Atrial fibrillation influences survival in patients with hepatocellular carcinoma: Experience from a single center in Taiwan

BackgroundIt is unclear whether atrial fibrillation (AF) adversely influences the clinical course of patients with hepatocellular carcinoma (HCC).MethodsDuring the period from January 1, 2001 to December 31, 2010, 476 patients (mean ± SD age 60.3 ± 12.9 years) diagnosed with HCC were retrospectively enrolled in our study. The HCC stage, treatment, baseline characteristics, underlying cardiovascular diseases, and corresponding drug treatment were systematically reviewed. The primary endpoint was death from any cause.ResultsAF was associated with a significantly reduced survival time in patients with HCC (AF vs. non-AF patients mean ± SD survival time 470.1 ± 89.6 days vs. 1161.2 ± 32.6 days, log-rank p < 0.001; probability of survival 0.20, 95% confidence interval 0.10–0.38, p < 0.001). After adjustment for sex and age, AF was still associated with poorer survival times (hazard ratio 4.131, 95% confidence interval 2.134–5.733, p < 0.001). The causes of death among 22 patients with both HCC and AF included 11 cases of hepatic failure, four cases of ruptured tumor, and two cases of bleeding from esophageal varices. None of these patients with AF used warfarin. Seven bleeding events related to HCC were noted, but none of these patients developed a major thromboembolism. The mean ± SD follow-up period was 645 ± 468 days.ConclusionPatients with HCC had a significantly reduced survival time with the comorbidity of AF. Tumor rupture was relatively common among patients with both HCC and AF. The anticoagulation treatment of AF in patients with HCC deviated from the current guidelines without an increase in thromboembolic events.     

Factors that influence survival in colorectal cancer with synchronous distant metastasis

BackgroundTreatments for the purposes of curing or more effectively managing metastatic colorectal cancer (CRC) are evolving. Our study focused on patients with primary CRC with synchronous distant metastasis, and we analyzed the factors influencing patient survival.MethodsData review was conducted retrospectively. Clinicopathological parameters included age, sex, site of primary cancer, tumor cell differentiation, number of liver metastasis, presence of extrahepatic metastasis, treatment of liver metastasis, pre-treatment carcinoembryonic antigen (CEA) level, status of treatment response, salvage treatment and survival.ResultsA total of 420 patients were identified and considered for our study. Of those, 275 patients (65.4%) had liver-only metastasis, 100 patients (23.8%) had concomitant lung metastasis, and 40 patients (9.5%) had other metastases. Additionally, 145 patients (34.5%) had liver-directed treatment including surgical resection (28.5%), radiofrequency ablation (RFA) (10.6%) and transcatheter arterial chemoembolization (TAE) (1.2%). There were 80 patients (19%) with CEA levels < 10, 135 patients (32.1%) with CEA 10–100, and 165 patients (39.2%) with CEA > 100. There were 200 patients (47.6%) who had received chemotherapy, 130 patients (30.9%) with target therapy, and 40 patients (9.5%) who had not undergone any salvage treatment. Three significant factors were identified, including treatment of liver metastasis (p = 0.027), pre-treatment CEA (p = 0.04), and salvage treatment (p = 0.005).ConclusionWe demonstrated three factors influencing patient survival including treatment of liver metastasis, pre-treatment CEA level, and salvage treatment. Aggressive treatment of liver metastasis including surgical resection or RFA combined with chemotherapeutic agents appear to provide an increased rate of survival to patients.     

沙库巴曲缬沙坦联合卡维地洛治疗不同病因老年人慢性心力衰竭的有效性和安全性分析

目的探讨沙库巴曲缬沙坦联合卡维地洛治疗不同病因老年人慢性心力衰竭的疗效。方法选取2019年3月—2021年2月常州市第四人民医院收治的89例慢性心力衰竭患者,依据病因将其分为冠状动脉粥样硬化性心脏病(以下简称冠心病)组(45例)、高血压心脏病组(16例)和扩张型心肌病组(28例)。所有患者采用沙库巴曲缬沙坦联合卡维地洛连续治疗3个月。对比3组患者心功能指标、临床疗效、血清学指标及治疗期间不良反应。结果治疗前,3组患者左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)及心脏指数比较,差异无统计学意义(P>0.05);治疗后3组患者LVEDD、LVESD均低于治疗前(P <0.05),LVEF及心脏指数则均高于治疗前(P <0.05);治疗后3组患者LVEDD、LVESD、LVEF及心脏指数比较,差异无统计学意义(P>0.05)。3组患者临床疗效、总有效率比较,差异无统计学意义(P>0.05)。3组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论沙库巴曲缬沙坦联合卡维地洛可用于治疗老年人慢性心力衰...     

急诊经肝动脉栓塞治疗肝癌破裂出血的临床体会

目的探讨原发性肝癌破裂出血急诊介入的临床疗效。方法回顾性分析采用介入栓塞技术对我院16例原发性肝癌破裂出血的治疗情况。结果本组病例均行TAE获得有效止血。其中2例获得Ⅱ期手术治疗，1例因术前失血过多而死于肝功能衰竭，13例多次介入肿瘤缩小。一年存活率为37．5％（6／16）。结论介入栓塞治疗急诊肝癌破裂出血创伤小，适应证广，临床疗效确切，可作为急诊肝癌破裂出血的首选治疗方法。     

经导管动脉栓塞治疗急性非曲张静脉上消化道出血的疗效分析

  目的  评估经导管动脉栓塞（transcatheter arterial embolization, TAE）治疗急性非曲张静脉上消化道出血（acute non-variceal upper gastrointestinal bleeding, ANVUGIB）的安全性和有效性。  方法  回顾性纳入266例2016年3月–2021年3月期间因ANVUGIB行血管造影的患者,统计血管造影阳性率、TAE技术成功率和临床成功率,TAE治疗后30 d内再出血率及全因死亡率,分析与上述事件相关的影响因素。  结果  266例患者均完成血管造影,血管造影阳性率为54.1%（144/266）,TAE技术成功率为97.3%（217/223）,TAE临床成功率为73.1%（155/212）,TAE治疗后30 d内再出血率及全因死亡率分别为26.9%（57/212）、16.1%（35/217）。本研究发现休克指数>1〔比值比（OR）=5.950,95%置信区间（CI）:1.481～23.895,P=0.012〕、CT血管造影（CTA）阳性（OR=6.813,95%CI:1.643～28.252,P=0.008）及间隔时间<24 h （OR=10.530,95%CI:2.845～38.976,P<0.001）是血管造影阳性的独立预测因子;休克指数>1（OR=2.544,95%CI:1.301～4.972,P=0.006）及国际标准化比值>1.5（OR=3.207,95%CI:1.381～7.451,P=0.007）是TAE治疗后30 d内再出血的独立危险因素;术后出血（OR=3.174,95%CI:1.164-8.654,P=0.024）及栓塞后再出血（OR=34.665,95%CI:11.471～104.758,P<0.001）患者TAE治疗后30 d内的死亡风险更高。  结论  TAE治疗ANVUGIB安全有效。休克指数>1和CTA阳性的患者更有可能血管造影阳性,且应该在出血后早期完成血管造影。栓塞后再出血仍需要高度重视。     

Treatment selection for tonsillar squamous cell carcinoma

BackgroundThe optimal treatment for tonsillar squamous cell carcinoma (SCC) remains controversial. The purpose of this study was to evaluate long-term treatment outcomes of patients with tonsillar SCC, in order to aid in appropriate treatment selection.MethodsWe conducted a retrospective chart review of 105 patients with curatively treated tonsillar SCC between January 1996 and December 2005. Forty-three patients (41.0%) underwent primary surgery with or without adjuvant therapy (primary surgery group), and 62 patients (59.0%) were treated with radiotherapy/chemoradiotherapy (RT/CRT, organ preservation group). Twenty patients (19%) received tumor tonsillectomy before definitive RT/CRT and were grouped into the organ preservation group.ResultsNo significant differences were observed between the primary surgery and organ preservation groups in terms of local control (p = 0.212), regional control (p = 0.684), distant metastasis (p = 0.627), 5-year disease-specific survival (DSS, p = 0.774), and overall survival rates (OS, p = 0.667). The rates of major complication (p = 0.216), long-term dependency on feeding tubes (p = 0.876), and tracheostomy (p = 0.401) were also similar. Advanced T classification (T3–4) was the only factor associated with significantly worse DSS (p = 0.007) and OS (p = 0.012). However, there was also no difference in final treatment outcomes in T3–4 patients regardless of whether they were treated with primary surgery or RT/CRT. In the organ preservation group, tumor tonsillectomy before RT/CRT did not improve local control (p = 0.520) or other treatment outcomes, including 5-year DSS (p = 0.707) and OS (p = 0.745).ConclusionBoth primary surgery and RT/CRT organ preservation are effective treatments for tonsillar SCC. Single modality treatment, either surgery or RT/CRT, can typically be provided for stage I–II diseases. Although RT/CRT organ preservation is used more frequently for stage III–IV tonsillar SCC in recent years, primary surgery combined with adjuvant therapy still achieves equivalent outcomes. Multidisciplinary pretreatment counseling and the facilities and personnel available are therefore important for decision-making. In addition, if RT/CRT organ preservation is selected as the primary treatment, tumor tonsillectomy is not indicated.     

Incidence of liver trauma and relative risk factors for mortality: A population-based study

BackgroundLiver trauma is the main cause of death arising from blunt abdominal injury. Nonoperative management (NOM) has been advocated to be a safe option for stable patients who have suffered liver trauma. This study used a population-based dataset to illustrate the incidence of liver trauma, its various causes and treatment, and outcomes.MethodsInformation about all patients with any ICD-9-CM coded as liver injury was retrieved as part of a claims dataset for the years 2007 and 2008 from the database maintained in the Bureau of National Health Insurance in Taiwan. Thereafter, statistical analyses were conducted to discover the incidence, mortality rate, percentage of patients receiving NOM, and the association between variables such as age, gender, injury mechanisms, associated injuries, and outcome.ResultsA total of 3196 liver trauma patients were admitted in 2007 and 2008, resulting in 264 deaths. The incidence rate is 13.9/100,000 population. The highest incidence rate was in the age 15–24 years group, 25.9/100,000 population; the highest mortality rate was in the age 75–84 years group, 2.1/100,000 population. Additionally, rural residents possessed a higher incidence and mortality rate than urban residents (15.9/100,000 population vs. 12.2/100,000 population and 1.4/100,000 population vs. 1.0/100,000 population). By using logistic regression, the mortality rate was significantly higher in the groups with patients aged >64 years, renal failure or liver cirrhosis, with head or chest, or other abdominal injury. If a patient received a hepatic or abdominal operation, this was retrospectively found to be associated with increased mortality risk (4.731 times, p < 0.001 and 4.311 times, p < 0.001, respectively); however, the characteristics of the treating hospitals did not influence the mortality rate. Patients whose monthly income was >US$660 were found to have a higher mortality risk (2.209 times, p < 0.001).ConclusionThe overall incidence rate of liver trauma was higher in the younger age group and in rural residents. A higher risk of mortality was found in the age > 64 years group, pedestrians hit in motor-vehicle accidents, renal failure or liver cirrhosis, with head or chest, or other abdominal injury.     

Standardized analysis of laparoscopic and robotic-assisted partial nephrectomy complications with Clavien classification

BackgroundLaparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN) are accepted as alternatives of open partial nephrectomy for managing renal tumors. However, LPN and RPN are technically challenging procedures. This report analyzed, according to the Clavien classification, the complications after LPN and RPN.MethodsWe analyzed consecutive LPN (n = 85) and RPN (n = 93) cases at our institution between April 1994 and December 2012. The data were retrospectively reviewed from a prospectively collected database. All complications that occurred within 3 months postoperatively were recorded and classified according to the modified Clavien classification system.ResultsThe mean tumor size was 3.90 ± 1.77 cm. The mean operative time was 255.0 ± 83.5 minutes, and the mean warm ischemia time was 31.6 ± 22.0 minutes. The overall complication rate was 18.5%. Clavien Grades I, II, IIIa, and IIIb complications accounted for 3.93%, 11.2%, 2.81%, and 1.69% of patients, respectively. The most common complication was perioperative hemorrhage that required blood transfusion. Delayed bleeding occurred in seven patients, and four patients underwent angiographic embolization. The proportions of intermediate and high PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) score (≥8) and RENAL (Radius/Exophytic/Nearness to collecting system/Anterior/Location) score (≥7) were 70.8% and 74.2%, respectively. A higher PADUA or RENAL score was associated with a significantly greater complication rate (p = 0.024 and p = 0.02, respectively).ConclusionThe overall complication rate in the present study was comparable to that reported in previous studies, although our patients had a larger mean tumor size and higher-complexity procedures.     

Transarterial detachable coil embolization of direct carotid-cavernous fistula: Immediate and long-term outcomes

BackgroundTransarterial embolization is a standard method for management of direct carotid-cavernous fistula (DCCF). The purpose of this study was to report our experiences, and immediate and long-term outcomes of endovascular embolization of DCCFs by using detachable coils (DCs).MethodsOver 8 years, 24 patients with 25 DCCFs underwent endovascular DC embolization. There were 15 men and nine women; age ranged from 8 to 82 years (mean, 39 years). Immediate and long-term angiographic as well as clinical outcomes after endovascular DC embolization were retrospectively analyzed. The number and the length of DCs used to occlude the fistula were also evaluated.ResultsEighteen DCCFs were successfully occluded by single-session endovascular embolization with preservation of the parent artery. Retreatments by transvenous (n = 5) and/ or transorbital routes (n = 3) had to be performed in seven patients because of residual fistula (n = 4) or recurrent fistula (n = 4) occurring within 3 weeks after embolization. The average numbers and length of coils to occlude the fistulas were 14 (range, 2–31) and 189 cm (range, 16–756 cm), respectively. Four patients had small residual fistulas with spontaneous thrombosis on follow-up angiography. Three patients had transient cranial nerve impairment of the third (n = 1) or sixth (n = 2) nerve. There was no significant procedure-related neurological complication. The follow-up period was 3–48 months (mean, 19 months)ConclusionEndovascular DC embolization of DCCFs was proved both efficacious and safe in managing high-flow fistulas with sustained angiographic and clinical effects, particularly in those DCCFs with small fistula track and/or cavernous sinus. However, retreatment via various routes may be necessary in some patients because of residual or recurrent fistulas.     

气管狭窄手术麻醉插管与手术方式的特点分析

目的 探讨在气管狭窄的外科治疗中如何正确选择麻醉插管方式与手术方式。方法 选取1998年1月—2018年12月在西南医科大学附属医院胸外科手术治疗的32例气管狭窄患者的临床资料，按不同致气管狭窄原因分为肿瘤组、非肿瘤组。比较两组患者临床资料的差异。记录并比较两组患者麻醉插管方式、手术方式、手术时间、手术出血量、术后插管时间、术后住院日及术后并发症等情况。随访1个月～20年，统计分析两组气管吻合口狭窄发生率、疾病复发率等指标。结果 肿瘤组气管修补术较非肿瘤组低（P <0.05），气管环形切除+端端吻合及单腔插管+全麻较非肿瘤组高（P <0.05）。两组手术切口比较，差异无统计学意义（P >0.05）。两组中、下段气管狭窄的麻醉方式和手术方式比较，差异无统计学意义（P >0.05）。肿瘤组手术时间、术中出血量较非肿瘤组高（P <0.05）。两组术后并发症比较，差异无统计学意义（P >0.05）。患者均治愈出院，两组患者均未发生手术及围手术期死亡。结论 气管狭窄往往是亚急诊或急诊性病种，手术治疗是最有效的方法。麻醉插管及手术方式应依据气管狭窄的特点而灵活选择，若能正确选择，将有效提高气管狭窄手术成功率。     

Risk factors for acute kidney injury in the elderly undergoing contrast-enhanced computed tomography in the emergency department

BackgroundThere have been few studies focusing on the incidence and risk factors for elderly patients undergoing computed tomography (CT) scans with intravascular contrast medium, who develop contrast-induced nephropathy (CIN) in the emergency department (ED). Our objective was to investigate the incidence of and risk factors for, CIN in elderly patients seen in the ED, who receive intravenous contrast media for CT examination.MethodsPatients ≥65 years of age who received contrast-enhanced CT were eligible for inclusion in this retrospective analysis. CIN was defined as an increase in serum creatinine (sCr) ≥0.5 mg/dL 48 to 72 hours after intravenous contrast administration. Multiple logistic regression analysis for risk factors for CIN and Chi-square test were performed for trend analysis for CIN incidence and mortality of different risk scores.ResultsA total of 594 patients, with a mean age of 79.8 ± 6.8 years were included. The overall incidence of CIN was 8.6%. In multivariate analyses, CIN was associated with diabetes mellitus [adjusted odds ratio (OR) = 1.93; 95% confidence interval (CI) = 1.04–3.62], precontrast sCr >1.5 mg/dL (OR = 2.72; 95% CI = 1.44–5.13), and acute hypotension (OR = 3.56; 95% CI = 1.29–9.84). CIN and mortality increased with increasing risk score (p < 0.001 and p = 0.001, respectively). The all-cause in-hospital mortality rate was 13.1%, and the mortality rates for patients with and without CIN (p < 0.001) were 47.1% and 9.9%, respectively.ConclusionOur investigation confirmed diabetes mellitus, precontrast sCr >1.5 mg/dL and acute hypotension as risk factors for CIN, and also developed a simple risk score for elderly patients seen in the ED.     

Abnormal thyroid function predicts mortality in patients receiving long-term peritoneal dialysis: A case-controlled longitudinal study

BackgroundThe population of uremia patients receiving long-term peritoneal dialysis (PD) is growing, and abnormal thyroid function occurs increasingly in patients with chronic kidney disease in comparison with the normal population. We aimed to elucidate the clinical impact of abnormal thyroid function in long-term PD patients.MethodsThis was a retrospective, case-controlled, longitudinal study. We collected the characteristics, laboratory data, dialysis parameters, and thyroid and heart function of patients who underwent long-term PD for >8 years during the past 25 years in Taipei Veterans General Hospital, Taiwan. Patients with hyperthyroidism were excluded. None of these subjects presented a recent history of infection or inflammatory disease or took any drugs known to influence thyroid function. Abnormal thyroid function was defined as the presence of primary hypothyroidism and sick euthyroid syndrome.ResultsA total of 46 patients were enrolled. The mean duration of PD therapy was 147.8 (48.3) months. Nineteen of 46 (41.3%) patients had abnormal thyroid function tests. Patients with abnormal thyroid function had a worse prognosis in cumulative patient survival analysis by Kaplan–Meier method (p = 0.02). After adjusting for diabetes mellitus, cardiothoracic ratio, C-reactive protein (CRP), and cardiovascular diseases, abnormal thyroid function remained as an independent predictor of patient survival (hazard ratio = 7.633, 95% confidence interval 1.3–43.9, p = 0.02). The CRP levels were significantly inversely correlated with free thyroxine levels (r = –0.547; p = 0.01). The most common cause of death among the patients was sepsis (67.7%) rather than cardiovascular disease (20.0%).ConclusionPD patients with abnormal thyroid function had poor cumulative survival. Lower thyroid hormone level in PD patients was associated with high CRP levels. Physicians should be alert for the presence of abnormal thyroid function and proinflammatory status in long-term PD patients.     

肛裂缝切术治疗陈旧性肛裂的临床疗效观察

目的:探讨肛裂缝切术治疗陈旧性肛裂的临床疗效。方法:纳入204例陈旧性肛裂患者,随机分为治疗组与对照组,每组102例。治疗组采用肛裂缝切术治疗,对照组采用肛裂切除术治疗。评价两组的临床疗效,比较两组患者的术后并发症发生情况,同时比较两组的住院费用及住院时间。结果:经手术治疗后,两组患者的治愈率均为100%。治疗组患者的术后创缘疼痛、水肿、出血及小便困难、发热情况均优于对照组(P0.01,P0.05)。治疗组患者的住院时间较对照组明显缩短(P0.01),住院费用明显少于对照组(P0.01)。结论:肛裂缝切术治疗陈旧性肛裂疗效确切,可有效减少术后疼痛、出血、水肿等并发症,缩短住院时间,减少住院费用。     

Randomized control trial to study the efficacy and safety of platelet-rich plasma as intraoperative holding solution in hair restoration surgery: A pilot study

BackgroundHair restoration surgery is a definitive surgical procedure undertaken for androgenetic alopecia (AGA). Platelet-rich plasma (PRP) therapy has gained importance in recent times as a valuable adjunct to therapy in hair restoration. However, the various beneficial effects of PRP as intraoperative holding solution hair restoration surgery remain to be objectively defined.MethodsTwenty cases of AGA were allocated into two groups (PRP and non-PRP). The follicular grafts harvested were stored in platelet-rich plasma/chilled ringers lactate solution depending on subject/control and were implanted in receding hairline using hair implanters. Patients were reviewed at the end of 2 weeks, 4 weeks, 8 weeks, 3 months, and 6 months using clinical and folliculoscopic images. The analysis was performed using SPSS version 20.0.ResultsFollicular growth as assessed using the percentage of grafts in actively growing phase posttransplant showed faster recovery from ‘shock effluvium’ in the PRP group when compared with the non-PRP group from Week 4, through Week 8 and 3 months with the ‘lead’ increases of percentage growth difference being statistically significant(P = 0.02) between the two groups. At the end of 6 months, 100% of patients recorded a hair shaft length of >10 mm in the PRP group, whereas only 20% achieved >10 mm length. The difference in hair densities between PRP and the non-PRP group from 4 weeks up to 6 months in the non PRP group remained significant (P < 0.05).ConclusionIntraoperative PRP as a holding solution improves outcome in hair restoration surgery by a significant improvement in the mean density of the implanted follicular unit grafts at 6 months.     

Not only hysterectomy but also cesarean section can predict incomplete flexible sigmoidoscopy among patients with prior abdominal or pelvic surgery

BackgroundFlexible sigmoidoscopy (FS) is a safe and effective method for colorectal cancer (CRC) screening. Several studies have demonstrated that individuals who have undergone surgery are at a greater risk of having incomplete FS. This study explored predictors of incomplete FS and reduced polyp detection rates for participants who had undergone abdominal or pelvic surgery.MethodsFrom January 2009 to December 2009, individuals participating in health examinations and who had undergone abdominal or pelvic surgery were invited to participate in this investigation. Four experienced gastroenterologists performed examinations using a 60-cm Olympus video sigmoidoscope. Factors associated with incomplete FS insertions and reduced polyp detection rates were analyzed using logistic regression models.ResultsOverall, 106 eligible individuals were analyzed, and 45 (42%) incomplete FS insertions were reviewed. Fifty participants (47%) had undergone pelvic surgery, and the other 56 (53%) had undergone abdominal surgery. Pelvic surgeries were cesarean section (25%) and hysterectomy (15%); appendectomy (36%) was the most common abdominal surgery. The main pathological FS findings were hemorrhoids (54%) and adenomatous polyps (18%). Multivariate analysis indicated that only prior pelvic surgery [odds ratio (OR), 3.54; p = 0.01] was an independent risk factor for incomplete FS insertion. Incomplete examinations were inversely related to adenomatous polyp detection rates (OR, 0.23; p = 0.03).ConclusionPrior pelvic surgery, particularly cesarean section and hysterectomy, is an independent factor for incomplete FS insertion in a selected adult population. In addition, incomplete FS can increase the risk of missing polyps, particularly in individuals who underwent pelvic surgery.     

Number of involved lymph nodes is important in the prediction of prognosis for primary duodenal adenocarcinoma

BackgroundThe significance of lymph node involvement regarding the prognosis of primary duodenal adenocarcinoma remains controversial. This study aims to evaluate the prognostic accuracy of nodal metastasis using the seventh edition American Joint Committee on Cancer staging system in patients with primary duodenal adenocarcinoma.MethodsBetween 1993 and 2010, 36 patients who had undergone surgical resection for primary duodenal adenocarcinoma at the Kaohsiung Veterans General Hospital were retrospectively reviewed.ResultsThe median disease-free survival for all patients was 19 months and the median overall survival was 21 months. Lymph node metastases were found in 26 (72%) of the patients, and 14 patients (39%) patients had in excess of three positive lymph nodes (N2). Patients with N2 disease had significantly reduced overall survival, as compared to patients with three or fewer positive lymph nodes (N1; p = 0.036). In univariate analysis, factors including age >75 years, body weight loss, tumor size ≤4 cm, N2 disease and lymph node ratio >0.4 predicted shorter overall survival. Multivariate analysis demonstrated that N2 and lymph node ratio >0.4 are significant risk factors associated with overall survival (p = 0.026 and p = 0.042 respectively). N2 is also the only independent predictive factor for disease-free survival (p = 0.023).ConclusionSubdivision of metastatic lymph nodes into N1 and N2 improves predictive ability. The seventh edition American Joint Committee on Cancer staging system is applicable in the present study with regard to the prediction of the prognosis for primary duodenal adenocarcinoma.     

High serum DcR3 levels are associated with the occurrence of peritonitis in patients receiving chronic peritoneal dialysis

BackgroundPeritoneal dialysis (PD)-related peritonitis is a serious complication that typically leads to hospitalization, catheter loss, and even mortality. Previous studies of the risk factors for peritonitis are discordant. To date, no biomarker associated with PD-related peritonitis has been investigated. However, it has been shown that serum decoy receptor 3 (DcR3) is a valuable marker in predicting the outcome of several inflammatory diseases. The aim of this study was to investigate whether serum DcR3 is a predictor of peritonitis in chronic PD patients.MethodsWe conducted a prospective cohort study of PD patients in the PD unit of a tertiary referral center from March 1 to November 30, 2007, and followed up until December 31, 2009. Clinical and laboratory parameters were recorded and serum DcR3 was measured to assess risk factors for developing PD-related peritonitis.ResultsA total of 77 patients (38 men and 39 women; mean age 58 ± 13 years) were enrolled in this study. The average time on PD was 24.5 months and 46 patients (60%) were diabetic. The mean follow-up duration was 499 ± 17 days. The rate of peritonitis incidence was 0.17 episodes per patient-year. Baseline serum DcR3 in 77 patients was 1.94 ± 1.23 ng/mL. Kaplan–Meier survival analysis showed that patients with serum DcR3 > 1.8 ng/mL had a higher risk of peritonitis than those with serum DcR3 < 1.8 ng/mL (p = 0.016). The Cox proportional hazard model further showed that high serum DcR3 (>1.8 ng/mL) was an independent risk factor for subsequent peritonitis (hazard ratio 3.61, 95% CI 1.17–11.08; p = 0.03).ConclusionSerum DcR3 was associated with increased risk of PD-related peritonitis.     

Assessment of the quality of anticoagulation management with warfarin in a tertiary care center

Objectives:To evaluate the quality of an anticoagulation clinic in a tertiary hospital and identified factors affecting the time in the therapeutic range (TTR) and its relation to different complications.Methods:This single-center retrospective study conducted between March 2015 and June 2016 included 1914 patients receiving warfarin therapy. They were divided into 4 warfarin indication groups: non-valvular atrial fibrillation (AF) (n=403), valvular AF (n=227), prosthetic valves (n=700), and venous or pulmonary embolism (n=584).Results:The median age was 56 (25th, 75th percentiles: [45, 67]) years, and 53.2% were female. The median TTR was 0.52 (0.28, 0.76). Low hemoglobin (0.007) and high alkaline phosphatase (0.020) levels negatively affected the TTR. Venous thromboembolism (VTE) was associated with low TTRs. Minor bleeding occurred in 64 (3.35%), gastrointestinal bleeding in 14 (0.7%), and stroke in 41 (2.2%) patients, with no inter-group differences. The TTR was not associated with minor bleeding (odds ratio [OR]=0.49; p=0.09), gastrointestinal bleeding (OR=0.29; p=0.18), or stroke (OR=1.15; p=0.79).Conclusion:Reflecting the real-life experience of anticoagulation control, our patients spend less than half the TTR within the INR. The low target TTR mandates the need to improve service quality and control factors affecting the TTR, including hemoglobin levels and regular visits for patients with VTE.     

The role of autologous bone graft in surgical treatment of hypertrophic nonunion of midshaft clavicle fractures

BackgroundThis study was conducted to evaluate the results of treating hypertrophic nonunion of mid-shaft clavicle fracture with a limited contact dynamic compression plate (LC-DCP) without autologous cancellous bone graft.MethodsFrom 1995 to 2008, 51 cases of hypertrophic nonunion of mid-shaft clavicle fracture were managed with open reduction and internal fixation by LC-DCP without bone graft involvement. Of these 51 cases, 30 had nonunion after failure of initial surgical treatment (Group 1), and 21 had nonunion after failure of conservative treatment (Group 2). Preoperative and postoperative case management were the same for both groups, with the average follow-up period being 20.4 months (range 18–36). Our study evaluated the radiographic results and functional outcomes of these cases according to the quick disability of arm, shoulder, and hand score.ResultsAll 51 cases resulted in uneventful unions. There was no statistically significant difference between the two groups regarding patient demography, cause of injury, preoperative and postoperative functional scores, length of operation, union time, and duration of hospitalization (p > 0.05).ConclusionLC-DCP fixation is an effective method for treating hypertrophic nonunion of mid-shaft clavicle fracture. Local bone graft is sufficient to achieve necessary union, and autologous bone graft from other sites of the body appears unnecessary.