1.Criminological Characteristics and Criminal Responsibility Capacity of Offenders with Alcoholism
Chun-yan LIU ; Qi LI ; Ning YANG ; Xi DENG ; Can-can CAO ; Bo HAO ; Lu LIU ; Hu ZHAO
Journal of Sun Yat-sen University(Medical Sciences) 2023;44(3):386-394
ObjectiveTo analyze the criminal behavior characteristics of alcohol-related crime offenders and explore the relationship between criminal behavior characteristics and criminal responsibility capacity. MethodsBasic information, alcohol use information, psychiatric symptoms before and after the crime, criminological behavioral characteristics and conclusion of judicial evaluation were collected. ResultsThe drinking history of the chronic alcoholism group 25.0 (13.3~30.0) years was significantly longer than that of the acute alcoholism group 1.2 (0~14.3) years. In the chronic alcoholism group, 85.0% drank alcohol at least once a day, 52.5% had morning or bedtime drinking habits, and 92.5% drank mainly alone. Violent crimes accounted for 57.6%. Delirium existed in 52.5% of the chronic alcoholics' mental state at the time of the crime, and 84.6% of the acute alcoholics' mental state was hazy. In the chronic alcoholism group, 42.5% committed the crime with pathological motive, and in the acute alcoholism group, 69.2% committed the crime with realistic motive. Acute alcoholism group 96.2% were assessed as complete criminal responsibility capacity, and chronic alcoholism group 50.0% were assessed as complete criminal responsibility capacity. ConclusionCompared with acute alcoholism offenders, chronic alcoholics had a longer drinking duration, more frequency drinking, and obvious morning drinking or bedtime drinking habits. The nature of alcoholism crime cases was mostly violent. Compared with the chronic alcoholism group, the acute alcoholism group had highly selective motives for committing crimes and were mostly rated as complete criminally responsibility.
2.A comparison of CAS risk model and CHA2DS2-VASc risk model in guiding anticoagulation treatment in Chinese patients with non-valvular atrial fibrillation.
Jia Long DENG ; Liu HE ; Chao JIANG ; Yi Wei LAI ; De Yong LONG ; Cai Hua SANG ; Chang Qi JIA ; Li FENG ; Xu LI ; Man NING ; Rong HU ; Jian Zeng DONG ; Xin DU ; Ri Bo TANG ; Chang Sheng MA
Chinese Journal of Cardiology 2022;50(9):888-894
Objective: To compare the differences between CAS risk model and CHA2DS2-VASc risk score in predicting all cause death, thromboembolic events, major bleeding events and composite endpoint in patients with nonvalvular atrial fibrillation. Methods: This is a retrospective cohort study. From the China Atrial Fibrillation Registry cohort study, the patients with atrial fibrillation who were>18 years old were randomly divided into CAS risk score group and CHA2DS2-VASc risk score group respectively. According to the anticoagulant status at baseline and follow-up, patients in the 2 groups who complied with the scoring specifications for anticoagulation were selected for inclusion in this study. Baseline information such as age and gender in the two groups were collected and compared. Follow-up was performed periodically to collect information on anticoagulant therapy and endpoints. The endpoints were all-cause death, thromboembolism events and major bleeding, the composite endpoint events were all-cause death and thromboembolism events. The incidence of endpoints in CAS group and CHA2DS2-VASc group was analyzed, and multivariate Cox proportional risk model was used to analyze whether the incidence of the endpoints was statistically different between the two groups. Results: A total of 5 206 patients with AF were enrolled, average aged (63.6±12.2) years, and 2092 (40.2%) women. There were 2 447 cases (47.0%) in CAS risk score group and 2 759 cases (53.0%) in CHA2DS2-VASc risk score group. In the clinical baseline data of the two groups, the proportion of left ventricular ejection fraction<55%, non-paroxysmal atrial fibrillation, oral warfarin and HAS BLED score in the CAS group were lower than those in the CHA2DS2-VASc group, while the proportion of previous diabetes history and history of antiplatelet drugs in the CAS group was higher than that in the CHA2DS2-VASc group, and there was no statistical difference in other baseline data. Patients were followed up for (82.8±40.8) months. In CAS risk score group, 225(9.2%) had all-cause death, 186 (7.6%) had thromboembolic events, 81(3.3%) had major bleeding, and 368 (15.0%) had composite endpoint. In CHA2DS2-VASc risk score group, 261(9.5%) had all-cause death 209(7.6%) had thromboembolic events, 112(4.1%) had major bleeding, and 424 (15.4%) had composite endpoint. There were no significant differences in the occurrence of all-cause death, thromboembolic events, major bleeding and composite endpoint between anticoagulation in CAS risk score group and anticoagulation in CHA2DS2-VASc risk score group (log-rank P =0.643, 0.904, 0.126, 0.599, respectively). Compared with CAS risk score, multivariable Cox proportional hazards regression models showed no significant differences for all-cause death, thromboembolic events, major bleeding and composite endpoint between the two groups with HR(95%CI) 0.95(0.80-1.14), 1.00(0.82-1.22), 0.83(0.62-1.10), 0.96(0.84-1.11), respectively. All P>0.05. Conclusions: There were no significant differences between CAS risk model and CHA2DS2-VASc risk score in predicting all-cause death, thromboembolic events, and major bleeding events in Chinese patients with non-valvular atrial fibrillation.
Adolescent
;
Anticoagulants
;
Atrial Fibrillation/drug therapy*
;
Cohort Studies
;
Female
;
Hemorrhage/complications*
;
Humans
;
Male
;
Retrospective Studies
;
Risk Assessment
;
Stroke/epidemiology*
;
Stroke Volume
;
Thromboembolism/etiology*
;
Ventricular Function, Left
3.Blood glucose levels and the relationship of body mass index and circumference with blood glucose in China.
Xaio Qing DENG ; Mei ZHANG ; Xiao ZHANG ; Zhen Ping ZHAO ; Chun LI ; Zheng Jing HUANG ; Zi Wei SONG ; Bo JIANG ; Xiao Hui GUO ; Ning YU ; Li Min WANG
Chinese Journal of Epidemiology 2022;43(8):1178-1188
Objective: To describe and compare blood glucose levels in adults aged 18 years old and above in China and explore the relationship between BMI and waist circumference with blood glucose. Methods: China Chronic Disease and Risk Factor Surveillance were conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method selected permanent residents aged 18 years and above. Information on demographics, behavior-related risk factors, BMI, waist circumference, and blood glucose were collected through a face-to-face questionnaire, physical measurement, and laboratory examination. After complex weighting of data, they described the blood glucose levels of people with different characteristics and explored the relationship of BMI and waist circumference with blood glucose by multiple linear regression model analysis. Results: A total of 177 816 adults were included in the study. The average fasting blood glucose and average glycosylated hemoglobin were (5.73±1.46) mmol/L and (5.37±0.83) %, with people aged 60 years old and above group highest than that of other, with males higher than females (P<0.001); and urban was higher slightly than rural for the average of average glycosylated hemoglobin (P<0.001). The average fasting blood glucose and average glycosylated hemoglobin increased with increased BMI and waist circumference (P<0.001). Results from multiple linear regression model analysis showed that: 1) for each increase in BMI unit and waist circumference, the fasting glucose levels increased by 0.019 mmol/L and 0.008 mmol/L (all P<0.001) in those not diagnosed with diabetes, 2) by 0.021 mmol/L (P=0.163) and 0.014 mmol/L (P=0.004) in those newly detected as diabetes, and 3) by 0.028 mmol/L (P=0.088) and 0.023 mmol/L (P<0.001) in those self-reported as having been diagnosed as diabetes, respectively. However, glycosylated hemoglobin levels increased: 1) by 0.015% and 0.006% in those not diagnosed as diabetes (all P<0.001), 2) by 0.050% and 0.019% in those newly detected as diabetes (all P<0.001), and 3) by 0.033% and 0.019% in those self-reported as having been diagnosed as diabetes (all P<0.001), respectively. These associations with waist circumference were more robust than with BMI. Conclusions: Adults not diagnosed with diabetes with abnormal BMI or waist circumference are the key population for prevention and control. Measures improving the awareness rate of waist circumference should be taken to maintain average blood glucose in various groups.
Adolescent
;
Adult
;
Blood Glucose/analysis*
;
Body Mass Index
;
China/epidemiology*
;
Diabetes Mellitus/epidemiology*
;
Female
;
Glycated Hemoglobin/analysis*
;
Humans
;
Male
;
Middle Aged
;
Risk Factors
;
Waist Circumference
4.Diagnostic values of urinary citrate for kidney stones in patients with primary gout.
Yu WANG ; Hui Min ZHANG ; Xue Rong DENG ; Wei Wei LIU ; Lu CHEN ; Ning ZHAO ; Xiao Hui ZHANG ; Zhi Bo SONG ; Yan GENG ; Lan Lan JI ; Yu WANG ; Zhuo Li ZHANG
Journal of Peking University(Health Sciences) 2022;54(6):1134-1140
OBJECTIVE:
To evaluate the relationship between 24 h urinary ion content and kidney stones, and to explore the diagnostic values of kidney stone in primary gout patients.
METHODS:
Patients diagnosed with primary gout had ultrasound scanning of both feet and kidneys in Peking University First Hospital from Jan. 2020 to May 2021. Their clinical characteristics were compared between the positive and negative kidney stone groups, and the relationship between kidney stone and urinary ion composition were analyzed. Risk factors of kidney stone were analyzed. The explored diagnostic values were evaluated for urinary oxalate and citrate according with uric acid kidney stones by dual-energy computed tomography (DECT).
RESULTS:
Among the 100 gouty patients, 80 patients had uric acid crystal deposition in lower joints of extremity by ultrasonography, 61 patients had kidney stone, and 34 had kidney uric acid stones by DECT. All the multiple kidney stones were proved as uric acid kidney stones by DECT. Compared with patients without kidney stone group proved by ultrasonography, patients with kidney stone had longer gouty duration [(48.7±26.6) months vs. (84.0±30.6) months, P=0.01], higher 24 h urinary oxalate [(20.1±9.6) mg vs. (28.6±20.7) mg, P=0.001] and lower 24 h urinary citrate [(506.3±315.4) mg vs. (355.7±219.6) mg, P=0.001]. Compared with the patients without kidney stone by DECT, the patients with uric acid kidney stone also had longer disease duration [(49.1±28.4) months vs. (108.3±72.2) months, P=0.001], higher 24 h urinary oxalate [(23.6±16.9) mg vs. (28.5±18.8) mg, P < 0.05], lower 24 h urinary citrate [(556.0±316.3) mg vs. (391.7±261.2) mg, P < 0.05], higher serum uric acid [(466.2±134.5) μmol/L vs. (517.2±18.1) μmol/L, P < 0.05] and higher 24 h urinary uric acid [(1 518.1±893.4) mg vs. (1 684.2±812.1) mg, P < 0.05]. Logistic regression analysis showed long gout disease duration (OR=1.229, 95%CI: 1.062-1.522, P < 0.05), high serum uric acid level (OR=1.137, 95%CI: 1.001-1.213, P=0.01), low 24 h urinary citrate (OR=0.821, 95%CI: 0.659-0.952, P=0.01) were all risk factors of kidney stones by ultrasonography. Also, long gout disease duration (OR=1.201, 95%CI: 1.101-1.437, P=0.005), high serum creatine uric level (OR=1.145, 95%CI: 1.001-1.182, P=0.04), low 24 h urinary citrate (OR=0.837, 95%CI: 0.739-0.931, P=0.02) were all risk factors of kidney uric acid stones by DECT.
CONCLUSION
Long disease duration and low 24 h urinary citrate were risk factors for kidney stones.
Humans
;
Urinary Calculi
;
Uric Acid/analysis*
;
Citric Acid
;
Kidney Calculi/diagnostic imaging*
;
Gout/diagnostic imaging*
;
Citrates
;
Oxalates
5.A nomogram for predicting lymph node metastasis in early gastric cancer.
Hao CUI ; Bo CAO ; Huan DENG ; Gui Bin LIU ; Wen Quan LIANG ; Tian Yu XIE ; Lu YE ; Qing Peng ZHANG ; Ning WANG ; Fei De LIU ; Bo WEI
Chinese Journal of Gastrointestinal Surgery 2022;25(1):40-47
Objective: To explore the independent risk factors of lymph node metastasis (LNM) in early gastric cancer, and to use nomogram to construct a prediction model for above LNM. Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) primary early gastric cancer as stage pT1 confirmed by postoperative pathology; (2) complete clinicopathological data. Exclusion criteria: (1) patients with advanced gastric cancer, stump gastric cancer or history of gastrectomy; (2) early gastric cancer patients confirmed by pathology after neoadjuvant chemotherapy; (3) other types of gastric tumors, such as lymphoma, neuroendocrine tumor, stromal tumor, etc.; (4) primary tumors of other organs with gastric metastasis. According to the above criteria, 1633 patients with early gastric cancer who underwent radical gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital First Medical Center from December 2005 to December 2020 were enrolled as training set, meanwhile 239 patients with early gastric cancer who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital Fourth Medical Center from December 2015 to December 2020 were enrolled as external validation set. Risk factors of LNM in early gastric cancer were identified by using univariate and multivariate logistic regression analyses. A nomogram prediction model was established with significant factors screened by multivariate analysis. Area under the receiver operating characteristic curve (AUC) was used for assessing the predictive value of the model. Calibration curve was drawn for external validation. Results: Among 1633 patients in training set, the mean number of retrieved lymph nodes was 20 (13-28), and 209 patients (12.8%) had lymph node metastasis. Univariate analysis showed that gender, resection range, tumor location, tumor morphology, lymph node clearance, vascular invasion, lymphatic cancer thrombus, tumor length, tumor differentiation, microscopic presence of signet ring cells and depth of tumor invasion were associated with LNM (all P<0.05). Multivariate analysis revealed that females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa, and poor differentiation were independent risk factors for LNM in early gastric cancers (all P<0.05). Receiver operating characteristic curve indicated that AUC of training set was 0.818 (95%CI: 0.790-0.847) and AUC of external validation set was 0.765 (95%CI: 0.688-0.843). The calibration curve showed that the LNM probability predicted by nomogram was consistent with the actual situation (C-index: 0.818 in training set and 0.765 in external validation set). Conclusions: Females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa and poor differentiation are independent risk factors for LNM of early gastric cancer. The establishment of a nomogram prediction model for LNM in early gastric cancer has great diagnostic value and can provide reference for treatment selection.
Female
;
Gastrectomy
;
Humans
;
Lymph Node Excision
;
Lymph Nodes
;
Lymphatic Metastasis
;
Nomograms
;
Retrospective Studies
;
Risk Factors
;
Stomach Neoplasms/surgery*
6.Application of bone suppression imaging in the diagnosis of occupational pneumoconiosis
XIE Yuan lin QING Geng geng MA Le HUANG Li ming DENG Xue ning CHEN Wei bo ZOU Shan CHEN Wei guo
China Occupational Medicine 2022;49(05):572-
Objective ( )
To explore the application value of bone suppression imaging BSI in the diagnosis of occupational
( pneumoconiosis) Methods -
pneumoconiosis hereinafter referred to as " " . A total of 330 chest films of high kV digital
( )
radiograph DR of patients with suspected pneumoconiosis were selected by convenient sampling method. BSI is applied to the
, , , ,
chest films and the differences of small opacity shape small opacity aggregation the number of large opacity lung areas small
( ),
opacity profusion and diagnostic stage of pneumoconiosis were analyzed by simple DR reading DR group simple BSI reading
( ) ( ) Results
BSI group and DR and BSI combined reading combined group . There was no significant difference in the
distribution of small shadows and the detection rate of small shadows aggregation and large shadows in pneumoconiosis among
( P ) ,
the three film reading methods all >0.05 . For the concentration distribution of each lung area there was statistically
(P< ),
significant difference between the DR group and the BSI group 0.05 but there was no statistically significant difference
, ( P )
between the DR group and the combined group and between the BSI group and the combined group all >0.05 . The results of
,
consistency analysis showed that the DR group and the BSI group and the DR group and the combined group had high
( , P<
consistency in the judgment of small shadow intensity in the lung region both weighted Kappa coefficient were 0.75 all
)
0.01 . There was a high consistency between BSI group and DR group and combined group and DR group in the diagnosis of
( , , P< ) ,
pneumoconiosis stage weighted Kappa coefficient were 0.77 0.79 all 0.01 . Compared with the DR group the diagnostic
,
rate of pneumoconiosis stage Ⅰwas significantly reduced and the diagnostic rate of pneumoconiosis stage Ⅱ was significantly
( P< ) ,
increased in the BSI group and the combined group all 0.01 . However there was no significant difference in the diagnosticrate of pneumoconiosis stage Ⅲ >0.05 . Both the BSI reading and DR and BSI combined reading can improve
,
the display of pneumoconiosis lesions to varying degrees and therefore can improve the diagnosis of pneumoconiosis. In
,
addition the identification and diagnosis of pneumoconiosis lesions in the BSI reading is comparable to that in the combined
,
group which has a good application value in the diagnosis of pneumoconiosis.
7. The protective effect of miR-5088-5p on hepatocyte pyroptosis induced by homocysteine
Xiao-Yan DONG ; Da-Yue LIU ; Ling-Bo XU ; Yi-Deng JIANG ; An-Ning YANG ; Gui-Zhong LI ; Xiao-Yan DONG ; Da-Yue LIU ; Ling-Bo XU ; Ling-Yu GU ; Yi-Deng JIANG ; An-Ning YANG ; Yun JIAO ; Gui-Zhong LI ; Xiao-Yan DONG ; Da-Yue LIU ; Ling-Bo XU ; Ling-Yu GU ; Yi-Deng JIANG ; An-Ning YANG ; Yun JIAO ; Gui-Zhong LI ; Ling-Yu GU ; Yun JIAO
Chinese Pharmacological Bulletin 2021;37(11):1565-1570
Aim To explore the role of miR-5088-5p in hepatocyte pyroptosis induced by homocysteine. Methods Hepatocytes were cultured and divided into control group and Hcy group. After transfected miR-5088-5p NC and miR-5088-5p mimic under Hcy treatment, the expression of NLRP3, Caspase 1 and IL-1β was detected by Western blot. The expression of miR-5088-5p was detected by RT-qPCR. CBS
8.Short-term efficacy of Billroth Ⅱ+Braun anastomosis versus Roux-en-Y anastomosis in totally three-dimensional laparoscopic distal gastrectomy
Hao CUI ; Guoxiao LIU ; Huan DENG ; Bo CAO ; Wang ZHANG ; Tianyu XIE ; Kecheng ZHANG ; Jianxin CUI ; Qingpeng ZHANG ; Ning WANG ; Lin CHEN ; Bo WEI
Chinese Journal of Digestive Surgery 2021;20(5):528-534
Objective:To compare the short-term efficacy of Billroth Ⅱ+Braun anasto-mosis versus Roux-en-Y anastomosis in totally three-dimensional (3D) laparoscopic distal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 140 patients with gastric cancer who were admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2020 were collected. There were 105 males and 35 females, aged from 23 to 84 years, with a median age of 55 years. Of the 140 patients, 54 patients undergoing totally 3D laparoscopic distal gastrectomy with Billroth Ⅱ+Braun anastomosis were allocated into Billroth Ⅱ+Braun group, and 86 patients undergoing totally 3D laparoscopic distal gastrectomy with Roux-en-Y anastomosis were allocated into Roux-en-Y group, respectively. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect remnant gastritis and its severity, bile reflux, reflux esophagitis in the postoperative 3 months up to April 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the Mann-Whitney U test. Results:(1) Surgical situations: 140 patients underwent totally 3D laparoscopic distal gastrectomy. The operation time, cases with volume of intraoperative blood loss <50 mL, 50 to 200 mL or >200 mL, the number of lymph node dissected were (233±39)minutes,15, 35, 4, 30±13 for the Billroth Ⅱ +Braun group , respectively, versus (240±52)minutes,25, 51, 10, 27±10 for the Roux-en-Y group, showing no significant difference between the two groups ( t=0.856, χ2=0.774, t=1.518, P>0.05). (2) Postoperative situations: cases with drainage tube, time to postoperative first flatus, cases with postoperative grade Ⅱ, Ⅲ, Ⅳ, Ⅴ complications, cases with postoperative complications, cases with postoperative severe complications, duration of postoperative hospital stay, surgery cost and total hospitalization cost of the Billroth Ⅱ+Braun group were 38, (3.5±0.8)days,4, 1, 0, 0, 5, 1, (9.0±5.0)days, (3.8±1.2)×10 4 yuan and (9.7±2.1)×10 4 yuan, respectively. The above indicators of the Roux-en-Y group were 59, (3.7±1.0)days, 9, 1, 0, 1, 11, 2, (9.0±4.0)days, (4.3±1.0)×10 4 yuan and (9.2±2.1)×10 4 yuan, respectively. There was a significant difference in the surgery cost between the two groups ( t=2.453, P<0.05), while there was no significant difference in cases with drainage tube, time to postoperative first flatus, cases with postoperative grade Ⅱ, Ⅲ, Ⅳ, Ⅴ complications, cases with postoperative complications, duration of postoperative hospital stay or total hospitalization cost between the two groups ( χ2=0.049, t=?1.339, Z=0.000, χ2=0.409, t=0.197, 1.383, P>0.05). There was also no significant difference in cases with postoperative severe complications between the two groups ( P>0.05).(3) Follow-up: 134 of 140 patients received the follow-up, including 52 cases in the Billroth Ⅱ+Braun group and 82 cases in the Roux-en-Y group. Results of follow-up within postoperative 3 months showed that the incidence rates of remnant gastritis, bile reflux, reflux esophagitis were 61.5%(32/52), 38.5%(20/52), 26.9%(14/52) for the Billroth Ⅱ+Braun group, respectively, versus 41.5%(34/82), 22.0%(18/82), 12.2%(10/82) for the Roux-en-Y group, showing significant differences between the two groups ( χ2=5.131, 4.270, 4.695, P<0.05). Cases with grade 0,Ⅰ,Ⅱ, Ⅲ, Ⅳ residual food were 42, 3, 5, 2,0 for the Billroth Ⅱ+Braun group, versus 67, 9, 1, 5,0 for the Roux-en-Y group, showing no significant difference between the two groups ( Z=?0.156, P>0.05). Cases with minimal lesion, grade A, grade B gastritis (severity of gastritis) were 6, 5, 3 for the Billroth Ⅱ+Braun group, versus 8, 2, 0 for the Roux-en-Y group, showing no significant difference between the two groups ( Z=?1.468, P>0.05). Conclusions:It is safe and feasible to operate Billroth Ⅱ+Braun or Roux-en-Y anastomosis in totally 3D laparoscopic distal gastrectomy. Billroth Ⅱ+Braun anastomosis can reduce the surgical cost. Roux-en-Y anastomosis has advantages in reducing the incidence of reflux esophagitis, bile reflux and reflux gastritis.
9.AncPhore: A versatile tool for anchor pharmacophore steered drug discovery with applications in discovery of new inhibitors targeting metallo-
Qingqing DAI ; Yuhang YAN ; Xiangli NING ; Gen LI ; Junlin YU ; Ji DENG ; Lingling YANG ; Guo-Bo LI
Acta Pharmaceutica Sinica B 2021;11(7):1931-1946
We herein describe AncPhore, a versatile tool for drug discovery, which is characterized by pharmacophore feature analysis and anchor pharmacophore (
10.Risk factors of postoperative complication after total gastrectomy in advanced gastric cancer patients receiving neoadjuvant chemotherapy.
Hao CUI ; Ke Cheng ZHANG ; Bo CAO ; Huan DENG ; Guo Xiao LIU ; Jian Xin CUI ; Tian Yu XIE ; Wen Quan LIANG ; Qing Peng ZHANG ; Ning WANG ; Lin CHEN ; Bo WEI
Chinese Journal of Gastrointestinal Surgery 2021;24(2):153-159
Objective: At present, there are few studies focusing on the factors short-term complications after total gastrectomy in patients with advanced gastric cancer receiving neoadjuvant chemotherapy (NACT). The purpose of this study is to provide a reference for clinical prevention of complications in these patients. Methods: A retrospective case-control study was conducted. Case inclusion criteria: (1) clinical stage II-III gastric cancer diagnosed by preoperative gastroscopy, pathology, abdominal CT, EUS or PET-CT; (2) evaluated suitable for NACT by MDT discussion; (3) no previous history of other malignant tumors and no concurrent tumor; (4) undergoing total gastrectomy+ D2 lymphadenectomy after NACT. Exclusion criteria: (1) age <18 or >80 years old; (2) severe concurrent diseases, and ASA classification>grade III; (3) stump gastric cancer or history of gastric surgery; (4) incomplete clinicopathological data. According to the above criteria, clinicopathological data of 140 advanced gastric cancer patients who underwent total gastrectomy after NACT in Chinese PLA General Hospital between June 2012 and June 2019 were collected, including 109 males and 31 females with mean age of (56.9±11.4) years and body mass indey (BMI) of (23.3±3.1) kg/m(2). Logistic analysis was used to analyze the relationship between postoperative complication and clinicopathological data. Factors in univariate analysis with P<0.05 were included in the multivariate analysis. Results: Postoperative complications (Clavien-Dindo classification ≥ II) occurred in 35 cases (25.0%) and severe complications (Clavien-Dindo classification ≥ IIIa) occurred in 4 cases (2.9%), including 1 case of esophago-jejunal anastomotic leakage, 1 case of vena cava thrombosis, 1 case of pleural effusion, 1 case of septic shock during perioperative days resulting in death. Univariate analysis showed that BMI (P=0.011), cycle of NACT (P=0.027), tumor diameter (P=0.021), and vascular invasion (P=0.033) were associated with postoperative complication within 30 days, while open/laparoscopic total gastrectomy were not associated with postoperative complication (P=0.926). Multivariate analysis revealed that BMI ≥ 25 kg/m(2) (OR=3.294, 95% CI: 1.343-8.079, P=0.009) and < 4 cycles of NACT (OR=2.922, 95% CI: 1.217-7.016, P=0.016) were independent risk factors for postoperative complication. The 3-year overall survival rates of patients with or without complication were 54.4% and 64.0%, respectively (P=0.395), and 3-year disease-free survival rates were 47.4% and 52.9%, respectively (P=0.587). Conclusions: Higher BMI and fewer cycles of NACT are independent risk factors of postoperative complication in advanced gastric cancer patients undergoing total gastrectomy after NACT. No obvious association is found between postoperative complication and surgical approaches.
Aged
;
Aged, 80 and over
;
Case-Control Studies
;
Female
;
Gastrectomy/adverse effects*
;
Humans
;
Lymph Node Excision
;
Male
;
Middle Aged
;
Neoadjuvant Therapy
;
Postoperative Complications/etiology*
;
Retrospective Studies
;
Risk Factors
;
Stomach Neoplasms/surgery*

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