Meta-Analysis of Efficacy and Safety of Fast-Track Surgery in Gastrectomy for Gastric Cancer

Background

Fast-track surgery (FTS) is a promising program for surgical patients and has been applied to several surgical diseases. FTS is much superior to conventional perioperative care. Our aim was to evaluate and compare the safety and efficacy of FTS and conventional perioperative care for patients undergoing gastrectomy using a systematic review.

Methods

We searched the literature in PubMed, SCOPUS, and EMBASE up to November 2013. No language restriction was applied. Weighted mean differences (WMDs) and odds ratios (ORs) with their 95 % confidence intervals (CIs) were used for analysis by a fixed or a random effects model according to the heterogeneity assumption.

Results

In the present meta-analysis, we included five randomized controlled trials and one controlled clinical trial from five studies. Compared with conventional care, FTS shortened the duration of flatus (WMD ?21.08; 95 % CI ?27.46 to ?14.71, z = 6.48, p < 0.00001 in the open surgery group; WMD ?8.20; 95 % CI ?12.87 to ?3.53, z = 3.44, p = 0.0006 in the laparoscopic surgery group), accelerated the decrease in C-reactive protein (WMD ?15.56; 95 % CI 21.28 to 9.83, z = 5.33, p < 0.00001), shortened the postoperative stay (WMD ?2.00; 95 % CI ?2.69 to ?1.30, z = 5.64, p < 0.00001), and reduced hospitalization costs (WMD ?447.72; 95 % CI ?615.92 to ?279.51, z = 5.22, p < 0.00001). FTS made no significant difference in operation times (p = 0.93), intraoperative blood loss (p = 0.79), or postoperative complications (p = 0.07).

Conclusions

Based on current evidence, the FTS protocol was feasible for gastric cancer patients who underwent gastrectomy (distal subtotal gastrectomy, proximal subtotal gastrectomy, or radical total gastrectomy) via open or laparoscopic surgery. Larger studies are needed to validate our findings.     

后牙区过渡义齿修复的临床应用研究

目的：评价后牙区过渡义齿的临床修复效果。方法选择承德医学院附属医院口腔修复科2009年7月—2013年5月收治的后牙区过渡义齿修复患者58例,随机平分为试验组和对照组。试验组只在模型上修整所拔天然牙并完成义齿制作,戴牙时进行软衬。对照组则按照Felly氏三等分原则对模型进行修整,拔牙后戴入全口义齿。分别在第1周、第5周、第9周对患者进行复诊或电话回访,记录评价2种修复方法的临床效果。结果试验组在第1周、第5周疗效良好率分别为86.2%、82.7%,明显高于对照组（62.1%、58.6%）,且差异具有统计学意义（P<0.05）。在第9周时,两组无显著差别。结论后牙区过渡义齿修复具有很好的临床效果,值得应用推广。     

Structural insights into the effects of 2′-5′ linkages on the RNA duplex

The mixture of 2′-5′ and 3′-5′ linkages generated during the nonenzymatic replication of RNA has long been regarded as a central problem for the origin of the RNA world. However, we recently observed that both a ribozyme and an RNA aptamer retain considerable functionality in the presence of prebiotically plausible levels of linkage heterogeneity. To better understand the RNA structure and function in the presence of backbone linkage heterogeneity, we obtained high-resolution X-ray crystal structures of a native 10-mer RNA duplex (1.32 Å) and two variants: one containing one 2′-5′ linkage per strand (1.55 Å) and one containing three such linkages per strand (1.20 Å). We found that RNA duplexes adjust their local structures to accommodate the perturbation caused by 2′-5′ linkages, with the flanking nucleotides buffering the disruptive effects of the isomeric linkage and resulting in a minimally altered global structure. Although most 2′-linked sugars were in the expected 2′-endo conformation, some were partially or fully in the 3′-endo conformation, suggesting that the energy difference between these conformations was relatively small. Our structural and molecular dynamic studies also provide insight into the diminished thermal and chemical stability of the duplex state associated with the presence of 2′-5′ linkages. Our results contribute to the view that a low level of 2′-5′ substitution would not have been fatal in an early RNA world and may in contrast have been helpful for both the emergence of nonenzymatic RNA replication and the early evolution of functional RNAs.The capacity of RNA to act as both a carrier of genetic information and as a catalyst has led many to investigate its potential role as the first biopolymer (1–4). An early stage involving nonenzymatic replication simplifies RNA-first scenarios, but known nonenzymatic copying reactions generate a mixture of 3′-5′ and 2′-5′ backbone linkages because of the similar nucleophilicity and orientation of the 2′ and 3′ hydroxyl groups on ribose (Fig. 1). Although regioselectivity for the 3′-5′ linkage can be improved by using different metal ions or activated monomers, it reaches, at most, ∼90% (5–11). This lack of regiospecificity has been regarded as a central problem for the emergence of the RNA world, because the resulting backbone heterogeneity was expected to disrupt the folding, molecular recognition, and catalytic properties of functional RNAs. However, we recently observed that functional nucleic acid molecules can still evolve in the presence of nonheritable mixed DNA/RNA backbone heterogeneity (12), and known functional RNAs retain catalytic and ligand binding behavior in the presence of 2′-5′/3′-5′ backbone linkage heterogeneity (13).Open in a separate windowFig. 1.Template-directed chemical incorporation of an activated monomer at the 3′ end of an RNA primer. (LG, leaving group: in contemporary biochemistry, LG = pyrophosphate, in model prebiotic reactions, LG = 2-methylimidazole). Extant enzyme polymerases produce homogeneous 3′-5′–linked RNA (left product), whereas known model prebiotic reactions produce both 3′-5′ and 2′-5′ (right product) linked RNA.The well-known duplex-destabilizing property of 2′-5′ linkages can enable thermal strand separation of long RNA duplexes in the presence of the high Mg²⁺ concentrations required for known prebiotic copying reactions (13–16). However, the mechanism responsible for this destabilization has not yet been satisfactorily elucidated, although a very preliminary modeling study has suggested that the reduced base overlap between adjacent intrastrand bases caused by the 2′-5′ linkage might be one of the reasons for the decreased T_m (17). In addition, the diminished chemical stability of this linkage in the duplex state has been suggested as a potential proofreading mechanism for linkage heterogeneity in prebiotic RNA synthesis (5). These observations, coupled with the fact that strands containing these linkages can still template RNA primer extension (18), suggest that, far from being a problem, 2′-5′ backbone linkages may have been an essential feature of early (pre)-RNA.Given the potential importance of mixed RNA backbone isomers in early evolution, we sought to elucidate the structural origins of the properties of mixed-backbone RNA duplexes. Although NMR structures of a homogeneously 2′-5′-linked DNA and RNA duplex as well as X-ray crystal structures of 2′-5′-linked dinucleotides have been reported (19–26), no crystallographic data are available on mixed-backbone RNA. Here we report high-resolution crystal structures of three RNA 10mer duplexes of the same self-complementary sequence, the first being native RNA, the second containing two, and the third containing six 2′-5′ linkages. These data, along with accompanying molecular dynamics simulations, provide clear structural insights into the origins of the above phenomena, as well as explaining how RNA duplexes adjust their overall and local structures to accommodate mixed regioisomers. Additionally, both duplexes containing 2′-5′ linkages crystallized more readily than the native RNA duplex, most likely due to additional interhelical interactions mediated by the surface exposed 3′-hydroxyl of the 2′-linked sugars, suggesting that the incorporation of 2′-5′ linkages into RNA structures may facilitate duplex packing and RNA crystallographic analysis.     

Diagnostic accuracy of glycated hemoglobin compared with oral glucose tolerance test for diagnosing diabetes mellitus in Chinese adults: A meta-analysis

Aims

A meta-analysis was conducted to evaluate the diagnostic value of glycated hemoglobin (HbA1c) ≥6.5% (48 mmol/mol) for diabetes in Chinese adults.

Methods

Oral glucose tolerance test (OGTT) was selected as the reference standard. PubMed, EMBASE, CNKI, Wanfang Data, and VIP were searched to obtain all diagnostic tests with HbA1c ≥6.5% (48 mmol/mol) for diabetes in Chinese adults published between January 2003 and October 2013. The qualities of the included studies were assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-DiSc software was used to conduct a comprehensive quantitative assessment, and summary receiver operating characteristic (sROC) curves were obtained.

Results

A total of 9 studies with 25,932 subjects were included. Pooled sensitivity was 0.518, pooled specificity 0.956, pooled positive likelihood ratio 19.007 and pooled negative likelihood ratio was 0.477. Pooled diagnostic odds ratio was 40.631. AUC_sROC was 0.929.

Conclusion

Compared with OGTT, using HbA1c ≥6.5% (48 mmol/mol) to diagnose diabetes in Chinese adults exhibited high specificity and low sensitivity and would have failed to diagnose 48.7% of newly diagnosed diabetes. The diagnostic HbA1c value could be reduced to improve sensitivity. Long-term prospective studies are required to establish an appropriate HbA1c value as a diagnostic criterion for diabetes in China.     

S100蛋白检测在脑梗死中的应用研究

目的：探讨S100蛋白检测在脑梗死（CI）中的作用价值。方法分析我院自2012年1月~2013年4月收治的76例CI患者,检测S100蛋白在CI患者发病后第3、7、14天时的水平,以及与神经功能缺损评分、脑梗死病灶面积大小的关系。同时选取我院同期行健康体检患者56例进行对照分析。结果（1）CI组与对照组比较,在术后3d与7d时,S100蛋白水平比较,P＜0.01,P＜0.05。（2）神经功能缺损评分中型、重型组与轻型组S100蛋白水平比较,P＜0.05,P＜0.01。（3）梗死面积中、大组与小梗死面积组比较,P＜0.05, P＜0.01。结论 S100蛋白在CI发病早期为高表达,同时其高表达神经功能缺损严重程度及梗死面积增大有密切关系,表明S100蛋白与CI的病理、生理的过程有一定的相关性。     

食管癌患者的心理社会因素相关性研究

目的探讨心理社会相关因素对食管癌患者的影响。方法对49例食管癌患者(研究组)和49名患者邻居(对照组)采用艾森克个性问卷、社会支持量表、生活事件量表进行评定分析。结果研究组艾森克个性问卷E维度得分明显低于对照组,N维度得分及L维度得分明显高于对照组(P<0.01);社会支持量表的客观支持、支持利用度及社会支持总分研究组低于对照组(P<0.01);生活事件量表的总生活事件、负性生活事件得分研究组明显高于对照组(P<0.05)。结论食管癌患者与心理社会因素高度相关,在进行药物治疗的同时应注重心理社会干预。     

食物及药物中毒性急性肾功能衰竭血液透析治疗

目的 总结分析38例食物及药物中毒性急性肾功能衰竭患者经血液透析治疗后肾功能恢复正常的经验。方法 38例误食毒性物质或药物后发生急性肾功能衰竭患者(18例毒蕈中毒,14例鱼胆中毒,药物中毒6例)经临时血液透析通路进行血液透析。结果 38例患者经血液透析治疗后随访半年至一年尿量及肾功能均恢复正常。结论 血液透析是治疗急性食物或药物中毒导致急性肾功能衰竭的有效治疗方法之一。     

Gene polymorphisms of the renin-angiotensin-aldosterone system and angiotensin II type 1-receptor activating antibodies in renal rejection

Steroid refractory acute rejection (SRAR) is a major vital factor in renal transplantation recipients. The pathogenesis of SRAR may involve both immune and non-immune mechanisms. A decreased renal allograft function has also been associated with increased activity of renin-angiotensin-aldosterone system (RAS), which may be genetically determined. A total 206 renal transplant recipients, 116 males and 90 females, were included. The effects of gene polymorphisms of the four components of RAS including angiotensinogen (AGT), angiotensin-converting enzyme (ACE), angiotensin type 1 receptor (AT1R), and aldosterone synthase (CYP11B2) were investigated in 19 cases of renal transplant patients with SRAR. The association between SRAR and the activating antibodies targeting the AT1R were also investigated. Genotyping was performed for the M235T-AGT, the I/D-ACE, the A1166C-AT1R, and the -344T/C-CYP11B2 gene polymorphisms using polymerase chain reaction. Our results showed that renal allograft recipients with SRAR had significantly higher occurrences of the DD genotype of ACE and CC genotype of AT1R than recipients without SRAR. The other genetic polymorphisms of the RAS were not associated with SRAR. Activating antibodies targeting the AT1R were detected in the sera from 14 SRAR victims with malignant hypertension and without anti-HLA antibodies. This study provides evidence that determination before transplantation of the polymorphism of the gene encoding components of RAS may help identify patients who are at risk for SRAR. The detection of the antibodies of AT1R may contribute to the prevention of SRAR.     

新塔花胶囊治疗稳定型心绞痛临床疗效观察

目的：探讨新塔花胶囊对稳定型心绞痛的疗效及作用机制。方法：４７例经临床症状及心电图检查证实的稳定型心绞痛患者随机分为２组。治疗组３７例口服新塔花胶囊，对照组１０例口服川芎嗪胶囊，均为每日３次，每次４粒，１个月为１个疗程。分别观察治疗前后２组患者心绞痛缓解及心电图、动态心电图改善情况。结果：心绞痛缓解情况治疗组显效７例，有效２３例，无效７例，总有效率８１．１％；对照组有效７例，无效３例，总有效率７０．０％。２组比较有显著性差异（Ｐ＜０．０１）。心电图显示２组的ＳＴ段改善有显著性差异（Ｐ＜０．０５）。动态心电图ＳＴ段降低持续时间，治疗组服药后时间明显缩短（Ｐ＜０．０５）。结论：新塔花胶囊治疗稳定型心绞痛是安全有效的药物。     

经食管左心房调搏术引发心律失常的分析及纠治

目的 :探讨经食管左心房调搏术 (TEAP)引发心律失常的纠治措施。方法 :对我院 73 0例行TEAP检查引发的5 3例心律失常进行分类。并分析其发生机制及制订纠治方案。结果 :5类心律失常分别为房性过早搏动、室性过早搏动、心房颤动、心房扑动、心脏停搏。若各种类型早搏在数分钟后不能自行终止 ,则可应用阻断植物神经的药物 ;对持续时间较长的房颤、房扑 ,可静脉注射西地兰 ;在心脏停搏时间≥ 2 5s时 ,应进行保护性起搏。结论 :TEAP引发的心律失常 ,可以得到有效的纠治。