We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for d...We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for differentiating ER from late recurrence,with implications for postrecurrence survival and overall survival.This offers not only a valuable timeframe for enhancing surveillance strategies in patients at higher risk,especially those who have undergone neoadjuvant chemoradiotherapy(CRT),but also raises questions about its applicability across different populations.Furthermore,the article suggests that while CRT is very effective in reducing locoregional recurrence,this treatment alone may not fully address the overall risk of ER.The authors advocate for personalized risk assessment and intensive surveillance during the postoperative period to improve outcomes,particularly in the first year.Future research should focus on larger,multicenter studies and incorporate advanced diagnostic techniques with genetic and molecular biomarkers to enhance prediction and management of ER.The ultimate goal is to refine treatment and surveillance strategies to improve survival and quality of life for patients with RC.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases pos...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC.The rate of HCC recurrence is generally reported as 8%-20%in the literature.Many predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian data.AIM To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.METHODS We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021.Data was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of recurrence.Overall survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier analysis.Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.RESULTS Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years.The median time to recurrence was 2.9 years±0.75 years.When comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT survival.Further studies are required to confirm predictors of recurrence and improve recipient outcomes.展开更多
BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the cor...BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.展开更多
In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients c...In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients compared to relying solely on preoperative markers,which has significant implications for customizing adjuvant therapy and potentially improving outcomes for this aggressive form of cancer.However,the study’s single-center design and short follow-up period may limit the generalizability of its findings and potentially introduce reporting bias.Future studies could consider additional confounding factors,such as adjuvant chemotherapy and variations in surgical techniques,to improve the model’s accuracy.Furthermore,it would be valuable to validate the nomogram in broader,prospective cohorts and explore the inclusion of additional markers like circulating tumor DNA to refine further its predictive power and applicability across diverse patient populations.展开更多
BACKGROUND Ischemic stroke(IS)survivors face an elevated risk of epileptic seizures,and recurrent seizures following the first episode often signal worsening functional outcomes.AIM To investigate risk factors associa...BACKGROUND Ischemic stroke(IS)survivors face an elevated risk of epileptic seizures,and recurrent seizures following the first episode often signal worsening functional outcomes.AIM To investigate risk factors associated with seizure recurrence after a first episode in patients with IS and explore their associations with cognitive function,anxiety,and depression.METHODS A total of 100 patients with IS admitted to Shaanxi Provincial People’s Hospital between January 2017 and January 2024 were enrolled in this study.After a 1-5-year follow-up,patients were categorized into recurrence(n=43)and nonrecurrence(n=57)groups.Their medical records were collected and analyzed using univariate and multivariate analyses to determine potential predictors of seizure recurrence.Variables with statistical significance in the univariate analysis were incorporated into a binary logistic regression model for multivariate analysis.The risk model’s predictive performance was evaluated using the receiver operating characteristic curve.How independent risk factors,identified in multivariate analysis,related to cognitive[Montreal Cognitive Assessment(MoCA)]and emotional[Self-Rating Anxiety Scale(SAS)/Self-Rating Depression Scale(SDS)]outcomes,were assessed.RESULTS Recurrent seizures were significantly associated with age,stroke severity(National Institutes of Health Stroke Scale),late-onset seizures,electroenceph-alogram abnormalities,cortical involvement,hemorrhagic infarction,and extensive cerebral infarctions,with lateonset seizures,cortical involvement,and hemorrhagic infarction serving as independent predictors.The risk model revealed an area under the curve of 0.732,with 88.37%specificity and 42.11%sensitivity.These three were also correlated with lower MoCA scores and higher SAS and SDS scores.CONCLUSION In patients with IS,recurrent seizures after the first episode can be independently predicted by late-onset seizures,cortical involvement,and hemorrhagic cerebral infarction-factors also correlating with cognitive impairment and emotional distress.These findings underscore the need for close clinical monitoring and targeted interventions(e.g.,cognitive rehabilitation and psychological support)to mitigate seizure recurrence in high-risk individuals.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making pr...BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making precise treatment plans and improving patient prognosis.AIM To establish an intratumoral and peritumoral model for predicting ER in HCC patients following curative ablation.METHODS This study included a total of 288 patients from three Centers.The patients were divided into a primary cohort(n=222)and an external cohort(n=66).Radiomics and deep learning methods were combined for feature extraction,and models were constructed following a three-step feature selection process.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),while calibration curves and decision curve analysis(DCA)were used to assess calibration and clinical utility.Finally,Kaplan-Meier(K-M)analysis was used to stratify patients according to progression-free survival(PFS)and overall survival(OS).RESULTS The combined model,which utilizes the light gradient boosting machine learning algorithm and incorporates both intratumoral and peritumoral regions(5 mm and 10 mm),demonstrated the best predictive performance for ER following HCC ablation,achieving AUCs of 0.924 in the training set,0.899 in the internal validation set,and 0.839 in the external validation set.Calibration and DCA curves confirmed strong calibration and clinical utility,whereas K-M curves provided risk stratification for PFS and OS in HCC patients.CONCLUSION The most efficient model integrated the tumor region with the peritumoral 5 mm and 10 mm regions.This model provides a noninvasive,effective,and reliable method for predicting ER after curative ablation of HCC.展开更多
BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influen...BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influence of PrPC expression in cholangiocarcinoma(CCA)on patient outcomes following surgical resection.METHODS Patients who underwent curative surgical resection for either intrahepatic or hilar CCA were enrolled in this retrospective study.Based on the immunohistochemical staining results of the surgical specimens,patients were categorized into two groups:The low PrPC group(negative or 1+)and the high PrPC group(2+or 3+).Survival analyses,including overall survival and recurrence-free survival,were conducted using the Kaplan-Meier method and compared using the log-rank test.RESULTS In total,seventy-six patients diagnosed with CCA(39 with intrahepatic and 37 with hilar CCA)underwent curative hepatectomy from January 2011 to November 2021.Among these patients,38(50%)demonstrated high PrPC expression,whereas the remaining 38(50%)showed low expression of PrPC.During a median follow-up period of 31.2 months(range:1 to 137 months),the high PrPC group had a significantly shorter median overall survival than the low PrPC group(40.4 months vs 137.9 months,respectively;P=0.041).Moreover,the high PrPC group had a significantly shorter median recurrence-free survival than the low PrPC group(13.3 months vs 23.8 months,respectively;P=0.026).CONCLUSION PrPC expression is significantly associated with early recurrence and decreased survival period in CCA patients following surgical resection.Thus,PrPC may be used as a prognostic factor in treatment planning.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 Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk...BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk factors for recurrence remain unknown.AIM To comprehensively explore risk factors for short-term recurrence of CPs after endoscopic surgery and develop a nomogram prediction model.METHODS Overall,362 patients who underwent endoscopic polypectomy between January 2022 and January 2024 at Nanjing Jiangbei Hospital were included.We screened basic demographic data,clinical and polyp characteristics,surgery-related information,and independent risk factors for CPs recurrence using univariate and multivariate logistic regression analyses.The multivariate analysis results were used to construct a nomogram prediction model,internally validated using Bootstrapping,with performance evaluated using area under the curve(AUC),calibration curve,and decision curve analysis.RESULTS CP re-occurred in 166(45.86%)of the 362 patients within 1 year post-surgery.Multivariate logistic regression analysis showed that age(OR=1.04,P=0.002),alcohol consumption(OR=2.07,P=0.012),Helicobacter pylori infection(OR=2.34,P<0.001),polyp number>2(OR=1.98,P=0.005),sessile polyps(OR=2.10,P=0.006),and adenomatous pathological type(OR=3.02,P<0.001)were independent risk factors for post-surgery recurrence.The nomogram prediction model showed good discriminatory(AUC=0.73)and calibrating power,and decision curve analysis showed that the model had good clinical benefit at risk probabilities>20%.CONCLUSION We identified multiple independent risk factors for short-term recurrence after endoscopic surgery.The nomogram prediction model showed a certain degree of differentiation,calibration,and potential clinical applicability.展开更多
Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and p...Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.展开更多
Hepatocellular carcinoma(HCC)is one of the most common malignant tumors globally and is the most prevalent type of primary liver cancer,posing a heavy burden on global health.Surgical resection and liver transplantati...Hepatocellular carcinoma(HCC)is one of the most common malignant tumors globally and is the most prevalent type of primary liver cancer,posing a heavy burden on global health.Surgical resection and liver transplantation are the gold standard for the radical treatment of HCC.However,due to the heterogeneity and high invasiveness of HCC,the rates of local and distant recurrence are extremely high,with over 70%of patients experiencing recurrence within 5 years after treatment,significantly impacting the long-term quality of life.Therefore,researchers are exploring other treatment methods to reduce tumor recurrence and improve patient survival.To date,extensive research has concentrated on new alternative therapies,including radiotherapy(e.g.,selective internal radiotherapy),targeted drug therapy(e.g.,sorafenib and lenvatinib),and immunotherapy(e.g.,immune checkpoint inhibitors),which have played an integral role in the comprehensive treatment of HCC.This review mainly focuses on the cutting-edge advancements in these treatment methods for HCC and their potential role in reducing HCC recurrence.展开更多
BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholan...BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholangiocarcinoma.Although PSC predominantly affects adults,the incidence in pediatric patients is rising.For individuals in the advanced stages of liver disease,liver transplantation(LT)is the sole curative treatment option.However,the recurrence of PSC in the transplanted liver,known as recurrent PSC(rPSC),remains a significant concern.AIM To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.METHODS A literature search was carried out across databases,including PubMed,Embase,Cochrane Library,and Scopus,covering studies published from 1990 through 2024.The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies.Statistical analyses were conducted using RevMan 5.3 software,where the risk of recurrence was quantified using hazard ratios(HR)with 95%CI.RESULTS A total of nine reports with 2524 pediatric patients with PSC were included in this analysis.The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant,including concurrent inflammatory bowel disease(IBD),elevated liver enzyme levels,and the presence of PSCautoimmune hepatitis(AIH)overlap syndrome(all P<0.05).No statistically significant association was found between acute allograft rejection,Epstein-Barr virus infection,and the risk of rPSC recurrence in the pediatric liver transplant recipients.CONCLUSION The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT,including IBD,elevated liver enzyme levels,and PSC-AIH overlap syndrome.展开更多
OBJECTIVES:To systematically review the efficacy and safety of Jianpi formulas(健脾剂)in reducing the recurrence of colorectal adenoma(CRA)after polypectomy.METHODS:Randomized controlled trials(RCTs)investigating Jian...OBJECTIVES:To systematically review the efficacy and safety of Jianpi formulas(健脾剂)in reducing the recurrence of colorectal adenoma(CRA)after polypectomy.METHODS:Randomized controlled trials(RCTs)investigating Jianpi formulas for CRA post-polypectomy were systematically retrieved from eight electronic databases.The quality of the methodology was assessed using the Cochrane collaboration tool.The Grades of Recommendations Assessment Development and Evaluation(GRADE)approach was employed for evidence assessment.Statistical analyses were conducted using Statistics and Data Analysis(STATA)17(StataCorp(College Station,TX,USA)and Review Manager(RevMan)5.4(The Cochrane Collaboration(London,UK).RESULTS:The Meta-analysis,encompassing 18 RCTs with 1838 patients,revealed that Jianpi formulas significantly outperformed postoperative routine treatment.It demonstrated a reduction in the half-year recurrence rate[relative risk(RR)=0.41,95%confidence interval(CI)=0.33-0.49,Z=9.08,P<0.00001],the oneyear recurrence rate[RR=0.58,95%CI=0.49-0.69,Z=6.12,P<0.00001],and an enhancement in the clinical effective rate[RR=1.27,95%CI=1.19-1.36,Z=7.06,P<0.00001].The half-year recurrence rate and the clinical effective rate were medium-quality evidence.The one-year recurrence rate was low-quality evidence.Additionally,Jianpi formulas appear to be safe and do not increase adverse reactions compared to postoperative routine treatment alone.CONCLUSION:Jianpi formulas exhibit efficacy in reducing postoperative half-year and one-year recurrence rates while improving the clinical effective rate after polypectomy for CRA.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 Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better...BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.展开更多
BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk ...BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk factors for recurrence following open neonatal hernia repair.METHODS We retrospectively reviewed the data of 56 neonates who underwent open hernia repair at Shijiazhuang Maternal and Child Health Hospital between March 2021 and December 2023.The patients were categorized into recurrence and non-recurrence groups based on their experience of postoperative recurrence.Uni-variate analysis was performed to examine various factors,and those with P<0.1 in univariate analysis were included in multivariate logistic regression.No-mogram models were constructed,and their performance was evaluated using receiver operating characteristic curves.RESULTS Of the 56 children,11(19.64%)experienced postoperative recurrence,whereas the remaining 45(80.36%)did not.Univariate analysis identified anemia(P=0.079),persistent postoperative pain(P=0.049),and low birth weight(P=0.017)as factors associated with recurrence.Multivariate logistic regression analysis re-vealed that anemia(P=0.029),persistent postoperative pain(P=0.008),and low birth weight(P=0.009)were independent risk factors for recurrence after open hernia repair in neonates.CONCLUSION The risk of recurrence after open hernia repair should be closely monitored in neonates with low birth weight,anemia,and persistent postoperative pain.展开更多
Cancer recurrence,driven by the phenomenon of tumor dormancy,presents a formidable challenge in oncology.Dormant cancer cells have the ability to evade detection and treatment,leading to relapse.This review emphasizes...Cancer recurrence,driven by the phenomenon of tumor dormancy,presents a formidable challenge in oncology.Dormant cancer cells have the ability to evade detection and treatment,leading to relapse.This review emphasizes the urgent need to comprehend tumor dormancy and its implications for cancer recurrence.Despite notable advancements,significant gaps remain in our understanding of the mechanisms underlying dormancy and the lack of reliable biomarkers for predicting relapse.This review provides a comprehensive analysis of the cellular,angiogenic,and immunological aspects of dormancy.It highlights the current therapeutic strategies targeting dormant cells,particularly combination therapies and immunotherapies,which hold promise in preventing relapse.By elucidating these mechanisms and proposing innovative research methodologies,this review aims to deepen our understanding of tumor dormancy,ultimately facilitating the development of more effective strategies for preventing cancer recurrence and improving patient outcomes.展开更多
BACKGROUND Infection by the hepatitis B virus(HBV)represents a significant global sociosanitary burden.While liver transplantation(LT)is an important therapeutic option,treatments that prevent HBV reinfection are nece...BACKGROUND Infection by the hepatitis B virus(HBV)represents a significant global sociosanitary burden.While liver transplantation(LT)is an important therapeutic option,treatments that prevent HBV reinfection are necessary.The combination of anti-hepatitis B immunoglobulin(HBIG)and nucleoside/nucleotide analogs(NA)is the standard post-transplant treatment;however,there are limitations in using HBIG,particularly its cost.We present two illustrative clinical cases as examples of post-transplant management using dual NA therapy,unaccompanied by HBIG.CASE SUMMARY The first case involves a 42-year-old man with HBV-related cirrhosis,who,in the context of a diagnosis of hepatocellular carcinoma and hepatopulmonary syndrome,underwent LT without viremia at the time of transplantation.A lack of availability of HBIG led to the combined use of two NAs,entecavir,and tenofovir alafenamide—resulting in the negativization of hepatitis B surface antigen(HBsAg)and maintenance of a negative viral load in the post-transplant period.In the second case,a 63-year-old woman presented with acute hepatic failure due to HBV with viremia during transplantation.Combined therapy with entecavir and tenofovir alafenamide,again due to the unavailability of HBIG,ultimately led to the negativization of HBsAg and viral load.CONCLUSION These cases suggest the efficacy of dual NA therapy in post-transplant HBV management,emphasizing the need to reconsider traditional treatment approaches.展开更多
Objective:Hyper-progression recurrence(HPR)after hepatectomy is a specific recurrence pattern associated with extremely poor prognosis in patients with hepatocellular carcinoma(HCC).This study was aimed at investigati...Objective:Hyper-progression recurrence(HPR)after hepatectomy is a specific recurrence pattern associated with extremely poor prognosis in patients with hepatocellular carcinoma(HCC).This study was aimed at investigating the probable risk factors and establishing comprehensive models for formulating clinical strategies.Methods:Overall,16,158 patients with HCC from 8 hospitals were screened,among whom 3,125 patients who underwent R0 resection were included,and divided into development(n=2,113)and validation(n=1,012)cohorts.A comprehensive study of HPR predictive models and biological features was conducted.Results:Among the 3,125 enrolled patients,506(16.19%)developed HPR.The influence of HPR on extremely poor prognosis was reflected by recurrence features,adverse effects on systemic and liver function,and limited therapeutic options.Nine variables closely associated with HPR were identified,and incorporated into nomogram and conditional inference tree models,which successfully achieved pre-and post-operative HPR risk stratification and facilitated clinical decision-making.Multi-dimensional verification also confirmed the predictive accuracy of model combinations and their reliability in clinical applications.Furthermore,biological analyses revealed that HCCs with HPR exhibited hyperactive biological processes,inactive metabolism,and immune exhaustion features,together with high MYCN/HMGA2 co-expression,thereby enhancing understanding of the molecular events leading to HPR and providing valuable knowledge for HPR management.Conclusions:HPR after hepatectomy is associated with extremely poor prognosis and requires substantial attention.We constructed comprehensive predictive models and propose a clinical strategy for guiding HPR prevention and management.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignancies,with high recurrence rates after treatment.Identifying reliable biomarkers for predicting recurrence is essential for improving patient ou...BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignancies,with high recurrence rates after treatment.Identifying reliable biomarkers for predicting recurrence is essential for improving patient outcomes.Hepatitis B corerelated antigen(HBcrAg)has shown potential as a predictive marker for HCC recurrence.AIM To evaluate the association between HBcrAg levels and the risk of HCC recurrence.METHODS A systematic review was conducted following PRISMA guidelines.PubMed,EMBASE,Web of Science,and the Cochrane Library were searched without restrictions on date or language.Observational studies reporting hazard ratios(HRs)for HBcrAg as a predictor of HCC recurrence were included.Data extraction and quality assessment were performed independently by two reviewers.Statistical analyses used a random-effects model to account for heterogeneity(I²≥50%),and sensitivity analysis was performed to ensure the robustness of the results.RESULTS A total of 1339 articles were initially identified,and 17 studies were included in the final meta-analysis after screening.The pooled analysis showed a significant association between elevated HBcrAg levels and HCC recurrence(HR=4.42,95%confidence interval:3.43-5.41)with substantial heterogeneity(I²=92.6%).Subgroup analysis revealed higher pooled HRs in studies with≥500 participants(HR=4.18)and HBcrAg cut-offs≥4.0 LogU/mL(HR=5.29).Studies with≥10 years of follow-up showed a lower HR(2.89)compared to those with<10 years(3.27).Patients treated with nucleos(t)ide analogs had a pooled HR of 1.98,while those without nucleos(t)ide analog had a higher HR of 3.87.Sensitivity analysis confirmed the robustness of the results,with no significant publication bias detected.CONCLUSION This meta-analysis provides strong evidence that elevated HBcrAg levels are associated with an increased risk of HCC recurrence.HBcrAg may serve as a valuable biomarker for predicting recurrence,aiding personalized management and surveillance strategies for HCC patients.展开更多
文摘We provide an editorial of recent findings on early recurrence(ER)in rectal cancer(RC),focusing on the study on ER of resectable RC by Tsai et al.The study established an 8-month recurrence-free survival cut-off for differentiating ER from late recurrence,with implications for postrecurrence survival and overall survival.This offers not only a valuable timeframe for enhancing surveillance strategies in patients at higher risk,especially those who have undergone neoadjuvant chemoradiotherapy(CRT),but also raises questions about its applicability across different populations.Furthermore,the article suggests that while CRT is very effective in reducing locoregional recurrence,this treatment alone may not fully address the overall risk of ER.The authors advocate for personalized risk assessment and intensive surveillance during the postoperative period to improve outcomes,particularly in the first year.Future research should focus on larger,multicenter studies and incorporate advanced diagnostic techniques with genetic and molecular biomarkers to enhance prediction and management of ER.The ultimate goal is to refine treatment and surveillance strategies to improve survival and quality of life for patients with RC.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related deaths worldwide.Liver transplantation(LT)offers the most effective treatment.HCC recurrence is the strongest risk factor that decreases post-LT survival in patients transplanted for HCC.The rate of HCC recurrence is generally reported as 8%-20%in the literature.Many predictors of HCC have already been researched,however,to our knowledge there are no published studies on this topic using Australian data.AIM To determine the rate and identify predictors of HCC recurrence in a contemporary Western Australian LT cohort.METHODS We performed a retrospective cohort study of all liver transplants in patients with HCC at Sir Charles Gairdner Hospital between 2006 and 2021.Data was collected from various health record databases and included recipient demographics,serum biochemistry,radiology,operation notes,explant histopathology and details of recurrence.Overall survival of HCC patients post-LT,stratified for recurrence,was calculated by Kaplan Meier analysis.Univariate and multivariate Cox regression was used to determine predictors of HCC recurrence post-LT.RESULTS Between 1/1/2006 and 12/31/2021,119 patients were transplanted with HCC.8.4%of subjects developed recurrent HCC after LT with median follow-up time of 5.4 years.The median time to recurrence was 2.9 years±0.75 years.When comparing baseline characteristics,a greater proportion of subjects with recurrence had common characteristics on explant histopathology,including>3 viable nodules(P=0.001),vascular invasion(P=0.003)and poorly differentiated HCC(P=0.03).Unadjusted survival curves showed lower 1-year,3-year,5-year and 10-year survival rates in subjects with HCC recurrence compared to those without HCC recurrence(90%vs 92%,70%vs 88%,42%vs 80%,14%vs 76%,respectively;log rank P<0.001).CONCLUSION HCC recurrence was low at 8.4%in this contemporary Australian cohort,however it significantly impacted post-LT survival.Further studies are required to confirm predictors of recurrence and improve recipient outcomes.
文摘BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.
文摘In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients compared to relying solely on preoperative markers,which has significant implications for customizing adjuvant therapy and potentially improving outcomes for this aggressive form of cancer.However,the study’s single-center design and short follow-up period may limit the generalizability of its findings and potentially introduce reporting bias.Future studies could consider additional confounding factors,such as adjuvant chemotherapy and variations in surgical techniques,to improve the model’s accuracy.Furthermore,it would be valuable to validate the nomogram in broader,prospective cohorts and explore the inclusion of additional markers like circulating tumor DNA to refine further its predictive power and applicability across diverse patient populations.
文摘BACKGROUND Ischemic stroke(IS)survivors face an elevated risk of epileptic seizures,and recurrent seizures following the first episode often signal worsening functional outcomes.AIM To investigate risk factors associated with seizure recurrence after a first episode in patients with IS and explore their associations with cognitive function,anxiety,and depression.METHODS A total of 100 patients with IS admitted to Shaanxi Provincial People’s Hospital between January 2017 and January 2024 were enrolled in this study.After a 1-5-year follow-up,patients were categorized into recurrence(n=43)and nonrecurrence(n=57)groups.Their medical records were collected and analyzed using univariate and multivariate analyses to determine potential predictors of seizure recurrence.Variables with statistical significance in the univariate analysis were incorporated into a binary logistic regression model for multivariate analysis.The risk model’s predictive performance was evaluated using the receiver operating characteristic curve.How independent risk factors,identified in multivariate analysis,related to cognitive[Montreal Cognitive Assessment(MoCA)]and emotional[Self-Rating Anxiety Scale(SAS)/Self-Rating Depression Scale(SDS)]outcomes,were assessed.RESULTS Recurrent seizures were significantly associated with age,stroke severity(National Institutes of Health Stroke Scale),late-onset seizures,electroenceph-alogram abnormalities,cortical involvement,hemorrhagic infarction,and extensive cerebral infarctions,with lateonset seizures,cortical involvement,and hemorrhagic infarction serving as independent predictors.The risk model revealed an area under the curve of 0.732,with 88.37%specificity and 42.11%sensitivity.These three were also correlated with lower MoCA scores and higher SAS and SDS scores.CONCLUSION In patients with IS,recurrent seizures after the first episode can be independently predicted by late-onset seizures,cortical involvement,and hemorrhagic cerebral infarction-factors also correlating with cognitive impairment and emotional distress.These findings underscore the need for close clinical monitoring and targeted interventions(e.g.,cognitive rehabilitation and psychological support)to mitigate seizure recurrence in high-risk individuals.
基金Supported by Anhui Provincial Key Research and Development Plan,No.202104j07020048.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.Ablation therapy is one of the first-line treatments for early HCC.Accurately predicting early recurrence(ER)is crucial for making precise treatment plans and improving patient prognosis.AIM To establish an intratumoral and peritumoral model for predicting ER in HCC patients following curative ablation.METHODS This study included a total of 288 patients from three Centers.The patients were divided into a primary cohort(n=222)and an external cohort(n=66).Radiomics and deep learning methods were combined for feature extraction,and models were constructed following a three-step feature selection process.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),while calibration curves and decision curve analysis(DCA)were used to assess calibration and clinical utility.Finally,Kaplan-Meier(K-M)analysis was used to stratify patients according to progression-free survival(PFS)and overall survival(OS).RESULTS The combined model,which utilizes the light gradient boosting machine learning algorithm and incorporates both intratumoral and peritumoral regions(5 mm and 10 mm),demonstrated the best predictive performance for ER following HCC ablation,achieving AUCs of 0.924 in the training set,0.899 in the internal validation set,and 0.839 in the external validation set.Calibration and DCA curves confirmed strong calibration and clinical utility,whereas K-M curves provided risk stratification for PFS and OS in HCC patients.CONCLUSION The most efficient model integrated the tumor region with the peritumoral 5 mm and 10 mm regions.This model provides a noninvasive,effective,and reliable method for predicting ER after curative ablation of HCC.
基金Supported by National Research Foundation of Korea Grant Funded by the Korea Government,No.RS-2023-00213951.
文摘BACKGROUND The cellular prion protein(PrPC),traditionally associated with neurodegenerative disorders,plays an important role in cancer progression and metastasis by inhibiting apoptosis.AIM To investigate the influence of PrPC expression in cholangiocarcinoma(CCA)on patient outcomes following surgical resection.METHODS Patients who underwent curative surgical resection for either intrahepatic or hilar CCA were enrolled in this retrospective study.Based on the immunohistochemical staining results of the surgical specimens,patients were categorized into two groups:The low PrPC group(negative or 1+)and the high PrPC group(2+or 3+).Survival analyses,including overall survival and recurrence-free survival,were conducted using the Kaplan-Meier method and compared using the log-rank test.RESULTS In total,seventy-six patients diagnosed with CCA(39 with intrahepatic and 37 with hilar CCA)underwent curative hepatectomy from January 2011 to November 2021.Among these patients,38(50%)demonstrated high PrPC expression,whereas the remaining 38(50%)showed low expression of PrPC.During a median follow-up period of 31.2 months(range:1 to 137 months),the high PrPC group had a significantly shorter median overall survival than the low PrPC group(40.4 months vs 137.9 months,respectively;P=0.041).Moreover,the high PrPC group had a significantly shorter median recurrence-free survival than the low PrPC group(13.3 months vs 23.8 months,respectively;P=0.026).CONCLUSION PrPC expression is significantly associated with early recurrence and decreased survival period in CCA patients following surgical resection.Thus,PrPC may be used as a prognostic factor in treatment planning.
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.
文摘BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk factors for recurrence remain unknown.AIM To comprehensively explore risk factors for short-term recurrence of CPs after endoscopic surgery and develop a nomogram prediction model.METHODS Overall,362 patients who underwent endoscopic polypectomy between January 2022 and January 2024 at Nanjing Jiangbei Hospital were included.We screened basic demographic data,clinical and polyp characteristics,surgery-related information,and independent risk factors for CPs recurrence using univariate and multivariate logistic regression analyses.The multivariate analysis results were used to construct a nomogram prediction model,internally validated using Bootstrapping,with performance evaluated using area under the curve(AUC),calibration curve,and decision curve analysis.RESULTS CP re-occurred in 166(45.86%)of the 362 patients within 1 year post-surgery.Multivariate logistic regression analysis showed that age(OR=1.04,P=0.002),alcohol consumption(OR=2.07,P=0.012),Helicobacter pylori infection(OR=2.34,P<0.001),polyp number>2(OR=1.98,P=0.005),sessile polyps(OR=2.10,P=0.006),and adenomatous pathological type(OR=3.02,P<0.001)were independent risk factors for post-surgery recurrence.The nomogram prediction model showed good discriminatory(AUC=0.73)and calibrating power,and decision curve analysis showed that the model had good clinical benefit at risk probabilities>20%.CONCLUSION We identified multiple independent risk factors for short-term recurrence after endoscopic surgery.The nomogram prediction model showed a certain degree of differentiation,calibration,and potential clinical applicability.
基金Supported by the Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.
基金Supported by the National Natural Science Foundation of China,No.82270634Third Affiliated Hospital of Naval Medical University,No.tf2024yzyy01.
文摘Hepatocellular carcinoma(HCC)is one of the most common malignant tumors globally and is the most prevalent type of primary liver cancer,posing a heavy burden on global health.Surgical resection and liver transplantation are the gold standard for the radical treatment of HCC.However,due to the heterogeneity and high invasiveness of HCC,the rates of local and distant recurrence are extremely high,with over 70%of patients experiencing recurrence within 5 years after treatment,significantly impacting the long-term quality of life.Therefore,researchers are exploring other treatment methods to reduce tumor recurrence and improve patient survival.To date,extensive research has concentrated on new alternative therapies,including radiotherapy(e.g.,selective internal radiotherapy),targeted drug therapy(e.g.,sorafenib and lenvatinib),and immunotherapy(e.g.,immune checkpoint inhibitors),which have played an integral role in the comprehensive treatment of HCC.This review mainly focuses on the cutting-edge advancements in these treatment methods for HCC and their potential role in reducing HCC recurrence.
文摘BACKGROUND Primary sclerosing cholangitis(PSC)is a long-term liver condition defined by the inflammation and scarring of the bile ducts,resulting in complications such as liver cirrhosis,portal hypertension,and cholangiocarcinoma.Although PSC predominantly affects adults,the incidence in pediatric patients is rising.For individuals in the advanced stages of liver disease,liver transplantation(LT)is the sole curative treatment option.However,the recurrence of PSC in the transplanted liver,known as recurrent PSC(rPSC),remains a significant concern.AIM To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.METHODS A literature search was carried out across databases,including PubMed,Embase,Cochrane Library,and Scopus,covering studies published from 1990 through 2024.The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies.Statistical analyses were conducted using RevMan 5.3 software,where the risk of recurrence was quantified using hazard ratios(HR)with 95%CI.RESULTS A total of nine reports with 2524 pediatric patients with PSC were included in this analysis.The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant,including concurrent inflammatory bowel disease(IBD),elevated liver enzyme levels,and the presence of PSCautoimmune hepatitis(AIH)overlap syndrome(all P<0.05).No statistically significant association was found between acute allograft rejection,Epstein-Barr virus infection,and the risk of rPSC recurrence in the pediatric liver transplant recipients.CONCLUSION The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT,including IBD,elevated liver enzyme levels,and PSC-AIH overlap syndrome.
基金Jinhua Traditional Chinese Medicine Science and Technology Research Project:Gut Microbiota Distribution Characteristics in Spleen-Deficiency Colorectal Adenoma Patients(No.2023KR04)Jinhua Traditional Chinese Medicine Science and Technology Major Research Project:Clinical Efficacy and Mechanism of Shugan Jianpi Tiaochang Pills in Preventing Postoperative Recurrence of Colorectal Adenomas based on Metabolomics Technology(No.2024ZD03)。
文摘OBJECTIVES:To systematically review the efficacy and safety of Jianpi formulas(健脾剂)in reducing the recurrence of colorectal adenoma(CRA)after polypectomy.METHODS:Randomized controlled trials(RCTs)investigating Jianpi formulas for CRA post-polypectomy were systematically retrieved from eight electronic databases.The quality of the methodology was assessed using the Cochrane collaboration tool.The Grades of Recommendations Assessment Development and Evaluation(GRADE)approach was employed for evidence assessment.Statistical analyses were conducted using Statistics and Data Analysis(STATA)17(StataCorp(College Station,TX,USA)and Review Manager(RevMan)5.4(The Cochrane Collaboration(London,UK).RESULTS:The Meta-analysis,encompassing 18 RCTs with 1838 patients,revealed that Jianpi formulas significantly outperformed postoperative routine treatment.It demonstrated a reduction in the half-year recurrence rate[relative risk(RR)=0.41,95%confidence interval(CI)=0.33-0.49,Z=9.08,P<0.00001],the oneyear recurrence rate[RR=0.58,95%CI=0.49-0.69,Z=6.12,P<0.00001],and an enhancement in the clinical effective rate[RR=1.27,95%CI=1.19-1.36,Z=7.06,P<0.00001].The half-year recurrence rate and the clinical effective rate were medium-quality evidence.The one-year recurrence rate was low-quality evidence.Additionally,Jianpi formulas appear to be safe and do not increase adverse reactions compared to postoperative routine treatment alone.CONCLUSION:Jianpi formulas exhibit efficacy in reducing postoperative half-year and one-year recurrence rates while improving the clinical effective rate after polypectomy for CRA.
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 Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.
文摘BACKGROUND Inguinal and umbilical hernias are common neonatal conditions.Open hernia repair is currently the primary surgical treatment,but postoperative recurrence remains a significant risk.AIM To identify the risk factors for recurrence following open neonatal hernia repair.METHODS We retrospectively reviewed the data of 56 neonates who underwent open hernia repair at Shijiazhuang Maternal and Child Health Hospital between March 2021 and December 2023.The patients were categorized into recurrence and non-recurrence groups based on their experience of postoperative recurrence.Uni-variate analysis was performed to examine various factors,and those with P<0.1 in univariate analysis were included in multivariate logistic regression.No-mogram models were constructed,and their performance was evaluated using receiver operating characteristic curves.RESULTS Of the 56 children,11(19.64%)experienced postoperative recurrence,whereas the remaining 45(80.36%)did not.Univariate analysis identified anemia(P=0.079),persistent postoperative pain(P=0.049),and low birth weight(P=0.017)as factors associated with recurrence.Multivariate logistic regression analysis re-vealed that anemia(P=0.029),persistent postoperative pain(P=0.008),and low birth weight(P=0.009)were independent risk factors for recurrence after open hernia repair in neonates.CONCLUSION The risk of recurrence after open hernia repair should be closely monitored in neonates with low birth weight,anemia,and persistent postoperative pain.
基金supported by the National Natural Sciences Foundation of China(82170974)the Central South University Research Program of Advanced Interdisciplinary Studies(2023QYJC038).
文摘Cancer recurrence,driven by the phenomenon of tumor dormancy,presents a formidable challenge in oncology.Dormant cancer cells have the ability to evade detection and treatment,leading to relapse.This review emphasizes the urgent need to comprehend tumor dormancy and its implications for cancer recurrence.Despite notable advancements,significant gaps remain in our understanding of the mechanisms underlying dormancy and the lack of reliable biomarkers for predicting relapse.This review provides a comprehensive analysis of the cellular,angiogenic,and immunological aspects of dormancy.It highlights the current therapeutic strategies targeting dormant cells,particularly combination therapies and immunotherapies,which hold promise in preventing relapse.By elucidating these mechanisms and proposing innovative research methodologies,this review aims to deepen our understanding of tumor dormancy,ultimately facilitating the development of more effective strategies for preventing cancer recurrence and improving patient outcomes.
文摘BACKGROUND Infection by the hepatitis B virus(HBV)represents a significant global sociosanitary burden.While liver transplantation(LT)is an important therapeutic option,treatments that prevent HBV reinfection are necessary.The combination of anti-hepatitis B immunoglobulin(HBIG)and nucleoside/nucleotide analogs(NA)is the standard post-transplant treatment;however,there are limitations in using HBIG,particularly its cost.We present two illustrative clinical cases as examples of post-transplant management using dual NA therapy,unaccompanied by HBIG.CASE SUMMARY The first case involves a 42-year-old man with HBV-related cirrhosis,who,in the context of a diagnosis of hepatocellular carcinoma and hepatopulmonary syndrome,underwent LT without viremia at the time of transplantation.A lack of availability of HBIG led to the combined use of two NAs,entecavir,and tenofovir alafenamide—resulting in the negativization of hepatitis B surface antigen(HBsAg)and maintenance of a negative viral load in the post-transplant period.In the second case,a 63-year-old woman presented with acute hepatic failure due to HBV with viremia during transplantation.Combined therapy with entecavir and tenofovir alafenamide,again due to the unavailability of HBIG,ultimately led to the negativization of HBsAg and viral load.CONCLUSION These cases suggest the efficacy of dual NA therapy in post-transplant HBV management,emphasizing the need to reconsider traditional treatment approaches.
基金supported by the National Natural Science Foundation of China(Grant Nos.NSFC 82273405,and 81972306)supported partly by the Guangxi Nature Sciences grants(Grant No.2018GXNSFAA138028)the Guangxi Medical University Training Program for Distinguished Young Scholars.
文摘Objective:Hyper-progression recurrence(HPR)after hepatectomy is a specific recurrence pattern associated with extremely poor prognosis in patients with hepatocellular carcinoma(HCC).This study was aimed at investigating the probable risk factors and establishing comprehensive models for formulating clinical strategies.Methods:Overall,16,158 patients with HCC from 8 hospitals were screened,among whom 3,125 patients who underwent R0 resection were included,and divided into development(n=2,113)and validation(n=1,012)cohorts.A comprehensive study of HPR predictive models and biological features was conducted.Results:Among the 3,125 enrolled patients,506(16.19%)developed HPR.The influence of HPR on extremely poor prognosis was reflected by recurrence features,adverse effects on systemic and liver function,and limited therapeutic options.Nine variables closely associated with HPR were identified,and incorporated into nomogram and conditional inference tree models,which successfully achieved pre-and post-operative HPR risk stratification and facilitated clinical decision-making.Multi-dimensional verification also confirmed the predictive accuracy of model combinations and their reliability in clinical applications.Furthermore,biological analyses revealed that HCCs with HPR exhibited hyperactive biological processes,inactive metabolism,and immune exhaustion features,together with high MYCN/HMGA2 co-expression,thereby enhancing understanding of the molecular events leading to HPR and providing valuable knowledge for HPR management.Conclusions:HPR after hepatectomy is associated with extremely poor prognosis and requires substantial attention.We constructed comprehensive predictive models and propose a clinical strategy for guiding HPR prevention and management.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common malignancies,with high recurrence rates after treatment.Identifying reliable biomarkers for predicting recurrence is essential for improving patient outcomes.Hepatitis B corerelated antigen(HBcrAg)has shown potential as a predictive marker for HCC recurrence.AIM To evaluate the association between HBcrAg levels and the risk of HCC recurrence.METHODS A systematic review was conducted following PRISMA guidelines.PubMed,EMBASE,Web of Science,and the Cochrane Library were searched without restrictions on date or language.Observational studies reporting hazard ratios(HRs)for HBcrAg as a predictor of HCC recurrence were included.Data extraction and quality assessment were performed independently by two reviewers.Statistical analyses used a random-effects model to account for heterogeneity(I²≥50%),and sensitivity analysis was performed to ensure the robustness of the results.RESULTS A total of 1339 articles were initially identified,and 17 studies were included in the final meta-analysis after screening.The pooled analysis showed a significant association between elevated HBcrAg levels and HCC recurrence(HR=4.42,95%confidence interval:3.43-5.41)with substantial heterogeneity(I²=92.6%).Subgroup analysis revealed higher pooled HRs in studies with≥500 participants(HR=4.18)and HBcrAg cut-offs≥4.0 LogU/mL(HR=5.29).Studies with≥10 years of follow-up showed a lower HR(2.89)compared to those with<10 years(3.27).Patients treated with nucleos(t)ide analogs had a pooled HR of 1.98,while those without nucleos(t)ide analog had a higher HR of 3.87.Sensitivity analysis confirmed the robustness of the results,with no significant publication bias detected.CONCLUSION This meta-analysis provides strong evidence that elevated HBcrAg levels are associated with an increased risk of HCC recurrence.HBcrAg may serve as a valuable biomarker for predicting recurrence,aiding personalized management and surveillance strategies for HCC patients.
