Right hemicolectomy anastomotic leak study: a review of right hemicolectomy in the binational clinical outcomes registry (BCOR)

Backgrounds

Surgery remains mainstay management for colon cancer. Post-operative anastomotic leak (AL) carries significant morbidity and mortality. Rates of, and risk factors associated with AL following right hemicolectomy remain poorly documented across Australia and New Zealand. This study examines the Bowel Cancer Outcomes Registry (BCOR) to address this.

Methods

A retrospective cohort study was undertaken of consecutive BCOR-registered right hemicolectomy patients undergoing resection for colon cancer (2007–2021). The primary outcome measure was AL incidence. Clinicopathological data were extracted from the BCOR. Factors associated with AL and primary anastomosis were identified using logistic regression. AL-rate trends were assessed by linear regression.

Results

Of 13 512 patients who had a right hemicolectomy (45.2% male, mean age 72.5 years, SD 12.1), 258 (2.0%) had an AL. On multivariate analysis, male sex (OR 1.33; 95% CI 1.03–1.71) and emergency surgery (OR 1.41; 95% CI 1.04–1.92) were associated with AL. Private health insurance status (OR 0.66; 95% CI 0.50–0.88) and minimally-invasive surgery (OR 0.61; 95% CI 0.47–0.79) were protective for AL. Anastomotic technique (handsewn versus stapled) was not associated with AL (P = 0.84). Patients with higher ASA status (OR 0.47; 95% CI 0.39–0.58), advanced tumour stage (OR 0.56; 95% CI 0.50–0.63), and emergency surgery (OR 0.16; 95% CI 0.13–0.20) were less likely to have a primary anastomosis. AL-rate and year of surgery showed no association (P = 0.521).

Conclusion

The AL rate in Australia and New Zealand following right hemicolectomy is consistent with the published literature and was stable throughout the study period. Sex, emergency surgery, insurance status, and minimally invasive surgery are associated with AL incidence.     

Complete coding sequences and haplotypic associations of HLA-B*0707, -B*1524, -B*4405, -B*4802, -DRB1*0409, -DRB1*0411, -DRB1*1115, -DRB1*1305, and the novel allele -DRB1*0709. Group-specific amplification of cDNA from DRB1 alleles associated to DRB3 and DRB4

We present here the characterization of the complete coding sequences, previously unavailable, of the human leukocyte antigen (HLA) alleles B*0707, B*1524, B*4405, B*4802, DRB1*0409, DRB1*0411, DRB1*1115, DRB1*1305, and that of a new allele, DRB1*0709. For the isolation of cDNA from the DRB1 gene, we designed a novel set of polymerase chain reaction (PCR) primers that makes it possible to amplify separately the groups of DRB1 alleles associated to each of the DRB3 and DRB4 loci. The primary structures, functional features, evolutionary relationships, haplotypic associations, and population distributions of each of the nine HLA-B and -DRB1 alleles reported here are reviewed.     

HLA-DR51 expression failure caused by a two-base deletion at exon 2 of a DRB5 null allele (DRB5*0110N) in a Spanish gypsy family

Here we describe a new HLA class II null allele at the DRB5 gene. Serologic HLA typing of a Spanish gypsy family rendered the following paternal haplotype: A2-Cblk-B52-Bw4-DR15-DQ5. However, DNA typing demonstrated the presence of a DRB5 gene in the haplotype DRB1*1502-DRB5*0102-DQB1*05031. Complete DRB5 cDNA sequencing revealed a DRB5*0102 allele with a deletion of two nucleotides at exon 2 (239-240) in codon 80. This change generates a frame shift leading to a stop codon at position 86, and could explain the lack of DR51 protein at the cell surface. This is the second DRB5 null allele described together with DRB5*0108N, raising the number of HLA alleles with an expression disorder.     

Complete HLA-B44 subtyping in Spaniards. Additional evidence for heterogeneity in Caucasian populations

HLA-B44 is one of the most common HLA class I alleles in Caucasians. Exon 3 oligotyping and sequence analysis have define five B44 subtypes: B^*4402, B^*4403, B^*4404, B^*4405 and B^*4406, with variations in exons 2 and 3. We have developed a conventional DNA typing system by using a single B12-group specific amplification including exon2-intron2-exon3 in combination with 6 oligoprobes to define all B44 subtypes. 140 HLA-B44 positive unrelated Spanish Caucasians were typed. Family studies established 30 B44-bearing haplotypes. The distribution of B44 subtypes in our population was: B^*4402 32.5%, B^*4403 66.5%, B^*4404 0.5%, B^*4405 0.5%, B^*4406 not found. B^*4402 and B^*4403 represented the 99% of the B44 alleles, as described in Caucasians. However, these two major subtypes showed an inverted frequency when compared with other Caucasian populations, B^*4403 twice as frequently as B^*4402 in Spaniards. HLA-B44-associated chromosomes showed 20 different haplotypes (including HLA-A,-C,-DR,-DQ), although demonstrating clear separated haplotype composition between B^*4402 and B^*4403: B^*4402 associated to class I alleles A2 ( ) and Cw5 ( ), and B^*4403 associated to the class II allele DRB1^*0701 ( ). These findings, in addition to the validation of a complete B44 oligotyping system, revealed further evidence of antigen frequency differences among populations of the same ethnic origin.     

Risk factors for coronary artery disease in Indians

Background: A case control study was carried out to study the emerging risk factors for coronary artery disease in Indians.     

塞来昔布在类风湿性关节炎中对甲氨喋呤的药代动力学影响

目的：确定塞来昔布对于经常服用稳定剂量甲氨喋呤（ＭＴＸ）治疗类风湿性关节炎（ＲＡ）患者的肾脏清除率和血浆药代动力学方面的影响。方法：选取１４例至少已服用ＭＴＸ３个月,且每个星期的剂量稳定在５－１５ｍｇ,有类风湿关节炎的成年妇女,随机给予塞来昔布（２００ｍｇ．ｂｉｄ）或安慰剂单盲治疗,每一阶段７,分二阶段交叉试验,研究ＭＴＸ的药代动力学和肾脏平均清除率。结果：当ＭＴＸ和塞来昔布或安慰剂合用时,ＭＴＸ     

心房颤动的电生理重构

心房颤动 (atrial fibrillation,AF)是临床上最常见的一种持续性心律失常 ,其发病率随年龄而增加 ,40岁以下人群发病率约为 0 .2 %～ 0 .3% ,6 0～ 90岁年龄组发病率增至5 %～ 9% [1 ] 。新近 Framingham的研究表明 AF可以成为一种独立的因素使患者病死率增加 [2 ] 。 AF的发病机制尚未完全清楚 ,可能为非单一机制 ,普遍认为持续性 AF是由于心房内的多子波折返 ,每 1个折返环本身都在不停地改变其大小及传导方向。近年来 ,在 AF的基础及临床研究中 ,两个方面的进展具有十分重要的意义 :一是发现部分 AF起源于心房内某些部位如肺静脉口…     

Association of PDCD1 with susceptibility to systemic lupus erythematosus

Objective

The A allele of the PD1.3 single‐nucleotide polymorphism (SNP) on the programmed cell death gene PDCD1 was markedly more frequent in patients with systemic lupus erythematosus (SLE) than in unaffected controls in a recent study involving large sets of Swedish, European American, and Mexican families. This study sought to determine the role of PDCD1 in susceptibility to SLE in the Spanish population.

Methods

Seven PDCD1 SNPs were studied in 518 SLE patients and 800 healthy control subjects who had been recruited in 5 distant towns spanning continental Spain. Patients and controls were of Spanish ancestry. The diagnosis of SLE was in accordance with the American College of Rheumatology updated classification criteria.

Results

The A allele of the PD1.3 polymorphism was significantly less frequent in Spanish female patients with SLE than in Spanish female controls (9.0% versus 13.0%, odds ratio 0.67, 95% confidence interval 0.50–0.89). This difference was consistent across the 5 sets of samples grouped by town of recruitment. The other PDCD1 SNPs were not associated with SLE susceptibility. The haplotype structure of PDCD1 in the Spanish controls was different from that reported in other healthy control populations.

Conclusion

Our results confirm the association of PDCD1 with susceptibility to SLE, but the findings show a lack of involvement of the PD1.3 SNP, which is contrary to the role of the PD1.3 A allele observed previously. These contradictory results probably reflect population differences in the haplotype structure of the PDCD1 locus. More research focusing on new polymorphisms and identifying associations in other populations will be needed to clarify the role of PDCD1 in SLE susceptibility.