Comparison of safety between manual and mechanical anastomosis of esophageal carcinoma after esophagectomy: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To compare the safety of manual anastomosis and mechanical anastomosis after esophagectomy by meta-analysis. Methods    The randomized controlled trials (RCTs) about manual anastomosis and mechanical anastomosis after esophagectomy were searched from PubMed, EMbase and The Cochrane Library from inception to January 2018 by computer, without language restrictions. Two authors according to the inclusion and exclusion criteria independently researched literature, extracted data, evaluated bias risk and used R software meta package for meta-analysis. Results     Seventeen RCTs were enrolled, including 2 159 patients (1 230 by manual anastomosis and 1 289 by mechanical anastomosis). The results of meta-analysis showed that: (1) there was no significant difference in the incidence of anastomotic leakage between mechanical and manual anastomosis (RR=1.00, 95%CI 0.67–1.48, P=0.181); (2) no significant difference was found in the 30-day mortality (RR=0.95, 95%CI 0.61–1.49, P=0.631);(3) compared with manual anastomosis, the mechanical anastomosis group may increase the risk of anastomotic stenosis (RR=0.74, 95%CI 0.48-1.14, P<0.001). Conclusion     Esophageal cancer surgery using a linear or circular stapler can increase the incidence of anastomotic stenosis after surgery. There is no significant difference in the anastomotic leakage and 30-day mortality between manual anastomosis, linear stapler and circular stapler.

Application of controlled hypotension for subcarinal lymph node dissection in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A case control study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the feasibility and clinical effect of controlled hypotension in video-assisted thoracoscopic surgery (VATS) for subcarinal lymph node dissection in patients with lung cancer. Methods    We analyzed the clinical data of 53 non-small cell lung cancer (NSCLC) patients undergoing VATS with controlled systolic blood pressure while dissecting the subcarinal lymph node from September to October 2016 in our department (a treatment group, including 31 males and 22 females with an average age of 53.20±8.80 years ranging 43-68 years). We selected 112 NSCLC patients undergoing VATS without controlled systolic blood pressure while dissecting the subcarinal lymph node from January to August 2016 in our department (a contol group, including 67 males and 45 females with an average age of 54.32±7.81 years ranging 39-73 years). The clinical data of both groups were compared. Results    The operation time and blood loss of the treatment group were less than those of the control group (177.6±39.4 min vs. 194.3±47.8 min, 317.9±33.6 ml vs. 331.2±38.7 ml, P<0.05). The duration of subcarinal lymph node dissection and total duration of lymph node dissection of the treatment group were also less than those of the control group (10.5±4.3 min vs. 13.6±5.2 min, 37.7±7.5 min vs. 48.7±6.4 min, P<0.001). The thoracic drainage at postoperative days 1, 2, 3 and total drainage volume, duration of tube placement and hospital stay of the treatment group were less than those of the control group (P<0.05). Whereas the postoperative complications of the two groups did not differ significantly (P>0.05). Conclusion    Controlled hypotension reduces the difficulty of dissecting subcarinal lymph nodes and the risk of bleeding, and produces less  drainage volume, which is safe and effective.

Anti-diabetic medication reduces risk of pulmonary tuberculosis in diabetic patients: a population-based cohort study in Taiwan

Objective: The increased risk of pulmonary tuberculosis [PTB] in patients with diabetes mellitus [DM] remains to be clarified with cohort study. The present study further examined whether the anti-diabetic drug treatment associates with developing PTB. Design: Nation wide cohort study Setting: China Medical University Hospital

Subjects: From the Taiwan National Health Insurance database, we identified 22,256 adult patients newly diagnosed with DM in 2000-2006 as DM cohort and 89,024 persons without DM frequency matched with sex, age and DM diagnosed year as non-DM comparison cohort. Intervention: None Main outcome measures: Both cohorts were followed till the end of 2009 to document PTB incidence. Medications were analyzed for the DM cohort to examine the hazard of developing PTB

Results: The incidence of PTB was 1.64-fold higher in DM cohort than in comparison cohort [52.1 Vs 31.8 per 10,000 person-years] with an adjusted hazard ratio of 1.53 [95% CI = 1.40 - 1.67], measured using multivariable Cox proportional hazards regression analysis. Men were at higher risk than women to have PTB. The age-specific incidence rates showed that DM cohort to comparison cohort incidence rate ratio was higher in younger group. However, the Cox model measured HR increased with age. Alcoholism, chronic obstructive pulmonary disease, alcoholic liver damage and chronic kidney diseases were comorbidities independently associated with PTB. In the DM cohort, anti-DM medications significantly reduced the risk of PTB with a HR of 0.52 for those who had taken metformin, followed by alpha-glucosidase inhibitors, thiazolidinediones, insulins and sulfonylureas [HR = 0.76]. The effects of all anti-diabetic drugs were statistically significant

Conclusions: These findings show patients with DM are associated with an elevated risk of developing PTB, but treatment with anti-diabetic drugs may mediate the risk significantly

Proteomic identification and functional characterization of MYH9, Hsc70, and DNAJA1 as novel substrates of HDAC6 deacetylase activity

Histone deacetylase 6 (HDAC6), a predominantly cytoplasmic protein deacetylase, participates in a wide range of cellular processes through its deacetylase activity. However, the diverse functions of HDAC6 cannot be fully elucidated with its known substrates. In an attempt to explore the substrate diversity of HDAC6, we performed quantitative proteomic analyses to monitor changes in the abundance of protein lysine acetylation in response to HDAC6 deficiency. We identified 107 proteins with elevated acetylation in the liver of HDAC6 knockout mice. Three cytoplasmic proteins, including myosin heavy chain 9 (MYH9), heat shock cognate protein 70 (Hsc70), and dnaJ homolog subfamily A member 1 (DNAJA1), were verified to interact with HDAC6. The acetylation levels of these proteins were negatively regulated by HDAC6 both in the mouse liver and in cultured cells. Functional studies reveal that HDAC6-mediated deacetylation modulates the actin-binding ability of MYH9 and the interaction between Hsc70 and DNAJA1. These findings consolidate the notion that HDAC6 serves as a critical regulator of protein acetylation with the capability of coordinating various cellular functions.

Kidney cancer and diabetes mellitus: a population-based case-control study in Taiwan

<p><b>INTRODUCTION</b>The purpose of this study was to explore whether diabetes mellitus (DM) correlates with the risk of kidney cancer in Taiwan.</p><p><b>MATERIALS AND METHODS</b>We designed a population-based case-control study from the Taiwan National Health Insurance Database, which consisted of 116 patients with newly diagnosed kidney cancer as cases and 464 subjects without kidney cancer as controls in 2000 to 2009. Both cases and controls were aged ≥20 years. Baseline comorbidities were compared between kidney cancer cases and controls.</p><p><b>RESULTS</b>Multivariable analysis showed no association was detected between DM and kidney cancer (OR 1.06, 95% CI, 0.58 to 1.94). Hypertension (OR 2.05, 95% CI, 1.23 to 3.42), chronic kidney diseases (OR 2.57, 95% CI, 1.23 to 5.37), cystic kidney diseases (OR 18.6, 95% CI, 1.84 to 187.6) and kidney stones (OR 4.02, 95% CI, 2.43 to 6.66) were significant comorbidities associated with increased risk of kidney cancer. Use of alpha-glucosidase inhibitor was associated with increased risk of kidney cancer (OR 4.31, 95% CI, 1.07 to 17.3).</p><p><b>CONCLUSION</b>DM does not correlate with the risk of kidney cancer. Hypertension, chronic kidney diseases, cystic kidney diseases, kidney stones and use of alpha-glucosidase inhibitors are associated with kidney cancer.</p>

Cardiovascular disease and colorectal cancer: a population-based observation in Taiwan

To explore the relationship between cardiovascular disease and colorectal cancer in Taiwan. Population-based cohort study. Using database of the Taiwan National Health Insurance program from 2000 to 2006, 89,034 patients [35 years or older] with newly diagnosed cardiovascular disease [CVD] which included coronary artery disease, heart failure, cerebrovascular disease, peripheral atherosclerosis, or hypertension, and 89,034 control subjects without CVD were studied. The incidence of colorectal cancer at the end of 2009 and the association with CVD and other co-morbidities were determined. The incidence of colorectal cancer was 1.19-fold higher in the CVD group compared with the non-CVD group [10.87 Vs 9.11 per 10,000 person-years, 95%CI = 1.05-1.36]. After adjustment for covariates, no association was found between CVD and colorectal cancer [95%CI = 0.87-1.13]. Men [HR = 1.53, 95%CI = 1.34-1.75], increasing age [HR = 1.07, 95%CI = 1.06-1.07], and colorectal adenoma [HR = 1.80, 95%CI = 1.06-3.05] were associated with colorectal cancer. No association between cardiovascular disease and colorectal cancer is found. Men, increasing age, and colorectal adenoma correlate with the increased risk of colorectal cancer