AIM:To develop a prognostic approach for gastrointestinal stromal tumors(GISTs) using a cluster of indicators and follow-up information.METHODS:One hundred and four GISTs that had not been subjected to targeted therap...AIM:To develop a prognostic approach for gastrointestinal stromal tumors(GISTs) using a cluster of indicators and follow-up information.METHODS:One hundred and four GISTs that had not been subjected to targeted therapies were collected and classified by NIH risk assessment and anatomic location.By immunohistochemistry,the expressions of PTEN,Ki-67,CD44s matrix metalloproteinase(MMP)-9 and TIMP-1 were detected on tissue microarray.Univariate and multimarker survival analyses were performed and then a COX hazard proportion model was constructed to evaluate a cluster of predictors of GIST.RESULTS:Our data showed small intestinal GIST are more aggressive than gastric GIST.The NIH risk assessment correlated with disease-free survival foreither gastric GIST or small intestinal GIST.Immunohistochemical analysis revealed that Ki-67 labeling indexes(LIs) < 5% predicted higher disease-specific survival(DSS) in gastric and small intestinal GIST.CD44s positivity and PTEN LIs ≥ 50% correlated with higher DSS in gastric GIST.MMP-9 and TIMP-1 had no correlation with survival.Multimarker analysis revealed that the expression pattern of PTEN LIs ≥ 50% combined with Ki-67 LIs < 5% and CD44s positivity reliably predicted favorable outcomes for gastric GIST(P = 0.009),as did the combination of PTEN LIs ≥ 50% and Ki-67 LIs < 5% for small intestinal GIST(P = 0.011).Authors also found that high NIH risk grade was correlated with DSS in patients with gastric GIST and disease-free survival in patients with small intestinal GIST.CONCLUSION:PTEN LIs ≥ 50%,Ki-67 LIs < 5% and CD44s positivity provides an accurate,favorable prognosis for gastric GIST.PTEN LIs ≥ 50% and Ki-67 LIs < 5% does the same for small intestinal GIST.Ki-67 LIs enhances the NIH assessment.展开更多
Objective： This study aims to explore the clinicopathologic characteristics and prognostic factors of gastric cancer patients with metachronous ovarian metastasis. Methods： Clinicopathologic data were collected from...Objective： This study aims to explore the clinicopathologic characteristics and prognostic factors of gastric cancer patients with metachronous ovarian metastasis. Methods： Clinicopathologic data were collected from 63 post-operative gastric cancer patients with metachronous ovarian metastasis. The patients were admitted to the Cancer Institute and Hospital, Chinese Academy of Medical Science and Peking Union Medical College between January 1999 and December 2011. A log-rank test was conducted for survival analysis. Possible prognostic factors that affect survival were examined by univariate analysis. A Cox regression model was used for multivariate analysis. Results： The incidence of ovarian metastasis was 3.4% with a mean age of 45 years. Up to 65.1% of the patients were pre- menopausal. The mean interval between ovarian metastasis and primary cancer was 16 months. Lowly differentiated carcinoma ranked first in the primary gastric cancers. The majority of lesions occurred in the serous membrane （87.3%）. The metastatic sites included Nz.3 lymph nodes （68.3%）, bilateral ovaries （85.7%）, and peritoneal membrane （73%）. Total resection of metastatic sites was performed （31.7%）. The overall median survival was 13.6 months, whereas the overall 1-, 2-, and 3-year survival rates were 52.5%, 22.0%, and 9.8%, respectively. The 5-year survival rate was zero. Univariate analysis showed that the patient prognosis was correlated with metastatic peritoneal seeding, vascular tumor embolus, range of lesion excision, and mode of comprehensive treatment with adjuvant chemotherapy （P〈0.05）. Multivariate analysis indicated that metastatic peritoneal seeding was an independent prognostic factor for gastric cancer patients with ovarian metastasis （P〈0.01）. Conclusion： Effective control of peritoneal seeding--induced metastasis is important for improving the prognosis of gastric cancer patients with ovarian metastasis.展开更多
Logistic support personnel＇s work is critical for supporting and guaranteeing treatment, education, research and prevention in a hospital, where the performance appraisal for such personnel plays a quite ~important r...Logistic support personnel＇s work is critical for supporting and guaranteeing treatment, education, research and prevention in a hospital, where the performance appraisal for such personnel plays a quite ~important role in the entire performance appraisal system. As a part of the appraisal system for logistic staff of a hospital, the performance appraisal for logistic support personnel is essential for improving the overall logistic services of the hospital. In this paper, it is analyzed to increase a hospital＇s awareness of its importance.展开更多
AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration fo...AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical practice.In 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line treatment.Indications in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory ascites.Although still debated,albumin administration in refractory ascites is accepted by the Italian health care system.We analyzedalbumin prescription and related costs before and after implementation of the new guidelines.RESULTS:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 years.Complications of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and plasmapheresis.Albumin consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the hospital.Lastly,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.展开更多
Facts and evidence hold out a steadily increasing prevalence of breast cancer in the mid-1940s. In most cases, the disease is discovered when the disease has reached an advanced stage, therefore, early diagnosis can s...Facts and evidence hold out a steadily increasing prevalence of breast cancer in the mid-1940s. In most cases, the disease is discovered when the disease has reached an advanced stage, therefore, early diagnosis can significantly reduce the burden of disease. Breast cancer has some risk factors, such as tumor size and lymph node involvement. The aim of this study was to evaluate the correlation between tumor size and axillary lymph node involvement and the prognosis for patients with breast cancer has been surgery. The study population consisted of 100 patients with breast cancer surgery at Shohada Hospital of Tajrish during the last 10 years. The results suggest that lymph node involvement was significantly associated with prognosis in patients with breast cancer and in cases where the tumor size was less than 1 cm, it has no impact on the prognosis of breast cancer. Also, a family history of the disease among close relatives is an independent risk factor for poor prognosis, in patients with breast cancer in general it can be said that involvement of lymph nodes in patients with breast cancer is due to an unfavorable prognosis; but the number of lymph nodes involved and the size of the tumor did not have any effect on the prognosis.展开更多
OBJECTIVE To analyze the pathological features and prognosis factors of gastrointestinal stromal tumor （GIST） after primary resection. METHODS Medical records of the diagnosis, surgery, and follow-up of 327 patients...OBJECTIVE To analyze the pathological features and prognosis factors of gastrointestinal stromal tumor （GIST） after primary resection. METHODS Medical records of the diagnosis, surgery, and follow-up of 327 patients with GISTs who underwent surgery between 1988 and 2007 were retrospectively reviewed. The predic-tive factors for the survival of these patients were identi. ed using multivariate analysis. RESULTS In the 327 tumors, 152 （46.5%） were located in the stomach, 89 （27.2%） in the small intestine, 33 （10.1%） in the colon and rectum, and 43 （13.1%） in other sites including the omentum and mesentery. The 3-year and 5-year overall survival rates of the 327 GIST patients were 74.4% and 62.7%, respectively, and univariate survival analysis demonstrated that factors, such as tumor size, mitotic index, NIH categories, Ki-67 index, tumor location, surgical margins, tumor bleeding, and tumor necrosis have significant effect on survival of the patients （P 〈 0.05）. Multivariate analysis demonstrated that the NIH categories, surgical margins, and Ki-67 index were independent prognostic factors for the survival rate. In the group of patients with postoperative recurrence or metastasis, the median survival time of patients who did not receive imatinib treatment was 30 months and that of patients who received imatinib treatment was 59 months. Their 5-year survival rates were 16.4% and 39.4%, respectively, and the difference was statistically significant （P = 0.017）. CONCLUSION Complete resection is the .rst choice of treat-ment for GISTs. It is reasonable to evaluate the prognosis of resect-able GISTs and guide the adjunctive therapy with NIH categories and Ki-67 index. Imatinib treatment can signi.cantly increase the survival rate of patients with recurrent and metastatic GISTs.展开更多
The purpose of this paper is to engage with Gilles Deleuze＇s work on time and space in cinema as a theoretical trajectory for exploring the video art of Lia Lapithi Shukuroglou. In Cinema 2： The Time-Image （1989）,...The purpose of this paper is to engage with Gilles Deleuze＇s work on time and space in cinema as a theoretical trajectory for exploring the video art of Lia Lapithi Shukuroglou. In Cinema 2： The Time-Image （1989）, Deleuze argues that post-Second World War cinema has been shaped by a historical transformation compelling it to create new signs and images. Centering on the post-war landscape of Cyprus in 1974, the moment of ＂historical transformation＂ in Deleuze is transposed to this national context; examining Lapithi＇s response to the crisis of historical time in its relation to physical spaces. It negotiates a contextualized reading of three videos and argues that they manifest Deleuzian ＂time-images＂. These texts react to the territorialization of real spaces by deterritorializing official national history. Using Martin Jones＇ study, Deleuze, cinema and national identity： Narrative time in national contexts （2006） Lapithi＇s time-images are interpreted as ＂unruly＂ as they resist a linear narrative and destabilize public time. Contrary to Martin Jones＇s view that time-images constitute a temporary deviation from flowing national time, the author argues that Lapithi excavates alternative temporalities in perpetuity; whilst proposing that in the context of Cyprus the deterritorialization of space by time postpones the nation＇s identity.展开更多
Background:Surgical-site infection(SSI)was one of the most common post-operative morbidities of ileostomy reversal.Although several skin-closure procedures had been developed to reduce the rate of SSI,the optimal proc...Background:Surgical-site infection(SSI)was one of the most common post-operative morbidities of ileostomy reversal.Although several skin-closure procedures had been developed to reduce the rate of SSI,the optimal procedure remains unclear.In this study,we compared the effect of two surgical techniques for wound closure following ileostomy reversal:gunsight suture(GS)and linear suture(LS).Methods:A total of 233 patients who underwent loop ileostomy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2017 were enrolled into our study.These patients were divided into two groups:the LS group and the GS group.We compared the clinical characteristics between the two groups and analyzed the data using IBM SPSS to identify risk factors for SSI.Results:Both groups successfully underwent surgery.The rate of SSI was significantly lower in the GS group(n=2,0.02%)than in the LS group(n=16,12.00%,P=0.007).The length of hospital stay after the operation in the GS group was significantly shorter than that in the LS group(8.163.2 vs 10.865.4 days,P<0.001).Multivariate analysis showed that GS was an independent protective risk factor for SSI(odds ratio=0.212,P=0.048).Conclusions:Compared with the LS technique,the GS technique can significantly decrease the rate of SSI and shorten the length of hospital stay after surgery.The GS technique may be recommended for wound closure following ileostomy reversal.展开更多
Objective： To explore the treatment methods and outcome of posterior wall fractures of the acetabulum. Methods： The data of 31 patients （25 males and 6 females, aged 19-59 years, mean： 40.5 years） with posterior ...Objective： To explore the treatment methods and outcome of posterior wall fractures of the acetabulum. Methods： The data of 31 patients （25 males and 6 females, aged 19-59 years, mean： 40.5 years） with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study. The types of fractures, number of fragments, combined dislocations, and sciatic nerve function were documented before admission. All the fractures were treated with open reduction and internal fixation. Based on the fracture type and site, either screws alone or reconstructive plates were used. The patients were immobilized for an average of 12 weeks before partial weight bearing was permitted. After follow-up for 12-70 months （43.6 months on average）, modified Merle d＇Aubigne score was adopted to evaluate the outcomes of the operations. Results： The percentages of the excellent, good, fair and poor results were 48.4%, 41.9%, 6.5%, and 3.3%, respectively, with a good to excellent rate of 90.2%. Idiopathic sciatic nerve injury occurred in only one case. Conclusions： The sciatic nerve should be routinely exposed and protected during the surgery. The type of fixation should be based on the fracture type and site. Prolonged immobilization may be helpful in improving the final outcomes.展开更多
基金Supported by Grants from the National Key Basic Research Program Project of China,No.2004CB518708National BioTech 863 program,No. 2002-BA711 A11
文摘AIM:To develop a prognostic approach for gastrointestinal stromal tumors(GISTs) using a cluster of indicators and follow-up information.METHODS:One hundred and four GISTs that had not been subjected to targeted therapies were collected and classified by NIH risk assessment and anatomic location.By immunohistochemistry,the expressions of PTEN,Ki-67,CD44s matrix metalloproteinase(MMP)-9 and TIMP-1 were detected on tissue microarray.Univariate and multimarker survival analyses were performed and then a COX hazard proportion model was constructed to evaluate a cluster of predictors of GIST.RESULTS:Our data showed small intestinal GIST are more aggressive than gastric GIST.The NIH risk assessment correlated with disease-free survival foreither gastric GIST or small intestinal GIST.Immunohistochemical analysis revealed that Ki-67 labeling indexes(LIs) < 5% predicted higher disease-specific survival(DSS) in gastric and small intestinal GIST.CD44s positivity and PTEN LIs ≥ 50% correlated with higher DSS in gastric GIST.MMP-9 and TIMP-1 had no correlation with survival.Multimarker analysis revealed that the expression pattern of PTEN LIs ≥ 50% combined with Ki-67 LIs < 5% and CD44s positivity reliably predicted favorable outcomes for gastric GIST(P = 0.009),as did the combination of PTEN LIs ≥ 50% and Ki-67 LIs < 5% for small intestinal GIST(P = 0.011).Authors also found that high NIH risk grade was correlated with DSS in patients with gastric GIST and disease-free survival in patients with small intestinal GIST.CONCLUSION:PTEN LIs ≥ 50%,Ki-67 LIs < 5% and CD44s positivity provides an accurate,favorable prognosis for gastric GIST.PTEN LIs ≥ 50% and Ki-67 LIs < 5% does the same for small intestinal GIST.Ki-67 LIs enhances the NIH assessment.
文摘Objective： This study aims to explore the clinicopathologic characteristics and prognostic factors of gastric cancer patients with metachronous ovarian metastasis. Methods： Clinicopathologic data were collected from 63 post-operative gastric cancer patients with metachronous ovarian metastasis. The patients were admitted to the Cancer Institute and Hospital, Chinese Academy of Medical Science and Peking Union Medical College between January 1999 and December 2011. A log-rank test was conducted for survival analysis. Possible prognostic factors that affect survival were examined by univariate analysis. A Cox regression model was used for multivariate analysis. Results： The incidence of ovarian metastasis was 3.4% with a mean age of 45 years. Up to 65.1% of the patients were pre- menopausal. The mean interval between ovarian metastasis and primary cancer was 16 months. Lowly differentiated carcinoma ranked first in the primary gastric cancers. The majority of lesions occurred in the serous membrane （87.3%）. The metastatic sites included Nz.3 lymph nodes （68.3%）, bilateral ovaries （85.7%）, and peritoneal membrane （73%）. Total resection of metastatic sites was performed （31.7%）. The overall median survival was 13.6 months, whereas the overall 1-, 2-, and 3-year survival rates were 52.5%, 22.0%, and 9.8%, respectively. The 5-year survival rate was zero. Univariate analysis showed that the patient prognosis was correlated with metastatic peritoneal seeding, vascular tumor embolus, range of lesion excision, and mode of comprehensive treatment with adjuvant chemotherapy （P〈0.05）. Multivariate analysis indicated that metastatic peritoneal seeding was an independent prognostic factor for gastric cancer patients with ovarian metastasis （P〈0.01）. Conclusion： Effective control of peritoneal seeding--induced metastasis is important for improving the prognosis of gastric cancer patients with ovarian metastasis.
文摘Logistic support personnel＇s work is critical for supporting and guaranteeing treatment, education, research and prevention in a hospital, where the performance appraisal for such personnel plays a quite ~important role in the entire performance appraisal system. As a part of the appraisal system for logistic staff of a hospital, the performance appraisal for logistic support personnel is essential for improving the overall logistic services of the hospital. In this paper, it is analyzed to increase a hospital＇s awareness of its importance.
文摘AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical practice.In 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line treatment.Indications in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory ascites.Although still debated,albumin administration in refractory ascites is accepted by the Italian health care system.We analyzedalbumin prescription and related costs before and after implementation of the new guidelines.RESULTS:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 years.Complications of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and plasmapheresis.Albumin consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the hospital.Lastly,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.
文摘Facts and evidence hold out a steadily increasing prevalence of breast cancer in the mid-1940s. In most cases, the disease is discovered when the disease has reached an advanced stage, therefore, early diagnosis can significantly reduce the burden of disease. Breast cancer has some risk factors, such as tumor size and lymph node involvement. The aim of this study was to evaluate the correlation between tumor size and axillary lymph node involvement and the prognosis for patients with breast cancer has been surgery. The study population consisted of 100 patients with breast cancer surgery at Shohada Hospital of Tajrish during the last 10 years. The results suggest that lymph node involvement was significantly associated with prognosis in patients with breast cancer and in cases where the tumor size was less than 1 cm, it has no impact on the prognosis of breast cancer. Also, a family history of the disease among close relatives is an independent risk factor for poor prognosis, in patients with breast cancer in general it can be said that involvement of lymph nodes in patients with breast cancer is due to an unfavorable prognosis; but the number of lymph nodes involved and the size of the tumor did not have any effect on the prognosis.
文摘OBJECTIVE To analyze the pathological features and prognosis factors of gastrointestinal stromal tumor （GIST） after primary resection. METHODS Medical records of the diagnosis, surgery, and follow-up of 327 patients with GISTs who underwent surgery between 1988 and 2007 were retrospectively reviewed. The predic-tive factors for the survival of these patients were identi. ed using multivariate analysis. RESULTS In the 327 tumors, 152 （46.5%） were located in the stomach, 89 （27.2%） in the small intestine, 33 （10.1%） in the colon and rectum, and 43 （13.1%） in other sites including the omentum and mesentery. The 3-year and 5-year overall survival rates of the 327 GIST patients were 74.4% and 62.7%, respectively, and univariate survival analysis demonstrated that factors, such as tumor size, mitotic index, NIH categories, Ki-67 index, tumor location, surgical margins, tumor bleeding, and tumor necrosis have significant effect on survival of the patients （P 〈 0.05）. Multivariate analysis demonstrated that the NIH categories, surgical margins, and Ki-67 index were independent prognostic factors for the survival rate. In the group of patients with postoperative recurrence or metastasis, the median survival time of patients who did not receive imatinib treatment was 30 months and that of patients who received imatinib treatment was 59 months. Their 5-year survival rates were 16.4% and 39.4%, respectively, and the difference was statistically significant （P = 0.017）. CONCLUSION Complete resection is the .rst choice of treat-ment for GISTs. It is reasonable to evaluate the prognosis of resect-able GISTs and guide the adjunctive therapy with NIH categories and Ki-67 index. Imatinib treatment can signi.cantly increase the survival rate of patients with recurrent and metastatic GISTs.
文摘The purpose of this paper is to engage with Gilles Deleuze＇s work on time and space in cinema as a theoretical trajectory for exploring the video art of Lia Lapithi Shukuroglou. In Cinema 2： The Time-Image （1989）, Deleuze argues that post-Second World War cinema has been shaped by a historical transformation compelling it to create new signs and images. Centering on the post-war landscape of Cyprus in 1974, the moment of ＂historical transformation＂ in Deleuze is transposed to this national context; examining Lapithi＇s response to the crisis of historical time in its relation to physical spaces. It negotiates a contextualized reading of three videos and argues that they manifest Deleuzian ＂time-images＂. These texts react to the territorialization of real spaces by deterritorializing official national history. Using Martin Jones＇ study, Deleuze, cinema and national identity： Narrative time in national contexts （2006） Lapithi＇s time-images are interpreted as ＂unruly＂ as they resist a linear narrative and destabilize public time. Contrary to Martin Jones＇s view that time-images constitute a temporary deviation from flowing national time, the author argues that Lapithi excavates alternative temporalities in perpetuity; whilst proposing that in the context of Cyprus the deterritorialization of space by time postpones the nation＇s identity.
基金supported by the Guangzhou Science and Technology Plan Project[No.201704020059 and 201803010074]National Key Clinical Discipline.
文摘Background:Surgical-site infection(SSI)was one of the most common post-operative morbidities of ileostomy reversal.Although several skin-closure procedures had been developed to reduce the rate of SSI,the optimal procedure remains unclear.In this study,we compared the effect of two surgical techniques for wound closure following ileostomy reversal:gunsight suture(GS)and linear suture(LS).Methods:A total of 233 patients who underwent loop ileostomy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2017 were enrolled into our study.These patients were divided into two groups:the LS group and the GS group.We compared the clinical characteristics between the two groups and analyzed the data using IBM SPSS to identify risk factors for SSI.Results:Both groups successfully underwent surgery.The rate of SSI was significantly lower in the GS group(n=2,0.02%)than in the LS group(n=16,12.00%,P=0.007).The length of hospital stay after the operation in the GS group was significantly shorter than that in the LS group(8.163.2 vs 10.865.4 days,P<0.001).Multivariate analysis showed that GS was an independent protective risk factor for SSI(odds ratio=0.212,P=0.048).Conclusions:Compared with the LS technique,the GS technique can significantly decrease the rate of SSI and shorten the length of hospital stay after surgery.The GS technique may be recommended for wound closure following ileostomy reversal.
文摘Objective： To explore the treatment methods and outcome of posterior wall fractures of the acetabulum. Methods： The data of 31 patients （25 males and 6 females, aged 19-59 years, mean： 40.5 years） with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study. The types of fractures, number of fragments, combined dislocations, and sciatic nerve function were documented before admission. All the fractures were treated with open reduction and internal fixation. Based on the fracture type and site, either screws alone or reconstructive plates were used. The patients were immobilized for an average of 12 weeks before partial weight bearing was permitted. After follow-up for 12-70 months （43.6 months on average）, modified Merle d＇Aubigne score was adopted to evaluate the outcomes of the operations. Results： The percentages of the excellent, good, fair and poor results were 48.4%, 41.9%, 6.5%, and 3.3%, respectively, with a good to excellent rate of 90.2%. Idiopathic sciatic nerve injury occurred in only one case. Conclusions： The sciatic nerve should be routinely exposed and protected during the surgery. The type of fixation should be based on the fracture type and site. Prolonged immobilization may be helpful in improving the final outcomes.
