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1.
J Otolaryngol Head Neck Surg ; 49(1): 13, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143701

RESUMO

OBJECTIVE: To evaluate the graft success rate and postoperative hearing gain for marginal perforations using endoscopic cartilage myringoplasty with the removal of a small rim of the external auditory canal (EAC). STUDY DESIGN: Prospective case series. MATERIALS AND METHODS: We performed a prospective study in 41 patients with marginal perforations who underwent endoscopic cartilage myringoplasty with the removal of a small rim of EAC. Patients were followed up for 6 months. RESULTS: Of the 41 patients with unilateral marginal perforation included in this study, the graft success rate was 100% (41/41). The mean ABG improved from 11.31 ± 9.71 dB preoperatively to 7.31 ± 2.32 dB postoperatively for small-and medium-sized perforations (P = 0.13); the mean ABG improved from 21.46 ± 8.39 dB preoperatively to 9.84 ± 2.41 dB postoperatively for large perforations (P < 0.05); the mean ABG improved from 28.79 ± 6.74 dB preoperatively to 10.13 ± 3.56 dB postoperatively for subtotal and total perforations (P < 0.05). There were no cases of graft lateralization or significant blunting or atelectasis or graft adhesions. Three patients developed postoperative otorrhoea and five patients had mild myringitis. CONCLUSIONS: Endoscopic cartilage myringoplasty with the removal of a small rim of the EAC is simple and feasible, showing a high graft success rate and minimal complications for repairing marginal perforations.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32044273

RESUMO

INTRODUCTION: Sigmoid sinus diverticulum has been considered the most common cause of pulsatile tinnitus; the mechanism underlying sigmoid sinus diverticulum formation is unclear. To the best of our knowledge, no previous studies have assessed whether the formation of sigmoid sinus diverticulum is related to compression of the internal jugular vein by the styloid process. OBJECTIVE: To discuss the relationship between the styloid process and the formation of sigmoid sinus diverticulum. METHODS: The medical records of nine patients diagnosed with venous pulsatile tinnitus caused by sigmoid sinus diverticulum were reviewed between April 2009 and May 2019. All patients underwent high-resolution computed tomography of the temporal bones, computed tomography venogram of the head and neck, magnetic resonance venography, and brain magnetic resonance imaging. The length and medial angulation of the styloid process were measured, and compression of the internal jugular vein was recorded. RESULTS: The study population consisted of nine female right-sided pulsatile tinnitus patients with a mean age of 53.8±4.6 years. The mean lengths of the styloid process were 3.9±0.6cm on the right side and 4.1±0.7cm on the left side. The mean medial angulation of the styloid process was significantly smaller on the right side than the left side (65.3°±1.2° vs. 67.8°±1.7°, p<0.05). In addition, computed tomography venogram of the head and neck demonstrated the left internal jugular vein was compressed by the styloid process in eight of the nine patients. CONCLUSION: The formation of sigmoid sinus diverticulum with venous pulsatile tinnitus may be related to compression of the contralateral internal jugular vein by the styloid process. However, accumulation of data in additional cases is required to verify this suggestion.

3.
Adv Mater ; : e1908419, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32104957

RESUMO

Infrared (IR) photodetectors are a key optoelectronic device and have thus attracted considerable research attention in recent years. Photosensitivity is an increasingly important device performance parameter for nanoscale photodetectors and image sensors, as it determines the ultimate imaging quality and contrast. However, photosensitivities of state-of-the-art low-dimensional nanostructure-based IR detectors are considerably low, limiting their practical applications. Herein, a biomimetic IR detection amplification (IRDA) system that boosts photosensitivity by several orders of magnitude by introducting nanowire field effect transistors (FETs), resulting in a peak photosensitivity of 7.6 × 104 under an illumination of 1342 nm, is presented. Consequently, high-contrast imaging of IR light is obtained on the flexible IRDA arrays. The image information can be then trained and recognized by an artificial neural network for higher image-recognition efficiency. This work provides a new perspective for developing high-performance IR imaging systems, and is expected to undoubtedly enlighten future work on artificial intelligence and biorobotic systems.

4.
J Immunol ; 204(5): 1146-1157, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31932498

RESUMO

Upon activation by CD40 or TLR signaling, B lymphocytes activate NF-κB to induce activation-induced cytidine deaminase and, therefore, Ig class switch DNA recombination, as central to the maturation of the Ab and autoantibody responses. In this study, we show that NF-κB activation is boosted by colocalization of engaged immune receptors, such as CD40, with RAB7 small GTPase on mature endosomes, in addition to signals emanating from the receptors localized on the plasma membrane, in mouse B cells. In mature endosomes, RAB7 directly interacts with TRAF6 E3 ubiquitin ligase, which catalyzes K63 polyubiquitination for NF-κB activation. RAB7 overexpression in Cd19+/creRosa26fl-STOP-fl-Rab7 mouse B cells upregulates K63 polyubiquitination activity of TRAF6, enhances NF-κB activation and activation-induced cytidine deaminase induction, and boosts IgG Ab and autoantibody levels. This, together with the extensive intracellular localization of CD40 and the strong correlation of RAB7 expression with NF-κB activation in mouse lupus B cells, shows that RAB7 is an integral component of the B cell NF-κB activation machinery, likely through interaction with TRAF6 for the assembly of "intracellular membrane signalosomes."

6.
J Otolaryngol Head Neck Surg ; 48(1): 72, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852515

RESUMO

OBJECTIVE: We evaluated microwave ablation (MWA) for treatment of idiopathic recurrent anterior epistaxis (RAE) in children, in terms of technical feasibility, efficacy, and safety. STUDY DESIGN: A prospective pilot case series. SETTING: Tertiary university hospital. METHODS: Children with idiopathic RAE were treated with endoscopic MWA and reevaluated at 1 and 4 weeks and at 6 months thereafter. The primary outcome was successful hemostasis on the day of the procedure. Secondary outcomes were the rebleeding rates after 1 and 4 weeks, and 6 months, and any complications. RESULTS: Of the 92 children with idiopathic RAE who met the inclusion criteria, the operation was interrupted in 7 children due to intraoperative noncooperation, and silver nitrate cautery was performed instead. All procedures were completed, and hemostasis was achieved within 10-20 s by MWA in 85 children. Two to four ablations were conducted. No recurrent epistaxis occurred and no severe MWA -related complications, such as septal perforation or synechiae formation, were observed at the 6-month follow-up. CONCLUSIONS: Endoscopic MWA is a feasible and safe technique for the treatment of idiopathic pediatric RAE in the clinical setting, especially those cases that do not respond to in-office chemical cautery.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31722853

RESUMO

INTRODUCTION: Recurrent epistaxis is commonly encountered in the rhinology outpatient clinic. Under endoscopic guidance, both bipolar cautery and monopolar forceps (combined with suction) have been employed to control the bleeding. However, the use of monopolar forceps requires the placement of grounding pads. Most procedures are currently performed in operating rooms. OBJECTIVE: We investigated outcomes after the use of Microwave Ablation (MWA) to control epistaxis in adults with isolated mucosal bulge lesions. All procedures were performed with patients under local anesthesia in our outpatient clinic. METHODS: This is a retrospective cohort study. We included 83 adults with epistaxis of isolated mucosal bulge lesions. Microwave ablation was performed in the outpatient clinic to control bleeding, after induction of local anesthesia. The primary outcome was successful hemostasis. The secondary outcomes were the rebleeding rates at weeks 1 and 4 and month 6, and complications (crust or synechiae formation, septal perforation, and/or orbit or brain complications). RESULTS: All bleeding points were successfully ablated; hemostasis was achieved within 1-2min. The mean pain score was 1.83 intra-operatively and 0.95 1h postoperatively. No patient re-bled, and no severe MWA-related complication (septal perforation, synechiae formation, or orbit or brain complication) was recorded to 6 months of follow-up. CONCLUSIONS: Endoscopic microwave ablation with patients under local anesthesia is a novel, safe, effective, rapid, well-tolerated, outpatient treatment for adults with epistaxis of isolated mucosal bulge lesions, especially those for whom general anesthesia might be risky, those with electrical implants, and those exhibiting contraindications for arterial embolization.

8.
Ear Nose Throat J ; : 145561319891264, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31779475

RESUMO

OBJECTIVE: The objective is to reduce the rates of misdiagnosis and inappropriate treatment of laryngeal tuberculosis (LTB). STUDY DESIGN: Retrospective case series. MATERIALS AND METHODS: Medical records of 3 histopathology-confirmed cases at a tertiary medical center from 2000 to 2018. RESULTS: Seventeen patients with LTB included in this study. Of the 17 patients, 16 patients were male and 1 was female; 11 patients had a history of smoking. Odynophagia was the chief complaint in 6 cases, and 11 patients complained of hoarseness. The appearance of the affected larynx was ranged from diffuse swelling (n = 7, 41.2%), mucosa white lesion (n = 5,29.4%), and granulomatous tumors (n = 2, 11.76%), and these features presented together (n = 2, 11.76%). Seventeen patients with LTB were misdiagnosed as acute epiglottitis in 4 (23.5%) patients, acute laryngitis in 1 (5.9%) patient, leukoplakia in 5 (29.4%) patients, laryngopharyngeal reflux (LPR) in 6 (35.3%) patients, and laryngocarcinoma in 1 (5.9%) patient. Chest computed tomography reported old pulmonary tuberculosis in 2 (11.7%) patients, active pulmonary tuberculosis in 7 (41.2%) patients, and normal lung status in 8 (47.1%) patients. Histopathological examination reported Mycobacterium tuberculosis infection by revealing epithelioid cell granulomas with Langhans-type giant cells in 14 (82.4%) patients and epithelioid cell granulomas with caseous necrosis and Langhans-type giant cells in 3 (17.6%) patients. CONCLUSIONS: Laryngeal tuberculosis was easily misdiagnosed as acute epiglottitis or leukoplakia because of diffuse swelling of the epiglottis or white lesions over the true vocal cord, especially patients with increasing LTB were misdiagnosed as LPR with the enhancement of LPR awareness among otolaryngologist. Clinicians should be aware of the possibility of LTB for chronic intractable laryngitis with failure treatment of proton pump inhibitor and recurrent acute epiglottitis with foreign body injury.

9.
Ear Nose Throat J ; : 145561319879238, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597530

RESUMO

OBJECTIVE: To compare the outcomes of adult patients with recurrent epistaxis treated intraoperatively with either bipolar electrocautery or microwave ablation (MWA). STUDY DESIGN: Prospective randomized control study. MATERIALS AND METHODS: One hundred ten patients with idiopathic recurrent epistaxis who met the inclusion criteria were randomly assigned into MWA group and bipolar electrocautery group. Primary outcomes were the proportion of patients in each group whose bleeding had stopped within 24 hours after treatment and time to achieve successful hemostasis. Secondary outcomes were the rebleeding rate after 3 days, 1 and 12 weeks, and 6 months and complications. RESULTS: Successful immediate arrest of epistaxis was achieved in all patients. The times to achieve successful hemostasis were 2.13 ± 1.04 minutes in the MWA group and 6.60 ± 2.68 minutes in the bipolar electrocautery group (P = .000). The rates of recurrent bleeding were similar in patients treated with the different approaches (P = .231). However, secondary crusting was observed endoscopically in 59 patients in the bipolar electrocautery group, while pseudomembrane of the ablation zone was seen in 19 (36.5%) patients in the MWA group. Nevertheless, there were no severe postoperative complications, including septal perforation and orbit and brain complications, in either group at the 6-month follow-up. CONCLUSION: Bipolar electrocautery and MWA had similar outcomes for the treatment of adult patients with recurrent epistaxis. However, MWA resulted in rapid hemostasis with less local nasal pain and less crust. Thus, MWA could be a favorable treatment option for patients with idiopathic recurrent epistaxis.

10.
Acta Otolaryngol ; 139(12): 1083-1089, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31553254

RESUMO

Background: Some studies have shown that topical application of epidermal growth factor (EGF) accelerates healing in traumatic tympanic membrane perforations (TMPs), however, the optimal dose and starting time of application have not been established.Objectives: To determine the optimal dose and starting time of application of EGF for the regeneration of TMPs.Methods and materials: Patients with traumatic TMPs were first randomly assigned to low-dose EGF, high-dose EGF, and spontaneous healing groups. Then, the same patients were retrospectively analyzed at 6 months based on the starting time of treatment. The closure times, closure rates, and hearing gain were compared among the groups at 6 months.Results: The mean closure time was 10.20 ± 5.13 days in the low-dosage EGF group, 14.39 ± 6.20 days in the high-dosage EGF group, and 33.17 ± 16.37 days in the spontaneous healing group; the difference was significant (p < .001).Conclusions: Daily application of EGF shortened the closure time of traumatic TMPs compared with those that healed spontaneously. However, high-dose EGF instead prolonged the closure time compared to low-dose EGF.

11.
Small ; 15(38): e1902801, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31373177

RESUMO

The development of noncontact humidity sensors with high sensitivity, rapid response, and a facile fabrication process is urgently desired for advanced noncontact human-machine interaction (HMI) applications. Here, a flexible and transparent humidity sensor based on MoO3 nanosheets is developed with a low-cost and easily manufactured process. The designed humidity sensor exhibits ultrahigh sensitivity, fast response, great stability, and high selectivity, exceeding the state-of-the-art humidity sensors. Furthermore, a wearable moisture analysis system is assembled for real-time monitoring of ambient humidity and human breathing states. Benefiting from the sensitive and rapid response to fingertip humidity, the sensors are successfully applied to both a smart noncontact multistage switch and a novel flexible transparent noncontact screen for smart mobile devices, demonstrating the potential of the MoO3 nanosheets-based humidity sensors in future HMI systems.

12.
ACS Nano ; 13(8): 9139-9147, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31330103

RESUMO

Achieving high deformability in response to minimal external stimulation while maximizing human-machine interactions is a considerable challenge for wearable and flexible electronics applications. Various natural materials or living organisms consisting of hierarchical or interlocked structures exhibit combinations of properties (e.g., natural elasticity and flexibility) that do not occur in conventional materials. The interlocked epidermal-dermal microbridges in human skin have excellent elastic moduli, which enhance and amplify received tactile signal transport. Herein, we use the sensing mechanisms inspired by human skin to develop Ti3C2/natural microcapsule biocomposite films that are robust and deformable by mimicking the micro/nanoscale structure of human skin-such as the hierarchy, interlocking, and patterning. The interlocked hierarchical structures can be used to create biocomposite films with excellent elastic moduli (0.73 MPa), capable of high deformability in response to various external stimuli, as verified by employing theoretical studies. The flexible sensor with a hierarchical and interlocked structure (24.63 kPa-1) achieves a 9.4-fold increase in pressure sensitivity compared to that of the planar structured Ti3C2-based flexible sensor (2.61 kPa-1). This device also exhibits a rapid response rate (14 ms) and good cycling reproducibility and stability (5000 times). In addition, the flexible pressure device can be used to detect and discriminate signals ranging from finger motion and human pulses to voice recognition.

13.
Am J Otolaryngol ; 40(5): 696-699, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31229366

RESUMO

OBJECTIVE: The objective of this study was to compare the re-bleeding of idiopathic recurrent epistaxis with no definite bleeding site treated with either prophylactic microwave ablation (MWA) or continuous observation. STUDY DESIGN: Case series with chart review. SUBJECTS AND METHODS: 61 patients with idiopathic recurrent epistaxis but no definite bleeding sites in the first operation were assigned to prophylactic MWA group (n = 39) and continuous observation group (n = 22). Patients in prophylactic MWA group were given prophylactic MWA at the common bleeding sites. Patients in continuous observation group were only observed in the ward. The bleeding sites, re-bleeding and complications were evaluated during 3 months follow-up period. RESULTS: Rebleeding was experienced by 7 of the patients (17.9%) who were treated with prophylactic MWA whereas, 13 of the patients (59.1%) who used continuous observation had rebleeding. The rebleeding rate for patients undergoing prophylactic MWA group was lower than that for the observation-only group (p < 0.01). All the ablations were completed for the patients with known bleeding site within 1-2 min. These patients only had the complain of slight postoperative pain, no serious complications (including nasal adhesion, crust, septal perforation, etc.) were found in the follow-up period. CONCLUSIONS: MWA is a simple, convenient, rapid, and definite hemorrhage control method with minimally invasive therapeutic technique. Prophylactic MWA at the common bleeding sites helps to significantly reduce the rate of rebleeding in patients in whom no definite bleeding sites have been identified.


Assuntos
Epistaxe/terapia , Micro-Ondas/uso terapêutico , Observação/métodos , Ablação por Radiofrequência/métodos , Adulto , Estudos de Coortes , Epistaxe/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Resultado do Tratamento
14.
Nanoscale ; 11(25): 12116-12123, 2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31197296

RESUMO

Metal germanate nanospheres including Ca2Ge7O16, Zn2GeO4 and SrGe4O9 were successfully synthesized by a direct and large-scale electrospraying method. As anodes for lithium ion batteries, the prepared metal germanate nanospheres showed high electrochemical lithium storage performance including excellent cycling stability and high rate capacity. Especially, the Ca2Ge7O16 nanosphere anode delivered a high specific capacity of ∼ 670 mA h g-1 at 0.2 A g-1. The capacity retention was maintained around 71% even after 500 cycles. Moreover, when applied as room-temperature ammonia gas sensors, all three prepared germinate nanospheres showed significant sensing response values (6.04 for SrGe4O9, 2.73 for Zn2GeO4 and 1.70 for Ca2Ge7O16), fast response-recovery time, excellent stability and outstanding selectivity.

15.
Opt Lett ; 44(9): 2197-2200, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042182

RESUMO

We report on the high-performance nanoporous (NP) GaN-based metal-insulator-semiconductor (MIS) ultraviolet (UV) photodetectors (PDs) with a thermal oxidized ß-Ga2O3insulating layer. The devices show a high responsivity of 4.5×105 A/W and maximum external quantum efficiency of 1.55×108% at 360 nm under a 10 V applied bias, which are attributed to the trap-assisted tunneling induced internal gain mechanism. Correspondingly, a specific detectivity of 8.27×1015 Jones and excellent optical switching repeatability are also observed in our fabricated PDs. The NP-GaN/ß-Ga2O3 MIS UV PD may act as an excellent candidate for the application in UV photodetection due to the high performance and simple fabrication process.

16.
Int J Pediatr Otorhinolaryngol ; 121: 41-45, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30861426

RESUMO

OBJECTIVE: To compare the outcomes of adolescent patients with recurrent anterior epistaxis (RAE) treated with either silver nitrate cauterization or microwave ablation (MWA). STUDY DESIGN: and methods: In this prospective, randomized study, one hundred 13-18-year-old adolescents with RAE were assigned to two groups: the MWA group (n = 50) or the silver nitrate cauterization group (n = 50). Both groups were followed up for 12 months. The primary and secondary outcomes were evaluated. RESULT: Ablation hemostasis was successfully achieved within 10-20 s in all patients in the MWA group. Eighteen (36.0%) patients in the silver nitrate group had recurrent epistaxis compared to three (6.0%) in the MWA group (P = 0.01) within 2-8 weeks after treatment. Two (2/48, 4.2%) patients in the MWA group had recurrent epistaxis compared to seventeen (17/43, 39.5%) in the silver nitrate group at 6 months; this difference was statistically significant (P = 0.01). However, 8 (8/37, 21.6%) patients in the MWA group had recurrent epistaxis compared to 15 (15/41,36.6%) in the silver nitrate group at 12 months; this difference was not statistically significant (P = 0.12). No treatment-related complications, including necrosis or septal perforation were seen in either group during follow up. CONCLUSIONS: MWA may be a useful treatment for adolescents with RAE, as it had a lower incidence of recurrent epistaxis within 6 months of treatment compared to silver nitrate cauterization.


Assuntos
Técnicas de Ablação , Anti-Infecciosos Locais/uso terapêutico , Cauterização , Epistaxe/terapia , Micro-Ondas/uso terapêutico , Nitrato de Prata/uso terapêutico , Adolescente , Feminino , Humanos , Masculino , Estudos Prospectivos , Recidiva
18.
Appl Opt ; 58(4): 1016-1024, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30874151

RESUMO

This paper describes a novel optical design for a multi-channel narrow-band imager observing at the Lyman ultraviolet wavelengths. As one of the key instruments onboard the Census of Warm-Hot Intergalactic Medium, Accretion, and Feedback Explorer space mission, the imager is designed to map the neutral hydrogen Lyman-α line emissions from the intergalactic medium and nearby galaxies. The optical design features an instantaneous field of view (FOV) of 20 arc min in diameter and a moderate and adjustable spectral resolution of 500-2000. A highly dispersive monochromator system is used to split the incident light into several wavelength channels, each with a full-field imaging capability and adjustable bandwidth, and the ensuing imaging optics form the individual channel images on different areas of the same microchannel plate detector. Channel wavelengths are tunable and a continuous wavelength scanning across the entire band of interest is proposed, which yields spectrally resolved 3D images with moderate spectral resolutions.

19.
Int Forum Allergy Rhinol ; 9(6): 702-706, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30702210

RESUMO

BACKGROUND: Arterial epistaxis is commonly seen in the rhinology clinic and can have a significant impact on quality of life. Previous studies have explored various therapies to address epistaxis. METHODS: Patients were treated in the outpatient clinic or operating room by microwave ablation (MWA) with a 2450-MHz cooled-shaft antenna to treat an epistaxis bleeding point. RESULTS: Of the 481 patients with arterial epistaxis, bleeding was controlled within 1 to 2 minutes and only 2 patients with recurrent bleeding required re-ablation. The shape of the thermal lesion was elliptical and it was approximately 2 mm in length, 1 mm in width, and 0.5 to 1 mm in penetration depth. Of the 481 patients, 167 (34.7%) complained of minor nasal pain on the same day of ablation. No patients complained of nasal pain or obstruction during the follow-up period. In addition, 139 (28.9%) patients showed a minor increase in rhinorrhea during the first postoperative week. Of the 481 patients, 469 (97.5%) were followed-up at 6 months with no severe MWA-related complications, such as septal perforation, synechiae formation, or orbit and brain complications. CONCLUSION: MWA is a technically feasible alternative method for patients with arterial epistaxis.

20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(1): 66-72, 2019 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-30703796

RESUMO

OBJECTIVE: To investigate the surgical efficacy and prognostic factors of T3NxM0 middle-low rectal cancer without neoadjuvant therapy. METHODS: Clinical data of patients with middle-low rectal cancer undergoing TME surgery with T3NxM0 confirmed by postoperative pathology at Colorectal Surgery Department of Changhai Hospital from January 2008 to December 2010 were analyzed retrospectively. INCLUSION CRITERIA: (1)no preoperative neoadjuvant chemoradiotherapy (nCRT); (2) complete preoperative evaluation, including medical history, preoperative colonoscopy or digital examination, blood tumor marker examination, and imaging examination; (3) distance between tumor lower margin and anal verge was ≤ 10 cm; (4) negative circumferential resection margin (CRM-). Finally, a total of 331 patients were included in this study. According to the number of metastatic lymph node confirmed by postoperative pathology, the patients were divided into N0 group without regional lymph node metastasis (190 cases) and N+ group with regional lymph node metastasis (141 cases). The perioperative conditions, local recurrence, distant metastasis and prognostic factors were analyzed. RESULTS: Compared to N0 group in the perioperative data, N+ group had higher ratio of tumor deposit [29.8%(42/141) vs. 0, χ²=64.821, P<0.001] and vascular invasion [7.1%(10/141) vs. 0.5%(1/190),χ²=10.860, P<0.001]. There were no significant differences in tumor diameter, number of lymph nodes detected, positive nerve invasion, degree of tumor differentiation, morbidity of postoperative complication and postoperative adjuvant chemotherapy rate between the two groups (all P>0.05). The median follow-up period was 73.4 months. The merged 5-year local recurrence rate was 2.7%(9/331), 5-year distant metastasis rate was 23.3% (77/331), 5-year disease-free survival (DFS) rate was 73.4%, and 5-year overall survival (OS) rate was 77.2%. Multivariate analysis showed that lymph node metastasis (HR=3.120, 95%CI: 1.918 to 5.075, P<0.001), nerve invasion (HR=0.345, 95%CI: 0.156 to 0.760, P=0.008) and vascular invasion (HR=0.428, 95%CI: 0.189 to 0.972, P=0.043) were independent risk factors for DFS in patients with T3NxM0 rectal cancer after operation. Preoperative carcinoembryonic antigen level (HR=1.858, 95%CI:1.121 to 3.079, P=0.016), lymph node metastasis (HR=3.320, 95%CI: 1.985 to 5.553, P<0.001) and nerve invasion (HR=0.339, 95%CI: 0.156 to 0.738, P=0.006) were independent risk factors for OS in patients with T3NxM0 rectal cancer after operation. CONCLUSIONS: Optimal local control rate of middle-low rectal cancer patients with T3NxM0 and CRM- can be achieved by standard TME surgery alone. For patients with preoperative elevated blood carcinoembryonic antigen level, regional lymph node metastasis, or neurovascular invasion confirmed by pathology after surgery, adjuvant chemoradiotherapy should be actively applied after surgery to improve prognosis.


Assuntos
Protectomia/métodos , Neoplasias Retais/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Mesocolo/cirurgia , Terapia Neoadjuvante , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/patologia , Estudos Retrospectivos
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