Pharmacological interventions for improved colonic anastomotic healing: A meta-analysis

AIM: To identify pharmaceuticals for the prophylaxis of anastomotic leakage (AL), we systematically reviewed studies on anastomosis repair after colorectal surgery.METHODS: We searched PubMed and EMBASE for articles published between January 1975 and December 2012. We included studies in English with the primary purpose of promoting healing of anastomoses made in the colon or rectum under uncomplicated conditions. We excluded studies on adverse events from interventions, nutritional interventions or in situ physical supporting biomaterials. The primary outcome was biomechanical strength or AL. We performed meta-analyses on therapeutic agents investigated by three or more independent research groups using the same outcome. The DerSimonian-Laird method for random effects was applied with P < 0.05.RESULTS: Of the 56 different therapeutic agents assessed, 7 met our inclusion criteria for the meta-analysis. The prostacyclin analog iloprost increased the weighted mean of the early bursting pressure of colonic anastomoses in male rats by 60 mmHg (95%CI: 30-89) vs the controls, and the immunosuppressant tacrolimus increased this value by 29 mmHg (95%CI: 4-53) vs the controls. Erythropoietin showed an enhancement of bursting pressure by 45 mmHg (95%CI: 14-76). The anabolic compound growth hormone augmented the anastomotic strength by 21 mmHg (95%CI: 7-35), possibly via the up-regulation of insulin-like growth factor-1, as this growth factor increased the bursting pressure by 61 mmHg (95%CI: 43-79) via increased collagen deposition. Hyperbaric oxygen therapy increased the bursting pressure by 24 mmHg (95%CI: 13-34). Broad-spectrum matrix metalloproteinase inhibitors increased the bursting pressure by 48 mmHg (95%CI: 31-66) on postoperative days 3-4. In the only human study, the AL incidence was not significantly reduced in the 103 colorectal patients treated with aprotinin (11.7%) compared with the 113 placebo-treated patients (9.7%).CONCLUSION: This systematic review identified only one randomized clinical trial and seven therapeutic agents from pre-clinical models that could be explored further for the prophylaxis of AL after colorectal surgery.     

心房颤动患者射频消融术后运动耐力现状及影响因素分析

背景　运动耐力水平低下与心血管疾病所致死亡风险相关,对于心房颤动患者而言运动耐力可能是影响其生活质量和临床预后的重要因素。即使成功行射频消融术,患者运动耐力水平依然不容乐观,且针对其现状及影响因素的调查研究较少。目的　探讨心房颤动患者射频消融术后运动耐力现状及其影响因素。方法　采用便利抽样法,选取2018年5月-2019年6月在南京医科大学第一附属医院心内科就诊的189例完成射频消融术的心房颤动患者为研究对象,采用自制一般资料调查表收集患者的一般资料,运用心肺运动试验（CPET）评估患者运动耐力。运动耐力的影响因素采用多元线性回归分析。结果　心房颤动患者射频消融术后最大摄氧量（VO2max）平均为（19.7±6.1）ml?kg-1?min-1。Weber心功能分级A级85例（45.0%）、B级45例（23.8%）、C级52例（27.5%）、D级7例（3.7%）。不同性别、年龄、文化程度、吸烟、饮酒、运动习惯、术前美国纽约心脏病协会（NYHA）心功能分级、术前心房颤动症状（EHRA）分级、体质指数（BMI）心房颤动患者射频消融术后VO2max比较,差异均有统计学意义（P<0.05）。多元线性回归分析结果显示,运动习惯〔β=3.956,95%CI（2.746,5.269）〕、术前EHRA分级〔β=-4.651,95%CI（-5.318,-3.983）〕、BMI〔β=-0.224,95%CI（-0.383,-0.066）〕是心房颤动患者射频消融术后运动耐力的影响因素（P<0.05）。结论　心房颤动患者即使射频消融术成功,短期内仍存在不同程度的运动耐力下降,提示临床应结合患者运动习惯、术前EHRA分级及BMI等采取相应干预措施以促进其运动耐力提升,进一步改善生活质量。     

Material and Structural Performance Evaluations of Hwangtoh Admixtures and Recycled PET Fiber-Added Eco-Friendly Concrete for CO2 Emission Reduction

In order to reduce carbon dioxide (CO₂) emissions and produce an eco-friendly construction material, a type of concrete that uses a minimal amount of cement, yet still retains equivalent properties to ordinary cement concrete, has been developed and studied all over the world. Hwangtoh, a type of red clay broadly deposited around the world, has traditionally been considered an eco-friendly construction material, with bonus advantages of having health and cost benefits. Presently, Hwangtoh is not commonly used as a modern construction material due to properties such as low strength and high rates of shrinkage cracking. Recent studies, however, have shown that Hwangtoh can be used as a mineral admixture to improve the strength of concrete. In addition, polyethylene terephthalate (PET) fibers recycled from PET bottle waste can be used to control shrinkage cracks in Hwangtoh concrete. Therefore, in this study, performance verification is conducted on newly developed Hwangtoh concrete mixed with short recycled PET fibers. The results show that Hwangtoh concrete has compressive strength, elastic modulus, and pH properties that are similar to these features in ordinary cement concrete. The properties of carbonation depth and creep strain of Hwangtoh concrete, however, are larger and smaller, respectively, than in ordinary cement concrete. According to flexural tests, reinforced concrete (RC) specimens cast with Hwangtoh admixtures (with and without PET fibers) possess similar or better capacities than ordinary RC specimens. The addition of PET fibers significantly improves the structural ductility of RC specimens under normal environmental conditions. However, the implementations of the concrete in aggressive environment must be carefully considered, since a previous study result indicates degradation of its durability performance in aggressive environments, such as seawater [1]. The results of this study validate the possibility of using eco-friendly Hwangtoh concrete reinforced with recycled PET fibers as a structural material for modern construction.     

Home-based exercise: promising rehabilitation for symptom relief,improved functional status and quality of life for post-surgical lung cancer patients

Background

Post-thoracotomy non-small cell lung cancer (NSCLC) patients report cancer-related fatigue (CRF) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life (QOL). The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF, other symptoms, functional status, and QOL for post-surgical NSCLC patients starting within days after hospital discharge.

Methods

Seven post-thoracotomy NSCLC patients completed the Brief Fatigue Inventory (BFI) measuring CRF severity, and the M.D. Anderson Symptom Inventory measuring symptom severity at pre- and post-surgery, and at the end of each week of the six-week intervention. Additionally, the Medical Outcomes Short-Form-36 measuring physical and mental functional status; and the Quality of Life Index (QLI) measuring QOL were completed pre- and post-surgery, after week 3, and at the end of the intervention (week 6).

Results

Participants had a mean age of 65 years, a mean of 6 co-morbid conditions, and initiated the intervention within 4 days after hospital discharge. Participants’ CRF severity scores were reduced to mild levels while the mean number of symptoms decreased from 10.4 post-surgery to 7.0 at week 6 with lower levels of severity and interference. Likewise, participants’ post-intervention functional status and QOL improved to near or above pre-surgical levels.

Conclusions

The exercise intervention for post-surgical NSCLC patients showed promising preliminary efficacy in improving CRF, other symptom severity, functional status, and QOL. Further testing via a two-arm randomized controlled trial is being conducted.     

23例手部腱鞘巨细胞瘤患者术后功能恢复及复发随访结果分析

目的：探讨手部腱鞘巨细胞瘤（TGCT）的术前诊断、手术治疗、功能锻炼及复发因素,为手部TGCT的诊断和治疗提供理论依据。方法：回顾性分析23例手部TGCT患者的临床资料,比较患者术前彩超诊断与术后病理诊断情况,分析手部X线检查结果,随访患者并行浅表局部彩超检查,嘱患者填写《密歇根大学手概况问卷调查表》（MHQ）,同时采用E-link测量患者患侧与健侧握力3次,计算患侧手与健侧手的总主动活动度（TAM）,评价患者主观满意度和患手功能恢复情况。结果：23例手部TGCT患者,其中包括男性4例,女性19例,年龄18~68岁,平均年龄（48.5±15.1）岁。左手12例,右手11例;局部结节型TGCT（L-TGCT）21例,弥漫型TGCT（D-TGCT）2例。患者的术前彩超诊断结果与术后病理诊断结果均一致,术前X线检查无骨质损害。随访6~26个月,平均随访时间（16.0±6.5）个月,浅表局部彩超检查见肿物复发1例,复发率4.3%。2例D-TGCT患者患侧握力和TAM值较健侧明显降低,21例L-TGCT患者患侧握力和TAM值与健侧比较无明显差异。MHQ得分,80分以下3例,80分以上20例。结论：彻底切除TGCT可降低复发率,术后积极功能锻炼可取得良好的康复效果。     

持续被动运动机辅助功能锻炼在胫骨平台骨折术后的应用

目的 探讨持续被动运动（CPM）机辅助功能锻炼在胫骨平台骨折术后的应用。方法 选择2017年1月～2019年1月在我院创伤骨科收住的胫骨平台骨折患者92例,采用抛银币法分为CPM组与对照组,每组各46例。两组患者均行胫骨平台骨折切开复位内固定术。对照组术后患肢主动运动训练,CPM组术后第2天开始进行CPM机辅助功能锻炼,两组患者均治疗6个月。观察两组患者治疗后膝关节及胫骨平台后倾角（PA）恢复情况。结果 治疗6个月后,两组患者ROM、膝关节Harris评分和BI评分均较治疗前明显上升（P＜0.05或P＜0.01）,且CPM组上升幅度较对照组更高,差异有统计学意义（P＜0.05）;两组患者PA较治疗前明显上升（P＜0.05或P＜0.01）,且CPM组上升幅度较对照组更更高,差异有统计学意义（P＜0.05）。结论 CPM机辅助功能锻炼用于胫骨平台骨折术后的疗效确切,能增加患者关节活动度,能有效矫正PA,改善膝关节功能,从而提高患者独立活动能力。     

体育运动对孤独症谱系障碍的干预

孤独症谱系障碍是以社会交往障碍、兴趣狭隘和重复刻板行为为特征的神经发育疾病。目前,其发病机制还没有被完全认知,临床上采用多种方法进行治疗与干预,其中体育运动干预也有明显的效果。针对体育运动对孤独症谱系障碍症状的改善做一综述,为后续研究提供理论支持。