We also excluded 517 patients randomized to peginterferon maintenance in order to eliminate a potential effect of maintenance peginterferon on clinical outcomes, although we found no effect of maintenance peginterferon on clinical outcomes in our prior analysis.9 Of the remaining 333 nonresponders who were randomized to the no-treatment (control) arm, 24 were excluded for the following reasons: 17 were not followed after randomization, six were treated with interferon outside of the HALT-C selleck compound Trial, and one had negative HCV RNA test results during the randomized phase of the HALT-C Trial. Thus,

the first comparison group consisted of 309 nonresponder patients randomized to the control arm of HALT-C Trial who were viremic and did not receive subsequent interferon. The second comparison group consisted of patients who had a breakthrough or relapse and who were randomized to the control arm

of the HALT-C Trial. Of the 80 patients in the BT/R group randomized to the control (untreated) arm, three were excluded for the following reasons: two were not followed after randomization, and one patient was treated with peginterferon and ribavirin outside of the HALT-C Trial. Thus, a total of 77 patients with BT/R who were randomized to the control arm and who remained viremic after randomization were included in this analysis. The beginning date for this analysis was Kinase Inhibitor Library nmr the day when patients began peginterferon and ribavirin treatment during the lead-in phase of the HALT-C Trial (August 2000

to January 2003). The end date for MCE公司 determination of clinical outcomes for the SVR patients was the day of their amended protocol study visit or telephone contact (September 2008 to March 2009). The date for assessment of blood tests for SVR patients was the day of the amended protocol study visit or the most recent laboratory tests from the patient’s medical records (for patients participating by telephone). For the NR and BT/R groups, clinical outcome data were included for the first 7.5 years of participation in the HALT-C Trial. The blood test results from the Month 72 visit for the NR and the BT/R groups were used for analysis of changes in blood tests because a larger number of patients had reached that time point (239 of 386) compared with the number available at the Month 84 visit (144 of 386). The median follow-up time for patients in the SVR group was 86 months, patients in the BT/R group was 85 months, and patients in the NR group was 79 months. Follow-up rates through Month 72 were 60% (185/309) in the NR group and 70% (54/77) in the BT/R group. The survival status of all patients was evaluated by searching the online U.S. Social Security Death Index (SSDI) (http://ssdi.rootsweb.ancestry.com), which is generated from the U.S. Social Security Administration’s Death Master File.

We performed a one-way sensitivity analysis to explore the impact of each variable on results. Analyses were done for survival of untreated patients, duration of sorafenib treatment, disease costs, discounting rate, and utilities. We also explored the impact of alternative survival distributions (lognormal, log-logistic, exponential) on the predicted survival probability. A Tornado diagram was used to represent and assess the relative weight of each variable on overall uncertainty in one-way sensitivity analyses. Parameter Poziotinib research buy uncertainty was dealt with by probabilistic sensitivity analysis using Monte Carlo simulation by randomly sampling a distribution of all variables 10,000 times and then

simulating outcomes. Results from the probabilistic sensitivity analysis were presented as a cost-effectiveness acceptability curve. To decide whether to perform an intervention it is necessary to choose a cost-effectiveness threshold: the amount of money that we are willing to spend to gain 1 year of life. There is no empiric evidence to support the choice of a particular

threshold. However, the cutoff worldwide considered plausible in high throughput screening the developed world is $50,000 (which corresponds to about €38,000). 12 BCLC, Barcelona Clinic Liver Cancer; HCC, hepatocellular carcinoma; ICER, incremental cost effectiveness ratio The results of our base-case analyses are shown in Tables 2 and 3, with the total costs versus LYG (Table 2) and QALY (Table 3) among the competing strategies. The BSC strategy costs €4,142 on average for BCLC B and C patients considered together. It was, therefore, the least expensive, but also the least effective, of the competing strategies. The introduction of sorafenib in the entire population of the SOFIA study at the

received mean dose of 696 mg/die increased the total cost significantly (€18,418), with a slight increase in effectiveness. Specifically, compared with BSC, the sorafenib treatment had an ICER of €47,796 for LYG and €58,456 for QALY. In the group of BCLC B HCC patients, the sorafenib treatment at the received mean dose of 705 mg daily had an ICER of €42,527 for LYG and of €55,242 medchemexpress for QALY. Instead, in the group of BCLC C HCC patients, the sorafenib treatment at the received mean dose of 682 mg daily had an ICER of €39,766 for LYG and of €48,009 for QALY. In the group of patients treated with a dose-adjusted of sorafenib for ≥70% of the treatment period who received an average dosage of 474 mg daily, the sorafenib treatment had an ICER of €29,469 for LYG and of €39,332 for QALY (ICER for QALY of €62,889 for BCLC B and of €31,585 for BCLC C patients). In the group of patients who maintained full dose or received dose-adjusted sorafenib for <70% of the whole treatment period (an average dosage of 748 mg daily), the sorafenib treatment had an ICER of €59,508 for LYG and of €65,296 for QALY (ICER for QALY of €52,655 for BCLC B and of €62,186 for BCLC C patients).

We performed a one-way sensitivity analysis to explore the impact of each variable on results. Analyses were done for survival of untreated patients, duration of sorafenib treatment, disease costs, discounting rate, and utilities. We also explored the impact of alternative survival distributions (lognormal, log-logistic, exponential) on the predicted survival probability. A Tornado diagram was used to represent and assess the relative weight of each variable on overall uncertainty in one-way sensitivity analyses. Parameter selleck inhibitor uncertainty was dealt with by probabilistic sensitivity analysis using Monte Carlo simulation by randomly sampling a distribution of all variables 10,000 times and then

simulating outcomes. Results from the probabilistic sensitivity analysis were presented as a cost-effectiveness acceptability curve. To decide whether to perform an intervention it is necessary to choose a cost-effectiveness threshold: the amount of money that we are willing to spend to gain 1 year of life. There is no empiric evidence to support the choice of a particular

threshold. However, the cutoff worldwide considered plausible in RG7420 cost the developed world is $50,000 (which corresponds to about €38,000). 12 BCLC, Barcelona Clinic Liver Cancer; HCC, hepatocellular carcinoma; ICER, incremental cost effectiveness ratio The results of our base-case analyses are shown in Tables 2 and 3, with the total costs versus LYG (Table 2) and QALY (Table 3) among the competing strategies. The BSC strategy costs €4,142 on average for BCLC B and C patients considered together. It was, therefore, the least expensive, but also the least effective, of the competing strategies. The introduction of sorafenib in the entire population of the SOFIA study at the

received mean dose of 696 mg/die increased the total cost significantly (€18,418), with a slight increase in effectiveness. Specifically, compared with BSC, the sorafenib treatment had an ICER of €47,796 for LYG and €58,456 for QALY. In the group of BCLC B HCC patients, the sorafenib treatment at the received mean dose of 705 mg daily had an ICER of €42,527 for LYG and of €55,242 medchemexpress for QALY. Instead, in the group of BCLC C HCC patients, the sorafenib treatment at the received mean dose of 682 mg daily had an ICER of €39,766 for LYG and of €48,009 for QALY. In the group of patients treated with a dose-adjusted of sorafenib for ≥70% of the treatment period who received an average dosage of 474 mg daily, the sorafenib treatment had an ICER of €29,469 for LYG and of €39,332 for QALY (ICER for QALY of €62,889 for BCLC B and of €31,585 for BCLC C patients). In the group of patients who maintained full dose or received dose-adjusted sorafenib for <70% of the whole treatment period (an average dosage of 748 mg daily), the sorafenib treatment had an ICER of €59,508 for LYG and of €65,296 for QALY (ICER for QALY of €52,655 for BCLC B and of €62,186 for BCLC C patients).

Mechanism

dissection studies suggested that knocking out AR in BM-MSCs led to improved self-renewal and migration by alteration of the signaling of epidermal growth factor receptor and matrix metalloproteinase 9 and resulted in suppression of infiltrating macrophages and hepatic selleck chemical stellate cell activation through modulation of interleukin (IL)1R/IL1Ra signaling. Therapeutic approaches using either AR/small interfering RNA or the AR degradation enhancer, ASC-J9®, to target AR in BM-MSCs all led to increased efficacy for liver repair. Conclusion: Targeting AR, a key factor in male sexual phenotype, in BM-MSCs improves ACP-196 price transplantation therapeutic efficacy for treating liver fibrosis. (HEPATOLOGY 2013;57:1550–1563) Chronic liver disease (CLD) with cirrhosis is the twelfth leading cause of death, with 27,555 deaths each year in the United States,1 and the 10-year mortality rate is 32%-66%,2 depending on the cause of the cirrhosis. Many factors may contribute to liver cirrhosis, including hepatitis B, hepatitis C, alcoholic liver disease, hepatotoxic drugs, and toxins. Among those factors, chronic alcoholism and hepatitis C are the most common causes to induce

cirrhosis in the western world. Because patients with liver cirrhosis may also develop hepatocellular MCE公司 carcinomas (HCCs),3 early treatment of liver cirrhosis with proper therapy will not only improve cirrhotic symptoms, but also prevent HCC incidence. Current treatment for liver cirrhosis is to prevent further damage of functional hepatocytes, and liver transplantation (LT) remains the standard treatment

for advanced liver cirrhosis. However, the efficacy of LT is limited by the availability of donor organs and several adverse effects, such as graft-versus-host disease, mental changes, and complications resulting from perioperation,4, 5 which all may complicate this therapy. Therefore, alternative therapeutic approaches, such as transplantation of hepatocytes, hematopoietic stem cells, endothelial progenitor cells, and bone marrow mesenchymal stem cells (BM-MSCs),6-10 may become other options. BM-MSC transplantation has been extensively studied in clinical trials. Clinical outcomes displayed short-term relief in liver function. But, unfortunately, long-term observations showed failure with recurring symptoms,11 and only low numbers of BM-MSCs finally migrated to the target liver, which could be the result of high apoptotic rates of BM-MSCs from microischemia.12 Therefore, improving self-renewal and survival of BM-MSCs may become a key step to improve the efficacy of using BM-MSCs to treat cirrhotic livers.

3, 4 Intrahepatic chemokines, such as the CCR5 ligands, RANTES (regulated on activation normal T cell expressed and secreted), macrophage

inflammatory protein (MIP)-1β and MIP-1α, and the CXCR3 ligand, IP-10, are elevated in HCV patients, and the levels of some of them are reported to correlate with the severity of liver inflammation.3-5 However, the cellular source and underlying mechanism of chemokine induction during HCV infection remain elusive.2 Toll-like receptor-3 (TLR3) and the retinoic inducible gene I (RIG-I)-like receptors (RLRs; RIG-I and melanoma differentiation-associated gene 5; MDA5) constitute two parallel classes of cellular sensors

Smoothened Agonist in vitro that recognize viral pathogen-associated molecular patterns (PAMPs) and initiate innate immune responses. Despite operating HER2 inhibitor via distinct adaptors and mechanisms, both pathways culminate in the activation of interferon regulatory factor-3 (IRF3)-dependent interferon (IFN) antiviral response and the production of nuclear factor kappa B (NF-κB)-dependent proinflammatory mediators. TLR3 and RLRs sense viral double-stranded RNA (dsRNA), a major viral PAMP, in endosomal and cytoplasmic compartments, respectively. RIG-I also recognizes viral RNAs bearing 5′-triphosphates.6 The importance of RLR and TLR3 pathways in innate immunity to HCV is suggested

by the fact that HCV encodes a serine protease, nonstructural protein (NS)3/4A, which inactivates both pathways by cleaving two adaptor proteins, mitochondrial antiviral signaling protein (MAVS) and Toll-interleukin (IL)-1 receptor homology domain containing adaptor-inducing interferon β (TRIF).7-10 Though much has been learned concerning how TLR3 and RIG-I pathways act to control MCE HCV replication through activating IRF3 and antiviral interferon-stimulated gene (ISG) expression,8, 11-13 little is known about the mechanisms governing the chemokine and proinflammatory cytokine response to HCV infection. A better understanding of the latter is crucial to broadening our knowledge on immune response to, and pathogenesis of, HCV and to design new effective immunotherapies for HCV. Here, we demonstrate that TLR3 senses HCV infection in cultured hepatocytes, leading to NF-κB activation and production of proinflammatory chemokines/cytokines previously reported in hepatitis C patients. Our study also defines the molecular features of HCV dsRNA that serves as the PAMP for TLR3.

In host tissues, cell walls in contact with the hyphae usually exhibited a few gold particles, whereas host cytoplasm and cell walls distant from the hyphae were free of labelling. Furthermore, over lignitubers in the infected

host cells labelling with gold particles was detected. No gold particles were found over sections of non-inoculated wheat roots. The results indicate that 1,3-β-glucanase secreted by Ggt may be involved in pathogenesis of the take-all fungus through degradation of callose in postinfectionally formed cell wall appositions, such as lignitubers. “
“In surveys to determine the occurrence and distribution of the ‘torrado’ disease (Tomato torrado virus, ToTV) in the main Spanish tomato growing areas from 2001 to 2008,

GSK-3 beta phosphorylation a total of 584 samples from symptomatic and asymptomatic plants were collected from 92 greenhouses. The tests showed that 451 plants from 85 greenhouses of different areas were infected with ToTV. The majority of the positive samples showed typical symptoms of the disease. However, plants showing different symptoms of necrosis and even asymptomatic plants were infected with the virus. Co-infection of ToTV with Pepino mosaic virus (PepMV) occurred in a large number of samples (60.5%), and several samples were infected with other tomato-infecting viruses, including Cucumber mosaic virus (CMV), Potato virus Y (PVY), Tomato spotted wilt virus (TSWV), Tomato selleck kinase inhibitor mosaic virus (ToMV), Parietaria mottle virus (PMoV), Tomato chlorosis virus (ToCV) and Tomato yellow leaf curl virus (TYLCV). Tomato apex necrosis virus (ToANV) was not detected in any of those samples with similar symptoms to those described for that virus. Additional tests revealed that (i) ToTV whitefly transmission is highly efficient and variety-dependent in tomato plants, (ii) Datura stramonium is another solanaceous species susceptible to this virus and (iii) the tissue-printing hybridization is a reliable technique which could facilitate the routine diagnosis and large-scale analysis of ToTV. “
“In the detection of plant pests, speed and accuracy

are vital. High-resolution melting curve (HRMC) analysis was therefore evaluated as a new tool for the identification of root-knot nematodes (Meloidogyne spp.). On the basis MCE of the second intergenic spacer (IGS2) region of the ribosomal DNA cistron, Meloidogyne chitwoodi, M. fallax and M. hapla were successfully distinguished from each other and the group of the three tropical species, M. incognita, M. arenaria and M. javanica. Conversely, it was shown that the IGS2 region is not suitable for the tropical species M. enterolobii (senior synonym of M. mayaguensis) as the amplification of multiple fragments of different lengths prevented a reliable HRMC analysis. However, the obtained results provide a proof of principle that HRMC analysis can be a suitable single-tube assay for fast and accurate root-knot nematode identification.

PURPOSE: The purpose of our study is to assess CNV profiles of CTCs and matched primary

tumor samples as biomarkers for malignant potential and risk of HCC recurrence. METHODS: Serum and tumor samples were collected from 100 patients over three years. Peripheral blood samples collected before, at the time of, and at multiple points after surgery were analyzed for CTCs. CTCs isolated from the peripheral blood were identified using a high definition CTC assay and primary tumor tissues were sampled as touch preps. The genomes of the isolated CTC and touch prep single cells STA-9090 were amplified and sequenced to determine genome wide CNV profiles (single cell genomic analysis). RESULTS: Presently, 45 patients have undergone total hepatectomy with liver transplantation and 16 partial hepatic resections for HCC with 3 episodes of recurrence to date. One patient recurred after partial hepatectomy and two after transplant. CTC levels varied between patients and at different times in the clinical course. Over 80% of CTCs and primary tumor cells identified were successfully isolated, and genetically amplified for CNV profiling. CNV profiles of different cell populations from the same patient often had similar mutation patterns. Some of those mutations identified have been

associated with more aggressive malignancy. CONCLUSION: We successfully demonstrated Galunisertib supplier the ability to perform high-content CNV analysis of single cells from primary HCC tumors and CTCs in patients with tumor recurrence following definitive surgical

therapy. The initial success of this pilot study suggests that CNV analysis of CTCs may prove beneficial in predicting risk of HCC recurrence after liver transplantation or resection. A comprehensive study to further investigate is currently underway. Disclosures: Kelly Bethel – Consulting: Epic Sciences, Inc; Stock Shareholder: Epic Sciences, Inc Peter Kuhn – Stock Shareholder: Epic Sciences The following people have nothing to 上海皓元医药股份有限公司 disclose: Jennifer Au, Angel E. Dago, Randolph L. Schaffer Background: Hepatocellular carcinoma (HCC) has a poor prognosis due to widespread intrahepatic and extrahepatic metastasis. There is a need to understand signaling cascades that promote disease progression. Aspartyl-(Asparaginyl) -β-hydroxylase (ASPH) is known to be overexpressed in human HCC and correlates with poor prognosis and survival following surgery. We developed a small molecule as an ASPH inhibitor and preclinically evaluated its efficacy for HCC in vitro and in vivo. Methods: Levels of ASPH expression were evaluated by immunohistochemistry (IHS) in human HCC tumors included dysplastic nodules and adjacent normal liver. Small molecule inhibitors (SMIs) were designed based on the crystal structure of the ASPH catalytic site followed by computer assisted drug design. In order to test candidate compounds for inhibition of β-hydroxylase activity, a CO2 capture assay was performed.

In several cases, there was also portal thrombosis. More recently, focal fibrous obliteration of small portal veins has been recognized in some of these cases.108 Most of those cases had a history of didanosine use, often over 2 years. The growing cumulative data is of concern for a possible new form

of liver toxicity of the drug. In a recent nested case-control study, the association of noncirrhotic portal hypertension with prolonged didanosine use was very robust.109 Interestingly, a report of ”fatal portal hypertension” had already been reported in 2001 by Australian investigators.110 Selleckchem Dactolisib The patient had been exposed to didanosine and stavudine for 14 months. Of concern, the subject had been off therapy for more than 2 years when he died due to variceal hemorrhage, suggesting that the changes in the liver leading to portal hypertension are irreversible. Further research is needed to sort out the link of didanosine (or dideoxynucleosides) with this complication, in particular, the question of which are the additional required predisposing factors. In this regard, several individuals in one of the case series of nodular regenerative hyperplasia had thrombophilic disorders.107 Nonalcoholic steatohepatitis (NASH) is the result of complex metabolic disturbances in which lipid and carbohydrate metabolysis pathways check details are altered.111 HAART has been shown to alter both metabolic systems.29

medchemexpress Although HAART-related NASH has thus far not been defined as a specific entity, there are data supporting the contribution of HAART to the development of liver steatosis which as a result can lead to inflammation and fibrosis.112 Steatosis in HIV-infected patients has been reported to be independently associated with the use of dideoxynucleosides and occasionally of other NRTIs.113-118 However, other studies have not found such an association.119, 120 NRTIs can cause mitochondrial toxicity and steatohepatitis in a condition reflective of diminished mitochondrial beta-oxidation of fatty acids.121, 122 In an in vitro study, incubation with high concentrations of stavudine

can rapidly induce accumulation of lipids within rat hepatocytes.123 However, some authors have found no correlation between mitochondrial function or DNA and the presence of NASH.112 Steatosis may be part of a metabolic syndrome associated with HAART. Thus, hyperglycemia, overweight, and insulin resistance have been associated with liver steatosis in treatment-experienced HIV-infected patients.112, 114 Several studies assessing liver histopathology have found NASH in more than half the HAART-treated HIV-infected patients who underwent liver biopsy due to chronic unexplained aminotransferase elevation, some of them also with lipodystrophy.112, 124, 125 Significant liver fibrosis, and even cirrhosis, has been recognized in some of those patients.

Clinical outcomes including complications, postoperative stay and readmissions were evaluated for 30 days postoperatively. Results: The median age of patients was 61 years (range 27–88). Forty patients (58%) were male. The most common indication for surgery

was malignancy (64 cases; 93%). Of these, 27 cases (42%) were rectal cancer. Sphincter-saving proctectomy was performed in 27 cases (35%), followed by sigmoidectomy 13 cases (19%) and right hemicolectomy 12 cases (17%). Abdominoperineal resection was performed in 5 cases (7%). Laparoscopic surgery was successfully performed in 18 cases (26%). The median postoperative EPZ-6438 supplier stay was 5 days (range 2–24). Complications occurred in 8 cases (12%) including 2 anastomotic leakages and 2 wound infections. Readmission was found in 2 cases selleck chemicals llc (3%; 1 early postoperative small bowel obstruction and 1 diarrhea). No mortality was reported in this study. Conclusion: In this single-surgeon experience with a fairly high proportion of open surgery, the postoperative stay of 5 days was achievable with an enhanced recovery program for colon AND rectal

surgery. The program reduced length of hospital stay with a low rate of complication and readmission. Key Word(s): 1. Colon surgery; 2. Rectal surgery; 3. Outcome; 4. Enhanced recovery; Presenting Author: LI SUN Additional Authors: FAN FENG, MENGBIN LI, JIANJUN YANG, LIU HONG, MAN GUO, DAIMING FAN, HONGWEI ZHANG Corresponding Author: DAIMING FAN, HONGWEI ZHANG Affiliations: Xijing Hospital of Digestive Diseases Objective: Thoracoscopic-laparoscopic esophagectomy (TLE) has been widely applied 上海皓元医药股份有限公司 for the treatment of esophageal cancer. Different kinds of patient position and ventilation have their own disadvantages. The aim of the present study is to evaluate the safety and efficacy of combination of TLE, single lumen tube, bilateral lung ventilation and semi-prone position in esophagectomy. Methods: From November 2010 to September 2012, a prospective group of 102 patients with resectable

esophageal squamous cell carcinoma (ESCC) and medically suitable for three stage esophagectomy were treated with TLE. Patients were intubated with single lumen tube for bilateral lung ventilation and set in semi-prone position. Results: TLE was attempted in all the patients. Ninety nine patients were treated with TLE, three patients underwent conversion to thoracotomy. The total operation time was 305.87 ± 35.86 min, total blood loss was 117.11 ± 39.06 ml, total lymph node dissection was 30.88 ± 8.78, mean postoperative stay was 9.58 ± 2.84 days. Postoperative morbidity occurred for 28 patients (27.45%), with 15 patients (14.71%) experiencing respiratory complications. One patient (0.98%) experienced mortality within 30 days after discharge. Only one patient (0.

As IBD affects young adults, fertility and pregnancy must be considered. Active UC reduces fertility through inflammation effects on the female reproductive system and previous surgery, and sulphasalazine can induce AZD0530 cost reversible decrease in sperm motility in men.176–178 Clinical remission

is recommended prior to conception and maintenance of remission during pregnancy is the goal during pregnancy to reduce feto-maternal complications. Active flares during pregnancy need to be treated aggressively using drugs established to be safe in pregnancy. Corticosteroids tend to be safe in pregnancy as placental 11-hydroxygenase converts steroids to less active metabolites. Although spontaneous abortion and congenital cleft palate are risks with corticosteroids in animals, no increase in congenital malformations in humans have been found.179 Fecundity and surgery is discussed in statement 30. Drugs that absolutely need to be avoided during pregnancy are methotrexate and thalidomide. Breastfeeding.  MK0683 mw 5-ASA and corticosteroids are safe with breastfeeding. Recommendation is to avoid breastfeeding for

4 h following per oral drug administration to reduce neonatal exposure to drugs.179 Azathioprine metabolites have not been found in babies exclusively breastfed by mother receiving thiopurines.180 Therefore most clinicians believe that women should not stop a thiopurine when breastfeeding. There medchemexpress is some evidence that breast-feeding for at least 6 months reduces an infant’s risk of developing both CD and UC therefore the decision to breast feed needs to take this into consideration.78 Co-management with an obstetrician experienced in managing IBD is recommended. Nutrition.  Up to 85% of patients hospitalized with exacerbations of IBD have protein-calorie malnutrition.181 Osteoporosis.  Systemic inflammation secondary to active colitis and recurrent or chronic use of high dose corticosteroids are risk factors for osteoporosis, which may increase fracture risk. Osteopenia and osteoporosis are common in Asian patients with IBD.182 Optimal nutrition, calcium and vitamin D intake, weight bearing exercise, cessation

of smoking, moderation of alcohol consumption, and minimization of the use of corticosteroids are recommended. A review of diet by a dietician is recommended. Patients with established osteoporosis should be referred to an endocrinologist or rheumatologist. When indicated, the gold standard elective surgery for ulcerative colitis is restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) and this should be performed in a specialized centre. Level of agreement: a-67%, b33%, c-0%, d-0%, e-0% Quality of evidence: III Classification of recommendation: C Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) offers patients an unchanged body image with no stoma, a preserved anal route of defecation and good postoperative quality of life.