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1.
Background
Non-asthmatic eosinophilic bronchitis (NAEB) is one common cause of chronic cough which is characterized as airway eosinophilic inflammation like asthma but lack of airway hyper-responsiveness. Previous studies showed that Th2-pathway plays a role in NAEB, but the role of non-Th2 pathway in mechanism of NAEB remains unknown. Recently, IL-17A, a Th17-pathway cytokine, has been demonstrated to be involved in asthma development. However, the relationship between Th17-pathway and NAEB is unknown.Methods
We aim to assess the airway level of IL-17A in the subjects with NAEB. Relationships between the IL-17A level and airway function in NAEB or asthma are also observed. We measured IL-17A concentrations in the sputum supernatant from 12 subjects with EB, 16 subjects with asthma [9 eosinophilic asthmatic (EA) and 7 non-eosinophilic asthmatic (NEA) according to the sputum eosinophil ≥?3%], and 9 healthy control subjects.Results
Increasing IL-17A level was found in NAEB group (29.65?±?8.13 pg/ml), EA group (32.45?±?3.22 pg/ml), and NEA group (29.62?±?6.91 pg/ml) compared with the healthy control group (17.05?±?10.30 pg/ml) (P?<?0.05, P?<?0.01, P?<?0.05, respectively). The sputum IL-17A level was correlated with FENO (r?=?0.44, P?<?0.01), FEV1/FVC% (r?=???0.38, P?<?0.05), MMEF%pred (r?=???0.34, P?<?0.05), and sputum neutrophil% (r?=?0.33, P?<?0.05) in total.Conclusion
Th17-pathway may play a role not only in asthmatics, but also in subjects with NAEB, as reflected by increasing IL-17A concentrations in sputum supernatant.2.
Purpose
Genetic susceptibility for tuberculosis in human has been previously demonstrated. Polymorphisms in genes involved in immune responses may alter the susceptibility of individuals to tuberculosis. Polymorphisms of beta-2 adrenergic receptor (ADRB2) gene can be possibly an important risk factor in tuberculosis. In this study, the association between rs1042713 (Arg16Gly +46A>G) and rs1042714 (Gln27Glu +79C>G) polymorphisms in ADRB2 gene and tuberculosis was evaluated.Methods
Genotype distributions of the rs1042713 (Arg16Gly +46A>G) and rs1042714 (Gln27Glu +79C>G) polymorphisms in ADRB2 gene in 106 patients with pulmonary tuberculosis and 88 healthy subjects were studied by PCR–RFLP method in an Iranian population.Results
The frequency of rs1042713*G and rs1042714*G alleles in ADRB2 gene in tuberculosis patients was significantly different from healthy controls [odds ratio (OR) 0.176, 95% confidence interval (CI) 0.065–0.48, P value <0.001 and OR 0.45, 95% CI 0.247–0.825, P value = 0.009, respectively]. There were no significant differences in haplotype analysis between the patients and control subjects.Conclusion
The association was reported between rs1042713 and rs1042714 polymorphisms in ADRB2 gene and tuberculosis for the first time. rs1042713*G and rs1042714*G polymorphisms in ADRB2 gene makes people more susceptible to develop the disease.3.
Zhang Wei Zhu Li-Qun Huo Xiao-Ling Qin Jian Yuan Guo-Yue 《Hepatology International》2016,10(3):511-517
Purpose
To investigate the association between the single nucleotide polymorphisms (SNPs) of the adiponectin gene and nonalcoholic fatty liver disease (NAFLD) as well as the impact of the interaction of multiple SNPs on NAFLD risk, based on a Chinese population study.Methods
A total of 612 subjects (411 male, 201 female) were selected, including 302 NAFLD patients and 310 controls. Three SNPs were selected for genotyping in the case-control study: rs266729, rs822393, and rs1501299. A logistic regression model was used to examine the interaction between the SNPs and NAFLD. The odds ratio (OR) and 95 % confidence interval (95 % CI) were calculated. Generalized multifactor dimensionality reduction (GMDR) was employed to analyze the interaction among SNPs.Results
Logistic analysis showed a significant association between genotypes of variants in rs266729 and rs822393 and increased NAFLD risk. The carriers of the homozygous mutant of two SNP polymorphisms revealed increased NAFLD risk compared to those with wild-type homozygotes; ORs (95 % CI) were 1.31 (1.14–1.81) (p = 0.001) and 1.18 (1.05–1.71) (p = 0.005), respectively. There was a significant two-locus model (p = 0.0010) involving rs266729 and rs822393, indicating a potential gene-gene interaction between rs266729 and rs822393. Overall, the two-locus models had a cross-validation consistency of 10 and testing accuracy of 62.17 %. Subjects with the CG or GG and CT or TT genotype have the highest NAFLD risk compared to subjects with the CC-CC genotype; the OR (95 % CI) was 2.52 (1.31–3.82), p < 0.001, after covariate adjustment.Conclusions
Our results support an important association of the rs266729 (?11377 G/C) and rs822393 (?4522 C/T) polymorphism with increased risk of NAFLD. The interaction analysis showed a combined effect of rs266729 and rs822393 on NAFLD.4.
Ana L. Teixeira António Araújo Ana Coelho Ricardo Ribeiro Mónica Gomes Carina Pereira Rui Medeiros 《Journal of cancer research and clinical oncology》2011,137(3):435-439
Purpose
Lung cancer is the third most common type of cancer in Europe and is the first cause of death by cancer worldwide. Non-small cell lung cancer accounts for 75–85% of all histological types of LC. The transforming growth factor beta 1 is a multifunctional regulatory polypeptide that controls many aspects of cellular function (cellular proliferation, differentiation, migration, apoptosis, immune surveillance). TGFB1+869T>C is a functional polymorphism described in TGFB1 gene and this transition has been associated with higher circulating levels of TGFß1 that may modulate cellular microenvironment and consequently LC development and prognosis.Methods
We studied TGFB + 869T > C functional polymorphism by allelic discrimination using 7300 real-time polymerase chain reaction system in 305 patients with NSCLC and 380 healthy individuals.Results
We found an increased risk for C carriers to develop NSCLC, both epidermoid NSCLC and non-epidermoid NSCLC (odds ratio (OR) = 2.03, P < 0.0001, OR = 2.37, P < 0.001 and OR = 1.83, P = 0.001, respectively). TGFB1+869T>C functional polymorphism may influence NSCLC susceptibility with impact in cellular microenvironment.Conclusions
Our results suggest that individual differences influence the susceptibility to LC and tumoral behavior. This genetic profiling may help define higher risk groups for an individualized chemoprevention strategy and therapy.5.
6.
Aims
Gestational diabetes mellitus (GDM) is a complex disease induced by a combination of genetic factors and environmental exposures. Growing evidence suggests that common single nucleotide polymorphisms within miRNA-binding sites (miR-binding SNPs) contribute to the development of various diseases. However, the roles of miR-binding SNPs in GDM have not been fully elucidated. The CDKN2A/B genes have been identified as two of the strongest genetic determinants for diabetes risk. The aim of the study was to first investigate the associations between miR-binding SNPs of CDKN2A/B, GDM susceptibility, and quantitative metabolism traits.Methods
Three miR-binding SNPs of CDKN2A/B gene (rs1063192, rs3217992, and rs3088440) were selected and genotyped using TaqMan allelic discrimination assays in 839 cases of GDM and 900 controls.Results
The CC genotype of CDKN2B rs1063192, which is located in the hsa-miR-323b-5p binding site, was significantly associated with GDM [OR 1.418 (1.143, 1.908); p = 0.003]. The C allele of rs1063192 occurred with significantly higher frequency in GDM [OR 1.22 (1.03, 1.44); p = 0.021]. The rs1063192 genotype CC exhibited increased glucose levels at 1 h and 3 h, as well as higher insulin levels at 3 h during an OGTT compared with the control TT genotype (p < 0.05). We also found that the rs1063192 CC genotype was associated with lower total cholesterol and LDL cholesterol levels (p < 0.05).Conclusions
The CC genotype of CDKN2B rs1063192 in the hsa-miR-323b-5p binding site increased the risk of GDM in pregnant Chinese Han women. Importantly, our study provides evidence that miR-binding SNPs are a novel source of GDM susceptibility loci.7.
Purpose
Prolonged postoperative ileus (PPOI) after colorectal resection significantly impacts patients’ recovery and hospital stay. Because treatment options for PPOI are limited, it is necessary to focus on prevention strategies. The aim of this study is to investigate risk factors associated with PPOI in patients undergoing colorectal surgery.Methods
Data from all consecutive patients who underwent colorectal resection in our department were retrospectively analyzed from a prospective database over a 9-month period. PPOI was defined as the necessity to insert a nasogastric tube in a patient who experienced nausea and two episodes of vomiting with absence of bowel function. Multivariable analysis was performed considering a prespecified list of 16 potential preoperative risk factors.Results
A total of 523 patients (mean age 59 years; 52.2% males) were included, and 83 patients (15.9%) developed PPOI. Statistically significant independent predictors of PPOI were male sex (OR 2.07; P = 0.0034), open resection (OR 4.47; P < 0.0001), conversion to laparotomy (OR 4.83; P = 0.0015), splenic flexure mobilization (OR 1.72; P = 0.063), and rectal resection (OR 2.72; P = 0.0047). Discriminative ability of this prediction model was 0.72.Conclusions
Therapeutic strategies aimed to prevent PPOI after colorectal resection should focus on patients with increased risk. Patients and medical staff can be informed of the higher PPOI risk, so that early treatment can be started.8.
Risk factors for surgical site infection following colorectal resection: a multi-institutional study
Derek B. Hennessey John P. Burke Tara Ni-Dhonochu Conor Shields Desmond C. Winter Kenneth Mealy 《International journal of colorectal disease》2016,31(2):267-271
Introduction
Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly affects patients undergoing colorectal surgery. This study examined a multi-institutional dataset to determine risk factors for SSI following colorectal resection.Methods
Data on 386 patients who underwent colorectal resection in three institutions were accrued. Patients were identified using a prospective SSI database and hospital records. Data are presented as median (interquartile range), and logistic regression analysis was used to identify risk factors.Results
Patients (21.5 %) developed a postoperative SSI. The median time to the development of SSI was 7 days (5–10). Of all infections, 67.5 % were superficial, 22.9 % were deep and 9.6 % were organ space. In univariate analysis, an ASA grade of II (RR 0.6, CI 0.3–0.9, P?=?0.019), having an elective procedure (RR 0.4, CI 0.2–0.6, P?<?0.001), using a laparoscopic approach (RR 0.5, CI 0.3–0.9, P?=?0.019), having a daytime procedure (RR 0.3, CI 0.1–0.7, P?=?0.006) and having a clean/contaminated wound (RR 0.4, CI 0.2–0.7, P?=?0.001) were associated with reduced risk of SSI. In multivariate analysis, an ASA grade of IV (RR 3.9, CI 1.1–13.7, P?=?0.034), a procedure duration over 3 h (RR 4.3, CI 2.3–8.2, P?<?0.001) and undergoing a panproctocolectomy (RR 6.5, CI 1.0–40.9, P?=?0.044) were independent risk factors for SSI. Those who developed an SSI had a longer duration of inpatient stay (22 days [16–31] vs 15 days [10–26], P?<?0.001).Conclusions
Patients who develop an SSI have a longer duration of inpatient stay. Independent risk factors for SSI following colorectal resection include being ASA grade IV, having a procedure duration over 3 h, and undergoing a panproctocolectomy.9.
Jie Shang Jeanette C. Reece Daniel D. Buchanan Graham G. Giles Jane C. Figueiredo Graham Casey Steven Gallinger Stephen N. Thibodeau Noralane M. Lindor Polly A. Newcomb John D. Potter John A. Baron John L. Hopper Mark A. Jenkins Aung Ko Win 《International journal of colorectal disease》2016,31(8):1451-1457
Purpose
Gallbladder diseases and cholecystectomy may play a role in the development of colorectal cancer (CRC). Our aim was to investigate the association between cholecystectomy and CRC risk overall and by sex, family history, anatomical location, and tumor mismatch repair (MMR) status.Methods
This study comprised 5847 incident CRC cases recruited from population cancer registries in Australia, Canada, and the USA into the Colon Cancer Family Registry between 1997 and 2012 and 4970 controls with no personal history of CRC who were either randomly selected from the general population or were spouses of the cases. The association between cholecystectomy and CRC was estimated using logistic regression, after adjusting for confounding factors.Results
Overall, there was no evidence for an association between cholecystectomy and CRC (odds ratio [OR] = 0.88, 95 % confidence interval 0.73, 1.08). In the stratified analyses, there was no evidence for a difference in the association between women and men (P = 0.54), between individuals with and without family history of CRC in first-degree relative (P = 0.64), between tumor anatomical locations (P = 0.45), or between MMR-proficient and MMR-deficient cases (P = 0.54).Conclusion
Cholecystectomy is not a substantial risk factor for CRC, regardless of sex, family history, anatomical location, or tumor MMR status.10.
Takeshi Kimura Atsushi Uda Tomoyuki Sakaue Kazuhiko Yamashita Tatsuya Nishioka Sho Nishimura Kei Ebisawa Manabu Nagata Goh Ohji Tatsuya Nakamura Chihiro Koike Mari Kusuki Takeshi Ioroi Akira Mukai Yasuhisa Abe Hiroyuki Yoshida Midori Hirai Soichi Arakawa Ikuko Yano Kentaro Iwata Issei Tokimatsu 《Infection》2018,46(2):215-224
Objective
To evaluate the long-term effects of comprehensive antibiotic stewardship programs (ASPs) on antibiotic use, antimicrobial-resistant bacteria, and clinical outcomes.Design
Before–after study.Setting
National university hospital with 934 beds.Intervention
Implementation in March 2010 of a comprehensive ASPs including, among other strategies, weekly prospective audit and feedback with multidisciplinary collaboration.Methods
The primary outcome was the use of antipseudomonal antibiotics as measured by the monthly mean days of therapy per 1000 patient days each year. Secondary outcomes included overall antibiotic use and that of each antibiotic class, susceptibility of Pseudomonas aeruginosa, the proportion of patients isolated methicillin-resistant Staphylococcus aureus (MRSA) among all patients isolated S. aureus, the incidence of MRSA, and the 30-day mortality attributable to bacteremia.Results
The mean monthly use of antipseudomonal antibiotics significantly decreased in 2011 and after as compared with 2009. Susceptibility to levofloxacin was significantly increased from 2009 to 2016 (P = 0.01 for trend). Its susceptibility to other antibiotics remained over 84% and did not change significantly during the study period. The proportion of patients isolated MRSA and the incidence of MRSA decreased significantly from 2009 to 2016 (P < 0.001 and = 0.02 for trend, respectively). There were no significant changes in the 30-day mortality attributable to bacteremia during the study period (P = 0.57 for trend).Conclusion
The comprehensive ASPs had long-term efficacy for reducing the use of the targeted broad-spectrum antibiotics, maintaining the antibiotic susceptibility of P. aeruginosa, and decreasing the prevalence of MRSA, without adversely affecting clinical outcome.11.
Purpose
Abnormalities of the solute-linked carrier family 26 member A3 (SLC26A3) are implicated in the pathogenesis of several diseases including ulcerative colitis (UC). The short communication aimed at investigating the associations of UC with SLC26A3 (rs17154444, rs7810937, rs7785539, rs2108225 and rs6951457) polymorphisms and its expression in colonic tissues.Methods
The techniques of SNaPshot method, quantitative real-time PCR and immunohistochemical analysis were conducted.Results and conclusion
We found that the rs2108225 variation in SLC26A3 might increase the risk of UC and affect its expression at both the mRNA and protein levels in colonic tissues of patients with UC. Moreover, the rs17154444 variation might influence the severity of UC.12.
Jamie R. J. Inshaw Neil M. Walker Chris Wallace Leonardo Bottolo John A. Todd 《Diabetologia》2018,61(1):147-157
Aims/hypothesis
The genetic risk of type 1 diabetes has been extensively studied. However, the genetic determinants of age at diagnosis (AAD) of type 1 diabetes remain relatively unexplained. Identification of AAD genes and pathways could provide insight into the earliest events in the disease process.Methods
Using ImmunoChip data from 15,696 cases, we aimed to identify regions in the genome associated with AAD.Results
Two regions were convincingly associated with AAD (p < 5 × 10?8): the MHC on 6p21, and 6q22.33. Fine-mapping of 6q22.33 identified two AAD-associated haplotypes in the region nearest to the genes encoding protein tyrosine phosphatase receptor kappa (PTPRK) and thymocyte-expressed molecule involved in selection (THEMIS). We examined the susceptibility to type 1 diabetes at these SNPs by performing a meta-analysis including 19,510 control participants. Although these SNPs were not associated with type 1 diabetes overall (p > 0.001), the SNP most associated with AAD, rs72975913, was associated with susceptibility to type 1 diabetes in those individuals diagnosed at less than 5 years old (p = 2.3 × 10?9).Conclusion/interpretation
PTPRK and its neighbour THEMIS are required for early development of the thymus, which we can assume influences the initiation of autoimmunity. Non-HLA genes may only be detectable as risk factors for the disease in individuals diagnosed under the age 5 years because, after that period of immune development, their role in disease susceptibility has become redundant.13.
Mariko Hojo Takashi Asahara Akihito Nagahara Tsutomu Takeda Kohei Matsumoto Hiroya Ueyama Kenshi Matsumoto Daisuke Asaoka Takuya Takahashi Koji Nomoto Yuichiro Yamashiro Sumio Watanabe 《Digestive diseases and sciences》2018,63(11):2940-2949
Background
Recently, problems associated with proton pump inhibitor (PPI) use have begun to surface. PPIs influence the gut microbiota; therefore, PPI use may increase the risk of enteric infections and cause bacterial translocation. In this study, we investigated fecal microbiota composition, fecal organic acid concentrations and pH, and gut bacteria in the blood of the same patients before and after PPI use.Methods
Twenty patients with reflux esophagitis based on endoscopic examination received 8 weeks of treatment with PPIs. To analyze fecal microbiota composition and gut bacteria in blood and organic acid concentrations, 16S and 23S rRNA-targeted quantitative RT-PCR and high-performance liquid chromatography were conducted.Results
Lactobacillus species were significantly increased at both 4 and 8 weeks after PPI treatment compared with bacterial counts before treatment (P?=?0.011 and P?=?0.002, respectively). Among Lactobacillus spp., counts of the L. gasseri subgroup, L. fermentum, the L. reuteri subgroup, and the L. ruminis subgroup were significantly increased at 4 and 8 weeks after treatment compared with counts before treatment. Streptococcus species were also significantly increased at 4 and 8 weeks after PPI treatment compared with counts before treatment (P?<?0.01 and P?<?0.001, respectively). There was no significant difference in the total organic acid concentrations before and after PPI treatment. Detection rates of bacteria in blood before and after PPI treatment were 22 and 28%, respectively, with no significant differences.Conclusions
Our quantitative RT-PCR results showed that gut dysbiosis was caused by PPI use, corroborating previous results obtained by metagenomic analysis.14.
S. Sethi A. Anzueto M. Miravitlles P. Arvis J. Alder D. Haverstock M. Trajanovic R. Wilson 《Infection》2016,44(1):65-76
Purpose
Changes in sputum microbiology following antibiotic treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), including patterns of bacteriological relapse and superinfection are not well understood. Sputum microbiology at exacerbation is not routinely performed, but pathogen presence and species are determinants of outcomes. Therefore, we determined whether baseline clinical factors could predict the presence of bacterial pathogens at exacerbation. Bacterial eradication at end of treatment (EOT) is associated with clinical resolution of exacerbation. We determined the clinical, microbiological and therapeutic factors that were associated with bacteriological eradication in AECOPD at EOT and in the following 8 weeks.Methods
Sputum bacteriological outcomes (i.e., eradication, persistence, superinfection, reinfection) from AECOPD patients (N = 1352) who were randomized to receive moxifloxacin or amoxicillin/clavulanate in the MAESTRAL study were compared. Independent predictors of bacterial presence in sputum at exacerbation and determinants for bacteriological eradication were analyzed by logistic regression and receiver operating characteristic (ROC) analyses.Results
Significantly greater bacteriological eradication with moxifloxacin was mainly driven by superior Haemophilus influenzae eradication (P = 0.002, EOT). Baseline clinical factors were a weak predictor of the presence of pathogens in sputum (AUCROC = 0.593). On multivariate analysis, poorer bacterial eradication was associated with antibiotic resistance (P = 0.0001), systemic steroid use (P = 0.0024) and presence of P. aeruginosa (P = 0.0282).Conclusions
Since clinical prediction of bacterial presence in sputum at AECOPD is poor, sputum microbiological analysis should be considered for guiding antibiotic therapy in moderate-to-severe AECOPD, particularly in those who received concomitant systemic corticosteroids or are at risk for infection with antibiotic-resistant bacteria.15.
Marjolijn E. W. Timmerman Henk Groen Erik Heineman Paul M. A. Broens 《International journal of colorectal disease》2016,31(8):1467-1473
Purpose
The impact of lower body mass index (BMI) on appendicitis has never been addressed. We investigated whether different BMIs affect the diagnosis and treatment of appendicitis in children.Methods
The correlation between BMI and diagnosis accuracy and treatment quality was evaluated by retrospective analysis of 457 children diagnosed with appendicitis. Based on BMI percentiles, patients were classified as either underweight (n = 36), normal weight (n = 346), overweight (n = 59), or obese (n = 16). Diagnosis accuracy was measured by negative appendectomy rate, perforation rate, and number of consultations. Treatment quality was measured by complication rate and length of hospital stay.Results
Underweight patients had the highest negative appendectomy (OR 3.00, P = 0.008) and complication (OR 2.75, P = 0.041) rate. BMI did not influence perforation rate or number of consultations. Both underweight and obese patients stayed in the hospital longer than normal weight patients (regression coefficient 2.34, P = 0.001, and regression coefficient 9.40, P < 0.001, respectively).Furthermore, in obese patients, the hospital stay after open appendectomy was prolonged compared to laparoscopic appendectomy (P < 0.001). No such differences were observed in patients with lower BMI.Conclusions
Underweight children are misdiagnosed more often, stay in hospital longer, and experience more postoperative complications than children of normal weight. Obesity is associated with longer hospital stays. Laparoscopic appendectomy might shorten the length of hospital stays in these patients. We conclude that in addition to obesity, underweight should also be considered a risk factor for children with appendicitis.16.
Purpose
Recently, the roles of TIM-1 genetic polymorphisms in asthma have been extensively studied, with conflicting results. Therefore, we performed the present meta-analysis to better assess potential associations of TIM-1 genetic polymorphisms with asthma.Methods
Eligible articles were searched in PubMed, Medline, EMBASE, Google Scholar, and CNKI up to December 2016. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to detect any potential associations between TIM-1 genetic polymorphisms and asthma.Results
A total of 12 articles including 3120 asthma patients and 2825 control subjects were analyzed. The overall and subgroup analyses revealed that TIM-1-416G>C single nucleotide polymorphism was significantly associated with asthma for the Asian population in the codominant (G/G vs. G/C, p = 0.0003, OR 1.86, 95% CI 1.33–2.60) and dominant (G/G vs. G/C + C/C, p < 0.0001, OR 1.94, 95% CI 1.40–2.69) genetic models. Nevertheless, we failed to detect any significant associations between TIM-1-416G>C single nucleotide polymorphism and asthma in Caucasians. Additionally, according to our analyses, TIM-1 5383_5397 insertion/deletion polymorphism was not correlated with asthma in both Asians and Caucasians.Conclusions
In conclusion, our findings suggest that TIM-1-416G>C single nucleotide polymorphism is associated with asthma susceptibility for the Asian ethnicity in certain genetic models. However, TIM-1 5383_5397 insertion/deletion polymorphism may not be correlated with the risk of asthma.17.
Mikkel Jessen Malene Nerstrøm Therese Emilie Wilbek Søren Roepstorff Morten S. Rasmussen Peter-Martin Krarup 《International journal of colorectal disease》2016,31(9):1619-1624
Purpose
Anastomotic leakage (AL) after right hemicolectomy is a devastating complication, and risk factors for AL in this setting are rarely investigated exclusively. Recent reports suggest that anastomotic type may influence the rate of AL in ileocolic anastomoses. We investigated risk factors and short-term outcomes in patients subjected to right hemicolectomy.Methods
Data from all patients undergoing right hemicolectomy at our institution between 2009 and 2013 were collected in a database. Risk factors for clinical AL, 30-day mortality, hospital and intensive care unit stay were investigated. Stepwise logistic regression was used to adjust for confounding.Results
22/445 (4.9 %) patients had AL. Median time to AL was 6 days (range 2–11 days). A stapled anastomosis was associated with an increased AL rate compared with the handsewn approach (adjusted odds ratio (aOR) 2.84; 95 % CI 1.14–7.07; P?=?0.025). Other risk factors for AL were tobacco use (aOR 2.70; 95 % CI 1.06–6.86; P?=?0.037) and diabetes (aOR 5.95; 95 % CI 2.23–15.90; P?<?0.001). Anastomotic ischemia was present in 6/13 stapled and 1/9 handsewn leaking anastomoses, P?=?0.081, while generalized peritonitis was observed after 4/13 stapled and 7/9 handsewn leaking anastomoses, P?=?0.030. Thirty-day mortality was 2/22 (9.1 %) in patients with AL and 23/423 (5.4 %) in patients without AL, P?=?0.468, and 13/160 (8.1 %) and 12/285 (4.2 %), P?=?0.085, in stapled and handsewn anastomoses, respectively.Conclusions
Risk factors for AL after right hemicolectomy were diabetes, tobacco use and stapled compared with handsewn anastomoses.18.
Hong-Yu Zhang Chun-Lin Zhao Jing Xie Yan-Wei Ye Jun-Feng Sun Zhao-Hui Ding Hua-Nan Xu Li Ding 《International journal of colorectal disease》2016,31(5):951-960
Background
Currently, many surgeons place a prophylactic drain in the abdominal or pelvic cavity after colorectal anastomosis as a conventional treatment. However, some trials have demonstrated that this procedure may not be beneficial to the patients.Objective
To determine whether prophylactic placement of a drain in colorectal anastomosis can reduce postoperative complications.Methods
We systematically searched all the electronic databases for randomized controlled trials (RCTs) that compared routine use of drainage to non-drainage regimes after colorectal anastomosis, using the terms “colorectal” or “colon/colonic” or “rectum/rectal” and “anastomo*” and “drain or drainage.” Reference lists of relevant articles, conference proceedings, and ongoing trial databases were also screened. Primary outcome measures were clinical and radiological anastomotic leakage. Secondary outcome measures included mortality, wound infection, re-operation, and respiratory complications. We assessed the eligible studies for risk of bias using the Cochrane Risk of Bias Tool. Two authors independently extracted data.Results
Eleven RCTs were included (1803 patients in total, 939 patients in the drain group and 864 patients in the no drain group). Meta-analysis showed that there was no statistically significant differences between the drain group and the no drain group in (1) overall anastomotic leakage (relative risk (RR)?=?1.14, 95 % confidence interval (CI) 0.80–1.62, P?=?0.47), (2) clinical anastomotic leakage (RR?=?1.39, 95 % CI 0.80–2.39, P?=?0.24), (3) radiologic anastomotic leakage (RR?=?0.92, 95 % CI 0.56–1.51, P?=?0.74), (4) mortality (RR?=?0.94, 95 % CI 0.57–1.55, P?=?0.81), (5) wound infection (RR?=?1.19, 95 % CI 0.84–1.69, P?=?0.34), (6) re-operation (RR?=?1.18, 95 % CI 0.75–1.85, P?=?0.47), and (7) respiratory complications (RR?=?0.82, 95 % CI 0.55–1.23, P?=?0.34).Conclusions
Routine use of prophylactic drainage in colorectal anastomosis does not benefit in decreasing postoperative complications.19.
Själander A Friberg B Svensson P Stigendal L Lethagen S 《Journal of thrombosis and thrombolysis》2007,24(1):39-41
Background
Oral anticoagulation (OA) is a common treatment with a known risk of fatal or major bleeding, but also minor bleeding symptoms and menorrhagia can cause substantial discomfort and necessitate medical or surgical interventions. The extent of these side effects is however not previously reported. The objective of this study is to assess the frequency of minor bleeding symptoms and menorrhagia attributed to OA treatment.Methods
Ninety fertile women between 15 and 49 years-of-age on OA treatment completed an inquiry at the anticoagulation clinics of Malmö, Lund and Gothenburg, Sweden.Results
The frequency of minor bleeding symptoms was significantly increased during OA treatment (P < 0.05) except for hematuria. The incidence of bleeding after tooth extraction (>3 h) increased from 3.0 to 45.2%, easy bruising 17.8–75.6%, epistaxis 11.1–23.6%, gingival bleeding 22.2–48.3% and hematuria 10.0–15.6% (Table 1). Hematemesis was reported in 5.6% prior to as compared to 14.4% during OA treatment, blood in the feces in 8.9 and 18.9%, respectively. Mean duration of menses increased from 5.6 to 6.1 days (P < 0.01) and reported menorrhagia from 44.2 to 70.8% (P < 0.001). Eighteen percent were treated for menorrhagia before and 29.9% during OA treatment (P < 0.01).Conclusions
OA treatment is known to confer increased risk of fatal or major bleeding. This study shows that fertile women on OA also experience significantly increased minor bleeding symptoms including menorrhagia that may considerably impair quality of life.20.