[Risk factors of permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma]

Objective: To investigate the risk factors of turning temporary stoma into permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma. Methods: A case-control study was carried out. Data of rectal cancer patients who underwent transabdominal anterior resection with temporary stoma and completed follow-up in Department of General Surgery of Xiangya Hospital of Central South University from June 2008 to June 2018 were collected and analyzed. In this study, temporary stoma included defunctioning stoma (ostomy was made during operation) and salvage stoma (ostomy was made within one month after operation due to anastomotic leakage or severe complications). Cases of multiple intestinal tumors were excluded. A total of 308 rectal cancer patients were enrolled in the study, including 198 males and 110 females with a median age of 56 (48-65) years. Ninety-four patients received intraperitoneal chemotherapy during operation. Among 308 patients, upper rectal cancer was observed in 64 cases, middle rectal cancer in 89 cases and low rectal cancer in 155 cases. Twenty patients underwent transverse colostomy and 288 underwent ileostomy. Phone call following-up was conducted from August to September 2019 to investigate whether stoma was reversed, causes of reversal failure, and tumor relapsed or not in detail. Permanent stoma was defined as that the stoma was still not reversed by the latest follow-up. The univariate analysis was performed with chi-square test or Fisher's exact test, and variables with P value < 0.10 were included in the non-conditional logistic regression model for multivariate analysis. Results: The median follow-up time was 54.3 (32.4-73.8) months. During follow-up, 8 cases had local recurrence and 37 cases had distant metastasis. Among the 308 patients with temporary ostomy, 247 (80.2%) patients had stomas reversed and the median interval time was 4.5 (3.5-6.1) months. The median interval time in 65 patients with salvage stoma was significantly longer that in 182 patients with defunctioning stoma [5.5 (4.3-7.5) vs. 4.2 (3.4-5.5) months; Z=-4.387, P<0.001]. The temporary ostomy was confirmed to become permanent stoma in 61 patients (19.8%), including 45 cases of defunctioning stoma and 16 cases of salvage stoma. Univariate analysis showed that preoperative anemia, intraperitoneal chemotherapy during operation, middle rectal cancer, transverse colostomy, pathological stage, postoperative local recurrence and distant metastasis were associated with permanent stoma (all P<0.10). Multivariate analysis revealed that the intraperitoneal chemotherapy during operation (OR=1.961, 95% CI: 1.029-3.738, P=0.041), middle rectal cancer (OR=2.401, 95% CI: 1.195-4.826, P=0.014), transverse colostomy (OR=3.433, 95% CI: 1.234-9.553, P=0.018), and distant metastasis (OR=8.282, 95% CI:3.820-17.954, P<0.001) were independent risk factors of permanent stoma. Conclusions: There is high risk of turning temporary stoma into permanent stoma among rectal cancer patients undergoing transabdominal anterior resection who receive intraperitoneal chemotherapy during operation, present as the middle rectal cancer, undergo transverse colostomy or develop distant metastasis. Surgeons need to evaluate and balance the risks and benefits thoroughly, and then inform the patients in order to avoid potential conflicts.

Genetic variation in three mitochondrial genes among cattle tick Rhipicephalus microplus originating from four provinces of China

The cattle tick, Rhipicephalus microplus (formerly Boophilus microplus), is the most important blood-feeding ectoparasite of cattle in tropical and subtropical regions of the world. In this study, we examined sequence variability in three mitochondrial (mt) DNA (cox1, nad1, nad4) among cattle tick R. microplus originating from four provinces of China. A portion of cox1 (pcox1), nad1 (pnad1) and nad4 (pnad4) genes were amplified by polymerase chain reaction (PCR) separately from adult R. microplus individuals and the amplicons were subjected to sequence from both directions. The sequence of mt cox1, nad1, nad4 genes was 817 bp, 350 bp, and 794 bp in size, respectively. The intraspecific sequence variations within R. microplus were 0-8.6% for cox1, 0-4.9% for nad1 and 0-10.3% for nad4. However, the interspecific sequence differences among the members of the Rhipicephalus [R. sanguineus (JX416325) and R. turanicus (NC035946)] were significantly higher, being 16.9-20.5%, 18- 22.8%, 22.8-25.3% for pcox1, pnad1 and pnad4, respectively. In addition, genetic differences were 7.9-8.6% for cox1, 4.3-4.9% for nad1 and 10-10.3% for nad4 between the two detected lineages (R. microplus clade A and clade B). Phylogenetic analyses indicated that all the Rhipicephalus isolates from the present study represents R. microplus, supporting that R. microplus represents species complex. Our result provided an additional genetic evidence for the existence of species complex within R. microplus in China.