Objective We searched and reviewed medical evidence to find the guide of bowel preparation we should choose before large bowel preparation. Method Firstly, we put forward clinical questions. Secondly, we searched medical evidence from PubMed, MEDLINE, EMbase, Cochrane Library, Science and ACP in recent 10 years. And then we reviewed the results. Results We finally identified 17 literatures including 2 system reviews, 6 meta-analyses and 9 randomized control trials which included 4 multicentre randomized clinical trials. Most of literature suggested that there was no evidence showing the benefit of mechanical bowel preparation (MBP). No MBP before large bowel surgery would not increase rate of anastomotic leakage. On the contrary, MBP may increase the percentage of anastomotic leakage and wound infection. Considering the research with the clinical situation, we produced a new method of simplified MBP to treat the patient. It reached the predictive effect. Conclusion No evidence of systematic review and meta-analysis supports the benefit of BMP. The new simplified bowel preparation before surgery in West China Hospital was worthy to test.
Objective To compare the clinical effects of one-stage anastomosis on patients with middle and lower rectum carcinoma and intestinal obstruction and the ones without intestinal obstruction, and to evaluate the safety and feasibility of patients with middle and lower rectum carcinoma and intestinal obstruction undergoing one-stage anastomosis. Methods The data of patients diagnosed definitely by pathology as middle and lower rectum carcinoma underwent one-stage anastomosis in West China Hospital of Sichuan University between January 2007 and December 2008 was retrospectively analyzed. The clinical effects were compared between intestinal obstruction group and non-intestinal obstruction group. Results During this period, 525 patients were included into intestinal obstruction group (n=87) and non-intestinal obstruction group (n=438). Among the patients included, there were 307 males and 218 females. Ages were from 25 to 85 years, and the average age was 60 years old. According to tumor histology, there were 487 cases of adenocarcinoma, 29 of mucinous adenocarcinoma and 9 of other types. According to the degree of tumor differentiation, there were 140 cases of low differentiation, 372 of middle differentiation and 13 of high differentiation. According to TNM stage, there were 4 cases of stage 0, 93 of stageⅠ, 189 of stage Ⅱ, 202 of stage Ⅲ and 37 of stage Ⅳ. Constituent ratio of gender, distributions of distances from tumor to anus, TNM stages and differentiation degrees of tumor were significantly different between intestinal obstruction group and non-intestinal obstruction group (Plt;0.05); and there was no statistical difference in the age, pathological types， significant internal medical complications and operative types between the two groups (Pgt;0.05). There was no statistical diffe rence in operative duration and intraoperative blood loss between the two groups (Pgt;0.05). There was no statistical difference in postoperative time of first defecation, first out-of-bed activity and first oral feeding, and postoperative hospital stay between the two groups (Pgt;0.05); while time of first aerofluxus was earlier in intestinal obstruction group than that in non-intestinal obstruction group (Plt;0.05). There was no statistical significance in the disease incidence of postoperative complications between the two groups (Pgt;0.05). Conclusions Comparing with patients with non-intestinal obstruction, there is no significant evidence shows that one-stage anastomosis will affect the rehabilitation and increase the risk of complications in patients with middle and lower rectum carcinoma and intestinal obstruction. It is considered that it would be safe and feasible for patients with middle and lower rectum carcinoma and intestinal obstruction to have one-stage anastomosis; however, it is necessary for us to have more researches to evaluate the long-term clinical effect.
Objective To explore the clinical effect of different strategies for surgical treatment of cancer of rectum combined with neo-adjuvant chemotherapy under multi-disciplinary team. Methods From January 2007 to December 2007, the patients diagnosed definitely as rectal cancer were analyzed retrospectively, of whom accept surgery combined with neo-adjuvant chemotherapy were included. The clinical effects were studied and observed, the differences among the strategies for different surgical treatment 〔high anterior resection (HAR), low anterior resection (LAR), out-pouching with colo-anal anastomosis (OCAA), radical resection with non-saving anus (RNSA), and palliation colostomy (PCO)〕 in the multi modality therapy were compared. Results Comparing the constituent ratio of gross type of tumor in five groups, the difference between PCO group and the other 4 groups had mainly statistical significance （P＜0.05）. The difference of constituent ratio of Dukes staging had statistical significance between HAR group and OCAA group, HAR group and PCO group, LAR group and PCO group （P＜0.05）. According to the duration of operation, the persisting time of PCO group was obviously shorter than that of the other 4 groups （P＜0.05）, meanwhile, the persisting time of LAR group was shorter than that of OCAA group and RNSA group （P＜0.05）. According to the volume of ascites discovered in operation, mainly between HAR group and LAR group, between HAR group and RNSA group, the incidence of a seroperitoneum more than 200 ml in the former was less than the latter （P＜0.05）. Regarding to indexes of laboratory, CEA value in PCO group was higher than the other 4 groups, serum amyloid A value in RNSA group was higher than the other 4 groups, and the differences had statistical significances （P＜0.05）. Conclusion Mini-invasive surgery may have certain significance in clinical effect of the comprehensive treatment for advanced rectal cancer when different operative methods were combined with neo-adjuvant chemotherapy. And by the way, better clinical effect will take place when the anus-retained operation is possibly performed.
Objective To explore the mental health status and influencing factors of clinical medical students pursuing a professional master’s degree under the “dual-track integration” training systems. Methods Clinical medical students pursuing a professional master’s degree who underwent residency standardized training in 123 hospitals from different areas of China were selected as the research objects from May 28th to June 4th, 2024, and the mental health and stress were investigated by questionnaire. Results A total of 1195 clinical medical students pursuing a professional master’s degree were included. Symptom Checklist-90 analysis showed that 582 (48.7%) master students had mental health problems. The two-group students (with and without psychological problems) had statistical differences in exercise frequency, sleep quality, extent of staying up late, interpersonal communication, and average number of night shifts per month (P<0.001). The subjective scores of interpersonal pressure, economic pressure, love and marriage pressure, schoolwork pressure, scientific research pressure, clinical work pressure, entering higher education pressure and employment pressure, and the proportion of graduating from 985/211 university of the master students with psychological problems were significantly higher than those of the master students without psychological problems (P<0.001). Logistic regression analysis showed that poor sleep quality [odds ratio (OR)=1.626, 95% confidence interval (CI) (1.085, 2.438), P=0.019], 985/211 university degree [OR=1.448, 95%CI (1.097, 1.910), P=0.009], interpersonal pressure [OR=1.194, 95%CI (1.121, 1.272), P<0.001], love and marriage pressure [OR=1.067, 95%CI (1.014, 1.122), P=0.012] and entering higher education pressure [OR=1.110, 95%CI (1.055, 1.167), P<0.001] were independent risk factors, while the male sex [OR=0.621, 95%CI (0.472, 0.817), P=0.001] were protective factor for psychological problems of these medical students. Conclusions Under the “dual-track integration” training systems, the clinical medical students pursuing a professional master’s degree have a higher prevalence of psychological problems, especially the females and the 985/211 bachelor’s degree scholars. It is important to improve sleep quality, strengthen interpersonal interaction and reduce pressure load to improve the mental health level of these clinical medical students.