Paper-based microfluidics for rapid diagnostics and drug delivery.

Paper is a common material that is promising for constructing microfluidic chips (lab-on-a-paper) for diagnostics and drug delivery for biomedical applications. In the past decade, extensive research on paper-based microfluidics has accumulated a large number of scientific publications in the fields of biomedical diagnosis, food safety, environmental health, drug screening and delivery. This review focuses on the recent progress on paper-based microfluidic technology with an emphasis on the design, optimization and application of the technology platform, in particular for medical diagnostics and drug delivery. Novel advances have concentrated on engineering paper devices for point-of-care (POC) diagnostics, which could be integrated with nucleic acid-based tests and isothermal amplification experiments, enabling rapid sample-to-answer assays for field testing. Among the isothermal amplification experiments, loop-mediated isothermal amplification (LAMP), an extremely sensitive nucleic acid test, specifically identifies ultralow concentrations of DNA/RNA from practical samples for diagnosing diseases. We thus mainly focus on the paper device-based LAMP assay for the rapid infectious disease diagnosis, foodborne pathogen analysis, veterinary diagnosis, plant diagnosis, and environmental public health evaluation. We also outlined progress on paper microfluidic devices for drug delivery. The paper concludes with a discussion on the challenges of this technology and our insights into how to advance science and technology towards the development of fully functional paper devices in diagnostics and drug delivery.

Laparoscopic hepatectomy produces better outcomes for hepatolithiasis than open hepatectomy: An updated systematic review and meta-analysis.

BACKGROUND: The present meta-analysis focused on comparing the efficacy and safety of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) for hepatolithiasis. In detail, short-term outcomes including operative time, intraoperative blood loss, intraoperative blood transfusion, postoperative time to oral intake, length of hospital stay, overall postoperative complication rate, initial residual stone, and stone recurrence were analyzed systematically. METHODS: PubMed, Embase, Web of Science and Cochrane Library were comprehensively searched for eligible studies up to Jun. 30. 2017. Bibliographic citation management software (EndNoteX7) was applied to literature management. Quality assessment was carried out according to the modification of the Newcastle-Ottawa Scale (NOS). The data were analyzed by Stata SE12.0 (StataCorp, College Station, TX). Sensitivity analysis was conducted by deleting single study step by step. Odds ratio (OR) were calculated for dichotomous data, and standard mean difference (SMD) with 95% confidence intervals (CI) was calculated continuous data. RESULTS: A total of 17 eligible studies with 1351 patients were identified after a thorough literature search. The pooled results of the present meta-analysis showed that laparoscopic approach was related to significantly less intraoperative estimated blood loss in patients with hepatolithiasis (SMD: -0.52; 95% CI: -0.93 to -0.1; I2 = 91%; P < 0.0001); lower overall postoperative complication rate (OR: 0.52; 95% CI: 0.39 to 0.70; I2 = 0%; P < 0.0001) and intraoperative transfusion rate (OR = 0.25; 95% CI: 0.12 to 0.53; P < 0.0001; I2 = 30.1%; P = 0.239); shorter time to oral intake (SMD: -1.66; 95% CI: -2.41 to -0.92; I2 = 91%; P < 0.0001), and shorter stay in hospital (SMD: -0.89; 95% CI: -1.19 to -0.59; I2 = 83%; P < 0.00001). However, no significant differences was detected between LH and OH in terms of operative time (SMD: 0.22; 95% CI: -0.21 to 0.65; I2 = 92%; P = 0.31), initial residual stones (OR: 0.79; 95% CI: 0.50 to 1.25; I2 = 0%; P = 0.31), and stone recurrence (OR: 0.67; 95% CI: 0.35 to 1.27; I2 = 0%; P = 0.22). In addition, our stratified analysis according to types of LH indicated that the laparoscopic approach still produced more favorable outcomes whatever patients underwent left lateral sectionectomy (LLS) or left hemihepatectomy (LHH). CONCLUSION: The laparoscopic hepatectomy is a better alternative to open approach in patients with hepatolithiasis, providing less overall complication rate, shorter postoperative stay of hospital stay, less blood loss, and shorter time to oral intake. However, high-quality randomized controlled trials (RCTs) are badly needed to provide higher-level evidence due to unavoidable bias from non-randomized trials.