The value of single-incision laparoscopic surgery for colorectal cancer: a systematic literature review.

BACKGROUND/AIMS: Recently, single-incision laparoscopic colectomy (SILC) for colorectal malignancy is rapidly becoming the central issue for explorers of minimally invasive surgery worldwide. The aim of this systematic review was to establish the safety and efficacy of SILC for colorectal malignancy when implemented by experienced surgeons. METHODOLOGY: PubMed, WHO international trial register and Embase were searched for publications concerning SILC and MLC from 2000 to 2013, with the last search on September 10, 2013. Only pure single-incision laparoscopic colonic surgery for malignant disease was included. Primary outcomes were the early postoperative complication profiles of SILC. Secondary outcomes were duration of operation time, blood loss, lymph node yields, conversion rate, distal margin of the resected tumor, and duration of hospital stay. RESULTS: Eight studies involving 547 patients met the inclusion criteria. Compared with multiport laparoscopic colectomy (MLC), SILC has less postoperative complication and bleeding. The conversion, the median lymph node retrieval, proximal margin of the resected tumor and distal margin of the resected tumor for malignant disease achieved with SILC was acceptable. There was no significant reduction in length of hospital stay with SILC. CONCLUSION: SILC is a technically reliable and realistic approach with short-term results similar to those obtained with the MLC procedure.

Safety of fast-track rehabilitation after gastrointestinal surgery: systematic review and meta-analysis.

AIM: To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery. METHODS: We searched MEDLINE, WHO International Trial Register, Embase and The Cochrane Central Register of Controlled Trials up to 2014 for randomized controlled trials (RCTs) comparing FT and CC or comparing LFT and OFT, with 10 or more randomized participants and about 30 d follow-up. Two reviewers independently extracted data on complications, anastomotic leak, obstruction, wound infection, re-admission between FT and CC or LFT and OFT after gastrointestinal surgery. RESULTS: Twenty-four RCTs of FT vs CC or LFT vs OFT were included. Compared with CC, FT reduced overall complications and wound infection. However, anastomotic leak, obstruction and re-admission were not significantly reduced. The pooled risk ratio (RR) of 0.69 (95%CI: 0.60-0.78; P < 0.001), pooled RR of 0.71 (95%CI: 0.57-0.88; P < 0.001), pooled RR of 0.93 (95%CI: 0.68-1.25; P > 0.05), a pooled RR of 0.87 (95%CI: 0.67-1.15; P > 0.05) and pooled RR of 0.94 (95%CI: 0.73-1.22; P > 0.05) respectively. Compared with OFT, LFT reduced complications, with a pooled RR of 0.66 (95%CI: 0.54-0.81; P < 0.001). CONCLUSION: FTs are safe after gastrointestinal surgery. Additional large, prospective RCTs should be conducted to establish further the safety of this approach.

Cross-brain neurofeedback: scientific concept and experimental platform.

The present study described a new type of multi-person neurofeedback with the neural synchronization between two participants as the direct regulating target, termed as "cross-brain neurofeedback." As a first step to implement this concept, an experimental platform was built on the basis of functional near-infrared spectroscopy, and was validated with a two-person neurofeedback experiment. This novel concept as well as the experimental platform established a framework for investigation of the relationship between multiple participants' cross-brain neural synchronization and their social behaviors, which could provide new insight into the neural substrate of human social interactions.

Determination of dominant frequency of resting-state brain interaction within one functional system.

Accumulating evidence has revealed that the resting-state functional connectivity (RSFC) is frequency specific and functional system dependent. Determination of dominant frequency of RSFC (RSFC(df)) within a functional system, therefore, is of importance for further understanding the brain interaction and accurately assessing the RSFC within the system. Given the unique advantages over other imaging techniques, functional near-infrared spectroscopy (fNIRS) holds distinct merits for RSFC(df) determination. However, an obstacle that hinders fNIRS from potential RSFC(df) investigation is the interference of various global noises in fNIRS data which could bring spurious connectivity at the frequencies unrelated to spontaneous neural activity. In this study, we first quantitatively evaluated the interferences of multiple systemic physiological noises and the motion artifact by using simulated data. We then proposed a functional system dependent and frequency specific analysis method to solve the problem by introducing anatomical priori information on the functional system of interest. Both the simulated and real resting-state fNIRS experiments showed that the proposed method outperforms the traditional one by effectively eliminating the negative effects of the global noises and significantly improving the accuracy of the RSFC(df) estimation. The present study thus provides an effective approach to RSFC(df) determination for its further potential applications in basic and clinical neurosciences.

Is resting-state functional connectivity revealed by functional near-infrared spectroscopy test-retest reliable?

Recently, resting-state functional near-infrared spectroscopy (rs-fNIRS) research has experienced tremendous progress. Resting-state functional connectivity (RSFC) has been adopted as a pivotal biomarker in rs-fNIRS studies. However, it is yet to be clear if the RSFC derived from rs-fNIRS is reliable. This concern impedes extensive utilization of rs-fNIRS. We systematically address the issue of reliability. Sixteen subjects participate in two rs-fNIRS sessions held one week apart. RSFC in sensorimotor system is calculated using the seed-correlation approach. Then, test-retest reliability is evaluated at three different scales (map-, cluster-, and channelwise) for individual- and group-level RSFC derived from different types of fNIRS signals [oxygenated (HbO), deoxygenated (HbR), and total hemoglobin (HbT)]. The results show that, for HbO signals, individual-level RSFC generally has good-to-excellent map-/clusterwise reliability, while group-level RSFC has excellent reliability. For HbT signals, the results are similar. For HbR signals, the clusterwise reliability is comparable to that for HbO while the mapwise reliability is slightly lower (fair to good). Focusing on RSFC at a single channel, we report poor channelwise reliability for all three types of signals. We hereby propose that fNIRS-derived RSFC is a reliable biomarker if interpreted in map- and clusterwise manners. However, channelwise interpretation of individual RSFC should proceed with caution.

A cross-sectional study of HIV and syphilis infections among male students who have sex with men (MSM) in northeast China: implications for implementing HIV screening and intervention programs.

BACKGROUND: China has 76.2 million high school and college students, in which the number of reported HIV/AIDS cases is increasing rapidly. Most of these cases are attributed to male-to-male sexual contact. Few studies have explored HIV prevalence and behavioural characteristics of Chinese male students who have sex with men (MSM). METHODS: A cross-sectional study of MSM high school and college students in Liaoning Province was conducted. Data were collected through face-to-face interviews and blood specimens were obtained and tested for HIV and syphilis. RESULTS: There were 436 eligible participants. HIV and syphilis prevalence was 3.0% and 5.0%, respectively. In multivariate analysis, sexual orientation known by family members (OR: 7.3; 95% CI: 1.5-34.6), HIV/AIDS information obtained from clinical doctors (OR: 6.7; 95% CI: 1.7-25.9), HIV/AIDS information obtained through free educational services and materials such as voluntary counseling and testing (VCT) and condom distribution services (OR: 0.2; 95% CI: 0.4-1.0), inconsistent condom use (OR: 5.7; 95%: 1.3-25.3), sexual partner experienced anal bleeding after insertive anal intercourse (OR: 6.8; 95% CI: 1.6-28.4), and history of illegal drug use (OR: 18.9; 95% CI: 2.2-165.3) were found to be significantly associated with HIV infection. CONCLUSIONS: Greater effort should be made towards stemming the HIV and syphilis epidemics among Chinese student MSM. Immediate screening and comprehensive interventions towards student MSM should be implemented in order to curb the spread of HIV. Family and school-based interventions should be considered to target this educated, yet vulnerable, population.

Test-retest assessment of independent component analysis-derived resting-state functional connectivity based on functional near-infrared spectroscopy.

Recent studies of resting-state functional near-infrared spectroscopy (fNIRS) have emerged as a hot topic and revealed that resting-state functional connectivity (RSFC) is an inherent characteristic of the resting brain. However, it is currently unclear if fNIRS-based RSFC is test-retest reliable. In this study, we utilized independent component analysis (ICA) as an effective RSFC detection tool to address the reliability question. Sixteen subjects participated in two resting-state fNIRS recording sessions held 1week (6.88±1.09 days) apart. Then, RSFC in the sensorimotor regions was extracted using ICA. Test-retest reliability was assessed for intra- and inter-sessions, at both individual and group levels, and for different hemoglobin concentration signals. Our results clearly demonstrated that map-wise reliability was excellent at the group level (with Pearson's r coefficients up to 0.88) and generally fair at the individual level. Cluster-wise reliability was better at the group level (having reproducibility indices of up to 0.97 for the size and up to 0.80 for the location of the detected RSFC) and was weaker but still fair at the individual level (0.56 and 0.46 for intra- and inter-session reliabilities, respectively). Cluster-wise intra-class correlation coefficients (ICCs) also exhibited fair-to-good reliability (with single-measure ICC up to 0.56), while channel-wise single-measure ICCs indicated lower reliability. We conclude that fNIRS-based, ICA-derived RSFC is an essential and reliable biomarker at the individual and group levels if interpreted in map- and cluster-wise manners. Our results also suggested that channel-wise individual-level RSFC results should be interpreted with caution if no optode co-registration procedure had been conducted and indicated that "cluster" should be treated as a minimal analytical unit in further RSFC studies using fNIRS.

Detecting resting-state functional connectivity in the language system using functional near-infrared spectroscopy.

Functional connectivity has become one of the important approaches to understanding the functional organization of the human brain. Recently, functional near-infrared spectroscopy (fNIRS) was demonstrated as a feasible method to study resting-state functional connectivity (RSFC) in the sensory and motor systems. However, whether such fNIRS-based RSFC can be revealed in high-level and complex functional systems remains unknown. In the present study, the feasibility of such an approach is tested on the language system, of which the neural substrates have been well documented in the literature. After determination of a seed channel by a language localizer task, the correlation strength between the low frequency fluctuations of the fNIRS signal at the seed channel and those at all other channels is used to evaluate the language system RSFC. Our results show a significant RSFC between the left inferior frontal cortex and superior temporal cortex, components both associated with dominant language regions. Moreover, the RSFC map demonstrates left lateralization of the language system. In conclusion, the present study successfully utilized fNIRS-based RSFC to study a complex and high-level neural system, and provides further evidence for the validity of the fNIRS-based RSFC approach.

Functional connectivity as revealed by independent component analysis of resting-state fNIRS measurements.

As a promising non-invasive imaging technique, functional near infrared spectroscopy (fNIRS) has recently earned increasing attention in resting-state functional connectivity (RSFC) studies. Preliminary fNIRS-based RSFC studies adopted a seed correlation approach and yielded interesting results. However, the seed correlation approach has several inherent problems, such as neglecting of interactions among multiple regions and a dependence on seed region selection. Moreover, ineffectively reduced noise and artifacts in fNIRS measurements also negatively affect RSFC results. In this study, independent component analysis (ICA) was introduced to meet these challenges in RSFC detection based on resting-state fNIRS measurements. The results of ICA on data from the sensorimotor and the visual systems both showed functional system-specific RSFC maps. Results from comparison between ICA and the conventional seed correlation approach demonstrated, both qualitatively and quantitatively, the superior performance of ICA with higher sensitivity and specificity, especially in the case of higher noise level. The capability of ICA to separate noise and artifacts from resting-state fNIRS data was also demonstrated, and the extracted noise and artifacts were illustrated. Finally, some practical issues on performing ICA on resting-state fNIRS data were discussed.

Use of fNIRS to assess resting state functional connectivity.

Recently, resting state functional connectivity (RSFC) studies based on fMRI and EEG/MEG have provided valuable insight into the intrinsic functional architecture of the human brain. However, whether functional near infrared spectroscopy (fNIRS), a suitable imaging method for infant and patient populations, can be used to examine RSFC remains elusive. Using an ETG-4000 Optical Topography System, the present study measured 29 adult subjects (14 females) over the sensorimotor and auditory cortexes during a resting session and a motor-localizer task session. The RSFC maps were computed by seed-based correlation analysis and data-driven cluster analysis. The results from both analyses showed robust RSFC maps, which were not only consistent with the localizer task-related activation results, but also those of previous fMRI findings. Moreover, the strong consistency between the seed-based correlation analysis and the data-driven cluster analysis further validated the use of fNIRS to assess RSFC. The potential influence of a specific low-frequency filtering range (0.04-0.15 Hz and 0.01-0.08 Hz) and three fNIRS parameters (oxy-Hb, deoxy-Hb, and total-Hb) on RSFC results were also examined.

[Genetic characteristics of HIV-1 primary drug resistance-associated mutations in treatment-naive individuals in Liaoning province, 2004-2008].

OBJECTIVE: To investigate the HIV-1 drug resistance associated mutations and examine the susceptibility of HIV-1 with these mutations to antiretroviral in treatment-naive individuals in Liaoning province from 2004 to 2008. METHODS: RNA was extracted from 20 plasma samples of diagnosed untreated HIV-1-infected treatment-naive patients by drawing method. After the viral loading (VL) test, the protease and nucleoside reverse transcriptase coding regions were amplified by RT-PCR, nested PCR and sequence analysis directly. Levels of resistance and prevalence were evaluated according to the Stanford University HIV Drug Resistance Database's algorithm (http://hivdb.stanford.edu). RESULTS: Among the 20 plasma samples, 13 got PCR products because of their VL values higher than 1000 copies/ml.Meanwhile, the 13 samples got 65 sequences by using 5 primers each. Polymorphisms in subtype H and circulating recombinant forms (CRFs) CRF10_CD sequences were identified. An overall prevalence of 30.8% (4/13) resistance to NNRTIs, 7.7% (1/13) to PI and no NRTIs mutations were found. The most frequent substitutions (4/13) in the RT region at positions P225H, K238S, V179D, K238T and a major position I54S in PR implied to a multiple drug-resistance. A71V or L10V only, respectively, substitution in PR was found in 3 samples, but no any worse with drug sensitivity. CONCLUSION: HIV-1 polymorphisms in subtype H and CRFs CRF10_CD sequences were identified circulating in Liaoning. A major mutation position I54S in PR implied that it would be the time to commence a higher level drug regimen.

[HIV-1 drug-resistance profiles of treated AIDS patients in Liaoning: genetic characteristics and prevalence].

OBJECTIVE: Since the advent in 2004 of highly active antiretroviral therapy (HAART) in Liaoning, a dramatic improvement had been seen in the number of patients attaining undetectable viral loads (92/104), but the extent of mutation diversity on human immunodeficiency virus 1 (HIV-1) and the prevalence of drug resistance had remained elusive. This study aimed to analyze both HIV-1 mutation profiles and prevalence related to antiretroviral resistance following therapeutic failure. METHODS: A total of 104 blood samples circling Liaoning from HAART-treated between 2004 and 2008 were studied. Patients' CD(4)(+) T-cell count and viral load were determined. HIV-1 pol (PR and part of RT) gene fragments were amplified from patients' plasma by reverse transcriptase polymerase chain reaction (RT-PCR) and nest-PCR, subsequently sequenced and analyzed. RESULTS: CD(4)(+) T cell numbers and viral replication capacity were assessed. 88.4% (92/104) of the patients were successful after initial non-suppressive NRTI & NNRTI-based HAART regimens. Subjects on non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens developed more (6/104) drug-resistance mutations than those on nucleoside reverse transcriptase inhibitor (NRTI) regimens did (5/104). No protease-inhibitor (PI) drug resistance mutations developed. The whole rate of drug resistance mutations was about 6.73%. Subjects developing NNRTI-resistance (NNRTI-R) seemed more likely to develop drug-resistant viremia than with NRTI-based HAART. CONCLUSION: This finding might have implications in which that the prevalence of drug-resistance mutations was low but remained risk of transmission in HIV-infected therapeutic failure. Meanwhile, data from the present study showed that there was a high frequency of primary mutations, which offered resistance to nrti and nnrti. Monitoring patients with treatment failure seems an important tool in helping the physicians to improve their treatment schedule and to carry out epidemiological surveillance programs.

The impacts of current antiretroviral therapy regimens on Chinese AIDS patients and their implications for HIV-1 drug resistance mutation.

This study sought to investigate the impacts of the antiretroviral (ARV) therapy regimens currently used in Chinese HIV-1-infected individuals. Seven hundred eighteen ARV-treated and treatment-naive HIV-1-infected individuals living in seven provinces were enrolled in 2005 by a multistage sampling approach according to a national cross-sectional survey program on HIV-1 drug resistance. All patients were investigated clinically, and CD4+ T cell counts and HIV-1 viral loads were measured while genotyping for drug resistance was determined by a home brew nested PCR. Viral inhibition in ARV-treated individuals was higher than that in ARV treatment-naive individuals. The overall prevalence of drug-resistant mutations was 37.8%. Higher frequencies of mutations in ARV-treated and drug withdrawal groups were found than in the ARV treatment-naive group (P<0.01). Of the four regimens currently used, the D4T/3TC/NVP regimen showed a higher-level viral inhibition. No statistical significance was found among the four regimens in drug-resistant mutations. The rate of resistance-associated mutations to non-nucleotide reverse transcriptase inhibitors (NNRTIs) was higher than that to nucleotide reverse transcriptase inhibitors (NRTIs) (P<0.01). The most common mutations conferring resistance to NNRTIs were K103N, Y181C and G190A, representing 56.5, 30.4 and 14.5%, respectively. Furthermore, higher viral inhibition and a lower rate of drug-resistant mutations were achieved in the good compliance group. This study revealed an efficient viral inhibition achieved with the current first-line regimens in China. Most of these regimens could rapidly result in emergence of drug-resistant mutations, suggesting that a second-line ARV therapy is urgently needed and that the compliance with treatment must be emphasized during long-term treatment.