endometrial (n=441) or cervical cancers (n=155) within the time period 2001-2015, at Kanuni Sultan Suleyman Training and Research Hospital Gynecological Oncology Department, were analyzed to define riskfactors for IH. Sample size calculation for a control group assignment was performed to be able to detect a 50% variation in the rate of at least 2-3 riskfactors; regarding an α-error of 0.05 and a power of 80%. 344 control patients who were operated with a midline incision and had not by the time of the study been diagnosed with an IH were enrolled as the control group. The control group was comprised of 126 ovarian cancers; 159 endometrial cancers; and 59 cervical can- cers by systematic randomization by which: each of the (4 control cases per 1 study case) matched control case group was randomly picked from the gynecological oncology data- base by using a random number generator, matching each hernia case with 4 control cases, with the same exclusion criteria and with the same oncological diagnosis as the study case; totaling up to 344 patients (Table 1). This study had a sufficient statistical power to detect a 50% decrease in the rate of the presence at least 2 riskfactors in the control group in contrast to the study group.
ed that smoking did not appear to influence the occurrence of pancreatic cancer in young patients, or at least did not play a major role as a risk factor. Therefore, debate continues on the role of smoking in EOPC patients. In this study, smoking frequency was higher than in the general population (34.6 vs. 25.9%), sup- porting the hypothesis that smoking is a predis- posing factor for pancreatic cancer. However, there was no difference in the mean BMI and drinking history of EOPC compared to the NOPC subjects. A role for alcohol intake in EOPC has been indirectly suggested by Raimondi et al. . Other studies showed that obesity (BMI > 30) at a younger age (20 to 49 years) is associ- ated with an earlier onset of pancreatic cancer by 2-6 years . Our criterion for obesity in men is a BMI > 28 according to the Asia Obesity Standard, which is different from the previous study. EOPC occurred more frequently in males; in China, the majority of smokers are men. Our results thus support the hypothesis that tobac- co smoking plays a role in the early onset of pancreatic cancer.
Abstract: Objective: This study aimed to investigate the relationship between the timing of anti-viral therapy and the progression of hepatitis virus B (HBV) related primary liver cancer (PLC) as well as the riskfactors of death in these patients. Methods: The clinical information of inpatients who were diagnosed with HBV related PLC and hospitalized between July 2008 and December 2011 was reviewed, the correlation between the timing of anti-viral therapy and progression of PLC was evaluated, and the riskfactors related to death of PLC patients were analyzed with Logistic regression analysis. Results: In patients receiving antiviral therapy in hepatitis stage, the time from initiation of antiviral therapy to PLC was significantly longer than that in patients receiving antiviral therapy since the diagnosis of hepatic cirrhosis, and the median time was 66 months and 12 months, respectively (P<0.05). The risk for death in HBeAg positive PLC patients was 1.438 folds that in HBeAg negative patients. The risk for death in patients with high albumin level was lower than in those with low albumin level. Conclusion: Initiation of antiviral therapy since the hepatitis stage may significantly prolong the time to PLC. Being positive for HBeAg and hypoalbuminemia are riskfactors of death in patients with HBV related PLC besides PTA.
In recent years, the incidence of thyroid cancer has been rising and thyroid cancer is the most frequent endocrine malignancy . The cause of thyroid cancer is not yet clear. In most cases, early diagnosis results in a better prognosis . At the current time, ionizing radiation, exces- sive intake of iodine, female hormone levels and a family history of cancer have been identi- fied to be related to thyroid cancer, however, the mechanism is still not clear. The past years witnessed an increase in the incidence of thy- roid cancer in Urumqi, China. Moreover, thyroid cancer attacks more women than men, and the pathological type and age of onset show signifi- cant differences in different ethnic groups. In the current study, patients with thyroid can-
Abstract: Aims: The purpose of the study is to investigate the relationship between rs1799939, rs1800858 and rs74799832 polymorphisms of RET with thyroid cancer (TC) susceptibility. Methods: Genotypes distribution of control groups were tested by Hardy-Weinberg equilibrium (HWE). Rs1799939, rs1800858 and rs74799832 polymorphisms of RET were researched in 135 patients with TC and 135 healthy people using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Odds ratio (OR) with 95% confidence interval (CI) were calculated to evaluate the association between RET polymorphisms and the risk of TC by Chi-squared test. Results: Genotypes frequencies of the control group were consistent with HWE. The frequency of genotype AA and allele A in rs1799939 were significantly higher in patients with TC than controls (OR=3.768, P=0.046; OR=1.695, P=0.035). Genotype GG and allele G of rs1800858 remarkably increased the risk of TC (OR=2.149, P=0.039; OR=1.45, P=0.039). Moreover, CC genotype and C allele in rs74799832 polymorphism was related with TC suscep- tibility. (OR=2.28, P=0.049; OR=1.566, P=0.049). Conclusion: In present result, RET rs1799939, rs1800858 and rs74799832 polymorphisms might be the riskfactors for TC.
Therefore, care intervention in the course of chemotherapy is of great significance to im- prove the patients’ emotion, quality of life and survival. Currently, multiple psychological in- terventions including behavioral cognition ther- apy, health education, and physical-mental treatment, have been evaluated in exploring depression control of LC patients . A meta- analysis from China reviewing eight clinical studies indicates that psychological interven- tion improves the quality of life of LC patients; however, the number of the studies included was inadequate . Different results were derived from a systematic review in which two different indexes were used in evaluating qual- ity of life of patients . In our study, we found that the quality of life of the two groups of patients declined remarkably due to the impact of chemotherapy, with a more significant reduc- tion in the patients with comprehensive care than those with usual care, which correspond- ed to the results of other studies . In anoth- er study, the quality of life of the patients in both study groups after two cycles of chemo- therapy was higher than that before chemo- therapy, with a greater improvement in the intervention group versus the control group . This might be explained by the fact that our study was only involved in one chemothera- py cycle with a shorter duration of observation. Moreover, some studies show that comprehen- sive care significantly improves the quality of life of patients, while others have not brought about such significant results [17, 34]. In gen- eral, with the differences in intervention meth- ods, personal characteristics of patients, out- come measures, randomization and analysis methods, the efficacy of comprehensive care on the quality of life of LC patients undergoing chemotherapy is required for further evalua- tion.
Abstract: Objective: To investigate the characteristics and riskfactors of biochemical recurrence after radical prosta- tectomy in patients with prostate cancer in order to provide a basis for improving the therapeutic efficacy of the dis- ease. Methods: A retrospective analysis was performed on clinical characteristics and follow-up data of the patients with prostate cancer treated with radical prostatectomy in our hospital between January 2008 and December 2012 to characterize the biochemical recurrence of the patients and explore the riskfactors using the Cox regression model. Results: Among the 237 patients with prostate cancer treated with radical prostatectomy, 54 (22.8%) had biochemical recurrence during the follow-up period after surgery. The time to recurrence after surgery was 1.0~55.0 months, with a median of 23.0 months. The 1-, 2-, and 3-year biochemical recurrence-free survival rates after sur- gery were 94.9%, 88.2%, and 81.4%, respectively. The multivariate Cox regression analysis showed that high PSA level at diagnosis (10~20 μg/L and >20 μg/L) (HR=1.52, 95% CI: 1.01~2.30, HR=3.02, 95% CI: 1.54~5.90), high pre-surgical Gleason score (7 and ≥8) (HR=1.61, 95% CI: 1.05~2.49, HR=2.15, 95% CI: 1.21~3.84), late pathologi- cal stages (HR=2.50, 95% CI: 1.32~4.72) and pelvic lymph node metastasis (HR=1.84, 95% CI: 1.06~3.20) were riskfactors of recurrence in the patients. Conclusion: There is still a risk of biochemical recurrence after radical prostatectomy in patients with prostate cancer. The patients with high PSA level, high pre-surgical Gleason score, late pathological stages, or pelvic lymph node metastasis were more likely to experience biochemical recurrence after surgery. These patients should be treated under comprehensive consideration to prevent recurrence and prolong survival time.
Abstract: Objective: To determine the long-term outcomes associated with bilobectomy for non-small cell lung can- cer (NSCLC) and to identify the associated riskfactors. Methods: A cohort of 260 patients with NSCLC who under- went bilobectomy was enrolled in this study from June 2005 to January 2015 at our hospital. The clinical data of these patients were reviewed and analyzed retrospectively. All 260 patients were followed up from 12 months to 71 months with a median period of 54 months. Survival analysis were conducted to evaluate the 5-year and 10-year overall survival and disease-free survival, and the riskfactors associated with prognosis were further identified. The riskfactors associated to poor prognosis were confirmed by the Cox regression analysis. Results: Among 260 patients, there were 150 patients undergoing upper and middle bilobectomy and 110 patients receiving middle and lower bilobectomy. No patients died during surgery or within 30 days postoperatively. The complications within 30- day was 30.8%. Patients were followed-up from 12 months to 71 months with a median period of 54 months. Until the last follow-up (June 2016), a total of 116 deaths and 31 recurrences were reported. The 5- and 10-year overall survivals were 60% and 55.3%, respectively; the 5- and 10-year disease-free survivals were 50.8% and 43.5%, respectively. Cox regression analysis showed that clinical stage III and N2 disease were independent riskfactors associated to poor prognosis. Conclusions: Bilobectomy is effective in the treatment of non-small cell lung cancer with a satisfactory long-term survival outcome.
Subsequently, multivariate logistic analysis showed that tumor size, tumor number and positive SLN rates were independent risk fac- tors for axillary non-SLN metastasis. In the study by Viale et al., multivariate analysis also showed that tumor size, the number of tumors and SLN positive rates were independent riskfactors for axillary non-SLN metastasis, again consistent with our data . The MSKCC axil- lary non-SLN metastasis prediction model obtained an AUC of 0.76 by verifying the clinical data of 373 SLN-positive BC patients, which was in accordance with the range of 0.58-0.86 obtained by many national medical centers and hospitals [24, 25]. In this study, the AUC was 0.771, indicating that the model could well pre- dict the non-SLN metastasis.
The incidence of seroma after incisionalhernia repair is high, reaching values of 3% . The reasons for this are not known, however, high BMI, lowered preoperative serum concentration of total protein and albumin and high serum concentration of IL-1-RA are related to an elevated risk for postoperative seroma formation . In this study, the small number of patients studied and the absence of seroma does not allow us to correlate the in- flammatory response and the amount of fluid drained with the development of seroma. A significant reduction of pH values was detected in DM fluid only on POD-4. The pH value within the wound-milieu indirectly and directly in- fluences all biochemical reactions which take place in the healing process. It could be proven that wound healing is correlated to wound pH changes, as they can lead to an inhibition of endogenous enzymes [25,26], such as an in- activation of fibroblast bindering its wound healing ac- tivity . For more than three decades the common assumption amongst physicians was that a low pH value, as found in normal skin, is favorable for wound healing. Recent investigation showed that the wound pH is indeed potent influential factor in the healing process . A significant reduction in pH is associated with the forma- tion of seroma  and the stabilization of the pH values can reduce the adverse tissue reaction .
with previous studies. The different clinical stage of the studies may be attributed to the controversial results. Furthermore, patients in this study were treated with an individualized comprehensive therapy, which can also cause the different results. In addition, previous stud- ies have showed that clinical stage, depth of invasion, vascular invasion were riskfactors associated with the prognosis of patients with cervical cancer [13, 14]. The findings were basi- cally consistent with the previous studies, indi- cating that tumor size (>4 cm), deep invasion (>1/2 muscular layer) and vascular invasion predicted a poor prognosis. Therefore, in clini- cal practice, patients at high risk should be monitored and followed up closely, in order to improve the clinical prognosis. Additionally, this study also showed that lymph node metastasis was an independent risk factor in early cervical cancer. At present, lymph node metastasis is widely recognized as a major risk factor in cervi- cal cancer. Fang et al. reported that the inci- dence of pelvic lymph node metastasis in early cervical cancer was 23.35%, which was associ- ated with the prognosis of the patients . Cheng and his colleagues’ study showed that the 5-year OS was 31.96% in patients with 2 or more lymph node metastasis, which was signifi- cantly lower than those without lymph node metastasis, the 5-year OS was 79.33% . A retrospective study by Zhu et al. showed a neg- ative correlation between the number of lymph node metastasis and the survival rate of patients . Therefore, after radical surgery, attention should be paid on patients with lymph node metastasis, and postoperative radiother- apy and chemotherapy was an effective strate- gy to reduce the recurrence and metastasis of cervical cancer and improve the long-term survival.
Considering the two group’s homogeneity regarding important riskfactors such as BMI, ASA score III, age, size of the VH defect, and pathology, we observed a statistically significant lower incidence of post-operative complications in the BIOMESH group. These better short-term outcomes are probably related to the intrinsic characteristic of the porcine BIOMESH which provides a collagen and extracellular matrix scaffold in which the host fibroblast enhances angiogenesis and deposits new collagen resulting in a lower risk of infection, erosion, and rejection [9, 20–22]. In patients who underwent chemo- therapy, in which the presence of immunosuppression has a negative impact on mesh incorporation, these are crucial aspects to consider. The non-synthetic nature of these prostheses certainly play a role in diminishing the rate of post-operative infections.
supplies its lower fibres and passes down beneath the external oblique, to emerge in the front of the cord through superficial inguinal ring. Division of the nerve paralyses these muscle fibres, so relaxing the conjoint tendon and causes a direct inguinal hernia. The anterior cutaneous twigs of the last six thoracic nerves gain a superficial level by piercing the rectus sheath, a short distance from the midline. The lateral cutaneous nerve attain a superficial level by passing between the digitation of the external oblique muscle, each splits into a small posterior division and a larger anterior division which supplies the external oblique muscle. They then course forwards as the lateral margin of the rectus sheath. The intercostal nerves gain the abdominal wall by passing under the costal margin between the slips of the diaphragm. They run forwards between the internal oblique and the transversus abdominis, supply them and pierce the posterior rectus sheath, run deep to the rectus a little distance, supply it and terminate as anterior cutaneous nerve as described already.
This prospective study of 60 consecutive cases of incisionalhernia admitted in Government Mohan Kumaramangalam Medical College Hospital, Salem was done in the period from July 2011 to June 2013. The cases were evaluated through proper history taking, clinical examination, operative procedure and post operative follow-ups.
6) THE INTERNAL OBLIQUE: Muscle arises from last five fibs, the thoracolumbar fascia, the intermediate lip of -iliac crest and the lateral half of inguinal ligament. Its fibres course opposite the direction of external oblique. Internal oblique also gives way to flat aponeurosis medially which splits to enclose the rectus muscle. The fibres that arise from lateral half of inguinal ligament pursue a downward course and insert into os pubis between the symphysis and the tubercle. Some of the lower fibres are pulled into the scrotum by the testis as it passes through the abdominal wall. These fibres known as cremasteric muscle of spermatic cord that pulls up the testis during coughing and sneezing to act as a ball valve to prevent the hernia to occur.
The data in this study were gathered from 4 hospitals serving 1,600,000 inhabitants in western Sweden: Sahlgrenska University Hospital, Göteborg; NU Hospital Group, Trollhättan; Skaraborg Hospital, Skövde and Södra Älvsborg Hospital, Borås. All patients who under- went primary or secondary laparotomy through midline abdominal incisions for vascular procedures or laparoto- mies with drainage or lavage, procedures on the small bowel, the colon or the rectum between January 1, 2010 and December 31, 2010 were included. The patients were identified using codes from the Nordic Medico- Statistical Committee (NOMESCO) Classification of Sur- gical Procedures version 1.9. Exclusion criteria were trauma surgery, no initial closure of the abdominal wall and pa- tients with primary mesh inlay at the midline abdominal in- cision. To conform with the hypothesis we excluded the patients where a documented suture quota <3.5 was stated in the operative report (n = 4), since such a low ratio cannot be considered clinically acceptable (Fig. 1).
These hernias may occur after large surgeries such as intestinal or vascular (large arteries, and veins) surgery, or after smaller surgeries such as an appendectomy or an even through the small scar of a laparoscopy wound. Surgical correction of Incisional hernias is usually recommended, as they carry a potential risk of becoming strangulated at the opening in the abdominal wall and having their blood supply cut off. If this happens it becomes a medical and surgical emergency.
Participants randomized into the watchful waiting group will receive standardized oral information and written instructions which, like those described by Fitz- gibbons et al., will deal with physical activity, diet, pain and pain medication, constipation management, sexual activity, hernia warning signs, and symptoms of acute incarceration . They will be told to consult a physi- cian immediately if acute symptoms develop. Physical examinations will be performed during follow-up visits at 1 month, 12 months and 24 months by a physician. After 6 and 18 months, participants will also be inter- viewed regarding potential hernia-related pain or dis- comfort by a physician or a study nurse. The frequency and scope of study visits is presented in table 1.
Published domestic and international studies were reviewed and screened for factors affect- ing intraoperative pressure. A questionnaire was developed and subsequently revised by seven clinical nursing specialists, after three evaluations. The questionnaire contained 33 questions about the following: sex, age, weight, surgical history, preexisting comorbidities, body mass index (BMI), length of bed rest, glycemic index, glycemic load, mobility, skin sensation, state of consciousness, blood pressure, glu- cose level, and fever 1 day prior to surgery. Other factors included surgery length, anesthe- sia time, preoperative waiting time, recovery time, operating position, table tilting during sur- gery, physical maneuvering, wet linen, and hypothermia/hypotension. Data were also col- lected for lowest oxygen saturation during sur- gery, operating room temperature, emergency surgery status, cardiopulmonary bypass, inten- sive care unit (ICU) stay, anesthesia method, and American Society of Anesthesiologist classification.
Emergency surgery increases the risk of IH as a result of post-operative complications, inadequate patient preparation, use of drains and the midline approach in the emergency operations. The nature of the surgical operation; operations in which there maybe wound contamination(bowel resection or secondary peritonitis), surgery for malignant tumours, abdominal aortic aneurysm, stoma closure, major abdominal surgeries and operations followed by open abdomen treatment with negative pressure and delayed primary wound closure, are all riskfactors for development of IH . Selection of the site incision, suturematerials and the technique of closure of incision areimportant factors. Midline abdominal incision has a higher risk for developing IH compared to transverse and oblique incisions (11%, 4.7% and 0.7% respectively). The technique of closing the abdominal fascia and the suture material used play a major role in developing IH. Re-laparotomy is a strong risk factor. Also factors related to the surgeon experience, long operation time and increased blood loss increase the risk of IH. Wound infection and wound dehiscence are major riskfactors for IH. This risk is more prominent after burst abdomen with evisceration. The 10-year cumulative risk for developing IH after wound dehiscence is 78% regardless of suture material and technique used. Murray (2911) reported an increase of IH by 1.9 fold after surgical site infection. Operation on the previously infected or the relatively avascular scar tissue increases the risk of IH.