used to analyze the results. Results: Mean age was higher in the SCAD group (55.6 ± 9.3 vs. 61.8± 8.8, p=0.014). Men with SCAD (47.3%), patients with high blood pressure (SCAD = 90.6% and NSCAD = 65.2%, p = 0.02) and smokers (SCAD = 59.4% and NSCAD = 17.4%, p = 0.002) predominated. The most frequent diagnosis was chronic stable angina (87%). Three-vessel disease predominated in the SCAD group (75%). The GCS was lower in the SCAD group [(-19.5.0 ± 3.8 vs. -25.2 ± 5.7, p = 0.033); area under the curve = 0.208]. There were no differences in GCS according to the number of significantly diseased vessels. Conclusions: The results found do not justify the use of GCS through 2D-ST echocardiography to discriminate the presence or nor of SCAD.
Subject(s)
Echocardiography , Myocardial Ischemia , Heart Function TestsABSTRACT
Objective:To investigate the short term efficacy of laparoscopic assisted transanal total mesorectal excision (taTME) for low rectal cancer.Methods:The prospective study was conducted. The clinicopathological data of 80 patients who underwent laparoscopic assisted taTME for low rectal cancer in 8 medical centers，including 27 cases in the First Affiliated Hospital of Jilin University，16 cases in the Daping Hospital of Army Medical University，15 cases in the Beijing Friendship Hospital of Capital Medical University，10 cases in the Peking University Cancer Hospital，7 cases in the Peking Union Medical College Hospital of Chinese Academy of Medical Sciences，2 cases in the Peking University People′s Hospital，2 cases in the Liaoning Cancer Hospital Institute，1 case in the Ruijin Hospital of Shanghai Jiaotong University School of Medicine，from August 2017 to September 2018 were collected. Observation indicators：(1) clinical data of enrolled patients；(2) surgical situations；(3) postoperative histopathological examination；(4)postoperative complications and hospitalization. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and (or) percentages. Results:(1) Clinical data of enrolled patients：a total of 80 patients were selected for eligibility. There were 59 males and 21 females，aged from 53 to 79 years，with a median age of 61 years. (2）Surgical situations：all 80 patients underwent surgery successfully，including 73 cases undergoing low anterior resection，4 cases undergoing Hartmann operation，1 case undergoing intersphincteric and abdominoperineal resection，1 case undergoing other operations and 1 case missing operation information. Nineteen of the 80 patients underwent transabdominal and transanal operations simultaneously. The operation time of 80 patients was 255 minutes (range，211?305 minutes). Of 80 patients，77 cases had the volume of intraoperative blood loss ≤500 mL，3 cases had the volume of intraoperative blood loss >500 mL，44 cases underwent instrumental anastomosis，24 cases underwent manual anastomosis，12 cases were missing anastomosis information，66 cases had specimens been taken out through anus，2 cases had specimens been taken out through Pfannens-tiel incision，10 cases had specimens been taken out through other ways，2 cases were missing the information of specimens removal ways，57 cases underwent preventive stoma，32 cases under-went anal canal indwelling，30 cases underwent free of splenic flexure and 2 cases were converted to open surgery. (3) Postoperative histopathological examination：of 80 patients，68 cases had the integrity of mesorectal specimens with complete，5 cases had the integrity of mesorectal specimens with near complete，1 case had the integrity of mesorectal specimens with not complete，6 cases were missing the information of integrity of mesorectal specimens，1 case had rectal perforation，1 case had positive circumferential margin and 1 case had positive distal margin. The number of lymph node dissected and diameter of tumor were 12(range，9?16) and 3.0 cm(range，1.9?4.0 cm) of 80 patients. Four of 80 patients achieved pathological complete remission. Cases with tumor stage as T0 stage，Tis stage，T1 stage，T2 stage，T3 stage or T4 stage of the pT staging，cases with tumor stage as N0 stage，N1 stage or N2 stage of the pN staging，cases with tumor stage as M0 stage or M1 stage of the pM staging were 4，2，11，24，35，4，55，21，4，75，5 of 80 patients. (4) Postopera-tive complications and hospitalization：8 of 80 patients underwent anastomotic leakage，including 2 cases with grade A anastomotic leakage，4 cases with grade B anastomotic leakage and 2 cases with grade C anastomotic leakage.Seven of 80 patients underwent intestinal obstruction. The 2 cases with grade A anastomotic leakage were improved after symptomatic drug treatment，the 4 cases with grade B anastomotic leakage were improved after treatment with antibiotics or catheter drainage and the 2 cases with grade C anastomotic leakage were improved after operation. The duration of hospital stay of 80 patients was 14 days(range，11?21 days). No patient died during hospitalization.Conclusion:Laparoscopic assisted taTME for low rectal cancer is safe and feasible，which has a good short term efficacy.
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The Kunze-Riehm syndrome also called as Michelin tire baby syndrome (MTBS), is a rare genodermatosis, characterized by multiple symmetric circumferential folding of excess skin with the various phenotypic abnormality. The diagnosis is made on the basis of the characteristic clinical features in the literature there are approximately 31 cases reported and to the best of our knowledge, this would be the sixth case published from India. Herein authors report a rare case of Kunze- Riehm syndrome in a neonate.
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Aim:The aim of the study was to investigate the circumferential anthropometric body characteristics of adult male Ijaws of southern Nigeria. Methodology:The research design was a non-experimental, cross-sectional design. It made use of a total number of four hundred (400) subjects whose ages ranged between 21 to 40 years with BMI of 18.50 to <30.00. Individuals whose BMI fell within the category of overweight according to conventional BMI classification were included in the study because they looked apparently healthier than those with BMI classified as normal. Minimum sample size was determined using the Taro Yamane’s formula. Circumferential body anthropometric measurements and BMI were taken using stadiometer, digital calipers, calibrated flexible meter tape and weighting scale. Statistical analysis was done using statistical package for the social science (SPSS version 25.0) and Microsoft Excel 2019. Continuous variables were presented as mean±SD; minimum and maximum. Age was categorized into two groups (21 –30 and 31 –40) years while Body Mass Index (BMI) was also categorized into two; normal weight (18.5 –24.9) and slightly overweight (25.0 –30.7). Independent sample t-test was therefore carried out to determine significant difference in the measured anthropometric parameters according to age. The confidence interval was set at 95%, therefore p< 0.05 was considered significant.Results:Results were presented in tables. Age and BMI were had no impact on the studied anthropometric parameters as there were no statistically significant difference seen when compared across age and BMI groups.On comparison with other racial populations, racial variation was observed. Conclusion: Circumferential anthropometric studies are mainly used to demonstrate health status, growth rate and other population demography. This study catalogued anthropometric description of body circumference of the Ijaw ethnic group. These anthropometric values will be useful in medical studies and forensics.
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Objective To design and develop an in vitro simulation device for circumferential stress of mural coronary artery, so as to achieve the in vitro loading of mural circumferential stress under coronary myocardial bridge oppression with different degrees. MethodsUsing the in vitro simulation device for myocardial bridge coronary artery hemodynamics, the in vitro measurement of mural circumferential stress was achieved. Based on the experimental data, the in vitro loading of mural circumferential stress under coronary myocardial bridge oppression with different degrees was achieved. Results The in vitro measurement experiment showed that the maximum, average and fluctuation of circumferential stress at proximal end of mural coronary artery would increase significantly with the increase in the degree of myocardial bridge oppression. The in vitro loading experiment of mural circumferential stress verified that the loading waveform coincided basically with the experimental waveform from in vitro measurement. Conclusions The device could realize the in vitro loading of mural circumferential stress, which provided an in vitro simulation platform which was as close as possible to the in vivo environment, so as to explore the influence from hemodynamic abnormality of proximal mural coronary artery on the occurrence of atherosclerosis and plaque rupture.
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Objective To study the effects of abnormal blood flow on the secretion of ET-1/NO and the expression of the mRNA and the protein of ET-1, eNOS, VCAM-1, ICAM-1 and MCP-1 in human umbilical vein endothelial cells (HUVECs), so as to explore the mechanism of atherosclerosis （AS） caused by abnormal hemodynamics. MethodsThe HUVECs were divided into stress group, wall pressure group and normal group according to the different stress. The HUVECs were cultured under the corresponding stress for 24 hours and then collected. The secretion levels of NO and ET-1 were detected by enzyme method and radioimmunoassay method. The mRNA expression levels of eNOS and ET-1 were detected by qPCR. The expression levels of the mRNA and the protein of VCAM-1, ICAM-1, MCP-1 were detected by qPCR and Western blot. Results Compared with normal group, the secretion level and the mRNA expression level of ET-1 in wall pressure group increased significantly (P＜0.01), and the secretion level of NO and the mRNA expression level of eNOS in stress group also increased significantly (P＜0.01), The expressions level of the mRNA and the protein of VCAM-1, ICAM-1 and MCP-1 obviously increased in stress group and wall pressure group (P＜0.01). Conclusions Stress or wall pressure acting on HUVECs alone could lead to its dysfunction of the secretion and the expression of gene and protein. The mechanism of AS caused by abnormal blood flow was related to these dysfunction of HUVEC.
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Objective To study the effects of abnormal blood flow on the secretion of ET-1/NO and the expression of the mRNA and the protein of ET-1, eNOS, VCAM-1, ICAM-1 and MCP-1 in human umbilical vein endothelial cells (HUVECs), so as to explore the mechanism of atherosclerosis （AS） caused by abnormal hemodynamics. MethodsThe HUVECs were divided into stress group, wall pressure group and normal group according to the different stress. The HUVECs were cultured under the corresponding stress for 24 hours and then collected. The secretion levels of NO and ET-1 were detected by enzyme method and radioimmunoassay method. The mRNA expression levels of eNOS and ET-1 were detected by qPCR. The expression levels of the mRNA and the protein of VCAM-1, ICAM-1, MCP-1 were detected by qPCR and Western blot. Results Compared with normal group, the secretion level and the mRNA expression level of ET-1 in wall pressure group increased significantly (P＜0.01), and the secretion level of NO and the mRNA expression level of eNOS in stress group also increased significantly (P＜0.01), The expressions level of the mRNA and the protein of VCAM-1, ICAM-1 and MCP-1 obviously increased in stress group and wall pressure group (P＜0.01). Conclusions Stress or wall pressure acting on HUVECs alone could lead to its dysfunction of the secretion and the expression of gene and protein. The mechanism of AS caused by abnormal blood flow was related to these dysfunction of HUVEC.
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Objectives: To evaluate the degree of coronary artery stenosis with duration of myocardial early systolic lengthening derived from 2D speckle tracking imaging (2D-STD in patients with coronary artery disease (CAD). Methods: 185 patients with suspected CAD underwent 2D-STI before coronary CT angiography (CCTA) were included in this study. Duration of myocardial early systolic lengthening, LS, RS, and CS were measured by 2D-STI. According to the results of CCTA, the myocardial segment were divided into normal group (without coronary artery stenosis), mild stenosis group(coronary artery stenosis<50%), moderate stenosis group (50%>coronary artery stenosis < 70%) and severe stenosis group (70%>coronary artery stenosis <100%). Results: Duration of myocardial early systolic lengthening, LS, RS and CS were similar between mild stenosis group and normal group (P>0.05). Duration of myocardial early systolic lengthening was increased, and LS was decreased in moderate stenosis group than in normal group (P<0.05). Duration of myocardial early systolic lengthening was increased, LS, RS and CS were significantly decreased in severe stenosis group than in normal group (P<0.01). The cutoff value of early systolic lengthening for diagnose severe stenosis was 60.0 ms (area under ROC curve [AUCl=0.91, P<0.01), with the sensitivity 85.5% and specificity 74.1%, respectively. Conclusions: Duration of myocardial early systolic lengthening is prolonged in patients with significant CAD (moderate and severe stenosis), and might be used a useful parameter to identify patients with significant CAD (moderate and severe stenosis).
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Esophageal cancer is the sixth leading cause of cancer-related death worldwide due to its high malignancy and poor prognosis. In recent decades, the applications of new technologies, devices and neoadjuvant therapy lead to the great progress in the diagnosis and treatment of esophageal cancer. However, the five-year survival rate of esophageal cancer remains unsatisfied. Clinical and pathological factors such as the primary tumor (T), regional lymph nodes (N) and distant metastasis (M) and the longitudinal margins of esophageal lesions, lymphatic invasion, peripheral nerve invasion have been identified as important predictors of the prognosis of esophageal cancer. However, the effect of circumferential resection margin on the prognosis evaluation of esophageal cancer is still controversial, and no definite identification of circumferential resection margin of esophageal cancer has been acknowledged worldwide. Therefore, the studies of circumferential resection margin involvement in predicting the prognosis of esophageal cancer are reviewed.
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BACKGROUND: We aimed to establish robust histoprognostic predictors on residual rectal cancer after preoperative chemoradiotherapy (CRT).METHODS: Analyzing known histoprognostic factors in 146 patients with residual disease allows associations with patient outcome to be evaluated.RESULTS: The median follow-up time was 77.8 months, during which 59 patients (40.4%) experienced recurrence and 41 (28.1%) died of rectal cancer. On univariate analysis, residual tumor size, ypT category, ypN category, ypTNM stage, downstage, tumor regression grade, lymphatic invasion, perineural invasion, venous invasion, and circumferential resection margin (CRM) were significantly associated with recurrence free survival (RFS) or/and cancer-specific survival (CSS) (all p<0.005). On multivariate analysis, higher ypTNM stage and CRM positivity were identified as independent prognostic factors for RFS (ypTNM stage, p=0.024; CRM positivity, p<0.001) and CSS (p=0.022, p=0.017, respectively). Furthermore, CRM positivity was an independent predictor of reduced RFS and CSS, irrespective of subgrouping according to downstage (non-downstage, p<0.001 and p<0.001; downstage, p=0.002 and p=0.002) or lymph node metastasis (non-metastasis, p<0.001 and p=0.001; metastasis, p<0.001 and p<0.001).CONCLUSION: CRM status may be as powerful as ypTNM stage as a prognostic indicator for patient outcome in patients with residual rectal cancer after preoperative CRT.
Subject(s)
Humans , Chemoradiotherapy , Follow-Up Studies , Lymph Nodes , Multivariate Analysis , Neoplasm Metastasis , Neoplasm, Residual , Prognosis , Rectal Neoplasms , RecurrenceABSTRACT
Objective To investigate the value of endorectal ultrasonography (ERUS) and MRI examination in the preoperative evaluation of T staging and circumferential resection margin (CRM) of rectal cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 193 patients [122 males and 71 females,age (60± 12)years with the range of 26-90 years] who underwent radical resection of rectal cancer at the First Hospital of Jilin University from May 2016 to January 2018 were collected.All patients underwent ERUS and MRI examination before surgery,total mesorectal excision during surgery and postoperative pathological examination.Postoperative pathological results as the gold standard,the sensitivity,specificity in T staging and the CRM diagnostic coincidence rate of rectal carcinoma by ERUS and MRI examination are evaluated.Observation indicators:(1) evaluation of T staging of rectal cancer by ERUS and MRI examination;(2) evaluation of CRM in rectal cancer by ERUS and MRI examination.Measurement data with normal distribution were represented as Mean±SD.Sensitivity,specificity and coincidence rate were calculated by chi-square test of paired fourfold table.McNemar test was used to compare the coincidence rate of T staging between ERUS and MRI examination.Consistency between CRM measurement by ERUS examination and pathological examination of rectal cancer was conducted by Kappa analysis.Fisher exact probability test was used to compare the coincidence rate of positive CRM between ERUS and MRI examination.Results (1) Evaluation of T staging of rectal cancer by ERUS and MRI examination.The overall coincidence rate of T staging of rectal cancer and coincidence rates of T1,T2,T3,T4 staging by ERUS examination were 74.61％ (144/193),93.78％ (181/193),80.83％ (156/193),79.79％ (154/193) and 94.82％ (183/193),respectively.The sensitivity ofT1,T2,T3 and T4 staging was 55.56％ (10/18),77.50％ (31/40),78.46％ (102/130),20.00％ (1/5),and the specificity was 97.71％ (171/175),81.70％ (125/153),82.54％ (52/63),96.81％ (182/188),respectively.The overall coincidence rate of T staging of rectal cancer and coincidence rates of T1,T2,T3,T4 staging by MRI examination were 50.78％ (98/193),90.67％ (175/193),74.09％ (143/193),58.55％ (113/193) and 78.24％ (151/193),respectively.The sensitivity of T1,T2,T3 and T4 staging was 0 (0/18),17.50％ (7/40),68.46％ (89/130),40.00％ (2/5),and the specificity was 100.00％ (175/175),88.89％ (136/153),38.10％ (24/63),79.26％ (149/188),respectively.There was statistically significant difference between the overall coincidence rate of ERUS and MRI examination for T staging of rectal cancer (x2 =8.631,P＜0.05).(2) Evaluation of CRM in rectal cancer by ERUS and MRI examination.The sensitivity and specificity of positive CRM evaluation of rectal cancer by ERUS examination were 100.00％ (5/5) and 97.34％ (183/188) respectively,and the coincidence rate with results of pathological examination was 97.41％ (188/193),showing a high consistency between positive CRM evaluation of rectal cancer by ERUS examination and pathological examination (Kappa value =0.655,P ＜ 0.05).The sensitivity and specificity of positive CRM evaluation of rectal cancer by MRI examination were 40.00％ (2/5) and 92.02％ (173/188),and the coincidence rate with pathological examination was 90.67％ (175/193),respectively,showing a high consistency between positive CRM evaluation of rectal cancer by MRI and pathological examination (Kappa value =0.206,P＜0.05).There were statistically significant differences in the diagnostic coincidence rate and specificity of CRM positive evaluation for rectal cancer between ERUS and MRI examination (x2 =5.896,P＜0.05).Conclusion ERUS examination has a high coincidence rate in the preoperative T staging of rectal cancer and a high consistency between positive CRM evaluation of rectal cancer with pathological examination,which are superior to MRI examination in the two aspects.
ABSTRACT
Circumferential mixed hemorrhoids are very difficult to treat non-surgically. Therefore, it is important to explore the surgical methods for its complete resolution as well as maintenance of normal anal anatomy and function. The present study was designed to evaluate the effect of segmented and plastic hemorrhoidectomy (SPH) on patients with circumferential mixed hemorrhoids. A total of 300 patients with circumferential mixed hemorrhoids were divided into experimental group (n=150) undergoing SPH and control group (n=150) undergoing Milligan-Morgan hemorrhoidectomy. There were no differences in cure and effectiveness rates between two groups. Compared with the control group, patients in the experimental group had shorter healing time (15.7±1.3 vs 12.5±0.7 days) and recovery to normal activity (18.5±2.7 vs 14.7±1.2 days). In addition, anal function of all patients in the experimental group was normal during short- and long-term follow-up. However, more cases in the control group showed anal dampness and itching, and poor control of intestinal liquid. Compared with the control group, patients in the experimental group had better outcomes in overall anal function and smoothness at 6, 12, and 18 months after operation as well as patient satisfaction. Furthermore, the rating in the visual analogue scale for defecation pain and edema in the experimental group was less than that in the control group. SPH was more effective, had fewer complications, better protection of anal function, and a better cosmetic result.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Hemorrhoids/surgery , Postoperative Complications , Severity of Illness Index , Case-Control Studies , Single-Blind Method , Follow-Up Studies , Treatment Outcome , Patient SatisfactionABSTRACT
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Abstract: Introduction: Sepsis is one of the main causes of morbidity and mortality in the ICU, and when associated with SCM, the prognosis worsens; it can occur in up to 68% of patients. ECHO parameters have been proposed useful for the assessment of the LV systolic function, such as STRAIN-GLS and STRAIN-CS. In this study, the association of these with mortality in patients with sepsis in the ICU was assessed. Material and methods: A prospective, cross-sectional, cohort study was conducted in patients with sepsis admitted to the ICU of a hospital center in Mexico City from January 1st to July 31st, 2018. Transthoracic ECHO was taken within the first 24 hours of the diagnosis of sepsis. Results: Thirty patients were included, 17 were male (56.7%); the median age was 68.5 years (RIQ 56-84); the median hospital stay was 12 days (RIQ 7-17). The death rate was of 23.3%. The average length of stay in the ICU was 19.1 days (3-185 days). Independently assessed by CS, it was found that 36% of the population presented LV systolic dysfunction, while assessed by GLS, it was 40%. When comparing non-survivors and survivors, there were no significant demographic differences; a difference of proportions was observed in the number of patients with diabetes. Differences in medians of systolic pulmonary artery pressure (SPAP), VAI, CS and GLS were observed. When testing the ability to discriminate survivors against non-survivors, it was found that CS was marginally superior to GLS, APACHE (Acute Physiology Age and Chronic Health Evaluation) II, SAPS (Simplified Acute Physiology Score) II, and SOFA (Sequential Organ Failure Assessment). When testing the ability of CS and GLS to discriminate hospital stay greater than seven days, it was observed that the echocardiographic measures were superior. Cut-off points were selected for discrimination of survivors against non-survivors by analyzing sensitivity and specificity for the following echocardiographic measurements: CS ≥ -15.1 (S: 71.43%, E: 83.33%, LR(+) 4.3, LR(-) 0.34) and GLS ≥ -15.4 (S: 85.71%, E: 73.91%, LR(+) 3.3, LR(-) 0.19). In the multivariate analysis, it was found that a CS ≥ -15.1 was predictive of mortality during hospitalization in the study period and population, adjusted for other echocardiographic variables such as LVEF < 55%, GLS ≥ -15.4 and confounders such as sex [RM = 10.23 (95% CI, 1.01-103.2), p < 0.049]. In linear regression models, no predictive echocardiographic variables were found for days of hospital stay in the study period and population. Conclusions: The development of new ECHO techniques such as speckle tracking echocardiography (STE) has facilitated the ability to evaluate LV function through the quantitative evaluation of myocardial deformation; although they are complex techniques, if performed and interpreted appropriately, they are very useful in different clinical conditions. MD can be an early marker of mortality in patients with sepsis; obtained by measuring the GLS and CS, it could be a reliable predictor of the outcomes of patients in the ICU, and it can also potentiate scales such as APACHE II, SOFA and SAPS II to allow early identification of septic patients at high risk. There are still some obstacles to the regular clinical application of GLS and CS in septic patients in the ICU. The optimal GLS limit for the prediction of mortality in these patients remains uncertain, and the intrinsic differences between the populations could contribute to the observed differences. However, it is known to be an effective parameter for the quantification of left ventricular function, even more sensitive than the LVEF by bidimensional ECHO, depending relatively less on the operator and loading conditions. Current results should be confirmed in additional large-scale and multi-center studies. Therefore, it still remains in the field of clinical research for patients in critical condition.
Resumo: Introdução: A sepse é uma das principais causas de morbidade e mortalidade na UTI e quando associada à SCM piora o prognóstico, pode ocorrer em até 68% dos pacientes. Os parâmetros do ECO têm sido propostos como úteis para a avaliação da função sistólica do VE, como STRAIN-GLS e STRAIN-CS, neste estudo foi avaliada a associação destes com a mortalidade em pacientes com sepse na UTI. Material e métodos: Realizou-se um estudo prospectivo, transversal, de coorte de um centro hospitalar em pacientes com sepse internados na UTI na Cidade do México, avaliados de 1 de janeiro a 31 de julho de 2018. Foi realizado ECO transtorácico nas primeiras 24 horas do diagnóstico de sepse. Resultados: Foram incluídos 30 pacientes, sendo 17 do sexo masculino (56.7%), idade média 68.5 anos (RiQ 56 - 84), internação média de 12 dias (RIQ 7-17). Com uma taxa de mortalidade de 23.3%. O tempo médio de permanência na UTI foi de 19.1 dias (3-185 dias). Avaliada independentemente pelo CS, constatou-se que 36% da população apresentava disfunção sistólica do VE, enquanto avaliada por GLS obtiveram 40% da população. Quando comparados não-sobreviventes e sobreviventes não houve diferenças demográficas significativas, observou-se uma diferença de proporções no número de pacientes com diabetes. Foram observadas diferenças nas medianas de PSAP, VAI, CS e GLS. Ao testar a capacidade de discriminar sobreviventes versus não sobreviventes, verificou-se que o CS foi marginalmente superior ao GLS APACHE II, SAPS II e SOFA. Ao testar a capacidade de CS e GLS em discriminar a permanência hospitalar superior a 7 dias, observou-se que as medidas ecocardiográficas foram superiores. Foram selecionados pontos de corte para a discriminação de sobreviventes versus não sobreviventes analisando a sensibilidade e especificidade para as seguintes medidas ecocardiográficas: EC ≥ -15.1 (S: 71.43%, E: 83.33%, LR (+) 4.3, LR (-) 0.34) e GLS ≥ -15.4 (S: 85.71%, E: 73.91%, LR (+) 3.3, LR (-) 0.19). Na análise multivariada, verificou-se que um CS ≥ -15.1 foi preditivo de mortalidade durante a internação no período e população do estudo, ajustado para outras variáveis ecocardiográficas como FEVE < 55%, GLS ≥ -15.4 e confundidores como sexo. [RM = 10.23 (IC 95%, 1.01-103.2), p < 0.049]. Nos modelos de regressão linear, não foram encontradas variáveis ecocardiográficas preditivas para os dias de internação hospitalar no período e população do estudo. Conclusões: O desenvolvimento de novas técnicas de ECO, como STE, facilitou a capacidade de avaliar a função do VE através da avaliação quantitativa da deformação miocárdica, embora sejam técnicas complexas, si se realizam e interpretam de forma adequada, são muito úteis em diferentes condições clínicas. A MD pode ser um marcador precoce de mortalidade em pacientes com sepse, obtida pela mensuração da GLS e CS poderia ser um preditor prognóstico confiável dos resultados de pacientes na UTI, e também pode potencializar escalas como APACHE II, SOFA e SAPS II para permitir a identificação precoce de pacientes sépticos de alto risco. Existem ainda alguns obstáculos para a aplicação clínica regular de GLS e CS em pacientes sépticos na UTI, apesar de ser um estudo à beira do leito, é necessário levar em conta a gravidade da doença e comorbidades prévias. O limite ideal de GLS para a predição de mortalidade nesses pacientes permanece incerto e as diferenças intrínsecas entre as populações poderiam contribuir para as diferenças observadas, porém é sabido que é um parâmetro efetivo para a quantificação da função ventricular esquerda, mais sensível que a FEVE por ECO bidimensional, dependem relativamente menos do operador e das condições de carga. Os resultados atuais devem ser confirmados em estudos adicionais em larga escala e multicêntricos. Por isso, ainda permanece no campo da pesquisa clínica para pacientes em estado crítico.