Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarte...Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.展开更多
BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicat...BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicated by diabetes is highly pre-valent in clinical settings.AIM To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.METHODS A retrospective analysis was conducted on the clinical data of 203 diabetic pa-tients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023.Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial suscept-ibility.Based on a one-year follow-up,patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data.Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.RESULTS Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS.A total of 134 pathogenic bacteria strains were isolated and identified,including 81 strains(60.4%)of gram-positive bacteria and 53 strains(39.6%)of gram-negative bacteria.Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin,while remaining highly sensitive to vancomycin,gentamicin,and rifampicin.Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin,but showed high sensitivity to imipenem,meropenem,cefepime,and ceftazidime.Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels,smoking history,Lund-Mackay scores,visual analog scale(VAS)scores,nasal septum deviation,allergic rhinitis,bronchial asthma,postoperative infection,long-term use of nasal decongestants,and adherence to medical prescriptions.Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.CONCLUSION In CRS patients with nasal polyps(CRSwNP),the detection rate of nasal pathogens is relatively high,and most of the isolated bacteria exhibit antimicrobial resistance.Additionally,the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.展开更多
BACKGROUND In the biologic era,postoperative recurrence(POR)of Crohn’s disease(CD)remains a significant concern.The underlying cause of this phenomenon remains unclear at present.AIM To examine whether intestinal fib...BACKGROUND In the biologic era,postoperative recurrence(POR)of Crohn’s disease(CD)remains a significant concern.The underlying cause of this phenomenon remains unclear at present.AIM To examine whether intestinal fibrosis increases the likelihood of POR when antitumor necrosis factor biologics are used following ileocecal resection(ICR).METHODS We performed a single-centre,retrospective cohort study of patients with CD who underwent ICR.Recurrence was defined by endoscopy(Rutgeerts score≥i2),radiography(active inflammation in the neoterminal ileum)or surgery(another resection>3 months post-ICR),and patients were categorised by the presence of intestinal fibrosis on histopathological evaluation.RESULTS Among 102 patients with CD who underwent ICR and received infliximab within 3 months,69(67.6%)had intestinal fibrosis.In addition,60 patients(58.8%)experienced POR in various forms:52.6%,41.2%,and 10.8%had endoscopic,radiographic,and surgical recurrence,respectively.Patients with intestinal fibrosis experienced faster radiographic recurrence(log rank P=0.03).After adjusting for risk factors associated with POR,intestinal fibrosis increased the risk of early radiographic recurrence(adjusted hazard ratio=4;95%confidence interval:1.03-15.56;P=0.045).CONCLUSION Despite the limited sample size,our study revealed a strong correlation between radiographic POR and intestinal fibrosis in patients who received postoperative anti-tumor necrosis factorαprophylaxis.展开更多
AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.METHODS: From the pathology department database, we retrospectively retrieved the data of all the ...AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn’s disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy.RESULTS: From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence (HR = 0.30, 95%CI: 0.13-0.70, P = 0.006).CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation.展开更多
AIM To assess magnetic resonance imaging(MRI)and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers,all patients with CD who un...AIM To assess magnetic resonance imaging(MRI)and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers,all patients with CD who underwent ileocolonic resection were consecutively and prospectively included.All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity[median=6 mo(5.0-9.3)].The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level.Endoscopic postoperative recurrence(POR)was defined as Rutgeerts'index≥i2b.The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC)was lower in patients with endoscopic POR compared to those with no recurrence(2.03±0.32 vs 2.27±0.38×10^(-3)mm^2/s,P=0.032).Clermont score(10.4±5.8 vs 7.4±4.5,P=0.038)and relative contrast enhancement(RCE)(129.4%±62.8%vs 76.4%±32.6%,P=0.007)were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3±4.5 vs 4.8±3.7;P=0.15)and MR scoring system(P=0.056).ADC<2.35×10^(-3)mm^2/s[sensitivity=0.85,specificity=0.65,positive predictive value(PPV)=0.85,negative predictive value(NPV)=0.65]and RCE>100%(sensitivity=0.75,specificity=0.81,PPV=0.75,NPV=0.81)were the best cutoff values to identify endoscopic POR.Clermont score>6.4(sensitivity=0.61,specificity=0.82,PPV=0.73,NPV=0.74),Ma RIA>3.76(sensitivity=0.61,specificity=0.82,PPV=0.73,NPV=0.74)and a MR scoring system≥MR1(sensitivity=0.54,specificity=0.82,PPV=0.70,and NPV=0.70)demonstrated interesting performances to detect endoscopic POR.Faecal calprotectin values were significantly higher in patients with endoscopic POR(114±54.5μg/g vs 354.8±432.5μg/g;P=0.0075).Faecal calprotectin>100μg/g demonstrated high performances to detect endoscopic POR(sensitivity=0.67,specificity=0.93,PPV=0.89 and NPV=0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.展开更多
AIM:To evaluate the effectiveness of adalimumab in preventing recurrence after intestinal resection for Crohn's disease in high-risk patients.METHODS:A multicenter,prospective,observational study was conducted fro...AIM:To evaluate the effectiveness of adalimumab in preventing recurrence after intestinal resection for Crohn's disease in high-risk patients.METHODS:A multicenter,prospective,observational study was conducted from June 2009 until June 2010.We consecutively included high-risk Crohn's disease patients who had undergone an ileal/ileocolonic resection.High-risk patients were defined as two or more criteria:smokers,penetrating pattern,one or more previous surgical resections or prior extensive resection.Subcutaneous adalimumab was administered 2 wk(± 5 d) after surgery at a dose of 40 mg eow,with an initial induction dose of 160/80 mg at weeks 0 and 2.Demographic data,previous and concomitant treatments(antibiotics,5-aminosalicylates,corticosteroids,immunomodulators or biologic therapies),smoking status at the time of diagnosis and after the index operation and number of previous resections(type and reason for surgery) were all recorded.Biological status was assessed with C-reactive protein,erythrocyte sedimentation rate and fecal calprotectin.One year(± 3 mo) after surgery,an ileocolonoscopy and/or magnetic resonance enterography was performed.Endoscopic recurrence was defined as Rutgeerts score ≥ i2.Morphological recurrence was based on magnetic resonance(MR) score ≥ MR1.RESULTS:Twenty-nine patients(55.2% males,48.3% smokers at diagnosis and 13.8% after the index operation),mean age 42.3 years and mean duration of the disease 13.8 years were included in the study.A mean of 1.76(range:1-4) resections previous to adalimumab administration and in 37.9% was considered extensive resection.51.7% had previously received infliximab.Immunomodulators were given concomitantly to 17.2% of patients.Four of the 29(13.7%) developed clinical recurrence,6/29(20.7%) endoscopic recurrence and 7/19(36.8%) morphological recurrence after 1-year.All patients with clinical recurrence showed endoscopic and morphological recurrence.A high degree of concordance was found between clinical-endoscopic recurrence(k = 0.76,P < 0.001) and clinical-morphological recurrence(k = 0.63,P = 0.003).Correlation between endoscopic and radiological findings was good(comparing the 5-point Rutgeerts score with the 4-point MR score,a score of i4 was classified as MR3,i3 as MR2,and i2-i1 as MR1)(P < 0.001,r s = 0.825).During follow-up,five(17.2%) patients needed adalimumab dose intensification(40 mg/wk);Mean time to intensification after the introduction of adalimumab treatment was 8 mo(range:5 to 11 mo).In three cases(10.3%),a biological change was needed due to a worsening of the disease after the dose intensification to 40 mg/wk.One patient suffered an adverse event.CONCLUSION:Adalimumab seems to be effective and safe in preventing postoperative recurrence in a selected group of patients who had undergone an intestinal resection for their CD.展开更多
BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recur...BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula.AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures.METHODS In this retrospective study,525 patients with anorectal abscesses treated by incision and drainage alone,at a tertiary general hospital from August 2012 to July 2022,were included.A new classification for anorectal abscesses based on their propensity to develop into fistulas,considering 18 other potential risk factors,was established.These factors,from electronic medical records,were screened for significance using theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses.RESULTSOne year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,respectively.Univariateχ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(P<0.05).Fistula-prone abscess,≥7 days between symptomonset and surgery,chronic diarrhea,preoperative antibiotic use,and local anesthesia were risk factors for recurrence,while diabetes mellitus was protective(P<0.05).Moreover,fistula-prone abscess[odds ratio(OR)=7.651,95%CI:4.049–14.458,P<0.001],≥7 days from symptom onset to surgery(OR=2.137,95%CI:1.090–4.190,P=0.027),chronic diarrhea(OR=2.508,95%CI:1.216–5.173,P=0.013),and local anesthesia(OR=2.308,95%CI:1.313–4.059,P=0.004)were independent risk factors for postoperative anorectal abscess recurrence using multivariatelogistic regression.Body mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone abscess.CONCLUSIONThe choice of surgical procedure for treating anorectal abscesses should follow this new classification.Prompt andthorough incision and drainage can significantly reduce postoperative recurrence.展开更多
As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the for...As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the formation of NG by inhibiting the proliferation of thyroid follicular cells,promoting cell apoptosis,regulating immunity,improving the microcirculation of thyroid tissue and other mechanisms,and can reduce the postoperative recurrence of NG.展开更多
Objective: To investigate the effect of docetaxel and cisplatin combined with intensity-modulated radiotherapy in thetreatment of postoperative recurrence of esophageal cancer and the content of tumor markers in serum...Objective: To investigate the effect of docetaxel and cisplatin combined with intensity-modulated radiotherapy in thetreatment of postoperative recurrence of esophageal cancer and the content of tumor markers in serum. Methods: According tosimple randomization method, 60 patients with postoperative recurrence of esophageal cancer admitted from February 2018 toSeptember 2019 were divided into control group (n = 30 cases) and observation group (n = 30 cases). All patients received IMRT.Fluorouracil + cisplatin was used in the control group and docetaxel + cisplatin was used in the observation group. After 2 coursesof continuous treatment, the therapeutic effect, serum tumor marker content and adverse reactions were compared between thetwo groups. Results: After treatment, the effective rate of observation group was higher than control group, and the difference wasstatistically significant (P < 0.05).The contents of carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) andcarbohydrate antigen 19-9 (CA19-9) in observation group were lower than those in control group, and the difference was statisticallysignificant (P < 0.05). The incidence of adverse reactions in the observation group was lower than that in the control group, and thedifference was statistically significant (P < 0.05). Conclusion: Docetaxel and cisplatin combined with intensemodulated radiotherapyfor postoperative recurrence of esophageal cancer can improve the therapeutic effect, inhibit the malignant degree of tumor, andreduce the incidence of adverse reactions.展开更多
Backgroud:Summarize the formula rule of traditional Chinese medicine fOr preventing and treating bladder cancer recurrence after operation and explore the molecular mechanism of core medicines.Methods:Literatures coll...Backgroud:Summarize the formula rule of traditional Chinese medicine fOr preventing and treating bladder cancer recurrence after operation and explore the molecular mechanism of core medicines.Methods:Literatures collected from CNKI,Wanfang Med Online,CMJD,PUBMED and Elsiver databases were as prescription sources,and association rules and complex system entropy clustering analysis were carried out using the Traditional Chinese Medicine Inheritance Support System(TCMISSV2.5).BATMAN-TCM online analysis tool was used to construct target-pathway-disease correlation map to reveal the potential mechanism of action.Results:A total of 122 prescriptions were eligible for data analysis.The high-frequency traditional Chinese medicines are Poria,Radix et Rhizoma Rhei,Radix Astragali,Herba Hedyotidis Diffusae and Rhizoma Atractylodis Macrocephalae.The high-frequency drug pairs are Rhizoma Atractylodis MacrocephalaeIPoria,Poria/Rhizoma Alismatis,Radix Astragali/Rhizoma Atractylodis Macrocephalaeand and Herba Hedyotidis Diffusae/Herba Scutellariae Darbatae..There are 5 groups of drug pairs with high correlation strength.Cluster analysis shows 6 core drug combinations and 3 new prescriptions.In clinical practice,the core compatibility of traditional Chinese medicines for preventing postoperative recurrence of bladder cancer is Poria,Radix Astragali and Herba Hedyotidis Diffusae.The possible signaling pathways are the neuroactive ligand receptor interaction signaling pathway and calcium signaling pathway.Conclusion:Prevention and treatment of postoperative recurrence of bladder cancer mainly use medicines with effects of eliminating dampness and diuresis for removing edema,heat-clearing and detoxifying,and qi-invigorating.The potential mechanism of the compatibility of core drugs may be realized by interfering with the signal pathway of neuroactive ligand receptor interaction and calcium signal pathway.展开更多
Objective To establish a lung cancer dormancy mouse model and verify the effects of Wushen(WS),a formula food,on postoperative recurrence.Methods We established a Lewis cell tumor dormancy model system that definitive...Objective To establish a lung cancer dormancy mouse model and verify the effects of Wushen(WS),a formula food,on postoperative recurrence.Methods We established a Lewis cell tumor dormancy model system that definitively links surgery and the subsequent wound-healing response to the outgrowth of lung cancer cells.We used this model to observe the effects of WS on the postoperative recurrence and the nutritional status of the mice.Finally,the immunocyte subtypes and cytokine levels in the serum and spleens of mice were detected by flow cytometry and ELISA.Results The recurrence rate in the WS group was obviously lower than that in the control group.Wushen increased the body weights and serum albumin levels of the mice.The levels of NK,Gr1+CD11b+CD3+CD8+and CD3+CD4+T cells in the spleens of mice in the WS group were also increased.Compared with the control group,the levels of CD4+IFN-γ+,CD4+IL-2 and CD4+/IL-10+in the spleens of mice in the WS group were decreased.Wushen also seemed to decrease the levels of IL-6 and TNF-α,but the decrease was not significant.Conclusion The postoperative lung cancer recurrence model was successfully established.Wushen inhibited postoperative recurrence,apparently by regulating the level of immune cell subtypes and cytokines in the serum and spleen.展开更多
Objective: to analyze the prevention and clinical effect of hysteroscopic endometrial polypectomy (TCRP) in the treatment of postoperative recurrence of endometrial polyp (EP). Methods: a total of 112 EP patients were...Objective: to analyze the prevention and clinical effect of hysteroscopic endometrial polypectomy (TCRP) in the treatment of postoperative recurrence of endometrial polyp (EP). Methods: a total of 112 EP patients were selected from Our hospital from August 2020 to August 2021, and were randomly divided into 2 groups with 56 patients in each group according to the number table. Patients in the control group were given TCRP operation treatment, and patients in the observation group were given levonorgestrel intrauterine sustained release system (LNG?IUS) on this basis. Postoperative observation time, endocrine hormone test results before and after treatment and recurrence rate of EP were compared between the two groups. Results: the observation group was shorter than the control group, and the endocrine hormone test results were better than the control group after treatment, P < 0.05. The recurrence rate of EP in observation group was lower than that in control group, P < 0.05. Conclusion: TCRP combined with LNG?IUS has a definite therapeutic effect on EP, can improve the endocrine status of patients and reduce the recurrence rate of EP after operation, which is worthy of promotion and application.展开更多
Objective: analyze the related influencing factors of postoperative recurrence of varicose veins of lower extremities. Methods: 30 patients with postoperative recurrence of varicose veins of lower extremities in our h...Objective: analyze the related influencing factors of postoperative recurrence of varicose veins of lower extremities. Methods: 30 patients with postoperative recurrence of varicose veins of lower extremities in our hospital from January 2018 to December 2019 were selected as the experimental group. And 30 patients without recurrence of varicose veins after operation in our hospital at the same time were selected as the control group;the clinical data of the two groups were retrospectively analyzed, and the related influencing factors of postoperative recurrence were analyzed and discussed. Results: the independent influencing factors of postoperative recurrence of varicose veins of lower limbs included skin vein ulcer near ankle joint, high ligation of great saphenous vein, disobeying doctor's advice, unreasonable diet, less than 30 minutes of exercise per day, age ≥ 60 years old (P < 0.05). Conclusion: the factors influencing the postoperative recurrence of varicose veins of lower extremities are complex and diverse. It is necessary to formulate targeted measures in combination with relevant influencing factors in order to effectively prevent postoperative recurrence of varicose veins of lower limbs.展开更多
To investigate the effects of intravesical therapy with elemene in preventing postoperative recurrence of superficial bladder cancer and its toxic and side effects.Methods This series included 123 patients with superf...To investigate the effects of intravesical therapy with elemene in preventing postoperative recurrence of superficial bladder cancer and its toxic and side effects.Methods This series included 123 patients with superficial bladder cancer (T1),consisting of transitional cell carcinoma GⅠ in 37 cases,GⅡ in 73 and GⅢ in 13.They all underwent surgical treatment.Postoperatively,they were randomly assigned to 2 groups;63 patients in elemene group received instillation of elemene (400 mg,once a week) 2 weeks after operation and 60 patients in mitomycin C (MMC) group received instillation of MMC (40 mg,once a week) 2 weeks after operation.The instillations were repeated for 6 weeks and thereafter monthly for 1 year.The recurrence rates,side effects,and NK cell activity before and after treatment were evaluated.Results The recurrence rate of elemene group (mean follow-up of 19.7 months) was 7.9% (5 cases),which was significantly lower than that (25.0%,15 cases) of MMC group (mean follow-up of 19.4 months;P<0.05).The side effect in elemene group (3.2%,2 cases) was significantly milder than that in MMC group (25.0%,15 cases)(P<0.05).In elemene group,the NK cell activity after treatment (28±2)% was significantly higher than that before treatment(20±2)%(P<0.05).Conclusion Instillation of elemene after operation is effective and safe in preventing postoperative recurrence of bladder cancer.8 refs.展开更多
BACKGROUND The computed tomography(CT)-based preoperative risk score was developed to predict recurrence after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma(PDAC)in South Korea.However,w...BACKGROUND The computed tomography(CT)-based preoperative risk score was developed to predict recurrence after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma(PDAC)in South Korea.However,whether it performs well in other countries remains unknown.AIM To externally validate the CT-based preoperative risk score for PDAC in a country outside South Korea.METHODS Consecutive patients with PDAC who underwent upfront surgery from January 2016 to December 2019 at our institute in a country outside South Korea were retrospectively included.The study utilized the CT-based risk scoring system,which incorporates tumor size,portal venous phase density,tumor necrosis,peripancreatic infiltration,and suspicious metastatic lymph nodes.Patients were categorized into prognosis groups based on their risk score,as good(risk score<2),moderate(risk score 2-4),and poor(risk score≥5).RESULTS A total of 283 patients were evaluated,comprising 170 males and 113 females,with an average age of 63.52±8.71 years.Follow-up was conducted until May 2023,and 76%of patients experienced tumor recurrence with median recurrence-free survival(RFS)of 29.1±1.9 months.According to the evaluation results of Reader 1,the recurrence rates were 39.0%in the good prognosis group,82.1%in the moderate group,and 84.5%in the poor group.In comparison,Reader 2 reported recurrence rates of 50.0%,79.5%,and 88.9%,respectively,across the same prognostic categories.The study validated the effectiveness of the risk scoring system,demonstrating better RFS in the good prognosis group.CONCLUSION This research validated that the CT-based preoperative risk scoring system can effectively predict RFS in patients with PDAC,suggesting that it may be valuable in diverse populations.展开更多
The peritoneum is a frequently involved site of metastasis in gastrointestinal malignancies,posing a major risk to human health.In recent years,treatment methods such as cytoreductive surgery(CRS)and hyperthermic intr...The peritoneum is a frequently involved site of metastasis in gastrointestinal malignancies,posing a major risk to human health.In recent years,treatment methods such as cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)have significantly prolonged the survival time of patients with gastrointestinal peritoneal metastases.With the continuous advancements in comprehensive treatment for peritoneal cancer,targeted therapy and immunotherapy are gradually being applied to patients with gastrointestinal peritoneal metastases.Gastrointestinal peritoneal metastases are now widely acknowledged as a regional abdominal disease.Consequently,preventing both localized abdominal and systemic recurrences has become a central focus in their diagnosis and management.This article systematically reviews the recurrence patterns of gastrointestinal peritoneal metastatic tumors following surgery,with an emphasis on intraperitoneal,single-site,and multi-site recurrence patterns.It also discusses factors influencing the time to recurrence,such as the degree of cytoreduction and the type of chemotherapy used.The importance of assessment tools for recurrence,such as tumor marker detection,imaging,and laparoscopy,is emphasized.Additionally,strategies for preventing recurrence are outlined,including tumor-free principles,adjuvant chemotherapy,HIPEC,and integrated traditional Chinese and Western medicine.The article highlights new advances in targeted therapy and immunotherapy,aiming to provide guidance for clinical practice and future research.展开更多
Crohn's disease is a chronic inflammatory condition that may involve any segment of the gastrointestinal tract. Although several drugs have proven efficacy in inducing and maintaining disease in remission, resecti...Crohn's disease is a chronic inflammatory condition that may involve any segment of the gastrointestinal tract. Although several drugs have proven efficacy in inducing and maintaining disease in remission, resectional surgery remains as a cornerstone in the management of the disease, mainly for the treatment of its stenosing and penetrating complications. However, the occurrence of new mucosal (endoscopic) lesions in the neoterminal ileum early after surgery is almost constant, it is followed in the mid-term by clinical symptoms and, in a proportion of patients, repeated intestinal resections are required. Pathogenesis of postoperative recurrence (POR) is not fully understood, but luminal factors (commensal microbes, dietary antigens) seem to play an important role, and environmental and genetic factors may also have a relevant influence. Many studies tried to identify clinical predictors for POR with heterogeneous results, and only smoking has repeatedly been associated with a higher risk of POR. Ileocolonoscopy remains as the gold standard for the assessment of appearance and severity of POR, although the real usefulness of the available endoscopic score needs to be revisited and alternative techniques are emerging. Several drugs have been evaluated to prevent POR with limited success. Smoking cessation seems to be one of the more beneficial therapeutic measures. Aminosalicylates have only proved to be of marginal benefit, and they are only used in low-risk patients. Nitroimidazolic antibiotics, although efficient, are associated with a high rate of intolerance and might induce irreversible side effects when used for a long-term. Thiopurines are not widely used after ileocecal resection, maybe because some concerns in giving immunomodulators in asymptomatic patients still remain. In the era of biological agents and genetic testing, a well-established preventive strategy for POR is still lacking, and larger studies to identify good clinical, serological, and genetic predictors of early POR as well as more effective drugs (or drug combinations) are needed.展开更多
BACKGROUND Postoperative recurrence is common in Crohn’s disease(CD),with endoscopic lesions in a majority of patients by 12 months after surgery.Ileocolonoscopy is the reference standard but is invasive and poorly s...BACKGROUND Postoperative recurrence is common in Crohn’s disease(CD),with endoscopic lesions in a majority of patients by 12 months after surgery.Ileocolonoscopy is the reference standard but is invasive and poorly suited to frequent surveillance.Intestinal ultrasound(IUS)-including small intestine contrast ultrasound and contrast enhanced ultrasound-is a repeatable,noninvasive alternative.AIM To summarize the evidence on the diagnostic accuracy and prognostic value of IUS for detecting postoperative recurrence in CD.METHODS We systematically searched PubMed and EMBASE through June 2025 for original English-language studies evaluating IUS against clinical or endoscopic outcomes in postoperative CD.This scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline.After screening 259 unique records,41 full texts were assessed and 20 studies were included.RESULTS Bowel wall thickness thresholds of≥5 mm at the neo-terminal ileum predict endoscopic recurrence with sensitivities 81%-94%and specificities 86%-100%;lower cutoffs at the anastomosis(≥3-3.5 mm)also carry risk(data from singlecenter cohorts).Dualsite assessment(neo-terminal ileum+ileocolonic anastomosis)improves performance.Adding Doppler hyperemia or mesenteric lymphadenopathy increases accuracy;combining bowel wall thickness≥3 mm with fecal calprotectin≥50μg/g yields high specificity(approximately 93%-100%)with a negative predictive value of nearly 95%when both are negative.Contrast enhanced ultrasound-based composite scores reach approximately 98%diagnostic accuracy in prospective cohorts.Small intestine contrast ultrasound shows similarly strong early diagnostic performance-for example,an area under the receiver operating characteristic curve up to 0.95 when using ileocolonic anastomosis wall thickness≥3 mm to 3.5 mm plus lesion length,with 82%-94%sensitivity and>90%specificity reported even within 7 days postresection.Overall,IUS shows moderate agreement with endoscopy(κapproximately 0.5-0.8)and stronger prognostic value when performed within 12 months post-surgery.CONCLUSION IUS can be integrated into postoperative surveillance algorithms-particularly within the first year-and can reduce routine endoscopy in selected patients.Research priorities include standardized thresholds and composite scoring,consensus training/competency,and multicenter validation including artificial intelligenceassisted interpretation.展开更多
AIM To evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.METHODS Data from all patients who underwent Crohn's disease(CD)-related resection at the Unive...AIM To evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.METHODS Data from all patients who underwent Crohn's disease(CD)-related resection at the University of Szeged, Hungary between 2004 and 2014 were analyzed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after surgery, resection margins, neural fiber hyperplasia, submucosal and myenteric plexitis were evaluated as possible predictors of postoperative recurrence. Histological samples were analyzed blinded to the postoperative outcome and the clinical history of the patient. Plexitis was evaluated based on the appearance of the most severely inflamed ganglion or nerve bundle. Patients underwent regular follow-up with colonoscopy after surgery. Postoperativerecurrence was defined on the basis of endoscopic and clinical findings, and/or the need for additional surgical resection. RESULTS One hundred and four patients were enrolled in the study. Ileocecal, colonic, and small bowel resection were performed in 73.1%, 22.1% and 4.8% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Twenty-six patients underwent previous CD-related surgery. Forty-three point two percent of the patients were on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-tumor necrosis factor-alpha postoperative treatment. Postoperative recurrence occurred in 61.5% of the patients; of them 39.1% had surgical recurrence. 92.2% of the recurrences developed within the first five years after the index surgery. Mean disease duration for endoscopic relapse was 2.19 years. The severity of submucosal plexitis was a predictor of the need for second surgery(OR = 1.267, 95%CI: 1.000-1.606, P = 0.050). Female gender(OR = 2.21, 95%CI: 0.98-5.00, P = 0.056), stricturing disease behavior(OR = 3.584, 95%CI: 1.344-9.559, P = 0.011), and isolated ileal localization(OR = 2.671, 95%CI: 1.033-6.910, P = 0.043) were also predictors of postoperative recurrence. No association was revealed between postoperative recurrence and smoking status, postoperative prophylactic treatment and the presence of myenteric plexitis and relapse.CONCLUSION The presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.展开更多
Endoscopic and clinical recurrence of Crohn’s disease (CD) is a common occurrence after surgical resection. Smokers, those with perforating disease, and those with myenteric plexitis are all at higher risk...Endoscopic and clinical recurrence of Crohn’s disease (CD) is a common occurrence after surgical resection. Smokers, those with perforating disease, and those with myenteric plexitis are all at higher risk of recurrence. A number of medical therapies have been shown to reduce this risk in clinical trials. Metronidazole, thiopurines and anti-tumour necrosis factors (TNFs) are all effective in reducing the risk of endoscopic or clinical recurrence of CD. Since these are preventative agents, the benefits of prophylaxis need to be weighed-against the risk of adverse events from, and costs of, therapy. Patients who are high risk for post-operative recurrence should be considered for early medical prophylaxis with an anti-TNF. Patients who have few to no risk factors are likely best served by a three-month course of antibiotics followed by tailored therapy based on endoscopy at one year. Clinical recurrence rates are variable, and methods to stratify patients into high and low risk populations combined with prophylaxis tailored to endoscopic recurrence would be an effective strategy in treating these patients.展开更多
基金supported by grants from the National Natural Science Foundation of China(91959203,82272836 and 82373017)。
文摘Background:The high recurrent rate after surgery hinders the survival of patients with hepatocellular carcinoma(HCC).This prospective cohort study aimed to evaluate the efficacy and safety of lenvatinib plus transarterial chemoembolization(TACE)as an adjuvant therapy in HCC patients with high risk of recurrence.Methods:Patients were enrolled from eight hepatobiliary centers in China.The primary endpoint was disease-free survival(DFS).The secondary endpoints were overall survival(OS)and safety.Additionally,propensity score matching(PSM)and other three propensity score analyses were performed to balance the potential baseline bias to validate the conclusion.The adverse events(AEs)were recorded throughout the study.The study was registered at Clinical Trials.gov(NCT03838796).Results:A total of 297 patients were enrolled,with 147 in the LEN+TACE group and 150 in the TACE group.Before PSM,the LEN+TACE group achieved significantly better DFS than the TACE group(19.0 vs.10.0 months,P=0.011).PSM analysis identified 111 matched pairs.After PSM,the LEN+TACE group also showed better DFS(19.0 vs.9.0 months,P=0.018).Other three propensity score analyses yielded similar DFS benefit tendency.Furthermore,favorable OS was also obtained in the LEN+TACE group before PSM.Lenvatinib related AEs of grade 3 or 4 occurred in 28.6%of the patients in the LEN+TACE group.Conclusions:Adjuvant lenvatinib plus TACE might be a promising adjuvant approach for HCC patients with high risk of recurrence,which could significantly prolong DFS and potentially OS with a manageable safety profile.
文摘BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicated by diabetes is highly pre-valent in clinical settings.AIM To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.METHODS A retrospective analysis was conducted on the clinical data of 203 diabetic pa-tients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023.Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial suscept-ibility.Based on a one-year follow-up,patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data.Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.RESULTS Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS.A total of 134 pathogenic bacteria strains were isolated and identified,including 81 strains(60.4%)of gram-positive bacteria and 53 strains(39.6%)of gram-negative bacteria.Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin,while remaining highly sensitive to vancomycin,gentamicin,and rifampicin.Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin,but showed high sensitivity to imipenem,meropenem,cefepime,and ceftazidime.Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels,smoking history,Lund-Mackay scores,visual analog scale(VAS)scores,nasal septum deviation,allergic rhinitis,bronchial asthma,postoperative infection,long-term use of nasal decongestants,and adherence to medical prescriptions.Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.CONCLUSION In CRS patients with nasal polyps(CRSwNP),the detection rate of nasal pathogens is relatively high,and most of the isolated bacteria exhibit antimicrobial resistance.Additionally,the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.
基金Supported by the National Natural Science Foundation of China,No.82200621the Original Research Projects,Shanghai Ninth People’s Hospital,No.2022LHA08 and No.YBKB202220.
文摘BACKGROUND In the biologic era,postoperative recurrence(POR)of Crohn’s disease(CD)remains a significant concern.The underlying cause of this phenomenon remains unclear at present.AIM To examine whether intestinal fibrosis increases the likelihood of POR when antitumor necrosis factor biologics are used following ileocecal resection(ICR).METHODS We performed a single-centre,retrospective cohort study of patients with CD who underwent ICR.Recurrence was defined by endoscopy(Rutgeerts score≥i2),radiography(active inflammation in the neoterminal ileum)or surgery(another resection>3 months post-ICR),and patients were categorised by the presence of intestinal fibrosis on histopathological evaluation.RESULTS Among 102 patients with CD who underwent ICR and received infliximab within 3 months,69(67.6%)had intestinal fibrosis.In addition,60 patients(58.8%)experienced POR in various forms:52.6%,41.2%,and 10.8%had endoscopic,radiographic,and surgical recurrence,respectively.Patients with intestinal fibrosis experienced faster radiographic recurrence(log rank P=0.03).After adjusting for risk factors associated with POR,intestinal fibrosis increased the risk of early radiographic recurrence(adjusted hazard ratio=4;95%confidence interval:1.03-15.56;P=0.045).CONCLUSION Despite the limited sample size,our study revealed a strong correlation between radiographic POR and intestinal fibrosis in patients who received postoperative anti-tumor necrosis factorαprophylaxis.
文摘AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn’s disease (CD) in our center (1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy (median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy.RESULTS: From 205 patients who underwent surgery, 161 patients (follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype (B3) were postoperative risk factors. Previous perianal abscess/fistula (other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management (n = 49/161) prevented clinical (HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence (HR = 0.30, 95%CI: 0.13-0.70, P = 0.006).CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation.
文摘AIM To assess magnetic resonance imaging(MRI)and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers,all patients with CD who underwent ileocolonic resection were consecutively and prospectively included.All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity[median=6 mo(5.0-9.3)].The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level.Endoscopic postoperative recurrence(POR)was defined as Rutgeerts'index≥i2b.The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC)was lower in patients with endoscopic POR compared to those with no recurrence(2.03±0.32 vs 2.27±0.38×10^(-3)mm^2/s,P=0.032).Clermont score(10.4±5.8 vs 7.4±4.5,P=0.038)and relative contrast enhancement(RCE)(129.4%±62.8%vs 76.4%±32.6%,P=0.007)were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3±4.5 vs 4.8±3.7;P=0.15)and MR scoring system(P=0.056).ADC<2.35×10^(-3)mm^2/s[sensitivity=0.85,specificity=0.65,positive predictive value(PPV)=0.85,negative predictive value(NPV)=0.65]and RCE>100%(sensitivity=0.75,specificity=0.81,PPV=0.75,NPV=0.81)were the best cutoff values to identify endoscopic POR.Clermont score>6.4(sensitivity=0.61,specificity=0.82,PPV=0.73,NPV=0.74),Ma RIA>3.76(sensitivity=0.61,specificity=0.82,PPV=0.73,NPV=0.74)and a MR scoring system≥MR1(sensitivity=0.54,specificity=0.82,PPV=0.70,and NPV=0.70)demonstrated interesting performances to detect endoscopic POR.Faecal calprotectin values were significantly higher in patients with endoscopic POR(114±54.5μg/g vs 354.8±432.5μg/g;P=0.0075).Faecal calprotectin>100μg/g demonstrated high performances to detect endoscopic POR(sensitivity=0.67,specificity=0.93,PPV=0.89 and NPV=0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.
文摘AIM:To evaluate the effectiveness of adalimumab in preventing recurrence after intestinal resection for Crohn's disease in high-risk patients.METHODS:A multicenter,prospective,observational study was conducted from June 2009 until June 2010.We consecutively included high-risk Crohn's disease patients who had undergone an ileal/ileocolonic resection.High-risk patients were defined as two or more criteria:smokers,penetrating pattern,one or more previous surgical resections or prior extensive resection.Subcutaneous adalimumab was administered 2 wk(± 5 d) after surgery at a dose of 40 mg eow,with an initial induction dose of 160/80 mg at weeks 0 and 2.Demographic data,previous and concomitant treatments(antibiotics,5-aminosalicylates,corticosteroids,immunomodulators or biologic therapies),smoking status at the time of diagnosis and after the index operation and number of previous resections(type and reason for surgery) were all recorded.Biological status was assessed with C-reactive protein,erythrocyte sedimentation rate and fecal calprotectin.One year(± 3 mo) after surgery,an ileocolonoscopy and/or magnetic resonance enterography was performed.Endoscopic recurrence was defined as Rutgeerts score ≥ i2.Morphological recurrence was based on magnetic resonance(MR) score ≥ MR1.RESULTS:Twenty-nine patients(55.2% males,48.3% smokers at diagnosis and 13.8% after the index operation),mean age 42.3 years and mean duration of the disease 13.8 years were included in the study.A mean of 1.76(range:1-4) resections previous to adalimumab administration and in 37.9% was considered extensive resection.51.7% had previously received infliximab.Immunomodulators were given concomitantly to 17.2% of patients.Four of the 29(13.7%) developed clinical recurrence,6/29(20.7%) endoscopic recurrence and 7/19(36.8%) morphological recurrence after 1-year.All patients with clinical recurrence showed endoscopic and morphological recurrence.A high degree of concordance was found between clinical-endoscopic recurrence(k = 0.76,P < 0.001) and clinical-morphological recurrence(k = 0.63,P = 0.003).Correlation between endoscopic and radiological findings was good(comparing the 5-point Rutgeerts score with the 4-point MR score,a score of i4 was classified as MR3,i3 as MR2,and i2-i1 as MR1)(P < 0.001,r s = 0.825).During follow-up,five(17.2%) patients needed adalimumab dose intensification(40 mg/wk);Mean time to intensification after the introduction of adalimumab treatment was 8 mo(range:5 to 11 mo).In three cases(10.3%),a biological change was needed due to a worsening of the disease after the dose intensification to 40 mg/wk.One patient suffered an adverse event.CONCLUSION:Adalimumab seems to be effective and safe in preventing postoperative recurrence in a selected group of patients who had undergone an intestinal resection for their CD.
基金Supported by The Zhenjiang City Key Research and Development Plan Social Development,China,No.SH2023047.
文摘BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula.AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures.METHODS In this retrospective study,525 patients with anorectal abscesses treated by incision and drainage alone,at a tertiary general hospital from August 2012 to July 2022,were included.A new classification for anorectal abscesses based on their propensity to develop into fistulas,considering 18 other potential risk factors,was established.These factors,from electronic medical records,were screened for significance using theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses.RESULTSOne year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,respectively.Univariateχ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(P<0.05).Fistula-prone abscess,≥7 days between symptomonset and surgery,chronic diarrhea,preoperative antibiotic use,and local anesthesia were risk factors for recurrence,while diabetes mellitus was protective(P<0.05).Moreover,fistula-prone abscess[odds ratio(OR)=7.651,95%CI:4.049–14.458,P<0.001],≥7 days from symptom onset to surgery(OR=2.137,95%CI:1.090–4.190,P=0.027),chronic diarrhea(OR=2.508,95%CI:1.216–5.173,P=0.013),and local anesthesia(OR=2.308,95%CI:1.313–4.059,P=0.004)were independent risk factors for postoperative anorectal abscess recurrence using multivariatelogistic regression.Body mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone abscess.CONCLUSIONThe choice of surgical procedure for treating anorectal abscesses should follow this new classification.Prompt andthorough incision and drainage can significantly reduce postoperative recurrence.
基金Supported by the Key Project of Teaching Reform Research of Taishan Vocational College of Nursing(202307).
文摘As important drugs for the treatment of nodular goiter(NG),Prunella Spica preparations are widely used clinically,and have a significant effect on NG.Various active ingredients in the preparations intervene in the formation of NG by inhibiting the proliferation of thyroid follicular cells,promoting cell apoptosis,regulating immunity,improving the microcirculation of thyroid tissue and other mechanisms,and can reduce the postoperative recurrence of NG.
文摘Objective: To investigate the effect of docetaxel and cisplatin combined with intensity-modulated radiotherapy in thetreatment of postoperative recurrence of esophageal cancer and the content of tumor markers in serum. Methods: According tosimple randomization method, 60 patients with postoperative recurrence of esophageal cancer admitted from February 2018 toSeptember 2019 were divided into control group (n = 30 cases) and observation group (n = 30 cases). All patients received IMRT.Fluorouracil + cisplatin was used in the control group and docetaxel + cisplatin was used in the observation group. After 2 coursesof continuous treatment, the therapeutic effect, serum tumor marker content and adverse reactions were compared between thetwo groups. Results: After treatment, the effective rate of observation group was higher than control group, and the difference wasstatistically significant (P < 0.05).The contents of carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) andcarbohydrate antigen 19-9 (CA19-9) in observation group were lower than those in control group, and the difference was statisticallysignificant (P < 0.05). The incidence of adverse reactions in the observation group was lower than that in the control group, and thedifference was statistically significant (P < 0.05). Conclusion: Docetaxel and cisplatin combined with intensemodulated radiotherapyfor postoperative recurrence of esophageal cancer can improve the therapeutic effect, inhibit the malignant degree of tumor, andreduce the incidence of adverse reactions.
基金the National Natural Science Foundation of Hebei(No.H2018201179)Hebei University of Science and Technology(No.QN2016077)Health and Family Planning Commission of Hebei(No.20160388).
文摘Backgroud:Summarize the formula rule of traditional Chinese medicine fOr preventing and treating bladder cancer recurrence after operation and explore the molecular mechanism of core medicines.Methods:Literatures collected from CNKI,Wanfang Med Online,CMJD,PUBMED and Elsiver databases were as prescription sources,and association rules and complex system entropy clustering analysis were carried out using the Traditional Chinese Medicine Inheritance Support System(TCMISSV2.5).BATMAN-TCM online analysis tool was used to construct target-pathway-disease correlation map to reveal the potential mechanism of action.Results:A total of 122 prescriptions were eligible for data analysis.The high-frequency traditional Chinese medicines are Poria,Radix et Rhizoma Rhei,Radix Astragali,Herba Hedyotidis Diffusae and Rhizoma Atractylodis Macrocephalae.The high-frequency drug pairs are Rhizoma Atractylodis MacrocephalaeIPoria,Poria/Rhizoma Alismatis,Radix Astragali/Rhizoma Atractylodis Macrocephalaeand and Herba Hedyotidis Diffusae/Herba Scutellariae Darbatae..There are 5 groups of drug pairs with high correlation strength.Cluster analysis shows 6 core drug combinations and 3 new prescriptions.In clinical practice,the core compatibility of traditional Chinese medicines for preventing postoperative recurrence of bladder cancer is Poria,Radix Astragali and Herba Hedyotidis Diffusae.The possible signaling pathways are the neuroactive ligand receptor interaction signaling pathway and calcium signaling pathway.Conclusion:Prevention and treatment of postoperative recurrence of bladder cancer mainly use medicines with effects of eliminating dampness and diuresis for removing edema,heat-clearing and detoxifying,and qi-invigorating.The potential mechanism of the compatibility of core drugs may be realized by interfering with the signal pathway of neuroactive ligand receptor interaction and calcium signal pathway.
文摘Objective To establish a lung cancer dormancy mouse model and verify the effects of Wushen(WS),a formula food,on postoperative recurrence.Methods We established a Lewis cell tumor dormancy model system that definitively links surgery and the subsequent wound-healing response to the outgrowth of lung cancer cells.We used this model to observe the effects of WS on the postoperative recurrence and the nutritional status of the mice.Finally,the immunocyte subtypes and cytokine levels in the serum and spleens of mice were detected by flow cytometry and ELISA.Results The recurrence rate in the WS group was obviously lower than that in the control group.Wushen increased the body weights and serum albumin levels of the mice.The levels of NK,Gr1+CD11b+CD3+CD8+and CD3+CD4+T cells in the spleens of mice in the WS group were also increased.Compared with the control group,the levels of CD4+IFN-γ+,CD4+IL-2 and CD4+/IL-10+in the spleens of mice in the WS group were decreased.Wushen also seemed to decrease the levels of IL-6 and TNF-α,but the decrease was not significant.Conclusion The postoperative lung cancer recurrence model was successfully established.Wushen inhibited postoperative recurrence,apparently by regulating the level of immune cell subtypes and cytokines in the serum and spleen.
文摘Objective: to analyze the prevention and clinical effect of hysteroscopic endometrial polypectomy (TCRP) in the treatment of postoperative recurrence of endometrial polyp (EP). Methods: a total of 112 EP patients were selected from Our hospital from August 2020 to August 2021, and were randomly divided into 2 groups with 56 patients in each group according to the number table. Patients in the control group were given TCRP operation treatment, and patients in the observation group were given levonorgestrel intrauterine sustained release system (LNG?IUS) on this basis. Postoperative observation time, endocrine hormone test results before and after treatment and recurrence rate of EP were compared between the two groups. Results: the observation group was shorter than the control group, and the endocrine hormone test results were better than the control group after treatment, P < 0.05. The recurrence rate of EP in observation group was lower than that in control group, P < 0.05. Conclusion: TCRP combined with LNG?IUS has a definite therapeutic effect on EP, can improve the endocrine status of patients and reduce the recurrence rate of EP after operation, which is worthy of promotion and application.
文摘Objective: analyze the related influencing factors of postoperative recurrence of varicose veins of lower extremities. Methods: 30 patients with postoperative recurrence of varicose veins of lower extremities in our hospital from January 2018 to December 2019 were selected as the experimental group. And 30 patients without recurrence of varicose veins after operation in our hospital at the same time were selected as the control group;the clinical data of the two groups were retrospectively analyzed, and the related influencing factors of postoperative recurrence were analyzed and discussed. Results: the independent influencing factors of postoperative recurrence of varicose veins of lower limbs included skin vein ulcer near ankle joint, high ligation of great saphenous vein, disobeying doctor's advice, unreasonable diet, less than 30 minutes of exercise per day, age ≥ 60 years old (P < 0.05). Conclusion: the factors influencing the postoperative recurrence of varicose veins of lower extremities are complex and diverse. It is necessary to formulate targeted measures in combination with relevant influencing factors in order to effectively prevent postoperative recurrence of varicose veins of lower limbs.
文摘To investigate the effects of intravesical therapy with elemene in preventing postoperative recurrence of superficial bladder cancer and its toxic and side effects.Methods This series included 123 patients with superficial bladder cancer (T1),consisting of transitional cell carcinoma GⅠ in 37 cases,GⅡ in 73 and GⅢ in 13.They all underwent surgical treatment.Postoperatively,they were randomly assigned to 2 groups;63 patients in elemene group received instillation of elemene (400 mg,once a week) 2 weeks after operation and 60 patients in mitomycin C (MMC) group received instillation of MMC (40 mg,once a week) 2 weeks after operation.The instillations were repeated for 6 weeks and thereafter monthly for 1 year.The recurrence rates,side effects,and NK cell activity before and after treatment were evaluated.Results The recurrence rate of elemene group (mean follow-up of 19.7 months) was 7.9% (5 cases),which was significantly lower than that (25.0%,15 cases) of MMC group (mean follow-up of 19.4 months;P<0.05).The side effect in elemene group (3.2%,2 cases) was significantly milder than that in MMC group (25.0%,15 cases)(P<0.05).In elemene group,the NK cell activity after treatment (28±2)% was significantly higher than that before treatment(20±2)%(P<0.05).Conclusion Instillation of elemene after operation is effective and safe in preventing postoperative recurrence of bladder cancer.8 refs.
文摘BACKGROUND The computed tomography(CT)-based preoperative risk score was developed to predict recurrence after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma(PDAC)in South Korea.However,whether it performs well in other countries remains unknown.AIM To externally validate the CT-based preoperative risk score for PDAC in a country outside South Korea.METHODS Consecutive patients with PDAC who underwent upfront surgery from January 2016 to December 2019 at our institute in a country outside South Korea were retrospectively included.The study utilized the CT-based risk scoring system,which incorporates tumor size,portal venous phase density,tumor necrosis,peripancreatic infiltration,and suspicious metastatic lymph nodes.Patients were categorized into prognosis groups based on their risk score,as good(risk score<2),moderate(risk score 2-4),and poor(risk score≥5).RESULTS A total of 283 patients were evaluated,comprising 170 males and 113 females,with an average age of 63.52±8.71 years.Follow-up was conducted until May 2023,and 76%of patients experienced tumor recurrence with median recurrence-free survival(RFS)of 29.1±1.9 months.According to the evaluation results of Reader 1,the recurrence rates were 39.0%in the good prognosis group,82.1%in the moderate group,and 84.5%in the poor group.In comparison,Reader 2 reported recurrence rates of 50.0%,79.5%,and 88.9%,respectively,across the same prognostic categories.The study validated the effectiveness of the risk scoring system,demonstrating better RFS in the good prognosis group.CONCLUSION This research validated that the CT-based preoperative risk scoring system can effectively predict RFS in patients with PDAC,suggesting that it may be valuable in diverse populations.
基金supported by the National Natural Science Foundation of China(No.81971858,No.92148201)Tianjin Health Research Project(TJWJ2023XK014).
文摘The peritoneum is a frequently involved site of metastasis in gastrointestinal malignancies,posing a major risk to human health.In recent years,treatment methods such as cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)have significantly prolonged the survival time of patients with gastrointestinal peritoneal metastases.With the continuous advancements in comprehensive treatment for peritoneal cancer,targeted therapy and immunotherapy are gradually being applied to patients with gastrointestinal peritoneal metastases.Gastrointestinal peritoneal metastases are now widely acknowledged as a regional abdominal disease.Consequently,preventing both localized abdominal and systemic recurrences has become a central focus in their diagnosis and management.This article systematically reviews the recurrence patterns of gastrointestinal peritoneal metastatic tumors following surgery,with an emphasis on intraperitoneal,single-site,and multi-site recurrence patterns.It also discusses factors influencing the time to recurrence,such as the degree of cytoreduction and the type of chemotherapy used.The importance of assessment tools for recurrence,such as tumor marker detection,imaging,and laparoscopy,is emphasized.Additionally,strategies for preventing recurrence are outlined,including tumor-free principles,adjuvant chemotherapy,HIPEC,and integrated traditional Chinese and Western medicine.The article highlights new advances in targeted therapy and immunotherapy,aiming to provide guidance for clinical practice and future research.
文摘Crohn's disease is a chronic inflammatory condition that may involve any segment of the gastrointestinal tract. Although several drugs have proven efficacy in inducing and maintaining disease in remission, resectional surgery remains as a cornerstone in the management of the disease, mainly for the treatment of its stenosing and penetrating complications. However, the occurrence of new mucosal (endoscopic) lesions in the neoterminal ileum early after surgery is almost constant, it is followed in the mid-term by clinical symptoms and, in a proportion of patients, repeated intestinal resections are required. Pathogenesis of postoperative recurrence (POR) is not fully understood, but luminal factors (commensal microbes, dietary antigens) seem to play an important role, and environmental and genetic factors may also have a relevant influence. Many studies tried to identify clinical predictors for POR with heterogeneous results, and only smoking has repeatedly been associated with a higher risk of POR. Ileocolonoscopy remains as the gold standard for the assessment of appearance and severity of POR, although the real usefulness of the available endoscopic score needs to be revisited and alternative techniques are emerging. Several drugs have been evaluated to prevent POR with limited success. Smoking cessation seems to be one of the more beneficial therapeutic measures. Aminosalicylates have only proved to be of marginal benefit, and they are only used in low-risk patients. Nitroimidazolic antibiotics, although efficient, are associated with a high rate of intolerance and might induce irreversible side effects when used for a long-term. Thiopurines are not widely used after ileocecal resection, maybe because some concerns in giving immunomodulators in asymptomatic patients still remain. In the era of biological agents and genetic testing, a well-established preventive strategy for POR is still lacking, and larger studies to identify good clinical, serological, and genetic predictors of early POR as well as more effective drugs (or drug combinations) are needed.
文摘BACKGROUND Postoperative recurrence is common in Crohn’s disease(CD),with endoscopic lesions in a majority of patients by 12 months after surgery.Ileocolonoscopy is the reference standard but is invasive and poorly suited to frequent surveillance.Intestinal ultrasound(IUS)-including small intestine contrast ultrasound and contrast enhanced ultrasound-is a repeatable,noninvasive alternative.AIM To summarize the evidence on the diagnostic accuracy and prognostic value of IUS for detecting postoperative recurrence in CD.METHODS We systematically searched PubMed and EMBASE through June 2025 for original English-language studies evaluating IUS against clinical or endoscopic outcomes in postoperative CD.This scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline.After screening 259 unique records,41 full texts were assessed and 20 studies were included.RESULTS Bowel wall thickness thresholds of≥5 mm at the neo-terminal ileum predict endoscopic recurrence with sensitivities 81%-94%and specificities 86%-100%;lower cutoffs at the anastomosis(≥3-3.5 mm)also carry risk(data from singlecenter cohorts).Dualsite assessment(neo-terminal ileum+ileocolonic anastomosis)improves performance.Adding Doppler hyperemia or mesenteric lymphadenopathy increases accuracy;combining bowel wall thickness≥3 mm with fecal calprotectin≥50μg/g yields high specificity(approximately 93%-100%)with a negative predictive value of nearly 95%when both are negative.Contrast enhanced ultrasound-based composite scores reach approximately 98%diagnostic accuracy in prospective cohorts.Small intestine contrast ultrasound shows similarly strong early diagnostic performance-for example,an area under the receiver operating characteristic curve up to 0.95 when using ileocolonic anastomosis wall thickness≥3 mm to 3.5 mm plus lesion length,with 82%-94%sensitivity and>90%specificity reported even within 7 days postresection.Overall,IUS shows moderate agreement with endoscopy(κapproximately 0.5-0.8)and stronger prognostic value when performed within 12 months post-surgery.CONCLUSION IUS can be integrated into postoperative surveillance algorithms-particularly within the first year-and can reduce routine endoscopy in selected patients.Research priorities include standardized thresholds and composite scoring,consensus training/competency,and multicenter validation including artificial intelligenceassisted interpretation.
文摘AIM To evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.METHODS Data from all patients who underwent Crohn's disease(CD)-related resection at the University of Szeged, Hungary between 2004 and 2014 were analyzed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after surgery, resection margins, neural fiber hyperplasia, submucosal and myenteric plexitis were evaluated as possible predictors of postoperative recurrence. Histological samples were analyzed blinded to the postoperative outcome and the clinical history of the patient. Plexitis was evaluated based on the appearance of the most severely inflamed ganglion or nerve bundle. Patients underwent regular follow-up with colonoscopy after surgery. Postoperativerecurrence was defined on the basis of endoscopic and clinical findings, and/or the need for additional surgical resection. RESULTS One hundred and four patients were enrolled in the study. Ileocecal, colonic, and small bowel resection were performed in 73.1%, 22.1% and 4.8% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Twenty-six patients underwent previous CD-related surgery. Forty-three point two percent of the patients were on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-tumor necrosis factor-alpha postoperative treatment. Postoperative recurrence occurred in 61.5% of the patients; of them 39.1% had surgical recurrence. 92.2% of the recurrences developed within the first five years after the index surgery. Mean disease duration for endoscopic relapse was 2.19 years. The severity of submucosal plexitis was a predictor of the need for second surgery(OR = 1.267, 95%CI: 1.000-1.606, P = 0.050). Female gender(OR = 2.21, 95%CI: 0.98-5.00, P = 0.056), stricturing disease behavior(OR = 3.584, 95%CI: 1.344-9.559, P = 0.011), and isolated ileal localization(OR = 2.671, 95%CI: 1.033-6.910, P = 0.043) were also predictors of postoperative recurrence. No association was revealed between postoperative recurrence and smoking status, postoperative prophylactic treatment and the presence of myenteric plexitis and relapse.CONCLUSION The presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.
基金Supported by NIH grant,No.K23DK084338(to Moss AC)NIH training grant,No.5T32DK007760-14(to Vaughn BP)
文摘Endoscopic and clinical recurrence of Crohn’s disease (CD) is a common occurrence after surgical resection. Smokers, those with perforating disease, and those with myenteric plexitis are all at higher risk of recurrence. A number of medical therapies have been shown to reduce this risk in clinical trials. Metronidazole, thiopurines and anti-tumour necrosis factors (TNFs) are all effective in reducing the risk of endoscopic or clinical recurrence of CD. Since these are preventative agents, the benefits of prophylaxis need to be weighed-against the risk of adverse events from, and costs of, therapy. Patients who are high risk for post-operative recurrence should be considered for early medical prophylaxis with an anti-TNF. Patients who have few to no risk factors are likely best served by a three-month course of antibiotics followed by tailored therapy based on endoscopy at one year. Clinical recurrence rates are variable, and methods to stratify patients into high and low risk populations combined with prophylaxis tailored to endoscopic recurrence would be an effective strategy in treating these patients.
