ABSTRACT
INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols aim to optimize patient recovery after major surgery. Our study was to examine the evidence of the effectiveness of interventions designed to improve patient outcomes after radical cystectomy. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Medline, Embase, Cochrane from January 2005 to January 2021 without language restrictions. ELIGIBILITY CRITERIA: Randomized and non-randomized controlled studies implementing ERAS measuring its interventions on rates of postoperative complications, 30-day readmission, length of stay (LOS) and bowel function after radical cystectomy. DATA EXTRACTION AND SYNTHESIS: Two members of the investigating team independently selected studies and evaluated bias using the Cochrane collaboration tool. Meta-analysis of all comparative studies used inversed-weighted, fixed- effects models and random effects models to pool results. Publication bias was graphically assessed using contour-enhanced funnel plots and the Egger's test of funnel plot symmetry. RESULTS: Fifteen studies were included in our meta-analysis; we observed that ERAS decreased the time for the first bowel movement (standardized mean difference [SMD]: -1.30, 95% CI -1.90 to -0.70, P<0.00001) and shortened the length of stay (LOS) ([SMD]: -0.49, 95% CI -0.77 to -0.20, (P < 0.00001)); however, 30-day readmission (risk ratio [RR]: 0.97,95% [CI] 0.73 to 1.28, P=0.52) and the overall postoperative complication rate (risk ratio [RR]: 0.98,95% confidence interval [CI]: 0.88 to 1.09, P= 0.41) showed no significant difference.
ABSTRACT
Diagnosis of HIV infection and AIDS need to rely on HIV antibody or HIV antigen test internationally, and the test process is divided into preliminary screening test and confirmatory test. The HIV/AIDS screening laboratory of the First Affiliated Hospital of Nanjing Medical University has been using electrochemiluminescence (ECL) to screen the patients. A 50-year-old man with his enhanced computed tomography (CT) scan revealing two soft tissue density images were seen in the left kidney came to the hospital for medical treatment. The patient's postoperative pathological examination revealed (left kidney) renal clear cell carcinoma. The HIV screening tests of the patient several times in perioperative period showed reactivity, but the result of the confirmatory tests of Nanjing Municipal Center for Disease Control and Prevention were negative all the time. False positive HIV results are quite rare in the setting of renal clear cell carcinoma. There must be some substances that can react with the HIV Combi PT designed to detect anti-HIV antibodies of the IgG- and IgM-class as well as HIV p24 antigen in this patient. In conclusion, false positive results of HIV screening test may occur in serum of patients with renal cell carcinoma, and necessary confirmatory tests are needed. When clinicians encounter such problems, confirmatory tests should be conducted according to the guidelines to avoid misdiagnosis.
