BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate...BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate of AL,their preventive effects are controversial.AIM To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.METHODS A systematic search of major medical databases was conducted to identify studies up to June 2024.Intraoperative and postoperative outcomes were assessed;the primary outcome assessed was the incidence of AL.Pooled odds ratios(ORs)and mean differences(MDs)with a 95%confidence interval(CI)were calculated using fixed-effect or random-effect models under heterogeneity.RESULTS This meta-analysis incorporated 20 studies involving 3726 patients.Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group(OR:0.26,95%CI:0.19-0.35,P<0.001)than the unreinforced suture group.The reinforced suture group also exhibited a shorter hospital stay(MD:-1.17,95%CI:-1.78 to-0.57,P<0.001),earlier anal exhaust(MD:-0.13,95%CI:-0.22 to-0.05,P=0.002),longer operative time(MD:15.25,95%CI:10.71-19.80,P<0.001),lower infection rate(OR:0.54,95%CI:0.29-1.00,P=0.05)and lower reoperation rate(OR:0.19,95%CI:0.08-0.45,P<0.001).CONCLUSION The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence postrectal cancer surgery.Nevertheless,these conclusions warrant verification through additional high-quality randomized controlled trials.展开更多
BACKGROUND Gastric cancer is the fifth most common cancer and the fourth leading cause of death worldwide.Most cases of newly diagnosed gastric cancer involve not only locally advanced tumor growth and regional lymph ...BACKGROUND Gastric cancer is the fifth most common cancer and the fourth leading cause of death worldwide.Most cases of newly diagnosed gastric cancer involve not only locally advanced tumor growth and regional lymph node metastases but also distant metastases.We report a rare case finding of a mass in the right inguinal area which is derived from gastric cancer.CASE SUMMARY A 68-year-old male initially diagnosed with an inguinal hernia presented with a 2 cm mass in the right inguinal area.Gastrointestinal symptoms led to the discovery of a stomach tumor.Biopsy confirmed gastrointestinal adenocarcinoma.The diagnosis was advanced gastric cancer with peritoneal dissemination,and the inguinal mass was due to direct infiltration.Due to gastrointestinal bleeding,the patient underwent palliative gastrectomy and lymph node dissection.Postoperatively,the patient received hyperthermic intraperitoneal chemotherapy and localized radiation therapy.CONCLUSION This case indicates that a systematic evaluation should be conducted during the initial consultation to explore the potential connection between unrecognized distant masses and the primary tumor.展开更多
BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-neg...BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-negative BC in the ascending colon who underwent laparoscopic radical right hemicolectomy.The patient had undergone left modified radical mastectomy only 15 months ago and stopped chemotherapy just 3 months ago.The diagnosis of CMBC was made based on the previous history of BC and positive results of several specific immunohistochemical markers(gross cystic disease fluid protein 15,mammaglobin,GATA-binding protein 3,and cytokeratin 7)for breast carcinoma.CONCLUSION CMBC should be highly cautious in patients with a previous history of BC,especially triple-negative BC,and further examination to aid in diagnosis.展开更多
Age-related macular degeneration(AMD)is a disease that affects the vision of elderly individuals worldwide.Although current therapeutics have shown effectiveness against AMD,some patients may remain unresponsive and c...Age-related macular degeneration(AMD)is a disease that affects the vision of elderly individuals worldwide.Although current therapeutics have shown effectiveness against AMD,some patients may remain unresponsive and continue to experience disease progression.Therefore,in-depth knowledge of the mechanism underlying AMD pathogenesis is urgently required to identify potential drug targets for AMD treatment.Recently,studies have suggested that dysfunction of mitochondria can lead to the aggregation of reactive oxygen species(ROS)and activation of the cyclic GMP-AMP synthase(cGAS)/stimulator of interferon genes(STING)innate immunity pathways,ultimately resulting in sterile inflammation and cell death in various cells,such as cardiomyocytes and macrophages.Therefore,combining strategies targeting mitochondrial dysfunction and inflammatory mediators may hold great potential in facilitating AMD management.Notably,emerging evidence indicates that natural products targeting mitochondrial quality control(MQC)and the cGAS/STING innate immunity pathways exhibit promise in treating AMD.Here,we summarize phytochemicals that could directly or indirectly influence the MQC and the cGAS/STING innate immunity pathways,as well as their interconnected mediators,which have the potential to mitigate oxidative stress and suppress excessive inflammatory responses,thereby hoping to offer new insights into therapeutic interventions for AMD treatment.展开更多
AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpa...AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpatients,40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography(CT)were enrolled.The decision to perform a lung operation was made if the patient met the following criteria:(1)completely resected or resectable primary CRC;(2)completely resectable IPNs;(3)controlled or controllable extrapulmonary metastasis;and(4)adequate general condition and pulmonary function to tolerate pulmonary operation.Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation.RESULTS:A total of 40 cases of lung resection was performed in 29 patients.Five patients underwent repeated lung resection.The final pathology result showed metastasis from the CRC in 30 cases(75%)and benign pathology in 10 cases(25%).The primary tumor site was the rectum in 26/30(86.6%)cases with pulmonary metastasis,but only 3/10(30%)cases in the benign group had a primary rectal cancer(P=0.001).Positron emission tomography(PET)-CT was performed for 22/30(73.4%)patients in the lung metastasis group and for 6/10(60.0%)patients in the benign group.PET-CT revealed hot uptake of18fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups.The group with pulmonary metastasis had a higher incidence of primary rectal cancer(P=0.001),a more advanced tumor stage(P=0.011),and more frequent lymphatic invasion of tumor cells(P=0.005).Six cases with previous liver metastasectomy were present in the lung metastasis group.Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients.CONCLUSION:The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.展开更多
AIM:To detect the expression of tumor necrosis factor-a(TNF-a)in colorectal cancer(CRC)cells among Saudi patients,and correlate its expression with clinical stages of cancer.METHODS:Archival tissue specimens were coll...AIM:To detect the expression of tumor necrosis factor-a(TNF-a)in colorectal cancer(CRC)cells among Saudi patients,and correlate its expression with clinical stages of cancer.METHODS:Archival tissue specimens were collected from 30 patients with CRC who had undergone surgical intervention at King Khalid University Hospital.Patient demographic information,including age and gender,tumor sites,and histological type of CRC,was recorded.To measure TNF-a m RNA expression in CRC,total RNA was extracted from tumor formalin-fixed,paraffinembedded,and adjacent normal tissues.Reverse transcription and reverse transcription polymerase chain reaction were performed.Colorectal tissue microarrays were constructed to investigate the protein expression of TNF-a by immunohistochemistry.RESULTS:The relative expression of TNF-a m RNA in colorectal cancer was significantly higher than that seen in adjacent normal colorectal tissue.High TNF-a gene expression was associated with StageⅢandⅣneoplasms when compared with earlier tumor stages(P=0.004).Eighty-three percent of patients(25/30)showed strong TNF-a positive staining,while only 10%(n=3/30)of patients showed weak staining,and 7%(n=2/30)were negative.We showed the presence of elevated TNF-a gene expression in cancer cells,which strongly correlated with advanced stages of tumor.CONCLUSION:High levels of TNF-a expression could be an independent diagnostic indicator of colorectal cancer,and targeting TNF-a might be a promising prognostic tool by assessment of the clinical stages of CRC.展开更多
BACKGROUND In recent years,the predictive role of YKL-40 for long-term survival in colorectal cancer patients has been gradually investigated.However,whether it is a reliable and valuable prognostic indicator for pati...BACKGROUND In recent years,the predictive role of YKL-40 for long-term survival in colorectal cancer patients has been gradually investigated.However,whether it is a reliable and valuable prognostic indicator for patients with colorectal carcinoma has not been verified.AIM To identify the prognostic value of serum/plasma concentration of YKL-40 or expression status of YKL-40 in tumor cells in colorectal carcinoma patients.METHODS Several electronic databases including the PubMed,EMBASE,Web of Science,CNKI,VIP and WanFang were searched for relevant studies.The hazard ratios(HR)and 95%confidence intervals(CI)were combined and the primary and secondary outcomes were overall survival(OS)and progression-free survival(PFS),respectively.All statistical analysis were conducted by STATA 15.0 software.RESULTS A total of nine studies involving 2545 patients were included.The pooled results indicated that YKL-40 was significantly associated with poor OS(HR=1.80,95%CI:1.32-2.45,P<0.001)and PFS(HR=1.62,95%CI:1.22-2.16,P=0.001).Subgroup analysis stratified by the treatment,tumor type and source of YKL-40 showed similar results.CONCLUSION Elevated serum/plasma concentration of YKL-40 or positive expression in tumor cells was related with worse prognosis of colorectal carcinoma patients.YKL-40 might serve as a novel and reliable indicator for the evaluation of prognosis in colorectal cancer.展开更多
BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surg...BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surgery for these elderly patients can be challenging.An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.METHODS In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database.Patients with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis.The primary outcome was overall 3-year overall survival(OS)following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South Korea.Statistical analyses were performed using Stata/MP Version 15.1.RESULTS A total of 1267 patients were identified for analysis.The median post-operative length of stay was 8[interquartile range(IQR)6-12]d and median follow-up duration was 47(IQR 19-75)mo.Median OS was 78(IQR 65-85)mo.Following multivariate analysis,the factors significant for predicting overall mortality were serum albumin<35 g/dL,serum carcinoembryonic antigen≥20μg/L,T stage 3 or 4,moderate tumor cell differentiation or worse,mucinous histology,rectal tumors,and pre-existing chronic obstructive lung disease.Advanced age alone was not found to be significant.The Korean cohort consisted of 910 patients.The Singapore cohort exhibited a poorer OS,likely due to a higher proportion of advanced cancers.Despite the clinicopathologic differences,there was successful validation of the model following recalibration.An interactive online calculator was designed to facilitate post-operative survival prediction,available at http://bit.ly/sgh_crc.The main limitation of the study was selection bias,as patients who had undergone surgery would have tended to be physiologically fitter.CONCLUSION This novel scoring system generates an individualized survival probability following colorectal resection and can assist in the decision-making process.Validation with an external population strengthens the generalizability of this model.展开更多
BACKGROUND Lymph node(LN)staging in rectal cancer(RC)affects treatment decisions and patient prognosis.For radiologists,the traditional preoperative assessment of LN metastasis(LNM)using magnetic resonance imaging(MRI...BACKGROUND Lymph node(LN)staging in rectal cancer(RC)affects treatment decisions and patient prognosis.For radiologists,the traditional preoperative assessment of LN metastasis(LNM)using magnetic resonance imaging(MRI)poses a challenge.AIM To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable LNs.METHODS In this retrospective study,270 LNs(158 nonmetastatic,112 metastatic)were randomly split into training(n=189)and validation sets(n=81).LNs were classified based on pathology-MRI matching.Conventional MRI features[size,shape,margin,T2-weighted imaging(T2WI)appearance,and CE-T1-weighted imaging(T1WI)enhancement]were evaluated.Three radiomics models used 3D features from T1WI and T2WI images.Additionally,a nomogram model combining conventional MRI and radiomics features was developed.The model used univariate analysis and multivariable logistic regression.Evaluation employed the receiver operating characteristic curve,with DeLong test for comparing diagnostic performance.Nomogram performance was assessed using calibration and decision curve analysis.RESULTS The nomogram model outperformed conventional MRI and single radiomics models in evaluating LNM.In the training set,the nomogram model achieved an area under the curve(AUC)of 0.92,which was significantly higher than the AUCs of 0.82(P<0.001)and 0.89(P<0.001)of the conventional MRI and radiomics models,respectively.In the validation set,the nomogram model achieved an AUC of 0.91,significantly surpassing 0.80(P<0.001)and 0.86(P<0.001),respectively.CONCLUSION The nomogram model showed the best performance in predicting metastasis of evaluable LNs.展开更多
BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures ...BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring.Postoperative loss of anal function can cause physical and mental damage.Transanal opening of the intersphincteric space(TROPIS)is an effective procedure that completely preserves the external anal sphincter.However,its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications.On the basis of our clinical experience,we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.CASE SUMMARY A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS,which involved sepsis drainage and identification of the internal opening in the intersphincteric space.The patient with the high complex anal fistula recovered well postoperatively,without any postoperative complications or anal dysfunction.Anal function returned to normal after 17 months of follow-up.CONCLUSION The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function.It allows the complete removal of infected anal glands and reduces the risk of postoperative complications.Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.展开更多
BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields ...BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields in surgical operations.AIM To illustrate the major areas of research and forward-looking directions over the past twenty-six years.METHODS Using the Web of Science Core Collection database,a comprehensive review of scholarly articles pertaining to robot-assisted gastrointestinal and liver surgery was researched out between 2000 and 2023.We used Citespace(Version 6.2.4)and Bibliometrix package(Version 4.3.0)to visualize the analysis of all publications including country,institutional affiliations,authors,and keywords.RESULTS In total,346 articles were retrieved.Surgical Endoscopy had with the largest number of publications and was cited in this field.The United States was a core research country in this field.Yonsei University was the most productive institution.The current focus of this field is on rectal surgery,long-term prognosis,perioperative management,previous surgical experience,and the learning curve.CONCLUSION The scientific interest in robot-assisted gastrointestinal and liver surgery has experienced a significant rise since 1997.This study provides new perspectives and ideas for future research in this field.展开更多
AIM: To determine the accuracy of endoscopic polyp size measurements using disposable graduated biopsy forceps(DGBF). METHODS: Gradations accurate to 1 mm were assessed with the wire of disposable graduated biopsy for...AIM: To determine the accuracy of endoscopic polyp size measurements using disposable graduated biopsy forceps(DGBF). METHODS: Gradations accurate to 1 mm were assessed with the wire of disposable graduated biopsy forceps. When a polyp was noted, endoscopists determined the width of the polyp; then, the graduated biopsy forceps was inserted and the largest diameter of the tumor was measured. After excision, during surgery or endoscopy, the polyp was measured using the vernier caliper.RESULTS: One hundred and thirty-three colorectal polyps from 119 patients were studied. The mean diameter, by post-polypectomy measurement, was 0.92 ± 0.69 cm; 83 were < 1 cm, 36 were between 1 and 2 cm, and 14 were > 2 cm. The mean diameter, by visual estimation, was 1.15 ± 0.88 cm; compared to the actual size measured using vernier calipers, the difference was statistically significant. The mean diameter measured using the DGBF was 0.93 ± 0.68 cm; compared to the actual size measured using vernier calipers, this difference was not statistically significant. The ratio between the mean size estimated by visual estimation and the actual size was significantly different from that between the mean size estimated using the DGBF and the actual size(1.26 ± 0.30 vs 1.02 ± 0.11).CONCLUSION: The accuracy of polyp size estimation was low by visual assessment; however, it improved when the DGBF was used.展开更多
AIM:To assess the accuracy of polyp size using an endoscopic lesion measurement system(ELMS).METHODS:The accuracy of polyp size assessment was compared among measurements acquired by visual estimation,disposable gradu...AIM:To assess the accuracy of polyp size using an endoscopic lesion measurement system(ELMS).METHODS:The accuracy of polyp size assessment was compared among measurements acquired by visual estimation,disposable graduated biopsy forceps(DGBF;used as a"scale-plate")and the ELMS.RESULTS:There were 192 polyps from 166 cases included in this study.The mean diameter of the post polypectomy measurement was 0.85±0.53 cm(range:0.2-3.0 cm).The mean diameter by visual estimation was 1.10±0.53 cm,which was significantly different compared to the actual size of the polyp(P<0.001).The mean diameters obtained using DGBF(0.87±0.54cm)and ELMS(0.85±0.53 cm)did not significantly differ from the actual size of the polyp.The difference between the measurements from the ELMS and DGBF was not significant.CONCLUSION:Unlike visual estimations at colonoscopy,endoscopic graduated biopsy forceps and the endoscopic lesion measurement system are accurate methods to estimate polyp size.展开更多
AIM： To systematically review the literature for studies investigating the potential effect of gender of dialysis patients on the immunogenicity of hepatitis B virus vaccines. METHODS： Literature searches were condu...AIM： To systematically review the literature for studies investigating the potential effect of gender of dialysis patients on the immunogenicity of hepatitis B virus vaccines. METHODS： Literature searches were conducted by the MEDLINE and Google Scholar. The key words used included “hepatitis B （HB）”, “vaccine”, “dialysis”, “hemodialysis”, “sex”, “male” and “female”. Data of seroresponse to HB vaccine in clinical trials regarding sex of the recipients have been achieved and analyzed. Finally data from 19 clinical trials have been pooled and analyzed.RESULTS： Analysis of response to HB vaccination in our dialysis population showed males significantly res-pond less to hepatitis B vaccination （P = 0.002, Z = 3.08） with no significant heterogeneity detected [P = 0.766; heterogeneity χ2 = 14.30 （df = 19）; I2 = 0%]. A reanalysis of the pooled data was conducted regarding the dialysis mode to evaluate potential differential impact of sex on HB vaccine response. Hemodialysis was the only subgroup that showed a signifcant difference regarding dialysis mode in response to HB vaccination regarding sex （ P = 0.042, Z = 2.03）.CONCLUSION： This Meta-analysis showed significant effect for the sex of chronic kidney disease and dialysis patients on the immunogenicity of HB vaccine. This sex discrimination was most prominent among hemodialysis patients.展开更多
BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infec...BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infections that originate from these.Furthermore,the complete resection of this cyst is curative.We report our diagnostic and treatment experience with one case of malignant transformation of a perianal tailgut cyst,which was initially misdiagnosed as perianal abscess.CASE SUMMARY A 72-year-old woman visited our institution with complaints of a refractory nonhealing lesion on the right hip,which repeatedly broke and suppurated for more than 70 years,and aggravated in 4 mo.The patient was given a diagnosis of refractory perianal abscess with repeated incision and drainage procedures.Computed tomography of the pelvic cavity revealed a giant perianal cyst.Subsequent biopsy revealed a tumor with moderate-to-severe glandular epithelial dysplasia,and suggested that this was derived from the developmental cysts in the posterior rectal space.After further clarifying the nature and extent of the tumor by magnetic resonance imaging,total cystic resection was performed.Postoperative histopathological examination confirmed the malignancy,dictating the investigators to add postoperative chemotherapy to the treatment regimen.CONCLUSION The malignant transformation of perianal tailgut cysts is very uncommon,and this should be differentiated from perianal abscess.Complete surgical removal is curative,and postoperative pathology may determine the necessity of additional postoperative chemotherapy or radiotherapy,which may be beneficial for preventing local recurrence and metastasis.展开更多
Osteoporosis caused by aging is characterized by reduced bone mass and accumulated adipocytes in the bone marrow cavity. How the balance between osteoblastogenesis and adipogenesis from bone marrow mesenchymal stem ce...Osteoporosis caused by aging is characterized by reduced bone mass and accumulated adipocytes in the bone marrow cavity. How the balance between osteoblastogenesis and adipogenesis from bone marrow mesenchymal stem cells(BMSCs) is lost upon aging is still unclear. Here, we found that the RNA-binding protein Musashi2(Msi2) regulates BMSC lineage commitment. Msi2 is commonly enriched in stem cells and tumor cells. We found that its expression was downregulated during adipogenic differentiation and upregulated during osteogenic differentiation of BMSCs. Msi2 knockout mice exhibited decreased bone mass with substantial accumulation of marrow adipocytes, similar to aging-induced osteoporosis. Depletion of Msi2 in BMSCs led to increased adipocyte commitment. Transcriptional profiling analysis revealed that Msi2 deficiency led to increased PPARγ signaling.RNA-interacting protein immunoprecipitation assays demonstrated that Msi2 could inhibit the translation of the key adipogenic factor Cebpα, thereby inhibiting PPAR signaling. Furthermore, the expression of Msi2 decreased significantly during the aging process of mice, indicating that decreased Msi2 function during aging contributes to abnormal accumulation of adipocytes in bone marrow and osteoporosis. Thus, our results provide a putative biochemical mechanism for aging-related osteoporosis, suggesting that modulating Msi2 function may benefit the treatment of bone aging.展开更多
Purpose:Colostomy for patients with anorectal malformations decompresses an obstructed colon,avoids fecal contamination of the urinary tract,and protects a future perineal operation. The procedure is associated with s...Purpose:Colostomy for patients with anorectal malformations decompresses an obstructed colon,avoids fecal contamination of the urinary tract,and protects a future perineal operation. The procedure is associated with several significant complications. Materials and Methods:The medical records of 1700 cases of anorectal malformations were retrospectively reviewed. A total of 230 patients underwent reconstruction without a colostomy. Of the remaining 1470 patients,1420 had their colostomy performed at another institution (group A) and 50 did at our institution (group B) using a specific technique with separated stomas in the descending colon. Results:There were 616 complications identified in 464 patients of group A and in 4 patients in group B,an incidence of 33% vs 8% (P < 0.01). Complications in group A were classified into several groups. The first group was mislocation (282 cases),including 116 with stomas too close to each other,97 with stomas located too distally in the rectosigmoid (which interfered with the pullthrough),30 with inverted stomas,21 with stomas too far apart from each other,and 18 with right upper sigmoidostomies. The second largest group was prolapse (119 cases),which occurred mainly in mobile portions of the colon. The third group was composed of general surgical complications after colostomy closure (82 cases),such as intestinal obstruction (47 cases),wound infection (13 cases),incisional hernia (11 cases),anastomotic dehiscence (7 cases),sepsis (3 cases),and bleeding (1 case). Two of the septic patients died. Another group included 62 patients who received a Hartmann’s procedure,which we considered to be contraindicated in anorectal malformations. A total of 42 patients suffered from stenosis of the stoma; 29,from retraction. Conclusions:Most colostomy complications are preventable using separated stomas in the descending colon. Mislocated stomas lead to problems with appliance application,interference with the pull-through,megasigmoid,distal fecal impaction,and urinary tract infections. Loop colostomies lead to urinary tract infections,distal fecal impaction,and prolapse. Prolapse is a potentially dangerous complication that mostly occurs when the stoma is placed in a mobile portion of the colon. Recognizing this makes the complication preventable by trying to create colostomies in fixed portions of the colon or by fixing the bowel to the abdominal wall when necessary. The trend to avoid colostomies is justified; however,colostomy is the best way to prevent complications in anorectal surgery and,when indicated,should be done wit h a meticulous technique following strict rules to avoid complications.展开更多
Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis(CL) or for malaria in Fars province, Iran in 2016. Methods: ...Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis(CL) or for malaria in Fars province, Iran in 2016. Methods: Using time-series data including 29 177 CL cases recorded during 2010-2015 and 357 malaria cases recorded during 2010-2015, CL and malaria cases were predicted in 2016. Predicted cases were used to verify if they followed uniform distribution over time and space using space-time analysis. To testify the uniformity of distributions, permutation scan statistics was applied prospectively to detect statistically significant and non-significant outbreaks. Finally, the findings were compared to determine whether permutation scan statistics worked better for CL or for malaria in the area. Prospective permutation scan modeling was performed using SatScan software. Results: A total of 5 359 CL and 23 malaria cases were predicted in 2016 using time-series models. Applied timeseries models were well-fitted regarding auto correlation function, partial auto correlation function sample/model, and residual analysis criteria(Pv was set to 0.1). The results indicated two significant prospective spatial-temporal outbreaks for CL(P<0.5) including Most Likely Clusters, and one non-significant outbreak for malaria(P>0.5) in the area. Conclusions: Both CL and malaria follow a space-time trend in the area, but prospective permutation scan modeling works better for detecting CL spatial-temporal outbreaks. It is not far away from expectation since clusters are defined as accumulation of cases in specified times and places. Although this method seems to work better with finding the outbreaks of a high-frequency disease; i.e., CL, it is able to find non-significant outbreaks. This is clinically important for both high-and low-frequency infections; i.e., CL and malaria.展开更多
Apolipoprotein A-I(Apo A-I),the main protein component of high-density lipoprotein(HDL),plays a pivotal role in reverse cholesterol transport(RCT).Previous studies indicated a reduction of serum Apo A-I levels in vari...Apolipoprotein A-I(Apo A-I),the main protein component of high-density lipoprotein(HDL),plays a pivotal role in reverse cholesterol transport(RCT).Previous studies indicated a reduction of serum Apo A-I levels in various types of cancer,suggesting Apo A-I as a potential cancer biomarker.Herein,ectopically overexpressed Apo A-I in MDA-MB-231 breast cancer cells was observed to have antitumor effects,inhibiting cell proliferation and migration.Subsequent studies on the mechanism of expression regulation revealed that estradiol(E2)/estrogen receptorα(ERα)signaling activates Apo A-I gene transcription in breast cancer cells.Mechanistically,our Ch IP-seq data showed that ERαdirectly binds to the estrogen response element(ERE)site within the Apo A-I gene and establishes an acetylation of histone 3 lysine 27(H3 K27 ac)-enriched chromatin microenvironment.Conversely,Fulvestrant(ICI 182780)treatment blocked ERαbinding to ERE within the Apo A-I gene and downregulated the H3 K27 ac level on the Apo A-I gene.Treatment with p300 inhibitor also significantly decreased the Apo A-I messenger RNA(m RNA)level in MCF7 cells.Furthermore,the analysis of data from The Cancer Genome Atlas(TCGA)revealed a positive correlation between ERαand Apo A-I expression in breast cancer tissues.Taken together,our study not only revealed the antitumor potential of Apo A-I at the cellular level,but also found that ERαpromotes the transcription of Apo A-I gene through direct genomic effects,and p300 may act as a co-activator of ERαin this process.展开更多
Objective: To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29 201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and...Objective: To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29 201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and the endemic values of cutaneous leishmaniasis were determined by retrospective clusters derived from spatiotemporal permutation modeling on a time-series design. The accuracy of the values was assessed using receiver operating characteristic(ROC) curve. SPSS version 22, Arc GIS, and ITSM 2002 software tools were used for analysis. Results: Nine statistically significant retrospective clusters(P<0.05) resulted in finding seven significant and accurate endemic values(P<0.1). These valid endemic scores were generalized to the other 18 cities based on 6 different climates in the province. Conclusions: Retrospectively detected clusters with the help of ROC curve analysis could help determine cutaneous leishmaniasis endemic values which are essential for future prediction and prevention policies in the area.展开更多
文摘BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate of AL,their preventive effects are controversial.AIM To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.METHODS A systematic search of major medical databases was conducted to identify studies up to June 2024.Intraoperative and postoperative outcomes were assessed;the primary outcome assessed was the incidence of AL.Pooled odds ratios(ORs)and mean differences(MDs)with a 95%confidence interval(CI)were calculated using fixed-effect or random-effect models under heterogeneity.RESULTS This meta-analysis incorporated 20 studies involving 3726 patients.Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group(OR:0.26,95%CI:0.19-0.35,P<0.001)than the unreinforced suture group.The reinforced suture group also exhibited a shorter hospital stay(MD:-1.17,95%CI:-1.78 to-0.57,P<0.001),earlier anal exhaust(MD:-0.13,95%CI:-0.22 to-0.05,P=0.002),longer operative time(MD:15.25,95%CI:10.71-19.80,P<0.001),lower infection rate(OR:0.54,95%CI:0.29-1.00,P=0.05)and lower reoperation rate(OR:0.19,95%CI:0.08-0.45,P<0.001).CONCLUSION The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence postrectal cancer surgery.Nevertheless,these conclusions warrant verification through additional high-quality randomized controlled trials.
文摘BACKGROUND Gastric cancer is the fifth most common cancer and the fourth leading cause of death worldwide.Most cases of newly diagnosed gastric cancer involve not only locally advanced tumor growth and regional lymph node metastases but also distant metastases.We report a rare case finding of a mass in the right inguinal area which is derived from gastric cancer.CASE SUMMARY A 68-year-old male initially diagnosed with an inguinal hernia presented with a 2 cm mass in the right inguinal area.Gastrointestinal symptoms led to the discovery of a stomach tumor.Biopsy confirmed gastrointestinal adenocarcinoma.The diagnosis was advanced gastric cancer with peritoneal dissemination,and the inguinal mass was due to direct infiltration.Due to gastrointestinal bleeding,the patient underwent palliative gastrectomy and lymph node dissection.Postoperatively,the patient received hyperthermic intraperitoneal chemotherapy and localized radiation therapy.CONCLUSION This case indicates that a systematic evaluation should be conducted during the initial consultation to explore the potential connection between unrecognized distant masses and the primary tumor.
基金The Science and Technology Bureau of Wuhu,Anhui Province,China,Under The Key Research and Development and Achievement Transformation Project,No.2023yf099.
文摘BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-negative BC in the ascending colon who underwent laparoscopic radical right hemicolectomy.The patient had undergone left modified radical mastectomy only 15 months ago and stopped chemotherapy just 3 months ago.The diagnosis of CMBC was made based on the previous history of BC and positive results of several specific immunohistochemical markers(gross cystic disease fluid protein 15,mammaglobin,GATA-binding protein 3,and cytokeratin 7)for breast carcinoma.CONCLUSION CMBC should be highly cautious in patients with a previous history of BC,especially triple-negative BC,and further examination to aid in diagnosis.
基金funded by Chinese NSFC(Grant Nos.:82373336,82303238,and U22A20311,Sichuan Science and Technology Department,China(GrantNos.:2024NSFSC1945,,and 2023NSFSC0667)the Third People's Hospital of Chengdu Clinical Research Program,China(Grant Nos.:CSY-YN-01-2023-013,CSYYN-01-2023-005,and CSY-YN-03-2024-003)+1 种基金Sichuan University“From O to 1”Innovative Research Project,China(Project No.:2023SCUH0024)Health Commission of Chengdu,China(Grant No.:2024291).
文摘Age-related macular degeneration(AMD)is a disease that affects the vision of elderly individuals worldwide.Although current therapeutics have shown effectiveness against AMD,some patients may remain unresponsive and continue to experience disease progression.Therefore,in-depth knowledge of the mechanism underlying AMD pathogenesis is urgently required to identify potential drug targets for AMD treatment.Recently,studies have suggested that dysfunction of mitochondria can lead to the aggregation of reactive oxygen species(ROS)and activation of the cyclic GMP-AMP synthase(cGAS)/stimulator of interferon genes(STING)innate immunity pathways,ultimately resulting in sterile inflammation and cell death in various cells,such as cardiomyocytes and macrophages.Therefore,combining strategies targeting mitochondrial dysfunction and inflammatory mediators may hold great potential in facilitating AMD management.Notably,emerging evidence indicates that natural products targeting mitochondrial quality control(MQC)and the cGAS/STING innate immunity pathways exhibit promise in treating AMD.Here,we summarize phytochemicals that could directly or indirectly influence the MQC and the cGAS/STING innate immunity pathways,as well as their interconnected mediators,which have the potential to mitigate oxidative stress and suppress excessive inflammatory responses,thereby hoping to offer new insights into therapeutic interventions for AMD treatment.
文摘AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpatients,40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography(CT)were enrolled.The decision to perform a lung operation was made if the patient met the following criteria:(1)completely resected or resectable primary CRC;(2)completely resectable IPNs;(3)controlled or controllable extrapulmonary metastasis;and(4)adequate general condition and pulmonary function to tolerate pulmonary operation.Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation.RESULTS:A total of 40 cases of lung resection was performed in 29 patients.Five patients underwent repeated lung resection.The final pathology result showed metastasis from the CRC in 30 cases(75%)and benign pathology in 10 cases(25%).The primary tumor site was the rectum in 26/30(86.6%)cases with pulmonary metastasis,but only 3/10(30%)cases in the benign group had a primary rectal cancer(P=0.001).Positron emission tomography(PET)-CT was performed for 22/30(73.4%)patients in the lung metastasis group and for 6/10(60.0%)patients in the benign group.PET-CT revealed hot uptake of18fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups.The group with pulmonary metastasis had a higher incidence of primary rectal cancer(P=0.001),a more advanced tumor stage(P=0.011),and more frequent lymphatic invasion of tumor cells(P=0.005).Six cases with previous liver metastasectomy were present in the lung metastasis group.Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients.CONCLUSION:The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.
文摘AIM:To detect the expression of tumor necrosis factor-a(TNF-a)in colorectal cancer(CRC)cells among Saudi patients,and correlate its expression with clinical stages of cancer.METHODS:Archival tissue specimens were collected from 30 patients with CRC who had undergone surgical intervention at King Khalid University Hospital.Patient demographic information,including age and gender,tumor sites,and histological type of CRC,was recorded.To measure TNF-a m RNA expression in CRC,total RNA was extracted from tumor formalin-fixed,paraffinembedded,and adjacent normal tissues.Reverse transcription and reverse transcription polymerase chain reaction were performed.Colorectal tissue microarrays were constructed to investigate the protein expression of TNF-a by immunohistochemistry.RESULTS:The relative expression of TNF-a m RNA in colorectal cancer was significantly higher than that seen in adjacent normal colorectal tissue.High TNF-a gene expression was associated with StageⅢandⅣneoplasms when compared with earlier tumor stages(P=0.004).Eighty-three percent of patients(25/30)showed strong TNF-a positive staining,while only 10%(n=3/30)of patients showed weak staining,and 7%(n=2/30)were negative.We showed the presence of elevated TNF-a gene expression in cancer cells,which strongly correlated with advanced stages of tumor.CONCLUSION:High levels of TNF-a expression could be an independent diagnostic indicator of colorectal cancer,and targeting TNF-a might be a promising prognostic tool by assessment of the clinical stages of CRC.
文摘BACKGROUND In recent years,the predictive role of YKL-40 for long-term survival in colorectal cancer patients has been gradually investigated.However,whether it is a reliable and valuable prognostic indicator for patients with colorectal carcinoma has not been verified.AIM To identify the prognostic value of serum/plasma concentration of YKL-40 or expression status of YKL-40 in tumor cells in colorectal carcinoma patients.METHODS Several electronic databases including the PubMed,EMBASE,Web of Science,CNKI,VIP and WanFang were searched for relevant studies.The hazard ratios(HR)and 95%confidence intervals(CI)were combined and the primary and secondary outcomes were overall survival(OS)and progression-free survival(PFS),respectively.All statistical analysis were conducted by STATA 15.0 software.RESULTS A total of nine studies involving 2545 patients were included.The pooled results indicated that YKL-40 was significantly associated with poor OS(HR=1.80,95%CI:1.32-2.45,P<0.001)and PFS(HR=1.62,95%CI:1.22-2.16,P=0.001).Subgroup analysis stratified by the treatment,tumor type and source of YKL-40 showed similar results.CONCLUSION Elevated serum/plasma concentration of YKL-40 or positive expression in tumor cells was related with worse prognosis of colorectal carcinoma patients.YKL-40 might serve as a novel and reliable indicator for the evaluation of prognosis in colorectal cancer.
文摘BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC)becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surgery for these elderly patients can be challenging.An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.METHODS In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database.Patients with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis.The primary outcome was overall 3-year overall survival(OS)following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South Korea.Statistical analyses were performed using Stata/MP Version 15.1.RESULTS A total of 1267 patients were identified for analysis.The median post-operative length of stay was 8[interquartile range(IQR)6-12]d and median follow-up duration was 47(IQR 19-75)mo.Median OS was 78(IQR 65-85)mo.Following multivariate analysis,the factors significant for predicting overall mortality were serum albumin<35 g/dL,serum carcinoembryonic antigen≥20μg/L,T stage 3 or 4,moderate tumor cell differentiation or worse,mucinous histology,rectal tumors,and pre-existing chronic obstructive lung disease.Advanced age alone was not found to be significant.The Korean cohort consisted of 910 patients.The Singapore cohort exhibited a poorer OS,likely due to a higher proportion of advanced cancers.Despite the clinicopathologic differences,there was successful validation of the model following recalibration.An interactive online calculator was designed to facilitate post-operative survival prediction,available at http://bit.ly/sgh_crc.The main limitation of the study was selection bias,as patients who had undergone surgery would have tended to be physiologically fitter.CONCLUSION This novel scoring system generates an individualized survival probability following colorectal resection and can assist in the decision-making process.Validation with an external population strengthens the generalizability of this model.
基金Supported by the National Natural Science Foundation of China,No.81602145 and No.82072704Jiangsu Province TCM Science and Technology Development Plan Monographic Project,No.ZT202118+6 种基金Jiangsu Provincial Natural Science Foundation,No.BK20171509China Postdoctoral Science Foundation,No.2018M632265The“333 Talents”Program of Jiangsu Province,No.BRA2020390Key R&D Plan of Jiangsu Provincial Department of Science and Technology,No.BE2020723Nanjing Medical University Project,No.NMUC2020046Nanjing Science and Technology Project,No.202110027Elderly Health Research Project of Jiangsu Provincial Health Commission,No.LR2022006.
文摘BACKGROUND Lymph node(LN)staging in rectal cancer(RC)affects treatment decisions and patient prognosis.For radiologists,the traditional preoperative assessment of LN metastasis(LNM)using magnetic resonance imaging(MRI)poses a challenge.AIM To explore the value of a nomogram model that combines Conventional MRI and radiomics features from the LNs of RC in assessing the preoperative metastasis of evaluable LNs.METHODS In this retrospective study,270 LNs(158 nonmetastatic,112 metastatic)were randomly split into training(n=189)and validation sets(n=81).LNs were classified based on pathology-MRI matching.Conventional MRI features[size,shape,margin,T2-weighted imaging(T2WI)appearance,and CE-T1-weighted imaging(T1WI)enhancement]were evaluated.Three radiomics models used 3D features from T1WI and T2WI images.Additionally,a nomogram model combining conventional MRI and radiomics features was developed.The model used univariate analysis and multivariable logistic regression.Evaluation employed the receiver operating characteristic curve,with DeLong test for comparing diagnostic performance.Nomogram performance was assessed using calibration and decision curve analysis.RESULTS The nomogram model outperformed conventional MRI and single radiomics models in evaluating LNM.In the training set,the nomogram model achieved an area under the curve(AUC)of 0.92,which was significantly higher than the AUCs of 0.82(P<0.001)and 0.89(P<0.001)of the conventional MRI and radiomics models,respectively.In the validation set,the nomogram model achieved an AUC of 0.91,significantly surpassing 0.80(P<0.001)and 0.86(P<0.001),respectively.CONCLUSION The nomogram model showed the best performance in predicting metastasis of evaluable LNs.
文摘BACKGROUND High complex anal fistulas are epithelialized tunnels,with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line.Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring.Postoperative loss of anal function can cause physical and mental damage.Transanal opening of the intersphincteric space(TROPIS)is an effective procedure that completely preserves the external anal sphincter.However,its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications.On the basis of our clinical experience,we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.CASE SUMMARY A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS,which involved sepsis drainage and identification of the internal opening in the intersphincteric space.The patient with the high complex anal fistula recovered well postoperatively,without any postoperative complications or anal dysfunction.Anal function returned to normal after 17 months of follow-up.CONCLUSION The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function.It allows the complete removal of infected anal glands and reduces the risk of postoperative complications.Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.
基金Natural Science Foundation of Sichuan Province,No.2021YFS1834。
文摘BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields in surgical operations.AIM To illustrate the major areas of research and forward-looking directions over the past twenty-six years.METHODS Using the Web of Science Core Collection database,a comprehensive review of scholarly articles pertaining to robot-assisted gastrointestinal and liver surgery was researched out between 2000 and 2023.We used Citespace(Version 6.2.4)and Bibliometrix package(Version 4.3.0)to visualize the analysis of all publications including country,institutional affiliations,authors,and keywords.RESULTS In total,346 articles were retrieved.Surgical Endoscopy had with the largest number of publications and was cited in this field.The United States was a core research country in this field.Yonsei University was the most productive institution.The current focus of this field is on rectal surgery,long-term prognosis,perioperative management,previous surgical experience,and the learning curve.CONCLUSION The scientific interest in robot-assisted gastrointestinal and liver surgery has experienced a significant rise since 1997.This study provides new perspectives and ideas for future research in this field.
基金Supported by National Nature Science Foundation of China,No.3097383 and No.81273944grants from The Nanjing Medical Technology Development Project,No.NJYX201203
文摘AIM: To determine the accuracy of endoscopic polyp size measurements using disposable graduated biopsy forceps(DGBF). METHODS: Gradations accurate to 1 mm were assessed with the wire of disposable graduated biopsy forceps. When a polyp was noted, endoscopists determined the width of the polyp; then, the graduated biopsy forceps was inserted and the largest diameter of the tumor was measured. After excision, during surgery or endoscopy, the polyp was measured using the vernier caliper.RESULTS: One hundred and thirty-three colorectal polyps from 119 patients were studied. The mean diameter, by post-polypectomy measurement, was 0.92 ± 0.69 cm; 83 were < 1 cm, 36 were between 1 and 2 cm, and 14 were > 2 cm. The mean diameter, by visual estimation, was 1.15 ± 0.88 cm; compared to the actual size measured using vernier calipers, the difference was statistically significant. The mean diameter measured using the DGBF was 0.93 ± 0.68 cm; compared to the actual size measured using vernier calipers, this difference was not statistically significant. The ratio between the mean size estimated by visual estimation and the actual size was significantly different from that between the mean size estimated using the DGBF and the actual size(1.26 ± 0.30 vs 1.02 ± 0.11).CONCLUSION: The accuracy of polyp size estimation was low by visual assessment; however, it improved when the DGBF was used.
基金Supported by National Nature Science Foundation of China,No.30973837,No.81273944the Nanjing Medical Technology Development Project,No.NJYX201203
文摘AIM:To assess the accuracy of polyp size using an endoscopic lesion measurement system(ELMS).METHODS:The accuracy of polyp size assessment was compared among measurements acquired by visual estimation,disposable graduated biopsy forceps(DGBF;used as a"scale-plate")and the ELMS.RESULTS:There were 192 polyps from 166 cases included in this study.The mean diameter of the post polypectomy measurement was 0.85±0.53 cm(range:0.2-3.0 cm).The mean diameter by visual estimation was 1.10±0.53 cm,which was significantly different compared to the actual size of the polyp(P<0.001).The mean diameters obtained using DGBF(0.87±0.54cm)and ELMS(0.85±0.53 cm)did not significantly differ from the actual size of the polyp.The difference between the measurements from the ELMS and DGBF was not significant.CONCLUSION:Unlike visual estimations at colonoscopy,endoscopic graduated biopsy forceps and the endoscopic lesion measurement system are accurate methods to estimate polyp size.
基金Supported by Grant from the Baqiyatallah University of Medical Sciences
文摘AIM： To systematically review the literature for studies investigating the potential effect of gender of dialysis patients on the immunogenicity of hepatitis B virus vaccines. METHODS： Literature searches were conducted by the MEDLINE and Google Scholar. The key words used included “hepatitis B （HB）”, “vaccine”, “dialysis”, “hemodialysis”, “sex”, “male” and “female”. Data of seroresponse to HB vaccine in clinical trials regarding sex of the recipients have been achieved and analyzed. Finally data from 19 clinical trials have been pooled and analyzed.RESULTS： Analysis of response to HB vaccination in our dialysis population showed males significantly res-pond less to hepatitis B vaccination （P = 0.002, Z = 3.08） with no significant heterogeneity detected [P = 0.766; heterogeneity χ2 = 14.30 （df = 19）; I2 = 0%]. A reanalysis of the pooled data was conducted regarding the dialysis mode to evaluate potential differential impact of sex on HB vaccine response. Hemodialysis was the only subgroup that showed a signifcant difference regarding dialysis mode in response to HB vaccination regarding sex （ P = 0.042, Z = 2.03）.CONCLUSION： This Meta-analysis showed significant effect for the sex of chronic kidney disease and dialysis patients on the immunogenicity of HB vaccine. This sex discrimination was most prominent among hemodialysis patients.
文摘BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infections that originate from these.Furthermore,the complete resection of this cyst is curative.We report our diagnostic and treatment experience with one case of malignant transformation of a perianal tailgut cyst,which was initially misdiagnosed as perianal abscess.CASE SUMMARY A 72-year-old woman visited our institution with complaints of a refractory nonhealing lesion on the right hip,which repeatedly broke and suppurated for more than 70 years,and aggravated in 4 mo.The patient was given a diagnosis of refractory perianal abscess with repeated incision and drainage procedures.Computed tomography of the pelvic cavity revealed a giant perianal cyst.Subsequent biopsy revealed a tumor with moderate-to-severe glandular epithelial dysplasia,and suggested that this was derived from the developmental cysts in the posterior rectal space.After further clarifying the nature and extent of the tumor by magnetic resonance imaging,total cystic resection was performed.Postoperative histopathological examination confirmed the malignancy,dictating the investigators to add postoperative chemotherapy to the treatment regimen.CONCLUSION The malignant transformation of perianal tailgut cysts is very uncommon,and this should be differentiated from perianal abscess.Complete surgical removal is curative,and postoperative pathology may determine the necessity of additional postoperative chemotherapy or radiotherapy,which may be beneficial for preventing local recurrence and metastasis.
基金supported by the National Natural Science Foundation of China(NSFC)[81672119 and 81725010 to W.Z.]W Z is a scholar of‘the National Science Fund for Distinguished Young Scholars’(NSFC)[81725010]+4 种基金the Strategic Priority Research Program of the Chinese Academy of Science(XDA16020400 to P.H.)Ministry of Science and Technology of China(2017YFA0102700 to P.H.)National Natural Science Foundation of China(32170804 to PH)P.H.the fellowship of China Postdoctoral Science Foundation(2021TQ0207,2021M702184 to J.S.)the‘Basic research project of Shanghai Sixth People’s Hospital’(ynqn202102 to J.S.)。
文摘Osteoporosis caused by aging is characterized by reduced bone mass and accumulated adipocytes in the bone marrow cavity. How the balance between osteoblastogenesis and adipogenesis from bone marrow mesenchymal stem cells(BMSCs) is lost upon aging is still unclear. Here, we found that the RNA-binding protein Musashi2(Msi2) regulates BMSC lineage commitment. Msi2 is commonly enriched in stem cells and tumor cells. We found that its expression was downregulated during adipogenic differentiation and upregulated during osteogenic differentiation of BMSCs. Msi2 knockout mice exhibited decreased bone mass with substantial accumulation of marrow adipocytes, similar to aging-induced osteoporosis. Depletion of Msi2 in BMSCs led to increased adipocyte commitment. Transcriptional profiling analysis revealed that Msi2 deficiency led to increased PPARγ signaling.RNA-interacting protein immunoprecipitation assays demonstrated that Msi2 could inhibit the translation of the key adipogenic factor Cebpα, thereby inhibiting PPAR signaling. Furthermore, the expression of Msi2 decreased significantly during the aging process of mice, indicating that decreased Msi2 function during aging contributes to abnormal accumulation of adipocytes in bone marrow and osteoporosis. Thus, our results provide a putative biochemical mechanism for aging-related osteoporosis, suggesting that modulating Msi2 function may benefit the treatment of bone aging.
文摘Purpose:Colostomy for patients with anorectal malformations decompresses an obstructed colon,avoids fecal contamination of the urinary tract,and protects a future perineal operation. The procedure is associated with several significant complications. Materials and Methods:The medical records of 1700 cases of anorectal malformations were retrospectively reviewed. A total of 230 patients underwent reconstruction without a colostomy. Of the remaining 1470 patients,1420 had their colostomy performed at another institution (group A) and 50 did at our institution (group B) using a specific technique with separated stomas in the descending colon. Results:There were 616 complications identified in 464 patients of group A and in 4 patients in group B,an incidence of 33% vs 8% (P < 0.01). Complications in group A were classified into several groups. The first group was mislocation (282 cases),including 116 with stomas too close to each other,97 with stomas located too distally in the rectosigmoid (which interfered with the pullthrough),30 with inverted stomas,21 with stomas too far apart from each other,and 18 with right upper sigmoidostomies. The second largest group was prolapse (119 cases),which occurred mainly in mobile portions of the colon. The third group was composed of general surgical complications after colostomy closure (82 cases),such as intestinal obstruction (47 cases),wound infection (13 cases),incisional hernia (11 cases),anastomotic dehiscence (7 cases),sepsis (3 cases),and bleeding (1 case). Two of the septic patients died. Another group included 62 patients who received a Hartmann’s procedure,which we considered to be contraindicated in anorectal malformations. A total of 42 patients suffered from stenosis of the stoma; 29,from retraction. Conclusions:Most colostomy complications are preventable using separated stomas in the descending colon. Mislocated stomas lead to problems with appliance application,interference with the pull-through,megasigmoid,distal fecal impaction,and urinary tract infections. Loop colostomies lead to urinary tract infections,distal fecal impaction,and prolapse. Prolapse is a potentially dangerous complication that mostly occurs when the stoma is placed in a mobile portion of the colon. Recognizing this makes the complication preventable by trying to create colostomies in fixed portions of the colon or by fixing the bowel to the abdominal wall when necessary. The trend to avoid colostomies is justified; however,colostomy is the best way to prevent complications in anorectal surgery and,when indicated,should be done wit h a meticulous technique following strict rules to avoid complications.
文摘Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis(CL) or for malaria in Fars province, Iran in 2016. Methods: Using time-series data including 29 177 CL cases recorded during 2010-2015 and 357 malaria cases recorded during 2010-2015, CL and malaria cases were predicted in 2016. Predicted cases were used to verify if they followed uniform distribution over time and space using space-time analysis. To testify the uniformity of distributions, permutation scan statistics was applied prospectively to detect statistically significant and non-significant outbreaks. Finally, the findings were compared to determine whether permutation scan statistics worked better for CL or for malaria in the area. Prospective permutation scan modeling was performed using SatScan software. Results: A total of 5 359 CL and 23 malaria cases were predicted in 2016 using time-series models. Applied timeseries models were well-fitted regarding auto correlation function, partial auto correlation function sample/model, and residual analysis criteria(Pv was set to 0.1). The results indicated two significant prospective spatial-temporal outbreaks for CL(P<0.5) including Most Likely Clusters, and one non-significant outbreak for malaria(P>0.5) in the area. Conclusions: Both CL and malaria follow a space-time trend in the area, but prospective permutation scan modeling works better for detecting CL spatial-temporal outbreaks. It is not far away from expectation since clusters are defined as accumulation of cases in specified times and places. Although this method seems to work better with finding the outbreaks of a high-frequency disease; i.e., CL, it is able to find non-significant outbreaks. This is clinically important for both high-and low-frequency infections; i.e., CL and malaria.
基金supported by the National Natural Science Foundation of China(Nos.81672785,31871291,and82073113 to Li TAN)the National Key R&D Project of China(No.2016YFA0101800 to Li TAN)supported by the Innovative Research Team of High-level Local University in Shanghai。
文摘Apolipoprotein A-I(Apo A-I),the main protein component of high-density lipoprotein(HDL),plays a pivotal role in reverse cholesterol transport(RCT).Previous studies indicated a reduction of serum Apo A-I levels in various types of cancer,suggesting Apo A-I as a potential cancer biomarker.Herein,ectopically overexpressed Apo A-I in MDA-MB-231 breast cancer cells was observed to have antitumor effects,inhibiting cell proliferation and migration.Subsequent studies on the mechanism of expression regulation revealed that estradiol(E2)/estrogen receptorα(ERα)signaling activates Apo A-I gene transcription in breast cancer cells.Mechanistically,our Ch IP-seq data showed that ERαdirectly binds to the estrogen response element(ERE)site within the Apo A-I gene and establishes an acetylation of histone 3 lysine 27(H3 K27 ac)-enriched chromatin microenvironment.Conversely,Fulvestrant(ICI 182780)treatment blocked ERαbinding to ERE within the Apo A-I gene and downregulated the H3 K27 ac level on the Apo A-I gene.Treatment with p300 inhibitor also significantly decreased the Apo A-I messenger RNA(m RNA)level in MCF7 cells.Furthermore,the analysis of data from The Cancer Genome Atlas(TCGA)revealed a positive correlation between ERαand Apo A-I expression in breast cancer tissues.Taken together,our study not only revealed the antitumor potential of Apo A-I at the cellular level,but also found that ERαpromotes the transcription of Apo A-I gene through direct genomic effects,and p300 may act as a co-activator of ERαin this process.
文摘Objective: To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29 201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and the endemic values of cutaneous leishmaniasis were determined by retrospective clusters derived from spatiotemporal permutation modeling on a time-series design. The accuracy of the values was assessed using receiver operating characteristic(ROC) curve. SPSS version 22, Arc GIS, and ITSM 2002 software tools were used for analysis. Results: Nine statistically significant retrospective clusters(P<0.05) resulted in finding seven significant and accurate endemic values(P<0.1). These valid endemic scores were generalized to the other 18 cities based on 6 different climates in the province. Conclusions: Retrospectively detected clusters with the help of ROC curve analysis could help determine cutaneous leishmaniasis endemic values which are essential for future prediction and prevention policies in the area.
