ABSTRACT
Objective: Rural surgical training for residents is expected to increase the number of general surgeons working in rural areas; however, the impact of rural training programs to ensure such surgeons remains to be determined. Therefore, we reviewed the relevance of rural surgical rotation to the increase of general surgeons in rural areas.Materials and Methods: Studies on the outcomes of rural surgical rotations during the residency period in comparison to non-rural surgical rotations were retrieved using electronic databases through April 2022.Results: Among the 514 articles, five were eligible for review. All studies were published in the United States. Four studies reported an increased number of general surgeons in rural areas owing to rural surgical rotations. A meta-analysis of all studies showed a positive impact on the number of general surgeons in rural areas (odds ratio=2.19, 95% confidence interval=1.23–3.91). The programs generally ranged from 2 to 12 months with extensive experience with minor surgery and subspecialties necessary for surgery.Conclusions: Rural surgical rotations during the residency period can increase the number of general surgeons working in rural areas. Further studies are needed to evaluate the placement of general surgeons in rural areas.
ABSTRACT
AIM: To investigate the long-term oncologic outcomes and prognostic factors in patients with obstructive colorectal cancer (CRC) at multiple Japanese institutions. METHODS: We identified 362 patients diagnosed with obstructive colorectal cancer from January 1, 2002 to December 31, 2012 in Yokohama Clinical Oncology Group's department of gastroenterological surgery. Among them, 234 patients with stage II/III disease who had undergone surgical resection of their primary lesions were analyzed, retrospectively. We report the long-term outcomes, the risk factors for recurrence, and the prognostic factors. RESULTS: The five-year disease free survival and cancer-specific survival were 50.6% and 80.3%, respectively. A multivariate analysis showed the ASA-PS (HR = 2.23, P = 0.026), serum Albumin ≤ 4.0 g/dL (HR = 2.96, P = 0.007), T4 tumor (HR = 2.73, P = 0.002) and R1 resection (HR = 6.56, P = 0.02) to be independent risk factors for recurrence. Furthermore, poorly differentiated cancers (HR = 6.28, P = 0.009), a T4 tumor (HR = 3.46, P = 0.011) and R1 resection (HR = 6.16, P = 0.006) were independent prognostic factors in patients with obstructive CRC. CONCLUSION: The outcomes of patients with obstructive CRC was poor. T4 tumor and R1 resection were found to be independent prognostic factors for both recurrence and survival in patients with obstructive CRC.
Subject(s)
Colectomy , Colorectal Neoplasms/surgery , Intestinal Obstruction/surgery , Adult , Aged , Aged, 80 and over , Cell Differentiation , Chemotherapy, Adjuvant , Colectomy/adverse effects , Colectomy/mortality , Colorectal Neoplasms/complications , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/mortality , Disease Progression , Disease-Free Survival , Female , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Intestinal Obstruction/mortality , Japan , Kaplan-Meier Estimate , Male , Margins of Excision , Middle Aged , Multivariate Analysis , Neoplasm Metastasis , Neoplasm Recurrence, Local , Neoplasm Staging , Proportional Hazards Models , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
O objetivo deste trabalho foi avaliar a eficácia do sulfato de condroitina (SC) oral e intramuscular no tratamento de lesõestendíneas agudas induzidas experimentalmente em eqüinos. Foram utilizados 12 eqüinos, divididos aleatoriamente em trêsgrupos que receberam a administração de colagenase nos tendões flexores digitais superficiais, no terço médio da regiãometacarpiana, com a finalidade de se induzir a tendinite aguda. Após sete dias desta administração iniciou-se o tratamentocom sulfato de condroitina pelas vias intramuscular (grupo 1) e oral (grupo 2), e sem tratamento (grupo 3 controle). Estesanimais foram avaliados através de exames clínicos e ultra-sonográficos em diferentes momentos pelo período de 150 dias.Os resultados indicaram um efeito terapêutico benéfico do sulfato de condroitina, embora fossem reveladas diferenças naação do produto quando administrado por vias diferentes.
