BACKGROUND:Nickel-titanium memory-shape compression anastomosis clip (Ni-Ti CAC) has been used in gastrointestinal anastomosis, but its efficacy and safety still remain controversial.OBJECTIVE:To evaluate the efficacy and safety of Ni-Ti CAC in gastrointestinal anastomosis.METHODS:A computer-based online research of PubMed, EMbase, Cochrane Library, CBM, CNKI, and VIP databases was performed for articles published before January 15th, 2017 using the keywords of nickel-titanium, compression anastomosis clip, anastomosis, gastric, jejunum, ileum, small intestine, colon, rectum, and large intestine in English and Chinese, respectively. The randomized controled trials about Ni-Ti CACversus conventional methods for gastrointestinal anastomosis were included. Meta-analysis of the anastomosis time, time of exsufflation, and hospitalization time was performed, and sequential analysis was conducted on TSA v0.9 software.RESULTS AND CONCLUSION:A total of 18 eligible randomized controlled trials were enroled, involving 1860 patients. Ni-Ti CAC could reduce the anastomosis time [MD=-3.83, 95%CI(-6.48,-1.19),P=0.004] and time of exsufflation [MD=-0.14, 95%CI(-0.22,-0.05),P=0.002], but there was no significant difference in the hospitalization time [MD=-0.83, 95%CI(-1.82, 0.16), P=0.10]. The quality was ranked as low level based on GRADE system. The time of exsufflation of Ni-Ti CAC was superior to that of conventional method, which was confirmed by sequential analysis. One case of death was reported and incision infection was the most common adverse effects; additionaly, pulmonary embolism and abdominal pain occurred. To conclude, Ni-Ti CAC can facilitate gastrointestinal anastomosis, accelerate the time of exsufflation, and holds a good safety. However, more multicenter and high-quality randomized controlled trials are needed.

OBJECTIVE:To evaluate the clinical efficacy and safety of Shenqi fuzheng injection combined with chemotherapy in the treatment of colorectal cancer.METHODS:Retrieved from PubMed,EMBase,Clinical Trials,Cochrane Library,CJFD,CBM,Wanfang database and VIP,RCTs about Shenqi fuzheng injection combined with chemotherapy (trial group) vs.chemotherapy alone (control group) in the treatment of colorectal cancer were included.Meta-analysis was performed by Rev Man 5.3 statistical software after data extraction and quality evaluation with Cochrane system evaluator manual.RESULTS:A total of 25 RCTs were included,involving 1 987 patients.Results of Meta-analysis showed that objective remission rate of trial group was significantly higher than control group [RR=1.19,95％ CI (1.02,1.39),P=0.02];the improvement of survival quality was significantly better than control group [RR=1.72,95％CI(1.49,1.99),P＜0.001];CD4VCD8+ was significantly higher than control group [MD=0.40,95％ CI (0.29,0.50),P＜0.001];the incidence of gastrointestinal reaction was significantly higher than control group [RR=0.59,95％CI(0.52,0.68),P＜0.001];the incidence of liver and renal injury was significantly lower than control group [RR=0.52,95％CI(0.41,0.67),P＜0.001],with statistical significance.CONCLUSIONS:Shenqi fuzheng injection combined with chemotherapy can improve objective remission rate of colorectal cancer patients,survival quality and immune function,and reduce the occurrence of toxic reation.

OBJECTIVE:To systematically evaluate therapeutic efficacy and safety of Toutongning combined with flunarizine vs. flunarizine in the treatment of migraine,and to provide evidence-based reference in clinic. METHODS:Retrieved from PubMed,Cochrane library,Embase,Chinese Journal Full-text Database,Chinese Sci-tech Periodicals Database,Wanfang database and CBM,randomized controlled trials(RCTs)about therapeutic efficacy(total response rate,VAS score,blood potassium and blood magnesium concentration,CGRP level)and safety(the incidence of ADR)of Toutongning combined with flunarizine(trial group)vs. flunarizine in the treatment of migraine(control group)were collected. Meta-analysis of included trials meet inclusion criteria was conducted by using Stata 14.0 software,and trial sequential analysis(TSA)was conducted by using TSA 0.9 software after data extraction and quality evaluation with Cochrane 5.1.0 bias risk evaluation tool and Jadad scale. RESULTS:Totally 16 RCTs were included,involving 1 726 patients. Results of Meta-analysis showed that total response rate [RR=1.21,95%CI(1.16, 1.26),P<0.05],the decrease of VAS score [WMD=-1.04,95%CI(-1.42,-0.66),P<0.001],the decrease of blood potassium [WMD=-2.05,95%CI(-0.32,-0.18),P<0.001],the increase of blood magnesium [WMD=0.09,95%CI(0.04,0.14),P<0.001] and the decrease of CGRP [WMD=-2.22,95%CI(-3.25,-1.18),P<0.001] in trial group were better than control group,with statistical significance. The incidence of ADR in trial group was 2.27% in trial group and 2.89% in control group, without statistical significance(P>0.05). TSA showed that there were extract evidences for total response rate of Toutongning combined with flunarizine in the treatment migraine. CONCLUSIONS:Therapeutic efficacy of Toutongning combined with flunarizine is better than flunarizine in the treatment of migraine,and the ADR is not increased.

Objective:To analyze the law of distant metastasis in patients with small lung adenocarcinoma with different CT findings, and to explore the feasibility of different preoperative examination methods for small lung adenocarcinoma with different imaging characteristics.Methods:Clinicopathological data of cT1a-cN0 lung adenocarcinoma patients admitted to the respiratory center of China-Japan Hospital from January 2017 to December 2018 were retrospectively collected. A total number of 785 patients were included, including 289 males and 496 females. SPSS 22.0 was used for statistical analysis.Results:A total number of 785 patients were included in this study, including 287 pure ground-glass nodule (GGN) patients, 111 GGN predominant patients, 221 solid predominant patients and 166 solid nodule patients. Among the included patients, 8 had distant metastasis, including 6 with bone metastasis, 1 with brain metastasis and 1 with brain and adrenal metastasis. No distant metastasis was observed in the patients with pure GGN and GGN predominant nodule, while 1 solid predominant patients had distant metastasis, and 7 patients with solid nodules had distant metastasis. The probability of distant metastasis was 0.5% for the solid predominant patients and 4.2% for the solid nodule patients. Univariate analysis results showed that CEA level ( P=0.030), the largest diameter of the lung window tumor ( P=0.003), the largest diameter of the solid component of the lung window tumor ( P<0.001), the largest area of the lung window tumor ( P=0.002), mediastinal window tumor maximum area ( P<0.001), CTR ( P<0.001), TDR ( P<0.001), and pleural indentation sign ( P=0.037) were risk factors for distant metastases. Multivariate analysis showed that CEA ( OR=1.019, 95% CI: 1.002-1.037, P=0.028) and TDR ( OR=0.000, 95% CI: 0.000-0.310, P=0.001) were independent risk factors of distant metastasis. Conclusion:For patients with pure GGN and GGN predominant nodule, preoperative examination could not be required, but for pure solid nodules, it is necessary to perform relevant preoperative examination including skull MRI before surgery to exclude distant metastasis.

Objective To evaluate and compare the efficacy and safety of sedative and analgesic anesthesia in surgical patients with supine and prone position .Methods Sixty female patients, American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged from 18 -53 years, scheduled for elective plastic operations under sedative and analgesic anesthesia combined with local anesthesia were divided into two groups according to their surgical positions: supine group ( n=30 ) and prone group ( n=30 ) .All patients received Ⅳ dexmedetomidine ( DEX) 1 μg/kg over 15 min followed by 0.4 -0.7 μg/kg/h infusion. Both groups were administered Ⅳ midazolam 0.04 mg/kg and a continuous infusion of remifentanil of 0.1 μg/kg/min at the beginning of anesthesia .Heart rate ( HR) , mean arterial pressure (MAP), pulse oximetry (SpO2), respiratory rate (RR), bispectral index (BIS) and Ramsay sedation scores ( RSS) were recorded at the following time points: before anesthesia ( T0 ) , 5 min after induction with midazolam ( T1 ) , 10 min after induction of midazolam ( T2 ) , immediately after induction with DEX( T3 ) , the beginning of local anesthesia ( T4 ) , the beginning of surgery ( T5 ) , 30 min after anesthesia induction ( T6 ) , 60 min after anesthesia induction ( T7 ) , immediately after turning off DEX infusion (T8), the end of surgery (T9).Incidences of respiratory depression, incidences of apnea, oxygen supplementation by facial mask and jaw-thrust, frequencies of body movements and additional rescue medication were also recorded .After surgery , recall of events during surgery , the visual analogue scales (VAS) for pain in PACU, the satisfaction levels of patients and surgeons were also assessed .Results No significant differences were found in MAP , SpO2 , RR, BIS, RSS scores at any time point between two groups (all P >0.05).There were no significant differences in incidences of respiratory depression , frequencies of body movements and additional rescue medication during surgery between groups ( all P>0. 05).Neither were recall of events during surgery , the visual analogue scales (VAS) for pain and the satisfaction levels of patients and surgeons after surgery (all P>0.05).The HR at time points of T0, T1, T2 in prone group were significantly higher than those in supine group (all P<0.05).Compared with the supine group , the incidences of apnea , oxygen supplementation by facial mask and jaw-thrust in prone group were significantly lower .Conclusions Sedative and analgesic anesthesia is effective and safe for patients with prone surgical position and has a lower incidence of upper airway obstruction during surgery than patients in supine surgical position .

Objective To evaluate and compare the efficacy and safety of sedative and analgesic anesthesia in surgical patients with supine and prone position .Methods Sixty female patients, American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged from 18 -53 years, scheduled for elective plastic operations under sedative and analgesic anesthesia combined with local anesthesia were divided into two groups according to their surgical positions: supine group ( n=30 ) and prone group ( n=30 ) .All patients received Ⅳ dexmedetomidine ( DEX) 1 μg/kg over 15 min followed by 0.4 -0.7 μg/kg/h infusion. Both groups were administered Ⅳ midazolam 0.04 mg/kg and a continuous infusion of remifentanil of 0.1 μg/kg/min at the beginning of anesthesia .Heart rate ( HR) , mean arterial pressure (MAP), pulse oximetry (SpO2), respiratory rate (RR), bispectral index (BIS) and Ramsay sedation scores ( RSS) were recorded at the following time points: before anesthesia ( T0 ) , 5 min after induction with midazolam ( T1 ) , 10 min after induction of midazolam ( T2 ) , immediately after induction with DEX( T3 ) , the beginning of local anesthesia ( T4 ) , the beginning of surgery ( T5 ) , 30 min after anesthesia induction ( T6 ) , 60 min after anesthesia induction ( T7 ) , immediately after turning off DEX infusion (T8), the end of surgery (T9).Incidences of respiratory depression, incidences of apnea, oxygen supplementation by facial mask and jaw-thrust, frequencies of body movements and additional rescue medication were also recorded .After surgery , recall of events during surgery , the visual analogue scales (VAS) for pain in PACU, the satisfaction levels of patients and surgeons were also assessed .Results No significant differences were found in MAP , SpO2 , RR, BIS, RSS scores at any time point between two groups (all P >0.05).There were no significant differences in incidences of respiratory depression , frequencies of body movements and additional rescue medication during surgery between groups ( all P>0. 05).Neither were recall of events during surgery , the visual analogue scales (VAS) for pain and the satisfaction levels of patients and surgeons after surgery (all P>0.05).The HR at time points of T0, T1, T2 in prone group were significantly higher than those in supine group (all P<0.05).Compared with the supine group , the incidences of apnea , oxygen supplementation by facial mask and jaw-thrust in prone group were significantly lower .Conclusions Sedative and analgesic anesthesia is effective and safe for patients with prone surgical position and has a lower incidence of upper airway obstruction during surgery than patients in supine surgical position .

Objective:To analyze the clinical characteristics of patients with Vibrio vulnificus infection, share diagnosis and treatment experience, and establish a rapid diagnosis procedure for this disease. Methods:This study was a retrospective case series study. From January 2009 to November 2022, 11 patients with Vibrio vulnificus infection who met the inclusion criteria were admitted to the Department of Burns and Wound Repair of Guangdong Provincial People's Hospital Affiliated to Southern Medical University. The gender, age, time of onset of illness, time of admission, time of diagnosis, route of infection, underlying diseases, affected limbs, clinical manifestations and signs on admission, white blood cell count, hemoglobin, platelet count, C-reactive protein (CRP), alanine transaminase (ALT), aspartate transaminase (AST), creatinine, procalcitonin, albumin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and blood sodium levels on admission, culture results and metagenomic next-generation sequencing (mNGS) results of pathogenic bacteria and the Vibrio vulnificus drug susceptibility test results during hospitalization, treatment methods, length of hospital stay, and outcomes of all patients were recorded. Comparative analysis was conducted on the admission time and diagnosis time of patients with and without a history of exposure to seawater/marine products, as well as the fatality ratio and amputation of limbs/digits ratio of patients with and without early adequate antibiotic treatment. For the survived patients with hand involvement, the hand function was assessed using Brunnstrom staging at the last follow-up. Based on patients' clinical characteristics and treatment conditions, a rapid diagnosis procedure for Vibrio vulnificus infection was established. Results:There were 7 males and 4 females among the patients, aged (56±17) years. Most of the patients developed symptoms in summer and autumn. The admission time was 3.00 (1.00, 4.00) d after the onset of illness, and the diagnosis time was 4.00 (2.00, 8.00) d after the onset of illness. There were 7 and 4 patients with and without a history of contact with seawater/marine products, respectively, and the admission time of these two types of patients was similar ( P>0.05). The diagnosis time of patients with a history of contact with seawater/marine products was 2.00 (2.00, 5.00) d after the onset of illness, which was significantly shorter than 9.00 (4.25, 13.00) d after the onset of illness for patients without a history of contact with seawater/marine products ( Z=-2.01, P<0.05). Totally 10 patients had underlying diseases. The affected limbs were right-hand in 8 cases, left-hand in 1 case, and lower limb in 2 cases. On admission, a total of 9 patients had fever; 11 patients had pain at the infected site, and redness and swelling of the affected limb, and 9 patients each had ecchymosis/necrosis and blisters/blood blisters; 6 patients suffered from shock, and 2 patients developed multiple organ dysfunction syndrome. On admission, there were 8 patients with abnormal white blood cell count, hemoglobin, and albumin levels, 10 patients with abnormal CRP, procalcitonin, and NT-proBNP levels, 5 patients with abnormal creatinine and blood sodium levels, and fewer patients with abnormal platelet count, ALT, and AST levels. During hospitalization, 4 of the 11 wound tissue/exudation samples had positive pathogenic bacterial culture results, and the result reporting time was 5.00 (5.00, 5.00) d; 4 of the 9 blood specimens had positive pathogenic bacterial culture results, and the result reporting time was 3.50 (1.25, 5.00) d; the mNGS results of 7 wound tissue/exudation or blood samples were all positive, and the result reporting time was 1.00 (1.00, 2.00) d. The three strains of Vibrio vulnificus detected were sensitive to 10 commonly used clinical antibiotics, including ciprofloxacin, levofloxacin, and amikacin, etc. A total of 10 patients received surgical treatment, 4 of whom had amputation of limbs/digits; all patients received anti-infection treatment. The length of hospital stay of 11 patients was (26±11) d, of whom 9 patients were cured and 2 patients died. Compared with that of the 6 patients who did not receive early adequate antibiotic treatment, the 5 patients who received early adequate antibiotic treatment had no significant changes in the fatality ratio or amputation of limbs/digits ratio ( P>0.05). In 3 months to 2 years after surgery, the hand function of 8 patients was assessed, with results showing 4 cases of disabled hands, 2 cases of incompletely disabled hands, and 2 cases of recovered hands. When a patient had clinical symptoms of limb redness and swelling and a history of contact with seawater/marine products or a pre-examination triage RiCH score of Vibrio vulnificus sepsis ≥1, the etiological testing should be initiated immediately to quickly diagnose Vibrio vulnificus infection. Conclusions:Vibrio vulnificus infection occurs most frequently in summer and autumn, with clinical manifestations and laboratory test results showing obvious infection characteristics, and may be accompanied by damage to multiple organ functions. Both the fatality and disability ratios are high and have a great impact on the function of the affected limbs. Early diagnosis is difficult and treatment is easily delayed, but mNGS could facilitate rapid detection. For patients with red and swollen limbs accompanied by a history of contact with seawater/marine products or with a pre-examination triage RiCH score of Vibrio vulnificus sepsis ≥1, the etiological testing should be initiated immediately to quickly diagnose Vibrio vulnificus infection.

Objective:To evaluate the effect of interstitial lung disease(ILD) on postoperative morbidity and mortality in pulmonary resection for lung cancer patients.Methods:We retrospectively analyzed 971 patients undergoing pulmonary operation from January 2010 to January 2018 in our hospital. Clinical data including age, sex, history of chronic obstructive pulmonary disease(COPD), smoking history, smoking index, American Society of Anesthesiologists(ASA) classification, forced expiratory volume in 1 s(FEV1) % predict, surgical procedure, video assisted thoracoscopic surgery(VATS) or not, intraoperative blood transfusion, anesthesia time, operation time/one-lung ventilation time, blood loss, histology, postoperative morbidity, 60-days mortality, onset of acute exacerbation of interstitial lung disease(AE-ILD), drainage, extubation time, and postoperative stay were collected and analyzed.Results:There were 80(8.2%) and 891(91.8%) patients in ILD and non-ILD group, respectively. AE-ILD occurred in 5 patients, with a 60-day mortality of 80%. A multivariate regression analysis identified that the sex( P=0.023), ILD( P=0.001), COPD( P=0.027) were independent risk factors for postoperative morbidity. ILD( P=0.023) and postoperative morbidity( P=0.001) were independent risk factors for 60-day mortality in multivariate analysis. Conclusion:Patients with ILD had a higher incidence of postoperative morbidity and 60-day mortality. Based on the obvious postoperative morbidity and mortality, special attention and management should be taken in ILD patients.

BACKGROUND: Cisplatin acquired resistance is a vital problem in the chemotherapy of non-small cell lung cancer, which needs to be further addressed. In recent years, obtaining drug resistant cells from cell cultivation and serving for metabolomics research to find differential metabolites and get potential biomarkers, is a good reference for clinical research and cancer treatment. This study aimed to obtain metabolite information related to cisplatin resistance through metabolomics analysis. METHODS: Metabolites were extracted from A549 cells and cisplatin resistant A549/DDP cells, and ultraperformance liquid chromatography coupled with time of flight mass spectrometry was used to perform metabolomic analysis of endogenous molecules of the two cells and obtain metabolic differences. RESULTS: Through data analysis, 40 metabolites were identified as differential metabolites, mainly involving phospholipids, fatty acids, amino acids and metabolites related to energy metabolism. CONCLUSIONS The drug resistance of A549/DDP cells may be caused by the changes of cell membrane structure and related metabolic pathways.
A549 Cells ; Carcinoma, Non-Small-Cell Lung ; pathology ; Chromatography, High Pressure Liquid ; Drug Resistance, Neoplasm ; Humans ; Lung Neoplasms ; pathology ; Mass Spectrometry ; Metabolomics ; methods

OBJECTIVE： To systematically evaluate the efficacy and safety of Endostar combined with gemcitabine and cisplatin in the treatment of non-small cell lung cancer （NSCLC）， and to provide evidence-based reference for clinical drug use. METHODS： Retrieved from Cochrane Library， PubMed， Embase， ClinicalTrials， CNKI， Wanfang and VIP database， randomized controlled trials （RCT） about Endostar combined with gemcitabine and cisplatin（trial  group） vs. gemcitabine combined with cisplatin （control group） for NSCLC were collected. After literature screening， data extraction and quality evaluation with Cochrane 5.1.0 bias risk evaluation tool and Jadad scale， Meta-analysis was performed by using Rev Man 5.3 software. RESULTS： A total of 27 RCTs were included， involving 1 646 patients. Results of Meta-analysis showed that response rate [RR＝1.67， 95％CI（1.48，1.89），P＜0.000 01] and clinical benefit rate [RR＝1.26， 95％CI （1.20， 1.33），P＜0.000 01] of trial group were significantly higher than those of control group. There was no statistical significance in the incidence of leucopenia [RR＝0.98，95％CI（0.88， 1.11），P＝0.79]， thrombocytopenia [RR＝1.07， 95％CI（0.91， 1.26），P＝0.39] and gastrointestinal reaction [RR＝1.01， 95％CI（0.90， 1.14），P＝0.85] between 2 groups. CONCLUSIONS： Endostar combined with gemcitabine and cisplatin can improve therapeutic efficacy of NSCLC patients， without increasing the incidence of ADR.