Extensive hepatectomy can achieve a higher chance of radical resection of lesions in the hepatobiliary system, but the risk of fatal complications of severe liver failure after surgery also increases accordingly. Therefore, enhancing the liver’s regenerative capacity has always been a hot topic in clinical research. Portal vein blood supply is of great significance for maintaining the normal function of the liver and promoting the repair and proliferation of damaged liver tissue. After selectively altering the blood flow distribution in the portal vein, atrophy or proliferation will occur in different liver lobes. The discovery of the important physiological phenomenon of liver regeneration induced by deportalized blood flow of portal vein has made it possible to promote the volume growth and functional enhancement of the residual liver lobes before hepatectomy, and various technical schemes have been applied and developed in clinical practice. The interim research results show that the portal vein embolization technique is mature, has less trauma, but the induction speed is relatively slow. Portal vein combined with hepatic vein embolization has better induction efficacy and does not increase embolism-related complications, and has a wider range of applications. The induction ability of associating liver partition and portal vein ligation for staged hepatectomy is significant, but the surgical trauma is large, and there are higher requirements for perioperative management. There is a clear correlation between high surgical volume centers and technical improvements and a significant reduction in complications. Resection and partial liver transplantation with delayed total hepatectomy not only break through the bottlenecks of safety and ethical requirements for living donor liver transplantation in adults, but also innovate and enrich the second-stage extensive hepatectomy schemes. However, their technical standards and application scope still need more high-quality research evidence to support them.
Lung cancer is a complex disease with its own challenges, and is considered to be one of the most common causes of cancer death worldwide. The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has exacerbated these challenges. The aim of this review is to explore the impact of the COVID-19 pandemic on the screening, diagnosis and treatment of lung cancer. We hope to provide some experience and help for the whole process management of lung cancer patients.
In order to improve the management of medical technology and ensure the safety, efficiency, and economy of medical devices, we introduce the current situation and future of clinical medical engineering technology evaluation from eight aspects: evaluation standard, evaluation of technical performance, evaluation of reliability, evaluation of clinical application, evaluation of health economy, evaluation of service system, technology maturity, and human factor engineering. The evaluation of clinical medical engineering technology is still in the initial stage, and it is necessary to speed up the establishment of standardization system and evaluation criterion for all kinds of equipment evaluation.
Objective To determine the efficacy and complication rate of intramedullary nailing versus compression plate in the treatment of adult humeral shaft fracture. Methods We searched the specialized trials register of The Cochrane Collaboration’s Bone, Joint and Muscle Trauma Group, The Cochrane Library (including CENTRAL), MEDLINE (1966 to 2006), EMbase (1980 to 2006), PubMed (1966 to 2006), NRR , CCT and CBMdisc (1979 to July 2006). We also handsearched some Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomize controlled trials comparing intramedullary nailing versus compression plate for humeral shaft fracture in adults were included and the quality of these trials was critically assessed. Data analyses were done using The Cochrane Collaboration’s RevMan 4.2.8. Results Three randomize controlled trials involving 215 patients were included. The meta-analysis showed that intramedullary nailing may increase the re-operation rate (OR=2.68, 95%CI 1.19 to 6.04, P=0.02), pain in the shoulder (OR=13.02, 95%CI 2.23 to 75.95, P=0.004), and the rate of decreased range of motion of the shoulder (OR=18.60, 95%CI 1.01 to 341.83, P=0.05). The rates of no union, infection and iatrogenic radial nerve injury were comparable between intramedullary nailing and compression plate. Meta-analysis was not conducted for the time of union, because the relevant data were not available for the included trials. Conclusions Further well-designed and large-scale randomize controlled trials are required to determine the effects of intramedullary nailing and compression plate on these outcomes, because the trials available for this systematic review are too few and too small.
ObjectiveTo explore the effect of metabolic syndrome (MS) on postoperative pulmonary infection in patients with colorectal cancer (CRC) and to construct a risk prediction model for postoperative pulmonary infection in CRC patients. MethodsRetrospective collection of clinical data from 291 CRC patients who underwent surgical treatment at Department of General Surgery, Suzhou Ninth People’s Hospital in the period of January 2020 to August 2024. To explore the risk factors of postoperative pulmonary infection in patients with CRC and to establish a nomogram model. ResultsAmong the 291 CRC patients enrolled, there were 58 MS patients (19.93%) and 233 non-MS patients (80.07%). Compared with patients without MS, CRC patients with MS had longer surgery time (P<0.001) and higher incidence of postoperative pulmonary infection (P<0.001). The results of multiple logistic regression analysis showed that smoking history [OR=2.184, 95%CI (1.097, 4.345), P=0.026], body mass index (BMI)≥25 kg/m2 [OR=2.662, 95%CI (1.241, 5.703), P=0.012], MS [OR=2.770, 95%CI (1.415, 5.425), P=0.003], increased surgical time [OR=4.039, 95%CI (1.774, 9.197), P<0.001] and increased intraoperative bleeding [OR=2.398, 95%CI (1.246, 4.618), P=0.009] were all risk factors for postoperative pulmonary infection in CRC patients. Based on these risk factors, a nomogram model was constructed. The area under the curve (AUC) was 0.845 [95%CI (0.769, 0.906)], and the sensitivity and specificity were 84.2% and 87.5% respectively. The internal verification of Bootstrap test showed that the simulated curve and the actual curve had good consistency. The clinical decision curve analysis showed that when the threshold probability was in the range of 8%–84%, the net benefit of the model for patient diagnosis was higher. ConclusionsMS increases the risk of postoperative pulmonary infection in CRC patients. At the same time, smoking history, BMI≥25 kg/m2, long operation time, and more intraoperative blood loss are also risk factors for postoperative pulmonary infection in patients with CRC. Building a model based on this can effectively evaluate the risk of postoperative pulmonary infection in CRC patients.
Objective To systematically review the benefits and risks of more intensive versus less intensive blood pressure control in Asian elderly patients over 60 years old. Methods The PubMed, EMbase, Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of intensive versus less blood pressure control from inception to August 2022. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 6 RCTs involving 20 701 patients were included. The results of meta-analysis showed that intensive blood pressure control could reduce the incidence of cardiovascular death, stroke, and heart failure. However, it could not reduce the incidence of all-cause death and myocardial infarction. Subgroup analysis showed that systolic blood pressure greater than 140 mmHg could not reduce the incidence of cardiovascular death. The safety evaluation found no increase in adverse events or renal injury in intensive blood pressure control group. Conclusion The current evidence shows that intensive blood pressure control can reduce the incidence of cardiovascular death, stroke and heart failure events in elderly Asian patients over 60 years old, but it has no effect on all-cause mortality and myocardial infarction events. It has good safety. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Surgery is the only effective treatment for congenital choledochal cysts, as it allows for the resection of the cysts, the complete relief of cholangitis, and the prevention of canceration of cysts. The key elements of surgery for central choledochal cysts involve the cysts resection, bile-intestinal anastomosis, and biliopancreatic diversion. The difficulty in operating on central choledochal cysts lies in the rational decision making and effective management of cysts in the hilar and pancreatic regions. Depending on the type of central choledochal cysts with different anatomical patterns, a reasonable and feasible individualized surgical management strategy can be established to effectively avoid adverse therapeutic consequences such as postoperative biliary leakage, cholangio-intestinal anastomotic stricture, residual choledochal cysts and its carcinogenesis.
A complex mechanism of reduced number of bile duct innervating ganglion cells, smooth muscle distribution, foregut duplications, and abnormal pancreaticobiliary duct junction, which occurs during embryonic development and after birth in a genetic context, can lead to pathological congenital biliary dilatation. As a precancerous lesion of the biliary system, irrational treatment of congenital biliary dilatation will further increase the risk of malignancy in patients. By understanding the causes, pathological features, and limitations of early detection techniques of malignant tumor secondary to congenital biliary dilatation is helpful to clarify the key points in the management of congenital biliary dilatation, reduce the incidence of postoperative adverse treatment events and avoid the medical risk of secondary malignancy.
Objective To cultivate human retinal capillary endothelial cells (HRECs) and establish two-dimensional model of human retinal vessels in vitro. Methods In a fibronectincoated raising pound, HRECs were cultured by non-serum human-endothelial-cells substrate and two-dimensional model of human retinal vessels was established. Horseradish peroxidase was used to detect the permeability. Some of the vascular models were cultivated with 5 ng/ml vascular endothelial growth factor (VEGF), whose changes of permeability was compared with which of the models without cultivation with VEGF. The effect of VEGF on vascular permeability was observed. Results Meshy vascular structure came into being due to the confluent HRECs after 2 to 4 days. Comparatively complete two-dimensional vascular model after about 6 days. VEGF increased vascular permeability and promoted the formation of blood vessels. Conclusion HRECs can be cultivated successfully with human-endothelial-cells substrate; standard retinal two-dimensional vascular model in vitro can be established by using cellular raising pound and non-serum human-endothelial-cells substrate. (Chin J Ocul Fundus Dis, 2006, 22: 110-112)
Objective To systematically and thoughtfully summarize the experience and lessons of emergency medical rescue during the Wenchuan earthquake in order toprovide relevant evidence to inform decision making for future emergency medical situations. Methods The relevant data was collected and analyzed through brainstorming and questionnaire. Result ① The Sichuan province Headquarters for Earthquake Disaster Relief was organized at the first time after the earthquake, and a coordination mechanism was established between the national ministry and Sichuan, as well as different departments and the army, to ensure the powerful, ordered, and effective action for the medical rescue. ② Thirty-five thousand eight-hundred medical rescue workers were organized within 72 hours of the earthquake and were sent to all the worst-hit counties via land, water, and air. Some effective measures such as “Four concentration”and“Transfer of wounded patients” were used to reduce the mortality and disability of the wounded patients. ③ The anti-epidemic measures were performed across all the villages and settlements of the people affected by the earthquake to ensure no recurrence of public health events during the first two weeks after the quake. ④ Medical resources were organized scientifically and transparently to meet the demand of medical rescue. ⑤ The recovery and re-establishment of medical services were promoted by two phases. Conclusion The emergency medical rescue of those affected by the earthquake in the Sichuan Province is succesful. In the future, we should establish an effective emergency medical rescue system, supply the reserve of medical resources, improve the equipment of medical rescue teams, strengthen the establishment of discipline of disaster medicine, and improve the emergency pre-plan.