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In colorectal cancer surgery, loop ileostomy is sometimes necessary to prevent anastomotic leakage. Although ileostomy reversal is relatively simple, postoperative complication is inevitable. In recent years, laparoscopic surgery has been gradually applied in ileostomy reversal due to its small trauma, fast recovery, and low complications, exhibiting satisfactory short-term outcomes. This review analyzes the application of the laparoscopic technique in ileostomy surgery and explores the potential of total laparoscopic surgery, aiming to provide a new perspective for the clinical application of laparoscopic ileostomy reversal.
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Background & objectives: Data on neonatal COVID-19 are limited to the immediate postnatal period, with a primary focus on vertical transmission in inborn infants. This study was aimed to assess the characteristics and outcome of COVID-19 in outborn neonates. Methods: All neonates admitted to the paediatric emergency from August 1 to December 31, 2020, were included in the study. SARS-CoV-2 reverse transcription- (RT)-PCR test was done on oro/nasopharyngeal specimens obtained at admission. The clinical characteristics and outcomes of SARS-CoV-2 positive and negative neonates were compared and the diagnostic accuracy of a selective testing policy was assessed. Results: A total of 1225 neonates were admitted during the study period, of whom SARS-CoV-2 RT-PCR was performed in 969. The RT-PCR test was positive in 17 (1.8%). Mean (standard deviation) gestation and birth weight of SARS-CoV-2-infected neonates were 35.5 (3.2) wk and 2274 (695) g, respectively. Most neonates (11/17) with confirmed COVID-19 reported in the first two weeks of life. Respiratory distress (14/17) was the predominant manifestation. Five (5/17, 29.4%) SARS-CoV-2 infected neonates died. Neonates with COVID-19 were at a higher risk for all-cause mortality [odds ratio (OR): 3.1; 95% confidence interval (CI): 1.1-8.9, P=0.03]; however, mortality did not differ after adjusting for lethal malformation (OR: 2.4; 95% CI: 0.7-8.7). Sensitivity, specificity, accuracy, positive and negative likelihood ratios (95% CI) of selective testing policy for SARS-CoV-2 infection at admission was 52.9 (28.5-76.1), 83.3 (80.7-85.6), 82.8 (80.3-85.1), 3.17 (1.98-5.07), and 0.56 (0.34-0.93) per cent, respectively. Interpretation & conclusions: SARS-CoV-2 positivity rate among the outborn neonates reporting to the paediatric emergency and tested for COVID-19 was observed to be low. The selective testing policy had poor diagnostic accuracy in distinguishing COVID-19 from non-COVID illness.
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Objective: At present, though the laparoscopic delta-shaped anastomosis and overlapping delta-shaped anastomosis have been gradually applied to complete laparoscopic radical resection of left hemicolon cancer, the comparative evaluation of their efficacy has not been mentioned in the published literatures. This study aims to explore the safety, feasibility and short-term efficacy of overlapping delta-shaped anastomosis (ODA) in totally laparoscopic left hemicolectomy. Methods: A retrospective cohort study was performed. The clinical and pathological data of patients who underwent totally laparoscopic left hemicolectomy at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2017 to October 2020 were retrospectively analyzed. The case inclusion criteria were as follows: (1) age of 18-75 years; (2) body mass index (BMI) of 18.5-30 kg/m(2); (3) descending colonic and proximal sigmoid colonic adenocarcinoma was confirmed by preoperative colonoscopy and pathology. The exclusion criteria: (1) multiple primary colorectal cancers; (2) uncontrolled or poorly controlled diabetes mellitus, immune system diseases, or hematological diseases; (3) severe intestinal obstruction; (4) left transverse colonic or splenic flexure colonic adenocarcinoma; (5) distant metastasis of liver, lung and other viscera determined by enhanced computed tomography in the chest, abdomen and pelvis. According to the above criteria, a total of 115 patients with left hemicolon cancer were enrolled. All the patients underwent totally laparoscopic left hemicolectomy. Patients who underwent laparoscopic traditional delta-shaped anastomosis were selected as the control group. Patients who underwent laparoscopic ODA were selected as the ODA group. Effects of these two laparoscopic reconstruction methods on postoperative recovery and perioperative complications were analyzed and compared. Results: A total of 60 patients were enrolled in the ODA group, including 32 males and 28 females, with mean age of (57.3±10.4) years and body mass index (BMI) of (25.0±3.1) kg/m(2). While mean 55 patients were enrolled in the control group, including 31 males and 24 females, with mean age of (56.7±9.9) years and BMI of (24.4±2.9) kg/m(2). There was no statistically significant differences between the two groups in gender, age, BMI, American Society of Anesthesiologist (ASA) classification, TNM staging, preoperative abdominal surgery history, neoadjuvant chemotherapy and nutritional status (levels of hemoglobin, lymphocyte count, prealbumin, and albumin) (all P>0.05). All the patients in both groups received R0 resection without conversion to open laparotomy or conversion to extra-abdominal anastomosis. The digestive tract reconstruction time of the ODA group was significantly shorter than that of the control group [(15.1±1.7) minutes vs. (15.9±2.4) minutes, t=-2.053, P=0.042]. There were no statistically significant differences in the total operation time, intraoperative blood loss, length of skin incision, tumor size, proximal and distal margins, harvested lymph nodes, postoperative first ambulatory time, and postoperative hospital stay (all P>0.05). However, the time to the first flatus and the first defecation in the ODA group was significantly shorter as compared to control group [(1.5±0.5) days vs. (1.7±0.5) days, t=-2.028, P=0.045; (3.1±0.6) days vs. (3.4±0.7) days, t=-2.095, P=0.039], indicating faster intestinal function recovery in patients with ODA. The morbidity of postoperative complication was 6.7% (4/60) in the ODA group and 7.3% (4/55) in the control group and no significant difference was found (χ(2)=0.016, P=0.898). Two cases of incision infection, 1 case of lung infection, and 1 case of intra-abdominal infection occurred in the ODA group, while 3 cases of lung infection and 1 case of intra-abdominal infection occurred in the control group. All these complications were resolved after conservative treatment, and no secondary operation was performed due to complications. Conclusion: Compared with the traditional delta-shaped anastomosis, ODA is associated with a faster recovery of postoperative intestinal function without increasing the morbidity of postoperative complications, and has the satisfactory short-term efficacy.
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Anastomosis, Surgical , Colectomy , Laparoscopy , Retrospective Studies , Treatment OutcomeABSTRACT
Cetuximab has become an important molecular targeted drug for the treatment of metastatic colorectal cancer (mCRC), which increases the curative effect of chemotherapy and prolongs the survival time. However, some patients develop insensitiveness or resistance to cetuximab, while the complicated molecular mechanisms are not quite clear. With the deep research in epidermal growth factor receptor (EGFR) signaling pathway, the genetic alteration of KRAS, BRAF, PTEN and PIK3CA and polymorphism of microRNA (miRNA) have been proved to associated with cetuximab resistance. Wnt signaling pathway with its negative regulator RNF43 is also considered to be related with cetuximab resistance in recent studies. The review of the progress on molecular mechanisms of cetuximab resistance in mCRC can establish theoretical basis for finding out reasonable drugs to overcome the resistance.
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Background@#In worldwide, 16.9 million cases of stroke were reported in 2010. It has increased by 68% since 1990. In 2016, there were 5.5 million deaths attributable to cerebrovascular disease worldwide (2.7 million deaths from ischemic stroke and 2.8 million deaths from hemorrhagic stroke). Furthermore, dysphagia is one of the most common complication and occurs 35-78% of patients with stroke. Specifically, dysphagia occurs in 51-100% of the brain stem stroke patients. Moreover, it could be the independent factor to predict mortality. In other words, it directly impacts the quality of life and decreases social activity. </br> Incidence of cardiovascular disease and stroke have been increasing related to instability of economy, urbanization, bad lifestyle and stress. As a result of that, dysphagia has increased as well and is becoming one of the pressing issue of health care. It results malnutrition and prolonged the hospital stays. Unfortunately, its diagnosis and treatment are still not clearly defined yet. </br> Many researchers have investigated patients’ treatment outcome using a single treatment. In other word, researchers have studied the comparison of the separate results of electric stimulation and traditional swallowing therapies. In this study, we studied the results of combination therapy of traditional swallowing and muscle stimulation, and we aimed to identify the benefits of the combined therapeutic approach and to propose the effective, non-invasive methods for patients.@*Objective@#We aimed to study treatment outcome and quality of life among stroke patients with dysphagia.@*Material and Methods@#The study was conducted on a hospital-based, cross-sectional method. Study participants were obtained from Affiliated Hospital of Inner Mongolian University for the Nationalities between July 2018 and March 2019. All patients were divided into the three treatment groups. 150 dysphagic patients were evaluated by Swallowing Related Quality of Life (SWL-QOL) Scale before and after the treatment.@*Results@#In total, 150 participants (mean age=59.70±9.55 years) aged between 34-77 were obtained in this study. There were no statistically significant differences between the three groups in age (p=0.609).The data showed statistically significant positive treatment effect for all three groups (p=0.0001).The SWAL-QOL score was 39.25±3.50 in A group, 39.10±3.54 in B group, 42.12±4.55 in C group after the treatment. The SWAL-QOL score shows statistically significant difference, after the treatment (p=0.0001). @*Conclusions@#Rehabilitation treatment combined with neuromuscular electrical simulation appears better outcome than nerve or muscular stimulation combined with rehabilitation among stroke patients with dysphagia.
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Objective@#To explore the clinical safety and feasibility of enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma.@*Methods@#From May 1, 2017 to May 1, 2018, 46 patients who underwent laparoscopic-assisted radical resection for rectal carcinoma with enterostomy using running suture of dermis and seromuscular layer in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively enrolled in this study. Data regarding clinicopathologic characteristics, operation and postoperative outcomes, stoma-related complications and functions of stoma were collected and analyzed.@*Results@#All of the 46 patients successfully underwent this operation. Among them, 30 patients underwent laparoscopic-assisted abdominoperineal resection for rectal cancer with sigmoidostomy and 16 patients underwent laparoscopic-assisted low anterior resection for rectal cancer with loop ileostomy. The mean operation time was 115.3 minutes and intraoperative blood loss was 86.1 ml. The mean time for enterostomy was 14.1 minutes. The average time to flatus, time to fluid diet intake and length of hospital stay were 1.8 days, 2.9 days and 6.5 days, respectively. During the follow-up period, three patients suffered from stomal edema, two patients suffered from parastomal hernia, and two patients suffered from skin inflammation surrounding stoma. None of re-operation related stoma and severe mobility such as stomal stenosis, stomal necrosis, stomal prolapse, stomal retraction and stomal mucocutaneous separation occurred. Thirty-five patients recovered with satisfactory stomal function, two with middle function and one with poor function.@*Conclusion@#Enterostomy using running suture of dermis and seromuscular layer in laparoscopic-assisted radical resection for rectal carcinoma is a safe and feasible procedure with a satisfactory short-term effect.
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Objective@#The aim of this study was to explore the clinical safety, feasibility and short-term effect of overlapped delta-shaped anastomosis in total laparoscopic transverse colectomy.@*Methods@#The records, which were based on China National Cancer Center, of 20 and 31 patients who underwent total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis and laparoscopic-assisted transverse colectomy with conventional extracorporeal anastomosis, from March 2017 to May 2018 were reviewed retrospectively. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications were collected and compared.@*Results@#There was no difference between the two groups in overall operation time, anastomosis time and intraoperative blood loss (P>0.05), however, the length of incision was significantly shorter in overlapped delta-shaped group [(4.7±0.6) cm vs. (5.5±1.0) cm, P=0.002]. The time to ground activities, first flatus and postoperative hospitalization did not differ between the two groups (P>0.05). The postoperative visual analogue scale was lower in the overlapped delta-shaped group than the control group on postoperative day 1 (3.7±0.7 vs. 4.2±0.9, P=0.015) and postoperative day 3 (2.7±0.5 vs. 3.2±0.9, P=0.040). The perioperative complication rates were 10.0% and 12.9% in the overlapped delta-shaped group and the control group, respectively, and the difference was not significant (P=0.753).@*Conclusion@#Compared to conventional extracorporeal anastomosis, total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis was a safe and feasible procedure with satisfactory short-term effect, shorter incision and less postoperative pain.
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Objective@#The aim of this study was to explore the clinical safety, feasibility and short-term effect of overlapped delta-shaped anastomosis in total laparoscopic transverse colectomy.@*Methods@#The records, which were based on China National Cancer Center, of 20 and 31 patients who underwent total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis and laparoscopic-assisted transverse colectomy with conventional extracorporeal anastomosis, from March 2017 to May 2018 were reviewed retrospectively. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications were collected and compared.@*Results@#There was no difference between the two groups in overall operation time, anastomosis time and intraoperative blood loss (P>0.05), however, the length of incision was significantly shorter in overlapped delta-shaped group [(4.7±0.6) cm vs. (5.5±1.0) cm, P=0.002]. The time to ground activities, first flatus and postoperative hospitalization did not differ between the two groups (P>0.05). The postoperative visual analogue scale was lower in the overlapped delta-shaped group than the control group on postoperative day 1 (3.7±0.7 vs. 4.2±0.9, P=0.015) and postoperative day 3 (2.7±0.5 vs. 3.2±0.9, P=0.040). The perioperative complication rates were 10.0% and 12.9% in the overlapped delta-shaped group and the control group, respectively, and the difference was not significant (P=0.753).@*Conclusion@#Compared to conventional extracorporeal anastomosis, total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis was a safe and feasible procedure with satisfactory short-term effect, shorter incision and less postoperative pain.
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Objective@#This study aims to explore the clinical value of fusion indocyanine green fluorescence imaging (FIGFI) in total laparoscopic radical resection for right colon cancer.@*Methods@#From October, 2018 to December, 2018, 15 patients who underwent total laparoscopic radical resection for right colon cancer using FIGFI in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively enrolled in this study. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and complications were collected and analyzed.@*Results@#All patients successfully underwent total laparoscopic radical resection for right colon cancer using FIGFI. 1 patients (6.7%) received extended resection of bowel due to poor blood supply after mesentery excision. The average operation time was 133.7 minutes and intraoperative blood loss was 26.7 ml. The average time to ground activities, fluid diet intake, first flatus and postoperative hospitalization were 19.1 h, 11.7 h, 32.5 h and 5.0 d, respectively. The average length of tumor was 4.5 cm. The average proximal and distal resection margins were 14.9 cm and 12.1 cm, respectively. The average number of lymph nodes retrieved was 29.3 per patient. Only one patient suffered from incisional fat liquefaction after surgery and was managed effectively by regular dressing change. No severe complications such as indocyanine green allergy, anastomotic stenosis, anastomotic leakage, abdominal bleeding, bowel obstruction, pulmonary infection, and abdominal infection occurred in any patients.@*Conclusions@#FIGFI is helpful to judge the blood supply of intestinal segments and anastomotic stoma in total laparoscopic radical resection for right colon cancer quickly. It is a safe and feasible technique with satisfactory short-term effect.
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Objective@#The aim of this study was to explore the clinical safety and feasibility of intracorporeal delta-shaped anastomosis in total laparoscopic left hemicolectomy.@*Methods@#From January 1, 2017 to October 1, 2017, 11 patients who were diagnosed with left colon cancer and underwent total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis were retrospectively enrolled in this study. Clinicopathologic characteristics, surgical and postoperative outcomes were collected and analyzed.@*Results@#The median operation time was 121.8 minutes and the median time for anastomosis was 14.9 minutes. The median intraoperative blood loss was 45.5 ml. The lengths of the upper and lower segments of resection from colon cancer were 11.4 cm and 8.5 cm, respectively. The median number of lymph nodes retrieved was 29.5. The median time to ground activities, time to flatus, time to fluid diet intake and length of hospital stay were 1.4 days, 3.0 days, 3.8 days and 6.9 days, respectively. Only one patient suffered from incision infection during his hospitalization due to preoperative long-term smoking history. No mobility related to the anastomosis such as anastomotic bleeding, stenosis, obstruction and leakage occurred in any patients.@*Conclusion@#Total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis is a safe and feasible procedure with a satisfactory short-term effect.
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This article was aimed to analyze and summarize the historical origin, chemical constituents, pharmacological effects, clinical research and standardization research on Digeda-4 Flavored Decoction, in order to provide references for further study on Mongolian medicine and application. The historical origin, chemical constituents, pharmacological effects, clinical application and standardization research on Digeda-4 Flavored Decoction were analyzed and summarized through literature searching. It put forward the existing prescription problems and further research ideas. The results showed that Digeda-4 Flavored Decoction was a common Mongolian preparation. It had a long history with certain studies on its chemical constituents and pharmacological action of single herb. However, the research on compound prescription was still relatively backward. Studies on quality controlled standards, pharmacology, pharmacodynamics and toxicology studies were lacked of. The standardization, high speed, informationization were the future direction and trend of development. It was concluded that Digeda-4 Flavored Decoction was commonly used in Mongolian medicine. It was hoped to lay a solid foundation for its standardization research, pharmacological research, and standard clinical study in the future to develop Digeda-4 Flavored Decoction with stable quality, reliable curative effect, less toxic side effect, and convenient administration.
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Objective To study the effect of Mongolian medicine Senden decoction on IFN-γexpression of CIA model rats.Methods 10 rats were randomly selected as the normal group.The other 50 SD rats were established CIA model,and were randomly divided into 5 groups:the model group,Mongolian medicine morito decoction of high, medium and low dose group,tripterygium glycosides group.At different time points,the arthritis index,immunohisto-chemical expression of IFN-γwere detected in the synovial cytokine,the protein expression of IFN-γin jaw joint was detected by Western blot.Results Mongolian Senden decoction could improve CIA rat arthritis index,improve the IFN-γpositive expression in synovial joints, reduce the expression of IFN -γprotein in the claw gamma, tripterygium wilfordii group and Mongolian senden decoction high dose group improved the most obviously,and there was significant difference compared with model group(FAI 40d=27.276,FIFN-γPositive =32.654,FIFN-γprotein =674.124, all P=0.000).Conclusion Mongolian medicine Senden decoction can improve symptoms and IFN-γjoint inflam-matory cytokine expression in rat CIA model,the effect of joint synovial membrane,and the positive control medicine tripterygium glycosides, but there is a dose -response relationship, and low doses of Mongolian medicine senden decoction high dose effect is better than that of medium and low dose.
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This article was aimed to study the correlation between Mongolian medicine syndrome types of rheumatoid arthritis (RA) and indexes such as RF, ESR, CRP and anti-CCP antibody. Clinical epidemiology inquisition was used in this study. The Mongolian medicine syndrome types of 53 RA cases, which included Qi-Su-Xie-Ri type, Ba-Da-Gan-He-Yi type and Xie-Ri-Wu-Su type, were differentiated. Unified survey scale was designed. Indexes such as RF, CRP, ESR and anti-CCP antibody were detected. Data was recorded in details and statistical analysis was made. The results showed that compared with the Qi-Su-Xie-Ri type group, there were statistical significance on RF, ESR, CRP and anti-CCP antibody between the other two groups (P< 0.01). The order of RF, CRP and anti-CCP antibody from the highest to the lowest was Qi-Su-Xie-Ri type, Ba-Da-Gan-He-Yi type, and Xie-Ri-Wu-Su type. The order of ESR from the fastest to the slowest was Qi-Su-Xie-Ri type, Xie-Ri-Wu-Su type, and Ba-Da-Gan-He-Y i type. It was concluded that among Mongolian medicine syndrome types, levels of RF, ESR, CRP and anti-CCP antibody of Qi-Su-Xie-Ri type were the highest, which belonged to the active RA phase. Levels of the Ba-Da-Gan-He-Y i type and Xie-Ri-W u-Su type were relatively low, which belonged to the early, stable, or chronic RA phase.