Objective To explore risk factors of lymph node metastasis (LNM) in T1 rectal cancer. Methods The retrospective case-control study was conducted. The clinicopathologic data of 247 patients with T1 rectal cancer underwent radical resection were analyzed in the pathological database of the West China Hospital from January 2000 to December 2016, including the tumor size (maximum diameter), gross type, differentiation degree, histological type, lymph vascular infiltration, perineural infiltration, and carcinoma nodule. The univariate analysis and multivariate analysis were done using the Chi-square test and logistic regression model, respectively. Results The rate of LNM in the patients with T1 rectal cancer was 8.50% (21/247). No lymph metastasis was found in the well differentiated T1 rectal cancer. The results of the univariate analysis showed that the differentiation degree, histological type, and carcinoma nodule were related to the LNM in the T1 rectal cancer (P<0.050). The results of the multivariate analysis revealed that the poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule were the independent risk factors of the LNM in the T1 rectal cancer (OR=9.75, P=0.006; OR=5.98, P=0.042; OR=8.33, P=0.017; OR=10.87, P=0.026). Conclusion In this large population dataset, poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule are risk factors of LNM in T1 rectal cancer.
ObjectiveTo investigate the association of arterial stiffness with cardiovascular risk factors. MethodsFrom July 2014 to August 2015, 1 599 participants aged over 65 years old were recruited from 10 communities located in the northern Shanghai. Carotid-femoral pulse wave velocity (cf-PWV) was measured by SphygmoCor device. Cardiovascular risk factors were assessed by questionnaire, anthropometry or conventional biochemical measurements. SPSS 20.0 was applied for data management and statistical analysis. ResultsCf-PWV was significantly associated with cardiovascular risk factors (P<0.001). Moreover, with the accumulating cardiovascular risk factors, cf-PWV increased gradually and significantly (P<0.001). The increasing trend remained significant in all participants, in men and in women, respectively. ConclusionArterial stiffness is significantly associated with cardiovascular risk factors and their accumulation.
ObjectiveTo summarize the research progress of correlation between pancreatic cancer and diabetes mellitus.MethodsRecent studies on the association between pancreatic cancer and diabetes mellitus were extensively reviewed, and relevant research results on the association between pancreatic cancer and diabetes mellitus were reviewed.ResultsPancreatic cancer had a particular association with diabetes. Patients with pancreatic cancer may develop new diabetes or worsen existing diabetes mellitus. About 50% of patients with pancreatic cancer had diabetes mellitus before diagnosis, suggesting a “dual causal relationship” between pancreatic cancer and diabetes mellitus. Long-term type 2 diabetes mellitus (T2DM) was one of the high risk factors for the occurrence and development of pancreatic cancer. T2DM may also increase the risk of pancreatic cancer due to hyperinsulinemia, adipokine, and other factors. Pancreatic cancer was one of the cause of diabetes mellitus at the same time, but its mechanism was not yet known, also needed to get a lot of information to understand the impact of long-term diabetes mellitus on the development of pancreatic cancer, as well as the reason of pancreatic cancer related to diabetes mellitus mechanism.ConclusionThe clear relationship between pancreatic cancer and diabetes mellitus has not been proved, and further research is needed to clarify the relationship between them.
Objective To analyze the results of intra-aortic balloon pump (IABP) support in patients receiving coronary artery bypass graft (CABG) and the risk factors of postoperative death. Methods The clinical data of 334 patients undergoing CABG procedure and receiving IABP support in Fuwai Hospital from January 1999 to April 2012 were retrospectively analyzed. According to the IABP insertion timing, the patients were divided into three groups: pre-, intra- and postoperative IABP groups. There were 45 males and 11 females aged 60.5±10.7 years in the preoperative IABP group, 84 males and 23 females aged 61.1±8.4 years in the intraoperative IABP group and 119 males and 52 females aged 61.4±8.5 years in the postoperative IABP group.Outcomes of the three groups were compared, including mortality, major complications, ICU stay, hospital stay and total costs. Multivariable logistic regression analysis was used to predict independent risk factors for postoperative in-hospital death. Results The total in-hospital mortality was 16.8% (56/334). Mortality was significantly different among the pre-, intra- and postoperative IABP groups (3.6% vs.23.4%vs. 17.0%, P=0.006). There was no significant difference in complications among the three groups (P=0.960). Multivariable logistic regression analysis indicated that independent risk factors for postoperative mortality included old age (OR=1.05, P=0.040), female (OR=3.34, P<0.001) and increasing left ventricular end-diastolic diameter (LVEDD,OR=1.06, P=0.040). Preoperative IABP support was protective factor (OR=0.10, P=0.050). Conclusion The results of IABP support in CABG patients are satisfactory, and patients with preoperative IABP have a lower mortality. Risk factors for postoperative death include old age, female and increasing LVEDD. Preoperative IABP support is a protective factor.
ObjectiveTo investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction. Methods A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups (P>0.05). However, the proportion of female in the injured group was significantly higher than that of male (P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group (P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values. ResultsUnivariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury (P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury (P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] (χ2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years](χ2=302.479, P<0.001). ConclusionFemale and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.
Objective To analyze and summarize the clinical characteristics of foreign body incarceration in upper digestive tract, and to explore the risk factors of its complications. Methods The clinical data of patients with foreign bodies in the upper digestive tract treated in the Affiliated Hospital of Zunyi Medical University between January 1, 2012 and December 31, 2021 were retrospectively analyzed, including demographic data, foreign body type, incarceration site, incarceration time, causes, symptoms, treatment methods and complications of foreign body incarceration. Logistic regression analysis was used to explore the risk factors of complications. Results A total of 721 patients were finally included, ranging in age from 3 months to 90 years old, with an average age of 26.76 years. The proportion of foreign bodies in the upper digestive tract in patients ≤14 years old was the highest (51.18%), and the duration of foreign body incarceration<12 hours was the highest (55.34%). The most common sharp foreign bodies in the upper digestive tract were animal bones (228 cases), and the most common round shaped foreign bodies were coins (223 cases). The most common impaction site was the upper esophageal segment (85.02%). 105 patients (14.56%) had complications, and perforation was the most common (5.55%). Logistic regression analysis showed that age [odds ratio (OR)=0.523, 95% confidence interval (CI) (0.312, 0.875), P=0.014], foreign body type [OR=0.520, 95%CI (0.330, 0.820), P=0.005], incarceration site [OR=2.347, 95%CI (1.396, 3.947), P=0.001], incarceration time [OR=0.464, 95%CI (0.293, 0.736), P=0.001] were the influencing factors of complications. Conclusions The majority of foreign bodies in the upper digestive tract are animal bones. The incidence of complications increase in patients with age ≥ 60 years, sharp foreign body edges, incarceration in the upper segment of the esophagus, and long incarceration time. It is recommended to remove the sharp foreign bodies incarcerated in the upper segment of the esophagus from the elderly as soon as possible.
ObjectiveTo explore the relation between preoperative serum gamma-glutamyl transpeptidase to platelet ratio (GPR) and overall survival (OS) of patients with hepatitis B virus-associated hepatocellular carcinoma (Abbreviated as “patients with HCC”), and to establish a nomogram for predicting OS. MethodsAccording to the inclusion and exclusion criteria, the clinicopathologic data of patients with HCC who underwent radical resection in the Department of Hepatobiliary Surgery of Xianyang Central Hospital, from January 15, 2012 to December 15, 2018, were retrospectively analyzed. The optimal critical value of GPR was determined by receiver operating characteristic curve, then the patients were divided into a low GPR group (GPR was optimal critical value or less ) and high GPR group (GPR was more optimal critical value). The Kaplan-Meier method was used to draw the survival curve and analyze the OS of patients. The univariate and multivariate Cox proportional hazards regression model were used to analyze the factors influencing prognosis in the patients with HCC. According to the risk factors of OS for patients with HCC, a nomogram was established. The consistency index and calibration curve in predicting the 3-year and 5-year accumulative OS rates of patients with HCC were evaluated. ResultsA total of 213 patients were gathered. The optimal critical value of GPR was 0.906. There were 114 patients in the low GPR group and 99 patients in the high GPR group. The Kaplan-Meier survival curve analysis showed that the 1-, 3- and 5-year accumulative OS rates were 99.1%, 81.8%, 60.6% in the low GPR group, respectively, which were 74.2%, 49.1%, 35.7% in the low GPR group, respectively. The OS curve of the low GPR group was better than that of the high GPR group (χ2=25.893, P<0.001). The multivariate analysis results showed that the microvascular invasion, incomplete capsule, intraoperative bleeding ＞1 000 mL, postoperative complications, GPR >0.906, low tumor differentiation, and late TNM stage did not contribute to accumulative OS in the patients with HCC (P<0.05). The consistency index (95%CI) of the nomogram in predicting accumulative OS rates at 3- and 5-year for patients with HCC were 0.761 (0.739, 0.783) and 0.735 (0.702, 0.838), respectively. The calibration curves of 3- and 5-year accumulative OS rates of the nomogram were in good agreement with the actual results. ConclusionsPreoperative GPR is associated with OS, and patients with higher GPR have worse prognosis. The nomogram based on GPR has a good accuracy and differentiation.
ObjectiveTo investigate the risk factors of carotid endarterectomy.MethodThe literatures about carotid artery stenosis in the past 30 years were screened through literature retrieval, and the study of surgical risk factors related to carotid artery stenosis were reviewed.ResultsThere were many risk factors associated with the carotid endarterectomy, including demographic, underlying disease, surgical factors, perioperative management, and so on. However, the risk factors analysis were not comprehensive enough in the current study, so there was still lack of effective methods to predict the surgical risk of carotid artery stenosis.ConclusionTo fully understand the risk factors of carotid endarterectomy and to establish a multi-factor prediction model is the direction of further research.
ObjectiveTo investigate the independent risk factors associated with postoperative acute respiratory distress syndrome in patients undergoing type A aortic dissection surgery.MethodsThe clinical data of 147 patients who underwent acute type A aortic dissection surgery in the First Affiliated Hospital of Anhui Medical University from 2015 to 2019 were retrospectively analyzed. There were 110 males at age of 51.9±10.1 years and 37 females at age of 54.3±11.1 years. According to whether the patients developed ARDS after surgery, all of the patients were divided into a ARDS group or a non-ARDS group. Logistic regress analysis was utilized to establish the predictive mode to identify the independent risk factors related to ARDS.ResultsOf the patients, 25 developed postoperative ARDS. Among them, 5 patients were mild ARDS, 13 patients were moderate, and 7 patients were severe ARDS. Multivariate logistic regression analysis showed that deep hypothermic circulatory arrest time [odds ratio (OR)=1.067, 95% confidence interval (CI) 1.014-1.124, P=0.013], cardiopulmonary bypass time (OR=1.012, 95%CI 1.001-1.022, P=0.027) and perioperative plasma input (OR=1.001, 95%CI 1.000-1.002, P=0.011) were independently associated with ARDS in patients undergoing acute A aortic dissection surgery. Receiver operating characteristic (ROC) curve analysis demonstrated a good discrimination ability of the logistic regression model, with an area under the curve of 0.835 (95%CI 0.740-0.929, P=0.000).ConclusionDuration of deep hypothermic circulatory arrest, cardiopulmonary bypass time and perioperative plasma are independent risk factors for postoperative ARDS in patients undergoing type A aortic dissection surgery.
Objective To analyze the risk factors of atrial fibrillation (AF) after radical esophagectomy, providing the basis for prevention and treatment of AF after radical esophagectomy. Methods We conducted a retrospective analysis of 335 patients' clinical data, who accepted laparoscopic combined thoracic or open radical esophagectomy in the same treatment group at Department of Thoracic Surgery of Shengjing Hospital of China Medical University between January 2014 and August 2016. There were 262 males and 73 females at age of 65.1 (43-78) years. Results There were 48 of 335 patients with AF within 1 week after surgery. By univariate analysis: age, gender, history of peripheral vascular disease and cardiac stents or angina pectoris, preoperative brain natriuretic peptide (BNP), preoperative left ventricular diastolic dysfunction, operation pattern, intraoperative blood transfusion and lymph nodes and pericardial adhesion were possible risk factors. By multivariate analysis: age, gender, history of cardiac stents or angina pectoris, preoperative BNP, operation pattern, intraoperative blood transfusion and lymph nodes and pericardial adhesion were risk factors. Conclusion The risk factors of AF after radical esophagectomy are age, gender, history of cardiac stents or angina pectoris, preoperative BNP, operation pattern, intraoperative blood transfusion and lymph nodes and pericardial adhesion. Perioperative positive intervention to above factors may reduce the incidence of postoperative AF.