The Optimal Primary Treatment for Pediatric Perianal Abscess and Anal Fistula: A Systemic Review and Meta-Analysis

BackgroundPerianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients.MethodsUsing PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis.ResultsThirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615–2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109–0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761–10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information.ConclusionStrong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence.Level of evidenceType of study: Systemic review; Evidence level: Level II.     

营养教育在腹主动脉瘤患者根治术后的临床应用

目的 探讨营养教育在腹主动脉瘤患者根治术中的应用价值。 方法 选取2017年10月至2019年10月青岛市市立 医院收治的行根治术的腹主动脉瘤患者96例，采用随机数字表法分为对照组（48例，行常规护理）和观察组（48例，行常规护理 联合营养教育），比较两组康复效果、营养指标和生活质量，另参照焦虑自评量表（SAS）和抑郁自评量表（SDS）判定患者心理状 态。 结果 观察组首次排气时间、下床活动时间和住院时间短于对照组，心理状态评分低于对照组，依从性和生活质量综合评 定问卷评分高于对照组，差异有统计学意义（P<0.05）；观察组患者体重为(68.16±6.32) kg，体质指数为（23.02±0.54）kg/m2，血清 白蛋白水平为（37.2±2.4）g/L,血清转铁蛋白水平为（2.45±0.36）g/L，血清前白蛋白水平为（267.27±25.12）mg/L，总铁结合力为 （56.17±6.24）μmol/L，高于对照组的（64.32±5.44）kg、（21.72±0.78）kg/m2 、（32.1±1.8）g/L、（2.16±0.32）g/L、（215.12±22.26）mg/L和 （50.34±5.21）μmol/L，差异有统计学意义（P<0.05）。 结论 在腹主动脉瘤患者根治术中联合营养教育可促进患者术后康复，对 患者负面情绪有缓解作用，可提高患者依从性，改善营养不良状态，促进生活质量的提升。     

Abdominal access techniques

This article discusses the variety of techniques available to gain safe exposure to intra-abdominal organs. In recent years there have been significant advances in these techniques with a move towards minimally invasive strategies as the gold standard of care. This article will discuss the various options available, including laparoscopy and traditional open access, as well as the use of robotics within abdominal surgery.     

花宝金教授基于调气解毒法论治癌性疼痛

癌性疼痛是癌症患者的常见症状之一,其严重地摧残着患者的身心健康，影响着生命质量。中医药能够减轻疼痛，减少止痛药物的用量及减少不良反应，能够明显改善生命质量。花宝金教授指出正气不足为癌痛发作的内因，正气不足，脏腑功能失调，气血阴阳虚损，病邪乘虚而入，经脉不荣可发为疼痛。此外各种因素导致的气滞为癌痛发生的诱发因素，可导致形成血瘀、痰湿、热毒等积滞搏结发为癌肿，闭阻脉络，瘀塞不通，而致疼痛。病程日久所形成的癌毒为夙根，是癌痛反复发作的根本原因。“调气解毒法”是花宝金教授治疗癌性疼痛的主要方法之一，通过辨癌毒，从病机、治法、方药等方面论述调气解毒法在癌性疼痛中的应用。     

Abdominal tumors in patients with neurofibromatosis type I: Genotype-phenotype relationships

BackgroundGastrointestinal stromal tumors have been detected in 25% of the necropsies performed on NF1 patients, but have been reported only in 7% of NF1 patients in the largest series. Such data imply an important gap between the true presence of tumors and those diagnosed. Few genotype-phenotype relationships have been described but to date none referring to abdominal tumors.ObjectivesEvaluate retrospectively the efficacy of a regular and proactive follow-up of NF1 patients to early diagnose abdominal tumors and report their mutations.MethodsCohort study performed between 2010 and 2020, with 43 NF1 adult patients followed at our Dermatology department.ResultsEight abdominal tumors were diagnosed in six patients, meaning that 14% of the followed patients developed an abdominal tumor. Five patients (83%) were asymptomatic. Five (83.3%) had a family history of NF1 with abdominal tumors (patients 1,2 and 3,4,5 were relatives).ConclusionsAlthough currently gastrointestinal routine screening investigations for asymptomatic patients are not recommended in the guidelines, the family aggregation in our series suggests it should be considered a close follow-up of the relatives of a patient with an NF1-related abdominal tumor. Also, for the first time, two mutations [c.2041C > T (p.Arg681Ter) and c.4537C > T (p.Arg1513*)] have been associated with family aggregation of abdominal tumors in NF1 patients.