The respiratory sound features of COVID-19 patients fill gaps between clinical data and screening methods

BackgroundThe 2019 novel coronavirus (COVID-19) has continuous outbreaks around the world. Lung is the main organ that be involved. There is a lack of clinical data on the respiratory sounds of COVID-19 infected pneumonia, which includes invaluable information concerning physiology and pathology. The medical resources are insufficient, which are now mainly supplied for the severe patients. The development of a convenient and effective screening method for mild or asymptomatic suspicious patients is highly demanded. MethodsThis is a retrospective case series study. 10 patients with positive results of nucleic acid were enrolled in this study. Lung auscultation was performed by the same physician on admission using a hand-held portable electronic stethoscope delivered in real time via Bluetooth. The recorded audio was exported, and was analyzed by six physicians. Each physician individually described the abnormal breathing sounds that he heard. The results were analyzed in combination with clinical data. Signal analysis was used to quantitatively describe the most common abnormal respiratory sounds. ResultsAll patients were found abnormal breath sounds at least by 3 physicians, and one patient by all physicians. Cackles, asymmetrical vocal resonance and indistinguishable murmurs are the most common abnormal breath sounds. One asymptomatic patient was found vocal resonance, and the result was correspondence with radiographic computed tomography. Signal analysis verified the credibility of the above abnormal breath sounds. ConclusionsThis study describes respiratory sounds of patients with COVID-19, which fills up for the lack of clinical data and provides a simple screening method for suspected patients.

Characteristics, regularity and significance of lymph node metastasis in early gastric cancer / 中国实用外科杂志

The main risk factors of lymph node metastasis in early gastric cancer include tumor size, depth of invasion, lymphaticinvasion, perineural invasion, differentiation and histological manifestations. Understanding the characteristics and regularity of lymph node metastasis in early gastric cancer is helpful to evaluate the prognosis of patients, and it can also provide more choices for their treatment, which has important clinical guiding significance. Gastrectomy should be performed for patients with preoperative staging or highly suspected lymph node involvement in order to resect the tumors and select a reasonable range of lymph node dissection.

Prognostic value of three different lymph node staging systems in the survival of patients with gastric cancer following D2 lymphadenectomy.

The log odds of positive lymph nodes (LODDS) was defined as the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes, which is a novel and promising nodal staging system for gastric cancer. Here, we aimed to compare the prognostic effect of pN, lymph node ratio (LNR) and LODDS. The association between overall survival and pN, LNR and LODDS was retrospectively analysed. The discriminatory ability and monotonicity of gradients (linear trend χ (2) score), homogeneity ability (likelihood ratio test) and prognostic stratification ability (Akaike information criterion [AIC] and receiver operating characteristic [ROC] curve) were compared among three lymph node staging systems. The pN, LNR and LODDS were all identified as independent prognostic factors for gastric cancer patients in the multivariate analysis. LODDS showed the best prognostic performance (linear trend χ (2) score 266.743, likelihood ratio χ (2) test score 427.771, AIC value 5670.226, area under the curve (AUC) 0.793), followed by LNR and pN. In patients with different levels of retrieved lymph nodes (≤10, 11-14, 15-25 and >25), LODDS was the most powerful for prognostic prediction and discrimination of the heterogeneity among the subgroups. Significant differences in survival were observed among patients in different LODDS subgroups after being classified according to the pN and LNR classifications. LODDS appears to be a more powerful system for predicting the overall survival of gastric cancer patients, as compared to LNR and pN, and may serve as an alternative nodal staging system for gastric cancer.

CD44, Sonic Hedgehog, and Gli1 Expression Are Prognostic Biomarkers in Gastric Cancer Patients after Radical Resection.

Aim. CD44 and Sonic Hedgehog (Shh) signaling are important for gastric cancer (GC). However, the clinical impact, survival, and recurrence outcome of CD44, Shh, and Gli1 expressions in GC patients following radical resection have not been elucidated. Patients and Methods. CD44, Shh, and Gli1 protein levels were quantified by immunohistochemistry (IHC). The association between CD44, Shh, and Gli1 expression and clinicopathological features or prognosis of GC patients was determined. The biomarker risk score was calculated by the IHC staining score of CD44, Shh, and Gli1 protein. Results. The IHC positive staining of CD44, Shh, and Gli1 proteins was correlated with larger tumour size, worse gross type and histological type, and advanced TNM stage, which also predicted shorter overall survival (OS) and disease-free survival (DFS) after radical resection. Multivariate analysis indicated the Gli1 protein and Gli1, CD44 proteins were predictive biomarkers for OS and DFS, respectively. If biomarker risk score was taken into analysis, it was the independent prognostic factor for OS and DFS. Conclusions. CD44 and Shh signaling are important biomarkers for tumour aggressiveness, survival, and recurrence in GC.

Clinicopathological features and prognosis of young patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the clinicopathological characteristics and analyze the prognostic factors of young patients with gastric cancer.</p><p><b>METHODS</b>A total of 99 patients with the age less than or equal to 40 were admitted in The First Affiliated Hospital of Sun Yat-sen University from August 2001 to December 2009. Their clinicopathological and follow-up data were compared with middle-aged and elderly patients with the age more than 40.</p><p><b>RESULTS</b>There were statistically significant differences in gender, tumor location, Borrmann type, histological type, differentiated histology, depth of invasion, peritoneal metastasis between young patients and elder ones. The 5-year survival rates of young and elder patients were 49.1% and 44.4% respectively, and the difference was not statistically significant (P>0.05). Univariate and multivariate analyses showed that TNM stage (P=0.014) and surgical methods (P=0.012) were independent predictive factors of survival for young patients. For the young patients, the 5-year survival rate was 56.7% after curative resection, 11.1% after palliative resection. Those who underwent palliative surgery or biopsy alone died within 1 year after surgery. The difference between difference surgical procedures in survival were statistically significant (P<0.05).</p><p><b>CONCLUSIONS</b>As compared to elder patients, young patients with gastric cancer have special clinicopathological features. However, no significant difference of survival rate is found between the young and the elder patients. TNM stage and surgical methods are independent prognostic factors of young patients with gastric cancer. Radical resection appears to confer the only chance of prolonged survival.</p>

Consensus and controversy of surgical diagnosis and treatment for gastrointestinal stromal tumor / 中华胃肠外科杂志

At the end of 2012, Chinese Society of Clinical Oncology (CSCO) amended and revised the expert consensus of gastrointestinal stromal tumor (GIST) 2011. This article is respectively review hot topics regarding surgical intervention during the revision, including principles and indications of biopsy and surgery.

Meta-analysis of adjuvant chemotherapy on prognosis for gastric cancer patients after D2 dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate efficacy of adjuvant chemotherapy after D2 dissection on survival for patients with gastric cancer.</p><p><b>METHODS</b>Randomized clinical trials (RCT) that compared adjuvant chemotherapy after D2 dissection with D2 dissection alone for gastric cancer were searched with Pubmed, Cochrane, Embase and CBM databases. Eligible trials published between 1990 and 2012 were included in the study. The quality of RCTs was assessed by the Jadad scale. Data synthesis and statistical analysis were performed by RevMan 5.1 software.</p><p><b>RESULT</b>Eight RCTs with 3633 patients were included in this study. Among them, 1824 patients received adjuvant chemotherapy and 1809 patients didn't. Adjuvant chemotherapy was associated with a significant benefit in terms of overall survival (RR = 0.76, 95% CI: 0.69-0.84), disease free survival (RR = 0.72, 95%CI: 0.66-0.80) and recurrence rate (RR = 0.69, 95% CI: 0.62-0.77).</p><p><b>CONCLUSION</b>Adjuvant chemotherapy was associated with survival benefit for gastric cancer after D2 dissection.</p>

Effect of postoperative early enteral nutrition on the recovery of humoral immune function in patients with colorectal carcinoma undergoing elective resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of postoperative early oral feeding on humoral immune function and clinical outcome in colorectal cancer patients.</p><p><b>METHODS</b>Seventy patients with colorectal carcinoma requiring elective colorectal resection were prospectively enrolled and randomized into two groups: early oral feeding group(n=35) and conventional oral feeding group(n=35). The patients in early oral feeding group were started on oral feeding within 12 hours after operation, while patients in conventional group were started on oral feeding after the postoperative first passage of flatus. Postoperative parameters of clinic and humeral immune function were compared between two groups.</p><p><b>RESULTS</b>Sixty-two patients eventually completed the study, including 32 cases in early oral feeding group and 30 cases in conventional oral feeding group. The average time to first passage of flatus[(2±1) d vs. (4±2) d, P<0.01], the first passage of stool [(3.8±1.6) d vs. (6.4±2.5) d, P<0.01], resumption of regular diet [(4±2) d vs. (8.2±2.2) d, P<0.01] and the postoperative hospital stay [(6±1) d vs. (11.7±3.8) d, P<0.01] were significantly shorter in early oral feeding group as compared to conventional oral feeding group. Significantly faster recovery of postoperative humoral immunity was found. Plasma levels of globulin [(24.1±2.4) g/L vs. (22.1±3.3) g/L, P<0.05], immunoglobulin G[(10.8±2.4) g/L vs. (8.7±2.1) g/L, P<0.01] and complement 4 [(0.24±0.09) g/L vs. (0.17±0.05) g/L, P<0.05] on postoperative day 3 were higher in early oral feeding group as compared to conventional oral feeding group.</p><p><b>CONCLUSION</b>Application of postoperative early oral feeding in patients undergoing elective colorectal resection is safe and effective, which can lead to faster recovery of postoperative humoral immune function and bowel function, and shorter postoperative hospital stay.</p>

Application of enteral nutrition in preoperative bowel preparation for rectal cancer patients undergoing radical operation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and safety of enteral nutrition in preoperative bowel preparation for rectal cancer patients undergoing radical operation.</p><p><b>METHODS</b>Sixty rectal cancer patients undergoing selective low anterior resection were randomized into the trial group(n=30) and the control group(n=30). Patients in the trial group received clean liquid integral protein diet for 3 days before operation without mechanical bowel preparation. Patients in the control group received traditional diet and mechanical bowel preparation. The intraoperative and postoperative clinical data, the quality of bowel preparation, postoperative complications, and nutritional parameters were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in clinicopathological characteristics between the two groups before operation. The operative time, blood loss, quality of bowel preparation as well as postoperative hospital stay were not significantly different(all P>0.05). While the time to first flatus [(2.53±0.91) d vs. (3.03±0.68) d] and semi-liquid diet intake[(3.95±0.83) d vs. (4.52±1.14) d] were significantly shorter in the trial group as compared with the control group(all P<0.05). There were no death and no significant difference in postoperative complications [16.7%(5/30) vs. 20.0%(6/30), P>0.05]. The levels of postoperative total protein, albumin, and prealbumin decreased significantly. Meanwhile, the levels of postoperative albumin[(36.2±2.5) g/L vs. (33.5±2.6) g/L, P<0.01] and prealbumin [(325.4±28.2) mg/L vs. (302.5±34.2) mg/L, P<0.01] in the trial group were significantly higher than those in the control group.</p><p><b>CONCLUSIONS</b>Preoperative enteral nutrition can replace the mechanical bowel preparation with better efficacy, and improve the postoperative nutritional status without increasing surgical risk in rectal cancer patients undergoing radical operation.</p>

Impact of clinicopathological features and extent of lymph node dissection on the prognosis in early gastric cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the impact of clinicopathological features and extent of lymph node dissection on the prognosis in early gastric cancer (EGC) patients.</p><p><b>METHODS</b>A total of 142 EGC cases screened from database of gastric cancer of Sun Yat-sen University, from Aug. 1994 to Jan. 2010, were included in this study. According to the lymph node metastasis status, they were divided into lymph node negative (n = 116) and lymph node positive (n = 26) groups. The clinicopathological features of the two groups and the impact of extent of lymph node dissection on the prognosis were analyzed.</p><p><b>RESULTS</b>There were no significant differences in age, gender, tumor size and location, Borrmann typing, WHO TNM staging, histological typing, and CEA value between the two groups (P > 0.05). The TNM stages in the lymph node positive group were higher than that in the lymph node negative group (P < 0.001). Between the cases who underwent D1 (n = 21) and D2 (n = 121) dissection, there were no significant differences in postoperative hospital days, blood transfusion volume, and operation time (P > 0.05). The median numbers of LN dissected in D1 and D2 cases were 4 (0 to 16) and 20 (12 to 30), with a significant difference (P = 0.000), but the number of positive LN without significant difference (P = 0.502). The postoperative complication rates were 9.5% in the D1 and 3.3% in the D2 dissection groups, without a significant difference (P = 0.128). The median survival time of the lymph node negative and positive groups was 156 vs. 96 months (P = 0.010). In cases who received D2 and D1 lymph node dissection, the median survival time (MST) was 156 vs. 96 months (P = 0.0022). In the lymph node positive group, D2 dissection prolonged survival time significantly than D1 dissection (96 vs. 27months) (P = 0.001). Cox regression analysis showed that the extent of lymph node dissection and LN metastasis were independent prognostic factors for EGC patients.</p><p><b>CONCLUSIONS</b>It is not able to accurately assess the LN metastasis status preoperatively according to the routine clinicopathological features. For the patients with unknown LN metastasis status, D2 dissection should be the first choice. Comparing with D1 dissection, the morbidity of D2 dissection are not increased, but survival time is prolonged.</p>

Follow-up analysis of health-related quality of life research after radical surgery for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore how to improve follow-up rate and follow-up quality in studies related to quality of life.</p><p><b>METHODS</b>A retrospective cross-sectional study was performed in patients with rectal cancer who underwent primary surgery at the Gastrointestinal Surgery Department, The First Affiliated Hospital, Sun Yat-sen University from August 2002 to February 2011 using the European Organization for Research and Treatment of Cancer QLQ-C30 and CR-38 questionnaires. The influence factors of follow-up rate and reasons for missing sex-related items were analyzed.</p><p><b>RESULTS</b>A total of 438 questionnaires were issued. Two hundred and eighty-five responses were received and the follow-up rate was 65.1%. Two hundred and sixty-two patients returned the questionnaires by mail. Responders and non-responders did not differ by sociodemographic and clinical characteristics including sex, age, postoperative time, complication, clinical stage and stoma. Significant differences were found when comparing the missing sex-related items grouped by sex, age, education and working status.</p><p><b>CONCLUSIONS</b>Follow-up mode of mail supplemented by interview is suitable for current reality in China in studies on quality of life. Targeted methods should be adopted when investigating the different patient groups to improve follow-up rate of studies on quality of life and sexual function survey.</p>

Comparison of nutritional status between pancreaticojejunostomy and pancreaticogastrostomy following pancreaticoduodenectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the nutritional status between pancreaticojejunostomy(PJ) and pancreaticogastrostomy(PG) following pancreaticoduodenectomy.</p><p><b>METHODS</b>A retrospective clinical analysis was performed on 37 patients undergoing pancreaticoduodenectomy(PD) for duodenal carcinoma and pancreatic non-epithelial tumor with PG(n=19) and PJ(n=18) in the First Hospital of Sun Yat-sen University from April 2006 to December 2010. All the patients had a needle catheter jejunostomy inserted at the conclusion of laparotomy. Postoperative early enteral nutrition and parenteral nutrition was performed for all the patients. Nutritional status of two groups was compared in body mass index (BMI), serum nutritional parameters such as albumin, transferrin and prealbumin before surgery and on 1, 3, and 6 months postoperatively.</p><p><b>RESULTS</b>There were no significant differences between PG and PJ groups in operative time, blood loss, pancreatic fistula, perioperative death, or postoperative length of hospital stay. One month after surgery, there were no significant differences in BMI [(17.1±7.0) vs. (19.0±4.8) kg/m(2), P>0.05], albumin [(30.1±0.5) vs. (32.1±1.3) g/L, P>0.05], transferrin [(1.89±0.57) vs. (2.01±0.61) g/L, P>0.05] and prealbumin[(0.18±0.05) vs. (0.18±0.09) g/L, P>0.05]. These parameters were decreased at 1 month after surgery, and gradually recovered to baseline or higher than the preoperative levels at 6 months after surgery. However, the differences were still not statistically significant between two groups.</p><p><b>CONCLUSIONS</b>The influence of PJ and PG on the postoperative nutritional status are comparable.</p>

Assessment of 64-slice spiral computed tomography angiography with image fusion for perigastric arteries anatomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and clinical significance of 64-multislice spiral computed tomography angiography(MSCTA) with image fusion for the anatomy of perigastric arteries.</p><p><b>METHODS</b>A total of 53 patients underwent abdominal 64-MSCTA, among whom 26 patients with gastric cancer underwent gastrectomy. Using volume rendering techniques, computed tomography angiography(CTA) of perigastric arteries and the stomach were reconstructed respectively, and then the images were fused together. The branching pattern of the celiac trunk and the origins and courses along the stomach of the 10 perigastric arteries were assessed. The accuracy, sensitivity, and specificity of 64-MSCTA were determined based on intraoperative findings.</p><p><b>RESULTS</b>CTA clearly showed the celiac trunk. The most common branching pattern of the celiac trunk was Michels type I( in 46 patients(86.8%). The anatomy of perigastric arteries and stomach could be clearly demonstrated from any angle according to image fusion. The left gastric artery and the right gastroepiploic artery were shown in 100%, the left gastroepiploic artery 94.3%(50/53), the right gastric artery 83.0%(44/53), short gastric artery 58.5%(31/53), posterior gastric artery 49.1%(26/53), the replaced left hepatic artery 15.1%(8/53). The accessory left hepatic artery, accessory left gastric artery and replaced right hepatic artery were all identified in 7.5%(4/53) patients. The accuracy of preoperative CTA in term of correctly identifying perigastric arteries ranged from 84.6% to 100%, the sensitivity 82.6% to 100%, and the specificity was 100% for all the perigastric arteries.</p><p><b>CONCLUSIONS</b>64-MSCTA can clearly reveal individual perigastric arteries. The anatomy of the stomach and perigastric arteries can be shown in vivo by fused image, and can provide guidance for gastrectomy.</p>

Low and ultralow anterior resection with hand-assisted laparoscopic surgery for rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the experience and short-term clinical outcomes of hand-assisted laparoscopic surgery (HALS) in sphincter-preserving surgery for low and ultralow rectal cancer.</p><p><b>METHODS</b>Data of 49 patients with rectal cancer who underwent HALS for low or ultralow anterior resection between January 2010 and January 2011 were analyzed retrospectively.</p><p><b>RESULTS</b>The proximal resection margin was (14.3±6.9) cm and the distal margin was(4.3±1.9) cm. The mean operative time was(128.3±70.9) min. On postoperative macroscopic evaluation, the mesorectum was intact in 42 cases, nearly intact in 7 cases. The circumferential resection margin was more than 2 mm in 42 cases, and less than 2 mm in 7 cases. Forty-six patients underwent R0 resection, and 3 cases underwent R1 resection. The median retrieved lymph node (LN) was 16.20±9.23, and the median positive LN was 1.12±2.19. Postoperative pathological examination showed TNM stage was I( in 12 patients, II(A in 18, II(B in 1, III(A in 2, III(B in 8, III(C in 5, IIII( in 3. The median postoperative hospital stay was (6.25±3.87) d. There were no anastomotic leakage, ileus, intra-abdominal or anastomotic bleeding. There were two wound infections.</p><p><b>CONCLUSION</b>Low and ultralow anterior resection for rectal cancer using HALS approach is safe and feasible with favorable short-term outcome.</p>

Strategy for better combination of targeted therapy and surgery in the treatment of gastrointestinal stromal tumor / 中华胃肠外科杂志

For primary localized gastrointestinal stromal tumor(GIST), complete resection followed by imatinib adjuvant therapy has become a consensus among physicians for median and high risk patients. Preoperative imatinib may decrease surgical morbidity, increase resection rate, and even preserve organ function through down-staging of the tumor. For advanced GIST, the choice of treatment is targeted therapy with tyrosine kinase inhibitor. Although surgical intervention showed certain efficacy in several retrospective analyses, the role of surgery for advanced disease still needs to be proven by prospective controlled trials. Better combination of targeted therapy and surgery has become critical in multidisciplinary therapy for GIST.

Clinical analysis of imatinib in patients with advanced gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and influencing factors of imatinib in patients with advanced gastrointestinal stromal tumor(GIST).</p><p><b>METHODS</b>From April 2004 to January 2010, clinicopathological data of 73 adult patients with advanced GIST treated with imatinib at the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The treatment outcomes and associated factors were investigated.</p><p><b>RESULTS</b>Treatment outcomes included complete response in 1(1.4%) patients, partial response in 53(72.6%), stable disease in 14(19.2%), and primary resistant in 5(6.8%). All the patients had routine followed up, the length of which ranged from 12 to 76 (median 32) months. The median progression-free survival was 45.0 months(95% confidence interval, 34.2-55.8). The progression-free survival(PFS) rate was 87.7% in 1 year, 63.6% in 3 year, and 39.6% in 5 years. On multivariate analysis, both mutation status and patient performance were independent factors influencing the efficacy of imatinib treatment(both P<0.01). PFS was significantly better in patients with c-kit exon 11 mutations than those with exon 9 mutations, and better in lower ECOG scales than in higher ones.</p><p><b>CONCLUSION</b>Imatinib is effective in treating patients with advanced GIST, c-kit exon 9 mutations and poor performance status predict an adverse survival benefit of imatinib therapy.</p>

Meta-analysis of pancreaticoduodenectomy prospective controlled trials: pancreaticogastrostomy versus pancreaticojejunostomy reconstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pancreaticogastrostomy (PG) has been proposed as an alternative to pancreaticojejunostomy (PJ), assuming that postoperative complications are less frequent. The aim of this research was to compare the safety of PG with PJ reconstruction after pancreaticoduodenectomy.</p><p><b>METHODS</b>Articles of prospective controlled trials published until the end of December 2010 comparing PJ and PG after PD were searched by means of MEDLINE, EMBASE, Cochrane Controlled Trials Register databases, and Chinese Biomedical Database. After quality assessment of all included prospective controlled trials, meta-analysis was performed with Review Manager 5.0 for statistic analysis.</p><p><b>RESULTS</b>Overall, six articles of prospective controlled trials were included. Of the 866 patients analyzed, 440 received PG and 426 were treated by PJ. Meta-analysis of six prospective controlled trials (including RCT and non-randomized prospective trial) revealed significant difference between PJ and PG regarding postoperative complication rates (OR, 0.53; 95%CI, 0.30 - 0.95; P = 0.03), pancreatic fistula (OR, 0.47; 95%CI, 0.22 - 0.97; P = 0.04), and intra-abdominal fluid collection (OR, 0.42; 95%CI, 0.25 - 0.72; P = 0.001). The difference in mortality was of no significance. Meta-analysis of four randomized controlled trials (RCT) revealed significant difference between PJ and PG regarding intra-abdominal fluid collection (OR, 0.46; 95% CI, 0.26 - 0.79; P = 0.005). The differences in pancreatic fistula, postoperative complications, delayed gastric emptying, and mortality were of no significance.</p><p><b>CONCLUSIONS</b>Meta-analysis of six prospective controlled trials (including randomized controlled trials (RCT) and non-randomized prospective trial) revealed significant difference between PJ and PG regarding overall postoperative complications, pancreatic fistula, and intra-abdominal fluid collection. Meta-analysis of four RCT revealed significant difference between PJ and PG with regard to intra-abdominal fluid collection. The results suggest that PG may be as safe as PJ.</p>

Fast track surgery accelerates the postoperative rehabilitation and recovery of insulin sensitivity in elective operation for colorectal carcinoma: a randomized controlled clinical trial / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of fast track surgery on postoperative insulin sensitivity on the basis of clinical benefits in patients undergoing elective open colorectal resection.</p><p><b>METHODS</b>During May 2008 to December 2008, Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters, stress markers and insulin sensitivity were evaluated in both groups.</p><p><b>RESULTS</b>The 62 patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. The speed of recovery of postoperative insulin sensitivity on 7 days postoperative in the fast-track group (97% ± 9%) was significantly faster than the conventional care group (88.5% ± 9.0%, t = 2.552, P = 0.016). The hospitalization days in the fast-track group was 6 days (M(50)), and it was significantly shorter than the conventional care group ((11.7 ± 3.8) days, Z = 4.360, P = 0.000). The time of recovery of bowel function were faster in the fast-track group (time to pass flatus was 2 days (M(50))) than the conventional care group (4 days, Z = 3.976, P = 0.000). The Infectious complication rate in the fast-track group (2/32) is lower than the other group (8/30, P = 0.040).</p><p><b>CONCLUSION</b>Fast track surgery accelerates recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a lower rate of postoperative infectious complications and a shorter length of postoperative hospital stay.</p>

Impact of different gastrectomy and reconstruction methods on prognosis and quality of life in proximal gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the impact of different gastrectomy and reconstruction method on prognosis and quality of life in proximal gastric cancer.</p><p><b>METHODS</b>The 265 cases of proximal gastric cancer received radical resection, according to gastrectomy or reconstruction method, were divided into proximal gastrectomy/gastroesophagostomy group (PG) (n = 63) and total gastrectomy/esophagojejunostomy group (TG) (n = 202). The clinical pathologic features, prognosis, postoperative quality of life in 2 groups were compared.</p><p><b>RESULTS</b>There had no significant differences in age, gender, CEA value between two groups (all P > 0.05). In PG and TG group, tumor size (cm), ratio of organic invasion, lymph nodes metastasis, distal metastasis, TNM IV stage, Borrmann typing, poor or undifferentiated carcinoma was 2.9 ± 1.9 vs. 4.8 ± 2.8, 9.5% vs. 32.2%, 64.7% vs. 70.6%, 0 vs. 8.4%, 6.9% vs. 31.8%, 44.4% vs. 69.2%, 31.7% vs. 53.7%, respectively, all with significant difference (t = -6.260, χ(2) = 29.473, 14.559, 5.665, 32.483, 12.588, 10.954, all P < 0.05). In PG and TG group, the ratio of D3 and D3(+) resection, multi-visceral resection, complications was 0 vs. 13.8%, 9.5% vs. 38.6%, 7.9% vs. 1.5% respectively, showed increasing range of resection and decreasing complications significantly in TG group (all P < 0.05). The median survival time (months) was 62.5 vs. 78.9 in TG and PG group respectively, without significant difference (P > 0.05). In 2 groups, the evaluation index of post-operative quality of life without significant differences (P > 0.05).</p><p><b>CONCLUSIONS</b>For proximal gastric cancer, although the cases received TG with worse clinicopathological features, which prognosis was similar to that received PG. The postoperative quality of life without significant difference between the cases received gastroesophagostomy and esophagojejunostomy.</p>

Fast track surgery accelerates the recovery of postoperative insulin sensitivity / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.</p><p><b>METHODS</b>Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively.</p><p><b>RESULTS</b>Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.</p><p><b>CONCLUSION</b>Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.</p>