Objective To compare the long-term outcome between breast-conserving therapy with mastectomy therapy for early stage invasive breast cancer through a Meta analysis of the randomized controlled trials published worldwide. Methods Cochrane systematic evaluation was used to search through Cochrane libraries of clinical comparative trials, PubMed, Embase, Cancer Lit, and so on. The quality of literatures was independently evaluated and cross-checked by two evaluators, indicators for assessment including death number at the end of follow-up, locoregional and total recurrence. The results were analyzed with RevMan 4.2.2 software. Results Six articles were involved in the Meta analysis with total 3 933 patients. No statistical difference was found in the death at the end of follow-up between breast-conserving therapy group and mastectomy therapy group (OR=1.05, 95% CI=0.93—1.19， P=0.45). Locoregional and total recurrence rate of breast-conserving therapy group were statistical higher than those in mastectomy therapy group (OR=1.64, 95% CI: 1.10—2.44， P=0.01； OR=1.42, 95% CI: 1.22—1.64， Plt;0.01). Conclusions Breast-conserving therapy and mastectomy therapy have comparable effects on mortality in patient with early stage invasive breast cancer, even after long-term follow up. However, breast-conserving therapy is associated with significantly greater risk of locoregional recurrence.
Objectives To analyze and assess the status of detection of human immune-deficiency virus (HIV) by PCR, and to find a new screening test of HIV. Methods Using the following keywords "diagnosis tests", "AIDS", "PCR" and "HIV", we searched the Medline and CBM from 1991 to 2001. Then we assess each of diagnosis test according to the international standards. Results 567 articles were searched, in which 53 articles were chosen to assess. In these 53 articles, it was found that 47% applied comparison with Golden Standard, 25% calculated sensitivity, 23% calculated specificity, and 23% calculated predictive value, no likelihood ratio was calculated in these articles. Conclusions It was still a kind of pilot-study to apply PCR to screening detection of HIV. The design methods of study should be improved.
Objective To analyze the citation classics articles， and approach the research development history and the research direction in the future about surgical treatment for type 2 diabetes. Methods The most frequently cited articles had published in Social Sciences Citation Index database by the end of October 30， 2012 were retrieved. The 50 most frequently cited articles were selected. Articles were evaluated for several characteristics， including number of citations， publication time， country of origin， institution， journal， publication type of article， and authorship. Results The most frequently cited article received 1 751 citations and the least frequently cited article received 73 citations， with a mean of 242.76 citations per article. These citation classics were published in 18 high-impact journals， led by Annals of Surgery and Obesity Research as 10 papers. Of the 50 articles， 18 articles were clinical observational study， 20 articles concerned basic science， 10 articles were review articles， and 2 articles were commentary. These citation classics were published from 1990 to 2009， most of them （40） from 2000 to 2009. Three institutions produced 2 top-cited articles， including Medical College of Virginia， Monash University， and East Carolina University. These articles originated from 14 countries， the top was USA （22 articles）. Two persons authored 3 published papers （Cummings DE and Rubino F）. Conclusion Most “citation classics” in research about surgery for type 2 diabetes are observational studies published in high-impact journals by US-based authors after 1990.
Objective To determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration (PNA) in the management of bacterial liver abscess. Methods The medical records of 206 patients with bacterial liver abscess admitted to this hospital between January 1989 and December 2009 were analyzed retrospectively. The outcomes of 96 patients receiving percutaneous treatment including PCD (PCD group, n=56) and PNA (PNA group, n=40) were compared, including the length of hospital stay, rates of procedure-related complications, treatment success, and death. Results There was no statistical difference in patients’ demographics or abscess characteristics between two groups (Pgt;0.05). The morbidity, mortality, and length of hospital stay in the PCD group and the PNA group were 1.79% vs 2.50%， 1.79% vs 2.50%， and (19.2±13.1) d vs (20.2±12.9) d, respectively, and the P values were 1.000, 1.000, and 0.887, respectively. There was statistically significant difference in successful rate between two groups （96.43% vs 75.00%， P=0.002）, but all simple abscesses with diameter of 5 cm or less were successfully managed in both PNA group and PCD group （13/13 vs 16/17， P=1.000）. Conclusions PCD is more effective than PNA in the management of bacterial liver abscess. PNA can be used as a valid alternative for simple abscesses with 5 cm in diameter or smaller.
Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
ObjectiveTo investigate the clinical efficacy of AIRVO2 respiratory humidification apparatus in patients with tracheotomy after successful weaning from mechanical ventilation in intensive care unit (ICU).MethodsOne hundred subjects were randomly divided into a control group (treated with the tracheotomy mask joint oxygen inhalation by heating humidifier, n=50) and an observation group (treated with AIRVO2 model, n=50) on the basis of conventional therapy. Blood gas indexes (pH, PaO2, PaCO2, PaO2/FiO2) and clinical data (heart rate, respiratory rate, SpO2, sputum viscosity) were recorded at 0 h, 6 h, 12 h, 24 h, 48 h, 72 h after weaning. Besides, the incidence of postoperative pulmonary infection, rapid shallow breathing index (RSBI), successful weaning rate from mechanical ventilation and daily cost of weaning between the two groups were compared at 72 h after weaning.ResultsAfter treatment, all observed data of the patients were obviously improved compared with those before treatment. The differences of humidification effects between the observation group and the control group at the same time point were statistically significant (P<0.05). The differences of heart rate, respiratory rate, and SpO2 between the observation group and the control group at the same time point were statistically significant (P<0.05). The improvement of PaO2 and PaCO2 at the same time point were statistically different between the observation group and the control group (P<0.05). Seventy-two hours after weaning, the incidence of postoperative pulmonary infection and RSBI in the observation group were significantly lower than those in the control group (P<0.05), successful weaning rate from mechanical ventilation in the observation group was significantly higher than that in the control group (P<0.05), and the average daily cost of weaning from mechanical ventilation in the observation group was lower than that in the control group (P<0.05). Nine patients in the control group and 1 patient in the observation group needed secondary mechanical ventilation due to hypoxemia.ConclusionThe therapy of AIRVO2 respiratory humidification apparatus combined with conventional treatment may achieve satisfactory effect for patients of successful weaning from mechanical ventilation with tracheotomy, and it is worthy of promotion in clinical use.
Objective To formulate an evidence-based treatment plan for a child patient with Asymptomatic Wolff-Parkinson-White (WPW) Syndrome. Methods Based on the clinical problems whether the patients with asymptomatic WPW syndrome need prevent catheter ablation or not, we used “asymptomatic WPW syndrome” as the keywords and searched The Cochrane Library (Issue 3, 2007), MEDLINE (1981 to 2007), ACP Journal Club (1991 to 2007), BMJ Clinical Evidence (1999 to 2007) and NGC (1998 to 2007) for systematic reviews, randomized controlled trials (RCTs), controlled clinical trials and treatment guidelines. The methodological quality of the included studies was assessed to identify the current best evidence. Results Two RCTs were retrieved in MEDLINE. The results showed arrhythmic events increased significantly in the high-risk control group than those in the ablation group, and in the patients with multi-pathways than those with only one pathway. Based on the current evidence, integrated with clinical expertise and the patients’ values, the patients underwent electrophysiologic test and the result showed the dominance pathway in the right side and the concealed accessory pathway in the left side. Then prevent catheter ablation was performed, and no cardiovascular complications occurred in the following 12 months, which confirmed that the plan was proved optimal. Conclusion The findings of this study should reassure physicians and parents alike that in the children with the WPW syndrome who are at high risk for arrhythmias, ablation is an appropriate option.
Objective To discuss the methods of diagnosis and treatment of cystic neoplasms of pancreas. Methods Demographic data, clinical manifestations, diagnostic exams, surgical procedures, pathological diagnosis, postoperative complications, and follow-up data of 29 patients with cystic neoplasms of pancreas were analyzed retrospectively. Results There were 8 （28%） serous cystic tumors （SCN）, 12 （41%） mucinous cystic tumors （MCN）, 3 （10%） intraductal papillary mucinous tumors （IPMN）, and 6 （21%） solid pseudopapillary tumors （SPT）. Eight cases of SCN, 7 cases of MCN, 1 case of IPMN, and 5 cases of SPT were all benign. The ages of the patients were from 15 to 78 years〔average, （49±17）years〕and all tumors were more common in female （76%, 22/29）. Twenty-three cases of 29 patients were performed operations, 22 cases were underwent surgical resection, and 1 case was performed exploration and biopsy. There was no surgery-related death. The rest 6 cases were not performed operation. Twenty-one cases followed-up for 6 months to 8 years 〔average, （2.7±2.3） years〕, 8 cases didn’t followed-up. Sixteen cases with surgical resection had no recurrence during follow-up period, 1 case performed exploration and biopsy died in 1 year after operation, and 4 cases of SCN without surgery didn’t deteriorate. Conclusions The most common cystic neoplasms of pancreas are mucinous and serous cysts. These tumors are more frequent in female. Although almost all serous cysts are benign, 42% of mucinous cysts are malignant. Misdiagnosis may delay appropriate treatment and increase mortality. The resection rate of pancreatic cystic tumor is high, and the prognosis is good after radical resection.
ObjectiveTo discuss the indications of the nonoperative management for perforated peptic ulcer. MethodsClinical data of 145 patients with perforated peptic ulcer, aged below 70 years old, with first attack and onset timelt;12 h , admitted to our hospital between January 2002 and December 2009, were analyzed respectively. Patients who were negative for fluid of abdominopelvic cavity in ultrasound examination and leakage in watersoluble contrast examination received nonoperative management, otherwise underwent operation directly (If the patients were being on medication for the ulcer, they should also go directly to surgery). Non-operative patients were converted to operation if the symptom had not relieved during the first 12 h. When admitted , the APACHE Ⅱ score was calculated for all patients. ResultsSeventy-four and 71 patients underwent non-operative management and operation directly respectively. Sex, age, onset time, perforation site and so on were comparable between the two groups （Pgt;0.05）, while APACHE Ⅱ score over 8 was 25.7% and 76.1% respectively with significant difference (P=0000). In nonoperative group, 11 (149%) patients were converted to operation. The mortality (4.1% vs 9.8%, P=0.203), mobility (16.2% vs 25.3%, P=0.175), hospital stay 〔(11.4±2.5) d vs (11.3±1.3) d, P=0.447〕, and cost 〔(11 657.3±2 826.4) yuan vs (10 013.0±1 877.4) yuan, P=0.212〕 between two groups had also no significant difference. The mean APACHE Ⅱ score was significant different between the survivors and the dead (9.3 vs 20.2, P=0.000). APACHE Ⅱ score was positively related to mortality and morbility （r=0.98, P=0.000； r=0.52, P=0.000）. ConclusionsNon-operative management is a safe and effective way in selected patients with perforated peptic ulcer, such as APACHE Ⅱ score ≤8, negative for fluid of abdominopelvic cavity in ultrasound examination, and leakage in water-soluble contrast examination. APACHE Ⅱ score is an important factor in prognosis of these patients.
ObjectiveTo retrospectively investigate the correlation between tumor immune nutritional indexes and the resectability in patients with pancreatic cancer.MethodsWe selected pancreatic patients with pathological diagnosis who admitted to Xuanwu Hospital of Capital Medical University from January 2015 to December 2018. The clinical data of patients were retrospectively analyzed. Nutritional and inflammatory hematological parameters at one week before operation were carefully collected, the parameters including: the neutrophil count, lymphocyte count, monocyte count, hemoglobin (Hb), platelet count, albumin (Alb), prealbumin (PA), cholesterol, and serum tumor markers (CEA and CA19-9). The ratio of neutrophil count to lymphocyte count (NLR), ratio of platelet count to lymphocyte count (PLR), ratio of lymphocyte count to monocyte count (LMR), prognostic nutrition index (PNI), nutritional risk score (GNIR), and controlled nutritional status score (COUNT) were calculated. The receiver working characteristic curve (ROC curve) was used to evaluate the predictive value of various indexes in radical resection of pancreatic cancer.ResultsOf the 55 patients with pancreatic cancer, 22 received radical surgery and 33 did not. There was no significant difference in gender, BMI, neutrophil count, monocyte count, platelet count, hemoglobin, albumin, prealbumin, cholesterol, and tumor location between the radical operation group and the non-radical operation group (P>0.05), but there were significant differences in age, lymphocyte count, CEA, and CA19-9 between the two groups (P<0.05). There was no significant difference in the area under the curve (AUC) of neutrophil count, lymphocyte count, monocyte count, hemoglobin, platelet count, albumin, prealbumin, cholesterol, NLR, PLR, LMR, PNI, and GNIR to predict the resectability of pancreatic cancer (P>0.05), but there was statistical significance in COUNT score, CEA, and CA19-9 (P<0.05). The AUC values of COUNT, CEA, and CA19-9 were 0.700, 0.705, and 0.739 respectively, the sensitivity corresponding to the best critical point cutoff value were 59.09%, 80.00%, and 100%, as well as the specificity were 87.88%, 66.67%, and 42.42%, respectively. The specificity of COUNT was high, but the sensitivity was poor. The sensitivity of CEA and CA19-9 were high and the specificity were poor.ConclusionsThe COUNT is a simple and useful predictor to predict the resectability of pancreatic cancer. The combination of COUNT and serum tumor markers of CEA and CA19-9 can help to better predict the surgical indications of pancreatic cancer.