Effect of single-port video-assisted thoracoscopy on surgical site wound infection and healing in patients with lung cancer: A meta-analysis

We performed a meta-analysis to comprehensively assess the effect of single-port video-assisted thoracoscopy on surgical site wound infection and healing in patients with lung cancer. A computerised search for studies on single-port video-assisted thoracoscopy treatment of lung cancer was conducted from the time of database creation through February 2023 using the PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. Two investigators independently screened the literature, extracted information, and evaluated the quality of studies according to inclusion and exclusion criteria. Either a fixed or random-effects model was used in calculating the relative risk (RR) with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.4 software. The results showed that, compared with multi-port video-assisted thoracoscopy, single-port video-assisted thoracoscopy significantly reduced surgical site wound infection (RR: 0.38, 95% CI: 0.19–0.77, P = .007) and significantly promoted wound healing (RR: 0.37, 95% CI: 0.22–0.64, P < .001). Compared with multi-port video-assisted thoracoscopy, single-port video-assisted thoracoscopy significantly reduced surgical site wound infections and also promoted wound healing. However, because of large variations in study sample sizes, some of the literature reported methods of inferior quality. Additional high-quality studies containing large sample sizes are needed to further validate these results.     

Impaired lung function and lung cancer incidence in a cohort of Swedish construction workers

BACKGROUND: Although impaired lung function in general has been associated with an increased risk of lung cancer, past studies typically have not attempted to investigate separately the obstructive and restrictive components of respiratory impairment. To deal with this question further, data from a large (n = 176 997) cohort of male Swedish construction workers, for whom spirometry measurements before follow-up were available, were analysed. METHODS: Cancer incidence for 1971-2001 was obtained through linkage with the national cancer registry. Using a modification of the Global Initiative for Chronic Obstructive Lung Disease criteria for chronic obstructive pulmonary disease (COPD), subjects were classified into five categories of lung function: normal, mild COPD, moderate COPD, severe COPD and restrictive lung disease (RLD). Rate ratios (RR) and 95% confidence intervals (CI) for lung cancer across lung function categories were calculated using Poisson regression, adjusted for age and smoking. Other end points (histological types of lung cancer, non-lung tobacco-related cancers, other cancers, total mortality) were also investigated. RESULTS: 834 incident cases of lung cancer were identified. Increased rates of lung cancer were observed for both COPD (mild: RR 1.5, 95% CI 1.2 to 1.9; moderate/severe: RR 2.2, 95% CI 1.8 to 2.7) and RLD (RR 2.0, 95% CI 1.6 to 2.5) relative to normal lung function. These associations did not meaningfully change on applying follow-up lag times of 5, 10 and 15 years after spirometry. When analysed by histological type, associations with both COPD and RLD were stronger for squamous cell carcinoma and small cell carcinoma, and weaker for adenocarcinoma. Both COPD and RLD were associated with increased rates of total mortality. CONCLUSIONS: Obstructive and restrictive impairments in lung function are associated with increased lung cancer risk.     

Lung cancer in relation to exposure to silica dust, silicosis and uranium production in South African gold miners

BACKGROUND: A nested case-control study for lung cancer was performed on a cohort of 2260 South African gold miners in whom an association between exposure to silica dust and risk of lung cancer was previously reported. The objective was to investigate an expanded set of risk factors and also cancer cell type. METHODS: The 78 cases of lung cancer found during the follow up period from 1970 to 1986 were matched with 386 controls. Risk of lung cancer was related to smoking, exposure to silica dust, incidence of silicosis, and uranium production and the uranium content of the mine ore. RESULTS: The risk of lung cancer was associated with tobacco smoking, cumulative dust exposure, duration of underground mining, and with silicosis. The best predictive model included pack years of cigarette consumption (adjusted relative risk (RR) = 1.0 for < 6.5 pack years, 3.5 (95% confidence interval (CI) 0.7 to 16.8) for 6.5-20 pack years, 5.7 (95% CI 1.3 to 25.8) for 21-30 pack years, and 13.2 (95% CI 3.1 to 56.2) for more than 30 pack years) and silicosis (RR = 2.45 (95% CI 1.2 to 5.2)). No association was found with uranium production. The lung tumour cell type distribution was 40.3% small cell carcinoma, 38.8% squamous cell, 16.4% adenocarcinoma, and 4.5% large cell carcinoma. Small and large cell cancer combined were associated with exposure to dust. CONCLUSIONS: The results cannot be interpreted definitively in terms of causal association. Possible interpretations are: (1) subjects with high dust exposure who develop silicosis are at increased risk of lung cancer; (2) high levels of exposure to silica dust on its own is important in the pathogenesis of lung cancer and silicosis is coincidental; and (3) high levels of silica dust exposure may be a surrogate for the exposure to radon daughters.


     

The oncologic impact of hormone replacement therapy in premenopausal breast cancer survivors: A systematic review

SynopsisThis is the first systematic review to investigate the risk of recurrence in breast cancer survivors <50 years old who have used hormone replacement therapy (HRT).BackgroundThe risk of HRT in premenopausal breast cancer survivors is unclear. Due to the higher incidence of estrogen receptor negative tumours in women <50, the potential for HRT to promote breast cancer recurrence may differ from older age groups.MethodsWe performed a search of Medline, EMBASE and CINAHL through June 2016. For the observational studies relative risk (RR) and 95% confidence interval (CI) were calculated for the recurrence rate among HRT users and nonusers. A random effects model was used to estimate the combined RR using the Mantel-Haenszel method.ResultsFour papers satisfied our inclusion criteria. 3477 subjects were analyzed. On pooled meta-analysis of breast cancer recurrence in the observational studies, no significant association was found between HRT and risk of recurrence (RR 1.04 [95% CI 0.45, 2.41]). The randomized controlled trial (RCT) included found an increased risk of recurrence with HRT among women <50 (HR 1.56 [95% CI 1.1–2.2]). However, among women of all ages with an estrogen receptor negative tumour there was no significant difference in recurrence when compared to hormone receptor positive tumours (HR 1.15 [95% CI 0.7–1.8, p = 0.55]).DiscussionThis review on HRT in breast cancer survivors <50 revealed conflicting results between randomized and observational study data. Further studies are warranted to investigate the association between HRT and recurrence rates in younger breast cancer survivors.     

Reoperation as a quality indicator in colorectal surgery: a population-based analysis

OBJECTIVE: To describe unplanned procedures following colorectal cancer surgery that might be used as intermediate outcome measures, and to determine their association with mortality and length of stay. SUMMARY BACKGROUND: Variation in the quality of surgical care, especially for common illnesses like colorectal cancer, has received increasing attention. Nonfatal complications resulting in procedural interventions are likely to play a role in poor outcomes but have not been well explored. METHODS: Cohort analysis of 26,638 stage I to III colorectal cancer patients in the 1992 to 1996 SEER-Medicare database. Independent variables: sociodemographics, tumor characteristics, comorbidity, and acuity. Primary outcome: postoperative procedural intervention. Analysis: Logistic regression identified patient characteristics predicting postoperative procedures and the adjusted risk of 30-day mortality and prolonged hospitalization among patients with postoperative procedures. RESULTS: A total of 5.8% of patients required postoperative intervention. Patient characteristics had little impact on the frequency of postoperative procedures, except for acute medical conditions, including bowel perforation (relative risk [RR] = 3.0, 95% confidence interval [CI] = 2.5-3.6), obstruction (RR = 1.6; 95% CI = 1.4-1.8), and emergent admission (RR = 1.3; 95% CI = 1.1-1.4). After a postoperative procedure, patients were more likely to experience early mortality (RR = 2.4; 95% CI = 2.1-2.9) and prolonged hospitalization (RR = 2.2; 95% CI = 2.1-2.4). The most common interventions were performed for abdominal infection (31.7%; RR mortality = 2.9; 95% CI = 2.3-3.7), wound complications (21.1%; RR mortality = 0.7; 95% CI = 0.4-1.3), and organ injury (18.7%; RR mortality = 1.6; 95% CI = 1.1-2.3). CONCLUSIONS: Postoperative complications requiring additional procedures among colorectal cancer patients correlate with established measures of surgical quality. Prospective tracking of postoperative procedures as complication markers may facilitate outcome studies and quality improvement programs.     

Diabetes mellitus and the incidence and mortality of colorectal cancer: a meta‐analysis of 24 cohort studies

Aim The incidence and mortality of colorectal cancer (CRC) were quantified in persons with and without diabetes mellitus (DM). Method Medline and Embase were searched for articles published before July 2010. Cohort studies that evaluated incidence and mortality of DM and CRC were included. The initial search identified 1887 titles, of which 24 articles met the inclusion criteria. We defined the relative risk (RR) as the metric of choice; 95% confidence intervals (CIs) were calculated with a random‐effects model. Results There was an increase in the RR of developing CRC in persons with DM compared with those without DM (RR 1.28; 95% CI 1.19–1.39), without heterogeneity between studies (P_{heterogeneity} = 0.13). The association between duration of DM and CRC incidence was stronger in the 11–15‐year group (RR 1.51; 95% CI 1.12–2.03) than in the <10‐year group (RR 1.05; 95% CI 0.90–1.22) and the >15‐year group (RR 1.25; 95% CI 0.80–1.94), and there was significant heterogeneity among subgroups (P_{heterogeneity} = 0.01). In studies reporting standardized incidence ratios (SIRs), there was an increased incidence of CRC with DM (RR 1.27; 95% CI 1.14–1.42; P_{heterogeneity} = 0.09), and the association was stronger among men (RR 1.47; 95% CI 1.15–1.86) than women (RR 1.08; 95% CI 1.00–1.17); there was significant heterogeneity among gender (P_{heterogeneity} = 0.01). Conclusion This meta‐analysis suggests that individuals with DM have a significant increase in risk of developing CRC.     

Renal vein or inferior vena caval extension in patients with renal cortical tumors: impact of tumor histology

PURPOSE: We determined the prognostic significance of renal vein or inferior vena caval (IVC) extension in patients with nonmetastatic renal cell carcinoma (RCC) or oncocytoma undergoing surgery. MATERIALS AND METHODS: The charts of patients undergoing radical or partial nephrectomy from 1989 to 2001 for nonmetastatic RCC or oncocytoma were retrospectively reviewed. A total of 1082 patients (1120 renal units) underwent radical (850 renal units) or partial (270 renal units) nephrectomy. RESULTS: Renal vein extension was present in 60 patients (65.9%) and IVC extension was present in 31 (34.1%). The histological type associated with an increased risk of renal vein/IVC extension was conventional (80 of 702 cases, p <0.0001) and histological types with a decreased risk were oncocytoma (0 of 117, p = 0.00052) and papillary histology (0 of 146, p <0.0001). The 5-year actuarial recurrence-free probability was 59%, 65% and 91% in patients with IVC extension, renal vein extension and no renal vein or IVC extension, respectively. Larger tumor size, nodal metastases and conventional histology were associated with an increased risk of recurrence (RR = 3.38, 95% CI 2.53 to 4.51 for a doubling in size, RR = 9.97, 95% CI 5.51 to 18.1 and RR 3.78, 95% CI 2.15 to 6.65) as well as death (RR = 1.44, 95% CI 1.20 to 1.74 for a doubling in size, RR = 5.39, 95% CI 2.86 to 10.2 and RR = 1.56, 95% CI 1.09 to 2.24, respectively). CONCLUSIONS: Conventional RCC is associated with an increased risk, and oncocytoma and papillary histology are associated with a decreased risk of renal vein or IVC extension. Renal vein or IVC extension alone does not impart a worse prognosis independent of tumor size, nodal status and histology.     

Risk factors for surgical site infection in patients with gastric cancer: A meta-analysis

Surgical Site Infection (SSI) is one of the common postoperative complications after gastric cancer surgery. Previous studies have explored the risk factors (such as age, diabetes, anaemia and ASA score) for SSI in patients with gastric cancer. However, there are large differences in the research results, and the correlation coefficients of different research results are quite different. We aim to investigate the risk factors of surgical site infection in patients with gastric cancer. We queried four English databases (PubMed, Embase, Web of Science and the Cochrane Library) and four Chinese databases (China National Knowledge Infrastructure, Chinese Biological Medicine Database, Wanfang Database and Chinese Scientific Journal Database (VIP Database)) to identify published literature related to risk factors for surgical site infection in patients with gastric cancer. Rev Man 5.4 and Stata 15.0 were used in this meta-analysis. A total of 15 articles (n = 6206) were included in this analysis. The following risk factors were found to be significantly associated with surgical site infection in gastric cancer: male (OR = 1.28, 95% CI [1.06, 1.55]), age >60 (OR = 2.75, 95% CI [1.65, 4.57]), smoking (OR = 1.99, 95% CI [1.46, 2.73]), diabetes (OR = 2.03, 95% CI [1.59, 2.61]), anaemia (OR = 4.72, 95% CI [1.66, 13.40]), preoperative obstruction (OR = 3.07, 95% CI [1.80, 5.23]), TNM ≥ III (OR = 2.05, 95% CI [1.56, 2.70]), hypoproteinemia (OR = 3.05, 95% CI [2.08, 4.49]), operation time ≥3 h (OR = 8.33, 95% CI [3.81, 18.20]), laparotomy (OR = 2.18, 95% CI [1.61, 2.94]) and blood transfusion (OR = 1.44, 95% CI [1.01, 2.06]). This meta-analysis showed that male, age >60, smoking, diabetes, anaemia, preoperative obstruction, TNM ≥ III, hypoproteinemia, operation time ≥3 h, open surgery and blood transfusion were the risk factors for SSI in patients with gastric cancer.     

Familial risk of prostate cancer in Iceland

OBJECTIVE: To estimate the risk of prostate and other types of cancer among relatives of Icelandic men diagnosed with prostate cancer over a 5-year period. PATIENTS AND METHODS: The risk ratio (RR) was used to estimate the risk among relatives of 371 patients with prostate cancer, all of whom lived in Iceland and were diagnosed when alive over a 5-year interval (1983-7). Information on cancer incidence was obtained from the population-based Icelandic Cancer Registry, and information on families from a comprehensive genealogical database covering the population of Iceland. RESULTS: First-degree male relatives were at a 1.7-fold greater age-adjusted risk of prostate cancer (1832 men; 95% confidence interval, CI, 1.28-2.34). The risk was independent of proband's age at diagnosis. First-degree male relatives of patients who died from prostate cancer were at a statistically significantly greater risk of the disease (784 men; RR 2.17; 95% CI 1.34-3.53) and relatives of patients with incidental disease (T1a) were at a greater risk but not statistically significant so (261; RR 1.86; 95% CI 0.75-4.58). Female first-degree relatives were not at greater risk of breast cancer. The risk of kidney cancer was higher in first- and second-degree female relatives, with an RR (n, CI) of 2.50 (1780, 1.10-5.66) and 2.67 (5534, 1.04-6.81), respectively. The risk of kidney cancer was not statistically significantly greater in male relatives. CONCLUSION: Family history is a risk factor for prostate cancer in Icelandic men. The risk is potentially higher for relatives of patients who die from the disease. Female relatives are not at greater risk of breast cancer but they may be at greater risk of kidney cancer.     

Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta‐analysis

Venous thromboembolism (VTE) is a common complication after surgical treatment of fractures, which is associated with significant morbidity and mortality. Identifying the risk factors for VTE is important for preventive strategies to reduce the incidence of VTE. Therefore, we conducted a meta‐analysis to evaluate the incidence of VTE and the risk factors influencing the development of VTE in patients who underwent surgery for fractures below the hip. PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China) and CNKI (National Knowledge Infrastructure, China) databases were systematically searched to identify cohort or case–control studies that investigated the incidence and risk factors for VTE following surgical treatment of fractures below the hip. VTE risk ratios (RRs) were pooled by use of a fixed‐effect model or a random‐effect model, depending on the heterogeneity among the included studies. Heterogeneity between the studies was assessed by I² statistics. Twenty‐three studies with a total of 191 294 patients who met the inclusion criteria were included in this meta‐analysis. Our results demonstrated that age (≥60 years) (RR = 1·85, 95% confidence interval (CI): 1·34, 2·55; P = 0·000), previous VTE(RR = 5·25, 95% CI: 2·77, 9·96; P = 0·000), heart failure (RR = 1·74, 95% CI: 1·34, 2·27; P = 0·000), current smoking status (RR = 1·23, 95% CI: 1·07, 1·41; P = 0·004), hypertension (RR = 1·62, 95% CI: 1·27, 2·06; P = 0·000), hyperlipidaemia (RR = 2·16, 95% CI: 1·79, 2·62; P = 0·000), diabetes mellitus (RR = 1·46, 95% CI: 1·27, 1·68; P = 0·000), obesity (RR = 1·58, 95% CI: 1·35,·1·85; P = 0·000), multiple fractures (RR = 2·14, 95% CI: 1·00, 4·60; P = 0·050), varicose veins (RR = 3·07, 95% CI: 1·12, 8·47; P = 0·030), prolonged operation time (weighted mean differences (WMD) = 1·22, 95% CI: 0·63, 1·81; P = 0·000) and prolonged bed rest time (WMD = 3·12, 95% CI: 2·96, 3·29; P = 0·000) were associated with an increased risk of developing VTE. The other variables, including age (<60 years), previous smoking, immobility, pregnancy, cancer, open fractures and combination with trauma were not identified as significant risk factors for VTE. Almost all the risk factors mentioned above are in line with the known risk factors for VTE following surgery for fractures below the hip. Thus, surgeons should pay close attention to patients with these medical conditions in order to reduce the incidence of VTE following surgical treatment of fractures below the hip.     

A Study of Incidence of AKI in Critically Ill Patients

Background: There have been many studies to estimate the incidence of acute kidney injury (AKI) in critically ill patients. However, results were variable due to the non-usage of uniform criteria and retrospective design of most studies. There are no new studies from the developing countries looking at AKI in these patients since adoption of uniform Acute Kidney Injury Network (AKIN) criteria. Methods: In this prospective observational study from a tertiary care hospital in India, we enrolled 100 consecutively admitted critically ill patients and followed them during hospital stay. AKI was defined by AKIN criteria. Both the groups of patients, those who developed AKI and those who did not develop AKI, were then followed during the course of their hospital stay. Results: AKI occurred in 33 patients with an incidence rate of 17.3 per person year. Thirty-one out of 33 (93.9%) patients died in the AKI group, whereas 31 out of 67 (53.7%) patients died in the non-AKI group. Independent risk factors for AKI were older age (adjusted relative risk (RR) = 4.42, 95% CI = 2.57–5.23), septic shock (adjusted RR = 2.82, 95% CI = 1.43–3.80), prolonged duration of mechanical ventilation (adjusted RR = 2.35, 95% CI = 1.09–3.6), higher acute physiology and chronic health evaluation II (APACHE II) score (adjusted RR = 2.74, 95% CI = 1.28–4.13), and higher sequential organ failure assessment (SOFA) score (adjusted RR = 2.53, 95% CI = 1.04–4.08). Development of AKI was an independent risk factor for mortality (adjusted RR = 1.76, 95% CI = 1.25–1.84). Conclusion: Older patients, those with septic shock, and those requiring prolonged mechanical ventilation had increased risk for AKI. AKI was an independent predictor of mortality.     

Survival of women with breast cancer in relation to smoking.

OBJECTIVE: To compare survival of patients with breast cancer who had never smoked, were smokers, and who were ex-smokers. DESIGN: Observational study. SETTING: City of Malm?, Sweden. PATIENTS: 792 patients with breast cancer diagnosed between 1977-1986 in the Malm? mammographic screening trial. INTERVENTIONS: Follow-up of breast cancer cases through record-linkage with the Swedish Cause of Death Registry. MAIN OUTCOME MEASURES: Death from breast cancer. Relative risk (RR) with 95% confidence interval (CI) of death from breast cancer was calculated for different smoking groups using Cox's proportional hazards analysis. RESULTS: During a mean follow-up of 12.1 years, 145 patients died of breast cancer. Breast cancer mortality was 1347/10(5) person-years in those who had never smoked, 1941/10(5) in smokers, and 1493/10(5) in ex-smokers. The crude RR for smokers and ex-smokers, compared with those who had never smoked were 1.44 (1.01 to 2.06) and 1.13 (0.66 to 1.94), respectively. The RR associated with smoking remained significant after adjustment for age and stage at diagnosis, 2.14 (1.47 to 3.10), and other potential confounders. CONCLUSIONS: Survival after breast cancer was, as expected, strongly related to stage at diagnosis. However, stage by stage there was considerable variation between individual patients. We conclude that differences with regard to exposure to smoking contribute to this heterogeneity.     

Case-control study of prostatic cancer in Kyoto, Japan: demographic and some lifestyle risk factors

Demographic risk factors for prostatic cancer were examined in a case-control study of 100 triplets of prostatic cancer patients and age-, hospital-, and admission date-matched control series of benign prostatic hyperplasia (BPH) patients and general hospital patients. A higher risk of prostatic cancer was associated with the following factors: 1) long-term occupation in transport or communication (relative risk [RR] = 4.92, 95% confidence interval [CI]: 1.18-20.5) as compared with hospital controls; 2) the wife having a lower educational level (RR = 1.88, 95%CI: 1.02-3.45) as compared with hospital controls; 3) no past episode of hypertension as compared with BPH controls (RR = 2.30, 95%CI: 1.27-4.15); 4) having several sisters (more than four) as compared with both BPH and hospital controls (RR = 3.82, 95%CI: 1.35-10.8 and RR = 2.94, 95%CI: 1.08-8.03 respectively); 5) dense body hair as compared with hospital controls (RR = 4.28, 95%CI: 1.19-15.4). No significant links were found with blood type, daily drug use, head hair, skin color, body type, smoking habits, religion, body weight, and mental characteristics.     

Antioxidants in the chemoprevention of colorectal cancer and colorectal adenomas in the general population: a systematic review and meta‐analysis

Aim Antioxidants, such as vitamin A, C and E, selenium and β‐carotene, have been proposed as possible agents in the chemoprevention of colorectal cancer and have been the subject of recent trials and reviews. This review aimed to assess the present evidence on the effect of antioxidants on the incidence of colorectal neoplasms in the general population. Method A systematic review of randomized controlled trials was undertaken comparing antioxidants alone or in combination with other agents vs placebo. The following databases were searched for published and unpublished literature: Cochrane Library, MEDLINE, PreMEDLINE, CINAHL, EMBASE, Web of Science, and Biological Abstracts and Research Registers. Studies were quality appraised and extracted. Meta‐analysis was performed. Results Twelve studies were identified as relevant. In the nine comparing antioxidants with no antioxidants (n = 148 922), there was no difference in the incidence of colorectal cancer [relative risk (RR) 1.00, 95% confidence interval (CI) 0.88–1.13]. One study assessed the effect of antioxidants on adenoma formation (n = 15 538) and did not demonstrate a statistically significant effect (RR 1.47, 95% CI 0.97–2.23). Of 14 discrete analyses for different combinations of antioxidants, only one reported a statistically significant increase in relative risk of adenoma formation in participants receiving vitamin E (RR 1.74, 95% CI 1.09–1.79, P = 0.02) or vitamin E plus β‐carotene (RR 1.63, 95% CI 1.01–2.63, P = 0.04). Effectiveness did not seem to differ between healthy populations, participants with cardiovascular risk factors or populations exposed to smoking or asbestos. Conclusion The review demonstrates that antioxidants (vitamin A, C and E, selenium and β‐carotene), as single agents, in combination with other antioxidants or in combination with other agents, are not effective in the chemoprevention of colorectal neoplasia in the general population. This questions their involvement in future randomized controlled trials of chemoprevention in colorectal cancer.     

早期肠内营养和肠外营养对食管癌术后患者临床疗效的Meta分析

目的应用Meta分析法比较食管癌术后患者早期给予肠内营养(EN)和肠外营养(PN)的临床疗效。 方法通过计算机数据库检索PubMed、Embase、The Cochrane Library数据库,人工查找有关食管癌术后患者EN和PN支持治疗的随机对照试验,检索时限截至2018年1月。由两位作者按纳入、排除标准独立地筛选文献、提取资料和评价偏倚风险,再采用R软件的Meta包进行分析。 结果最终纳入15个随机对照试验,包括1 400例患者,其中EN组707例,PN组693例。Meta分析显示：与PN相比,EN能提高食管癌患者术后白蛋白(RBP)水平(平均值为2.11 g/L,95% CI：1.30～2.93,P<0.001)和视黄醇结合蛋白质水平(平均值为1.57 mg/L,95% CI：0.32～2.82, P<0.01),降低术后肺部感染发生率(RR＝0.40,95% CI：0.27～0.61,P<0.001)和切口感染发生率(RR＝0.38,95% CI：0.16～0.88,P＝0.024);但两组间术后前清白蛋白水平(平均值1.12 g/L,95% CI：－0.04～2.27,P＝0.058)、吻合口漏发生率(RR＝0.70,95% CI：0.43～1.13,P＝0.141)、总并发症发生率(RR＝0.84,95% CI：0.70～1.01,P＝0.061)比较差异无统计学意义。 结论食管癌术后早期给予EN,可以提高患者的营养状况,降低肺部感染和切口感染的发生率,但在吻合口漏的发生率上与PN相比无明显差别。     

Long-term outcome of lung transplantation is predicted by the number of HLA-DR mismatches

BACKGROUND: The importance of HLA mismatch in determining long-term outcome in lung transplantation remains largely uncertain. METHODS: A retrospective analysis of 102 consecutive primary lung transplants was performed to identify risk factors for poor long-term outcome after lung transplantation defined as graft survival and bronchiolitis obliterans syndrome (BOS) stage I and II. Variables included were patient characteristics (age, sex, prior diagnosis), the number of HLA mismatches between donor and recipient, cold ischemic time, cytomegalovirus serologic concordance, number of acute rejections, and time to first rejection. Variables carrying significance in a univariate analysis were subjected to a proportional hazard regression analysis. RESULTS: In the multivariate analysis, an increased number of acute rejections correlated positively with decreased graft survival (risk ratio [RR] = 1.25; 95% confidence interval [CI], 1.05-1.5; P = 0.011), development of BOS stage I (RR = 1.36/episode; 95% CI, 1.16-1.58;P < 0.001), and BOS stage II (RR = 1.42/episode; 95% CI, 1.2-1.67; P < 0.001). An increased time to rejection correlated positively with reduced graft survival (RR = 1.03/day; 95% CI, 1.01-1.06; P = 0.02), and BOS stage I and II (both RR = 1.04/day; 95% CI, 1.01-1.07; P < 0.005). Compared with 2 HLA-DR mismatches, 0 or 1 mismatch was associated with improved graft survival (RR = 0.43; 95% CI, 0.19-0.98; P = 0.045) and protected against development of BOS stage I (RR = 0.47; 95% CI, 0.23-0.98; P = 0.044) and BOS stage II (RR = 0.35; 95% CI, 0.15-0.83; P = 0.017). CONCLUSIONS: HLA-DR mismatching appears to be a risk factor for the development of BOS and graft loss. Improved outcome after lung transplantation might be achieved with prospective matching for HLA-DR. Alternatively, the amount and type of immunosuppressive drugs may be guided by the degree of HLA-DR (mis)matching.     

Bladder cancer incidence and risk factors in men with prostate cancer: results from Cancer of the Prostate Strategic Urologic Research Endeavor

PURPOSE: We evaluated a large disease registry to determine the incidence of bladder cancer in patients with prostate cancer and investigate whether the type of treatment for prostate cancer increased the risk of bladder cancer. MATERIALS AND METHODS: We analyzed the CaPSURE disease registry for men diagnosed with prostate cancer plus bladder cancer between 1989 and 2003. Demographics, comorbidities and prostate cancer treatment modalities were compared in patients with and without bladder cancer. A backward stepwise Cox proportional hazards regression model was used to predict bladder cancer onset after treatment for prostate cancer in patients who had bladder cancer 30 days or greater after prostate cancer treatment. RESULTS: Of 9,780 patients from CaPSURE 143 (1.46%) also had bladder cancer. Patients with bladder cancer and prostate cancer were older (p<0.01) and more likely to be white (p=0.03), and they had lower levels of income (p<0.01) and education (p=0.04) than patients with prostate cancer only. Comorbidities did not differ between patients with and without bladder cancer. Patients treated with radical prostatectomy were approximately half as likely to have posttreatment bladder cancer as patients who underwent radiation therapy (HR 0.51, 95% CI 0.29-0.89). Patients who smoked had an independent increase in the risk of bladder cancer (HR 2.08, 95% CI 1.09-3.97), while smokers treated with radiation therapy were at almost 4-fold risk for bladder cancer (HR 3.65, 95% CI 1.45-9.16). CONCLUSIONS: The incidence of bladder cancer in patients with prostate cancer was 1.5%. Radiation therapy and smoking increased the risk of bladder cancer.     

Familiality of cardiovascular mortality in end-stage renal disease patients

A very high rate of cardiovascular (CV) death is well recognized in individuals with end-stage renal disease (ESRD). Besides many other factors, this excess risk may also be related to familiality. We tested this hypothesis by estimating the risk of CV death among both ESRD patients and their relatives. In this case-control study, we used the Utah Population Database (UPDB), which includes genealogy records, state-wide death certificates as well as other data sets. These have been linked to the University of Utah Health Sciences Enterprise Data Warehouse which provides multiple diagnosis data sources. Patients with ESRD either on dialysis or who received a kidney transplant were identified in the clinical databases at the University of Utah Dialysis Program and Kidney Transplant Program or from Utah death certificates. CV deaths were identified by the reporting on the death certificates. The relative risks for CV death, adjusted for several potential confounders in the ESRD patients (n = 516) and in their first-degree (n = 2,418) and second-degree (n = 7,720) relatives were estimated in relation to the general population. Using information from death certificates, ESRD patients were found to have disproportionately increased risk for CV mortality (relative risk or RR = 2.4; 95% CI 2.11-2.72), compared to the general population. First-degree relatives of ESRD patients were also found to have an increased CV mortality risk (RR = 1.10; 95% CI 1.01-1.20). When the specific categories of CVD were analyzed, the first-degree relatives also had higher risks for death from acute myocardial infarction (RR = 1.20; 95% CI 1.03-1.40) or heart failure (RR = 1.32; 95% CI 1.12-1.56). An increased risk for CV mortality was, however, not observed in second-degree relatives of ESRD patients, except for the subcategory of hypertensive heart disease (RR = 1.24, 95% CI 1.01-1.49). In conclusion, this study suggests that, in addition to many putative risk factors, the increased risk of CV death in ESRD patients may have a familial contribution.     

妇科恶性肿瘤患者术后深静脉血栓危险因素的Meta分析

背景与目的 妇科恶性肿瘤患者术后发生深静脉血栓（DVT）,可引起患者肺栓塞或猝死,严重威胁患者的生命,本研究通过Meta分析明确妇科恶性肿瘤患者术后发生DVT的危险因素,为预防和降低妇科恶性肿瘤患者术后DVT的发生提供循证依据。方法 计算机检索多个国内外数据库,搜集有关妇科恶性肿瘤患者术后DVT危险因素的队列研究或病例对照研究,检索时限均为建库至2021年3月,采用Revman 5.3软件进行Meta分析。结果 共纳入19篇文献,包含4 964例患者,其中病例组1 040例,对照组3 924例,共研究了36项危险因素。将其中10项危险因素进行了数据合并分析显示,既往有DVT史（OR=3.70,95% CI=2.15~6.35,P<0.001）、年龄大（OR=2.99,95% CI=1.85~4.82,P<0.001）、合并高血压（OR=2.25,95% CI=1.32~3.83,P=0.003）、手术时间长（OR=1.03,95% CI=1.02~1.04,P<0.001）、BMI增加（OR=1.87,95% CI=1.55~2.25,P<0.001）、术后卧床时间长（OR=3.17,95% CI=2.56~3.92,P<0.001）、纤维蛋白原高（OR=2.80,95% CI=2.26~3.47,P<0.001）、肿瘤分期晚（OR=2.56,95% CI=1.83~3.57,P<0.001）、发生淋巴结转移（OR=2.88,95% CI=1.58~5.25,P=0.000 6）、D-二聚体高（OR=2.52,95% CI=1.84~3.43,P<0.001）均为妇科恶性肿瘤患者术后发生危险因素。结论 临床医护人员应结合本研究结果所确定10项危险因素,积极识别术后易发生DVT的妇科恶性肿瘤高危人群,并提供针对性的措施预防或降低其术后发生DVT风险。