1.Clinical observation on effect of red furnace massage tank in patients with wind-cold Bizu type Xiangbi disease
Yang YANG ; Yuanpin LIAO ; Haixia MA ; Jixiang ZENG ; Chunmei LUO ; Juanxia ZHENG
Chongqing Medicine 2024;53(12):1798-1801
Objective To investigate the application effect of red furnace massage tank therapy in the patients with wind-cold Bizu type Xiangbi disease.Methods Eighty patients with wind-cold Bizu type Xiangbi disease admitted to this hospital from March 2022 to March 2023 were selected as the study subjects and di-vided into the test group and control group according to the random number table method,40 cases in each group.The control group was given the conventional treatment,the test group was given the red furnace mas-sage tank therapy.The cervical vertebral function symptoms,pain degree and clinical effect on 14 d after inter-vention were evaluated.The patients were followed up in 1 month after intervention.Results After interven-tion,the improvement degree in the test group was superior to that in the control group[total effective rate:100.0%vs.87.5%,VAS score:0.5(0,1.0)point vs.1.0(0,1.0)point,cervical spondylosis symptom scale(NPQ)score:(3.55±1.83)points vs.(5.15±2.99)points,Tanaka Yasuhisa score:(17.05±1.32)points vs.(14.88±2.10)points],and the differences were statistically significant(P<0.05).No adverse reactions occurred in both groups.Conclusion Red furnace massage tank therapy could effectively improve the pain symptoms and cervical vertebral function of the patients with wind-cold Bizu type Xiangbi disease.
2.Multivariate analysis and construction and validation of a nomogram model from data of 1610 patients with non-tumor-related anastomotic stenosis after rectal cancer surgery
Kemao QIU ; Wei JIAN ; Jixiang ZHENG ; Mingyuan FENG ; Xiumin LIU ; Dingshan LU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2024;27(6):600-607
Objective:To assess the risk factors affecting development of non-tumor- related anastomotic stenosis after rectal cancer and to construct a nomogram prediction model.Methods:This was a retrospective study of data of patients who had undergone excision with one-stage intestinal anastomosis for rectal cancer between January 2003 and September 2018 in Nanfang Hospital of Southern Medical University. The exclusion criteria were as follows: (1) pathological examination of the operative specimen revealed residual tumor on the incision margin of the anastomosis; (2) pathological examination of postoperative colonoscopy specimens revealed tumor recurrence at the anastomotic stenosis, or postoperative imaging evaluation and tumor marker monitoring indicated tumor recurrence; (3) follow-up time <3 months; and (4) simultaneous multiple primary cancers. Univariate analysis using the χ 2 or Fisher's exact test was performed to assess the study patients' baseline characteristics and variables such as tumor-related factors and surgical approach ( P<0.05). Multivariate analysis using binary logistic regression was then performed to identify independent risk factors for development of non-tumor-related anastomotic stenosis after rectal cancer. Finally, a nomogram model for predicting non-tumor-related anastomotic stenosis after rectal cancer surgery was constructed using R software. The reliability and accuracy of this prediction model was evaluated using internal validation and calculation of the area under the curve of the model's receiver characteristic curve (ROC). Results:The study cohort comprised 1,610 patients, including 1,008 men and 602 women of median age 59 (50, 67) years and median body mass index 22.4 (20.2, 24.5) kg/m2. Non-tumor-related anastomotic stenosis developed in 121 (7.5%) of these patients. The incidence of non-tumor-related anastomotic stenosis in patients who had undergone neoadjuvant chemotherapy, neoadjuvant radiotherapy, and surgery alone was 11.2% (10/89), 26.4% (47/178), and 4.8% (64/1,343), respectively. Neoadjuvant treatment (neoadjuvant chemotherapy: OR=2.455, 95%CI: 1.148–5.253, P=0.021; neoadjuvant chemoradiotherapy, OR=3.882, 95%CI: 2.425–6.216, P<0.001), anastomotic leakage (OR=7.960, 95%CI: 4.550–13.926, P<0.001), open laparotomy (OR=3.412, 95%CI: 1.772–6.571, P<0.001), and tumor location (distance of tumor from the anal verge 5–10 cm: OR=2.381, 95%CI:1.227–4.691, P<0.001; distance of tumor from the anal verge <5 cm: OR=5.985,95% CI: 3.039–11.787, P<0.001) were identified as independent risk factors for non-tumor-related anastomotic stenosis. Thereafter, a nomogram prediction model incorporating the four identified risk factors for development of anastomotic stenosis after rectal cancer was developed. The area under the curve of the model ROC was 0.815 (0.773–0.857, P<0.001), and the C-index of the predictive model was 0.815, indicating that the model's calibration curve fitted well with the ideal curve. Conclusion:Non-tumor-related anastomotic stenosis after rectal cancer surgery is significantly associated with neoadjuvant treatment, anastomotic leakage, surgical procedure, and tumor location. A nomogram based on these four factors demonstrated good discrimination and calibration, and would therefore be useful for screening individuals at risk of anastomotic stenosis after rectal cancer surgery.
3.Multivariate analysis and construction and validation of a nomogram model from data of 1610 patients with non-tumor-related anastomotic stenosis after rectal cancer surgery
Kemao QIU ; Wei JIAN ; Jixiang ZHENG ; Mingyuan FENG ; Xiumin LIU ; Dingshan LU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2024;27(6):600-607
Objective:To assess the risk factors affecting development of non-tumor- related anastomotic stenosis after rectal cancer and to construct a nomogram prediction model.Methods:This was a retrospective study of data of patients who had undergone excision with one-stage intestinal anastomosis for rectal cancer between January 2003 and September 2018 in Nanfang Hospital of Southern Medical University. The exclusion criteria were as follows: (1) pathological examination of the operative specimen revealed residual tumor on the incision margin of the anastomosis; (2) pathological examination of postoperative colonoscopy specimens revealed tumor recurrence at the anastomotic stenosis, or postoperative imaging evaluation and tumor marker monitoring indicated tumor recurrence; (3) follow-up time <3 months; and (4) simultaneous multiple primary cancers. Univariate analysis using the χ 2 or Fisher's exact test was performed to assess the study patients' baseline characteristics and variables such as tumor-related factors and surgical approach ( P<0.05). Multivariate analysis using binary logistic regression was then performed to identify independent risk factors for development of non-tumor-related anastomotic stenosis after rectal cancer. Finally, a nomogram model for predicting non-tumor-related anastomotic stenosis after rectal cancer surgery was constructed using R software. The reliability and accuracy of this prediction model was evaluated using internal validation and calculation of the area under the curve of the model's receiver characteristic curve (ROC). Results:The study cohort comprised 1,610 patients, including 1,008 men and 602 women of median age 59 (50, 67) years and median body mass index 22.4 (20.2, 24.5) kg/m2. Non-tumor-related anastomotic stenosis developed in 121 (7.5%) of these patients. The incidence of non-tumor-related anastomotic stenosis in patients who had undergone neoadjuvant chemotherapy, neoadjuvant radiotherapy, and surgery alone was 11.2% (10/89), 26.4% (47/178), and 4.8% (64/1,343), respectively. Neoadjuvant treatment (neoadjuvant chemotherapy: OR=2.455, 95%CI: 1.148–5.253, P=0.021; neoadjuvant chemoradiotherapy, OR=3.882, 95%CI: 2.425–6.216, P<0.001), anastomotic leakage (OR=7.960, 95%CI: 4.550–13.926, P<0.001), open laparotomy (OR=3.412, 95%CI: 1.772–6.571, P<0.001), and tumor location (distance of tumor from the anal verge 5–10 cm: OR=2.381, 95%CI:1.227–4.691, P<0.001; distance of tumor from the anal verge <5 cm: OR=5.985,95% CI: 3.039–11.787, P<0.001) were identified as independent risk factors for non-tumor-related anastomotic stenosis. Thereafter, a nomogram prediction model incorporating the four identified risk factors for development of anastomotic stenosis after rectal cancer was developed. The area under the curve of the model ROC was 0.815 (0.773–0.857, P<0.001), and the C-index of the predictive model was 0.815, indicating that the model's calibration curve fitted well with the ideal curve. Conclusion:Non-tumor-related anastomotic stenosis after rectal cancer surgery is significantly associated with neoadjuvant treatment, anastomotic leakage, surgical procedure, and tumor location. A nomogram based on these four factors demonstrated good discrimination and calibration, and would therefore be useful for screening individuals at risk of anastomotic stenosis after rectal cancer surgery.
4.Construction of nomogram prediction model for knee joint cartilage injury in patients with anterior cruciate ligament rupture
Jianfeng NI ; Heyuan MENG ; Bao ZHANG ; Jixiang ZHENG
Chinese Journal of Postgraduates of Medicine 2024;47(5):427-433
Objective:To analyze the relevant factors of knee joint cartilage injury in patients with anterior cruciate ligament rupture and construct a nomogram prediction model.Methods:The clinical data of 160 patients with unilateral anterior cruciate ligament rupture who underwent surgical treatment from March 2020 to February 2023 at Tianjin 272 Hospital and the Ninety-Eighty-Third Hospital of the People′s Liberation Army Joint Logistics Support Force were retrospectively analyzed. The patients were divided into injured group (97 cases) and non injured group (63 cases) based on whether there was concurrent knee joint cartilage injury. The optimal cutoff values of each factor were analyzed by the receiver operating characteristic (ROC) curve. Using a multiple Logistic regression model to analyze the independent risk factors of knee joint cartilage injury in patients with anterior cruciate ligament rupture; construct a nomogram model for predicting knee joint cartilage injury in patients with anterior cruciate ligament rupture. The internal validation of the nomogram model was validated using calibration curves, and the predictive performance of the nomogram model is evaluated using decision curves.Results:The body mass index (BMI), rate of meniscus injury, number of sprains and injury time in injured group were significantly higher than those in non injured group: (24.15 ± 2.52) kg/m 2 vs. (22.84 ± 3.13) kg/m 2, 77.32% (75/97) vs. 17.46% (11/63), (2.64 ± 0.90) times vs. (1.17 ± 0.64) times, (19.15 ± 3.77) d vs. (12.92 ± 3.14) d, and there were statistical differences ( P<0.05). The ROC curve analysis results show that the optimal cutoff values for BMI, number of sprains and injury time were 22.9 kg/m 2, once and 16 d, respectively. BMI (>22.9 kg/m 2), meniscus injury (with), number of sprains (>1 time) and injury time (>16 d) were independent risk factors for knee joint cartilage injury in patients with anterior cruciate ligament rupture, and they were also predictive factors for building nomogram model. The internal validation results show that the nomogram model predicts a C-index of 0.819 (95% CI 0.715 to 0.883) for patients with anterior cruciate ligament rupture complicated by knee cartilage injury. The consistency between the observed values and the predicted values was good. The nomogram model predicts a threshold of over 0.14 for knee joint cartilage injury in patients with anterior cruciate ligament rupture, and the clinical net benefits provided by the column chart model were higher than BMI, meniscus injury, number of sprains and injury time. Conclusions:This study constructs a nomogram model based on BMI, meniscus injury, number of sprains, and injury time to predict knee joint cartilage injury in patients with anterior cruciate ligament rupture. The model has good predictive value for knee joint cartilage injury in patients with anterior cruciate ligament rupture, and can be used to identify high-risk patients who are prone to knee joint cartilage injury in patients with anterior cruciate ligament rupture.
5.An injectable signal-amplifying device elicits a specific immune response against malignant glioblastoma.
Qiujun QIU ; Sunhui CHEN ; Huining HE ; Jixiang CHEN ; Xinyi DING ; Dongdong WANG ; Jiangang YANG ; Pengcheng GUO ; Yang LI ; Jisu KIM ; Jianyong SHENG ; Chao GAO ; Bo YIN ; Shihao ZHENG ; Jianxin WANG
Acta Pharmaceutica Sinica B 2023;13(12):5091-5106
Despite exciting achievements with some malignancies, immunotherapy for hypoimmunogenic cancers, especially glioblastoma (GBM), remains a formidable clinical challenge. Poor immunogenicity and deficient immune infiltrates are two major limitations to an effective cancer-specific immune response. Herein, we propose that an injectable signal-amplifying nanocomposite/hydrogel system consisting of granulocyte-macrophage colony-stimulating factor and imiquimod-loaded antigen-capturing nanoparticles can simultaneously amplify the chemotactic signal of antigen-presenting cells and the "danger" signal of GBM. We demonstrated the feasibility of this strategy in two scenarios of GBM. In the first scenario, we showed that this simultaneous amplification system, in conjunction with local chemotherapy, enhanced both the immunogenicity and immune infiltrates in a recurrent GBM model; thus, ultimately making a cold GBM hot and suppressing postoperative relapse. Encouraged by excellent efficacy, we further exploited this signal-amplifying system to improve the efficiency of vaccine lysate in the treatment of refractory multiple GBM, a disease with limited clinical treatment options. In general, this biomaterial-based immune signal amplification system represents a unique approach to restore GBM-specific immunity and may provide a beneficial preliminary treatment for other clinically refractory malignancies.
6. Risk factor analysis on anastomotic leakage after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and establishment of a nomogram prediction model
Wei JIANG ; Mingyuan FENG ; Xiaoyu DONG ; Shumin DONG ; Jixiang ZHENG ; Xiumin LIU ; Wenju LIU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2019;22(8):748-754
Objective:
To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model.
Methods:
This study was a retrospective case-control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3-T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short-term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C-index) whose rage was 0.5 to 1.0. Higher C-index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer-Lemeshow test yielding a non-significant statistic (
7.miR-148b-3p, miR-190b, and miR-429 Regulate Cell Progression and Act as Potential Biomarkers for Breast Cancer
Wenzhu DAI ; Jixiang HE ; Ling ZHENG ; Mingyu BI ; Fei HU ; Minju CHEN ; Heng NIU ; Jingyu YANG ; Ying LUO ; Wenru TANG ; Miaomiao SHENG
Journal of Breast Cancer 2019;22(2):219-236
PURPOSE: Breast cancer is the most frequently diagnosed malignancy in women worldwide. MicroRNAs (miRNAs) are thought to serve as potential biomarkers in various cancers, including breast cancer. METHODS: We evaluated the miRNA expression profiles in 1,083 breast cancer samples and 104 normal breast tissues from The Cancer Genome Atlas database. We used the edgeR package of R software to analyze the differentially expressed miRNAs in normal and cancer tissues, and screened survival-related miRNAs by Kaplan-Meier analysis. A receiver operating characteristic curve was generated to evaluate the accuracy of these miRNAs as molecular markers for breast cancer diagnosis. Furthermore, the functional role of these miRNAs was verified using cell experiments. Targets of candidate miRNAs were predicted using 9 online databases, and Gene Ontology (GO) functional annotation and pathway analyses were conducted using Database for Annotation, Visualization and Integrated Discovery online tool. RESULTS: A total of 68 miRNAs showed significantly different expression patterns between the groups (p < 0.001), and 13 of these miRNAs were significantly associated with poor survival (p < 0.05). Three miRNAs with high specificity and sensitivity, namely, miR-148b-3p, miR-190b, and miR-429, were selected. In vitro experiments showed that the overexpression of these 3 miRNAs significantly promoted the proliferation and migration of MDA-MB-468 and T47D cells and reduced the apoptosis of T47D cells. GO and pathway enrichment analyses revealed that the targets of these dysregulated miRNAs were involved in many critical cancer-related biological processes and pathways. CONCLUSION: The miR-148b-3p, miR-190b, and miR-429 may serve as potential diagnostic and prognostic markers for breast cancer. This study demonstrated the roles of these 3 miRNAs in the initiation and progression of breast cancer.
Apoptosis
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Biological Phenomena
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Biological Processes
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Biomarkers
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Breast Neoplasms
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Breast
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Diagnosis
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Female
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Gene Ontology
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Genome
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Humans
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In Vitro Techniques
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Kaplan-Meier Estimate
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MicroRNAs
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ROC Curve
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Sensitivity and Specificity
8.Risk factor analysis on anastomotic leakage after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and establishment of a nomogram prediction model
Wei JIANG ; Mingyuan FENG ; Xiaoyu DONG ; Shumin DONG ; Jixiang ZHENG ; Xiumin LIU ; Wenju LIU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2019;22(8):748-754
Objective To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model. Methods This study was a retrospective case?control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3?T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short?term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C?index) whose rage was 0.5 to 1.0. Higher C?index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer?Lemeshow test yielding a non?significant statistic (P>0.05) suggested no departure from the perfect fit. Results Of 359 cases, 224 were male, 135 were female, 189 were ≥ 55 years old, 98 had a BMI > 24 kg/m2, 176 had preoperative albumin ≤ 40 g/L, 128 had distance from tumor to anus ≤ 5 cm, 257 were TNM 0?II stage, 102 were TNM III?IV stage, and 84 achieved pCR after neoadjuvant therapy. The incidence of postoperative AL was 9.5% (34/359). Univariate analysis showed that gender, preoperative albumin and distance from tumor to the anus were associated with postoperative AL (All P<0.05). Multivariate logistic regression analysis revealed that male (OR=2.480, 95% CI: 1.012?6.077, P=0.047), preoperative albumin≤40 g/L (OR=5.319, 95% CI: 2.106?13.433, P<0.001) and distance from tumor to anus≤5 cm (OR=4.339, 95% CI: 1.990?9.458, P<0.001) were significant independent risk factors for postoperative AL. According to these results, a nomogram prediction model was constructed. The male was for 55 points, the preoperative albumin≤40 g/L was for 100 points, and the distance from tumor to the anus ≤ 5 cm was for 88 points. Adding all the points of each risk factor, the corresponding probability of total score would indicated the morbidity of postoperative AL predicted by this nomogram modal. The AUC of the nomogram was 0.792 (95% CI: 0.729?0.856), and the C?index was 0.792 after internal verification. The calibration curve showed that the predictive results were well correlated with the actual results (P=0.562). Conclusions Male, preoperative albumin ≤ 40 g/L and distance from tumor to the anus≤5 cm are independent risk factors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. The nomogram prediction model is helpful to predict the probability of AL after surgery.
9.Risk factor analysis on anastomotic leakage after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and establishment of a nomogram prediction model
Wei JIANG ; Mingyuan FENG ; Xiaoyu DONG ; Shumin DONG ; Jixiang ZHENG ; Xiumin LIU ; Wenju LIU ; Jun YAN
Chinese Journal of Gastrointestinal Surgery 2019;22(8):748-754
Objective To investigate the risk factors of anastomotic leakage (AL) after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy and construct a nomogram prediction model. Methods This study was a retrospective case?control study that collected and reviewed the clinicopathological data of 359 patients who underwent laparoscopic surgery from January 2012 to January 2018, including 202 patients from the Department of General Surgery, Nanfang Hospital of Southern Medical University and 157 patients from the Department of Gastrointestinal Surgery of Fujian Provincial Cancer Hospital. Inclusion criteria: (1) age ≥ 18 years old; (2) diagnosis as rectal cancer by biopsy before treatment; (3) distance from tumor to anus within 12 cm; (4) locally advanced stage (T3?T4 or N+) diagnosed by imaging (CT, MRI, PET or ultrasound); (5) standardized neoadjuvant therapy followed by laparoscopic radical operation. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) short?term or incomplete standardized neoadjuvant therapy; (3) Miles, Hartmann, emergency surgery, palliative resection; (4) conversion to open surgery. Clinicopathological data, including age, gender, body mass index (BMI), preoperative albumin, distance from tumor to anus, operation hospital, American Society of Anesthesiologists score (ASA score), operation time, T stage, N stage, M stage, TNM stage, pathological complete response (pCR) were analyzed with univariate analysis to identify predictors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. Then, incorporated predictors of AL, which were screened by multivariate logistic regression, were plotted by the "rms" package in R software to establish a nomogram model. According to the scale of the nomogram of each risk factor, the total score could be obtained by adding each single score, then the corresponding probability of postoperative AL could be acquired. The area under ROC curve (AUC) was used to evaluate the predictive ability of each risk factor and nomogram on model. AUC > 0.75 indicated that the model had good predictive ability. The Bootstrap method (1000 bootstrapping resamples) was applied as internal verification to show the robustness of the model. The discrimination of the nomogram was determined by calculating the average consistency index (C?index) whose rage was 0.5 to 1.0. Higher C?index indicated better consistency with actual risk. The calibration curve was used to assess the calibration of prediction model. The Hosmer?Lemeshow test yielding a non?significant statistic (P>0.05) suggested no departure from the perfect fit. Results Of 359 cases, 224 were male, 135 were female, 189 were ≥ 55 years old, 98 had a BMI > 24 kg/m2, 176 had preoperative albumin ≤ 40 g/L, 128 had distance from tumor to anus ≤ 5 cm, 257 were TNM 0?II stage, 102 were TNM III?IV stage, and 84 achieved pCR after neoadjuvant therapy. The incidence of postoperative AL was 9.5% (34/359). Univariate analysis showed that gender, preoperative albumin and distance from tumor to the anus were associated with postoperative AL (All P<0.05). Multivariate logistic regression analysis revealed that male (OR=2.480, 95% CI: 1.012?6.077, P=0.047), preoperative albumin≤40 g/L (OR=5.319, 95% CI: 2.106?13.433, P<0.001) and distance from tumor to anus≤5 cm (OR=4.339, 95% CI: 1.990?9.458, P<0.001) were significant independent risk factors for postoperative AL. According to these results, a nomogram prediction model was constructed. The male was for 55 points, the preoperative albumin≤40 g/L was for 100 points, and the distance from tumor to the anus ≤ 5 cm was for 88 points. Adding all the points of each risk factor, the corresponding probability of total score would indicated the morbidity of postoperative AL predicted by this nomogram modal. The AUC of the nomogram was 0.792 (95% CI: 0.729?0.856), and the C?index was 0.792 after internal verification. The calibration curve showed that the predictive results were well correlated with the actual results (P=0.562). Conclusions Male, preoperative albumin ≤ 40 g/L and distance from tumor to the anus≤5 cm are independent risk factors for AL after laparoscopic surgery in rectal cancer patient with neoadjuvant therapy. The nomogram prediction model is helpful to predict the probability of AL after surgery.
10.Correlation Between Dual-energy and Perfusion CT in Patients with Focal Liver Lesions Using Third-generation Dual-source CT Scanner.
Jia XU ; Yongchang ZHENG ; Xuan WANG ; Huadan XUE ; Shitian WANG ; Jixiang LIANG ; Zhengyu JIN
Acta Academiae Medicinae Sinicae 2017;39(1):74-79
Objective To compare measurements of dual-energy CT iodine map parameters and liver perfusion CT parameters in patients with focal liver lesions using a third-generation dual-source CT scanner. Methods Between November 2015 and August 2016,33 patients with non-cystic focal lesions of liver were enrolled in this study. CT examinations were performed with a third-generation dual-source CT. The study CT protocol included a perfusion CT and dual-energy arterial and portal venous scans,with a time interval of 15 minutes. Iodine attenuation was measured at five region of interests including areas of high,medium,and low density within the lesion,as well as right and left liver parenchyma from the iodine map,while arterial liver perfusion (ALP),portal venous liver perfusion (PVP),and hepatic perfusion index (HPI) at the same location were measured from perfusion CT. The Pearson product-moment correlation coefficient was used to evaluate the relationship between iodine attenuation and perfusion parameters. Results The iodine attenuation at arterial phase showed significant intra-individual correlation with ALP (r=0.812,95% CI=0.728-0.885,P<0.001)and PVP (r=-0.209,95% CI=-0.323--0.073,P=0.007),but not significantly correlated with HPI (r=0.058,95% CI=0.046-0.498,P=0.461). The iodine attenuation at portal venous phase showed significant correlation with PVP (r=0.214,95% CI=0.072-0.361,P=0.005) but not with HPI(r=0.036,95% CI=-0.002-0.242,P=0.649). The mean effective dose of arterial phase and portal venous phase of dual-energy CT together [(3.53±1.17)mSv] was significantly lower than that of the perfusion CT [(14.53±0.45)mSv](t=25.212,P<0.001). Conclusion Iodine attenuation from arterial phase of dual energy CT demonstrates significant correlation with ALP and PVP,and iodine attenuation from portal venous phase demonstrates significant correlation with PVP.
Contrast Media
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Humans
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Iodine
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Liver
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diagnostic imaging
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pathology
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Perfusion
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Portal Vein
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Tomography, X-Ray Computed
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methods

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