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: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 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
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
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
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
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 Crohn's disease(CD)is a chronic inflammatory disease of the gastrointestinal tract,often requiring intestinal resection as a common treatment.However,recurrence after surgery is common.The anastomotic c...BACKGROUND Crohn's disease(CD)is a chronic inflammatory disease of the gastrointestinal tract,often requiring intestinal resection as a common treatment.However,recurrence after surgery is common.The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD.Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate.However,the results remain controversial.Therefore,evidence-based evidence is needed to prove the advantages of Kono-S anastomosis.AIM To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis.METHODS PubMed,Scopus,and Cochrane Library were searched until October 8,2023.Patients who underwent intestinal resection due to CD were included.The intervention measures included Kono-S anastomosis,whereas the control group received traditional anastomosis such as end-to-end,end-to-side,and side-to-side anastomosis.Only randomized clinical trials and observational studies were included.The primary outcome measures were hospital stay post-surgery,overall postoperative complication incidence,the proportion of Clavien-Dindo grade IIIa or higher,overall postoperative recurrence rate,and Rutgeerts score.RESULTS From 2011 to 2023,six articles met the inclusion and exclusion criteria.The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD[MD=-0.26,95%CI:-0.42 to-0.10,P=0.002]than other traditional anastomosis methods.Compared to other traditional anastomosis methods,Kono-S anastomosis can significantly reduce the total recurrence rate[MD=0.40,95%CI:0.17 to 0.98,P=0.05]and postoperative Rutgeerts score[MD=-0.81,95%CI:-0.96 to-0.66,P<0.001]in patients with CD.However,there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo≥IIIa.CONCLUSION Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards;however,additional larger trials are necessary to authenticate its effectiveness.展开更多
This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based r...This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based risk scoring system origi-nally developed in South Korea.The scoring system incorporated five parame-ters:(1)Tumor size;(2)Portal venous phase density;(3)Necrosis;(4)Peripan-creatic infiltration;and(5)Suspected metastatic lymph nodes.While demonstra-ting satisfactory recurrence prediction capability without requiring complex tech-nologies,thereby supporting clinical utility in Chinese populations,the study exhibited notable limitations.Most analyzed patients lacked neoadjuvant chemo-therapy exposure,resulting in underrepresentation of low-risk subgroups.Addi-tionally,the short follow-up duration potentially compromised long-term progno-stic assessment.Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management.However,clinical implementation continues to confront challenges including variability in imaging parameters,incomplete understanding of molecular underpinnings,and confounding treatment effects.Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic,molecular,and clinical data.Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation,ultimately advancing personalized therapeutic strategies for PDAC.展开更多
Accurate determination of lung cancer margins at the molecular level is of great significance to determine the optimal extent of resection during surgical operation and reduce the risk of postoperative recurrence.In t...Accurate determination of lung cancer margins at the molecular level is of great significance to determine the optimal extent of resection during surgical operation and reduce the risk of postoperative recurrence.In this study,internal extractive electrospray ionization mass spectrometry(i EESI-MS)was used to trace potential molecular tumor margins in lung cancer tissue.Molecular differential model for the determination of lung cancer tumor margin was established via partial least-squares discriminant analysis(PLS-DA)of iEESI-MS data collected from lung tissue pieces within cancer tumor area and iEESI-MS data collected from lung tissue pieces outside cancer tumor area.Proof-of-concept data demonstrate that the developed molecular differential model yields ca.1-2 mm wider potential molecular tumor margin of a lung cancer compared to the conventional histological analysis,showing promising potential of iEESI-MS to increase the accuracy of tumor margins determination and lower risk of lung cancer postoperative recurrence.Furthermore,our results revealed that creatine and taurine showed positive correlations with lung cancer.展开更多
BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonu...BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonuclease 1 autoantibodies(APE1-AAbs),peripheral pentraxin-3(PTX-3),and miR-486-3p in patients with CRC undergoing radical surgery and their relationship with postoperative recurrence and metastasis.METHODS A retrospective analysis was conducted on the clinical data of 154 CRC patients who underwent laparoscopic radical surgery in our hospital from January 2022 to January 2024.Patients were followed for one year postoperatively and divided into an occurrence group(n=28)and a non-occurrence group(n=126)based on whether they experienced recurrence or metastasis.The clinical data and the expression levels of APE1-AAbs,PTX-3,and miR-486-3p were compared between the two groups.Multivariate logistic regression analysis was performed to identify risk factors for postoperative recurrence and metastasis in CRC patients.The relationship of APE1-AAbs,PTX-3,and miR-486-3p with postoperative recurrence and metastasis was analyzed using Spearman correlation analysis.Receiver operating characteristic curves were drawn to evaluate the predictive value of serum APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination for postoperative recurrence and metastasis in CRC.RESULTS The occurrence group had significantly higher proportions of patients with an age≥60 years,lymph node metastasis,stage III disease,poor differentiation,tumor diameter>5 cm,and higher platelet count,carcinoembryonic antigen,and carbohydrate antigen 19-9 levels than the non-occurrence group(P<0.05).The expression levels of APE1-AAbs,PTX-3,and miR-486-3p in the occurrence group were significantly higher than those in the non-occurrence group(P<0.05).Multivariate logistic regression analysis showed that lymph node metastasis,stage III disease,poor differentiation,and elevated levels of APE1-AAbs,PTX-3,and miR-486-3p were risk factors for postoperative recurrence and metastasis in CRC patients(odds ratio>1,P<0.05).Spearman correlation analysis revealed that the levels of APE1-AAbs,PTX-3,and miR-486-3p were positively correlated with postoperative recurrence and metastasis in CRC patients(r=0.642,0.653,and 0.631,respectively,P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve values for APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination in predicting postoperative recurrence and metastasis in CRC were 0.764,0.783,0.806,and 0.875,respectively,with the combination significantly outperforming individual markers(P<0.05).CONCLUSION Serum APE1-AAbs,PTX-3,and miR-486-3p levels are higher in CRC patients with postoperative recurrence and metastasis.These three markers are risk factors for postoperative recurrence and metastasis in CRC and can be used as predictive biomarkers.The combined detection of these markers has higher predictive value compared to individual tests.展开更多
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 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.
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.
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.
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 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.
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 Crohn's disease(CD)is a chronic inflammatory disease of the gastrointestinal tract,often requiring intestinal resection as a common treatment.However,recurrence after surgery is common.The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD.Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate.However,the results remain controversial.Therefore,evidence-based evidence is needed to prove the advantages of Kono-S anastomosis.AIM To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis.METHODS PubMed,Scopus,and Cochrane Library were searched until October 8,2023.Patients who underwent intestinal resection due to CD were included.The intervention measures included Kono-S anastomosis,whereas the control group received traditional anastomosis such as end-to-end,end-to-side,and side-to-side anastomosis.Only randomized clinical trials and observational studies were included.The primary outcome measures were hospital stay post-surgery,overall postoperative complication incidence,the proportion of Clavien-Dindo grade IIIa or higher,overall postoperative recurrence rate,and Rutgeerts score.RESULTS From 2011 to 2023,six articles met the inclusion and exclusion criteria.The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD[MD=-0.26,95%CI:-0.42 to-0.10,P=0.002]than other traditional anastomosis methods.Compared to other traditional anastomosis methods,Kono-S anastomosis can significantly reduce the total recurrence rate[MD=0.40,95%CI:0.17 to 0.98,P=0.05]and postoperative Rutgeerts score[MD=-0.81,95%CI:-0.96 to-0.66,P<0.001]in patients with CD.However,there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo≥IIIa.CONCLUSION Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards;however,additional larger trials are necessary to authenticate its effectiveness.
文摘This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based risk scoring system origi-nally developed in South Korea.The scoring system incorporated five parame-ters:(1)Tumor size;(2)Portal venous phase density;(3)Necrosis;(4)Peripan-creatic infiltration;and(5)Suspected metastatic lymph nodes.While demonstra-ting satisfactory recurrence prediction capability without requiring complex tech-nologies,thereby supporting clinical utility in Chinese populations,the study exhibited notable limitations.Most analyzed patients lacked neoadjuvant chemo-therapy exposure,resulting in underrepresentation of low-risk subgroups.Addi-tionally,the short follow-up duration potentially compromised long-term progno-stic assessment.Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management.However,clinical implementation continues to confront challenges including variability in imaging parameters,incomplete understanding of molecular underpinnings,and confounding treatment effects.Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic,molecular,and clinical data.Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation,ultimately advancing personalized therapeutic strategies for PDAC.
基金supported by Jiangxi Provincial International Science and Technology Cooperation Project(Nos.20203BDH80W010 and 20232BBH80012)the National Natural Science Foundation of China(Nos.82160410 and 81860379)+1 种基金Foundation of Jiangxi Provincial Department of Science and Technology(No.20212ACB206018)Key Research and Development Program of Jiangxi Province(No.20223BBG71009)。
文摘Accurate determination of lung cancer margins at the molecular level is of great significance to determine the optimal extent of resection during surgical operation and reduce the risk of postoperative recurrence.In this study,internal extractive electrospray ionization mass spectrometry(i EESI-MS)was used to trace potential molecular tumor margins in lung cancer tissue.Molecular differential model for the determination of lung cancer tumor margin was established via partial least-squares discriminant analysis(PLS-DA)of iEESI-MS data collected from lung tissue pieces within cancer tumor area and iEESI-MS data collected from lung tissue pieces outside cancer tumor area.Proof-of-concept data demonstrate that the developed molecular differential model yields ca.1-2 mm wider potential molecular tumor margin of a lung cancer compared to the conventional histological analysis,showing promising potential of iEESI-MS to increase the accuracy of tumor margins determination and lower risk of lung cancer postoperative recurrence.Furthermore,our results revealed that creatine and taurine showed positive correlations with lung cancer.
文摘BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonuclease 1 autoantibodies(APE1-AAbs),peripheral pentraxin-3(PTX-3),and miR-486-3p in patients with CRC undergoing radical surgery and their relationship with postoperative recurrence and metastasis.METHODS A retrospective analysis was conducted on the clinical data of 154 CRC patients who underwent laparoscopic radical surgery in our hospital from January 2022 to January 2024.Patients were followed for one year postoperatively and divided into an occurrence group(n=28)and a non-occurrence group(n=126)based on whether they experienced recurrence or metastasis.The clinical data and the expression levels of APE1-AAbs,PTX-3,and miR-486-3p were compared between the two groups.Multivariate logistic regression analysis was performed to identify risk factors for postoperative recurrence and metastasis in CRC patients.The relationship of APE1-AAbs,PTX-3,and miR-486-3p with postoperative recurrence and metastasis was analyzed using Spearman correlation analysis.Receiver operating characteristic curves were drawn to evaluate the predictive value of serum APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination for postoperative recurrence and metastasis in CRC.RESULTS The occurrence group had significantly higher proportions of patients with an age≥60 years,lymph node metastasis,stage III disease,poor differentiation,tumor diameter>5 cm,and higher platelet count,carcinoembryonic antigen,and carbohydrate antigen 19-9 levels than the non-occurrence group(P<0.05).The expression levels of APE1-AAbs,PTX-3,and miR-486-3p in the occurrence group were significantly higher than those in the non-occurrence group(P<0.05).Multivariate logistic regression analysis showed that lymph node metastasis,stage III disease,poor differentiation,and elevated levels of APE1-AAbs,PTX-3,and miR-486-3p were risk factors for postoperative recurrence and metastasis in CRC patients(odds ratio>1,P<0.05).Spearman correlation analysis revealed that the levels of APE1-AAbs,PTX-3,and miR-486-3p were positively correlated with postoperative recurrence and metastasis in CRC patients(r=0.642,0.653,and 0.631,respectively,P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve values for APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination in predicting postoperative recurrence and metastasis in CRC were 0.764,0.783,0.806,and 0.875,respectively,with the combination significantly outperforming individual markers(P<0.05).CONCLUSION Serum APE1-AAbs,PTX-3,and miR-486-3p levels are higher in CRC patients with postoperative recurrence and metastasis.These three markers are risk factors for postoperative recurrence and metastasis in CRC and can be used as predictive biomarkers.The combined detection of these markers has higher predictive value compared to individual tests.
