OBJECTIVETo explore the risk factors and prevention strategies of post-operative complications in elderly patients with colorectal cancer.

METHODSData of 107 elderly patients (≥75 years) undergoing surgery for colorectal cancer were collected from January 2006 to December 2009 in the Department of Gastrointestinal Surgery, Peking University People's Hospital. POSSUM and E-POSSUM scoring systems were used to predict post-operative complications. ROC curve and observe/expect(O/E) were used to assess the validity of scoring systems. Logistic regression was used to evaluate the independent risk factors associated with post-operative complications of elderly patients with colorectal cancer.

RESULTSThe predictive complication rates of E-POSSUM and POSSUM in elderly patients with colorectal cancer were 13.9%-86.6%(average, 32.7%) and 19.1%-99.1% (average, 55.5%). The predictive validity of E-POSSUM was better than POSSUM(AUC of ROC: 0.862 vs. 0.576, O/E: 0.771 vs. 0.454), the former was closer to the actual complication rate(25.2%, 27/107). Concurrent diabetes mellitus(P=0.019) and rectal lesion(P=0.005) were independent risk factors associated with surgery-related post-operative complications. Anastomotic leakage was the most common surgery-related post-operative complications. Chronic obstructive pulmonary disease(P=0.026), ASA score(P=0.025), intestinal obstruction(P=0.037) and perforation(P=0.001) were independent risk factors associated with non-surgery-related post-operative complications. Pulmonary infection was the most common non-surgery-related post-operative complication.

CONCLUSIONSThe application of E-POSSUM scoring system can provide more accurate prediction of post-operative complications in elderly patients undergoing surgery for colorectal cancer. Positive interventions should be taken for high-risk patients to prevent post-operative complications.

Aged ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Male ; Postoperative Complications ; etiology ; prevention & control ; Risk Factors

Objective To explore the relationship between serum homocysteine and metabolic syndrome (MS).Methods A cohort with 1680 people involved in a community-based population in Beijing was investigated.Metabolic syndrome was defined by NCEP-ATP Ⅲ criteria.Multivariate logistic regression analysis was used to estimate the odds ratios (OR) of MS.Multiple linear regression analysis was performed to analyze the association between Hcy and characteristic variables.Results Homocysteine was higher in MS population compared to those without MS ( 17.99 μmol/L vs.17.18 μmol/L,P=0.007) after adjusted for age and sex.Levels of homocysteine increased with the presence of MS components (from 0 to 4 or 5) (16.71,16.94,17.62,18.20,17.82 μmol/L respectively,P=0.044 for linear trend).Among the components,groups with larger waist circumference,higher blood pressure and triglycerides showed significantly higher Hcy level than their counterparts.Results from multiple logistic regression analysis revealed that the highest Hcy quartile (Hcy Ⅳ ) was significantly associated with MS.Compared with the lowest Hcy quartile (Hcy Ⅰ ),the adjusted odds ratio of having MS in HcyⅣ was 1.379(1.005-1.892) after adjusting for age,sex,levels on creatinine/estimated glomerular filtration rate (eGFR)/low-density lipoprotein cholesterol (LDL-C) and uric acid,smoking,alcohol intake and exercise.In the partial correlation analyses,Hcy was positively associated with body mass index (BMI),waist circumsternece,blood pressure,LDL-C,triglycerides (TG),uric acid,serum creatinine,eGFR,but inversely associated with high-density lipoprotein cholesterol (HDL-C) and independently with age and sex.In multiple linear regression analysis,age,male sex,BMI,LDL-C,creatinine and uric acid were found to be independently associated with Hcy level.Conclusion There was an association noticed between the MS using NCEP-ATP Ⅲ criteria and the highest quartile level of Hcy in this study.Factors as age and being male,the levels of BMI,LDL-C,creatinine and uric acid were independently associated with the Hcy level.

Objective To explore the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and metabolic syndrome (MS).Methods A total of 1323 Beijing residents (559male) were investigated.MS was defined by the modified 2004 Chinese Diabetes Society criteria and 439 cases were diagnosed as MS according to this criteria.Multivariate logistic regression analysis was used to estimate the odds ratios (OR) of MS.Multiple linear regression analysis was performed to analyze the association between NT-proBNP and characteristic variables.Results NT-proBNP was significantly lower in MS group compared to non-MS group [32.51 (29.17,36.14) ng/L vs.38.55(35.73,41.50) ng/L,P =0.012] after adjusted for age and gender.NT-proBNP level decreased with the presence of MS components(from 0 to 4 or 5) (45.92,37.24,35.40,31.55 and 33.65 ng/L respectively,P =0.043 for linear trend).Among the components,groups with larger waist circumference,higher fasting glucose and triglycerides were associated with lower NT-proBNP level.After adjustment for potential confounders,compared with the lowest NT-proBNP quartile,the adjusted odds ratio of the second,third and fourth quartile for having MS were 0.782 (95 ％ CI: 0.544-1.122,P ＞ 0.05),0.709 (95 ％ CI: 0.489-1.028,P ＞ 0.05),0.604 (95 ％ CI:O.405-0.900,P ＜0.05),respectively.Multiple linear regression analysis showed that female gender(β =0.248,P ＜0.001),age(β =0.167,P ＜ 0.001),systolic blood pressure (β =0.154,P ＜ 0.001) were positively related to NT-proBNP level while waist circumference (β =-0.082,P =0.004),diastolic blood pressure (β =-0.085,P =0.015),triglycerides (β =-0.101,P ＜ O.001),total cholesterol (β =-0.078,P =0.004),eGFR (β =-0.150,P ＜ 0.001) were negatively corelated to NT-proBNP level.Conclusion In this cohort,higher serum NT-proBNP concentration is associated with lower incidence of metabolic syndrome.

Objective To analyze the association between single nucleotide polymorphisms(SNPs)of peroxisome proliferator-activated receptor(PPAR) and arterial stiffness in adult Chinese population (＞ 50 years).Methods Cardiovascular risk factors from participants of Beijing epidemiological investigation were analyzed.Carotid-femoral pulse wave velocity (cfPWV) was measured by Complior system.The subjects were divided into normal arterial stiffness group (cfPWV ＜ 12 m/s,n =844) and increased arterial stiffness group (cfPWV ＞ 12 m/s,n =530).Three valid SNPs including rs1053049,rs1800234 and rs8192678 in the PPAR and PPARγCla gene were genotyped by TaqMan allelic discrimination assays.Results The age [(67.9 ±8.8) years vs.(58.0 ±9.7) years],prevalence of hypertension[71.1％ (377/530) vs.30.5％ (257/844)] and diabetes mellitus [21.7％ (115/530) vs.11.0％ (93/844)] were all significantly higher in increased arterial stiffness group than in normal group (all P ＜ 0.05).The frequencies of CC,CT and TT type of rs8192678 [CC:32.2％ (272/844) vs.30.8％ (163/530),CT:48.7％ (411/844) vs.52.1％ (276/530),TT:19.1％ (161/844) vs.17.2％ (91/530)],rs1053049 [CC:55.7％ (470/844) vs.51.3％ (272/530),CT:36.7％ (310/844) vs.39.1％ (207/530),TT:7.6％ (64/844) vs.9.6％ (51/530)] and rs1800234 [CC:88.4％ (746/844) vs.90.4％ (479/530),CT + TT:11.6％ (98/844) vs.9.6％ (51/530)] were similar between the two groups.There was also no association between haplotypes and the increased arterial stiffness in this cohort.Conclusions In this community-based population,we found that aging,hypertension and diabetes mellitus were associated but SNPs of PPAR and PPARγCla were not associated with arterial stiffness.

Objective:To observe the outcome after sacral canal injection in patients with disc herniation associated with without sciatica. Methods:From December 2010 to June 2011,65 patients with acute low back pain without sciatica due to lumbar disc herniation or bulging confirmed by CT or MRI were randomly divided into sacral canal injection group (experi-mental group) and lumbar oblique wrench group (control group):the experimental group had 35 cases,including 30 males and 5 females,with an average age of (43.90±1.14) years old ranging from 33 to 56 years old. The control group had 30 cases,in-cluding 27 males and 3 females,with an average age of (44.00±1.19) years old ranging from 34 to 57 years old. The course of morbidity was 1 to 3 days. All patients received sacral canal injection or lumbar oblique wrench method. The visual analog scale (VAS) scores before and at 30 min after treatment were compared between two groups. Results:The symptom of acute low back pain were relieved obviously. The average VAS scores before and after treatment in experimental group were de-creased from 6.63 ±0.97 to 3.06 ±1.51,in control group were from 6.67 ±0.96 to 3.93 ±1.20 respectively. These two methods could improve the VAS score,but the effect of sacral canal injection group was better than that of lumbar oblique wrench group,there was statistically differences (P<0.05). Conclusion:It is effective that the methods of sacral canal injection and lumbar oblique wrench applied to patients with acute low back pain without sciatica due to lumbar disc herniation or bulging confirmed,the former has better effect.

Objective:To observe the clinical efficacy and safety of venetoclax(VEN)combined with azacitidine(AZA)in the treatment of adult acute myeloid leukemia(AML)patients who are unfit for intensive chemotherapy.Methods:The clinical data of 21 adult patients with unfit AML who were treated with VEN combined with AZA in the Second Hospital of Shanxi Medical University from January 2021 to May 2022 were collected,and the efficacy and safety were analyzed retrospectively.Results:After one course of treatment with VEN and AZA,16 out of 21 unfit AML patients reached complete remission(CR)/CR with incomplete hematologic recovery(CRi),2 patients reached partial remission(PR),the overall response rate(ORR)was 85.7％.Among the 16 patients with CR/CRi,13 achieved minimal residual disease(MRD)negativity.Among the 11 patients with adverse prognosis,8 achieved CR/CRi.By the deadline of follow-up,the median overall suivival(OS)of the entire cohort was not reached,with 1-year OS rate of 61.7％.The main adverse events of VEN combined with AZA were myelosuppression,gastrointestinal reactions and infections.There were 13 cases of leukopenia,7 cases of neutropenia,7 cases of anemia,4 cases of thrombocytopenia,and these hematologic adverse events were all grade 3-4.There were 11 cases with gastrointestinal reactions and 7 cases with infections.The above adverse events were controllable and tolerable.No tumor lysis syndrome or infection related death occurred.Conclusion:VEN combined with AZA can quickly achieve deep remission in adult patients with unfit AML,and it shows a good safety profile.

OBJECTIVETo analyze the characteristics and the number of organs involved in acute graft-versus-host disease (aGVHD) among different donors of allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSClinical data were retrospectively analyzed in 289 patients received allo-HSCT in our hospital, between November 2007 and December 2008. Clinical features of the involved organs between different donors were compared.

RESULTSThe cumulative incidence of aGVHD was 57.4% (166/289), grades I-II and grades III-IV were 52.1% and 11.0%, respectively. Skin was involved in 116 (69.9%) of the total 166 cases, gut 97 (47.6%), and liver 25(15.1%). Organs involved in HLA-identical sibling transplantation and in haplo-identical ones were skin 19 (42.2%), gut 25 (55.6%), and liver 12 (26.7%), and 79 (80.2%), 54 (44.6%) and 13 (10.7%) respectively. More aGVHD involvements of skin were found in HLA haplo-identical HSCT than in HLA identical sibling HSCT (P = 0.000). The involvement of skin grade II was 8(17.8%) and 38.8% (P = 0.01), gut grade II was 22 (48.9%) and 36 (29.8%) (P = 0.028) in HLA identical sibling transplantation and in haploidentical HSCT, repectively. The incidences of aGVHD grades I to II and grade III to IV were 103 (62.0%) versus 12 (7.2%) in the single organ involved group, 37 (22.3%) versus 11 (6.6%) in the double organs involved group, and 0% versus 3 (1.8%) in the triple organs involved group.

CONCLUSIONThe percentage of aGVHD with skin involvement in haploidentical HSCT is significantly higher than that in HLA identical HSCT. There is a significant difference in mild skin or GI aGVHD between HLA matched and mismatched HSCT, but no difference in severe skin or GI aGVHD between the two groups. The percentage of severe aGVHD was higher if three organs were involved.

Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Retrospective Studies ; Siblings ; Tissue Donors ; Transplantation, Homologous

BACKGROUNDTumor necrosis factor-induced protein 3 (TNFAIP3) gene has been shown important in cardiac remodeling. The aim of the present study was to investigate whether the variants of TNFAIP3 gene are associated with left ventricular hypertrophy (LVH) in hypertensive patients.

METHODSFour representatives of all the other single nucleotide polymorphisms (SNPs) in TNFAIP3 gene were tested for association with hypertrophy in two independent hypertensive populations (n = 2120 and n = 324).

RESULTSWe found that only the tag SNP (rs5029939) was consistently lower in the hypertensives with cardiac hypertrophy than in those without cardiac hypertrophy in the two study populations, indicating a protective effect on LVH (odds ratio (OR) (95% confidence interval (CI)) 0.58 (0.358 - 0.863), P = 0.035; OR (95%CI) = 0.477 (0.225 - 0.815), P < 0.05, respectively). Multiple regression analyses confirmed that the patients with G allele of rs5029939 had less thickness in inter-ventricular septum, left ventricular posterior wall, relative wall thickness and left ventricular mass index than did those with CC allele in the hypertensive patients in both study populations (all P < 0.01).

CONCLUSIONThese findings indicate that the SNP (rs5029939) in the TNFAIP3 gene may serve as a novel protective genetic marker for the development of LVH in patients with hypertension.

Adult ; Aged ; Cross-Sectional Studies ; DNA-Binding Proteins ; Echocardiography ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Hypertension ; genetics ; Hypertrophy, Left Ventricular ; genetics ; Intracellular Signaling Peptides and Proteins ; genetics ; Male ; Middle Aged ; Nuclear Proteins ; genetics ; Phenotype ; Polymorphism, Single Nucleotide ; genetics ; Tumor Necrosis Factor alpha-Induced Protein 3

BACKGROUNDHypertrophic cardiomyopathy (HCM) is a primary autosomal dominant inheritant myocardial disease with heterogeneity in clinical manifestations, natural history and prognosis. Even carrying an identical gene mutation among family members, a variety of clinical phenotypes have been found in patients with HCM. Modifier genes may contribute to the diversity. The plasma levels of atrial natriuretic peptides (ANP) were found previously to be elevated in HCM. Our studies suggested that ANP gene promoter polymorphism is associated with left ventricular hypertrophy in hypertension. The present study aimed to determine whether the two SNPs in the ANP gene are associated with HCM.

METHODSWe determined the relationships between the ANP gene polymorphism and HCM in 262 HCM patients and 614 age- and sex-matched healthy individuals. All of the subjects were genotyped for -A2843G and A188G polymorphisms.

RESULTSThe genotype frequency in the -A2843G and A188G polymorphisms of the ANP gene was not significantly different between the HCM patients and controls. The -A2843G and A188G polymorphisms were also not associated with clinical phenotype in cardiomyopathy patients.

CONCLUSIONSThe polymorphisms of the ANP gene are not associated with increasing risk of HCM or clinical phenotypes. The variations of the ANP gene may not serve as a genetic modifier for the development of HCM.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Atrial Natriuretic Factor ; genetics ; Cardiomyopathy, Hypertrophic ; genetics ; Case-Control Studies ; Echocardiography ; Female ; Genotype ; Humans ; Linkage Disequilibrium ; Male ; Middle Aged ; Phenotype ; Polymorphism, Genetic ; genetics ; Young Adult