Single-Incision Versus Conventional Laparoscopic Appendectomy: A Meta-analysis of Randomized Controlled Trials

Background

Single-incision laparoscopic appendectomy (SILA) has gained enormous popularity worldwide. We conducted a meta-analysis to assess feasibility, safety, and benefits of SILA as compared with conventional laparoscopic appendectomy (CLA).

Methods

A literature search in MEDLINE, EMBASE, and Cochrane Library was performed to identify eligible randomized controlled trials (RCTs). Primary outcome measures were total postoperative complications, wound infection, intra-abdominal abscess, and ileus. Secondary outcome measures were operative time, length of hospital stay, pain scores, conversion rate, reoperation rate, and time to return to normal activity.

Results

Eight RCTs, totaling 1,211 patients (604 for SILA and 607 for CLA), met the inclusion criteria. The incidences of total postoperative complications, wound infection, intra-abdominal abscess, and ileus were statistically similar between the SILA and CLA groups. Compared with CLA, SILA was associated with a significantly longer operative time (weighted mean difference?=?5.28 min; 95 % confidence interval?=?3.61 to 6.94). Time to return to normal activity was shorter in the SILA group (by 0.69 days). Length of hospital stay, pain scores, conversion rate, and reoperation rate were similar between groups.

Conclusion

SILA is feasible and safe with no obvious advantages over CLA. Therefore, it may be considered as an alternative to CLA.     

The activation of p38 and JNK by ROS,contribute to OLO-2-mediated intrinsic apoptosis in human hepatocellular carcinoma cells

In this study, we describe that a novel synthesized compound, olean-28,13β-olide 2 (OLO-2), exhibits selective cytotoxic activity via inducing apoptosis in human hepatocellular carcinoma (HCC) cell lines but not normal human hepatic cells in vitro. Exposure of human HCC HepG2 cells to OLO-2 results in significant loss of mitochondrial transmembrane potential (ΔΨ_m), the release of cytochrome c, the recruitment of B-cell lymphoma 2 (Bcl-2) assaciated X protein (Bax) and the downregulation of Bcl-2. The apoptosis induced by OLO-2 is associated with the activation of caspase-3/9 and the nuclear translocation of apoptosis inducing factor (AIF). Moreover, the increase of phosphorylated p38 and c-Jun N-terminal kinase (JNK) is observed. OLO-2-induced the externalization of phosphatidyl-serine (PS) and the loss of ΔΨ_m are blocked by p38 inhibitor SB203580 or JNK inhibitor SP600125. In addition, OLO-2 provokes the generation of reactive oxygen species (ROS) in HepG2 cells, while the antioxidant N-acetyl cysteine (NAC) almost completely blocks OLO-2-induced apoptosis and the activation of p38 and JNK. Taken together, the present study demonstrates that OLO-2 exhibits its cytotoxic activity through intrinsic apoptosis via ROS generation and the activation of p38 and JNK. Its potential to be a candidate of anti-cancer agent is worth being further investigated.     

CA199联合ERCP对胰胆管恶性肿瘤的诊断价值研究

目的研究CA19—9对胆道和胰腺恶性肿瘤的诊断价值,以及胆总管梗阻对CA19—9值的影响。方法首先回顾性分析168例胆道和胰腺疾病的患者血清CA199对胆道和胰腺恶性肿瘤的诊断价值。然后前瞻性地对54例因胆总管梗阻而行ERCP＋胆总管支架植入术的患者进行研究。结果胆道和胰腺恶性肿瘤组CA199水平明显高于良性疾病组,差异具有统计学意义（P〈0.01）。血清CA199对胰腺和胆道恶性肿瘤诊断的敏感性分别为100%和84%,特异性分别为87.27%和53.16%。在ERCP术前CA199对胆总管恶性梗阻的诊断的特异性只有43.48%,而在ERCP术后上升到86.96%。结论 CA199对胰腺和胆道恶性肿瘤具有较高的诊断价值,尤其是解除胆道梗阻以后其诊断恶性肿瘤的特异性显著升高。     

An unexpected dual-response pH probe based on acridine

A new pH fluorescent probe 2,8-bis(acridin-9-ylethynyl)-6H,12H-5,11-methanodibenzo[b,f][1,5]diazocine (TBN), which has two acridine moieties attached to Tröger''s base, is a useful fluorescent probe for monitoring extreme acidic and alkaline pH. TBN displays an excellent pH dependent behavior and responds linearly to extreme conditions in the pH ranges of 1.4–3.4 and 12.5–15.0. TBN can represent a novel type of fluorescent probe with perfect emission properties in extreme acidic and alkaline conditions by utilizing only one functional group.

A novel pH fluorescence probe for monitoring extreme acidic and alkaline pH which responds linearly to extreme conditions in the pH ranges of 1.4–3.4 and 12.5–15.0 by utilizing only the acridine moiety.     

某三级综合性医院门诊流程人性化再造的探索简

通过门诊大修改造案例,介绍了三级综合性医院门诊设计上如何关注细节,在流程再造、诊疗模式变革、人性化措施、色彩安排、信息系统上体现现代医院的服务要求以及现代医学模式的需求。     

多西环素对大鼠正畸移动牙根面骨型胶原酶表达的影响

目的:通过建立正畸牙根吸收动物模型,检测牙根面及根周组织中骨型胶原酶(MMP-13)的分布和表达,研究多西环素(DOXY)对根吸收及骨型胶原酶表达的影响。方法:选用SD大鼠36只建立正畸牙移动根吸收的动物模型,随机分为空白对照组、注射DOXY对照组、正常牙加力组、注射DOXY加力组。在加力的0天、7天、10天、14天分别处死各组大鼠。并取相应时段的标本制作组织切片,应用免疫组化技术检测分析各组中骨型胶原酶(MMP-13)在第一磨牙根吸收组织中的定位表达,检测多西环素对根周组织内骨型胶原酶表达及分布的影响。用计算机图像分析技术定量比较上述试验结果。结果:在多西环素的影响下,在第7天和第10天给药受力组的MMP-13的阳性表达低于受力不给药组。给药受力组MMP-13的阳性表达在第10天更低(P0.01)。两实验组MMP-13的阳性表达都在第10天到达峰值后第14天趋于平稳。结论:多西环素可能作为骨型胶原酶的抑制剂对破骨细胞的募集及牙根吸收有抑制作用。     

中医体质辨识在孕前优生优育保健模式中的研究和应用

目的：了解计划妊娠妇女体质类型分布情况,探讨将中医体质辨识融入孕前保健管理中的意义,为中西医结合孕前优生优育保健模式的建立提供依据。方法选取2013年1至10月在闸北区妇幼保健所前来孕前优生优育检查的妇女726例为研究对象,通过体质辨识评估问卷（王琦量表）展开调查。结果收集有效问卷706份,有效回收率96．98％。根据问卷调查结果,计划妊娠妇女平衡体质（平和质、基本平和质）318例,占45．04％,偏颇体质388例,占54．96％,其中单一偏颇体质160例,兼夹体质228例。计划妊娠妇女相信中西医结合保健有利于优生优育者占87．07％,对中西医结合孕前优生优育干预支持率89．66％。结论计划妊娠妇女偏颇体质比例高于平和体质,建议在常规孕前优生优育模式的基础上,对计划妊娠妇女进行中医体质辨识,运用辨体施养、辨体施膳、辨体施治等综合性干预措施,进一步促进其身心健康,达到优生优育目的。     

2015-2017年上海市8家基层医疗机构口服降糖药物利用评价

目的 通过调查2015—2017年上海市崇明区8家基层医疗机构(以下简称“崇明区8家医院”)口服降糖药的应用现状,评价利用情况及用药趋势,为临床合理用药提供参考。方法 采用金额排序分析和用药频度分析方法,对崇明区8家医院2015—2017年口服降糖药的用药金额、用药频度(DDDs)和限定日费用(DDC)等进行回顾性统计分析。结果 2015—2017年崇明区8家医院口服降糖药的使用总金额和DDDs总体呈逐年增长趋势,用药金额排序列前3位的分别为格列美脲、阿卡波糖、吡格列酮;DDDs排序列前3位的分别为格列美脲、二甲双胍、吡格列酮。2015—2016年DDC排序列前3位的依次为阿卡波糖、瑞格列奈、那格列奈,2017年DDC排序列前3位的是阿卡波糖、沙格列汀和西格列汀,而二甲双胍、格列美脲3年的DDC均较低;用药金额排序与DDDs排序的比值(B/A)在0.33~2.50之间。结论 格列美脲、二甲双胍及吡格列酮是崇明区8家医院2015—2017年最常用的品种,口服降糖药的应用基本合理,临床更倾向于选择每日服用一次的长效口服降糖药。     

A phase 2, open-label,multi-center study to evaluate the efficacy and safety of 99mTc-TRODAT-1 SPECT to detect Parkinson’s disease

Annals of Nuclear Medicine - To assess the efficacy and safety of 99mTc-TRODAT-1 SPECT in diagnosing Parkinson’s disease (PD). 99mTc-TRODAT-1 SPECT imaging was performed in 34 healthy...