The comparison between traditional Chinese medicine Jinzhen oral liquid (JZOL) and Western medicine in treating children with acute bronchitis (AB) showed encouraging outcomes. This trial evaluated the efficacy and safety of the JZOL for improving cough and expectoration in children with AB. 480 children were randomly assigned to take JZOL or ambroxol hydrochloride and clenbuterol hydrochloride oral solution for 7 days. The primary outcome was time-to-cough resolution. The median time-to-cough resolution in both groups was 5.0 days and the antitussive onset median time was only 1 day. This randomized controlled trial showed that JZOL was not inferior to cough suppressant and phlegm resolving western medicine in treating cough and sputum and could comprehensively treat respiratory and systemic discomfort symptoms. Combined with clinical trials, the mechanism of JZOL against AB was uncovered by network target analysis, it was found that the pathways in TRP channels like IL-1β/IL1R/TRPV1/TRPA1, NGF/TrkA/TRPV1/TRPA1, and PGE2/EP/PKA/TRPV1/TRPA1 might play important roles. Animal experiments further confirmed that inflammation and the immune regulatory effect of JZOL in the treatment of AB were of vital importance and TRP channels were the key mechanism of action.

Wuzhuyu Decoction, the classical formula recorded in the Treatise on Febrile Diseases(Shang Han Lun), has been included in the Catalogue of Ancient Classic Prescriptions(the First Batch). Consisting of Euodiae Fructus, Ginseng Radix et Rhizoma, Zingiberis Rhizoma Recens, and Jujubae Fructus, it is effective in warming the middle, tonifying deficiency, dispelling cold, and descending adverse Qi, and is widely applied clinically with remarkable efficacies. For a classical formula, the chemical composition is the material basis and an important premise for quantity value transfer. This study aimed to establish a rapid identification method of chemical components in Wuzhuyu Decoction by high-resolution mass spectrometry(HR-MS) and molecular network. AQUITY UPLC BEH C_(18) column(2.1 mm×100 mm, 1.7 μm) was used for sample separation, and acetonitrile-0.1% formic acid in water was used as mobile phases for gradient elution. Q-Exactive Orbitrap MS data were collected in positive and negative ion modes, and GNPS molecular network was plotted according to the similarity of MS/MS fragmentation modes. Cytoscape 3.6.1 was used to screen molecular clusters with similar structures. Finally, the chemical components of Wuzhuyu Decoction were rapidly identified according to the controls, as well as the information of retention time, accurate relative molecular weight of HR-MS, and MS/MS multistage fragments. A total of 105 chemical components were identified in Wuzhuyu Decoction. This study can provide data for the follow-up quality control, standard substance research, and pharmacodynamic material research on Wuzhuyu Decoction, as well as references for the rapid qualitative analysis of the chemical components of Chinese medicine.
Tandem Mass Spectrometry/methods* ; Chromatography, High Pressure Liquid/methods* ; Drugs, Chinese Herbal/chemistry* ; Quality Control

ObjectiveTo compare the therapeutic effects of oral Chinese medicines （including Chinese patent medicines） on coronary artery disease （CAD） by the Bayesian network Meta-analysis. MethodThe randomized controlled trials of treating CAD with oral Chinese medicines were retrieved from the China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， PubMed， Web of Science， Embase， and Cochrane Library from the inception to December 1， 2022. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included articles. The direct meta-analysis was performed to compare the performance of oral Chinese medicines alone and in combination with Western medicine in the treatment of CAD in terms of intima-media thickness （IMT）， vascular endothelial function， plaque score， hypersensitive C-reactive protein （hs-CRP）， total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， and total response rate. Furthermore， the Bayesian network Meta-analysis was performed to compare the therapeutic effects of different Chinese medicines. ResultA total of 41 articles were included. The direct meta-analysis results showed that Chinese medicines combined with Western medicine outperformed Western medicine alone in recovering all the indicators of CAD. The Bayesian network meta-analysis yielded the following results. In terms of the total response rate， modified Huangqi Guizhi Wuwutang and Sanqi Huayu pills had obvious advantages over other Chinese medicines. In terms of IMT and plaque score， Xiaoban Huazhuo decoction， Yiqi Tongluo formula， Ruangan Jiangzhi capsules， and Guanxin Shutong capsules had obvious advantages over other Chinese medicines. In terms of blood lipid indicators， Shenqi Roumai mixture， Ruangan Jiangzhi capsules， Xiaoban Huazhuo decoction， Qiwei Sanxiong decoction， and Sanqi Huayu pills were superior to other Chinese medicines. The Chinese medicines above mainly had the functions of activating blood， resolving stasis， resolving phlegm， and dredging vessels. ConclusionThe combination of oral Chinese medicines and Western medicine is effective in treating CAD. Clinicians can use the drugs targeting abnormal indicators according to the results of this Bayesian network meta-analysis combined with the actual situation of patients to achieve better therapeutic effects.

Objective:To explore the application of three-dimensional measurement data in the diagnosis and treatment of mandibular angle prominent in Shanghai female youth.Methods:The young females in Shanghai were selected from the Clinical Database of Shanghai Universal Medical Imaging Diagnostic Center in Xuhui and the Second Affiliated Hospital of Naval Medical University from January 2010 to December 2020. Three-dimensional reconstruction of the craniofacial region was performed using computer-aided technology, and the subjects were divided into prominent group, attractive group, and contrast group according to the three-dimensional reconstruction images and doctor’s evaluation results. The mandibular and facial regions of the three groups were measured in three dimensions. The measurement indicators included bone tissue indicators such as mandibular angle (∠Co-Go-Me), mandibular expansion angle (∠Go-Me-Go), mandibular body length/mandibular support height ratio (Go-Me/Co-Go), mandibular angle width/zygomatic width ratio (Go-Go/Zy-Zy), and mandibular width index (Go-Go/Co-Co); and the soft tissue indicators included mandibular angle (∠t-go’-gn), mandibular angle width/midface width ratio (go’-go’/zy’-zy’), and mandibular angle width/mandibular height ratio (go’-go’/s-gn). The data were analyzed using SPSS 18.0 software, with normally distributed metric data expressed as Mean±SD. One-way analysis of variance or Kruskal-Wallis rank sum test was used to compare the three groups, and LSD method was used for comparison among prominent group, contrast group and attractive group. Fisher discriminant analysis was used for indicators with statistical significance. P<0.05 was considered statistically significant. Results:A total of 200 young females in Shanghai were enrolled in this study. 73 cases were included in the prominent group, with an age of (26.1±3.2) years, body weight of (54.3±4.3) kg, and body mass index(BMI) of (21.3±1.9) kg/m 2; 32 cases in the attractive group, with an age of (25.3±3.1) years, body weight of (58.7±3.7) kg, and BMI of (20.0±1.5) kg/m 2; and 95 cases in the contrast group, with an age of (27.2±3.7) years, body weight of (53.3±3.4) kg, and BMI of (20.1±1.3) kg/m 2. There were no significant differences in age, body weight, and BMI among the three groups ( P>0.05). There were significant differences in the measurement values of indicators such as ∠Co-Go-Me, ∠Go-Me-Go, Go-Me/Co-Go, Go-Go/Co-Co, ∠t-go’-gn among the three groups ( P<0.01). The prominent group showed significant outward and posterior protrusion in the mandibular angle area compared with the contrast group in terms of ∠Co-Go-Me (111.69°±4.19° vs. 115.43°±3.01°), ∠Go-Me-Go (66.27°±4.51° vs. 64.19°±3.69°), and ∠t-go’-gn (126.13°±7.51° vs. 130.34°±7.21°) ( P<0.01). The attractive group showed significant differences compared with the contrast group in terms of ∠Co-Go-Me (121.61°±3.22° vs. 115.43°±3.01°), Go-Me/Co-Go (1.67±0.20 vs. 1.58±0.15), and ∠t-go’-gn (137.17°±7.57° vs. 130.34°±7.21°) ( P<0.01). The lower quartile of ∠Co-Go-Me in the prominent group was 110°, and the upper quartile of ∠GO-Me-Go was 72°, with a small overlap in the mode region compared with the other two groups. Three indicators, ∠Co-Go-Me ( D1), ∠Go-Me-Go ( D2), and Go-Me/Co-Go ( D3), were selected to establish Fisher discriminant functions. The Fisher discriminant function for prominent group was Z=0.237 D2-0.084 D1-5.813, with a discriminant rate of 60.3%, and for the attractive group was Z=0.257 D1-0.015 D3-28.610, with a Fisher discriminant rate of 85.3%. Conclusion:The ∠Co-Go-Me, ∠Go-Me-Go, ∠t-go’-gn, and other data in Shanghai female youth can be used to evaluate their mandibular contour morphology, providing a reference for the diagnosis and treatment of mandibular angle prominent. The ∠Co-Go-Me of the mandibular aesthetic group should approach 122°, and ∠Co-Go-Me<110° and ∠Go-Me-Go>72° can be used as preliminary indicators for the diagnosis of mandibular angle prominent in prominent group, guiding clinical practice.

Objective:To use the least square method to curve fit the mandibular contours of Chinese women, obtain an ideal fitting function model, and explore the effectiveness of using mathematical curves for bone cutting line design in mandibular osteotomy.Methods:(1) Female cranial CT data were selected from the Second Affiliated Hospital of Naval Medical University and Shanghai Universal Medical Imaging Diagnostic Center. The mandibular morphology of the CT reconstructed images was evaluated using the Likert scale, and samples were selected from individuals with mandibular angle hypertrophy, aesthetically pleasing mandibular morphology, and aesthetically pleasing appearance after osteotomy as references. The Python platform Spyder module was used to analyze the curve fitting of mandibular contour morphology and the goodness of fitting was measured by the coefficient of determination R2( R2 ≥ 0.800 was considered acceptable for the fitted function, while R2≥ 0.900 was deemed sufficient to meet clinical application requirements). The fitting degree of polynomial functions, logarithmic functions, and other mathematical curves in the facial contours of individuals with aesthetically pleasing mandibular morphology were analyzed to obtain an ideal mandibular contour curve fitting function model. (2) Patients with mandibular angle hypertrophy who underwent intraoral mandibular osteotomy from March 2020 to March 2021 at the Department of Plastic and Reconstructive Surgery of Second Affiliated Hospital of Naval Medical University were divided into a mathematical template group (guided by a mathematical curve-based bone cutting plan), a traditional template group (guided by traditional bone cutting templates), and a manual osteotomy group. Three-dimensional reconstruction technology was used to evaluate the efficacy postoperatively. Preoperative preparation time, bone cutting time, surgical time, and postoperative complications were compared among the three groups. Patient self-evaluation of surgical outcomes was assessed using the jawline component of the Face-Q questionnaire. Results:(1) A total of 205 female cranial CT data were selected, including 73 cases of mandibular angle hypertrophy, 32 cases of aesthetically pleasing mandibular morphology, and 5 cases of aesthetically pleasing appearance after osteotomy as reference samples for mandibular contour curve fitting. The result showed that the third-degree polynomial function ( R2=0.918±0.027) and logarithmic function ( R2=0.930±0.039) could be used to simulate the mandibular contour morphology in individuals with aesthetically pleasing mandibular morphology. (2) The mathematical template group (using logarithmic function for bone cutting design), traditional template group, and manual osteotomy group included 28, 14, and 11 patients with mandibular angle hypertrophy, respectively. All patients were satisfied with the postoperative mandibular contour morphology and no complications such as deformity or significant asymmetry were observed. The mathematical template group outperformed the manual osteotomy group in terms of the total score of the jawline questionnaire, surgical time, and bone cutting time(all P<0.01). The preoperative preparation time in the mathematical template group was shorter than that in the traditional template group [(82.39±9.77) min vs. (97.07±17.49) min, P<0.01], and the jawline questionnaire evaluation showed that the patients in the mathematical template group had higher scores in evaluating the lateral view of the mandible and the smoothness of the lower facial contour compared to the traditional template group [3.75±0.44 vs. 3.14±0.36, 3.71±0.46 vs. 3.36±0.50, both P<0.05]. Conclusion:Curve fitting based on the least square method can be used to simulate mandibular angle osteotomy. Models such as logarithmic functions can be used for preoperative design of mandibular osteotomy and have advantages in terms of contour smoothness and symmetry after surgery. Bone cutting design based on mathematical curves can meet patient demands and aesthetic standards, providing precise and individualized solutions for surgery.

Objective:To explore the application of three-dimensional measurement data in the diagnosis and treatment of mandibular angle prominent in Shanghai female youth.Methods:The young females in Shanghai were selected from the Clinical Database of Shanghai Universal Medical Imaging Diagnostic Center in Xuhui and the Second Affiliated Hospital of Naval Medical University from January 2010 to December 2020. Three-dimensional reconstruction of the craniofacial region was performed using computer-aided technology, and the subjects were divided into prominent group, attractive group, and contrast group according to the three-dimensional reconstruction images and doctor’s evaluation results. The mandibular and facial regions of the three groups were measured in three dimensions. The measurement indicators included bone tissue indicators such as mandibular angle (∠Co-Go-Me), mandibular expansion angle (∠Go-Me-Go), mandibular body length/mandibular support height ratio (Go-Me/Co-Go), mandibular angle width/zygomatic width ratio (Go-Go/Zy-Zy), and mandibular width index (Go-Go/Co-Co); and the soft tissue indicators included mandibular angle (∠t-go’-gn), mandibular angle width/midface width ratio (go’-go’/zy’-zy’), and mandibular angle width/mandibular height ratio (go’-go’/s-gn). The data were analyzed using SPSS 18.0 software, with normally distributed metric data expressed as Mean±SD. One-way analysis of variance or Kruskal-Wallis rank sum test was used to compare the three groups, and LSD method was used for comparison among prominent group, contrast group and attractive group. Fisher discriminant analysis was used for indicators with statistical significance. P<0.05 was considered statistically significant. Results:A total of 200 young females in Shanghai were enrolled in this study. 73 cases were included in the prominent group, with an age of (26.1±3.2) years, body weight of (54.3±4.3) kg, and body mass index(BMI) of (21.3±1.9) kg/m 2; 32 cases in the attractive group, with an age of (25.3±3.1) years, body weight of (58.7±3.7) kg, and BMI of (20.0±1.5) kg/m 2; and 95 cases in the contrast group, with an age of (27.2±3.7) years, body weight of (53.3±3.4) kg, and BMI of (20.1±1.3) kg/m 2. There were no significant differences in age, body weight, and BMI among the three groups ( P>0.05). There were significant differences in the measurement values of indicators such as ∠Co-Go-Me, ∠Go-Me-Go, Go-Me/Co-Go, Go-Go/Co-Co, ∠t-go’-gn among the three groups ( P<0.01). The prominent group showed significant outward and posterior protrusion in the mandibular angle area compared with the contrast group in terms of ∠Co-Go-Me (111.69°±4.19° vs. 115.43°±3.01°), ∠Go-Me-Go (66.27°±4.51° vs. 64.19°±3.69°), and ∠t-go’-gn (126.13°±7.51° vs. 130.34°±7.21°) ( P<0.01). The attractive group showed significant differences compared with the contrast group in terms of ∠Co-Go-Me (121.61°±3.22° vs. 115.43°±3.01°), Go-Me/Co-Go (1.67±0.20 vs. 1.58±0.15), and ∠t-go’-gn (137.17°±7.57° vs. 130.34°±7.21°) ( P<0.01). The lower quartile of ∠Co-Go-Me in the prominent group was 110°, and the upper quartile of ∠GO-Me-Go was 72°, with a small overlap in the mode region compared with the other two groups. Three indicators, ∠Co-Go-Me ( D1), ∠Go-Me-Go ( D2), and Go-Me/Co-Go ( D3), were selected to establish Fisher discriminant functions. The Fisher discriminant function for prominent group was Z=0.237 D2-0.084 D1-5.813, with a discriminant rate of 60.3%, and for the attractive group was Z=0.257 D1-0.015 D3-28.610, with a Fisher discriminant rate of 85.3%. Conclusion:The ∠Co-Go-Me, ∠Go-Me-Go, ∠t-go’-gn, and other data in Shanghai female youth can be used to evaluate their mandibular contour morphology, providing a reference for the diagnosis and treatment of mandibular angle prominent. The ∠Co-Go-Me of the mandibular aesthetic group should approach 122°, and ∠Co-Go-Me<110° and ∠Go-Me-Go>72° can be used as preliminary indicators for the diagnosis of mandibular angle prominent in prominent group, guiding clinical practice.

Objective:To use the least square method to curve fit the mandibular contours of Chinese women, obtain an ideal fitting function model, and explore the effectiveness of using mathematical curves for bone cutting line design in mandibular osteotomy.Methods:(1) Female cranial CT data were selected from the Second Affiliated Hospital of Naval Medical University and Shanghai Universal Medical Imaging Diagnostic Center. The mandibular morphology of the CT reconstructed images was evaluated using the Likert scale, and samples were selected from individuals with mandibular angle hypertrophy, aesthetically pleasing mandibular morphology, and aesthetically pleasing appearance after osteotomy as references. The Python platform Spyder module was used to analyze the curve fitting of mandibular contour morphology and the goodness of fitting was measured by the coefficient of determination R2( R2 ≥ 0.800 was considered acceptable for the fitted function, while R2≥ 0.900 was deemed sufficient to meet clinical application requirements). The fitting degree of polynomial functions, logarithmic functions, and other mathematical curves in the facial contours of individuals with aesthetically pleasing mandibular morphology were analyzed to obtain an ideal mandibular contour curve fitting function model. (2) Patients with mandibular angle hypertrophy who underwent intraoral mandibular osteotomy from March 2020 to March 2021 at the Department of Plastic and Reconstructive Surgery of Second Affiliated Hospital of Naval Medical University were divided into a mathematical template group (guided by a mathematical curve-based bone cutting plan), a traditional template group (guided by traditional bone cutting templates), and a manual osteotomy group. Three-dimensional reconstruction technology was used to evaluate the efficacy postoperatively. Preoperative preparation time, bone cutting time, surgical time, and postoperative complications were compared among the three groups. Patient self-evaluation of surgical outcomes was assessed using the jawline component of the Face-Q questionnaire. Results:(1) A total of 205 female cranial CT data were selected, including 73 cases of mandibular angle hypertrophy, 32 cases of aesthetically pleasing mandibular morphology, and 5 cases of aesthetically pleasing appearance after osteotomy as reference samples for mandibular contour curve fitting. The result showed that the third-degree polynomial function ( R2=0.918±0.027) and logarithmic function ( R2=0.930±0.039) could be used to simulate the mandibular contour morphology in individuals with aesthetically pleasing mandibular morphology. (2) The mathematical template group (using logarithmic function for bone cutting design), traditional template group, and manual osteotomy group included 28, 14, and 11 patients with mandibular angle hypertrophy, respectively. All patients were satisfied with the postoperative mandibular contour morphology and no complications such as deformity or significant asymmetry were observed. The mathematical template group outperformed the manual osteotomy group in terms of the total score of the jawline questionnaire, surgical time, and bone cutting time(all P<0.01). The preoperative preparation time in the mathematical template group was shorter than that in the traditional template group [(82.39±9.77) min vs. (97.07±17.49) min, P<0.01], and the jawline questionnaire evaluation showed that the patients in the mathematical template group had higher scores in evaluating the lateral view of the mandible and the smoothness of the lower facial contour compared to the traditional template group [3.75±0.44 vs. 3.14±0.36, 3.71±0.46 vs. 3.36±0.50, both P<0.05]. Conclusion:Curve fitting based on the least square method can be used to simulate mandibular angle osteotomy. Models such as logarithmic functions can be used for preoperative design of mandibular osteotomy and have advantages in terms of contour smoothness and symmetry after surgery. Bone cutting design based on mathematical curves can meet patient demands and aesthetic standards, providing precise and individualized solutions for surgery.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Objective: To investigate the characteristics of non-alcoholic fatty liver disease (NAFLD) and its associated factors in rheumatoid arthritis (RA) patients. Methods: This cross-sectional study recruited 385 RA patients [including 72 (18.7%) male and 313 (81.3%) female] who received abdominal sonographic examination from August 2015 to May 2021 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. There were 28 RA patients at 16-29 years old and 32, 80, 121, 99, 25 at 30-39, 40-49, 50-59, 60-69, ≥ 70 years old, respectively. Demographic and clinical data were collected including age, gender, history of alcohol consumption, disease duration, body mass index (BMI), waist circumference, blood pressure, RA disease activity indicators and previous medications. Logistic regression analyses were used to identify the associated factors of NAFLD in RA patients. Results: The prevalence of NAFLD was 24.2% (93/385) in RA patients, 26.3% (21/80) in 40-49 age group and 33.1% (40/121) in 50-59 age group. There were 22.1% (85/385) and 3.6% (14/385) RA patients with overweight and obese, in which the prevalence of NAFLD was 45.9% (39/85) and 78.6% (11/14) respectively, which was 2.6 folds and 4.5 folds that of RA patients with normal BMI. Although there was no significant difference of age, gender and RA disease activity indicators between RA patients with or without NAFLD, those with NAFLD had higher proportions of metabolic diseases including obese (11.8% vs. 1.0%), central obesity (47.3% vs. 16.8%), hypertension (45.2% vs. 29.8%) and type 2 diabetes mellitus (24.7% vs. 12.0%), consistent with higher levels of total cholesterol [(5.33±1.31) mmol/L vs. (4.73±1.12) mmol/L], triglyceride [(1.51±1.08) mmol/L vs. (0.98±0.54) mmol/L] and low-density lipoprotein cholesterol [(3.37±0.97) mmol/L vs. (2.97±0.78) mmol/L, all P<0.05]. Multivariate logistic regression analysis showed that BMI (OR=1.314) and triglyceride (OR=1.809) were the independent factors positively associated with NAFLD in RA patients. Conclusion: NAFLD is a common comorbidity in RA patients, especially in those with middle-aged, overweight or obese, which is associated with high BMI or high triglyceride. Screening and management of NAFLD in RA patients especially those with overweight, obese or dyslipidemia should be emphasized.
Adolescent ; Adult ; Aged ; Arthritis, Rheumatoid/epidemiology* ; Cholesterol, LDL ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease/epidemiology* ; Obesity/epidemiology* ; Overweight/epidemiology* ; Triglycerides ; Young Adult

Objective: The surgical indications, resection extent and management principle of lateral lymph node dissection (LLND) in lower rectal cancer have been controversial between Eastern and Western countries. This study aims to provide a theoretical basis for the rational implementation of LLND by reviewing the changes of LLND strategy over the past 30 years in a single-center, and analyzing prognostic factors for the survival outcomes of patients with lateral lymph node metastasis (LLNM). Methods: A retrospective observational study was performed. Clinical data of 289 patients with rectal cancer who received LLND at the Department of General Surgery of Peking University First Hospital from 1990 to 2019 were collected. Patients were divided into three groups based on decades. There were 89 cases in 1990-1999 group, 92 cases in the 2000-2009 group, and 108 cases in the 2010-2019 group. Data analyzed: (1) patient baseline data; (2) surgery and postoperative recovery; (3) lateral lymph node dissection; (4) postoperative survival and prognosis of patients with positive lateral lymph nodes. The surgical methods and pathological results of LLND were compared between groups, and the prognostic risk factors of patients with LLNM were analyzed. Results: A total of 289 patients underwent radical resection with LLND' accounting for 6.3% of the 4542 patients with rectal cancer during the same period in our hospital. Except decade-by-decade increase in tumors with distance from anal verge ≤ 7 cm, the proportion of ulcerated tumors, and the proportion of neoadjuvant radiochemotherapy, the differences in other baseline data were not statistically significant among 3 decade groups (all P>0.05). The proportion of LLND in the 3 groups decreased decade by decade [9.9% (89/898) vs. 8.0% (92/1154) vs. 4.3% (108/2490), χ(2)=40.159, P<0.001]. The proportion of laparoscopic surgery and unilateral LLND increased, while the mean operative time, intraoperative blood loss, surgical complications above grade III and postoperative hospital stay decreased decade by decade. These 289 patients completed a total of 483 lateral dissections, including 95 cases of the unilateral dissection and 194 cases of the bilateral dissection. The proportion of LLND in the 3 groups decreased decade by decade [9.9% (89/898) vs. 8.0% (92/1154) vs. 4.3% (108/2510), P<0.001]. The median number of dissected lymph nodes in the internal iliac artery and obturator regions increased (2 vs. 3 vs. 3, P<0.001), but those in the common iliac and external iliac regions decreased significantly (4 vs. 3 vs. 2, P=0.014). A total of 71 patients with LLNM were identified. The rate of LLNM in the 2010-2019 group was significantly higher than that in the previous two groups [37.0% (40/108) vs. 16.9% (15/89) vs. 17.4% (16/92), P=0.001]. The patients with LLNM showed a poorer overall survival (OS) and disease-free survival (DFS) compared with negative lateral lymph nodes (P<0.001). There were statistically significant differences in 5-year OS rate (30.9% vs. 27.2% vs. 0, P=0.028) and 5-year DFS rate (28.3% vs. 16.0% vs. 0, P=0.038) among patients with only internal iliac lymph node metastasis, patients with only obturator lymph node metastasis, and patients with external iliac or common iliac lymph node metastasis. Multivariate analysis of prognostic factors showed that external iliac or common iliac lymph node metastasis was an independent risk factor for OS (HR=1.649, 95%CI: 1.087-2.501) and DFS (HR=1.714, 95%CI: 1.173-2.504) in patients with LLNM (all P<0.05) . The OS and DFS were not significant different in patients with LLNM among 3 decade groups. Conclusions: In the past decade, the proportion of LLND in rectal cancer has decreased significantly. However, LLNM rate has been significantly increased due to preoperative imaging assessments focusing on suspicious LLNM without compromising the survival. Internal iliac artery and obturator lymph nodes can be regarded as regional lymph nodes with a satisfactory prognosis after LLND. For suspected external iliac or common iliac lymph node metastasis, the significance of LLND remains to be further evaluated.
Dissection ; Humans ; Lymph Node Excision ; Lymph Nodes ; Prognosis ; Rectal Neoplasms/surgery* ; Treatment Outcome