Risk Factors For Recurrence of Peptic Ulcer Disease: A Retrospective Study In Tertiary Care Referral Center

Backgrounds: Peptic ulcer disease (PUD) is a common gastrointestinal tract disease characterized by mucosal damage secondary to pepsin and gastric acid secretion. The aim of this study was to evaluate the five-year recurrence rate for treated patients with PUD and risk factors contributing to PUD relapses.Methods: From 2016 through 2021, all patients with endoscopy-proved PUD were identified by reviewing medical records (Best-Care system). Possible risk factors including smoking, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, caffeine, and steroid were analyzed by univariate analysis. Treatment outcomes, 5-year recurrence rate, and mortality rate were assessed.Results: Among 223 patients, there were 187 (83.8%), who diagnosed endoscopy-proved PUD and 36 (16.2%), who diagnosed clinical PUD. Among them, 126 (56.5%) patients were males and the mean age was 62±2 years. The five years recurrence rate of PUD was 30.9%. There was no significant difference in the recurrence rate between the duodenal ulcer (33.3%) and the gastric ulcer (28.8%). By univariate analysis, the use of steroid and NSAID and H. pylori infection were potential risk factors for PUD (P < 0.005). The common complication of PUD was gastrointestinal bleeding (34.1%). Patients who had a complicated PUD were associated with a higher rate of recurrence (45.9%) compared to the uncomplicated PUD (19.2%) (P > 0.05). Conclusion: Our findings demonstrated that the five years recurrence rate of PUD was 30.9%. The use of steroid and NSAID and H. pylori infection were risk factors for recurrence of PUD. PUD places a significant burden on health care systems. Therefore, a multicenter prospective study is needed for effective management to prevent recurrence and complications of PUD.

From LI-RADS Classification to HCC Pathology: A Retrospective Single-Institution Analysis of Clinico-Pathological Features Affecting Oncological Outcomes after Curative Surgery

Background: The latest Liver Imaging Reporting and Data System (LI-RADS) classification by the American College of Radiology has been recently endorsed in the American Association for the Study of Liver Disease (AASLD) guidelines for Hepatocellular carcinoma (HCC) management. Although the LI-RADS protocol has been developed as a diagnostic algorithm, there is some evidence concerning a possible correlation between different LI-RADS classes and specific pathological features of HCC. We aimed to investigate such radiological/pathological correlation and the possible prognostic implication of LI-RADS on a retrospective cohort of HCC patients undergoing surgical resection. Methods: We performed a retrospective analysis of the pathological characteristics of resected HCC, exploring their distribution among different LI-RADS classes and analyzing the risk factors for recurrence-free, overall and cancer-specific survival Results: LI-RADS-5 (LR-5) nodules showed a higher prevalence of microvascular invasion (MVI), satellitosis and capsule infiltration, as well as higher median values of alpha-fetoprotein (αFP) compared to LI-RADS-3/4 (LR-3/4) nodules. MVI, αFP, satellitosis and margin-positive (R1) resection resulted as independent risk factors for recurrence-free survival, while LI-RADS class did not exert any significant impact. Focusing on overall survival, we identified patient age, Eastern Cooperative Oncology Group performance status (ECOG-PS), Model for End Stage Liver Disease (MELD) score, αFP, MVI, satellitosis and R1 resection as independent risk factors for survival, without any impact of LI-RADS classification. Last, MELD score, log10αFP, satellitosis and R1 resection resulted as independent risk factors for cancer-specific survival, while LI-RADS class did not exert any significant impact. Conclusions: Our results suggest an association of LR-5 class with unfavorable pathological characteristics of resected HCC; tumor histology and underlying patient characteristics such as age, ECOG-PS and liver disease severity exert a significant impact on postoperative oncological outcomes.

Prognosis and adjuvant chemotherapy for patients with positive peritoneal cytology in stage IA endometrial cancer

This study evaluated the influence of positive peritoneal cytology (PPC) on the prognosis of patients with stage IA endometrial cancer, and the usefulness of adjuvant chemotherapy in their treatment. We retrospectively analyzed the data of patients with stage IA endometrial cancer admitted in our hospital between 2005 and 2015. Among 989 patients who underwent peritoneal cytology, 135 (13.7%) had PPC. Multivariate analysis extracted several independent risk factors for recurrence in stage IA patients, including those with PPC. Adjuvant chemotherapy did not cause a significant difference in the 5-year relapse-free survival rate in patients with PPC (p = 0.78). Similarly, the 5-year recurrence-free survival rate with or without chemotherapy was not different among type II cancer patients (p = 0.11). However, the baseline risk of 5-year relapse-free survival without chemotherapy in patients with PPC and type II was very low (66.7%). While PPC was an independent risk factor for recurrence in stage IA endometrial cancer, adjuvant chemotherapy did not influence the survival rate in patients with PPC. While it is controversial whether adjuvant chemotherapy should be administered in stage IA uterine cancer with only PPC as a prognostic factor, it should be considered for early-stage patients who have multiple risk factors for recurrence.

Do Patients with a Family or Personal History of Venous Thromboembolism have an Increased Risk of Recurrence?

Background A family (FH) and personal history (PH) of venous thromboembolism (VTE) are commonly evaluated risk factors for recurrence. We examined the association between FH/PH of VTE and the risk of recurrence and whether a stronger history status (i.e., both FH/PH vs. no FH/PH) carries an increased recurrence risk. Methods We prospectively followed 813 patients aged ≥ 65 years with acute VTE from 9 Swiss hospitals. We classified patients into four groups: no FH/PH, FH only, PH only, and both FH/PH. The primary outcome was recurrent VTE during the full observation period. We examined the association between FH/PH status and the time to VTE recurrence using competing risk regression, adjusting for confounders and periods of anticoagulation. Results Of 813 patients with VTE, 59% had no FH/PH, 11% a FH only, 24% a PH only, and 7% had both a FH and PH of VTE. Overall, 105 patients had recurrent VTE during the full observation period. After adjustment, patients with a FH only (subhazard ratio [SHR] 0.8, 95% confidence interval [CI] 0.4–1.7), PH only (SHR 1.5, 95% CI 0.9–2.5), and both FH/PH (SHR 1.4, 95% CI 0.6–3.1) did not have an increased risk of recurrent VTE compared with those without FH/PH. When we considered the period after the completion of initial anticoagulation only, the results were similar. Conclusion Our findings indicate that in patients with acute VTE, a FH and/or PH of VTE does not convey an increased risk of recurrent VTE. In particular, we did not find a “dose–effect” relationship between FH/PH status and VTE recurrence.

Surgical creation of multiple drainage holes versus local injection of corticosteroids for treatment of aural hematomas in dogs: 51 dogs with 71 aural hematomas (2000–2017)

OBJECTIVE To investigate the outcome of surgical creation of multiple drainage holes (MDHs) versus local corticosteroid injection (LCI) for treatment of aural hematomas (AHs) in dogs and identify risk factors for recurrence and development of new AHs. ANIMALS 51 dogs with 71 AHs. PROCEDURES Medical records were reviewed, and information on signalment, clinical findings, and outcome was recorded. Recurrence was defined as development of an AH at the primary site after the first month of treatment. Development of a new AH was defined as an AH occurring at a site different from the treated site. RESULTS The recurrence rate after the first month of treatment was significantly higher following the LCI procedure (17/48 AHs [33%]) than after the MDH procedure (1/24 AHs [4%]). The odds of recurrence increased as the numbers of LCI in the first month increased (OR, 2.414). Recurrent AHs after LCI resolved with additional LCIs; only 1 AH (2%) required a change to MDHs. No recurrence was observed after the eighth month, and the cosmetic results were good. Sixteen of 51 (31%) dogs had multiple or new AHs. The risk of new AHs was higher in Golden Retrievers and Labrador Retrievers and in dogs with allergic dermatitis. CONCLUSIONS AND CLINICAL RELEVANCE Long-term outcomes suggested that both creation of MDHs and LCI can be therapeutic options for dogs with AHs. However, the risk of new AH development should be considered, especially in retriever breeds and dogs with allergic dermatitis.

Insulin Resistance and Metabolic Syndrome Increase the Risk of Relapse For Fertility Preserving Treatment in Atypical Endometrial Hyperplasia and Early Endometrial Cancer Patients

ObjectiveFertility-sparing treatment for young women with atypical endometrial hyperplasia (AEH) and early endometrial cancer (EC) is a difficult challenge. Insulin resistance (IR) and metabolic syndrome (MetS) are two potentially crucial, but currently enigmatic factors in the recurrence of AEH and early EC patients. In this study we attempt to elucidate these factors.MethodsA retrospective study was conducted from January 2010 to December 2019. Risk factors for recurrence and complete remission time after recurrence (RCR time) were investigated. ROC curves were built to estimate the accuracy of the metabolic characteristics and Kaplan–Meier (K–M) analysis was used to calculate recurrence-free survival (RFS) for patients with various IR or MetS statuses.ResultsA total of 111 AEH or early EC patients met the criteria and were enrolled in our study. Univariate analysis found that BMI ≥25 kg/m2 (OR = 2.7, 95% CI: 1.1–6.4, P = 0.03), IR (OR = 9.5, 95% CI: 3.3–27.0, P &lt;0.001), MetS (OR = 4.9, 95% CI:1.5–15.5, P = 0.008), IR+ and MetS+ (OR = 21.0, 95% CI: 4.8–92.7, P &lt;0.001), histological type (OR = 3.5, 95% CI: 1.5–7.9, P = 0.003), and maintenance treatment (OR = 0.3, 95% CI: 0.1–0.6, P = 0.005) were all significantly associated with recurrence and longer RCR time. Among these factors, IR and MetS were determined to be two independent risk factors for recurrence. Moreover, using IR and MetS as markers significantly improved the diagnostic accuracy of recurrence for fertility-sparing treatment patients (AUC = 0.818, P &lt;0.05) and may play synergistic roles in suppressing treatment. K–M analysis indicated both metabolic features played important roles in RFS (P &lt;0.05).ConclusionBoth IR and MetS were significantly associated with recurrence and longer RCR time in AEH and early EC patients receiving fertility-sparing treatment.