AIM: To evaluate the relationship between lymph node micrometastases and prognosis of patients with gastric carcinoma and to evaluate the significance of the new assessment of nodal status in determining the pN catego...AIM: To evaluate the relationship between lymph node micrometastases and prognosis of patients with gastric carcinoma and to evaluate the significance of the new assessment of nodal status in determining the pN categories in the 5th edition of the UICC TNM classification. METHODS: A total of 850 lymph nodes from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenectomy were assessed by reverse transcription polymerase chain reaction assay in addition to histologic examination. Cytokeratin-20 gene marker was used in this assay. RESULTS: Routine examination by HE staining confirmed metastasis in 233 lymph nodes from 20 patients. All these 233 lymph nodes were cytokeratin-20 positive. Moreover, lymph node micrometastases were detected in an additional 67 lymph nodes in 12 of these 20 patients. Lymph node micrometastases were also detected in 10 lymph nodes from 2 of 10 patients who had no obvious metastases identified by HE staining. Totally, lymph node micrometastases were identified by the reverse transcription polymerase chain reaction assay in 77 (12.5%) lymph nodes from 14 (46.7%) patients with gastric carcinoma. Of 27 patients who underwent curative resection, 7 (25.9%) were up-staged (fromⅠB stage to Ⅱ stage in 1 patient, from IB stage to ⅢA stage in 1 patient, from Ⅱ stage to ⅢA stage in 1 patient, from ⅢA stage to ⅢB stage in 1 patient, from ⅢA stage to Ⅳ stage in 1 patient, from ⅢB stage to Ⅳ stage in 2 patients). In a median follow-up of 32(range 8-36) mo, Kaplan-Meier survival analysis showed significant improvements in median survival (22.86 ± 3.17 mo, 95% CI: 16.64-29.08 mo vs 18.00 ± 7.4 mo, 95% CI: 3.33-32.67 mo) of patients with negative lymph node micrometastases over patients with positive lymph node micrometastases (log-rank, P < 0.05). CONCLUSION: Lymph node micrometastases have a significant impact on the current staging system of gastric carcinoma, and are significant risk factors for prognosis of patients with gastric carcinoma.展开更多
AIM: To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benef it from lateral lymph node dissecti...AIM: To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benef it from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHODS: A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identif ied. RESULTS: Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter ≥ 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically signifi cant (χ2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor inf iltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (χ2 = 27.944, P = 0.0001). The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (χ2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically signif icant (χ2 = 22.308, P = 0.0001). Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 ± 2.1 m, 95% CI: 76.7-85.1 m vs 38 ± 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001). CONCLUSION: Tumor diameter, infiltration and differentiation are signif icant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter ≥ 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.展开更多
Isoflavones constitute a class of plant hormones including genistein,daidzein,glycitein,formononetin,biochanin A,and irilone,and the major source of human intake is soybeans.Inflammatory bowel disease(IBD)is a chronic...Isoflavones constitute a class of plant hormones including genistein,daidzein,glycitein,formononetin,biochanin A,and irilone,and the major source of human intake is soybeans.Inflammatory bowel disease(IBD)is a chronic recurrent inflammatory disease including ulcerative colitis,Crohn’s disease,and indeterminate colitis,which seriously affects the quality of life of patients and has become a global health problem.Although the pathogenesis of IBD is not very clear,many factors are thought to be related to the occurrence and development of IBD such as genes,immunity,and intestinal flora.How to control IBD effectively for a long time is still a problem for gastroenterologists.Diet has an important effect on IBD.Patients with IBD should pay more attention to diet.To date,many studies have reported that isoflavones have both good and bad effects on IBD.Isoflavones have many activities such as regulating the inflammatory signal pathways and affecting intestinal barrier functions and gut flora.They can also act through estrogen receptors,as they have a similar structure to estrogen.Isoflavones are easy to get from diet for human.Whether they are valuable to be applied to the treatment of IBD is worth studying.This review summarizes the relationship between isoflavones and IBD.展开更多
Pituitary stalk interruption syndrome(PSIS)is a rare congenital abnormality characterized by thinning or disappearance of the pituitary stalk,hypoplasia of the anterior pituitary and an ectopic posterior pituitary.Alt...Pituitary stalk interruption syndrome(PSIS)is a rare congenital abnormality characterized by thinning or disappearance of the pituitary stalk,hypoplasia of the anterior pituitary and an ectopic posterior pituitary.Although the etiology of PSIS is still unclear,gene changes and perinatal adverse events such as breech delivery may play important roles in the pathogenesis of PSIS.PSIS can cause multiple hormone deficiencies,such as growth hormone,which then cause a series of changes in the human body.On the one hand,hormone changes affect growth and development,and on the other hand,they could affect human metabolism and subsequently the liver resulting in nonalcoholic fatty liver disease(NAFLD).Under the synergistic effect of multiple mechanisms,the progression of NAFLD caused by PSIS is faster than that due to other causes.Therefore,in addition to early identification of PSIS,timely hormone replacement therapy and monitoring of relevant hormone levels,clinicians should routinely assess the liver function while managing PSIS.展开更多
AIM: To clarify the relationship between circumferential resection margin status and local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma. The relationship between circum...AIM: To clarify the relationship between circumferential resection margin status and local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma. The relationship between circumferential resection margin status and clinicopathologic characteristics of middle and lower rectal carcinoma was also evaluated. METHODS: Cancer specimens from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. RESULTS: Local recurrence occurred in 12.5% (7 of 56 cases) of patients with middle and lower rectal carcinoma. Distant recurrence occurred in 25% (14 of 56 cases) of patients with middle and lower rectal carcinoma. Twelve patients (21.4%) had positive circumferential resection margin. Local recurrence rate of patients with positive circumferential resection margin was 33.3% (4/12), whereas it was 6.8% (3/44) in those with negative circumferential resection margin (P = 0.014). Distant recurrence was observed in 50% (6/12) of patients with positive circumferential resection margin; conversely, it was 18.2% (8/44) in those with negative circumferential resection margin (P = 0.024). Kaplan-Meier survival analysis showed significant improvements in median survival (32.2 ± 4.1 mo, 95% CI: 24.1-40.4mo vs 23.0 ± 3.5 mo, 95% CI: 16.2-29.8 mo) for circumferential resection margin-negative patients over circumferential resection margin-positive patients (log-rank, P < 0.05). 37% T3 tumors examined were positive for circumferential resection margin, while only 0% T1 tumors and 8.7% T2 tumors were examined as circumferential resection margin. The difference between these three groups was statistically significant (P = 0.021). In 18 cancer specimens with tumor diameter ≥ 5 cm 7 (38.9%) were detected as positive circumferential resection margin, while in 38 cancer specimens with a tumor diameter of < 5 cm only 5 (13.2%) were positive for circumferential resection margin (P = 0.028). CONCLUSION: Our findings indicate that circumferential resection margin involvement is significantly associated with depth of tumor invasion and tumor diameter. The circumferential resection margin status is an important predictor of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma.展开更多
AIM: To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS: Specimens of middle and lower rectal carcinoma from 56 patients who received curative resec...AIM: To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS: Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS: Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients (12.5%), and was significantly associated with family history (c2 = 3.929, P = 0.047), high CEA level (c2 = 4.964, P = 0.026), cancerous perforation (c2 = 8.503, P = 0.004), tumor differentiation (c2 = 9.315, P = 0.009) and vessel cancerous emboli (c2 = 11.879, P = 0.001). In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age (c2 = 0.506, P = 0.477), gender (c2 = 0.102, c2 = 0.749), tumor diameter (c2 = 0.421, P = 0.516),tumor infiltration (c2 = 5.052, P = 0.168), depth of tumor invasion (c2 = 4.588, P = 0.101), lymph node metastases (c2 = 3.688, P = 0.055) and TNM staging system (c2 = 3.765, P = 0.152). The local recurrence rate of middle and lower rectal carcinoma was 33.3% (4/12) in patients with positive circumferential resection margin and 6.8% (3/44) in those with negative circumferential resection margin. There was a significant difference between the two groups (c2 = 6.061, P = 0.014). Local recurrence of rectal carcinoma occurred in 6 of 36 patients (16.7%) with mesorectal metastasis, and in 1 of 20 patients (5.0%) without mesorectal metastasis. However, there was no significant difference between the two groups (c2 = 1.600, P = 0.206). CONCLUSION: Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.展开更多
Background Haemorrhages of brainstem cavernous malformations(CMs)can lead to neurological deficits,the natural history of which is uncertain.The study aimed to evaluate the neurological outcomes of untreated brainstem...Background Haemorrhages of brainstem cavernous malformations(CMs)can lead to neurological deficits,the natural history of which is uncertain.The study aimed to evaluate the neurological outcomes of untreated brainstem CMs and to identify the adverse factors associated with worsened outcomes.Methods From 2009 to 2015,698 patients(321 women)with brainstem CMs were entered into the prospective cohort after excluding patients lost to follow-up(n=43).All patients were registered,clinical data were collected and scheduled follow-up was performed.Results After a median follow-up of 60.9 months,prospective haemorrhages occurred in 167 patients(23.9%).The mean modified Rankin Scale scores at enrolment and at censoring time were 1.6 and 1.2.Neurological status was improved,unchanged and worsened in 334(47.9%),293(42.0%)and 71(10.2%)patients,respectively;233(33.4%)recovered to normal levels.Lesions crossing the axial midpoint(relative risk(RR)2.325,p=0.003)and developmental venous anomaly(DVA)(RR 1.776,p=0.036)were independently significantly related to worsened outcomes.The percentage of worsened outcomes was 5.3%(18 of 337)in low-risk patients(neither DVA nor crossing the axial point)and increased to 26.0%(13 of 50)in high-risk patients(with both DVA and crossing the axial point).The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased(from 1.5%(8 of 531,if 0 prospective ictus)to 37.5%(48 of 128,if 1 ictus)and 38.5%(15 of 39,if>1 ictus)).Conclusions The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients(89.8%)with a fatality rate of 1.7%in our cohort,which seemed to be favourable.Radiological features significantly predicted worsened outcomes.Our results provide evidence for clinical consultation and individualised treatment.The referral bias of our cohort was underlined.展开更多
基金Supported by the National Natural Science Foundation of China, No 30271276
文摘AIM: To evaluate the relationship between lymph node micrometastases and prognosis of patients with gastric carcinoma and to evaluate the significance of the new assessment of nodal status in determining the pN categories in the 5th edition of the UICC TNM classification. METHODS: A total of 850 lymph nodes from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenectomy were assessed by reverse transcription polymerase chain reaction assay in addition to histologic examination. Cytokeratin-20 gene marker was used in this assay. RESULTS: Routine examination by HE staining confirmed metastasis in 233 lymph nodes from 20 patients. All these 233 lymph nodes were cytokeratin-20 positive. Moreover, lymph node micrometastases were detected in an additional 67 lymph nodes in 12 of these 20 patients. Lymph node micrometastases were also detected in 10 lymph nodes from 2 of 10 patients who had no obvious metastases identified by HE staining. Totally, lymph node micrometastases were identified by the reverse transcription polymerase chain reaction assay in 77 (12.5%) lymph nodes from 14 (46.7%) patients with gastric carcinoma. Of 27 patients who underwent curative resection, 7 (25.9%) were up-staged (fromⅠB stage to Ⅱ stage in 1 patient, from IB stage to ⅢA stage in 1 patient, from Ⅱ stage to ⅢA stage in 1 patient, from ⅢA stage to ⅢB stage in 1 patient, from ⅢA stage to Ⅳ stage in 1 patient, from ⅢB stage to Ⅳ stage in 2 patients). In a median follow-up of 32(range 8-36) mo, Kaplan-Meier survival analysis showed significant improvements in median survival (22.86 ± 3.17 mo, 95% CI: 16.64-29.08 mo vs 18.00 ± 7.4 mo, 95% CI: 3.33-32.67 mo) of patients with negative lymph node micrometastases over patients with positive lymph node micrometastases (log-rank, P < 0.05). CONCLUSION: Lymph node micrometastases have a significant impact on the current staging system of gastric carcinoma, and are significant risk factors for prognosis of patients with gastric carcinoma.
基金Supported by the WST Foundation of Guangdong Province, No. 2000112736580706003
文摘AIM: To evaluate the risk factors for lateral lymph node metastasis in patients with advanced low rectal cancer, in order to make the effective selection of patients who could benef it from lateral lymph node dissection, as well as the relationship of lateral lymph node metastasis with local recurrence and survival of patients with advanced low rectal cancer. METHODS: A total of 96 consecutive patients who underwent curative surgery with lateral pelvic lymphadenectomy for advanced lower rectal cancer were retrospectively analyzed. The relation of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and survival of patients was identif ied. RESULTS: Lateral lymph node metastasis was observed in 14.6% (14/96) of patients with advanced low rectal cancer. Lateral lymph node metastasis was detected in 10 (25.0%) of 40 patients with tumor diameter ≥ 5 cm and in 4 (7.1%) of 56 patients with tumor diameter < 5 cm. The difference between the two groups was statistically signifi cant (χ2 = 5.973, P = 0.015). Lateral lymph node metastasis was more frequent in patients with 4/4 diameter of tumor infiltration (7 of 10 cases, 70.0%), compared with patients with 3/4, 2/4 and 1/4 diameter of tumor inf iltration (3 of 25 cases, 12.0%; 3 of 45 cases, 6.7%; 1 of 16 cases, 6.3%) (χ2 = 27.944, P = 0.0001). The lateral lymph node metastasis rate was 30.0% (9 of 30 cases), 9.1% (4 of 44 cases) and 4.5% (1 of 22cases) for poorly, moderately and well-differentiated carcinoma, respectively. The difference between the three groups was statistically significant (χ2 = 8.569, P = 0.014). Local recurrence was 18.8% (18 of 96 cases), 64.3% (9 of 14 cases), and 11.0% (9 of 82 cases) in patients with advanced low rectal cancer, in those with and without lateral lymph node metastasis, respectively. The difference between the two groups was statistically signif icant (χ2 = 22.308, P = 0.0001). Kaplan-Meier survival analysis showed significant improvements in median survival (80.9 ± 2.1 m, 95% CI: 76.7-85.1 m vs 38 ± 6.7 m, 95% CI: 24.8-51.2 m) of patients without lateral lymph node metastasis compared with those with lateral lymph node metastasis (log-rank, P = 0.0001). CONCLUSION: Tumor diameter, infiltration and differentiation are signif icant risk factors for lateral lymph node metastasis. Lateral pelvic lymphadenectomy should be performed following surgery for patients with tumor diameter ≥ 5 cm. Lateral lymph node metastasis is an important predictor for local recurrence and survival in patients with advanced low rectal cancer.
基金Supported by Innovative Talent Support Program of the Institution of Higher Learning in Liaoning Province,No.2018-478Innovative Talents of Science and Technology Support Program of Young and Middle People of Shenyang,No.RC170446.
文摘Isoflavones constitute a class of plant hormones including genistein,daidzein,glycitein,formononetin,biochanin A,and irilone,and the major source of human intake is soybeans.Inflammatory bowel disease(IBD)is a chronic recurrent inflammatory disease including ulcerative colitis,Crohn’s disease,and indeterminate colitis,which seriously affects the quality of life of patients and has become a global health problem.Although the pathogenesis of IBD is not very clear,many factors are thought to be related to the occurrence and development of IBD such as genes,immunity,and intestinal flora.How to control IBD effectively for a long time is still a problem for gastroenterologists.Diet has an important effect on IBD.Patients with IBD should pay more attention to diet.To date,many studies have reported that isoflavones have both good and bad effects on IBD.Isoflavones have many activities such as regulating the inflammatory signal pathways and affecting intestinal barrier functions and gut flora.They can also act through estrogen receptors,as they have a similar structure to estrogen.Isoflavones are easy to get from diet for human.Whether they are valuable to be applied to the treatment of IBD is worth studying.This review summarizes the relationship between isoflavones and IBD.
基金Supported by The Innovative Talent Support Program of The Institution of Higher Learning in Liaoning Province,No.2018-478The Innovative Talents of Science and Technology Support Program of Young and Middle People of Shenyang,No.RC170446.
文摘Pituitary stalk interruption syndrome(PSIS)is a rare congenital abnormality characterized by thinning or disappearance of the pituitary stalk,hypoplasia of the anterior pituitary and an ectopic posterior pituitary.Although the etiology of PSIS is still unclear,gene changes and perinatal adverse events such as breech delivery may play important roles in the pathogenesis of PSIS.PSIS can cause multiple hormone deficiencies,such as growth hormone,which then cause a series of changes in the human body.On the one hand,hormone changes affect growth and development,and on the other hand,they could affect human metabolism and subsequently the liver resulting in nonalcoholic fatty liver disease(NAFLD).Under the synergistic effect of multiple mechanisms,the progression of NAFLD caused by PSIS is faster than that due to other causes.Therefore,in addition to early identification of PSIS,timely hormone replacement therapy and monitoring of relevant hormone levels,clinicians should routinely assess the liver function while managing PSIS.
基金Supported by the Guangdong WST Foundation of China, No 2000112736580706003
文摘AIM: To clarify the relationship between circumferential resection margin status and local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma. The relationship between circumferential resection margin status and clinicopathologic characteristics of middle and lower rectal carcinoma was also evaluated. METHODS: Cancer specimens from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. RESULTS: Local recurrence occurred in 12.5% (7 of 56 cases) of patients with middle and lower rectal carcinoma. Distant recurrence occurred in 25% (14 of 56 cases) of patients with middle and lower rectal carcinoma. Twelve patients (21.4%) had positive circumferential resection margin. Local recurrence rate of patients with positive circumferential resection margin was 33.3% (4/12), whereas it was 6.8% (3/44) in those with negative circumferential resection margin (P = 0.014). Distant recurrence was observed in 50% (6/12) of patients with positive circumferential resection margin; conversely, it was 18.2% (8/44) in those with negative circumferential resection margin (P = 0.024). Kaplan-Meier survival analysis showed significant improvements in median survival (32.2 ± 4.1 mo, 95% CI: 24.1-40.4mo vs 23.0 ± 3.5 mo, 95% CI: 16.2-29.8 mo) for circumferential resection margin-negative patients over circumferential resection margin-positive patients (log-rank, P < 0.05). 37% T3 tumors examined were positive for circumferential resection margin, while only 0% T1 tumors and 8.7% T2 tumors were examined as circumferential resection margin. The difference between these three groups was statistically significant (P = 0.021). In 18 cancer specimens with tumor diameter ≥ 5 cm 7 (38.9%) were detected as positive circumferential resection margin, while in 38 cancer specimens with a tumor diameter of < 5 cm only 5 (13.2%) were positive for circumferential resection margin (P = 0.028). CONCLUSION: Our findings indicate that circumferential resection margin involvement is significantly associated with depth of tumor invasion and tumor diameter. The circumferential resection margin status is an important predictor of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma.
基金The WST Foundation of Guangdong Province, No. 2000112736580706003
文摘AIM: To explore the risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. METHODS: Specimens of middle and lower rectal carcinoma from 56 patients who received curative resection at the Department of General Surgery of Guangdong Provincial People's Hospital were studied. A large slice technique was used to detect mesorectal metastasis and evaluate circumferential resection margin status. The relations between clinicopathologic characteristics, mesorectal metastasis and circumferential resection margin status were identified in patients with local recurrence of middle and lower rectal carcinoma. RESULTS: Local recurrence of middle and lower rectal carcinoma after curative resection occurred in 7 of the 56 patients (12.5%), and was significantly associated with family history (c2 = 3.929, P = 0.047), high CEA level (c2 = 4.964, P = 0.026), cancerous perforation (c2 = 8.503, P = 0.004), tumor differentiation (c2 = 9.315, P = 0.009) and vessel cancerous emboli (c2 = 11.879, P = 0.001). In contrast, no significant correlation was found between local recurrence of rectal carcinoma and other variables such as age (c2 = 0.506, P = 0.477), gender (c2 = 0.102, c2 = 0.749), tumor diameter (c2 = 0.421, P = 0.516),tumor infiltration (c2 = 5.052, P = 0.168), depth of tumor invasion (c2 = 4.588, P = 0.101), lymph node metastases (c2 = 3.688, P = 0.055) and TNM staging system (c2 = 3.765, P = 0.152). The local recurrence rate of middle and lower rectal carcinoma was 33.3% (4/12) in patients with positive circumferential resection margin and 6.8% (3/44) in those with negative circumferential resection margin. There was a significant difference between the two groups (c2 = 6.061, P = 0.014). Local recurrence of rectal carcinoma occurred in 6 of 36 patients (16.7%) with mesorectal metastasis, and in 1 of 20 patients (5.0%) without mesorectal metastasis. However, there was no significant difference between the two groups (c2 = 1.600, P = 0.206). CONCLUSION: Family history, high CEA level, cancerous perforation, tumor differentiation, vessel cancerous emboli and circumferential resection margin status are the significant risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. Local recurrence may be more frequent in patients with mesorectal metastasis than in patients without mesorectal metastasis.
基金supported by the Innovative Talent Support Program of the Institution of Higher Learning in Liaoning Province[No.2018-478]the Innovative Talents of Science and Technology Support Program of Young and Middle Aged People of Shenyang[RC170446].
基金The study was supported by the Beijing Municipal Science&Technology Commission(no.Z171100001017067)Capital’s Funds for Health Improvement and Research(no.CFH 2018-2-2043).
文摘Background Haemorrhages of brainstem cavernous malformations(CMs)can lead to neurological deficits,the natural history of which is uncertain.The study aimed to evaluate the neurological outcomes of untreated brainstem CMs and to identify the adverse factors associated with worsened outcomes.Methods From 2009 to 2015,698 patients(321 women)with brainstem CMs were entered into the prospective cohort after excluding patients lost to follow-up(n=43).All patients were registered,clinical data were collected and scheduled follow-up was performed.Results After a median follow-up of 60.9 months,prospective haemorrhages occurred in 167 patients(23.9%).The mean modified Rankin Scale scores at enrolment and at censoring time were 1.6 and 1.2.Neurological status was improved,unchanged and worsened in 334(47.9%),293(42.0%)and 71(10.2%)patients,respectively;233(33.4%)recovered to normal levels.Lesions crossing the axial midpoint(relative risk(RR)2.325,p=0.003)and developmental venous anomaly(DVA)(RR 1.776,p=0.036)were independently significantly related to worsened outcomes.The percentage of worsened outcomes was 5.3%(18 of 337)in low-risk patients(neither DVA nor crossing the axial point)and increased to 26.0%(13 of 50)in high-risk patients(with both DVA and crossing the axial point).The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased(from 1.5%(8 of 531,if 0 prospective ictus)to 37.5%(48 of 128,if 1 ictus)and 38.5%(15 of 39,if>1 ictus)).Conclusions The neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients(89.8%)with a fatality rate of 1.7%in our cohort,which seemed to be favourable.Radiological features significantly predicted worsened outcomes.Our results provide evidence for clinical consultation and individualised treatment.The referral bias of our cohort was underlined.
