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【Objective】 To explore the feasibility, safety and clinical application value of laparoscopic radical rectal cancer surgery with natural orifice specimen extraction (NOSE) by comparing the postoperative pathological data, surgery-related variables and postoperative recovery between laparoscopic radical rectal cancer surgery with NOSE and laparoscopic-assisted radical rectal cancer surgery. 【Methods】 A retrospective analysis was conducted on 74 patients who underwent radical rectal cancer surgery with anus preservation in the Department of General Surgery of The First Affiliated Hospital of Xi’an Jiaotong University from July 2017 to April 2022. Among them, 38 cases underwent surgery with specimen extraction through an abdominal auxiliary incision (auxiliary incision group), and 36 cases underwent surgery with specimen extraction through a natural orifice (NOSES group). The differences in the efficacy of the two surgeries were evaluated by comparing the postoperative pathological data, surgical variables, and postoperative recovery of the two groups. 【Results】 There were no statistically significant differences in general data and postoperative pathological data between the two groups (all P>0.05). The NOSES group exhibited significantly shorter operative time, time to first flatus, time to first oral intake postoperatively, and postoperative hospital stay compared to the auxiliary incision group (all P0.05). 【Conclusion】 Laparoscopic surgery with NOSE for rectal cancer is safe and feasible with minimally invasive and accelerated recovery, which is worth promoting and applying in clinical practice.
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Objective:To explore the prognostic value of circulating tumor cell (CTC) for colorectal cancer.Method:We analyze the correlation between CTC and clinicopathological data, survival curve and overall survival.Results:The positive rates of preoperative and postoperative CTC in 181 colorectal cancer patients were 66.3% and 65.7% respectively ( χ2=0.012, P=0.912). The postoperative CTC positive rates for recurrence and non-recurrence of stage Ⅱ colorectal cancer were 29.2% and 8.0%, respectively ( χ2=4.303, P=0.038). The progress free survuval of CTC-positive and CTC-negative in postoperative stage Ⅱ colorectal cancer patients were 28.7 months and 34.0 months, respectively ( χ2=4.096, P=0.043). Conclusion:Postoperative CTC detection has predictive prognostic value for patients with stage Ⅱ colorectal cancer.
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Objective:To investigate the relationship between transcription factors (TFs) and the prognosis of colon cancer, and to construct a prognosis model through TCGA and GEO dual databases, so as to quantify the risk of patients and guide clinical treatment decisions.Methods:The transcriptome and clinical data of colon cancer in TCGA and GEO databases were used in this study. The transcriptome data were annotated and the gene expression was calculated. The difference analysis of TFs in TCGA and GEO (log2FC > 1, P-value (Fdr) < 0.05) was performed. The difference TFs of double data intersection were used for correlation prognosis analysis ( P<0.01). The risk coefficient and risk value of prognosis-related TFs were calculated by COX multivariate analysis, and the prognosis model of TFs was constructed by COX model with "survival" and "glmnet" package. The survival curve ( P<0.001) and ROC curve (AUC>0.75) of the sequence set and verification set were drawn, and the distribution of risk value was visualized. After grouping according to risk value, GSEA enrichment analysis was calculated, gene set grid was constructed, target genes were predicted, and finally, pathway enrichment analysis of GO and KEGG was carried out. Results:387 TFs with different expressions in TCGA and GEO databases were used to draw heat map, volcanic map and TFs-related forest map, and the prognosis model of colon cancer was constructed according to COX multivariate analysis=0.310×HSF4+0.137×IRX3-0.127×ATOH1+0.290×OVOL3+0.137×HOXC6+0.155×SIX2+0.092×ZNF556-0.444×CXXC5+0.429×TIGD1+0.413×TCF7L1. Through enrichment analysis, our results showed that these prognostic factors may directly or indirectly act on cancer pathways, such as basic cell carcinoma and cancer signaling pathway, local tissue-cell adhesion, and extracellular matrix.Conclusions:The constructed TFs prognosis model of colon cancer can quantify the prognostic risk of colon cancer, and its high-risk group is an independent risk factor of colon cancer prognosis. This model is a new way to evaluate the prognosis of colon cancer.
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Objective:To investigate the risk factors for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer, and application value of a nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 228 patients with stage Ⅱ-Ⅲ colon cancer who underwent radical resection in the First Affiliated Hospital of Xi′an Jiaotong University from January 2013 to June 2016 were collected. There were 118 males and 110 females, aged from 25 to 87 years, with a median age of 62 years. All patients underwent open or laparoscopic-assisted radical resection of colon cancer. Observation indicators: (1) postoperative tumor recurrence; (2) risk factors analysis for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer; (3) development and evaluation of a nomogram prediction model for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer. Follow-up using outpatient examination and telephone interview was performed to detect postoperative 3-year tumor recurrence up to June 2019. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers, and comparison between groups was analyzed using the Pearson chi-square test or Fisher exact probability. Multivariate analysis was performed using Logistic stepwise regression analysis. The independent risk factors were included into R 3.6.1 software to construct a nomogram prediction model. The receiver operating characteristic curve (ROC) was drawed, and the area under curve (AUC) was used to evaluate discrimination of the nomogram prediction model. The calibration chart with R software was used to evaluate consistency of the nomogram prediction model. Results:(1)Postoperative tumor recurrence: 53 of 228 patients had postoperative tumor recurrence including 19 cases with locoregional recurrence and 34 cases with distant metastasis. Of the 34 patients with distant metastasis, there were 14 cases with liver metastasis, 7 cases with lung metastasis, 4 cases with brain metastasis, and 9 cases with multiple metastasis or isolated metastasis in other sites. The time to recurrence was 12 months (range, 6-19 months). (2) Risk factors analysis for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer:results of univariate analysis showed that bowel obstruction, preoperative carcinoembryonic antigen (CEA) level, ascites, vascular invasion were related factors for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer ( χ2=4.463, 13.622, 10.914, 5.911, P<0.05). Pathological N stage was also a related factor for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer ( P<0.05). Results of multivariate analysis showed that preoperative CEA level >5 μg/L, ascites, vascular invasion and pathological N stage as stage N1 or N2 were independent risk factors for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer ( odds ratio=3.129, 3.071, 7.634, 3.439, 15.467, 95% confidence interval as 1.328-7.373, 1.047-9.007, 1.103-52.824, 1.422-8.319, 3.498-68.397, P<0.05). (3) Development and evaluation of a nomogram prediction model for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer: based on preoperative CEA level, ascites, vascular invasion and pathological N stage of multivariate analysis, a nomogram prediction model for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer was developed using R 3.6.1 software. The nomogram score was 41.7 for preoperative CEA level >5 μg/L, 41.0 for ascites, 74.2 for vascular invasion, 45.1 and 100.0 for pathological N stage as stage N1 and N2, respectively. The total of different scores for risk factors corresponded to the probability of postoperative recurrence. The ROC of nomogram for recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer was drawed,with the AUC of 0.805(95% confidence interval as 0.737-0.873, P<0.05). The calibration chart showed a good consistency between the probability of recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer predicted by nomogram and the actual probability of postoperative recurrence. Conclusions:Preoperative CEA level >5 μg/L, ascites, vascular invasion and pathological N stage as stage N1 or N2 are independent risk factors for tumor recurrence after radical resection of stage Ⅱ-Ⅲ colon cancer. The nomogram prediction model contributes to prediction of the recurrent risks after radical resection of stage Ⅱ-Ⅲ colon cancer.
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Objective:To investigate prognostic factor in colorectal cancer (CRC).Methods:The clinicopathologic characteristics and progression free survival (PFS) of 181 CRC patients treated from Mar 2015 to Dec 2017 was collected for analysis. Univariate and multivariate analysis were performed to screen for prognostic factors affecting prognosis.Results:Univariate analysis found that age(χ 2=12.192, P=0.002), AJCC staging(χ 2=17.038, P=0.001), surgical approach(χ 2=6.105, P=0.047), postoperative carcinoembryonic antigen ( χ 2=10.081, P=0.001 ) and perioperative adverse events (χ 2=6.736, P=0.009)were significantly associated with prognosis. Multivariate analysis found that AJCC staging(Wald =8.104, P=0.044) and perioperative adverse events(Wald=7.656, P=0.006) were independent risk factors for prognosis. Conclusions:AJCC staging and perioperative adverse events can be used as independent risk factors for predicting prognosis in CRC patients.
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Objective To compare the clinical efficacy of laparoscopic radical resection of cervical cancer and laparotomy in the treatment of early cervical cancer.Methods From March 2015 to March 2017,102 patients with early cervical cancer in Taizhou Hospital were selected and randomly divided into control group and study group according to the digital table,with 51 cases in each group.The control group received traditional open surgery,the study group received laparoscopic surgery for cervical cancer.The operation time,intraoperative blood loss,postoperative first exhaust time,postoperative hospital stay,pelvic lymph node dissection and complication occurred in both two groups were observed and recorded in hysteroscopic cervical cancer.Results The operation time of the study group was significantly longer than that of the control group [(239.3 ±66.7)min vs.(156.9 ±41.5)min,t=5.65,P<0.01],the amount of intraoperative blood loss,the time of first postoperative exhaust and postoperative hospital stay of the study group were significantly less/shorter than those of the control group [(299.8 ±49.2)mL vs.(361.4 ± 60.3)mL,(44.6 ±6.7)min vs.(62.5 ±7.0)min,(6.5 ±2.3)d vs.(10.9 ±4.4)d,t=7.49,13.19,6.33,all P<0.01].And the number of pelvic lymph node dissection of the study group was significantly higher than that of the control group[(28.2 ±3.9)vs.(18.8 ±4.1),t=11.86,P<0.01].The incidence rate of postoperative complications in the study group was 9.8％,which in the control group was 25.5％,the difference was statistically significant(χ2 =0.092,P=0.035).Conclusion Laparoscopic radical resection of cervical cancer is superior to traditional laparotomy in the treatment of early cervical cancer.It has advantages of good clinical efficacy and less complication.It is worthy of clinical application.
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Objective To observe the effect of down-regulated CDX2 gene on the migration and invasion abilities of colon cancer cells (SW480 and HT29) and investigate the role and mechanisms of CDX2 gene in occurrence and development of colon cancer metastasis.Methods CDX2 gene in HT29 and SW480 cells was down-regulated using lentivirus RNA interference (RNAi) vector.The interference efficiency of CDX2 was detected by qRT-PCR and Western blotting.The effect of down-regulated CDX2 expression on colon cancer cells'migration and invasion was determined by Transwell and wound heal methods.Then the effects of down-regulated CDX2 on the expressions of epithelial-mesenchymal transition (EMT)-related genes (E-cadherin,ZEB-1,Vimentin,Twist and Snail) were detected by RT-PCR and Western blotting.Results The constructed CDX2 siRNA expression vector could significantly inhibit the expression of CDX2 in HT29 and SW480 cells.Compared with those of the cells transfected with empty vector (LV-NT-shRNA) and non-transfected cells,the migration and invasion abilities of cells transfected with LV-CDX2-shRNA were markedly enhanced (P ＜ 0.05).E-cadherin expression was reduced while expressions of ZEB-1,Vimentin,Twist,and Snail were significantly increased (all P＜0.05).Conclusion Down-regulating the expression of CDX2 can induce the occurrence of EMT,thus enhancing the invasion and migration of colon cancer cells.
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OBJECTIVE:To explore the regularity and the characteristics of ADR in county-level second grade class A hospi-tal,in order to promote rational drug use in the clinic. METHODS:In retrospective study,399 ADR reported to National ADR Monitoring Network by county-level second grade class A hospital from 2011 to 2014 were analyzed. RESULTS:399 cases of ADR most happened in 0-10 year-old children (39.35%);most of ADR cases (91.98%) were related to intravenous administra-tion;56.39% of ADR cases were caused by antibiotics(56.39%),among which cephalosporin antibiotics took up the highest pro-portion(19.55%). ADR mainly manifested as lesion of skin and appendants(50.38%). CONCLUSIONS:It contributes to guaran-tee the safety of drug use that mastering the situation of ADR monitoring and report and extracting valuable warning sign.
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Objective To investigate the clinical curative effect of Milligan‐Morgan and Ligasure blood vessels closed system for conducting mixed hemorrhoidectomy under local anesthesia .Methods 68 inpatients with mixed hemorrhoid in the general sur‐gery department of our hospital from April 2009 to April 2012 were selected and randomly divided into the Ligasure group (observa‐tion group ,34 cases) and the Milligan‐Morgan group (control group ,34 cases) .The operation adopted the local infiltration anesthe‐sia .The postoperative followed up lasted for 6‐36 months .The operation time ,intraoperative blood loss ,total hospitalization cost , postoperative hospital stay time ,postoperative pain degree and the postoperative complications were compared between the two groups .Results The average operation time in the control group and the observation group was (32 .35 ± 10 .24)min and (20 .29 ± 7 .88) min(P=0 .000) ,the average intraoperative blood loss was (29 .71 ± 14 .67)mL and (4 .97 ± 2 .89) mL(P=0 .000) ,the aver‐age postoperative pain score was (5 .88 ± 1 .12) points and (3 .47 ± 0 .83) points(P=0 .000) ,the average postoperative hospital stay time was (7 .97 ± 2 .55) d and (2 .29 ± 1 .17) d(P=0 .000) ,and the average hospitalization expense was (1 541 .32 ± 205 .91) Yuan and (2 872 .32 ± 652 .30) Yuan ,respectively ,the differences between the two groups were statistically significant (P=0 .000) .Dur‐ing the hospitalization period and follow‐up ,the anal exudation rate and the average postoperative pain score in the control group were higher than those in the observation group(P=0 .000) ,the occurrence rate of other complications had no statistically signifi‐cant differences between the two groups .Conclusion The Ligasure operation mode has less intraoperative blood loss ,shorter opera‐tion time and shorter postoperative hospital stay time .
