Abstract Background Chronic radiation proctitis (CRP) with rectal ulcer is a common complication after pelvic malignancy radiation, and gradually deteriorating ulcers will result in severe complications such as fistula. The aim of this study was to evaluate effect of colostomy on ulcerative CRP and to identify associated influence factors with effectiveness of colostomy. Methods Between November 2011 to February 2019, 811 hospitalized patients were diagnosed with radiation-induced enteritis (RE) in Sun Yat-sen University Sixth Affiliated Hospital, among which 284 patients presented with rectal ulcer, and 61 ulcerative CRP patients were retrospectively collected and analyzed. Results The overall effective rate of colostomy on ulcerative CRP was 49.2%, with a highest effective rate of 88.2% within 12 to 24 months after colostomy. 9 (31.1%) CRP patients with ulcers were cured after colostomy and 12 (19.67%) patients restored intestinal continuity, among which including 2 (3.3%) patients ever with rectovaginal fistula. 100% (55/55) patients with rectal bleeding and 91.4% (32/35) patients with anal pain were remarkably alleviated. Additionally, multivariable analysis showed the duration of stoma [OR 1.211, 95% CI (1.060–1.382), P = 0.005] and albumin (ALB) level post-colostomy [OR 1.437, 95% CI (1.102–1.875), P = 0.007] were two independent influence factors for the effectiveness of colostomy on the rectal ulcer of CRP patients. Conclusions Colostomy was an effective and safe procedure for treating rectal ulcer of CRP patients, and also a potential strategy for preventing and treating fistula. Duration of stoma for 12–24 months and higher ALB level could significantly improve the effectiveness of colostomy on ulcerative CRP patients.
KRAS/BRAF mutations (mutKRAS/mutBRAF) are unfavorable prognostic factors for colorectal cancer (CRC) metastases to the liver and lungs. However, their effects on the prognosis for patients with synchronous peritoneal metastasis (S-PM) of CRC after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are controversial. In the study, we aimed to determine the effects of mutKRAS/mutBRAF on the prognosis for patients with S-PM who received CRS.A total of 142 patients diagnosed with S-PM between July 2007 and July 2019 were included in this study. The demographics, mutKRAS/mutBRAF status, overall survival (OS), and progression-free survival (PFS) of the patients were evaluated. The Kaplan-Meier method and log-rank test were used to estimate the difference in survival between groups.Among 142 patients, 68 (47.9%) showed mutKRAS and 42 (29.5%) showed mutBRAF. The median OS values were 8.4 and 34.3 months for patients with mutBRAF and BRAF wild-type, respectively (P < 0.01). However, KRAS status was not significantly associated with median OS (P = 0.76). Multivariate analysis revealed carcinoembryonic antigen, CRS, HIPEC, and mutBRAF as independent predictors for OS. Based on these findings, a nomogram was constructed. The C-index was 0.789 (95% confidence interval, 0.742-0.836), indicating good predictive ability of the model. Furthermore, the 1- and 2-year survival calibration plots showed good agreement between the predicted and actual OS rates. The area under curves of the 1- and 2-year survival predictions based on the nomogram were 0.807 and 0.682, respectively. Additionally, mutBRAF was significantly associated with lower PFS (P < 0.001).mutBRAF is an independent prognostic risk factor for S-PM. The established nomogram predicted the OS of patients with CRC having S-PM with high accuracy, indicating its usefulness as a valuable prognostic tool for the designated patient cohort.
Abstract Background and Aims Stool DNA testing is an emerging and attractive option for colorectal cancer (CRC) screening. We previously evaluated the feasibility of a stool DNA (sDNA) test of methylated SDC2 for CRC detection. The aim of this study was to assess its performance in a multicenter clinical trial setting. Methods Each participant was required to undergo a sDNA test and a reference colonoscopy. The sDNA test consists of quantitative assessment of methylation status of SDC2 promoter. Results of real-time quantitative methylation-specific PCR were dichotomized as positive and negative, and the main evaluation indexes were sensitivity, specificity, and kappa value. All sDNA tests were performed and analyzed independently of colonoscopy. Results Among the 1110 participants from three clinical sites analyzed, 359 and 38 were diagnosed, respectively, with CRC and advanced adenomas by colonoscopy. The sensitivity of the sDNA test was 301/359 (83.8%) for CRC, 16/38 (42.1%) for advanced adenomas, and 134/154 (87.0%) for early stage CRC (stage I–II). Detection rate did not vary significantly according to age, tumor location, differentiation, and TNM stage, except for gender. The follow-up testing of 40 postoperative patients with CRC returned negative results as their tumors had been surgically removed. The specificity of the sDNA test was 699/713 (98.0%), and unrelated cancers and diseases did not seem to interfere with the testing. The kappa value was 0.84, implying an excellent diagnostic consistency between the sDNA test and colonoscopy. Conclusion Noninvasive sDNA test using methylated SDC2 as the exclusive biomarker is a clinically viable and accurate CRC detection method. Chinese Clinical Trial Registry Chi-CTR-TRC-1900026409, retrospectively registered on October 8, 2019; http://www.chictr.org.cn/edit.aspx?pid=43888&htm=4 .
Treatment of colorectal cancer (CRC) with synchronous peritoneal metastases (SPM) is controversial, and its prognosis remains poor. Here, we analysed the association between treatment strategies and the outcomes of patients with colorectal SPM and devised a nomogram to improve their prognosis prediction. We retrospectively analysed patients with colorectal SPM treated at The Sixth Affiliated Hospital, Sun Yat-sen University from June 2007 to June 2018. The Kaplan-Meier method with log-rank tests was used to compare the overall survival (OS) among patients undergoing different therapeutic regimens. Cox proportional hazards regression analysis was used to identify the prognostic factors. After variable selection, a nomogram was developed to predict the OS of patients with colorectal SPM. A total of 371 patients with colorectal SPM were eligible for this study. The median OS of all patients was 15.0 months (95% CI, 13.1 to 16.9), with a 3-year and 5-year OS rate of 23.7% and 16.9%, respectively. Patients who underwent complete cytoreductive surgery (CC0-1) had a better median OS of 49 months (p<0.001). Cox multivariate analysis showed that age >65 years; cancer antigen 125 level >35 U/mL; peritoneal carcinomatosis index >16 scores; and undergoing cytoreductive surgery, chemotherapy and hyperthermic intraperitoneal chemotherapy were independent prognostic factors for OS. The c-index of the prognostic nomogram was 0.747 (95% CI, 0.474 to 1.020). Our study suggests that patients with colorectal SPM who receive comprehensive treatment might achieve better prognoses. The prognostic nomogram demonstrated good predictive performance for patients with colorectal SPM.
Different types of wounds have different requirements of a wound sealant. One of the requirements of concern is the adaptability of the mechanical properties of biomaterials to native tissues. However, the mechanical properties of current sealant are untunable or adjustable in a small range normally. Therefore, the scope of application of these sealant is limited. In this study, we developed hyperbranched polyester (HBP)-based UV-curable sealant with tunable mechanical properties. This sealant was cured under UV-light for 2 minutes and exhibited strong adhesion with tissues. The shear adhesive strength of it to the porcine skin ranged between 20–30 kPa, which was higher than the fibrin glue (∼10 kPa). Moreover, the elastic modulus of the sealant in a tensile test ranged between 27–54 MPa, depending on the degree of acrylation of the HBPs. Additionally, we assessed the biocompatibility of the sealant by co-culturing it with mouse mesenchymal stem cells (mMSCs) for 7 days and discovered that the cell viability was unaffected. This sealant with a tunable elastic modulus might be a promising candidate for treating wounds with different elastic moduli.
Abstract Background and Objectives This study aimed to compare outcomes between neoadjuvant imatinib and upfront surgery in patients with localized rectal gastrointestinal stromal tumors (GIST) patients. Methods Eighty‐five patients with localized rectal GIST were divided into two groups: upfront surgery ± adjuvant imatinib (Group A, n = 33) and the neoadjuvant imatinib + surgery + adjuvant imatinib (Group B, n = 52). Baseline characteristics between groups were controlled for with inverse probability of treatment weighting (IPTW) adjusted analysis. Results The response rate to neoadjuvant imatinib was 65.9%. After the IPTW‐adjusted analysis, patients who underwent neoadjuvant therapy had better distant recurrence‐free survival (DRFS) and disease‐specific survival (DSS) compared with those who underwent upfront surgery (5‐year DRFS 97.8 vs. 71.9%, hazard ratio [HR], 0.15; 95% CI, 0.03–0.87; p = 0.03; 5‐year DSS 100 vs. 77.1%; HR, 0.11; 95% CI, 0.01–0.92; p = 0.04). While no significant association was found between overall survival (OS) and treatment groups ( p = 0.07), 5‐year OS was higher for the neoadjuvant group than upfront surgery group (97.8% vs. 71.9%; HR, 0.2; 95% CI, 0.03–1.15). Conclusions In patients with localized rectal GIST, neoadjuvant imatinib not only shrunk the tumor size but also decreased the risk of metastasis and tumor‐related deaths when compared to upfront surgery and adjuvant imatinib alone.
Objective To observe the effect of multiple interventions on secondary epilepsy patients.Methods 114 secondary epilepsy patients were randomly divided into the intervention group and control group with 57 cases in each group.The cases in the intervention group received multiple interventions including heath education,psychological treatment,safety nursing,overdose administration,early rehabilitation,discharge guide and so on besides usual nursing.While,the cases in the control group received usual nursing.The follow-up was performed for 6 months and the therapeutic efficacy of two groups was compared.Results After multiple interventions,the seizure frequency and trauma incidence rate decreased,compliance and quality of life increased in patients of the intervention group,and there was a significant difference compared with the control group(P0.05).Conclusion Multiple interventions can decrease seizure frequency and increase compliance of treatment and quality of life of secondary epilepsy patients.
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