目的:探讨经后腹腔镜手术治疗直径≥6.0cm的肾上腺肿瘤的安全性和效果。方法:对我院近5年收治经后腹腔镜手术治疗的直径≥6.0cm肾上腺肿瘤患者的临床资料进行回顾分析,27例患者年龄24～76岁,男性10例,女性17例,肿瘤直径6.0～8.5 cm。病理结果为:髓质脂肪瘤9例,肾上腺皮质腺瘤7例,肾上腺嗜铬细胞瘤6例,节细胞神经瘤3例,肾上腺皮质腺癌1例,肾上腺转移瘤1例。结果:24例患者顺利切除肿瘤,另外3例患者术中转开放手术,平均手术时间(119.46±36.65) min,术中估计出血量(80.14±36.48) mL,术后进食时间(1.88±0.82) d,术后引流管留置时间(2.05±0.65) d,术后住院时间(6.21±1.84) d。 结论:在技术熟练的前提下,直径≥6.0 cm的肾上腺肿瘤经后腹腔镜手术治疗仍然安全、微创。
ObjectivesTo systematically review the efficacy and safety of doxazosin for ureterolithiasis.MethodsPubMed, EMbase, Web of Science, The Cochrane Library and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of comparing doxazosin with conservative treatment or tamsulosin for ureterolithiasis from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, RevMan 5.3 software was used to perform meta-analysis.ResultsA total of 15 RCTs involving 1 062 patients were included. The results of meta-analysis showed that: compared with conservative treatment, doxazosin significantly facilitated ureteral stone expulsion (RR=1.62, 95%CI 1.45 to 1.81, P<0.000 01). No statistical significant difference was found in stone-free rate (RR=0.96, 95%CI 0.83 to 1.11, P=0.57), stone expulsion time (SMD=−0.17, 95%CI −0.52 to 0.19, P=0.35) or pain episode frequency (SMD=0.21, 95%CI −0.15 to 0.56, P=0.25) between doxazosin and tamsulosin. Treatment-associated serious side effects were rarely reported.ConclusionCurrent evidence shows that doxazosin is an efficient and safe medical expulsion agent for ureterolithiasis management. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To systematically review the efficacy of chlorhexidine versus povidone iodine in the prevention of wound infections after surgeries by meta-analysis. Methods All randomized controlled trials comparing these two disinfectants were searched from databases of PubMed, The Cochrane Library (Issue 3, 2016), EMbase, WanFang Data, VIP and CNKI from inception to August 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 14 randomized controlled trials were included. The results of meta-analysis showed that the chlorhexidine group had significantly lower rates in any surgical site infection (RR=0.71, 95% CI 0.58 to 0.88,P=0.001) and superficial incisional infection (RR=0.66, 95% CI 0.48 to 0.91,P=0.01) when compared with povidone iodine group. However, there were no significant differences in deep incisional infection (RR=0.51, 95% CI 0.23 to 1.11,P=0.09) and organ-space infection (RR=0.97, 95% CI 0.53 to 1.76,P=0.92) between the two groups. Furthermore, subgroup analysis revealed differences in any surgical site infection and superficial incisional infection could only be found in surgeries possibly contaminated. Conclusion Chlorhexidine may be superior in decreasing the incidence of infection in probably contaminated surgery.
Objective To investigate the effect of adductor canal block combined with local infiltration anesthesia on the rehabilitation of primary total knee arthroplasty (TKA). Methods A total of 104 patients who met the selection criteria for the first unilateral TKA between March 2017 and August 2017 were included in the study. They were randomly divided into trial group (53 cases) and control group (51 cases). In the trial group, the adductor canal block with intraoperative local infiltration anesthesia were performed. In the control group, only intraoperative local infil-tration anesthesia was performed. There was no significant difference in gender, age, body mass index, diagnosis, effected side, and the preoperative American Society of Anesthesiologists (ASA) grading between 2 groups (P>0.05). The operation time, length of stay, and complications were compared between 2 groups, as well as visual analogue scale (VAS) score of incision at rest and during activity, the range of motion (ROM) of knee flexion and extension activity, limb swelling (thigh circumference), walking distance, and pain VAS score while walking. Results The operation time of the trial group was significantly shorter than that of the control group (t=–2.861, P=0.005). However, there was no significant difference in length of stay between 2 groups (t=–0.975, P=0.332). The wound effusion occurred in 1 patient of trial group and 2 of control group; hematoma occurred in 2 patients of trial group and 3 of control group; no symptom of intermuscular venous thrombosis occurred in 1 patient in each of 2 groups; ecchymosis occurred in 14 patients of trial group and 15 of control group; there was no significant difference in the incidence of related complications between 2 groups (P>0.05). There was no significant difference in the preoperative VAS score at rest and during activity, ROM of knee flexion and extension activity, and thigh circumference between 2 groups (P>0.05). However, there were significant differences in the VAS score at rest and during activity after 2, 4, 8, and 12 hours, ROM of knee flexion and extension activity after 1 and 2 days, and the walking distance on the day of discharge, pain VAS scores while walking after 1 and 2 days and on the day of discharge, and thigh circumference after 1 day between 2 groups (P<0.05). Conclusion For the primary TKA, the adductor canal block combined with local infiltration anesthesia can early relieve the initial pain of the incision, shorten the operation time, and promote the mobility and functional recovery of the knee joint.
Objective To observe whether umbilical cord mesenchymal stem cells (UCMSCs) can differentiate into the smooth muscle cells (SMCs) induced by bladder SMCs (BSMCs) conditioned medium so as to seek an alternative seed cells for the repair and reconstruction of the urology system. Methods UCMSCs and BSMCs were harvested from umbilical cord of full-term births and bladder tissues which were obtained from patients who underwent a radical cystectomy. BSMCs conditioned medium was prepared by mixing supernatant of BSMCs at passages 1-5 with complete medium at ratio of 1 ∶ 1. UCMSCs at passage 3 were cultured with BSMCs conditioned medium (induced group, group A) and complete medium (control group, group B), respectively; simple BSMCs served as positive control group (group C). The morphological changes of co-cultured UCMSCs were observed by inverted phase microscope, the expressions of α-smooth muscle actin (α-SMA), Calponin, and smooth muscle myosin heavy chain (SM-MHC) of UCMSCs were tested by immunofluorescence staining and Western blot at 7 and 14 days. Results The morphology of UCMSCs in group A started to change from a polygonal and short spindle shape to a large and spindle shape after co-culture, which was similar to BSMCs morphology; but the morphology of UCMSCs did not change obviously in group B. Immunofluorescence staining showed that the expressions of α-SMA, Calponin, and SM-MHC were positive in group C. At 7 days, the expression of α-SMA could be observed in groups A and B; at 14 days, the positive expression of α-SMA increased gradually in group A, but it did not increase in group B. At 7 days, a positive expression of Calponin could be observed in group A, and positive expression increased obviously at 14 days; the expression of Calponin could not be observed at 7 and 14 days in group B. However, the expression of SM-MHC could not be observed in groups A and B. The results of Western blot showed the expressions of α-SMA, Calponin, and SM-MHC protein were consistent with the results of immunofluorescence staining. Conclusion UCMSCs have the potential of differentiation into SMCs and may be a potential seed cells for bladder tissue engineering.
Objective To systematically evaluate the quality of published pharmacoeconomics studies on Chinese patent medicines for neoplasms. Methods Datasets including CNKI, WanFang Data, VIP, SinoMed, PubMed, Web of Science, Cochrane Library, and EMbase were searched to collect pharmacoeconomics studies of Chinese patent medicines in neoplasms from the establishment of the database to September 30, 2022. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) and quality of health economics studies (QHES) were used to evaluate the reporting quality and methodological quality. Results A total of 25 studies were included, with an average CHEERS 2022 coincidence rate of 40.09% and an average QHES score of 53.2. Conclusion The quantity and quality of pharmacoeconomics studies on Chinese patent medicines in neoplasms are insufficient and flawed. It is suggested to strenthen the collaboration between scientific research institutions and hospitals and standardize the pharmacoeconomics studies on Chinese patent medicines in neoplasms to provide hygienic decision-making evidence for Chinese patent medicines in neoplasms.