Vitamin A is a fat-soluble vitamin, and it is not only necessary for the normal growth and development of epithelial cells, but also plays a very important role in the normal growth and development of the retina, lungs, gastrointestinal tract, brain, and immune system. Studies have confirmed that the low level of vitamin A in premature infants at birth can last through the entire infancy. Recently, there have been particular concerns about the level of vitamin A and development of diseases in premature infants, with major focuses on the related mechanisms of action of vitamin A in respiratory distress syndrome, chronic lung disease, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, and infections in premature infants, which still awaits further investigation.This paper summarizes and analyzes the current status of research on vitamin A level and diseases of premature infants at home and abroad. In addition, although enough evidence suggests that vitamin A supplementation is beneficial to preterm infants, evidence is still lacking for recommended methods for supplementation and dose of vitamin A, and further studies are needed.
Animals ; Humans ; Infant, Premature ; blood ; Infant, Premature, Diseases ; blood ; Vitamin A ; blood

OBJECTIVETo analyze the factors associated with anastomotic leakage after anterior resection in rectal cancer with the technique of total mesorectal excision (TME).

METHODSFrom January 2005 and December 2007, 738 consecutive patients with rectal cancer underwent anterior resection. The data of those patients was collected and reviewed retrospectively. The associations between anastomotic leakage and 9 patient-related variables as well as 7 surgical-related variables were examined.

RESULTSLow rectal cancer (located 7 cm or less above the anal edge), non-specialized surgeon and transanal tube use were the risk factors associated with anastomotic leakage on univariate analysis. The anastomotic leakage rate of low-rectal cancer was significantly higher than that of high-rectal cancer (5.9% vs. 0.9%, P = 0.003). The anastomotic leakage rate of the cases operated by colorectal surgeon was significantly lower than that of the cases operated by non-specialized surgeon (3.9% vs. 11.3%, P = 0.031). There was a tendency for colorectal surgeons to operate on a greater proportion of low rectal cancer than non-specialized surgeons (72.1% vs. 52.8%, P = 0.003). The leakage rate of transanal tube group was unexpectedly higher than that in patients without transanal tube (14.5% vs. 3.6%, P < 0.001). On multivariate logistic regression analysis, diabetes mellitus (P = 0.027), distance less than 1 cm from tumor to distal resection margin (P = 0.009) and defunctioning stoma (P = 0.031) were also associated with anastomotic leakage rate besides low rectal cancer, non-specialized surgeon and transanal tube use. In a further analysis of 522 patients with low rectal cancer, the leakage rate of defunctioning stoma group was significantly lower than that of non-stoma group (2.9% vs. 8.5%, P = 0.007). By contract, the leakage rate of transanal tube group was still higher than that in patients without transanal tube (15.1% vs. 4.9%, P = 0.008) because of its poor protective effect as well as the selection bias.

CONCLUSIONSLow-rectal cancer, non-specialized surgeons and diabetes mellitus are risk factors of anastomotic leakage after rectal surgery. A defunctioning stoma was effective in preventing leakage after low-rectal cancer surgery.

Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; adverse effects ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; Rectal Fistula ; etiology ; Rectal Neoplasms ; surgery ; Rectum ; surgery ; Retrospective Studies ; Risk Factors ; Surgical Stomas

OBJECTIVETo analyze the impact of meticulousness of pathologists on the lymph node harvest after radical resection of invasive rectal carcinoma.

METHODSFrom January 2008 to May 2009, the clinical data of rectal cancer patients undergone operation were reviewed retrospectively. After multidisciplinary cooperation on rectal cancer, a new rule was applied to request the pathologists to find no less than 15 nodes in single colorectal specimen from January 2009. Patients were divided into two groups (2008 group and 2009 group) and the node harvest numbers were compared. Excluded criteria were recurrent colorectal tumor, Tis tumor, R(1) or R(2) resection, tumor resection transanally or endoscopically, the cases enrolled in other prospective research, synchronous diseases affecting the surgical procedure for the rectal cancer (familial adenomatous polyposis, synchronous colorectal carcinoma) and rectal cancer receiving neoadjuvant chemoradiation. Statistical analysis was performed using One-Sample Kolmogorov- Smirnov test, Mann-Whitney test, Independent-Samples T test and Chi-Square test(SPSS 15.0).

RESULTSA total of 232 patients were identified, including 76 cases in the 2009 group and 156 cases in 2008 group. The lymph node retrieval in the 2009 group was significantly more than that in 2008 group (16.0+/-0.3 vs 11.4+/-0.3, P<0.01). A significantly higher percentage of patients was found in 2009 group with a lymph node harvest equal to or more than 12 nodes (72/76 vs 71/156, P<0.01). There were no significant differences in gender (46/76 vs 86/156, P=0.436), age (58.1+/-1.3 vs 59.2+/-1.1, P=0.527), distance from tumor to anal verge (7.4+/-0.4 vs 7.1+/-0.3, P=0.761), proportion of sphincter-sparing surgery (67/76 vs 140/156, P=0.715), ratio of well and moderate differentiated tumors (68/76 vs 125/156, P=0.074) and overall TNM stage (P=0.167) between the two groups.

CONCLUSIONSThe lymph node harvest in 2009 group is significantly more than that in 2008 group. The good performance of pathologists could produce adequate number of lymph nodes for rectal cancer without neoadjuvant chemoradiation.

Biopsy ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Period ; Rectal Neoplasms ; pathology ; surgery ; Rectum ; pathology ; Retrospective Studies

OBJECTIVETo evaluate the accuracy and value of the placement of metallic clips during colonoscopy in the localization of colorectal cancer and incision selection.

METHODSA total of 30 patients received metallic clip placement by colonoscopy before operation. Abdominal plain film (supine and upright position) was taken and incision was determined by the projection of clips on the abdominal wall.

RESULTSThe inaccuracy rate of localization by colonoscopy was 30%(9/30). Colonoscopy combined with the placement of metallic clips achieved an accurate incision rate of 100% (30/30).

CONCLUSIONSThere is a considerable rate of inaccuracy for localization in colonic cancer by colonoscopy. Colonoscopy combined with placement of metallic clips should be considered in order to select a reasonable incision.

Adult ; Aged ; Aged, 80 and over ; Colon ; surgery ; Colonic Neoplasms ; surgery ; Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Surgical Instruments

OBJECTIVETo evaluate the safety and efficacy of surgical treatment for recurrent colorectal carcinoma in the elderly.

METHODSThe clinical and follow up data of 24 elderly patients with recurrent colorectal carcinoma who were treated between January 2000 and June 2009 at the Changhai hospital of the Second Military Medical University were analyzed retrospectively.

RESULTSAmong the 24 patients there were 14 men and 10 women. The mean age of the patients was 76.9 ± 5.3 years. The local recurrence was found in 15 patients. In 9 patients, both distant metastases and local recurrence were found. A total of 24 patients received operation, including radical resection in 15 patients and palliative resection in 8 patients. One patient had laparotomy only because of diffuse metastases in the abdomen and involvement of the duodenum and common bile duct.The patient received stent placement in the common bile duct and chemotherapy after the surgery. Postoperative complication occurred in 7(29.2%) patients, which included ileus(n=1), pulmonary infection(n=1), urinary infection(n=1), wound infection(n=2), wound dehiscence(n=1), and wound fat liquefaction(n=1). There were no perioperative deaths. The median survival time was 6 months in the entire cohort. The median survival time was 33 months in patients undergoing radical resection, and the 1-, 3-, and 5-year survival rate was 71.4%, 28.6%, and 14.3%. The median survival time was 3 months in patients who underwent palliative resection, and the 1-year survival rate was 0. The difference between the two groups was statistically significant(P<0.01).

CONCLUSIONOutcomes are acceptable after radical resection for elderly patients with recurrent colorectal cancer if careful preoperative evaluation and perioperative management are performed.

Aged ; Aged, 80 and over ; Colorectal Neoplasms ; pathology ; surgery ; Female ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Prognosis ; Retrospective Studies ; Survival Rate

OBJECTIVETo investigate the emergency therapeutic strategy for sigmoid vovulus in the elderly.

METHODSClinical data of 14 elderly patients with sigmoid vovulus were analyzed retrospectively.

RESULTSThe mean age was(79.1±7.2) years(range, 70-93), and 11 patients (78.6%) were male. Emergency decompression and restoration with colonoscopy was performed in all the patients with a success rate of 100%. No patient required emergent surgery. Four patients(28.6%) recurred and they were managed well by repeat colonoscopic restoration.

CONCLUSIONEmergency colonoscopic restoration is the first treatment of choice for sigmoid vovulus in the elderly because it is safe and effective, and can be performed repeatedly.

Aged ; Aged, 80 and over ; Colon, Sigmoid ; surgery ; Colonoscopy ; Decompression, Surgical ; Emergencies ; Female ; Humans ; Intestinal Volvulus ; surgery ; Male ; Recurrence ; Retrospective Studies

OBJECTIVETo evaluate the efficacy and safety of colonoscopy-guided placement of self-expandable metallic stent without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction.

METHODSClinical data of 42 patients (24 males and 18 females with a mean age of 64.3 years) undergoing colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between January 2010 and June 2012 were reviewed retrospectively.

RESULTSThe obstruction was located in the rectum (n=19), sigmoid (n=9), descending colon (n=8), splenic flexure (n=1), hepatic flexure (n=3), and ascending colon (n=2). Technical success was achieved in all the 42 patients (100%). The mean time of operation was (11.8±10.4) min (range 1.1-51.0 min). No serious procedure-related complication occurred. Minor bleeding occurred in 3 cases (7.1%). One patient died on the second day after surgery because of heart failure.

CONCLUSIONSColonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe with shorter operative time.

Adult ; Aged ; Aged, 80 and over ; Colonoscopy ; Colorectal Neoplasms ; complications ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Stents

OBJECTIVETo investigate the diagnosis and surgical management of adult Hirschsprung's disease.

METHODSClinical data of 15 patients with adult Hirschsprung's disease were reviewed retrospectively from June 1992 to June 2004.

RESULTSPatients age ranged from 17 to 54 years old. The main manifestations included long-term (ranged from 9.5 month to 50 years) constipation and abdominal distention. Acute abdominal pain occurred in six patients, but no sign of de hydration and malnutrition occurred in all patients. Bowel stenosis and dilation could be examined by barium enema. Soave procedure was performed in 3 patients, subtotal colectomy with coloanal anastomosis was performed in twelve patients. The function of defecation was improved in all patients after operation.

CONCLUSIONSThe diagnosis of adult Hirschsprung's disease mainly depends on the history of constipation from infant and barium enema. Subtotal colectomy with coloanal anastomosis is an effective and safe operative procedure.

Adolescent ; Adult ; Female ; Hirschsprung Disease ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo apply and evaluate new methods regarding specific gene and antigen detection in plague surveillance program.

METHODS1798 samples from natural foci of plague were tested, using internal quality control multiple-polymerase chain reaction, F1 antigen marked by immuno chromatographic assay and enzyme linked immunosorbent assay. Culture of Yersinia pestis and reverse indirect hemagglutination assay were used as reference diagnostic methods.

RESULTSThe overall positive rate of culture on Yersinia pestis together with gene and antigen detection was 7.34%, showing an 16.81% increase when comparing to 6.28% using Yersinia pestis culture method alone. The rate of coincidence was 97.13%.

CONCLUSIONThe new standard being used for specific gene and antigen detection could increase the positive rate of diagnosis on plague.

Animals ; Bacterial Proteins ; genetics ; immunology ; Enzyme-Linked Immunosorbent Assay ; Mice ; Plague ; microbiology ; Polymerase Chain Reaction ; Yersinia pestis ; genetics ; immunology ; pathogenicity

Objective: To understand the research progresses of economic evaluation of COVID-19 vaccination strategies both at home and abroad, and provide reference for the economic evaluation of COVID-19 vaccination strategies using real word data in China. Methods: Literature retrieval was conducted for related papers published from January, 2020 to December, 2021 in Chinese and English databases, including the economic evaluation of COVID-19 vaccination, and the results of the related literatures were narratively integrated. Results: A total of 16 English literatures (including 3 reviews) were included, and it was found that the COVID-19 vaccination was cost-effective or cost-saving regardless of the vaccine types, while the cost-effectiveness in different population and under different vaccination dose strategies varied due to vaccine efficacy, vaccine price, duration of natural immunity, duration of vaccination campaign, vaccine supply, and vaccination pace. Conclusions: China lacks suitable evidences of economic evaluation of COVID-19 vaccination strategies based on real-world data in the context of long-term epidemic. Therefore, further researches of suitable strategies of booster COVID-19 vaccination are needed.
COVID-19/prevention & control* ; COVID-19 Vaccines ; China/epidemiology* ; Cost-Benefit Analysis ; Humans ; Vaccination