Objective To discuss the clinicopathologic risk factors related to local recurrence of rectal cancer after radical surgery. Methods The complete clinicopathologic data of 368 patients with rectal cancer from January 2004 to April 2011 in this hospital were retrospectively analyzed by univariate and multivariate analysis methods. Results There were 73 cases suffered from local recurrence and accounted for 19.84% （73/368） of rectal cancer during the same period. Univariate analysis results showed that gender， tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， stomal leak， and chemoradiotherapy were associated with postoperative recurrence （P＜0.05）. Multivariate analysis results showed that tumor from anal margin， tumor circumference， TNM staging， histology type， vessel infiltration， tumor perforation， and chemoradiotherapy were prognostic factor for local recurrence of rectal cancer （P＜0.05）. Conclusions There are many factors related to postoperative local recurrence， but the most dangerous factor is vessel infiltration.
ObjectiveTo investigate the clinicopathological characteristics and prognosis of elderly patients with colon cancer. MethodsThe clinicopathological and followup data of patients with colon cancer were compared retrospectively between those older than 60 years (405 patients) and those younger than 40 years (146 patients). ResultsFamily history, comorbidities, preoperative intestinal obstruction, and differentiation grade were significantly different between two groups (P＜0.05). The 5-year survival rate of patients in elder group and younger group was 64.9% and 56.8% respectively, and there was significant difference （P＜0.05）. The multivariate analysis indicated that the independent predictors of survival were comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage. ConclusionPatients older than 60 years with colon cancer have unique clinicopathological characteristics and better prognosis. The independent predictors of survival are comorbidities, perioperative CEA level, preoperative intestinal obstruction, tumor gross type, lymph node metastasis, hepatic metastasis, and TNM stage.
ObjectiveBy analyzing the correlation between the clinicopathological features of patients with colorectal liver metastases (CRLM) and their postoperative survival, this study is aimed to identify new and accurate prognostic indicators on the prognoses to provide a reference of the treatment strategy selection for patients with CRLM. MethodsThe clinical data of 233 patients with CRLM who received operation treatments in the Eastern Hepatobiliary Hospital of the Second Military Medical University from January 2006 to December 2009 were retrospectively investigated, and their clinicopathological features, as well as their prognosis were analyzed. The survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by log-rank test. Parametric survival analysis was used to identify predictors of cancer-specific survival. ResultsThe median survival time after cancer resection was 37.0 months, with cumulative 1-year, 3-year, and 5-year survival rates of 93.0%, 61.0%, and 17.0%, respectively. The median survival time, with cumulative 3-year, and 5-year survival rates of patients who had received radical operations was better than the others who received palliative operations:40.53 months vs 27.20 months, 59.0% vs 29.0%, and 20.0% vs 0(P < 0.05), respectively. In overall surviva, the results of univariate analysis showed that 13 factors, including surgical method, the first relapse after liver metastasis resection, the number of liver metastases, surgical margin, other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, whether any chronic liver disease was associ-ated, preoperative serum CEA level, preoperative serum CA19-9 leve, the position of the liver metastases, whether the liver metastasis capsule was complete, TNM stagethe of primary cancer, whether the liver metastasis was simultaneous liver metastases, and the maximum diameter of the liver metastases, were closely related to the clinicopathological features associated with prognosis and the differences were statistically significant (P < 0.05). The results of multivariate survival analysis demonstrated that received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases>3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM (P < 0.05). ConclusionsIt is important for long-term survival of patients with CRLM who were received operations. Received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases>3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM.
Objective To develop and validate a nomogram prediction model of early knee function improvement after total knee arthroplasty (TKA). Methods One hundred and sixty-eight patients who underwent TKA at Sichuan Province Orthopedic Hospital between January 2018 and February 2021 were prospectively selected to collect factors that might influence the improvement of knee function in the early postoperative period after TKA, and the improvement of knee function was assessed using the Knee Score Scale of the Hospital for Special Surgery (HSS) at 6 months postoperatively. The patients were divided into two groups according to the postoperative knee function improvement. The preoperative, intraoperative and postoperative factors were compared between the two groups; multiple logistic regression was performed after the potential factors screened by LASSO regression; then, a nomogram predictive model was established by R 4.1.3 language and was validated internally. Results All patients were followed up at 6 months postoperatively, and the mean HSS score of the patients increased from 55.19±8.92 preoperatively to 89.27±6.18 at 6 months postoperatively (t=−40.706, P<0.001). LASSO regression screened eight influencing factors as potential factors, with which the results of multiple logistic regression analysis showed that preoperative body mass index, etiology, preoperative joint mobility, preoperative HSS scores, postoperative lower limb force line, and postoperative analgesia were independent influencing factors for the improvement of knee function in the early postoperative period after TKA (P<0.05). A nomogram model was established based on the multiple logistic regression results, and the calibration curve showed that the prediction curve basically fitted the standard curve; the receiver operating characteristic curve showed that the area under the curve of the nomogram model for the prediction of suboptimal knee function in the early postoperative period after TKA was 0.894 [95% confidence interval (0.825, 0.963)]. Conclusions There is a significant improvement in knee function in patients after TKA, and the improvement of knee function in the early postoperative period after TKA is influenced by preoperative body mass index, etiology, and preoperative joint mobility, etc. The nomogram model established accordingly can be used to predict the improvement of knee function in the early postoperative period after TKA with a high degree of differentiation and accuracy.
ObjectiveTo explore the risk factors influenced postoperative complications of colon cancer. MethodsIn this study, 114 patients diagnosed definitely as colon cancer were enrolled from January 2009 to April 2010 in this hospital. The patients were divided into the complication group and non-complication group according to the occurrence of postoperative complications during hospital day. Furthermore, clinicopathological features and operative parameters of patients were compared in two groups, and independent factors for postoperative complications were identified by multiple regression analysis. ResultsThere were statistical differences between two groups in operation time (t=2.034, P=0.032), diabetes mellitus (χ2=5.920, P=0.015), differentiation degree of tumor (χ2=7.163, P=0.028), hospital stay (χ2=0.411, P=0.026), and ASA grades (χ2=11.585, P=0.009). The morbidity of patients with operative time gt;200 min was significant higher than that ≤100 min (χ2=8.884, P=0.003) and 100-200 min (χ2=7.318, P=0.007). The morbidity of patients with ASA Ⅳ grade was higher than that with ASA Ⅰ grade (χ2=13.426, P=0.000). For tumor differentiation, the morbidity of patients with well-differentiated tumor was higher than that with moderately differentiated tumor (χ2=4.950, P=0.026) and poorly differentiated tumor (χ2=7.476, P=0.006). The hospital stay (P=0.009), age (P=0.024), diabetes mellitus (P=0.018), and ASA grade (P=0.001) were the independent factors for postoperative complications by multivariate regression analysis. ConclusionThe physical quality indexes are the mostly common risk factors of postoperative complications for colon cancer, emphasizing on the high-risk factors and making a targeted and individual treatment plan for each patient are of great important to improve the prognosis.
ObjectiveTo investigate the long-term efficacy and the influencing factors of thymectomy for thymoma patients associated with myasthenia gravis. MethodsWe retrospectively analyzed the clinical and follow-up data of 126 thymoma patients associated with myasthenia gravis underwent extended thymectomy from June 2002 to December 2015 in our hospital. There were 26 males and 37 females at the mean age of 54.51±12.62 years. We built up survival analysis model to analyze the effect of those following factors on postoperative result:sex, the age when operated, the preoperative course of disease, the condition of associating with other diseases, history of critical illness, steroid administration time before operation, Osserman classification, Masaoka staging, WHO pathological type, surgical approach, tumor size and so on. Result The average follow-up time was 35(5-96) months. During follow-up period, 12 patients (19%) achieved complete remission, 39 patients (62%) achieved partial remission, 7 patients (11%) kept stable, 5 patients (8%) deteriorated and the total effective rate was 81%. The result of log-rank analysis showed that the preoperative course of disease (P=0.027), history of critical illness on myasthenia gravis (P=0.035) and Osserman classification (P=0.018) were related to incomplete remission, whlie the result of Cox regression analysis showed that the preoperative course of disease (P=0.001) and Osserman classification (P=0.012) were the independent risk factors for incomplete remission. ConclusionExtended thymectomy is an effective treatment for thymoma patients associated with myasthenia gravis, but the symptom of those patients whose preoperative course of disease are more than 12 months or Osserman classification is at ⅡB, Ⅲ and Ⅳ type of Osserman classification have poor effect after operation.
Objective To investigate and analyze the employment status and related influencing factors of maintenance hemodialysis (MHD) patients. Methods MHD patients from four hemodialysis centers in Beijing between January 2020 and January 2021 were selected. The baseline data and clinical data of patients with long dialysis interval were collected. An anxiety and depression survey was conducted on the patient. Results A total of 108 MHD patients were included. Among them, 41 patients were working and 67 patients were not working. Among the 41 patients at work, there were 3 workers, 1 farmer, 14 company employees, 6 public institution employees, 11 self-employed, 5 freelancer and 1 other. Among the 67 patients who did not work, 8 patients had the ability to work but did not work. Body mass index was an independent influencing factor for employment in MHD patients [odds ratio=1.135, 95% confidence interval (1.017, 1.266), P=0.024]. Conclusion The nutritional status of MHD patients should be taken seriously to improve their employment rate.
Objective To analyze the risk factors for delirium of the Stanford A aortic dissection patients after surgery. Method We retrospectively analyzed the clinical data of 335 patients with type A aortic dissection in Guangdong Cardiac Institution from January 2012 through December 2014. There were 280 males and 55 females. The average of age was 48.5±10.3 years. Delirium status of the patients were evaluated based on confusion assessment method for intensive care unit (CAM-ICU). The patients were divided into two groups including a delirium group and a control group. We tried to find the risk factors for postoperative delirium. Results There were 169 patients of delirium with a incident rate of 50.4%. One-way analysis of variance and multivariate analysis indicated that pre-operative D-dimer level (OR=2.480, 95% CI 1.347-4.564, P<0.01), the minimum mean arterial pressure during operation (OR=0.667, 95% CI 0.612-0.727, P<0.01), the postoperative ventilation time (OR=2.771, 95% CI 1.506-5.101, P<0.01) and the postoperative acute kidney failure (OR=1.911, 95% CI 1.065-3.430, P<0.05) were the independent risk factors for delirium of the Stanford A aortic dissection patient after surgery. Conclusion The incident rate of postoperative delirium of the Standford A aortic dissection patient is relatively high. Patients in this study with elevated pre-operative D-dimer level, lower intraoperative mean arterial pressure, longer postoperative ventilation and combination of acute kidney failure have a higher rate of postoperative delirium. Better understanding and intervention of these factors are meaningful to reduce the occurrence of postoperative delirium.
Objectives To observe the distribution of enlarged perivascular spaces (EPVSs) in acute ischemic stroke, and determine the factors that influence basal ganglia and centrum semiovale EPVSs. Methods We prospectively registered consecutive patients with acute ischemic stroke at the neurological wards of Jianyang Municipal People’s Hospital and West China Hospital of Sichuan University from February 1st to November 1st, 2014. Patients with ischemic stroke within 14 days of symptom onset, having magnetic resonance image (MRI) scan were included. Basal ganglia and centrum semiovale EPVSs, white matter hyperintensity, cerebral atrophy and lacunar infraction were rated using validated scales by reading MRI. Clinical information was obtained using standardized forms. The distribution of EPVSs was observed and analyzed. The evalution of EPVSs was analyzed in relation to age, vascular risk factor, cerebral atrophy, white matter hyperintensity, lacunar infraction, etc, by using univariate and multivariate logistical regression to evaluate the influencing factors for basal ganglia and centrum semiovale EPVSs. Results A total of 170 patients with acute ischemic stroke within 14 days from onset were included; in whom, 97.6% had EPVSs in basal ganglia and all had EPVSs in centrum semiovale. The most common scores of basal ganglia EPVSs were 1 point and 2 points. The most common scores of centrum semiovale EPVSs were 2 and 3 points. In logistic regression, age [odds ratio (OR)=1.043, 95% confidence interval (CI) (1.015, 1.071), P=0.002], periventricular white matter hyperintensity [OR=4.203, 95%CI (1.525, 11.583), P=0.006] and hypertension [OR=3.965, 95%CI (1.927, 8.157), P<0.001] were independently associated with increased severity of basal ganglia EPVSs. Only periventricular white matter hyperintensity [OR=2.248, 95%CI (1.054, 4.795), P=0.036] was independently associated with increased severity of centrum semiovale EPVSs in logistic regression. Conclusions EPVSs are common in ischemic stroke. There is a lower prevalence of EPVS in the basal ganglia compared with the centrum semiovale. Compared with centrum semiovale EPVSs, basal ganglia EPVSs are more associated with hypertensive cerebral small vessel disease, which may be a marker for hypertensive cerebral small vessel disease.