Risk Factors Associated With Sphincter-Preserving Resection in Patients With Low Rectal Cancer

Abdominoperineal resection (APR) and sphincter-preserving resection (SPR) are the two primary surgical options for rectal cancer. Retrospectively we collected rectal cancer patients for SPR and APR observation between 2005 and 2007. The patient-related, tumor-related, and surgery-related variables of the SPR and APR groups were analyzed by using logistic regression techniques. The mean distance from the anal verge (DAV) of cancer is significantly higher in SPR than that in APR (P < 0.001). In cancers with DAV <40 mm (SPR, 40 versus APR, 110), multivariate analysis shows that surgeon procedure volume (odds ratio [OR] = 0.244; 95% confidence interval [CI]: 0.077–0.772; P = 0.016) and neoadjuvant radiotherapy (OR = 0.031; 95% CI: 0.002–0.396; P = 0.008) are factors influencing SPR. In cancers with DAV ranging from 40 mm to 59 mm (SPR 190 versus APR 50), analysis shows that patient age (OR = 2.139; 95% CI: 1.124–4.069; P = 0.021), diabetes (OR = 2.657; 95% CI: 0.872–8.095; P = 0.086), and colorectal surgeon (OR = 0.122, 95% CI: 0.020–0.758; P = 0.024), are influencing factors for SPR. The local recurrence and disease-free survival reveal no significant difference. A significant difference exists in DAV, surgeon specialization, procedure volume, age, diabetes, and neoadjuvant radiotherapy between SPR and APR.Key words: Abdominoperineal resection, Sphincter-preserving resection, Anterior resection, Rectal cancer, TreatmentAbdominoperineal resection (APR) with permanent colostomy and sphincter-preserving resection (SPR) of the rectum are the two primary surgical options for the curative treatment of rectal cancer. With the introduction of the concept of total mesorectal excision (TME), combined with the significant effects of adjuvant radiochemotherapy and surgical staplers, SPR indication has been significantly expanded compared with APR in low or ultra-lower rectal cancer.For patients with rectal cancer, sphincter preservation (SP) is often as important as curing cancer. Surgeons need to determine whether a patient with lower rectal cancer is suitable for SP. However, a standard method of determining patient suitability is unavailable because this judgment depends on the different individual experiences of surgeons.In addition to the distance of the tumor from the anal verge (DAV), other important factors such as the patient''s individual condition, oncologic consideration, technical feasibility, and the surgeon''s personal experience, are reported as risk factors that may influence the SP rate.^1–3 This study aims to determine the significance of these factors on achieving SPR in a single large-volume institution.     

重型颅脑外伤患者急诊抢救护理体会

目的:总结重型颅脑外伤患者,急诊抢救护理经验。方法:对92例重型颅脑损伤患者进行抢救,围绕“急”、“快”、“准”、“细”实施相应护理措施。结果:92例中抢救成功84例,抢救成功率为91%。结论:迅速对病情作出判断,快速准确地降低颅内压、吸氧、吸痰、气管内插管、包扎伤口止血,细心、严密观察患者的意识、瞳孔和生命体征的变化及病情发展趋势,做好紧急手术的术前准备,能为抢救患者生命赢得时间。     

Impact of Dietary Aromatic Amino Acids on Osteoclastic Activity

We had shown that aromatic amino acid (phenylalanine, tyrosine, and tryptophan) supplementation prevented bone loss in an aging C57BL/6 mice model. In vivo results from the markers of bone breakdown suggested an inhibition of osteoclastic activity or differentiation. To assess osteoclastic differentiation, we examined the effects of aromatic amino acids on early /structural markers as vitronectin receptor, calcitonin receptor, and carbonic anhydrase II as well as, late/functional differentiation markers; cathepsin K and matrix metalloproteinase 9 (MMP-9). Our data demonstrate that the aromatic amino acids down-regulated early and late osteoclastic differentiation markers as measured by real time PCR. Our data also suggest a link between the vitronectin receptor and the secreted cathepsin K that both showed consistent effects to the aromatic amino acid treatment. However, the non-attachment related proteins, calcitonin receptor, and carbonic anhydrase II, demonstrated less consistent effects in response to treatment. Our data are consistent with aromatic amino acids down-regulating osteoclastic differentiation by suppressing remodeling gene expression thus contributing initially to the net increase in bone mass seen in vivo.     

Peritoneal transport rate,systemic inflammation,and residual renal function determine peritoneal protein clearance in continuous ambulatory peritoneal dialysis patients

Background

Peritoneal protein clearance (Pcl) is related to the mortality of patients on continuous ambulatory peritoneal dialysis (CAPD) as well as technique failure. In this prospective observational study, we aimed to investigate factors associated with the level of Pcl.

Methods

We prospectively enrolled 344 prevalent CAPD patients. A standard peritoneal equilibrium test was conducted for each patient. Baseline demographics, biochemistry, and Pcl were recorded.

Results

The average Pcl of the patients was 97.40 ± 54.14 mL/day. Peritoneal transport level, serum high-sensitivity C-reactive protein (hsCRP), and residual glomerular filtration rate (rGFR) were independently related to Pcl. The standard β values were 0.53, 0.17, and ?0.10, respectively. Moreover, compared with non-diabetic patients, diabetic patients had a non-significantly higher level of Pcl (104.90 ± 48.65 vs. 96.15 ± 54.97 mL/day; P = 0.06).

Conclusion

Continuous ambulatory peritoneal dialysis patients lose a high amount of protein through the peritoneum each day. The Pcl value is positively related to the level of peritoneal transport and hsCRP and negatively related to the rGFR.     

Is the supine position superior to the prone position for percutaneous nephrolithotomy (PCNL)?

The objective of this study is to update the two previous meta-analyses in order to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) for patients in the prone position versus supine position. An electronic database search of MEDLINE, EMBASE, google scholar, and the Cochrane library was performed up to June, 2013. All studies comparing prone with supine position for PCNL were included. The outcome measures were stone-free rate, operative time, complication and hospital stay. Two randomized controlled trials (RCTs) and 7 non-RCTs, including 6,413 patients (4,956 patients in the prone position group and 1,457 patients in the supine position group), met the inclusion criteria. Meta-analysis of extractable data showed that PCNL in the supine position was associated with a significantly shorter operative time (WMD: 21.7; 95 % CI 2.46–40.94; p = 0.03) but lower stone-free rate (OR: 1.36; 95 % CI 1.19–1.56; p < 0.0001) than PCNL in the prone position. There was no difference between the two positions regarding hospital stay (WMD = 0.05; 95 % CI ?0.16–0.25; p = 0.66) and complication rate (OR: 1.1; 95 % CI 0.94–1.28; p = 0.24). In conclusion, the present study found different results from the two previous meta-analyses results regarding stone-free rate; PCNL in the supine position had a significantly lower stone-free rate than that in prone position.     

Proteomic analysis of cerebrospinal fluid: toward the identification of biomarkers for gliomas

Gliomas are the most common primary brain tumors in adults and, despite advances in the understandings of glioma pathogenesis in the genetic era, they are still ineradicable, justifying the need to develop more reliable diagnostic and prognostic biomarkers for this malignancy. Because changes in cerebrospinal fluid (CSF) are suggested to be capable of sensitively reflecting pathological processes, e.g., neoplastic conditions, in the central nervous system, CSF has been deemed a valuable source for potential biomarkers screening in this era of proteomics. This systematic review focused on the proteomic analysis of glioma CSF that has been published to date and identified a total of 19 differentially expressed proteins. Further functional and protein-protein interaction assessments were performed by using Protein Analysis Through Evolutionary Relationships (PANTHER) website and Ingenuity Pathway Analysis (IPA) software, which revealed several important protein networks (e.g., IL-6/STAT-3) and four novel focus proteins (IL-6, galanin (GAL), HSPA5, and WNT4) that might be involved in glioma pathogenesis. The concentrations of these focus proteins were subsequently determined by enzyme-linked immunosorbent assay (ELISA) in an independent set of CSF and tumor cyst fluid (CF) samples. Specifically, glioblastoma (GBM) CF had significantly lower GAL, HSPA5, and WNT4 levels than CSF from different grades of glioma. In contrast, IL-6 level was significantly higher in GBM CF when compared with CSF and, among different CSF groups, was highest in GBM CSF. Therefore, these candidate protein biomarkers, identified from both the literatures and in silico analysis, may have potentials in clinical diagnosis, prognosis evaluation, treatment response monitoring, and novel therapeutic targets identification for patients with glioma.     

内源性含氮类生物物质在运动中对心血管系统的调节

目的：通过对人体运动时调节心血管机能的内源性含氮类生物活性物质的起源、发生及调节机制的阐述，以进一步认识体液性调节在运动过程中的作用和地位。资料来源：应用计算机检索Medline1980—01／2004—12期间有关内源性含氮类生物物质在运动中对心血管系统的调节的文章，检索词：“Nitricbioactive substance，Catecholamine，serotonin，histamine and peptide”，并限定文章语言种类为English。同时在图书馆阅读和收集关于生物活性物质的书籍。 资料选择：对有关含氮类生物活性物质的资料及书籍进行全面检索，从多种生物活性物质资料及书籍中提炼出在运动中对心血管机能起主要调节作用的含氮类活性物质的文章，排除重复性研究。 资料提炼：共收集13篇关于生物活性物质的文献，书籍4本，涉及运动中神经及体液因素对心血管机能的调节6篇，生物活性物质作用机制7篇。对资料进行归纳引用8篇描述部分含氮类物质的作用。 资料综合：含氮类生物物质指机体内某些细胞产生、释放、作用于效应器官或组织，具有机能调节作用的一类化学物质。主要存在血液中，并随血液循环到全身器官组织发挥其生物效应。剧烈运动中对心血管系统起主要调节作用的有儿茶酚胺、5-羟色胺、组织按、肽类物质，对机体具有正性机能调节作用，以适应运动的需要。 结论：含氮类生物物质是一种对释放刺激源及其敏感，效率非常高的物质。在运动中表现为随运动强度变化而对机体产生不同效应，总体结果是使机体更适应运动需要。