[Comparison of open versus laparoscopic surgeries for adrenal tumor: a meta-analysis].

OBJECTIVE: To systematically review the effectiveness and safety of open and laparoscopic surgeries for treatment of adrenal tumors. METHODS: The online databases including CNKI, PUBMED, SinoMed, EBSCO, Springerlink, WanFang Data, and VIP were searched for clinical trials published from 1999 to 2016. A meta-analysis was performed using RevMan 5.2 software. RESULTS: A total of 2340 patients in 25 trials were included. The results of meta-analysis showed that laparoscopic surgery was better than open surgery in terms of intestinal function recovery time (OR=-0.96, 95%CI [-1.22, -0.70] P<0.000 01), hospitalization time (OR=-3.48, 95%CI [-4.13, -2.78], P<0.000 01), complications (OR=0.22, 95%CI [0.14, 0.35], P<0.0001), and volume of blood loss (OR=-104.77, 95%CI [-138.95, -70.60], P<0.000 01). There was no significant difference in the surgery cost between open and laparoscopic surgeries. CONCLUSION: Laparoscopic surgery is superior to open surgery for treatment of adrenal tumors for shorter intestinal function recovery time, surgery duration, and hospitalization time and less complications and blood loss.

Association of Single Nucleotide Polymorphisms in Toll-like Receptors with Acinetobacter baumanii Infectionin a Chinese Population.

BACKGROUND: During recent years, infection of Acinetobacter baumanii showed a rapid growth in hospitals and community. Toll-like receptors (TLRs) are the most important pattern recognition receptors, which play a critical role during recognizing invading pathogens by the natural immune system. Our objective was to determine the associations of TLRs polymorphisms with the susceptibility to A. baumanii infection in a Chinese population. METHODS: We carried out a case-control study, genotyping 13 polymorphisms of TLR-2, TLR-4, TLR-5 and TLR-9 genes on 423 A. baumanii-infected patients and 385 exposed controls. Thirteen SNPs at the TLR-2 (rs3804099, rs7656411 and rs76112010), TLR-4 (rs1927914, rs10759932 and rs11536889), TLR-5 (rs1341987, rs1640827, rs1861172, rs2241097, rs5744174 and rs17163737) and TLR9 (rs187084) genes were analyzed. SNP genotyping was performed using an improved multiplex ligation detection reaction (iMLDR) technique. RESULTS: The SNP of TLR-9, rs187084, was related to A. baumanii-infection significantly under recessive model (G/G, to A/A + G/A, P = 0.0064, OR = 0.59, 95% CI = 0.40-0.86) after adjustment with age. Besides, the haplotype GCG of TLR-4 was significantly associated with A. baumanii infection (P = 0.027). CONCLUSION: TLR-4 and TLR-9 may be related to the susceptibility to A. baumanii infection in a Chinese population.

[Microwave ablation of the canine prostate: an experimental study].

OBJECTIVE: To investigate the effect of transrectal ultrasound-guided microwave ablation of canine prostate tissue. METHODS: Guided by transrectal ultrasound, we conducted microwave ablation on each side of the prostate in 12 male dogs, 6 at 40 W/ 120 s (group A) and the other 6 at 40 W/160 s (group B), and observed the changes in the thermal lesions using grayscale ultrasound. After thermal ablation, we measured the volume of the thermal lesions by contrast-enhanced ultrasound (CEUS). Then we harvested the whole prostate from the animals and determined the lesion volumes in the fresh tissue specimens. RESULTS: Grayscale ultrasound revealed an echogenic area at the initiation of the microwave ablation procedure, which was enlarged with the increase of ablation time. At the end of the procedure, the lesions appeared as an irregular heterogeneous echogenic area. CEUS showed oval non-perfused areas, which appeared as well-defined non-echoic areas in sharp contrast with the surrounding normal prostate parenchyma with bolus injection of contrast material (Sonovue, 2.4 ml), and that the thermal lesion volumes of groups A and B were (1.18 +/- 0.23) cm3 and (1.52 +/- 0.23) cm3, respectively. The thermal lesions of the gross specimen exhibited an elliptical shape, pale color and clear margin, and their volumes were (1.13 +/- 0.20) cm3 and (1.48 +/- 0.20) cm3, respectively, in groups A and B. CONCLUSION: Different combinations of time and power can produce coagulative necrotic lesions of different volumes in the local prostatic tissue. CEUS can accurately manifest the lesion area and thus avoid excessive or inadequate ablation treatment.

Penetration of erythromycin through Staphylococcus epidermidis biofilm.

BACKGROUND: The catheter related infection caused by Staphylococcus epidermidis biofilm is increasing and difficult to treat by antimicrobial chemotherapy. The properties of biofilms that give rise to antibiotic resistance are only partially understood. This study aimed to elucidate the penetration of erythromycin through Staphylococcus epidermidis biofilm. METHODS: The penetration ratio of erythromycin through Staphylococcus epidermidis biofilms of 1457, 1457-msrA, and wild isolate S68 was detected by biofilm penetration model at different time points according to the standard regression curve. The RNA/DNA ratio and the cell density within the biofilms were observed by confocal laser microscope and transmission electromicroscope, respectively. RESULTS: The penetration ratios of erythromycin through the biofilms of 1457, 1457-msrA, and S68 after cultivation for 36 hours were 0.93, 0.55 and 0.4, respectively. The erythromycin penetration ratio through 1457 biofilm (0.58 after 8 hours) was higher than that through the other two (0.499 and 0.31 after 24 hours). Lower growth rate of the cells in biofilm was shown, with reduction of RNA/DNA proportion observed by confocal laser microscope through acridine orange stain. Compared with the control group observed by transmission electrmicroscope, the cell density of biofilm air face was lower than that of agar face, with more cell debris. CONCLUSIONS: Erythromycin could penetrate to the Staphylococcus epidermidis biofilm, but could not kill the cells thoroughly. The lower growth rate of the cells within biofilm could help decreasing the erythromycin susceptibility.

Clinical study of distribution and drug resistance of pathogens in patients with severe acute pancreatitis.

BACKGROUND: Previous researches about necrotic pancreatic tissue infections are numerous, but the study on systemic infection related to the severe acute pancreatitis (SAP) treatment period is limited. This study aimed to investigate the distribution and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP during the past three years. METHODS: A retrospective study was conducted on the distribution, category and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP from 2008 to 2011. RESULTS: A total of 594 pathogenic bacteria samples were isolated. Among them 418 isolates (70.4%) were Gram bacteria negative, 142 isolates (23.9%) were Gram bacteria positive, and 34 isolates (5.7%) were found fungi. The most common Gram negative bacteria were Escherichia coli (19.8%), and the dominant Gram positive pathogenic bacteria were Enterococcus faecium. The distribution of SAP-related infectious pathogens was mainly in peritoneal drainage fluid, sputum, bile, and wound secretions. Almost all the Gram negative pathogenic bacteria were sensitive to carbapenum. Extended-spectrum ß-lactamases (ESBLs) producing strains were more resistant to penicillins and cephalosprins than the ESBLs non-producing strains. Staphylococcus was sensitive to vancomycin and linezolid. The drug resistance of meticillin-resistant staphylococcus (MRS) to commonly used antibiotics was higher than meticillin-sensitive streptococcus (MSS). Enterococcus sp. exhibited lower drug-resistance rates to vancomycin and linezolid. CONCLUSIONS: Gram negative bacteria were the dominant SAP-related infection after hepatobiliary surgery. A high number of fungal infections were reported. Drug resistant rates were high. Rational use of antibiotics according to the site of infection, bacterial species and drug sensitivity, correctly executing the course of treatment and enhancing hand washing will contribute to therapy and prevention of SAP-related infection and decrease its mortality.

Efficacy and safety of micafungin for invasive candida infections: a meta-analysis of randomized controlled trials.

BACKGROUND: Invasive fungal infections such as candidiasis and mold infections cause significant morbidity and mortality in seriously ill patients. Micafungin is an echinocandin antifungal agent with potent activity against most species of Candida and Aspergillus. We did this meta-analysis to clarify whether micafungin offers superior efficacy and safety compared with other antifungal agent for treating infections associated with invasive candidiasis. METHODS: We did a meta-analysis of randomized controlled trials to examine whether micafungin has superior efficacy and safety compared with other antifungal agents recommended by the treatment guidelines for fungal infection. Seven trials involving 2913 patients were included in this analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: Micafungin was associated with significantly better treatment success compared with the comparator antifungal agents (modified intention to treat, 2851 patients; random-effects model, OR 1.20, 95%CI 1.00 - 1.45, P = 0.0487). In addition, micafungin was more effective than the comparators for antifungal prophylaxis of neutropenic patients undergoing hematopoietic stem cell transplantation (OR 1.47, 95%CI 1.08 - 2.00, P = 0.01). Although there was no significant difference between the compared regimens in terms of the incidence of adverse drug effects (OR 0.94, 95%CI 0.77 - 1.11), fewer patients treated with micafungin withdrew from the studies because of adverse events (OR 0.64, 95%CI 0.44 - 0.94). CONCLUSIONS: Micafungin has a good safety and tolerability profile, with an efficacy at least comparable to the other antifungal agents. Micafungin offers advantages over other agents for antifungal prophylaxis. Micafungin offers an appropriate alternative for antifungal prophylaxis rather than the treatment of invasive candida infections.

[Ultrasound-guided transrectal microwave ablation of the prostate in dogs].

OBJECTIVE: To investigate the feasibility and safety of ultrasound-guided transrectal microwave ablation in reducing the prostate volume. METHODS: Ultrasound-guided transrectal microwave ablation of both sides of the prostate was conducted on experimental dogs with the output volume of 30W for 120 seconds. The dogs were sacrificed on the very day of the ablation, and the prostate and its surrounding tissues were excised for observation of the thermal lesions and pathological examination. RESULTS: A total of 12 thermal lesions were achieved on the two sides of the prostate. The ultrasonogram manifested dense echo and increasing extent in the ablated area, and then an irregular heterogeneous echogenic area and clearly differentiated margin. Pathological examination of the gross specimen showed a little stagnant blood under the rectal mucous, the urethra and bladder not injured, and the thermal lesions elliptical, clearly margined and with the mean size of (0.94 +/- 0.30) cm3. CONCLUSION: Ultrasound-guided transrectal microwave ablation of the prostate can effectively cause coagulative necrosis of the local tissue without inflicting thermal injury upon the surrounding tissues. Conventional grayscale ultrasound can give a real-time'display of the extent of thermal lesion and the whole process of the ablation.

[Placement of dual double-J stents following high-pressure balloon angioplasty for treatment of ureter-ileum bladder anastomosis stricture].

OBJECTIVE: To evaluate the benefit of placement of dual double-J stents following high-pressure balloon angioplasty for treatment of ureter-ileum anastomosis stricture after total bladder resection. METHODS: Seventeen patients (11 males and 6 females, mean age 56.65±6.28 years, 23 sides) undergoing total bladder resection were included in this study. Unilateral and bilateral ureteral stricture occurred postoperatively in 11 and 6 patients, respectively; 13 patients had ureter-ileum bladder anastomosis stricture after ileal bladder substitution, and 4 patients had ureter-ileum stricture after orthotopic construction of ileal neobladder. The control group consisted of 21 patients undergoing open surgery. RESULTS: In the double-J stenting group, the effective rate was 82.6% (19/23), similar to that of 85.7% (18/21) in the control group (P>0.05). Compared with the control group, the stenting group showed a significantly reduced mean time of operation (87.42±10.35 min vs 34.12±7.52 min, P<0.05), intraoperative blood loss (203.16±32.67 ml vs 21.54±6.15 ml, P<0.05), and mean postoperative hospital stay (10.12±1.19 vs 3.24±0.35 days, P<0.05). CONCLUSION: As a safe and minimally invasive approach to the management of ureter-ileum bladder anastomosis stricture, placement of dual double-J stents following high-pressure balloon angioplasty produces a effect comparable with that of open surgery.

Treatment of benign ureteral stricture by double J stents using high-pressure balloon angioplasty.

BACKGROUND: Balloon dilatation angioplasty is a minimally invasive surgery for treating benign ureteral stricture. The aim of this study was to investigate the effect of placing double J (D-J) stents using high-pressure balloon angioplasty in treating benign ureteral stricture. METHODS: A total of 42 patients (48 cases) with benign ureteral stricture (42 had benign ureteral stricture) were investigated by inserting dual D-J stents using high-pressure balloon angioplasty. The control group contained 50 patients (57 cases) employing the conventional balloon angioplasty with a single D-J stent inserted for comparison. RESULTS: The overall effective rate of the treated and control groups was 87.8% (36/41) and 62.7% (32/51), respectively (P < 0.05). CONCLUSION: This new approach produces a better curative effect than the conventional balloon angioplasty with a single D-J stent insertion in treating benign ureteral stricture.

[Construction of eukaryotic expression vector for VEGF165 gene and its expression in rat bladder smooth muscle cells].

OBJECTIVE: To construct an eukaryotic expression vector for vascular endothelial growth factor (VEGF) 165 gene and obtain VEGF expression in rat bladder smooth muscle cells. METHODS: VEGF165 cDNA was cloned into the eukaryotic expression vector pcDNA3.1(-), and the resultant recombinant vector pcDNA3.1(-)/VEGF165 was transfected into the rat bladder smooth muscle cells by electroporation. VEGF expression in the cells was determined by RT-PCR and immunofluoresence assay, and the biological activity of VEGF in the supernant of the transinfected cell culture was tested by MTT assay. RESULTS AND CONCLUSION: VEGF expression was obtained in the transinfected cells, and the supernant of the transinfected cell cultures stimulated the proliferation of the endothelial cells.