Objective To investigate the predictive value of serum homocysteine(HCY)and lipoprotein(a)[Lp(a)]in autologous arteriovenous fistula(AVF)failure in patients undergoing maintenance hemodialy-sis(MHD).Methods A total of 175 patients with MHD admitted to the hospital from January to December 2022 were selected as the observation group,among them,103 patients without AVF failure were selected as observation group 1,and 72 patients with AVF failure were selected as observation group 2.175 healthy indi-viduals who underwent physical examinations at the outpatient examination center of the hospital during the same period were selected as the control group.Enzyme-linked immunosorbent assay was used to detect the levels of HCY and Lp(a).Pearson method was used to analyze the correlation between HCY,Lp(a)with clin-ical indicators.Multivariate Logistic regression analysis was performed to analyze the influencing factors of AVF failure in MHD patients.Receiver operating characteristic(ROC)curve was plotted to analyze the pre-dictive value of serum HCY and Lp(a)for AVF failure in MHD patients.Results Compared with the control group,the serum levels of HCY and Lp(a)in observation group 1 were increased(P<0.05).Compared with the control group and observation group 1,the serum levels of HCY and Lp(a)in observation group 2 were in-creased(P<0.05).The serum levels of HCY and Lp(a)in observation group 2 were negatively correlated with ultrafiltration amount(P<0.05),and HCY and Lp(a)were positively correlated with parathyroid hor-mone(PTH),blood phosphorus(P),uric acid(UA)(P<0.05).Multivariate Logistic regression analysis showed that HCY,Lp(a),PTH,P,UA,diabetic nephropathy,duration of endovascular fistula use≥12 months,duration of puncture point compression≥30 min,and arteriovenous internal diameter<2 mm and vascular stenosis were the risk factors for AVF failure in MHD patients(P<0.05),and ultrafiltration a-mount was a protective factor for AVF failure in MHD patients(P<0.05).ROC curve results showed that the area under the curve of HCY and Lp(a)alone and in combination in the prediction of AVF failure in MHD patients were 0.822,0.820 and 0.908,respectively(Zcombination vs.HCY=3.144,Zcombination vs.Lp(a)=2.925,P<0.05).Conclusion The serum levels of HCY and Lp(a)in MHD patients with AVF failure are increased.They are the influencing factors of AVF failure in MHD patients,and the value of the combination of the two for pre-dicting AVF failure in MHD patients is relatively high.

Objective To evaluate the efficacy of MRI-detected extramural venous invasion (mrEMVI) in predicting tumor responses to preoperative chemoradiatiotherapy (pre-CRT) in patients with locally advanced rectal cancer (LARC).Methods The clinicopathological data,tumor response and mrEMVI information of 47 LARC from February 2013 to December 2014 were retrospectively collected.mrEMVI was given 0-4 score according to the degree,3-4 score were defined as mrEMVI positive;patients with mrEMVI positive were divided into three subgroups according to vascular size (large,middle and small).Association between different mrEMVI subgroup and tumor response was analyzed using Fisher exact test.Result 26 patients were mrEMVI positive.18 and 8 patients scored 3 and 4 for mrEMVI positive,respectively;16,6 and 4 patients were small,middle and larger vessels of mrEMVI positive,respectively.Patients with mrEMVI positive had less TRG 0-1 than mrEMVI negative (P =0.019).Scored 4 and larger vessel of mrEMVI positive had less TRG 0-1 than mrEMVI negative (P =0.038 and 0.017).Conclusions mrEMVI positive score 4 or larger vessel predict poor tumor response to pre-CRT in patients of locally advanced rectal cancer.

OBJECTIVETo summarize the application of protective terminal ileostomy in laparoscopic total mesorectal excision for rectal cancer patients, and explore the risk factors associated with postoperative complications and timing of stoma closure.

METHODSClinical data of 77 patients with middle or low rectal cancer undergoing laparoscopic total mesorectal excision (TME) with preventive terminal ileostomy in our department from January 2007 to December 2013 were retrospectively analyzed. Independent risk factors associated to postoperative complications of terminal ileostomy were examined by logistic regression and timing of stoma closure was investigated.

RESULTThe total postoperative complication morbidity was 57.1% (44/77). Electrolyte disturbance was found in 39 cases (50.6%, 39/77), including 1 case of hypovolemic syncope. Parastomal hernia occurred in 9 cases (11.7%, 9/77). Peristomal dermatitis and subcutaneous abscess was observed in 1 case (1.3%, 1/77). The result of the single factor analysis of the water electrolyte disturbance after operation, the risk factors of P<0.2 were new adjuvant chemotherapy (P=0.094), tumor antigen (P=0.086) and TNM staging (P=0.026); Postoperative parastomal hernia of the single factor analysis results, the risk factors of P<0.2 included uses of antidiabetic drugs (P=0.172), ASA anesthesia (P=0.168) grading and TNM stage(P=0.161); But multivariate analysis revealed no risk factors associated with the above complications (all P>0.05). Sixty-five patients underwent stoma closure during follow-up, including 2 cases (3.1%) within 90 days, 20 cases (30.8%) from 90 to 180 days, and 43 cases (66.2%) more than 180 days.

CONCLUSIONSNo risk factors were found to be associated with main postoperative complications of protective terminal ileostomy after laparoscopic TME for rectal cancer patients, such as electrolytes imbalance and parastomal hernia. The timing of stoma closure should be longer than 180 days.

Biopsy ; Chemotherapy, Adjuvant ; Factor Analysis, Statistical ; Humans ; Ileostomy ; Laparoscopy ; Logistic Models ; Neoplasm Staging ; Postoperative Complications ; Rectal Neoplasms ; Retrospective Studies ; Risk Factors

Objective To summarize the application of protective terminal ileostomy in laparoscopic total mesorectal excision for rectal cancer patients , and explore the risk factors associated with postoperative complications and timing of stoma closure. Methods Clinical data of 77 patients with middle or low rectal cancer undergoing laparoscopic total mesorectal excision (TME) with preventive terminal ileostomy in our department from January 2007 to December 2013 were retrospectively analyzed . Independent risk factors associated to postoperative complications of terminal ileostomy were examined by logistic regression and timing of stoma closure was investigated . Result The total postoperative complication morbidity was 57.1%(44/77). Electrolyte disturbance was found in 39 cases (50.6%, 39/77), including 1 case of hypovolemic syncope. Parastomal hernia occurred in 9 cases (11.7%, 9/77). Peristomal dermatitis and subcutaneous abscess was observed in 1 case (1.3%, 1/77). The result of the single factor analysis of the water electrolyte disturbance after operation, the risk factors of P<0.2 were new adjuvant chemotherapy (P=0.094), tumor antigen (P=0.086) and TNM staging (P=0.026); Postoperative parastomal hernia of the single factor analysis results, the risk factors of P<0.2 included uses of antidiabetic drugs (P=0.172), ASA anesthesia (P=0.168) grading and TNM stage (P=0.161); But multivariate analysis revealed no risk factors associated with the above complications (all P>0.05). Sixty-five patients underwent stoma closure during follow-up, including 2 cases (3.1%) within 90 days, 20 cases (30.8%) from 90 to 180 days, and 43 cases (66.2%) more than 180 days. Conclusions No risk factors were found to be associated with main postoperative complications of protective terminal ileostomy after laparoscopic TME for rectal cancer patients, such as electrolytes imbalance and parastomal hernia. The timing of stoma closure should be longer than 180 days.

Objective To summarize the application of protective terminal ileostomy in laparoscopic total mesorectal excision for rectal cancer patients , and explore the risk factors associated with postoperative complications and timing of stoma closure. Methods Clinical data of 77 patients with middle or low rectal cancer undergoing laparoscopic total mesorectal excision (TME) with preventive terminal ileostomy in our department from January 2007 to December 2013 were retrospectively analyzed . Independent risk factors associated to postoperative complications of terminal ileostomy were examined by logistic regression and timing of stoma closure was investigated . Result The total postoperative complication morbidity was 57.1%(44/77). Electrolyte disturbance was found in 39 cases (50.6%, 39/77), including 1 case of hypovolemic syncope. Parastomal hernia occurred in 9 cases (11.7%, 9/77). Peristomal dermatitis and subcutaneous abscess was observed in 1 case (1.3%, 1/77). The result of the single factor analysis of the water electrolyte disturbance after operation, the risk factors of P<0.2 were new adjuvant chemotherapy (P=0.094), tumor antigen (P=0.086) and TNM staging (P=0.026); Postoperative parastomal hernia of the single factor analysis results, the risk factors of P<0.2 included uses of antidiabetic drugs (P=0.172), ASA anesthesia (P=0.168) grading and TNM stage (P=0.161); But multivariate analysis revealed no risk factors associated with the above complications (all P>0.05). Sixty-five patients underwent stoma closure during follow-up, including 2 cases (3.1%) within 90 days, 20 cases (30.8%) from 90 to 180 days, and 43 cases (66.2%) more than 180 days. Conclusions No risk factors were found to be associated with main postoperative complications of protective terminal ileostomy after laparoscopic TME for rectal cancer patients, such as electrolytes imbalance and parastomal hernia. The timing of stoma closure should be longer than 180 days.