Effect of acupuncture inclusion in the enhanced recovery after surgery protocol on tumor patient gastrointestinal function: a systematic review and meta-analysis of randomized controlled studies.

Introduction: Acupuncture has been shown to be effective in restoring gastrointestinal function in tumor patients receiving the enhanced recovery after surgery (ERAS) protocol. The present systematic review and meta-analysis aimed to evaluate the rationality and efficacy of integrating acupuncture in the ERAS strategy to recuperate gastrointestinal function. Methods: We searched eleven databases for relevant randomized clinical trials (RCTs) of acupuncture for the treatment of gastrointestinal dysfunction in tumor patients treated with the ERAS protocol. The quality of each article was assessed using the Cochrane Collaboration risk of bias criteria and the modified Jadad Scale. As individual symptoms, the primary outcomes were time to postoperative oral food intake, time to first flatus, time to first distension and peristaltic sound recovery time (PSRT). Pain control, adverse events, and acupoint names reported in the included studies were also investigated. Results: Of the 211 reviewed abstracts, 9 studies (702 patients) met eligibility criteria and were included in the present systematic review and meta­analysis. Compared to control groups, acupuncture groups showed a significant reduction in time to postoperative oral food intake [standardized mean difference (SMD) = -0.77, 95% confidence interval (CI) -1.18 to -0.35], time to first flatus (SMD=-0.81, 95% CI -1.13 to -0.48), time to first defecation (SMD=-0.91, 95% CI -1.41 to -0.41, PSRT (SMD=-0.92, 95% CI -1.93 to 0.08), and pain intensity (SMD=-0.60, 95% CI -0.83 to -0.37).The Zusanli (ST36) and Shangjuxu (ST37) acupoints were used in eight of the nine included studies. Adverse events related to acupuncture were observed in two studies, and only one case of bruising was reported. Discussion: The present systematic review and meta­analysis suggested that acupuncture significantly improves recovery of gastrointestinal function and pain control in tumor patients receiving the ERAS protocol compared to the control group. Moreover, ST36 and ST37 were the most frequently used acupoints. Although the safety of acupuncture was poorly described in the included studies, the available data suggested that acupuncture is a safe treatment with only mild side effects. These findings provide evidence-based recommendations for the inclusion of acupuncture in the ERAS protocol for tumor patients. Systematic review registration: https://www.crd.york.ac.uk/prospero/ PROSPERO, identifier CRD42023430211.

Diagnostic Value of Serum Biomarkers in Combined Hepatocelluar-Cholangiocarcinoma.

OBJECTIVE: To explore the value of des-gamma-carboxyprothrombin (DCP), alpha-fetoprotein (AFP) and carbohydrate antigen-199 (CA-199) for diagnosis of combined hepatocellular-cholangiocarcinoma (cHCC-CC). STUDY DESIGN: Observational correlational study design. PLACE AND DURATION OF STUDY: The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, from June 2016 to June 2019. METHODOLOGY: Patients with cHCC-CC (n = 26) diagnosed by histological examination and immunohistochemical staining were matched as 1:2 to controls (n = 52) based on age (±2 years), gender (male or female), liver texture (cirrhosis or not) and ethnicity. Serum DCP, AFP and CA-199 levels were determined and Youden indices were calculated. Receiver operating characteristic (ROC) curves were generated and areas under the receiver operating characteristic curve (AUC) were calculated. RESULTS: The levels of DCP, AFP and CA-199 were clearly elevated in the cHCC-CC group relative to controls with p-values of <0.001, <0.001 and 0.001, respectively. Youden index values for DCP, AFP, CA-199, and their combination (DCP+AFP+CA-199) were 0.5, 0.423, 0.173 and 0.673, respectively. The AUC curve values for DCP, AFP, CA-199 and their combination (DCP+AFP+CA-199) were 0.759 (95% CI: 0.624 - 0.894), 0.826 (95% CI: 0.720 - 0.933), 0.727 (95% CI: 0.613 - 0.841) and 0.862 (95% CI: 0.755 - 0.968), respectively. CONCLUSION: DCP, AFP and CA-199 have diagnostic value for cHCC-CC, and the combination of DCP, AFP and CA-199 is useful for assisting diagnosis before histological examination. Clinicians should be alert for cHCC-CC when DCP, AFP, or CA-199 levels are abnormal.

Diagnostic Value of Serum Biomarkers for Patients Undergoing Curative Resection with Non-B, Non-C Hepatocellular Carcinoma.

OBJECTIVE: To determine the diagnostic value of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) for patients with non-B, non-C hepatocellular carcinoma (NBNC HCC). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, from June 2016 to June 2019. METHODOLOGY: Patients with NBNC HCC diagnosed by histology were inducted after curative resection. Serum levels of AFP and DCP were determined. Their receiver operating characteristic (ROC) curves were generated, and the area under the ROC curve (AUC) calculated. In subgroup analyses involving patients with hepatitis B core antibody (HBcAb) testing, the AUC of AFP and DCP were also calculated and compared. RESULTS: Serum levels of AFP and DCP were clearly increased in the NBNC HCC group relative to controls (p = 0.000 for both). The AUC for AFP, DCP and their combination (AFP+DCP) were 0.763 (95%CI: 0.712-0.814), 0.853 (95%CI: 0.811-0.894), and 0.867 (95%CI: 0.829-0.906), respectively. For HBcAb-positivity, the AUC of AFP and DCP were 0.7517 (95%CI: 0.6917-0.8116) and 0.8469 (95% CI: 0.7985-0.8963), respectively. For HBcAb-negativity, the AUC of AFP and DCP were 0.8083 (95%CI: 0.6993-0.9174) and 0.8740 (95%CI: 0.7901-0.9580), respectively. CONCLUSION: A combination of AFP and DCP is useful for assisting the diagnosis of NBNC HCC before surgery. AFP and DCP showed better diagnostic accuracy for HBcAb-negativity compared with HBcAb-positivity in NBNC HCC patients.

Diagnostic Value of Serum Biomarkers for Intrahepatic Cholangiocarcinoma.

OBJECTIVE: To explore the diagnostic value of carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) for the diagnosis of intrahepatic cholangiocarcinoma (ICC). STUDY DESIGN: Case control study. PLACE AND DURATION OF STUDY: First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, from June 2016 to March 2018. METHODOLOGY: Patients with ICC (n = 51) diagnosed by histological examination after surgery were matched 1:4 to control subjects (n = 204) based on age (±2 years), gender, and ethnicity. Serum CA 19-9 and CEA levels were determined and compared. Receiver operating characteristic (ROC) curves were generated, and areas under the receiver operating characteristic curve (AUC) were calculated. The cutoff values, sensitivities, specificities, and Youden index values were calculated and compared. RESULTS: The levels of CA 19-9 and CEA were elevated in the ICC patients relative to control subjects (p <0.001). CA 19-9 and CEA showed diagnostic efficacy for ICC, with AUC values of 0.6916 and 0.6376, respectively. The cutoff value, sensitivity, specificity, and Youden index for CA 19-9 were 26 U/ml, 58.82%, 83.82%, and 0.4262, respectively. The cutoff value, sensitivity, specificity, and Youden index for CEA were 1.95 ng/ml, 90.2%, 35.29%, and 0.2549, respectively. The combination of CA 19-9 and CEA exhibited the best diagnostic efficacy, with the sensitivity, specificity, and Youden index being 90.2%, 88.24%, and 0.7844, respectively. CONCLUSION: Combined CA 19-9 and CEA levels have diagnostic value for ICC. The combination of CA 19-9 and CEA can assist surveillance and diagnosis of ICC prior to surgery.

Serum Des-gamma-carboxy Prothrombin for Diagnosis of Adult Primary Cancer in Liver.

OBJECTIVE: To explore the diagnostic accuracy of serum des-gamma-carboxy prothrombin (DCP) in adult primary cancer in liver. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Traditional Chinese Medicine, the First Affiliated Hospital, College of Medicine, Zhejing University, Hangzhou, China, from June 2016 to March 2018. METHODOLOGY: A retrospective study of 1,190 cases was undertaken and all the participants were divided into Group 1 (non-cancer patients) and Group 2 (primary cancer in liver patients). The records of DCP and alpha fetoprotein (AFP) levels were extracted and compared between Group 1 and Group 2. The sensitivity, specificity, and cutoff point of DCP in Group 2 and its different histological types were calculated. The receiver operating characteristic (ROC) curves were obtained, and the areas under the receiver operating characteristic curve (AUROC) were calculated and compared in different histological types. RESULTS: The DCP and AFP levels in Group 2 were markedly higher than Group 1 (p <0.001). For primary cancer in liver, the sensitivity, specificity, cutoff value, and AUROC of DCP were 64.2%, 91%, 56.5 mAU/mL, and 0.807 (95% CI: 0.783- 0.832), respectively. For hepatocellular carcinoma (HCC), the sensitivity, specificity, cutoff value, and AUROC of DCP were 69.3%, 92.2%,60.5mAU/mL, and 0.846 (95% CI: 0.817-0.875), respectively. For intrahepatic cholangiocarcinoma (ICC), the sensitivity, specificity, cutoff value, and AUROC of DCP were 13.6%, 93.2%, 76.5 mAU/mL, and 0.512 (95% CI: 0.439- 0.586), respectively. For combined hepatocellular-cholangiocarcinoma (cHCC-CC), the sensitivity, specificity, cutoff value, and AUROC of DCP were 66.7%, 81.5%, 40.5 mAU/mL, and 0.737 (95% CI: 0.585-0.888), respectively. CONCLUSION: DCP could be considered not only for surveillance and diagnosis of primary cancer in liver, but also for differential diagnosis of its different histological types.

Evaluation of Serum Des-Gamma-Carboxy Prothrombin for the Diagnosis of Hepatitis B Virus-Related Hepatocellular Carcinoma: A Meta-Analysis.

AIM: To explore the diagnostic efficacy of des-gamma-carboxy prothrombin (DCP) in hepatitis B virus- (HBV-) related hepatocellular carcinoma (HCC). METHODS: A retrospective study of 459 cases from June 2016 to March 2018 was undertaken, and records of the DCP levels were extracted. The sensitivity, specificity, and cutoff points were calculated using SPSS 17.0 software. A systematic search in PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials was performed for articles published in English from 1997 to 2017, focusing on serum DCP for HBV-related HCC. Data on sensitivity, specificity, the positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were extracted from five studies by systematic search and one study of our own. The summary receiver operating characteristic (sROC) curve was obtained, and the area under the receiver operating characteristic (AUROC) curve was calculated. RESULTS: The pooled sensitivity, specificity, PLR, NLR, and DOR were 0.71 (95% CI: 0.59, 0.80), 0.93 (95% CI: 0.87, 0.96), 9.5 (95% CI: 5.2, 17.5), 0.32 (95% CI: 0.22, 0.46), and 30 (95% CI: 13, 72), respectively. The AUROC curve was 0.91 (95% CI: 0.88, 0.93). CONCLUSIONS: In the diagnosis of HBV-related hepatocellular carcinoma (HCC), DCP is an ideal marker that should be considered for surveillance purposes.

Acute Complete Adult-onset Kawasaki Disease in a Middle-Aged Woman.

A 55-year-old Chinese lady was diagnosed with acute complete Kawasaki disease (KD) in January 2015. To our knowledge, this patient was the first described woman who was over 50 years and fulfilled all the characteristics of acute complete KD. The patient had a striking result on the 26th day since this disease onset after the initiation of treatment of immunoglobulin (IG) and aspirin; and did not have any complications up to now. The purpose of this case report was to raise the awareness of KD in the middle-aged persons and the therapeutic schedules, as there is no valid therapeutic therapeutic for adults with KD.

Effect of Xuezhikang Capsule on serum tumor necrosis factor-alpha and interleukin-6 in patients with nonalcoholic fatty liver disease and hyperlipidemia.

OBJECTIVE: To evaluate the effect of Xuezhikang Capsule on the serum levels of inflammatory factors such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in patients with nonalcoholic fatty liver disease (NAFLD) and hyperlipidemia, and to explore whether it has anti-inflammatory effect. METHODS: A total of 84 patients were randomly assigned to two groups with stratified block randomization, the treatment group (42 cases) and the control group (42 cases). They were treated with Xuezhikang Capsule and polyene phosphatidylcholine capsule for twenty-four weeks, respectively. The changes in serum TNF-alpha and IL-6 were measured by enzyme linked immunosorbent assay before treatment and at the 12th and 24th week. RESULTS: Compared with those before treatment, the serum levels of TNF-alpha and IL-6 significantly decreased in both groups after treatment (P<0.01). There was no significant change between the two groups for the treatments at different time points (P>0.05) and between the two groups for treatments at the same time points (P>0.05). CONCLUSION: Xuezhikang Capsule can inhibit the serum inflammatory factor in patients with NAFLD and hyperlipidemia.

[Effect of Jinyingzi on experimental passive-Heymann nephritis in rats].

OBJECTIVE: To study the pharmacological actions of Jinyingzi on experimental Passive-Heymann Nephritis (PHN) model rats. METHODS: The rat model of PHN was induced by injecting anti-rabbit serum through caudal vein. The renal function about urinary protein, serum total protein, creatinine and urinary nitrogen on PHN rat were studied through op. Jinyingzi for 4 wk. RESULTS: Jinyingzi can remarkably reduce urinary protein, serum levels of serum creatinine and serum urinary nitrogen, increase serum total protein content, alleviate the pathological injury in PHN rats. CONCLUSION: Jinyingzi can lessen pathological changes of glomerulus in PHN rats, ameliorate their renal function.

Clinical observation of the effect of Xuesaitong soft capsule on post-hepatitis fibrosis.

OBJECTIVE: To study the effect of Xuesaitong soft capsule (XST) on liver fibrosis criteria in patients with post-hepatitis fibrosis. METHODS: Sixty-four patients with such fibrosis were randomly divided into the treated group and control group. They were treated with XST and Dahuang Zhechong pill (NFDA1) for 3 months respectively. Their liver fibrosis criteria were examined before and after treatment. RESULTS: The levels of serum procollagen III, hyaluronic acid, collagen IV, laminin in the two groups were significantly lower (P < 0.01) than those before treatment. The differences between the two groups were insignificant (P > 0.05). CONCLUSION: XST could recover liver dysfunction and had anti-liver fibrosis function.