Invasive IPMN relapse later and more often in lungs in comparison to pancreatic ductal adenocarcinoma

BackgroundThe different oncological outcomes of invasive intraductal papillary mucinous neoplasm (I-IPMN) and pancreatic ductal adenocarcinoma (PDAC) are debated. This study aimed to compare disease recurrence patterns and histopathological characteristics in patients with resected I-IPMN and PDAC.MethodsConsecutive patients undergoing surgical resection for stage I-III I-IPMN or PDAC between 2010 and 2016 were retrospectively analyzed. Patients treated with neoadjuvant therapy or resected for Tis neoplasia were excluded. All surgical specimens were re-staged according to AJCC-8th-edition.ResultsA total of 330 patients were included, of whom 43 had I-IPMN and 287 had PDAC. Median follow-up time was 26.7 (1.3–92.3) months and estimated median disease-free survival (DFS) was 60.3 months (47.2–73.4) for I-IPMN and 23.8 (19.3–28.2) months for PDAC (p < 0.001). During follow-up, 32.6% of I-IPMN and 67.9% of PDAC patients experienced recurrence (p < 0.001). The sites of first recurrence were the lungs (38.5% vs 13.1%, p = 0.027), liver (28.6% vs 45.0%, p = 0.180) and local (15.4% vs 36.6%, p = 0.101) for I-IPMN and PDAC, respectively. At multivariate analysis, I-IPMN histology remained an independent predictive factor for longer DFS (OR 0.528, CI 95% 0.278–1.000, p = 0.050), regardless of stage or adjuvant chemotherapy. I-IPMN and PDAC differed in rates of neuroinvasion (51.2% vs 97.2%) and positive lymph node status (N+) (46.5% vs 82.7%), especially in patients with lower T status.ConclusionI-IPMN showed a different recurrence pattern compared to PDAC, with a higher lung tropism, and longer DFS. This different biological behavior is associated with lower rates of neuroinvasion and nodal involvement, especially in early-stage disease.     

Clinical analysis of the risk factors for recurrence of HCC and its relationship with HBV

AIM: To comprehend the risk factors of recurrence of hepatocellular carcinoma (HCC) and its relationship with the infection patterns of hepatitis B virus (HBV).METHODS: All materials of 270 cases of postoperative HCC were statistically analyzed by SPSS software.Recurrence and metastasis were classified into early( ≤2 years) and late phase (&gt;2 years). Risk factors for recurrence and metastasis after surgery in each group were analyzed.RESULTS: Out of 270 cases of HCC, 162 cases were followed up in which recurrence and metastasis occurred in 136 cases. There were a lot of risk factors related to recurrence and metastasis of HCC; risk factors contributing to early phase recurrence were serum AFP level, vascular invasion, incisal margin and operative transfusion, gross tumor classification and number of intrahepatic node to late phase recurrence. The HBV infective rate of recurrent HCC was 94.1%, in which ““HBsAg, HBeAb, HBcAb““ positive pattern reached 45.6%. The proportion of HBV infection in solitary large hepatocellular carcinoma (SLHCC)evidently decreased compared to nodular hepatocellular carcinoma (NHCC) (P&lt;0.05).CONCLUSION: The early and late recurrence and metastasis after hepatectomy of HCC were associated with different risk factors. The early recurrence may be mediated by vascular invasion and remnant lesion, the late recurrence by tumor‘s clinical pathology propert, as multicentric carcinogenesis or intrahepatic carcinoma de novo. HBV replication takes a great role in this process.From this study, we found that SLHCC has more satisfactory neoplasm biological behavior than NHCC.     

Surgical management of isolated retroperitoneal recurrences of colorectal carcinoma

PURPOSE: Isolated locoregional disease accounts for approximately 20 percent of recurrences after treatment for colorectal cancer. It has been suggested that complete resection of these recurrences can result in increased survival. The value of surgery for isolated retroperitoneal recurrences has not been well defined. We have sought to characterize outcome and survival in patients undergoing resection for isolated retroperitoneal recurrences of colorectal cancer. METHODS: From a prospective database, 25 patients were identified as having undergone surgical exploration with curative intent for isolated retroperitoneal recurrences of colorectal cancer between 1988 and 1999. Variables studied included age, gender, location and size of the tumor, extent of resection, disease-free interval, and morbidity and mortality. Statistical analyses were performed using the log-rank test and Kaplan-Meier estimates, with overall survival as the primary end point. RESULTS: The study population consisted of 25 patients (13 males), with a median age of 55 years and a median follow-up of 29 (range, 1–151) months. The median time to first retroperitoneal recurrence was 23 (range, 3–72) months. Twenty patients underwent resection, whereas five patients were deemed unresectable at the time of operation. The median survival in patients who underwent resection patients was 31 months compared with 3 months in those patients who did not undergo resection (P = 0.0001). Analysis of the entire group demonstrated a disease-free interval of greater than 24 months to be a positive predictor of outcome (median survival, 30 vs. 48 months; P = 0.02). For patients undergoing resection, the presence of positive margins (P = 0.01) and tumor size 5 cm (P = 0.008) predicted a worse prognosis. In patients who underwent resection, the two-year and five-year overall survival rates were 60 and 15 percent, respectively. CONCLUSIONS: Patients with isolated retroperitoneal recurrences of colorectal cancer generally have a poor prognosis. However, a longer disease-free interval, complete negative-margin resection, and smaller tumor size are associated with long-term survival in selected patients.     

阿苯达唑脂质体及槐耳浸膏对小鼠肝细粒棘球蚴感染率影响的实验观察

目的 探讨阿苯达唑脂质体(L-ABZ)及槐耳浸膏(HEF)对小鼠肝细粒棘球蚴病术后感染的抑制作用，了解增强宿主免疫功能对本病术后复发的影响。 方法 雌性昆明小鼠，腹腔注射人肝细粒棘球蚴囊液，3周后取外周血IgG抗体阳性鼠，分为药物治疗组(A、B、C组)和模型对照组(D组), 每组40只。A 组灌胃L-ABZ(75 mg/kg)、B组灌胃HEF(15 000 mg/kg)、C 组两药联用(阿75 mg/kg+槐15 000 mg/kg)。隔天1次，共 3 次。麻醉各组小鼠，打开腹腔，肝脏注射经PBS浸泡20 min的原头节(0.3 ml/只，约含原头节6 000个，下同)，模拟开放式外膜内外囊完整摘除术术中外溢原头节再感染。缝合关闭腹腔，72 h后药物治疗组同法继续治疗1个月，D组灌服蒸馏水0.3 ml/只。E组(8只正常小鼠) 为空白对照。各组小鼠均于3个月后解剖。评价药物疗效（包括肝棘球蚴复发率、组织学观察、测定脾脏指数(SI)及IgG、IgE水平、流式细胞仪检测外周血CD4⁺、CD8⁺ T淋巴细胞百分率）。另取上述外周血IgG抗体阳性鼠分为F、G、H和I 4组，每组约30只, 分别同上述A、B、C和D组同法灌胃治疗, 于肝脏分别注射经20% NaCl、75%乙醇、L-ABZ及PBS浸泡20 min的原头节, 观察其感染率。 结果 C组肝棘球蚴复发率为5.7%，低于A组(17.1%)和B组(24.2%)；棘球蚴色泽发白呈结节状，生发层和角质层破坏严重。脾脏指数(A组为3.84±0.86、B组为3.95±1.01、C组为3.27±0.52)和IgE水平(A组为0.06±0.08、B组为0.07±0.08、C组为0.03±0.03)均明显低于D组(分别为5.46±0.52及0.20±0.02)(P＜0.05)，其中C组降低最为明显。CD8⁺水平，A组为16.61±3.89、B组为18.18±3.90、C组为15.38±2.63，均明显低于D组的32.90±4.71(P＜0.05)。CD4⁺/CD8，A组为3.21±0.70、B组为3.05±0.66、C组为3.53±0.57，均明显高于D组的1.57±0.26(P＜0.05)。C组CD8+降低、CD4⁺/CD8⁺升高最为明显。F、G和H组肝棘球蚴感染率分别为0、0及23.1%，与I 组（31.2%）相比较，差异有统计学意义（P＜0.01）。 结论 HEF可明显增强小鼠免疫功能，与L-ABZ联用可抑制棘球蚴生长，降低术后复发率。L-ABZ在术中对于原头节的杀灭作用不及20％ NaCl和75％乙醇。     

99例三阴乳腺癌术后复发转移的影响因素研究

目的对三阴乳腺癌(TNBC)术后复发转移的影响因素进行研究。方法回顾性分析99例三阴乳腺癌患者的临床、病理及预后资料,分析三阴乳腺癌术后复发转移的影响因素。结果99例患者中术后发生复发转移19例,其中胸壁复发7例(其中5例为胸壁复发并远处转移)、脑转移3例、肺转移4例、骨转移3例、肝转移1例、内乳锁骨上纵隔淋巴结转移2例,其中多处转移4例。不同年龄、月经是否绝经、是否脉管转移、不同原发肿瘤大小、不同Ki-67水平、不同组织学分级、不同手术方式、有无淋巴清扫患者复发转移发生情况比较差异无统计学意义(χ^2=1.526、0.849、3.437、3.723、0.416、4.998、0.176、2.070,P>0.05);有淋巴转移患者复发转移率为36.1%(13/36),高于无淋巴转移患者的9.5%(6/63),差异具有统计学意义(χ^2=10.442,P<0.05)。患者腋窝淋巴结转移是术后发生复发转移的危险因素;年龄、月经情况、有无脉管转移、原发肿瘤大小、Ki-67、组织学分级、手术方式、是否行腋淋巴清扫与术后发生复发转移无关。结论患者腋窝淋巴结转移是三阴乳腺癌术后复发转移的危险因素。     

Long-term functional outcomes after an external femoral derotation osteotomy in individuals with cerebral palsy

BackgroundIt is unknown how a femoral derotation osteotomy (FDO) during childhood affects functional outcomes in adulthood among individuals with bilateral cerebral palsy (CP).Research questionsHow do long-term functional outcomes after an FDO compare to matched individuals who did not have an FDO? How do outcomes change over time?MethodsWe queried the gait laboratory database for individuals who underwent an external FDO in childhood and were currently ≥25 years old. Participants returned for a long-term analysis (gait, physical examination, functional tests, imaging, questionnaires). The matched non-FDO group included only individuals in Gross Motor Function Classification System levels I-II, yielding three groups (non-FDO I-II, FDO I-II, FDO III-IV).ResultsSixty-one adults (11 non-FDO, 34 FDO I-II, 16 FDO III-IV) returned 13–25 years after baseline (non-FDO) or surgery (FDO). The non-FDO and FDO I-II groups were matched at baseline on most variables, except the FDO group had weaker hip abductors. At long-term, groups were similar on gait variables (median long-term hip rotation [primary outcome], non-FDO: −4°, FDO I-II: −4°, FDO III-IV: −5°), hip abduction test, fear of falling, and most pain measures despite anteversion being 29° greater in the non-FDO group. The FDO I-II group reported more falls than the non-FDO group. All groups improved on hip rotation, foot progression, and hip abductor strength. Speed and step length decreased/tended to decrease for all three groups. Hip abduction moment and gait deviation index did not change. Improvements in the FDO groups were maintained from short- to long-term.SignificanceThese results challenge the notion that an FDO is necessary to correct mean stance hip rotation for higher functioning individuals since nearly identical results were achieved by adulthood in the non-FDO I-II group. However, an FDO provides improvement earlier and maintenance from short- to long-term. This should factor into the shared decision-making process.     

Impact of time to resumption of antithrombotic therapy on outcomes after surgical evacuation of chronic subdural hematoma: A multicenter cohort study

BackgroundThe decision to resume antithrombotic therapy after surgical evacuation of chronic subdural hematoma (CSDH) requires judicious weighing of the risk of bleeding against that of thromboembolism. This study aimed to investigate the impact of time to resumption of antithrombotic therapy on outcomes of patients after CSDH drainage.MethodsData were obtained retrospectively from three tertiary hospitals in Singapore from 2010 to 2017. Outcome measures analyzed were CSDH recurrence and any thromboembolic events. Logistic and Cox regression tests were used to identify associations between time to resumption and outcomes.ResultsA total of 621 patients underwent 761 CSDH surgeries. Preoperative antithrombotic therapy was used in 139 patients. 110 (79.1%) were on antiplatelets and 35 (25.2%) were on anticoagulants, with six patients (4.3%) being on both antiplatelet and anticoagulant therapy. Antithrombotic therapy was resumed in 84 patients (60.4%) after the surgery. Median time to resumption was 71 days (IQR 29 – 201). Recurrence requiring reoperation occurred in 15 patients (10.8%), of which 12 had recurrence before and three after resumption. Median time to recurrence was 35 days (IQR 27 – 47, range 4 – 82 days). Recurrence rates were similar between patients that were restarted on antithrombotic therapy before and after 14, 21, 28, 42, 56, 70 and 84 days, respectively. Thromboembolic events occurred in 12 patients (8.6%), of which five had the event prior to restarting antithrombosis.ConclusionsTime to antithrombotic resumption did not significantly affect CSDH recurrence. Early resumption of antithrombotic therapy can be safe for patients with a high thromboembolic risk.     

大动脉炎合并脑梗死49例临床分析

目的 总结大动脉炎合并脑梗死患者的临床特点,分析此类患者脑梗死复发的相关因素。
方法 回顾性分析2010年1月-2020年6月随访超过3年的大动脉炎合并脑梗死患者的临床资料,对
此类患者脑梗死复发的相关因素进行分析。
结果 共纳入49例患者,首次脑梗死中位年龄30.0（22.0～45.0）岁,中位随访时间3.4（3.2～3.7）年。
11例（22.4%）出现复发性脑梗死,两次脑梗死间隔中位时间8.0（5.0～88.0）个月。与脑梗死无复发
患者相比,复发性脑梗死患者合并糖尿病比例（27.3% vs 2.6%,P =0.031）以及首次脑梗死后随访
期间平均TG水平（3.65±0.96 mmol/L vs 1.14±0.54 mmol/L,P =0.001）升高。大动脉炎受累动脉以颈
总动脉最为常见（48/49,98%）,其次是椎动脉（40/49,81.6%）,受累血管病变性质以狭窄（49/49,
100%）和闭塞（36/49,73.5%）最常见。脑梗死复发组动脉闭塞比例（100% vs 65.8%,P =0.024）和
动脉血栓发生率（45.5% vs 13.2%,P =0.033）均高于脑梗死无复发组。治疗方面,脑梗死复发组抗
血小板治疗患者比例（63.6% vs 97.4%,P =0.007）及接受血管重建术的患者比例（27.3% vs 68.4％,
P =0.033）均低于脑梗死无复发组。
结论 大动脉炎合并脑梗死的患者,如合并糖尿病、血脂控制欠佳、主动脉弓分支动脉有闭塞、血
栓形成者,脑梗死复发风险高。     

Proton pump inhibitor use and risk for recurrent Clostridioides difficile infection: a systematic review and meta-analysis

ObjectivesProton pump inhibitor (PPI) therapy is a potentially modifiable risk factor for recurrent Clostridioides difficile infection (CDI). Citing an absence of clinical trials, many guidelines do not provide recommendations for addressing PPI management. Our aim was to perform an updated systematic review and meta-analysis evaluating the association between PPI use and recurrent CDI addressing prior methodological limitations.MethodsData sources were MEDLINE and EMBASE. Eligible studies were cohort and case–control studies; there were no restrictions on study setting or duration of follow-up. Participants were adults with prior CDI who did or did not receive PPI therapy and were assessed for recurrent CDI. Summary (unadjusted) odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effects model. Prespecified subgroup analyses were performed to explore heterogeneity including study design, study quality, duration of follow-up, adjustment for confounders, and outcome definition.ResultsSixteen studies were included in the meta-analysis, comprising 57 477 patients with CDI, of whom 6870 (12%) received PPIs. The rate of recurrent CDI was 24% in patients treated with PPIs versus 18% in those who were not. A meta-analysis that pooled unadjusted odds ratios demonstrated higher odds of recurrent CDI in patients who received PPIs (OR 1.69, 95%CI 1.46–1.96) versus those who did not. There was moderate heterogeneity between studies (I² 56%); however, a sensitivity analysis restricted to studies with 56 days of follow-up substantially reduced the heterogeneity (OR 1.59, 95%CI 1.36–1.85; I² 12%). An analysis restricted to multivariate studies that combined adjusted ORs also demonstrated higher odds of recurrent CDI in patients who received PPIs (OR 1.49, 95%CI 1.12–2.00). No publication bias was identified.ConclusionsWe found significantly higher odds of recurrent CDI among users of PPIs that persisted across multiple sensitivity analyses. These results support stronger recommendations for PPI stewardship at CDI diagnosis.