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Purpose@#Prehabilitation (PH) is purported to improve patients’ preoperative functional status. This systematic review and meta-analysis sought to compare short-term postoperative outcomes between patients who underwent a protocolized PH program and the existing standard of care among colorectal cancer patients awaiting surgery. @*Methods@#A search in MEDLINE/PubMed, the Cochrane Library, Embase, Scopus, and CINAHL was conducted to identify relevant articles. Repetitive and exhaustive combinations of MeSH search terms (“prehabilitation,” “colorectal cancer,” “colon cancer,” and “rectal cancer”) were used to identify randomized and nonrandomized studies comparing PH versus standard of care for colorectal cancer patients awaiting surgery. The primary outcomes included postoperative morbidity, length of hospital stay, and readmission rates. @*Results@#Seven studies including 1,042 colorectal cancer patients (PH, 382) were included. No significant differences were found in intraoperative outcomes. The postoperative complication rates were comparable between groups (Clavien-Dindo grades I and II: risk ratio, 0.82; 95% confidence interval, 0.62–1.07; P=0.15; Clavien-Dindo grades ≥III: risk ratio, 1.02; 95% confidence interval, 0.72–1.44; P=0.92). There were also no significant differences in length of hospital stay (P=0.21) or the risk of 30-day readmission (P=0.68). @*Conclusion@#Although PH does not appear to improve short-term postoperative outcomes following colorectal cancer surgery, the quality of evidence is impaired by the limited trials and heterogeneity. Thus, further large-scale trials are warranted to draw definitive conclusions and establish the long-term effects of PH.
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Purpose@#This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids. @*Methods@#PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities. @*Results@#Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240). @*Conclusion@#LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.
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Purpose@#This systematic review and meta-analysis compared the outcomes of the watch-and-wait (WW) approach versus radical surgery (RS) in rectal cancers with clinical complete response (cCR) after neoadjuvant chemoradiotherapy. @*Methods@#This study followed the PRISMA guidelines. Major databases were searched to identify relevant articles. WW and RS were compared through meta-analyses of pooled proportions. Primary outcomes included overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis rates. Pooled salvage surgery rates and outcomes were also collected. The Newcastle-Ottawa scale was employed to assess the risk of bias. @*Results@#Eleven studies including 1,112 rectal cancer patients showing cCR after neoadjuvant chemoradiation were included. Of these patients, 378 were treated nonoperatively with WW, 663 underwent RS, and 71 underwent local excision. The 2-year OS (risk ratio [RR], 0.95; P = 0.94), 5-year OS (RR, 2.59; P = 0.25), and distant metastasis rates (RR, 1.05; P = 0.80) showed no significant differences between WW and RS. Local recurrence was more frequent in the WW group (RR, 6.93; P < 0.001), and 78.4% of patients later underwent salvage surgery (R0 resection rate, 97.5%). The 2-year DFS (RR, 1.58; P = 0.05) and 5-year DFS (RR, 2.07; P = 0.02) were higher among RS cases. However, after adjustment for R0 salvage surgery, DFS showed no significant between-group difference (RR, 0.82; P = 0.41). @*Conclusion@#Local recurrence rates are higher for WW than RS, but complete salvage surgery is often possible with similar long-term outcomes. WW is a viable strategy for rectal cancer with cCR after neoadjuvant chemoradiation, but further research is required to improve patient selection.
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Objective To investigate the application value of case-based learning (CBL) combined with teaching rounds in the standardized training of residents in department of hematology. Methods A total of 124 residents who received standardized training in department of hematology from August 2015 to July 2018 were selected and randomly divided into experimental group and control group. The residents in the experimental group received the teaching method of CBL combined with teaching rounds, while those in the control group received traditional teaching rounds. The two groups were compared in terms of department examination scores and teaching quality. Results Compared with the control group, the experimental group had significantly higher scores of the department examinations of hematological theoretical knowledge and case analysis (P<0.05). The residents in the experimental group thought that the new teaching method of CBL combined with teaching rounds could stimulate their interest in learning hematological diseases, improve self-study abilities , help them to combine theoretical knowledge with clinical practice , enhance their knowledge of hematological diseases, and cultivate their clinical thinking ability. Conclusion CBL combined with teaching rounds has achieved good results in standardized training of residents in department of hematology, and thus it holds promise for application in standardized training of other specialties in internal medicine.
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Objective To discuss the mechanism of inhibition of platelet activation by tanshinone type ⅡA(TanⅡA) through G protein signal pathway.Methods Methylthiazolyldiphenyl-tetrazolium bromide(MTT) test was used to determine the optimum effective concentration and optimal time of thrombin and TanⅡA on platelet.Northern blot and Western blot were used to detect the transcription and expression levels of G protein and related signal molecules,including protease activated receptors(PARs),P2Y1 and P2Y12 receptors,α2A-adrenergic receptor and thromboxane A2(TXA2) receptor,in control group,thrombin treated group and TanⅡA treated group,and the platelet aggregation rate was also detected.Results Platelet aggregation rate,and the transcription and expression levels of G protein and related molecules in thrombin treated group were higher than control group(P<0.05).The transcription and expression levels of G protein and related molecules in different concentrations of TanⅡA treated groups were lower than thrombin treated group(P<0.05).Conclusion TanⅡA could inhibit the activation of platelet by inhibiting the transcription and expression of G protein and the related molecules.
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Objective To learn birth weight of newborn babies and its influencing factors to provide evidence for maternal healthcare.Methods A retrospective analysis was conducted among 5 055 newborn babies from January 2007 to December 2007 to learn their birth weight,gender,pregnant week,maternal age,parity and living areas.Univariate and multivariate Logistic regression analysis were used to explore factors that influenced birth weight.Results For those 5 055 infants,the average birth weight was (3128±675) g,and the incidence of low birth weight or fetal macrosomia was 14.6％ and 8.2％,respectively.In single factor Chi-square test,living area,pregnant week and maternal age were factors that influenced low birth weight and fetal macrosomia (x2 values were 223.807 and 34.120; 2 211.570 and 68.941; 92.199 and 18.745,respectively).Moreover,parity was related with the occurrence of low birth weight (x2=54.822),and gender was found to affect fetal macrosomia (x2=34.503,both P＜0.05).In Logistic regression analysis,preterm birth (odds ratio (OR)=37.140,95％ confidence interval (CI):30.094-45.853),rural residents (OR=0.390,95％ CI:0.310-0.492) and maternal age (OR=0.864,95％ CI:0.779-0.959) were risk factors of low birth weight,and baby boy (OR=0.524,95％ CI:0.423-0.650),urban residents (OR=0.616,95％ CI:0.501-0.758),postterm delivery (OR=4.175,95％ CI:2.918-5.974) and advanced maternal age (OR=1.229,95％ CI:1.104-1.368) were risk factors of fetal macrosomia.Conclusion This investigation suggests a relatively lower average birth weight and higher incidence of fetal macrosomia and low birth weight infant in Changzhi of Shanxi Province.Health interventions,maternal healthcare service programme and pre-and post-natal health education should be carried out to achieve normal birth weight.
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Objective To investiGate the distribution of clinical infectious pathoGens and druG resistance status of common bacteria in the Ninth Peopleˊs Hospital Affiliated to medicine School of ShanGhai Jiao TonG University in 20l2. Methods Clinical isolated bacterial strains were collected from the Ninth Peopleˊs Hospital Affiliated to medicine School of ShanGhai Jiao TonG University durinG 20l2. The identification of bacteria and antimicrobial susceptibility were determined by VITEK 2 COMPACT automatic microbioloGy analyzer. The data were analyzed by WHONET 5. 4 software. Results A total of 3456 pathoGenic strains were collected. Of them,Gram positive cocci,Gram neGative bacilli and funGus accounted for 20. 3%,76. 8% and 2. 9% respectively. Methicillin resistant strains in S. aureus( MRSA ) and coaGulase neGative Staphylococcus ( MRCNS)accounted for averaGe of 44. 4% and 85. 5% respectively. No vancomycin and linezolid resistant strains were found. Extended spectrumβ-lactamases strains accounted for 66. 4% and 30. 6% in Escherichia coli ( E. coli)and Klebsiella spp respectively. Strains of E. coli and Klebsiella spp were still hiGhly susceptible to imipenem. Resistance rates of P. aeruGinosa and A. baumannii sppstrains to imipenem were 8. 3% and 58. 4%respectively. Conclusion The major clinical pathoGenic microorGanisms in the Ninth Peopleˊs Hospital Affiliated to medicine School of ShanGhai Jiao TonG University are still Gram neGative bacilli. Baterial resistance is serious. It is important to strenGthen the detection of resistant bacteria in routine work,which is useful for rational use of antimicrobial aGents.
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Objective To evaluate the training effect of Public health emergencies.Methods The testing materials from the training course on public health emergencies in longgang district of Shenzhen in 2009 were analyzed.Results Of all 162 students,98.2% considered the training course was completely important,97.3% students considered the training was very necessary,after training,80% students considered the master degree of related knowledge was improved,93.8% students considered the effect of training on the role of dealing with public health emergency training was very well or average.Conclusions Emergency response training for dealing with the public health emergencies is very effective and completely necessary.
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Objective To investigate clinical signifieances of serum levels of vascular endothelial growth factor (VEGF) in patients with diffuse large B-cell lymphoma (DLBCL) and to analyze the relationships with international prognostic index (IPI). Methods Serum levels of VEGF were measured by ELISA in 26 cases with newly diagnosed DLBCL and 9 cases with relapsed DLBCL. The clinical data of 26 patients were collected. According to the IPI, 26 patients were divided into two group: low risk group (IPI＜2) and moderate to high risk group (IPI≥2). Results Compared with the normal controls, newly diagnosed and relapsed DLBCL had significantly higher VEGF serum levels (P ＜0.01). In the patients responding to CHOP or RCHOP regimen a significantly decrease in VEGF serum levels occurred, while in the patients who did not achieve complete remission(CR) there was no significant decrease. Furthermore, pretreatment serum levels of VEGF were significantly lower in CR group than in partial remission (PR) and no remission (NR) group. In addition, serum levels of VEGF were significantly elevated in the high risk group than those at the low risk group(P＜0.01). Conclusion The serum levels of angiogenic factor VEGF are related to the development and progression of DLBCL. The VEGF combined with IPI can be used for evaluating the prognosis of DLBCL.
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Objective To explore the significance of LDH and ?2-m concentration in CSF in differentiating viral meningitis from purulent meningitis in pediartic patients.Methods Kinetic method was performed to detect the LDH concentration in CSF in 45 patients with purulent meningitis and 49 patients with viral meningitis and 22 healthy children of control group respectively.On the other hand,radioimmunoassay(RIA)was used to detect the concentration of ?2-m.Results The concentrations of LDH in CSF in purulent meningitis group(26.15?12.17)U/L were higher than that in viral meningitis group(8.76?4.94)U/L significantly(P
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Immunohistochemistry was utilized to investigate the light and electron micros-copic localization of neurotensin-like (NT) immunoreactive amacrine cells in thechicken retina.The results showed that the NT-immunoreactive cell bodies wereoval and situated in either the second or third row of cells from the inner borderof the inner nuclear layer.The processes of such cells extended into the innerplexiform layer where they ramified as a fine plexus in sublamina 1 and as a denseplexus in sublamina 3 and 4.At the ultrastructural level,NT positive soma exhibited a rather dense and evenlydistributed immune reaction product throughout their cytoplasm.The nucleus ofNT-amacrine cells possessed a round,unindented nuclear membrane.NT positiveprocesses of such cells receive synaptic input from processes of unlabeled amacrineand bipolar cells.They formed synaptic output onto processes of nonimmuno-reactive amacrine cells and bipolar cells.Moreover,each of the above synapticrelationships were identified in each of sublamina 1 and 3 to 4 of the inner plexiform layer.In addition,NT positive processes fromed synaptic output to processesdevoid of synaptic vesicles,which may originated from ganglion cells.They alsoformed synaptic output to somas situated in the innermost cell row of the innernuclear layer.Identification of synaptic elements and retinal circuitry were also discussed.
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The immunohistochemical single and double label techniques were used to study the localization and coexistence of immunoreaetive enkephalin (ENK) and somatostatin (SOM) in amacrine cells of the chicken retina. The single label experiments showed that certain SOM-immunoreactive amacrine cells are similar in morphology, location in the inner nuclear layer (INL) and the manner of processes ramified in the inner plexiform layer (IPL) to some ENK-immunoreactive amacrine cells, although the plexus of SOM-immunoreactive processes in sublamina 3 and 4 were not as dense as ENK-immunoreactive plexus and SOM-immunoreactive processes in sublamina 5 were not observed. The double label studies indicated that some amacrine cells showed both SOM and ENK positive immunoreactivity and some other amacrine cells showed only SOM or ENK positive immunoreactivity.The coexistence of two neuropeptides or a neuropeptide and a classical neurotransrnitter in the retinal amacrine cells were also discussed.