ObjectiveTo compare the short-term efficacy of laparoscopic transanal pull through surgery and conventional laparoscopic surgery for rectal cancer.MethodsRelevant literatures were retrieved from databases including PubMed, Cochrane Library databases, Embase, CNKI, CBM, Wan-fang database, and VIP databases from Jan. 2009 to Jul. 2019, all the relevant trial documents ［included randomized controlled trial and non randomized controlled trial］ were collected for comparison of laparoscopic transanal pull through surgery and conventional laparoscopic surgery on the clinical efficacy of rectal cancer patients, the qualified literatures were screened in strict accordance with inclusion and exclusion criteria, and Stata12.0 software was used for statistical analysis.ResultsA total of 19 articles were included in the literature with 2 683 patients were included among them. Meta analysis results showed that, compared with the conventional laparoscopic surgery group, in laparoscopic transanal pull through surgery group, operation time [WMD=–6.78, 95% CI was (–11.96, –1.60), P<0.01], intraoperative blood loss [WMD=–14.94, 95% CI was (–23.48, –6.40),P<0.01], postoperative exhaust time [WMD=–13.55, 95% CI was (–18.24, –8.85), P<0.01], postoperative hospitalization time [WMD=–1.60, 95% CI was (–2.00, –1.21), P<0.01], incidence of postoperative overall complication [OR=0.50, 95% CI was (0.38, 0.67), P<0.01], and incidence of incision infection [OR=0.19, 95% CI was (0.08, 0.45), P<0.01] reduced. Those differences were not significant, such as intraoperative lymph node resection [WMD=–0.02, 95% CI was (–0.44, 0.40), P=0.92], incision margin distance of tumor [WMD=0.13, 95% CI was (–0.30, 0.55), P=0.56], and incidence of anastomotic fistula [OR=0.97, 95% CI was (0.62, 1.50), P=0.87].ConclusionsLaparoscopic transanal pull through surgery has more safe, effective, and reliable effects than conventional laparoscopic surgery for rectal cancer. It has further research value, but there may be inevitable bias and other effects in the included literatures, so more randomized controlled clinical trials are needed in the future.
ObjectiveTo investigate the clinical characteristics of polymyositis (PM)/dermatomyositis (DM) with acute interstitial pneumonia (AIP) as the presenting symptoms, and identify characteristics of such disease. MethodsA retrospective analysis was conducted on the hospitalized patients with PM/DM with AIP as the presenting symptoms, from October 2009 to June 2015 in the Departemnt of Respiratory Medicine, Guangzhou Institute of Respiratory Diseases. ResultsThey were two males and six females with a mean age of 54.8±7.5 years. The common clinical features included fever (8 cases), shortness of breath (8 cases), rapidly progressive exertional dyspnea (8 cases), dry cough (6 cases), decreased muscle strength (8 cases), and typical rash (7 cases). Electromyography showed neurogenic or myogenic leision in these 8 cases. Muscle biopsy revealed myositis in 7 cases. High resolution CT (HRCT) revealed widespread ground glass patterns in all patients. All patients received noninvasive positive pressure mechanical ventilation on the first hospital day. High dose of methylprednisolone or combination with intravenous cyclophosphamide were initiated on 2.3±1.4 hospital day. Six patients survived to hospital discharge and two patient died. ConclusionsThe most common symptoms in patients of PM/DM with AIP are shortness of breath, progressive exertional dyspnea, and dry cough. Typical rash is seen in most of the patients.The diagnosis can be established by combinating the characteristics of HRCT, electromyography and muscle biopsy. Earlier intervention with noninvasive positive pressure mechanical ventilation and immunosuppressive may improve clinical outcome in patients of PM/DM with AIP.
Objective In vivo, the microenvironment of epidermal stem cells (ESCs) is complex, and estrogen might be involved in the micro environment. To investigate the biological effects of estrogen on the prol iferation and migration of ESCs in vitro. Methods hESCs were isolated from normal human foreskin and cultured. The second generation of hESCs were identified with flow cytometry after being marked with integrin β1, cytokeratin 19 (CK19), CK14, and CK10 antigens.hESCs of 2 × 106 cell density were cultured with ESCs special medium supplemented with 0.1 nmol/L Diethylstilbestrol in group A (estrogen group), with ESCs special medium supplemented with 10 nmol/L Raloxifene hydrochloride in group B (ER blocking agent group), and with ESCs special medium in group C (control group), respectively. The 100 μm “scratch” wounds were created by scraping confluent hESCs plated on Petri dishes with a sterile pipette tip in vitro. The migrating cells from the wound edge were quantified at 24, 48, and 72 hours after incubation. The rates of wound heal ing were calculated by SigmaScan Pro 5.0 software at 72 hours. The prol iferating effect of estrogen on hESCs was determined with MTT method at 24, 48, 72, 96, and 120 hours. Results Cultured primary hESCs could adhere to the wall showing ovoid in shape and grew into colonies. Flow cytometry showed the positive results for integrin β1, CK19, and CK14 (with positive rate of 96.63%, 95.47%, and 94.27%, respectively) and the negative result for CK10 (with positive rate of 1.32%). In group A, the number of cells crossing the wound edge was more than those of group B and group C at 24, 48, and 72 hours. The rates of wound heal ing were 69.00% ± 0.05% in group A, 35.00% ± 0.05% in group B, and 48.00% ± 0.06% in group C at 72 hours, showing significant differences among groups (P lt; 0.05). The prol iferating speed of hESCs was significantly higher in group A than in groups B and C (P lt; 0.01), and significantly higher in group C than in group B (P lt; 0.01) at 24, 48, 72, 96, and 120 hours. Conclusion The estrogen can promote the prol iferation and migration of hESCs in vitro. It may be involved in many biological activity of skin.
[Abstract]Currently, there is no high-level evidence to support the benefit of postoperative adjuvant therapy for patients with resectable esophageal squamous carcinoma. By reviewing existing studies, this article analyzes the role of postoperative adjuvant therapy in resectable esophageal squamous carcinoma from four aspects, namely, the contradiction between the needs of clinical practice and the guidelines, the evolution of postoperative adjuvant therapy, the progress of the research on high-risk factors, and the outlook for the future, and elaborates on the high-risk factors that can be used as screening for postoperative adjuvant therapy. Thus, it provides reference for individualized and precise treatment of resectable esophageal squamous carcinoma.
ObjectiveTo evaluate the difference between the tracheal intubation connected to conventional ventilation (TI-CV) and rigid bronchoscopy connected to high frequency ventilation (RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy (TBCB).MethodA prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate, blood pressure and arterial blood gas analysis were collected and analyzed.ResultsSixty-five patients were enrolled. There were 33 patients with an average age of (48.0±15.0) years in TI-CV group and 32 patients with an average age of (48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function (FEV1, FVC and DLCO), arterial blood gas (pH, PaO2 and PaCO2) and heart rate (HR), mean arterial pressure (MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was (7.34±0.06) and (7.26±0.06), and the PaCO2 was (48.82±9.53) and (62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P=0.000). At the end of operation, the pH was (7.33±0.06) and (7.21±0.08), the PaCO2 was (48.91±10.49) and (70.93±14.83) mm Hg, the HR were (79.6±21.1) and (93.8±18.7) bpm, the MAP were (72.15±13.03) and (82.63±15.65) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was (47.4±8.8) and (53.3±11.6) min with significant difference (P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO2, PaCO2, HR and MAP between two groups. No serious complications occurred in either group.ConclusionsCompared with rigid bronchoscopy, TI-CV under general anesthesia is more conducive to maintain effective ventilation, and maintain the HR and MAP stable during the TBCB procedure. TBCB procedure should be performed by TI-CV under general anesthesia in patients with poor cardiopulmonary function.
ObjectiveTo investigate the impact and mechanism of over-expression microRNA-92a (miR-92a) in clinicopathologic feature and prognosis of patients with colorectal cancer (CRC). MethodsThe expression levels of miR-92a and phosphatase and tensin homologue (PTEN) gene in 108 cases of colorectal cancer tissues were detected by using real-time fluorescent quantitative PCR (RT-PCR), and they were categorized as low or high in relation to the median value. Then the association between different levels of miR-92a gene expression and clinicopathologic feature and prognosis of CRC patients were evaluated. Moreover, the relationship between the expressions of miR-92a and PTEN gene were analyzed. ResultsHigh expression of miR-92a not only associated with lymph node metastasis (χ2=8.045, P=0.007), distant metastasis (χ2=5.708, P=0.030), and TNM staging (χ2=6.366, P=0.019) of CRC patients, but also related to the down-regulated of PTEN gene expression (χ2=21.333, P < 0.001). However, up-regulated miR-92a expression was negatively correlated with age, gender, tumor size, tumor location, depth of invasion and tumor differentiation. In addition, Kaplan-Meier survival curves showed that over-expression of miR-92a and low-expression of PTEN gene could potentially predict poor overall survival of CRC patients. ConclusionThe high expression of miR-92a can lead to a poor clinical prognosis of CRC patients through decreasing the expression level of PTEN gene.
Objective To investigate the effect of postoperative recovery between trans-abdominal drainage and trans-perineum drainage in patients with rectal cancer. Methods The randomized controlled trials which were related with the comparison between trans-abdominal drainage and trans-perineum drainage of rectal cancer patients were searched from January 2006 to January 2016, and then a meta-analysis was performed by using RevMan 5.2 software, basing on the data obtained from PubMed, CBM, CNKI, WanFang, and VIP database. Results The results of meta-analysis showed that, in the aspect of postoperative drainage, there was no significant difference in the postoperative drainage duration 〔MD=–0.03, 95% CI is (–1.63, 1.57), P=0.97〕 , volume of drainage liquid 〔MD=–9.53, 95% CI is (–104.95, 85.90), P=0.84〕 , and extubation time 〔MD=0.25, 95% CI is (–0.31, 0.82), P=0.38〕 between the trans-abdominal drainage group and the trans-perineum drainage group. In terms of postoperative infection, the trans-abdominal drainage could effectively reduce the incidence rate of drainage tube incision infection 〔OR=0.32, 95% CI is (0.21, 0.48), P<0.000 01〕 . However, there was no significant difference in the abdominal incision infection 〔OR=0.84, 95% CI is (0.51, 1.36), P=0.48〕 and pelvic infection 〔OR=0.77, 95% CI is (0.52, 1.15), P=0.20〕 . In addition, compared to the trans-perineum drainage, the trans-abdominal drainage could shorten the time of pain in drainage 〔MD=–5.07, 95% CI is (–6.96, –3.17), P<0.000 01〕 . But, there was no significant difference in the duration of hospitalization 〔MD=0.82, 95% CI is (–0.39, 2.03), P=0.19〕 , incidence of anastomotic bleeding 〔OR=0.95, 95% CI is (0.58, 1.54), P=0.82〕 , and incidence of anastomotic leakage 〔OR=1.33, 95% CI is (0.93, 1.92), P=0.12〕 between the two groups. Conclusion The trans-abdominal drainage could obviously decrease the incidence of drainage tube incision infection and shorten the time of pain in drainage, so it may promote the postoperative rehabilitation of rectal cancer patients.
Objective To investigate the difference of effect between laparoscopic and open surgery in patients with traumatic rupture of spleen. Methods The literatures on comparison of laparoscopic and open surgery in patients with traumatic rupture of spleen were retrieved in PubMed, Web of Science, CNKI, Wanfang, and VIP databases from Jan. 2007 to Jan. 2017, and then Stata 12.0 software was applied to present meta-analysis. Results ① The condition during operation: compared with the OS group, operative time of the LS group was shorter [SMD=–0.71, 95% CI was (–1.12, –0.30), P=0.001] and intraoperative blood loss of the LS group was less [SMD=–1.53, 95% CI was (–2.28, –0.78), P<0.001]. ② The postoperative condition: compared with the OS group, the postoperative anal exhaust time [SMD=–2.47, 95% CI was (–3.24, –1.70), P<0.001], postoperative ambulation time [SMD=–2.97, 95% CI was (–4.32, –1.62), P<0.001], and hospital stay [SMD=–1.68, 95% CI was (–2.15, –1.21), P<0.001] of the LS group were all shorter. ③ The overall incidence of complications and the incidence of complications: on the one hand, compared with the OS group, patients in the LS group had a lower overall incidence of postoperative complications [OR=0.29, 95% CI was (0.19, 0.43), P<0.001]. On the other hand, compared with the OS group, patients in the LS group had lower incidences of infection [OR=0.27, 95% CI was (0.13, 0.55), P<0.001], ascites [OR=0.36, 95% CI was (0.13, 1.00), P=0.049], bleeding [OR=0.29, 95% CI was (0.10, 0.90), P=0.032], ileus [OR=0.34, 95% CI was (0.13, 0.90), P=0.030], incision fat liquefaction [OR=0.27, 95% CI was (0.08, 0.94), P=0.040], and incision rupture [OR=0.17, 95% CI was (0.03, 0.96), P=0.045]. However, there was no statistical difference on splenectomy fever [OR=0.41, 95% CI was (0.13, 1.27), P=0.123], pancreatic fistula [OR=0.40, 95% CI was (0.06, 2.63), P=0.343], liver function lesion [OR=0.36, 95% CI was (0.10, 1.34), P=0.127], and thrombosis [OR=0.33, 95% CI was (0.09, 1.22), P=0.097] between the 2 groups. Conclusions Laparoscopic surgery can not only significantly reduce the incidence of multiple complications of traumatic rupture of spleen, but also can speed up the recovery rate of postoperative recovery. Therefore, it is safe and beneficial in treatment of patients with traumatic rupture of spleen.
ObjectiveTo research the effect of different surgical sutures on abdominal surgical incision healing quality, and provide a novel theory basis for promoting the healing of incision of abdominal wall. MethodsTotally 341 patients who underwent laparotomy were collected from general surgery of Affiliated Hospital of North Sichuan Medical College, and they were randomly divided into three groups: the including polydioxanoneⅡ(PDSⅡ) suture group, abdominal wall incision except the skin was successively sutured with PDSⅡsuture; the Vicryl group, abdominal wall incision except the skin was successively suture with antibacterial Vicryl; and the common silk thread group, abdominal wall incision was performed layering intermittent silk suture. ResultsIn terms of suture time, the PDSⅡsuture group [(11.23±1.62) min〕was significantly lower than the Vicryl group [(14.04±1.20) min〕, P < 0.05, and also both were significantly lower than the ordinary silk thread group [(21.95±1.95) min〕, P < 0.05. In respect of rejection reaction, incision infection and incision split, the PDSⅡsuture group and the Vicryl group were significantly lower than the ordinary silk thread group (P < 0.05), but compared the PDSⅡsuture group with the Vicryl group, the differences were not statistically significant (P > 0.05). Regarding post operation hospitalization duration, fat liquefaction and effusion, compared the differences between the three groups were not statistically significant (P > 0.05). ConclusionFull fascia is successively suture with PDSⅡsutures and antibacterial Vicryl suture that can significantly shorten the suture time, reduce the incidence of rejection incision, wound infection and wound dehiscence and promote the postoperative recovery of the patients.