Antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: an updated systematic review and meta-analysis.

BACKGROUND: The efficacy and necessity of prophylactic antibiotics in clean and clean-contaminated surgery remains controversial. METHODS: The studies were screened and extracted using databases including PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials.gov according to predefined eligibility criteria. Randomized controlled trials (RCTs) comparing the effect of preoperative and postoperative prophylactic antibiotic use on the incidence of surgical site infections (SSIs) in patients undergoing any clean or clean-contaminated surgery. RESULTS: A total of 16,189 participants in 48 RCTs were included in the primary meta-analysis following the eligibility criteria. The pooled odds ratio (OR) for SSI with antibiotic prophylaxis versus placebo was 0.60 (95% CI: 0.53-0.68). The pooled OR among gastrointestinal, oncology, orthopedics, neurosurgery, oral, and urology surgery was 3.06 (95% CI: 1.05-8.91), 1.16 (95% CI: 0.89-1.50), 2.04 (95% CI: 1.09-3.81), 3.05 (95% CI: 1.25-7.47), 3.55 (95% CI: 1.78-7.06), and 2.26 (95% CI: 1.12-4.55), respectively. Furthermore, the summary mean difference (MD) for patients' length of hospitalization was -0.91 (95% CI: -1.61, -0.16). The results of sensitivity analyses for all combined effect sizes showed good stability. CONCLUSION: Antibiotics are both effective, safe, and necessary in preventing surgical wound infections in clean and clean-contaminated procedures, attributed to their reduction in the incidence of surgical site infections as well as the length of patient hospitalization.

Intervertebral foramen puncture combined with internal fixation via paraspinal approach for treatment of lum-bosacral tuberculosis / 局解手术学杂志

Objective To explore the operative indications and efficacy of intervertebral foramen puncture combined with internal fixa -tion via paraspinal approach in the treatment of lumbosacral tuberculosis .Methods A total of 69 patients who treated with intervertebral fo-ramen puncture combined with internal fixation via paraspinal approach in spinal surgery department of Daping hospital affiliated to army medical university from January 2010 to January 2017 were retrospectively analyzed .All patients had preoperative standardized oral isoniazid , rifampicin,pyrazinamide,ethambutol for 2 to 4 weeks.The surgical methods included intervertebral foramen puncture ,drainage of paraverte-bral abscess and posterior paraspinal muscle gap approach fixation .The surgery time,intraoperative blood loss ,postoperation drainage ,abscess absorption,healing of lesions and Oswestry scores were recorded and observed .Results The operation time was from 130 to 220 minutes, with average of 140 minutes;the blood loss was from 50 to 150 mL,with average of 110 mL;the total volume of drainage was 30 to 180 mL, with average of 70 mL.All patients were followed up for 12 to 21 months.All cases were recovered except 1 patient who suffered from sacral tuberculosis received debridement and suturing caused by cutaneous necrosis .There was no infection , injury of spinal cord and nerve nor looseness or shift of internal fixation .The abscess was completely absorbed after 12 months.The Oswestry scores before surgery was (68.15 ± 18.36),while it was(11.64 ±8.12) at final followed-up,the difference was significant(P<0.05).Conclusion The surgical treatment of intervertebral foramen puncture combined with internal fixation via paraspinal approach is effective for patients who suffered large paraverte -bral abscess, parts of vertebral body collapse with segmental instability and mild kyphosis of spine with spinal cord disfunction ,which is a safe and effective surgical method .

Occurrence and prevention of complications after percutaneous endoscopic lumbar discectomy / 局解手术学杂志

Objective To analyze the occurrence of the complications after percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation or stenosis,and to reveal the effective prevention methods.Methods Retrospectively analyzed the clinical data of 568 cases who undertaken PELD,and all the related complications,possible causes,prevention and treatment methods were analyzed.Results There were 24 cases of complications occured in all the 568 cases treated with PELD,and the gross incidence rate was 4.23％,including 4 cases of dural laceration(0.70％),3 cases of hemorrhage of intravertebral vein plexus injury(0.53％),6 cases of postoperative wound pain (1.06％),8 cases of postoperative recurrence (1.41％),1 case with persistent symptoms after surgery (0.18％),2 cases of postoperative paresthesia(0.35％).Conclusion PELD is a minimally invasive surgery with high security and low incidence of complications.The effective preventions including careful decision-making,elaborate operation,and precise identification of the anatomical abnormality.

General anesthesia versus local anesthesia for penetrating keratoplasty: a prospective study.

AIM: To examine which anesthesia general or local is more effective for penetrating keratoplasty (PKP). METHODS: Patients with indications for PKP (n=141) were enrolled in a prospective study and randomly divided into general anesthesia group (group A, 70 eyes) and local anesthesia group (group B, 71 eyes). Patients received optical PKP (group A1, 30 eyes; group B1, 30 eyes) or therapeutic PKP (group A2, 40 eyes; group B2, 41 eyes). Measurement of anterior chamber treatment time (T) for PKP patients and the ratio (R) of the area of the pupils to that of recipient graft region. T and R values, as well as perioperative and postoperative complications, were compared between groups A and B using t-test or χ (2) test. RESULTS: Patients were followed for 2wk after PKP. T was (13.45±8.64)min for group A and (7.36±5.24)min for group B, a statistically significant difference (P<0.001). The R value for group A was stable during the operation, while for PKP patients in group B the value initially increased then gradually decreased to normal after suturing. In group B, extrusion of intraocular contents occurred in 5 eyes, and iridal prolapse occured in 11 cases; no perioperative complications occurred in group A. Relapse rate for fungal keratitis was 13.04% in group B and 0% in group A. CONCLUSION: Under general anesthesia, pupils remaine stable during PKP and perioperative complications are averted. General anesthesia gives more time to treat pathological changes in the anterior chamber and treatment success rate is higher.

Analysis of clinical features and prognosis of primary myelodysplastic syndromes with myelofibrosis patients / 中华血液学杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and prognosis of the primary myelodysplastic syndrome with myelofibrosis (MDS-MF) patients and to improve the cognition of MDS-MF.</p><p><b>METHODS</b>Four hundred and sixty-six primary MDS patients with bone marrow (BM) biopsy were divided into two groups according to whether BM associated with fibrosis, the clinical features and prognosis of the two groups were analyzed retrospectively.</p><p><b>RESULTS</b>167 (35.8%) MDS cases revealed myelofibrosis, of which MF-1 123 cases (26.4%), MF-2 40 cases (8.6%), MF-3 4 cases (0.9%). The proportion of hepatosplenomegaly in MDS-MF group was significantly higher than in MDS without MF group, the difference had statistical significance (P = 0.031). The proliferation of BM biopsy in MDS-MF group was significantly more active than in MDS without MF group. The number of blasts, megakaryocytes and abnormal megakaryocytes in MDS-MF group were significantly higher than in MDS without MF group, the differences had statistical significance (P < 0.05). Among the 345 patients who had available results of cytogenetic analysis, 121 cases were MDS-MF patients, the proportion of middle and high-risk prognostic group according to IPSS karyotype prognosis groups in MDS-MF group were significantly higher than in MDS without MF group, the differences had statistical significance (P = 0.047). The median survival was 17 (1 - 60) months in MDS-MF group, and was 32 (1 - 62) months in MDS without MF group. The difference had statistical significance (P = 0.001). Myelofibrosis had independent prognostic significance by multi-variable analysis (P = 0.019).</p><p><b>CONCLUSION</b>The myelofibrosis in MDS is main the proliferation of reticular fiber. The proliferation of reticular fiber is closely related with the number of blast cells, the proliferation and developmental abnormalities of megakaryocytes and the karyotype. The prognosis of MDS-MF patients is poor.</p>

[Clinical analysis of 47 patients with psoriasis arthropathy treated by traditional Chinese medicine syndrome differentiation and integrative medicine].

OBJECTIVE: To analyze the clinical characteristics of psoriasis arthropathy (PA) and to explore the effect of treatment by traditional Chinese medicine (TCM) syndrome differentiation and integrative medicine. METHODS: The initiating characteristics, clinical manifestations, related laboratory and X-ray data as well as the therapeutic efficacy of syndrome dependent TCM and integrative medicine on 47 PA patients were analyzed. RESULTS: Among all the 47 patients, 38 (80.6%) had the skin lesion revealed earlier to joint symptoms, the average time between the appearance of skin lesion and joint symptoms was 9.2 years; joint X-ray abnormality was found in 32 cases (68.1%); and psoriasis nail involvement was found in 33 cases (70.2%). Seventeen patients were treated with TCM alone and obtained satisfactory results, while the other 30 patients, were treated by integrative medicine with the dosage of medicine reduced immediately after symptoms were relieved, and finally cured or improved. CONCLUSION: TCM and integrative medicine are effective in treating PA, with lesser side effects.

[Comparison of primary extraovarian peritoneal serous papillary carcinoma with stage III-IV ovarian papillary serous carcinoma].

OBJECTIVE: Extraovarian peritoneal serous papillary carcinoma (EPSPC) is both histologically and clinically similar to stage III-IV ovarian papillary serous carcinoma (OPSC). The purpose of this study is to investigate the clinical findings, treatment, and outcome of EPSPC patients compared with stage III-IV OPSC patients. METHODS: The data of 12 EPSPC patients and 45 stage III-IV OPSC patients were retrospectively reviewed, comparing the characteristics on clinical presentation and treatment, sensitivity to first-line chemotherapy agents and survival. RESULTS: By analysis of patients' characteristics, presenting signs and symptoms, type and extent of surgery, tumor response to first-line chemotherapy, recurrence-free interval, recurrence site and serum CA-125 levels, no significant difference was observed between the EPSPC patients and stage III-IV OPSC controls. The prevailing presenting symptoms were abdominal mass and ascites. The mainstay of treatment was debulking surgery followed by adjuvant platinum-based chemotherapy. The complete clinical response of stage III-IV OPSC was 91.8% compared with 25.0% for women with EPSPC (P < 0.01). CONCLUSION: The clinical and surgical characteristics of EPSPC are similar to those of stage III-IV OPSC. When the same treatment strategy is applied, similar response and survival are expected in either condition.

[Primary peritoneal malignant tumor: clinical analysis of 28 cases].

BACKGROUND & OBJECTIVE: Primary malignant peritoneal tumor is a kind of rare malignancy. Its morphology and clinical manifestations are very similar to the advanced ovarian cancer, therefore, they are usually misdiagnosed and the proper treatment were delayed. This paper analyzed the clinical characteristics, diagnosis, treatment, and prognosis of primary malignant peritoneal tumor. METHODS: The clinical data of 28 cases of primary peritoneal malignant tumor patients admitted between January 1996 to February 2002 in People's Hospital, Peking University, was analyzed retrospectively. There are 20 cases of primary peritoneal seropapillary adenocarcinoma, 8 cases of primary peritoneal malignant Muellerian tube tumor. Their age ranged from 33 to 74, with median age of 54. RESULTS: Among 28 patients, 22 were misdiagnosed preoperatively, the misdiagnose rate were 79%. In all cases, cytoreductive surgery were performed. Postoperative chemotherapy were given either with CAP regimen or TP regimen. Postoperative survival time was 1-83 months, the median survival time was 30 months. CONCLUSION: The recognition of this special tumor should be stressed, to improve early diagnosis and treatment. The authors suggest that cytoreductive surgery on time and postoperative adjuvant chemotherapy should be implemented to improve survival rate.

Pathways for Nitrobenzene Biodegradation / 微生物学通报

Nitrobenzene is one of the toxic compounds. Much work had focused on biodegradation of it sofar. Two main pathways for nitrobenzene biodegradation, oxidative and partial reductive pathways, were reviewed in this article. The mechanism of these pathways including involved enzymes and genes was introduce in details. Comparative analysis of the pathways would provide basis for the development and application of biodegradation technology for nitrobenzene and other organic pollutants.