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Spontaneous bleeding or thrombosis in cirrhosis: What should be feared the most?

World Journal of Hepatology 2015年第14期7卷 1818-1827页

作者： Kryssia Isabel Rodríguez-Castro Alessandro Antonello Alberto Ferrarese department of Surgery Oncology and GastroenterologyPadua University Hospital Veneto oncological Institute (IOV-IRCCS)

The more modern and accurate concept of a rebalanced hemostatic status in cirrhosis is slowly replacing the traditional belief of patients with cirrhosis being "auto-anticoagulated", prone only to bleeding complications, and protected from thrombotic events. With greater attention to clinical thrombotic events, their impact on the natural history of cirrhosis, and with the emergence and increased use of point-of-care and global assays, it is now understood that cirrhosis results in profound hemostatic alterations that can lead to thrombosis as well as to bleeding complications. Although many clinical decisions are still based on traditional coagulation parameters such as prothrombin(PT), PT, and international normalized ratio, it is increasingly recognized that these tests do not adequately predict the risk of bleeding, nor they should guide pre-emptive interventions. Moreover, altered coagulation tests should not be considered as a contraindication to the use of anticoagulation, although this therapeutic or prophylactic approach is not at present routinely undertaken. Gastroesophageal variceal bleeding continues to be one of the most feared and deadly complications of cirrhosis and portal hypertension, but great progresses have been made in prevention and treatment strategies. Other bleeding sites that are frequently part of end-stage liver disease are similar to clinical manifestations of thrombocytopenia, with gum bleeding and epistaxis being very common but fortunately only rarely a cause of life-threatening bleeding. On the contrary, manifestations of coagulation factor deficiencies like soft tissue bleeding and hemartrosis are rare in patients with cirrhosis. As far as thrombotic complications are concerned, portal vein thrombosis is the most common event in patients with cirrhosis, but venous thromboembolism is not infrequent, and results in important morbidity and mortality in patients with cirrhosis, especially those with decompensated disease. Future studi

关键词： Bleeding Hemorrhage Thromboembolism Portal vein thrombosis Coagulation Cirrhosis

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Botulinum toxin associated with fissurectomy and anoplasty for hypertonic chronic anal fissure: A case-control study

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World Journal of Clinical Cases 2021年第32期9卷 9722-9730页

作者： Beatrice D'Orazio Girolamo Geraci Fausto Famà Gloria Terranova Gaetano Di Vita department of Surgical Oncological and Stomatological SciencesUniversity of PalermoPalermo 90100SicilyItaly department of Human Pathology in Adulthood and Childhood"G.Barresi" University Hospital of MessinaMessina 98121SicilyItaly department of Surgical Oncological and Stomatological SciencesPostgraduate Medical School in General SurgeryUniversity of PalermoPalermo 90100SicilyItaly

BACKGROUND Lateral internal sphincterotomy is still the approach of choice for the treatment of chronic anal fissure(CAF)with internal anal sphincter(IAS)hypertonia,but it is burdened by high-risk postoperative faecal incontinence(FI).Sphincter saving procedures have recently been reconsidered as treatments to overcome this *** most employed procedure is fissurectomy with anoplasty,eventually associated with pharmacological *** To evaluate whether fissurectomy and anoplasty with botulinum toxin injection improves the results of fissurectomy and anoplasty *** We conducted a case-control study involving 30 male patients affected by CAF with hypertonic IAS who underwent fissurectomy and anoplasty with V-Y cutaneous flap *** patients were divided into two groups:Those in group I underwent surgery alone,and those in group II underwent surgery and a botulinum toxin injection directly into the *** were followed up for at least 2 *** goals were to achieve complete healing of the patient and to assess the FI and recurrence rate along with manometry *** The intensity and duration of post-defecatory pain decreased significantly in both groups of patients starting with the first defecation,and this reduction was higher in group *** days after surgery,we achieved complete wound healing in all the patients in group II but only in 80%of the patients in group I(P<0.032).We recorded 2 cases of recurrence,one in each group,and both healed with conservative *** recorded one temporary and low-grade postoperative case of“de novo”*** parameters reverted to the normal range earlier for group II *** The injection of botulinum toxin A in association with fissurectomy and anoplasty with a V-Y advancement flap improves the results of surgery alone in patients affected by CAF with IAS hypertonia.

关键词： Proctology Fissurectomy Anoplasty Anal fissure Botulinum toxin

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oncological outcomes of patients with ductal adenocarcinoma of the prostate receiving radical prostatectomy or radiotherapy

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Asian Journal of urology 2021年第2期8卷 227-234页

作者： Mengzhu Liu Kun Jin Shi Qiu Pengyong Xu Mingming Zhang Wufeng Cai Xiaonan Zheng Lu Yang Qiang Wei Institute of urology Department of UrologyWest China HospitalSichuan UniversityChengduChina Center of Biomedical Big Data West China HospitalSichuan UniversityChengduChina Institute of urology Department of Urologythe First People’s HospitalYantaiChina

Objective:To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate(DAC)managed with radical prostatectomy(RP)or radiotherapy(RT)and optimize the proper treatment modality to DAC ***:The cohorts included a total of 528 patients from the Surveillance,Epidemiology and End Results(SEER)database,354 receiving RP and 174 receiving *** proportional hazards regressions were performed to assess cancer specific mortality(CSM)and overall mortality(OM)between treatment groups.A competing risk analysis was further *** analyses by age and level of prostate-specific antigen(PSA)were *** score matching was ***:Patients managed with RP had lower risks of CSM and OM compared with RT(before matching:Hazard ratio[HR]=0.24,95%confidence interval[CI]0.13-0.47 and HR=0.26,95%CI 0.17-0.40,respectively;after matching:HR=0.18,95%CI 0.04-0.82 and HR=0.28,95%CI 0.11-0.70,accordingly).Subgroup analyses demonstrated that patients in the middle tertile of the age or with lower tertile PSA level managed with RP took lower risks of OM significantly(HR=0.18,95%CI 0.06-0.57,p<0.01 and HR=0.17,95%CI 0.06-0.54,p<0.01).Conclusion:Among patients with DAC,treatment with RP was associated with better survival outcomes in comparison with *** with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.

关键词： Ductal adenocarcinoma of the prostate Cancer specific mortality Overall mortality Radical prostatectomy Radiotherapy

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A modified clinicopathological tumor staging system for survival prediction of patients with penile cancer

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Cancer Communications 2018年第1期38卷 726-735页

作者： Zai-Shang Li Antonio Augusto Ornellas Christian Schwentner Xiang Li Alcides Chaux Georges Netto Arthur LBurnett Yong Tang JiunHung Geng Kai Yao Xiao-Feng Chen Bin Wang Hong Liao Nan Liu Peng Chen Yong-Hong Lei Qi-Wu Mi Hui-Lan Rao Ying-Ming Xiao Qi-Lin Wang Zi-Ke Qin Zhuo-Wei Liu Yong-Hong Li Zi-Jun Zou Jun-Hang Luo Hui Li Hui Han Fang-Jian Zhou department of urology Shenzhen People’s HospitalThe Second Clinical College of Jinan UniversityShenzhen 518060GuangdongP.R.China Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center of Cancer MedicineGuangzhou 510060GuangdongP.R.China department of urology Sun Yat-sen University Cancer Center651 Dongfeng RoadEast Guangzhou 510060GuangdongP.R.China department of urology Brazilian National Institute of Cancer and Hospital Mário KröeffRio de Janeiro 20230-130Brazil Section of urology National Institute of CancerRio de JaneiroBrazil department of urology Diakonie Klinikum Stuttgart70174 StuttgartGermany Urological department Urological InstituteWest China Hospital of Sichuan UniversityChengdu 610041SichuanP.R.China department of Scientific Research Norte University1001-1925 AsunciónParaguay department of Pathology Johns Hopkins UniversityBaltimoreMD 21218USA department of urology Johns Hopkins UniversityBaltimoreMD 21218USA department of urology Affiliated Cancer Hospital of Guangxi Medical UniversityNanning 530021GuangxiP.R.China department of urology Kaohsiung Medical University HospitalKaohsiungTaiwan 807China department of urology The First People’s Hospital of ChenzhouChenzhou 423000HunanP.R.China department of urology Cancer Center of Guangzhou Medical UniversityGuangzhou 510000GuangdongP.R.China department of urology Sichuan Cancer HospitalChengdu 610041SichuanP.R.China department of urology oncological Surgery Chongqing Cancer Hospital&Institute&Cancer CenterChongqing 400040China department of urology Affiliated Tumor Hospital of Xinjiang Medical UniversityUrumqi 830011XinjiangP.R.China department of urology Yunnan Provincial Tumor HospitalThe Third Affiliated Hospital of Kunming Medical UniversityKunming 650118YunnanP.R.China department of urology Dongguan People’s HospitalDongguan 523059GuangdongP.R.China department of Pathology Sun Yat-sen University Cancer CenterGuangzhou 510060Guangdo

Background:The 8th American Joint Committee on Cancer tumor-node-metastasis(AJCC-TNM)staging system is based on a few retrospective single-center *** aimed to test the prognostic validity of the staging system and to determine whether a modified clinicopathological tumor staging system that includes lymphovascular emboliza-tion could increase the accuracy of prognostic prediction for patients with stage T2-3 penile ***:A training cohort of 411 patients who were treated at 2 centers in China and Brazil between 2000 and 2015 were staged according to the 8th AJCC-TNM staging *** internal validation was analyzed by bootstrap-corrected C-indexes(resampled 1000 times).Data from 436 patients who were treated at 15 centers over four conti-nents were used for external ***:A survivorship overlap was observed between T2 and T3 patients(P=0.587)classified according to the 8th AJCC-TNM staging *** embolization was a significant prognostic factor for metastasis and survival(all P<0.001).Based on the multivariate analysis,only lymphovascular embolization showed a significant influ-ence on cancer-specific survival(CSS)(hazard ratio=1.587,95%confidence interval=1.253-2.011;P=0.001).T2 and T3 patients with lymphovascular embolization showed significantly shorter CSS than did those without lymphovascu-lar embolization(P<0.001).Therefore,a modified clinicopathological staging system was proposed,with the T2 and T3 categories of the 8th AJCC-TNM staging system being subdivided into two new categories as follows:t2 tumors invade the corpus spongiosum and/or corpora cavernosa and/or urethra without lymphovascular invasion,and t3 tumors invade the corpus spongiosum and/or corpora cavernosa and/or urethra with lymphovascular *** modified staging system involving lymphovascular embolization showed improved prognostic stratification with significant differences in CSS among all categories(all P<0.005)and exhibited higher accur

关键词： Penile neoplasms Lymph node metastasis Staging Lymph node excision Prognosis

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Optimizing management of pancreaticopleural fistulas

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World Journal of Gastroenterology 2011年第42期17卷 4696-4703页

作者： Marek Wronski Maciej Slodkowski Wlodzimierz Cebulski Daniel Moronczyk Ireneusz W Krasnodebski department of General Gastroenterological and Oncological SurgeryMedical University of Warsaw

AIM:To evaluate the management of pancreaticopleural fistulas involving early endoscopic instrumentation of the pancreatic ***:Eight patients with a spontaneous pancre-aticopleural fistula underwent endoscopic retrograde cholang iopancreatography(ERCP) with an intentionto stent the site of a ductal disruption as the primarytreatment. Imaging features and management were evaluated retrospectively and compared with ***:In one case,the stent bridged the site of aductal disruption. The fistula in this patient closed with in3 wk. The main pancreatic duct in this case appearednormal,except for a leak located in the body of the pancreas. In another patient,the papilla of Vater couldnot be found and cannulation of the pancreatic ductfailed. This patient underwent surgical treatment. In the remaining 6 cases,it was impossible to insert a stentinto the main pancreatic duct properly so as to coverthe site of leakage or traverse a stenosis situated down-stream to the fistula. The placement of the stent failed because intraductal stones(n = 2) and ductal strictures(n = 2) precluded its passage or the stent was too short to reach the fistula located in the distal part of the pancreas(n = 2) . In 3 out of these 6 patients,the pancre-aticopleural fistula closed on further medical *** these cases,the main pancreatic duct was normalor only mildly dilated,and there was a leakage at the body/tail of the pancreas. In one of these 3 patients,additional percutaneous drainage of the peripancre atic fluid collections allowed better control of the leakageand facilitated resolution of the fistula. The remaining3 patients had a tight stenosis of the main pancreatic duct resistible to dilatation and the stent could not beinserted across the stenosis. Subsequent conservative treatment proved unsuccessful in these patients. Aftera failed the rapeutic ERCP,3 patients in our series developed superinfection of the pleural or peripancreatic fluid collections. Four out of

关键词： Pancreaticopleural fistula Pancreatitis Surgery Endoscopic retrograde cholangiopancreatography Magnetic resonance cholangiopancreatography

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Effect of puboprostatic ligament preservation during robotic-assisted laparoscopic radical prostatectomy on early continence:Randomized controlled trial

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Asian Journal of urology 2021年第3期8卷 260-268页

作者： Wattanachai Ratanapornsompong Suthep Pacharatakul Premsant Sangkum Chareon Leenanupan Wisoot Kongcharoensombat Division of urology Department of SurgeryFaculty of MedicineRamathibodi HospitalMahidol UniversityBangkokThailand Division of urology Department of SurgeryPolice HospitalBangkokThailand

Objective:To prove the effectiveness of puboprostatic ligament-preserving robotic-assisted laparoscopic radical(RARP)on enhancing early ***:Ninety-two patients with localized adenocarcinoma of the prostate scheduled for RARP from April 2018 to January 2019 were prospectively single-blinded and randomized into two groups,standard RARP(Group A)and puboprostatic ligament-sparing RARP(Group B).The outcomes were continent status at Foley catheter removal and 3 months after surgery using the score from the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF),pad usage,pathological margin status,blood loss,operative time,and ***:Ninety-six patients were randomized(46 patients in each group),with a mean±SD age of 67.30±6.07 *** were no differences in baseline *** 3 months after surgery,ICIQ-UI SF score(mean±SD)in Group A was significantly higher than Group B(8.74±4.28 vs.6.93±3.96,p=0.038)but no difference at Foley catheter *** A also had a significant higher score for interference with daily life(median[interquartile range,IQR]:4[1,5]vs.2[0,4];p=0.041)and higher pad use(median[IQR]:2[0,3]vs.1[1,2];p=0.041)at 3 *** case in Group A had complete or severe incontinence(>5 pads/day)at 3 *** A and B did not exhibit significant difference in margin status(p=0.828).There were no differences in operative time,blood loss,drain output or ***:Use of puboprostatic ligament-sparing RARP could be a method to accelerate early continence without affecting the final oncological outcome.

关键词： Puboprostatic ligament Robotic surgery Prostate cancer Urinary incontinence Radical prostatectomy Randomized controlled trial

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Laparoscopic radical prostatectomy： oncological and functional results of 126 patients with a minimum 3-year follow-up at a single Chinese institute

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Asian Journal of Andrology 2009年第5期11卷 548-556,I0001,I0002页

作者： Xin Gao Jian-Hua Zhou Liao-Yuan Li Jian-Guang Qiu Xiao-Yong Pu department of urology The Third Affiliated Hospital Sun Yat-Sen University Guangzhou 510630 China

In this study we evaluate the oncological and functional results of the largest cohort of patients in China treated by laparoscopic radical prostatectomy （LRP） and with at least 3 years of follow-up. 126 inconsecutive patients （range 56-78 years, median 62.5） who had an LRP were retrospectively analyzed. The mean prostate specific antigen level and Gleason score was 13.4 ng mL^-1 and 6.4, respectively. Twenty-seven patients had unilateral or bilateral nerve preservation and 29 had pelvic lymphadenectomy. Multivariate analysis was used to adjust for differences in clinical and pathological features when comparing the risk for biochemical progression-free survival （bPFS）. Urinary continence was assessed by incontinence questionnaire and erectile function by the Sexual Health Inventory for Men score. The mean operative duration was 250 min and blood loss 354 mL. Five patients received blood transfusion and nine had complications, including rectal injury （two）, ureteral injury （one）, active bleeding （one）, bladder neck stenosis （two）, paralytic ileus （one）, subcutaneous hematoma （one） and port-site hernia （one）. The overall positive surgical margin rate was 20.6% and correlated with pathological stage and Gleason score respectively （P = 0.03, P 〈 0.001 respectively）. All patients had 〉 3 years of follow-up （range 3-6.75 years, mean 4.6, median 4.75）. At 3 years of follow-up, the overall survival rate was 100% and the bPFS was 81.0% in all patients; 124 patients （98.4%） were continent; 22 of 27 patients （81.5%） who underwent nerve preservation retained erectile function. Our series confirms that LRP is an effective, safe and precise technique at Chinese institution.

关键词： complication follow-up laparoscopic surgery prostate cancer prostatectomy survival

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Neoadjuvant chemotherapy for gastric cancer. Is it a must or a fake?

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World Journal of Gastroenterology 2018年第2期24卷 274-289页

作者： Rossella Reddavid Silvia Sofia Paolo Chiaro Fabio Colli Renza Trapani Laura Esposito Mario Solej Maurizio Degiuli Surgical Oncology and Digestive Surgery Department of Oncology University of Turin San Luigi University Hospital department of Surgical Sciences Digestive and Oncological Surgery University of Turin Molinette Hospital

AIM To investigate the neoadjuvant chemotherapy(NAC) effect on the survival of patients with proper stomach cancer submitted to D2 *** We proceeded to a review of the literature with Pub Med, Embase, ASCO and ESMO meeting abstracts as well as computerized use of the Cochrane Library for randomized controlled trials(RCTs) comparing NAC followed by surgery(NAC + S) with surgery alone(SA) for gastric cancer(GC). The primary outcome was the overall survival rate. Secondary outcomes were the site of the primary tumor, extension of node dissection according to Japanese Gastric Cancer Association(JGCA) performed in both arms, disease-specific(DSS) and disease-free survival(DFS) rates, clinical and pathological response rates and resectability rates after perioperative treatment. RESULTS We identified a total of 16 randomized controlled trials comparing NAC + S(n = 1089) with SA(n = 973) published in the period from January 1993-March 2017. Only 6 of these studies were well-designed, structured trials in which the type of lymph node(LN) dissection performed or at least suggested in the trial protocol was reported. Two out of three of the RCTs with D2 lymphadenectomy performed in almost all cases failed to show survival benefit in the NAC arm. Inthe third RCT, the survival rate was not even reported, and the primary end points were the clinical outcomes of surgery with and without NAC. In the remaining three RCTs, D2 lymph node dissection was performed in less than 50% of cases or only recommended in the "Study Treatment" protocol without any description in the results of the procedure really perfomed. In one of the two studies, the benefit of NAC was evident only for esophagogastric junction(EGJ) cancers. In the second study, there was no overall survival benefit of NAC. In the last trial, which documented a survival benefit for the NAC arm, the chemotherapy effect was mostly evident for EGJ cancer, and more than one-fourth of patients did not have a proper

关键词： gastric cancer neoadjuvant chemotherapy perioperative chemotherapy D2 lymphadenectomy randomized control trial

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PD-L1 expression and its effect on clinical outcomes of EGFRmutant NSCLC patients treated with EGFR-TKIs

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Cancer Biology & Medicine 2018年第4期15卷 434-442页

作者： Yuchen Bai Xiaoxia Chen Likun Hou Jun Qian Tao Jiang Caicun Zhou Maciej Ciebiada department of General and oncological Pulmonology University Clinical Hospital Norbert BarlickiMedical University of LodzLodz 50243Poland department of urology Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China department of Medical Oncology department of Pathology Shanghai Pulmonary Hospital&Thoracic Cancer InstituteTongji University School of MedicineShanghai 200433China department of Medical Oncology Suzhou Cancer Centerthe Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou 215000China

Objective:Epidermal growth factor receptor(EGFR)activation was reported to upregulate programmed death-ligand 1(PD-L1)expression in lung cancer cells and subsequently contribute to immune escape,indicating its critical role in EGFR-driven lung *** study characterized PD-L1 expression in patients with surgically resected EGFR-mutant non-small cell lung cancer(NSCLC).The effect of PD-L1 expression on clinical outcomes was also investigated in advanced EGFR-mutant NSCLC treated with EGFR-tyrosine kinase inhibitors(TKIs).Methods:In total,73 patients with surgically resected NSCLC and EGFR mutations were ***-L1 expression and CD8+tumor-infiltrating lymphocyte(TIL)density were assessed by immunohistochemistry.A literature review of publications that assessed the predictive and prognostic value of PD-L1 expression in advanced EGFR-mutant NSCLC patients treated with EGFR-TKIs was ***:Nineteen(26.0%)patients were positive for PD-L1 expression,which was significantly associated with concomitant KRAS mutation(P=0.020)and marginally associated with higher CD8+TILs density(P=0.056).Positive PD-L1 expression was associated with markedly inferior overall survival(OS)in multivariate analysis(P=0.032).The combination of PD-L1 and CD8+TILs expression could be used to stratify the population into three groups with distinct prognoses.A meta-analysis of six publications showed that positive PD-L1 expression was not associated with OS[hazard ratio(HR)=0.90;95%confidence interval(CI),0.42–1.38]or progression-free survival(HR=1.03;95 CI,0.73–1.33)in advanced EGFR-mutant NSCLC patients receiving ***:PD-L1 expression tended to correlate with CD8+TIL expression,concomitant KRAS mutation,and poor survival in surgically resected EGFR-mutant ***-L1 expression was neither the predictive nor the prognostic factor in advanced EGFR-mutant NSCLC patients treated with EGFR-TKIs.

关键词： Non-small cell lung cancer EGFR mutation PD-L1 CD8 survival

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Listen and talk to the older patients:a critical emancipatory reflection on the practice of communication issues

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Frontiers of Nursing 2019年第1期6卷 35-40页

作者： Qiao-Miao Zeng Lian-Xiang He department of oncological Radiotherapy XiangYa Hospital Central South University Nursing Administration department XiangYa Hospital Central South University

Objective: Reflection is a process of deliberating thinking and examining one's practice in the past and thereby encouraging nurses to make improvements in future care delivery. This work outlines a piece of reflection involving the practice of communication between nurses and the elderly, to emancipate the authors from their constraints, help to find values as practitioners, and gain a greater understanding of the nurse-patient ***: Using Smyth's four-stage model as a guide, as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a deep reflection on the relationship that the authors developed with elderly patients and their families, encountered during the practice as a nurse. By applying the four main stages consisting of describe, inform, confront, and reconstruct, this model enabled the authors to frame, describe the practice issue, and explore the meaning behind it, which helps to facilitate a structured ***: Critical emancipatory reflection, in association with the Espoused theory and Theory-in-use, as well as reflexivity, critical social theory, and hegemony, was applied to uncover the various power relationships and constraining forces in the authors' practice involved in communicating with the elderly, such as the underlying false consciousness, hegemony, hidden assumptions, influential values, and dominant power structure, which are subtle and persuasive. By applying this process of critical reflection, transformative practice could be ***: The process of critical reflection facilitated the development of the abilities required to develop and maintain the nursepatient relationship. It helps to enhance the care of old patients and their families, which illuminates the future nursing practice.

关键词： emancipatory reflection older patients communication nurse-patient relationship person-centered care

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