Abstract:
BACKGROUND:Neoadjuvant chemoradiation reduces local recurrence in locally advanced rectal cancer, and adherence to national and societal recommendations remains unknown. OBJECTIVE:To determine variability in guideline adherence in rectal cancer treatment and investigate whether hospital volume correlated with variability seen. DESIGN:We performed a retrospective analysis using the National Cancer Database rectal cancer participant user files from 2005 to 2010. Stage-specific predictors of neoadjuvant chemotherapy and radiation use were determined, and variation in use across hospitals analyzed. Hospitals were ranked based on likelihood of preoperative therapy use by stage, and observed-to-expected ratios for neoadjuvant therapy use calculated. Hospital outliers were identified, and their center characteristics compared. RESULTS:A total of 23,488 patients were identified at 1183 hospitals. There was substantial variability in the use of neoadjuvant chemoradiation across hospitals. Patients managed outside clinical guidelines for both stage 1 and stage 3 disease tended to receive treatment at lower-volume, community cancer centers. CONCLUSIONS:There is substantial variability in adherence to national guidelines in the use of neoadjuvant chemoradiation for rectal cancer across all stages. Both hospital volume and center type are associated with over-treatment of early-stage tumors and under-treatment of more invasive tumors. These findings identify a clear need for national quality improvement efforts in the treatment of rectal cancer.
journal_name
Dig Dis Scijournal_title
Digestive diseases and sciencesauthors
Midura EF,Jung AD,Daly MC,Hanseman DJ,Davis BR,Shah SA,Paquette IMdoi
10.1007/s10620-017-4610-2subject
Has Abstractpub_date
2017-08-01 00:00:00pages
1906-1912issue
8eissn
0163-2116issn
1573-2568pii
10.1007/s10620-017-4610-2journal_volume
62pub_type
杂志文章abstract::Fish oil (a very long chain triglycerides, VLCT) has received much attention because of its favorable metabolic properties; however, its effect on gastrointestinal function has not been studied. We investigated the effects of intraduodenally administered VLCT on gut-hormone release [cholecystokinin (CCK), neurotensin,...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1023/a:1005594514399
更新日期:2000-09-01 00:00:00
abstract:BACKGROUND:We have reported previously that Candida albicans is involved in the pathogenesis of peptic ulcer perforation; it was shown that C. albicans aggravated the severity of duodenal ulceration and increased the rate of perforation. We considered it incumbent upon us to ascertain whether C. albicans is a virulence...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-007-0159-9
更新日期:2008-09-01 00:00:00
abstract::Metoclopramide tablets have been approved for use in the acute and chronic management of diabetic gastroparesis. Its efficacy as an antiemetic has been well documented. We measured the acute and chronic effects of oral metoclopramide on gastric liquid emptying in 12 diabetic patients with symptoms of stasis using scin...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/BF01318364
更新日期:1985-01-01 00:00:00
abstract::The wound-healing property of Preparation-H, a widely used over-the-counter hemorrhoidal product was investigated in a randomized, controlled, double-blind trial. Artificial ulcers were created in the rectum of 12 healthy male volunteers and the size of these ulcers followed until complete healing by visual examinatio...
journal_title:Digestive diseases and sciences
pub_type: 临床试验,杂志文章
doi:10.1007/BF01318426
更新日期:1984-09-01 00:00:00
abstract::Rabeprazole achieves more potent acid suppression than other proton pump inhibitors. Therefore it is administered at reduced as well as high dosages in eradication therapy for Helicobacter pylori; however, there is incomplete assessment of the efficacy of a reduced dosage of rabeprazole as might be employed in therapy...
journal_title:Digestive diseases and sciences
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s10620-005-2760-0
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Obesity is associated with a proinflammatory state. AIM:To determine whether obesity at diagnosis is a risk factor for Crohn's disease vs. ulcerative colitis and also vs. community controls and whether there is a U-shaped relationship between body mass index at diagnosis and risk of Crohn's disease versus u...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-010-1541-6
更新日期:2011-03-01 00:00:00
abstract::The evaluation of agents potentially accelerating gastric emptying in gastric stasis syndromes is time-consuming. Since a previous study showed that emptying is slowed after antecedent fat ingestion and intravenous cisapride abolishes this effect, we investigated whether emptying delayed by fat incorporated into a mea...
journal_title:Digestive diseases and sciences
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/BF01307519
更新日期:1991-09-01 00:00:00
abstract::Barrett's esophagus (BE) is intestinal metaplasia of the lower esophagus and a precursor lesion for esophageal adenocarcinoma (EAC). Both are important health issues as they have rising incidences in the Western world. Improving the management of BE relies on understanding the underlying biology of this disease, but t...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章,评审
doi:10.1007/s10620-016-4109-2
更新日期:2016-07-01 00:00:00
abstract::The present study investigated how reflux-induced esophagitis affects the smooth muscle reactivity of the esophageal body. Two different esophagitis models were used: acid gastric and mixed duodenogastric reflux. All test animals apart from the controls developed gross and histologic evidence of esophagitis. Contracti...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1023/b:ddas.0000004518.98825.6c
更新日期:2003-11-01 00:00:00
abstract::The molecular mechanisms of Helicobacter pylori associated tumor development are poorly understood. The spectra of genetic alterations in neoplasms may provide clues to the molecular carcinogenesis of a tumor and may be relevant for the prognosis of the patients. We investigated the p53 mutation pattern and the protei...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1023/a:1013275706401
更新日期:2002-01-01 00:00:00
abstract::Apoptosis is an important process in a wide variety of different biological systems. In addition to caspases, recently, calpains, another family of proteases, have been found to be involved in apoptosis of many cell systems. This study is designed with the aims to evaluate the possible effect of Z-LLY-FMK (a calpain i...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-008-0652-9
更新日期:2009-11-01 00:00:00
abstract::Heme oxygenase (HO)-1, the rate-limiting enzyme in heme degradation, is induced by oxidative stress and its major end product, bilirubin, is a potent physiological antioxidant. We studied the induction of HO-1 and bilirubin production in intestinal mucosa using a rat model of sepsis. E. coli lipopolysaccharide was adm...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1023/a:1005626622203
更新日期:2000-12-01 00:00:00
abstract::Two patients are presented having lymphomatous involvement of the central nervous system in whom dysphagia was the predominant symptom. All indicated studies failed to reveal evidence of direct esophageal involvement, and the dysphagia improved during treatment of the neural component. Esophageal manometric studies re...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/BF01311710
更新日期:1982-02-01 00:00:00
abstract::In 1958 the Yale freshman class gave blood samples as part of a study intended to determine the predictive value of plasma pepsinogen (PP) for the subsequent development of duodenal ulcer (DU). We report a long-term follow-up of this cohort. A self-administered questionnaire designed to ascertain information about the...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/BF01296515
更新日期:1986-11-01 00:00:00
abstract::The paraoxonase (PON) genes family maps to chromosome 7q21-q22, within a loci that also showed evidence of susceptibility genes for both Crohn's disease (CD) and ulcerative colitis (UC). In this case-control study we investigated the possible relationship between PON1 and PON2 polymorphisms and the risk of inflammator...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-006-9700-5
更新日期:2007-10-01 00:00:00
abstract::Esophageal diverticula can cause significant symptoms and affect the quality of life. There has been recent interest in the use of peroral endoscopic myotomy in the management of esophageal diverticula (D-POEM). In this meta-analysis, we have evaluated the efficacy and safety of D-POEM in the management of esophageal ...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章,评审
doi:10.1007/s10620-020-06678-5
更新日期:2020-10-29 00:00:00
abstract::It has previously been shown that mucosal nitric oxide synthase (NOS) is involved in acid-induced duodenal mucosal alkaline secretion. The primary aim of the present study was to elucidate which isoform of NOS is responsible in rats. Immunohistochemistry showed that inducible NOS (iNOS) was constitutively expressed in...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1023/a:1010674109111
更新日期:2001-08-01 00:00:00
abstract::Gallbladder dynamics, cholecystokinin (CCK), and pancreatic polypeptide (PP) release were studied in 14 patients with chronic pancreatitis (CP) (2 females, 12 males; age range 24-56 years) and 12 control subjects (4 females, 8 males, 21-50 years). On day 1, gallbladder contractility was investigated after ceruletide i...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/BF01316503
更新日期:1993-03-01 00:00:00
abstract::To date, tests of small intestinal passive permeability have involved the ingestion of test molecules whose permeation is assessed indirectly by measuring their urinary recovery. Excretion ratios of marker molecules (eg, lactulose-to-mannitol excretion ratio, LMER) are useful clinically. Measurement of permeability ma...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1023/a:1026679123148
更新日期:1999-02-01 00:00:00
abstract::In a Caucasian woman with a history of ocular and pulmonary sarcoidosis, the occurrence of sclerosing peritonitis with exudative ascites but without any of the well-known causes of this syndrome prompts us to consider that sclerosing peritonitis is a manifestation of sarcoidosis. The dramatic improvement that occurred...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/BF01299875
更新日期:1992-11-01 00:00:00
abstract:BACKGROUND AND AIMS:Irritable bowel syndrome (IBS) patients frequently complain of gas-related symptoms, and the lactulose breath test (LBT) is a test that assesses the amount of fermented gas generated by bacteria in the bowel. We aimed to assess the relationship among intestinal gas volume, LBT result, and gastrointe...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-011-1569-2
更新日期:2011-07-01 00:00:00
abstract::It is known that the muscularis mucosae and mucosa are not pharmacologically homogeneous throughout the rat colon. The aim of this study was to simultaneously characterize all three neurokinin (NK) receptors in the muscularis mucosae and mucosa along the length of the rat colon. Strips of proximal, mid, and distal col...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-006-3163-6
更新日期:2006-03-01 00:00:00
abstract::The effects of chronic normovolemic anemia on gastric microcirculation and gastric mucosal susceptibility to ethanol-induced gastric damage were investigated in anesthetized rats. Blood exchange by a plasma expander during four consecutive days rendered the animals anemic with a 34% decrease in the baseline hematocrit...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/BF02087418
更新日期:1994-04-01 00:00:00
abstract::The impact of treatment on progression of fibrosis in autoimmune hepatitis (AIH) is unknown. We assessed the changes in liver fibrosis before and after treatment among these patients. Nineteen AIH patients who had paired liver biopsies were studied. Of these, seven had been treated with 6 months of cyclosporine A and ...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-005-2472-5
更新日期:2005-03-01 00:00:00
abstract::The interaction of [35S]methionine with hepatic tRNA in normal, carcinogen-treated, and partially hepatectomized rats was studied. tRNA was preferentially labeled following [35S]methionine (1.6 mCi, 25 mg/kg body wt) administration by intraperitoneal injection. The extent of [35S]methionine-tRNA interaction was impair...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/BF01297152
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND AND AIM:Despite the limitations of screening or early diagnosis of colorectal cancers (CRC), carcinoembryonic antigen (CEA) is frequently measured in practice and during health promotion programs. The aim of this study was to evaluate the role of colonoscopy in healthy individuals with elevated CEA levels. ...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-011-1606-1
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:It is unclear whether the quality of bowel preparation affects colonoscopic detection of non-polypoid colorectal neoplasms (NP-CRNs). AIM:To evaluate the impact of bowel-cleansing quality on detection of NP-CRNs. METHODS:We performed a retrospective analysis of asymptomatic screening colonoscopy cases afte...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-015-3628-6
更新日期:2015-08-01 00:00:00
abstract::Patients with persistently normal ALT affected with HCV-related chronic hepatitis exist. The natural history of liver disease in these patients was demonstrated to be very slow and progression to cirrhosis likely absent. The case we report describes the occurrence of hepatocellular carcinoma (HCC) in a patient with pe...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1023/a:1020527118782
更新日期:2002-11-01 00:00:00
abstract:BACKGROUND:Flavonoids have been subjected to considerable investigations due to their antioxidant and anti-inflammatory properties. Yet the effects of flavonoids on the ileum and spleen against hepatic ischemia-reperfusion injury have so far not been addressed. AIMS:We aimed to investigate whether micronized purified ...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-009-1018-7
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:The chemokine SDF-1 and its receptor CXCR4 are essential for the proper functioning of multiple organs. In the liver, cholangiocytes and hepatic progenitor cells (HPCs) are the main cells that produce SDF-1, and SDF-1 is thought to be essential for HPC-stimulated liver regeneration. AIMS:In this study, CXCR...
journal_title:Digestive diseases and sciences
pub_type: 杂志文章
doi:10.1007/s10620-012-2239-8
更新日期:2012-11-01 00:00:00