Objective To compare the clinical effects of one-stage anastomosis on patients with middle and lower rectum carcinoma and intestinal obstruction and the ones without intestinal obstruction, and to evaluate the safety and feasibility of patients with middle and lower rectum carcinoma and intestinal obstruction undergoing one-stage anastomosis. Methods The data of patients diagnosed definitely by pathology as middle and lower rectum carcinoma underwent one-stage anastomosis in West China Hospital of Sichuan University between January 2007 and December 2008 was retrospectively analyzed. The clinical effects were compared between intestinal obstruction group and non-intestinal obstruction group. Results During this period, 525 patients were included into intestinal obstruction group (n=87) and non-intestinal obstruction group (n=438). Among the patients included, there were 307 males and 218 females. Ages were from 25 to 85 years, and the average age was 60 years old. According to tumor histology, there were 487 cases of adenocarcinoma, 29 of mucinous adenocarcinoma and 9 of other types. According to the degree of tumor differentiation, there were 140 cases of low differentiation, 372 of middle differentiation and 13 of high differentiation. According to TNM stage, there were 4 cases of stage 0, 93 of stageⅠ, 189 of stage Ⅱ, 202 of stage Ⅲ and 37 of stage Ⅳ. Constituent ratio of gender, distributions of distances from tumor to anus, TNM stages and differentiation degrees of tumor were significantly different between intestinal obstruction group and non-intestinal obstruction group (Plt;0.05); and there was no statistical difference in the age, pathological types， significant internal medical complications and operative types between the two groups (Pgt;0.05). There was no statistical diffe rence in operative duration and intraoperative blood loss between the two groups (Pgt;0.05). There was no statistical difference in postoperative time of first defecation, first out-of-bed activity and first oral feeding, and postoperative hospital stay between the two groups (Pgt;0.05); while time of first aerofluxus was earlier in intestinal obstruction group than that in non-intestinal obstruction group (Plt;0.05). There was no statistical significance in the disease incidence of postoperative complications between the two groups (Pgt;0.05). Conclusions Comparing with patients with non-intestinal obstruction, there is no significant evidence shows that one-stage anastomosis will affect the rehabilitation and increase the risk of complications in patients with middle and lower rectum carcinoma and intestinal obstruction. It is considered that it would be safe and feasible for patients with middle and lower rectum carcinoma and intestinal obstruction to have one-stage anastomosis; however, it is necessary for us to have more researches to evaluate the long-term clinical effect.
ObjectivesUsing systematic literature review to analyze the effects of levetiracetam (LEV) on neonatal safety during early pregnancy.MethodsThe scope of the literature must be English literature, published from 1997 to 2018. Meta-analysis was performed by random effects models.ResultsSeven literatures were included. A total of 672 cases exposed to LEV in treatment group and 772 234 cases in control groups were selected for meta-analysis. There was no significant difference in neonatal malignancy between treatment group and control group［OR=1.05, 95% CI (0.54, 2.02), P=0.37］. Further, we evaluated the effect of LEV monotherapy and polytherapy on neonatal safety, a total of 464 monotherapy cases and 632 polytherapy cases respectively were selected for meta-analysis. The results showed that there was no significant difference between these two therapies in neonatal malignancy ［OR=0.54, 95% CI(0.31, 0.96), P=0.32］.ConclusionsAs the papers we included, levetiracetam in the treatment of epilepsy during pregnancy is relatively safe for newborn.
Objective To systematically evaluate the effectiveness and safety of minimally invasive video-assisted thyroidectomy (MIVAT) and conventional open thyroidectomy (COT) in treatment of thyroid carcinoma without lymph node metastasis. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), WanFang, CBM, VIP and CNKI were searched to collect the randomized controlled trails (RCTs) and non-RCTs about MIVAT and COT in treatment of thyroid carcinoma without lymph node metastasis. The retrieval time was from inception to October 2015. The studies were screened according to the inclusion and exclusion criterias, and the data was extracted and the quality of studies was evaluated by 2 reviewers independently. Then the Meta-analysis was conducted by using RevMan 5.2 software. Results A total of 13 non-RCTs involving 3 083 cases were included. The results of Meta-analysis showed that: compared with COT group, operative time of MIVAT group was longer (MD=31.36, 95% CI: 27.68-35.03, P<0.05), hospital stay (MD=-0.16, 95% CI: -0.28--0.04, P=0.01) and length of scar (MD=-1.51, 95% CI: -1.63--1.39, P<0.05) of MIVAT group were shorter, but there was no significant difference in the incidences of transient hypocalcemia (OR=1.29, 95% CI: 0.93-1.78, P=0.13), transient laryngeal nerve palsy (OR=1.42, 95% CI: 0.93-2.17, P=0.11), hemotoma (OR=1.21, 95% CI: 0.64-2.29, P=0.56), recurrence (OR=0.61, 95% CI: 0.28-1.33, P=0.22), number of retrieved central lymph nodes (MD=-0.10, 95% CI: -0.98-0.78, P=0.82), and the size of tumors (MD=-0.02, 95% CI: -0.06-0.02, P=0.39) between the 2 groups. Conclusion MIVAT is safe and feasible in treatment of thyroid carcinoma without lymph node metastasis when its indications are strictly controlled.
This article discusses the concret implementation of day surgery in Ophthalmology Center, Beijing Tongren Hospital, Capital Medical University during the coronavirus disease 2019 epidemic and under the regular prevention and control, so as to provide a basis for ensuring the safety and effectiveness of clinical work in the special period. According to the requirements of health administration departments and the hospital for the prevention and control of epidemic, combining with the characteristics of concret work, the Ophthalmology Center carried out and accurately implemented a series of prevention and control management measures, and obtained good results in the clinical work on the basis of comprehensive security protection. From February to October, 2020, there were a total of 16 507 cases who underwent the day surgery in the Ophthalmology Center, with no surgical infection or suspected case of coronavirus disease 2019. The safety and quality management of epidemic prevention and control has played an active and effective role in the active development of day surgery in this center. The safe and optimized diagnosis and treatment process has reassured the patients and their families, and the strict implementation of protective measures by medical staff has ensured the safety of surgery and the work being proceed with smooth progress and high efficacy.
ObjectiveTo observe effect and safety of interstitial chemotherapy with 5-fluorouracil sustained release agent in radical operation of colorectal cancer. MethodsOne hundred and sixty patients with colorectal cancer from October 2011 to December 2013 were randomly divided into observation group and control group according to an incomplete random method, 78 cases of them were in the observation group and 82 cases of them were in the control group. All the patients were performed radical resection of colorectal cancer. The abdominal cavity and pelvic cavity were washed after surgery. 5-fluorouracil sustained release agent was implanted in the observation group patients for interstitial chemotherapy, the implant site was at the tumor resection area and the mesenteric artery. Routine chemotherapy was performed in these two groups after operation. The postoperative complications were observed. The postoperative local recurrence rate, liver metastasis rate, and 24-month survival rate were recorded. ResultsThe rates of abdominal complications and toxic effects had no significant differences between these two groups (P > 0.05). The rates of 12-month and 24-month local recurrence and the rate of liver metastasis in the observation group were significant lower than those in the control group[1.3% (1/78) versus 8.5% (7/82), x2=8.934, P=0.023; 5.2% (4/78) versus 23.2% (19/82), x2=14.834, P=0.004; 10.3% (8/78) versus 18.3% (15/82), x2=12.034, P=0.016]. The rate of 24-month survival in the observation group was significant higher than that in the control group[94.9% (74/78) versus 84.1% (69/82), x2=11.465, P=0.010]. ConclusionThe good safety of interstitial chemotherapy with 5-fluorouracil sustained release agent could effectively decrease local recurrence rate and liver metastasis rate of colorectal cancer after radical operation and improve survival time of patients.
Objective To systematically review the efficacy and safety of interferon based antiviral therapy for children with hepatitis B. Methods PubMed, EMbase, The Cochrane Library, WanFang Data and CNKI databases were searched to collect randomized controlled trials (RCTs) of interferon based antiviral therapy for children with hepatitis B from inception to December 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 12 studies involving 723 patients were included. The results of meta-analysis showed that: follow-up <12 months, the virological response rate (RR=2.82, 95%CI 1.98 to 4.02, P<0.000 01), serum HBeAg clearance rate (RR=3.02, 95%CI 1.95 to 4.67,P<0.000 01) and ALT normalization rate (RR=1.42, 95%CI 1.19 to 1.70,P=0.000 1) were significantly higher in the interferon group than the control group. Follow-up >12 months, the virological response rate (RR=1.75, 95%CI 1.18 to 2.60, P=0.006) and serum HBeAg clearance rate (RR=2.17, 95%CI 1.28 to 3.65, P=0.004) were also significantly higher in the interferon group. Severe adverse effects were not reported in included studies. Conclusion Current evidence shows that higher virological response is found in HBV infected children with interferon treatment. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
The incidence of myopia is increasing year by year and the trend of younger age is obvious. The situation of myopia prevention and control is very serious. The sclera is the target organ for the development of myopia. When myopia occurs and develops, the ultrastructure of the sclera tissue will undergo pathological changes, resulting in a decrease in its tensile strength, then progressive axial growth and posterior sclera expansion. Scleral collagen cross-linking can effectively increase the hardness and tensile strength of scleral tissue, which may have great potential in the prevention and control of myopia, especially pathological myopia. At present, the effectiveness of scleral collagen cross-linking technology in the prevention and treatment of pathological myopia researches are still in the stage of animal experiments, and there are a lot of controversies on the safety. The development of any new technology to ensure safety is the primary condition. A comprehensive understanding of the safety of scleral collagen crosslinking in the prevention and control of myopia can provide more basis and guidance for the further study of scleral collagen crosslinking.
Objective To evaluate the efficacy and safety of different doses of intravenous immunoglobulin (IVIG) in the treatment of relapsing-remitting multiple sclerosis (RRMS). Methods We searched for randomized controlled trials of different doses of IVIG in the treatment of RRMS. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses with The Cochrane Collaboration’s Revman 4.2.0 software. Results Three randomized controlled trials of different dose of IVIG in the treatment of RRMS were included. One was of high quality and the other two were of lower quality. Heterogeneity was identified in one study which reported IVIG in postpartum RRMS. Two studies reported the relapsefree rate and no significant difference was noted between IVIG and placebo. Two studies reported the annual relapse rate, and no significant difference was observed (OR -0.00, 95% CI -0.36 to 0.36, P=0.98). Two studies reported the MRI lesions, and no difference was identified, either. The incidence of adverse events was similar between IVIG and placebo. Conclusion There is insufficient evidence to support the dose-effect relationship of IVIG in the treatment of RRMS. Therefore, an individualized dosing regimen should be applied according to patients’ tolerance and economic status.
Objective To assess the efficacy and safety of Shenmai injection for children with viral myocarditis. Methods All randomized and quasi-randomized controlled trials (RCTs and quasi-RCTs) of Shenmai injection for children with viral myocarditis were searched from CBM (1981 to November 2009), CNKI (1980 to November 2009) and VIP (1989 to November 2009), The Cochrane Library (Issue 1,2010), PubMed (1966 to 2009), EMbase (1966 to 2009). Cochrane systematic reviews Handbook 5.0.1 was taken as a reference to quality evaluation of the included studies, and the Cochrane Collaboration’s RevMan 5.0 software was used for data analyses. Results A total of 15 RCTs were included. The quality of the included trials was low. The result of meta-analyses showed that: (1) The effective rate (RR 1.16, 95%CI 1.07 to 1.25) and the ECG improvement rate (RR 1.55, 95%CI 1.25 to 1.93) in Shenmai injection group were better than those in the control group. CK and CK-MB in Shenmai injection were lower than those in the control group, but the AST level was similar in the two groups. (2) The effective rate (RR 1.12, 95%CI 1.01 to 1.25) and the ECG improvement rate (RR 1.35, 95%CI 1.07 to 1.70) in Shenmai injection group were better than those in the western medicine plus routine therapy (RT) group. CK, AST and LDH in Shenmai injection group were lower than those in the western medicine plus RT group, but CK-MB was similar in the two groups. (3) The effective rate (RR 1.26, 95%CI 1.12 to 1.42) in Shenmai injection plus RT and western medicine group was better than that in RT and western medicine group. CK and LDH-1 in Shenmai injection plus RT and western medicine group were lower than those in RT and western medicine group. Adverse reactions of Shenmai injection in 4 studies included mild rash, rubicundity and chest distress. No severe adverse reactions were reported. Conclusion The evidence currently available shows that Shenmai injection may have some effect on children with viral myocarditis, including improving the effective rate, reducing myocardial enzymes and improving the ECG improvement rate. However, because of the low methodological quality of the included trials, this conclusion needs to be interpreted cautionsly, and more well-designed, high-quality RCTs need to be performed.