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BACKGROUND: Locally advanced colon cancer is considered a relative contraindication for minimally invasive proctectomy (MIP), and minimally invasive versus conventional open proctectomy (COP) for locally advanced colon cancer has not been studied. METHODS: We have searched the Embase, Cochrane Library, PubMed, Medline, and Web of Science for articles on minimally invasive (robotic and laparoscopic) and COP. We calculated pooled standard mean difference (SMD), relative risk (RR), and 95% confidence intervals (CIs). The protocol for this review has been registered on PROSPERO (CRD42023407029). RESULTS: There are 10132 participants including 21 articles. Compared with COP, patients who underwent MIP had less operation time (SMD 0.48; CI 0.32 to 0.65; I2â =â 0%, Pâ =â .000), estimated blood loss (MD -1.23; CI -1.90 to -0.56; I2â =â 95%, Pâ <â .0001), the median time to semi-liquid diet (SMD -0.43; CI -0.70 to -0.15; I2â =â 0%, Pâ =â .002), time to the first flatus (SMD -0.97; CI -1.30 to -0.63; I2â =â 7%, Pâ <â .0001), intraoperative blood transfusion (RR 0.33; CI 0.24 to 0.46; I2â =â 0%, Pâ <â .0001) in perioperative outcomes. Compared with COP, patients who underwent MIP had fewer overall complications (RR 0.85; CI 0.73 to 0.98; I2â =â 22.4%, Pâ =â .023), postoperative complications (RR 0.79; CI 0.69 to 0.90; I2â =â 0%, Pâ =â .001), and urinary retention (RR 0.63; CI 0.44 to 0.90; I2â =â 0%, Pâ =â .011) in perioperative outcomes. CONCLUSION: This study comprehensively and systematically evaluated the difference between the safety and effectiveness of minimally invasive and open treatment of locally advanced colon cancer through meta-analysis. Minimally invasive proctectomy is better than COP in postoperative and perioperative outcomes. However, there is no difference in oncological outcomes. This also provides an evidence-based reference for clinical practice. Of course, multi-center RCT research is also needed to draw more scientific and rigorous conclusions in the future.
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Neoplasias del Colon , Proctectomía , Humanos , Neoplasias del Colon/cirugía , Neoplasias del Colon/patología , Proctectomía/métodos , Proctectomía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Tempo Operativo , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Laparoscopía/métodos , Laparoscopía/efectos adversos , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversosRESUMEN
Background: Minimally invasive total mesorectal excision (MiTME) and transanal total mesorectal excision (TaTME) are popular trends in mid and low rectal cancer. However, there is currently no systematic comparison between MiTME and TaTME of mid and low-rectal cancer. Therefore, we systematically study the perioperative and pathological outcomes of MiTME and TaTME in mid and low rectal cancer. Methods: We have searched the Embase, Cochrane Library, PubMed, Medline, and Web of Science for articles on MiTME (robotic or laparoscopic total mesorectal excision) and TaTME (transanal total mesorectal excision). We calculated pooled standard mean difference (SMD), relative risk (RR), and 95% confidence intervals (CIs). The protocol for this review has been registered on PROSPERO (CRD42022374141). Results: There are 11010 patients including 39 articles. Compared with TaTME, patients who underwent MiTME had no statistical difference in operation time (SMD -0.14; CI -0.31 to 0.33; I2=84.7%, P=0.116), estimated blood loss (SMD 0.05; CI -0.05 to 0.14; I2=48%, P=0.338), postoperative hospital stay (RR 0.08; CI -0.07 to 0.22; I2=0%, P=0.308), over complications (RR 0.98; CI 0.88 to 1.08; I2=25.4%, P=0.644), intraoperative complications (RR 0.94; CI 0.69 to 1.29; I2=31.1%, P=0.712), postoperative complications (RR 0.98; CI 0.87 to 1.11; I2=16.1%, P=0.789), anastomotic stenosis (RR 0.85; CI 0.73 to 0.98; I2=7.4%, P=0.564), wound infection (RR 1.08; CI 0.65 to 1.81; I2=1.9%, P=0.755), circumferential resection margin (RR 1.10; CI 0.91 to 1.34; I2=0%, P=0.322), distal resection margin (RR 1.49; CI 0.73 to 3.05; I2=0%, P=0.272), major low anterior resection syndrome (RR 0.93; CI 0.79 to 1.10; I2=0%, P=0.386), lymph node yield (SMD 0.06; CI -0.04 to 0.17; I2=39.6%, P=0.249), 2-year DFS rate (RR 0.99; CI 0.88 to 1.11; I2=0%, P = 0.816), 2-year OS rate (RR 1.00; CI 0.90 to 1.11; I2=0%, P = 0.969), distant metastasis rate (RR 0.47; CI 0.17 to 1.29; I2=0%, P = 0.143), and local recurrence rate (RR 1.49; CI 0.75 to 2.97; I2=0%, P = 0.250). However, patients who underwent MiTME had fewer anastomotic leak rates (SMD -0.38; CI -0.59 to -0.17; I2=19.0%, P<0.0001). Conclusion: This study comprehensively and systematically evaluated the safety and efficacy of MiTME and TaTME in the treatment of mid to low-rectal cancer through meta-analysis. There is no difference between the two except for patients with MiTME who have a lower anastomotic leakage rate, which provides some evidence-based reference for clinical practice. Of course, in the future, more scientific and rigorous conclusions need to be drawn from multi-center RCT research. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022374141.
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Objective To introduce a novel femoral distractor which is applied in close reduction and internal fixation (CRIF) with antegrade intramedullary nail for femoral shaft fractures.Methods From September 2010 to March 2015,85 patients with femoral shaft fracture were treated by CRIF with antegrade intramedullary nail in which our self-designed novel distractor was used.They were 64 males and 21 females,with an average age of 36.6 years.By AO classification,we had 32 cases of type 32-A,40 cases of type 32-B,and 13 cases of type 32-C.The intervals between injury and surgery averaged 7.5 days (range,from 1 to 16 days).The fracture was located at the upper shaft in 26 cases,at the middle shaft in 57 cases,at the middle shaft and ipsilateral neck in one,and at the lower shaft and ipsilateral intertrochanteric site in one.Their operation time,intraoperative blood loss,intra-and post-operative complications,and fracture union time were recorded and analyzed.Results Successful close reduction was achieved in all the 85 patients with no iatrogenic injury to major vessels or nerves.Operation time averaged 105.5 minutes;time for X-ray exposure averaged 25.8 seconds;intraoperative blood loss averaged 209.2 mL.The 85 patients received follow-ups from 8 to 24 months (mean,16.3 months).Fracture union was achieved in 83 cases after an average duration of 7.8 weeks (range,from 4 to 12 weeks),but nonunion occurred in 2 cases.One-year follow-ups revealed recovery of normal function of the affected knee in all,with no limb shortening > 10 mm,rotational angulation > 15°,or lateral or anteroposterior angulation > 10°.No incision infection,deep vein thrombosis or pulmonary embolism happened during the entire follow-up.Conclusion Our self-designed novel distractor can facilitate CRIF with antegrade intramedullary nail for femoral shaft fractures,and avoid the complications and inconvenience associated with a traction table.
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Objective To evaluate the clinical value of white blood cell(WBC) ,neutrophilic granulocyte percentage(NEUT% ) and C‐reactive protein(CRP) in lung infection of early chronic obstructive pulmonary disease(COPD) ,and analyse the pathogen dis‐tribution .Methods 186 cases of hospitalized patients with COPD were enrolled as research group and 60 healthy ones as control group .Compared WBC ,NEUT% ,CRP levels between the two groups .According to sputum culture results ,patients were divided into normal flora group and pathogen growth group;according to the type of pathogen ,patients were divided into G+ and G- group . Analyse WBC and CRP levels in each groups and compare sensitivity ,specificity and positive predictive value of the two indicators . Distribution of positive sputum culture results were statistically analyzed .Results The levels of three indicators in research group were higher than those in control group(P0 .05) .Based on sputum culture positive results ,the number of fungi is 86 ,and Candida albicans were the most accounting for 35 .85% .The number of bacteria were 73 strains .Differences in WBC ,NEUT% and CRP between G+ group and G- group were not significant(P> 0 .05) .Conclusion WBC ,NEUT% and CRP levels in COPD patients were higher than those in healthy group .But due to many factors which could affect the levels of WBC ,NEUT% and serum CRP ,a preliminary diag‐nosis of COPD lung infection can′t be made just through the three indicators .
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Objective To analyze the identification and antibiotic resistance of non active Escherichia coli isolated from feces . Methods Clinical fecal specimens were collected from January 2013 to June 2015 for bacterial culture ,identification and antimicro-bial susceptibility testing .Results Sixty-one strains of E .coli ,inactive were detected ,18 strains of which could be agglutinated with diagnostic serum of Shigella .Three stains could produce extented spectrum β-lactamases(ESBLs);The rate of antibiotic resistance of amoxicillin and ticarcillin was 100% ,The rate of piperacillin ,cephalothin and sulfamethoxazole was 78% ,the rate of cefoxitin and amikacin was 33% ,the rate of piperacillin/tazobactam ,imipenem and meropenem was 0% .Conclusion Non active Escherichia coli can induce diarrhea ,which is easily misdiagnosed as Shigella ,the antimicrobial resistance between Escherichia coli and non active Escherichia coli is not significant difference .
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Objective To explore the relationship between self-management behaviors and family function among elderly pa-tients with diabetes in community in order to provide evidence for community nursing of diabetes.Methods A total of 670 elderly patients with diabetes were selected with convenience sampling household survey method and investigated with the family Adapta-tion,Partnership,Growth,Affection,and Resolve(APGAR)and the Summary of Diabetes Self-Care Activities(SDSCA).Results The family functions total score of the elderly patients with diabetes in community was (6.95±2.91),the self-management behav-iors total score was (20.06±5.80),among the self-management behaviors the score for exercise was the highest and blood glucose monitoring was the lowest;family function had remarkable positive relation with the total score of self-management behaviors a-mong elderly patients with diabetes in community(r=0.156,P <0.05).Conclusion There is a correlation between the self-man-agement behaviors and family function,good family function is conducive to the improvement of self-management behaviors for the elderly patients with diabetes.
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ObjectiveTo evaluate the value of MR imaging(MRI)in diagosing of obstetrical brachial plexus.MethodsBetween September 2006 to September 2011,eighteen cases (12 males and 6 females)of obstetrical brachial plexus injury had being used for investigation,aging from 2 month to 3 years, average of 10.6 month. Eight left side and 10 right side. Tassin Ⅰ was 4 cases,Tassin Ⅱ was 6 eases, Tassin Ⅲwas 5 eases, Tassin Ⅳ was 4 cases. All cases were performed to MRI test before operating and the result compare with finding during operating. ResultsFindings of MRI:pseudomeningocele was in 13 of the 18cases while 10 of the 15 patients had multiple pseudomeningoceles. Displacement of spinal cord was in 6 cases; Normal was 2 cases; thickening of nerve root was in 2 cases.ConclusionMR imaging is an effective tool for demonstrating lesions of the brachial plexus worthy of surgical exploration.
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Objective To explore the clinical classification of the brachial plexus root injury in adult.MethodsAll 155 cases of adult brachial plexus root injury in the First Affiliated Hospital of Sun Yat-sen University,were collected and analyzed on their characteristic,operative methods,and clinical outcome so as to find the distribution and incidence of different type of brachial plexus root injury and set up the clinical classification of adult brachial plexus root injury.ResultsBrachial plexus root injuries in adult could be classified into three types and seven subtypes.Type A is upper brachial plexus root injury,including type AⅠ (C5,C6 completely avulsion or rupture injury,with/without phrenic nerve injury),type AⅡ (C5-C7 completely injury),and type AⅢ (C5-C7 completely injury accompanied with C8,T1 incompletely injury).Type B is lower brachial plexus root injury,including type BⅠ[ C8,T1 (with/without C7)completely injury ] and type BⅡ (C8,T1,C7 completely injury,accompanied with C5、6 incompletely injury).Type C is total brachial plexus root injury,including type CⅠ(C5-T1 completely root avulsion) and type CⅡ(C7-T1 root avulsion accompanied with C5、6 root or trunkrupture).For the cases of every type,u pper brachial plexus root injury type A have 86 cases,in which type AⅠ 6 cases,type AⅡ 27 cases and type AⅢ 53 cases; lower brachial plexus root injury type B have 6 cases,in which type BⅠ 2 cases and type BⅡ 4 cases; total brachial plexus root injury type C have 63 cases,in which type CⅠ 51 cases and type CⅡ 12 cases. ConclusionExcept the upper,lower,and total three types,brachial plexus root injuries in adult could be classified further into seven subtypes.The distribution of different type of adult brachial plexus root injury is overbalance:upper type A (55.5%) is more often seen,total type C(40.6%) followed and lower type B(3.9%) is the least seen.In upper brachial plexus root injury,type AⅢ(61.6%) is more often seen,type AⅡ(31.4%) followed and type AⅠ(7%) is less seen.
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To establish a novel rapid, convenient, sensitive and specific method applicable to quantitative analysis of the rubella virus extensively, RV total RNA was extracted with Trizol. The envelope glycoprotein E1 gene was amplified from rubella virus by PCR, and the PCR products were cloned into the pMD18-T cloning vector and transfected into DH5alpha. After Amp selection and analysis of restriction enzyme, the clones carrying the E1 gene were identified. After quantitation and serial dilution, the quantitative analysis of E1 gene was made by real-time PCR with the use of FAM as indicator. Standard curve of the real-time PCR was plotted with starting cDNA concentration versus threshold cycle. Then the new method was used to measure 50 cases with suspectable RV infection. The results were compared with those obtained by ELISA assay. TaqMan(r)MGB real-time PCR could help evaluate the level of virus reliably. The correlation coefficient of the standard curve is 0.998, and the linear range of the system is from 10(3) copies/microl to 10(9) copies/microl in clinical samples. The CV value is 0.94% in batch assay and 3.36% in day to day assay. The new method is more sensitive and specific than ELISA assay. For its simplicity, sensitivity, specificity and digitized results, the real-time PCR for quantification of RV cDNA in clinical samples is available.
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Humanos , ADN Viral , Fluorescencia , Reacción en Cadena en Tiempo Real de la Polimerasa , Métodos , Virus de la Rubéola , Sensibilidad y EspecificidadRESUMEN
Objective To prepare highly expressed, purified and refolded SCR15-18 of human soluble complement receptor type 1 (sCR1-SCR15-18) protein. Methods The expression of recombinant pET32-sCR1-SCR15-18 in E.coli.. BL21 was induced by IPTG of different concentrations for different time period under different temperatures and the bacteria were split by sonication. The sCR1-SCR15-18 protein was purified by Ni2+-NTA resin affinity chromatography. The purified protein was refolded under different conditions. Then the bioactivity of the protein was analyzed. Results The sCR1-SCR15-18 protein of high expression, purity and bioactivity was attained. Conclusion The parameters of expression, purification and refolding of sCR1-SCR15-18 protein were optimized, which may pave a way for further studies.