Objective To systematically evaluate the effectiveness and safety of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) for hepatocellular carcinoma (HCC). Methods Databases including PubMed, EMbase, MEDLINE, SCI, CNKI, CBM, WanFang Data and The Cochrane Library (Issue 3, 2012) were searched to collect the randomized controlled trails (RCTs) and non-RCTs about LH versus OH for HCC. The retrieval time was from inception to August 2012. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated by 2 reviewers independently. Then the meta-analysis was conducted using RevMan 5.1 software. Results A total of 13 non-RCTs involving 701 patients were included. The results of meta-analysis showed that: Compared with OH, LH had lesser amount of intraoperative bleeding (MD=?144.09, 95%CI ?194.25 to ?93.94, Plt;0.000 01), shorter hospital stay (MD=?5.48, 95%CI ?7.10 to ?3.85, Plt;0.000 01), and lower postoperative complications (OR=0.43, 95%CI 0.27 to 0.66, P=0.000 1). But there were no differences between the 2 groups in operation time (MD=?0.64, 95%CI ?22.95 to 21.68, P=0.96), perioperative death rate, 3-5 year survival rate, and tumor free survival rate. Conclusion LH is superior to OH in treating HCC for it is associated with smaller wound, lesser operative blood loss, shorter hospital stay, and lower postoperative complications. And it is similar as OH in operation time, perioperative death rate and 3-5 year survival rate. So LH is safe and feasible for treating HCC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for HCC patients according to an integrative disease assessment.
Objective To evaluate the accuracy of the related parameters measured by spinal virtual surgery system (SVSS) three-dimensional (3D) techniques by comparing with the parameters measured by multi-spiral CT (MSCT) workstation. Methods Seven vertebrae specimens of adult men were scanned with MSCT, and the messages were sent toMSCT workstation and SVSS. The 3D image of spine was reconstructed by using volume rendering and multi-planar reformation; based on the parameter requirement of lower cervical pedicle fixation, 10 related parameters were measured. Then SPSS11.0 analyzer software was used to analyze the parameters measured by 2 systems. Between June 2009 and March 2010, 6 patients who received screw insertion in lower cervical spines were given MSCT scanning, then the messages were sent to SVSS 3D reconstruction to evaluate the situation and to collect the parameters of pedicle screw insertion. Results SVSS measurement showed that 1 pedicle was clausura (C3) and the diameters of 4 pedicles in coronal view were lee than 3 mm (C4 in 1, C5 in 2, C6 in 1), which did not fit for screw insertion; the results were similar to those by MSCT measurement. A total of 66 lower cervical pedicle were measured successfully. Significant differences were found in 14 parameters as follows between 2 systems (P lt; 0.05): the left pedicle height of C3, the both sides pedicle width of C4, the right pedicle spongy width of C4, the left X-direction entrance of C6, the both sides Y-direction entrance of C3, total pedicle length of sagittal view in both sides pedicle of C3 and the left pedicle of C5, total pedicle length of axial view in C3 pedicles, the left pedicle of C5, and the right pedicle of C6. There was no significantdifference in the other parameters (P gt; 0.05). In 6 cl inical cases, 34 screws were inserted, the postoperative MSCT scanning showed that 30 screws were placed successfully. The rate of accuracy was 88.24%. According to the Richter’s perforation classification, perforation at grade I and at grade II occurred in 2 cases (5.88%), respectively. Conclusion The accuracy of the parameters measured by SVSS is similar to that by MSCT.
Objective To assess the cl inical significance of transpedicular screw insertion in lower cervical vertebra assisted by multi-spiral CT (MSCT) three dimentional (3D) image reconstruction techniques. Methods Eight cervical vertebra specimens were examined by MSCT, and the messages were sent to SGI02 Workstation; according to the parameter requirements of lower cervical pedicle fixation, by using post-process of volume rendering (VR) the condition was judged and multi-plannar reformation (MPR) was used to do individual analysis; and the ideal path of screw insertion was obtained andthe related parameters were measured. After preoperative plan being finished, referring to these measured parameters, 3.5 mm screws were inserted into C3-7 pedicles of these 8 specimens. After insertion of screws, MSCT scanning and 3D reconstruction were performed again to evaluate the accuracy of lower cervical pedicle screw inserting. From May 2007 to November 2009, 28 patients who received screw insertion in lower cervical spines were given MSCT scanning and 3D reconstruction to evaluate the illness situation, to confirm shortest fixation volumes, and to collect the parameters of aim pedicle screw insertion. Results The time of insertion for each screw was (392 ± 62) seconds. It was found that one pedicle was clausura (1.25%, 1/80) and five pedicle diameters in coronal view were less than 3 mm (6.25%, 5/80), which all were not fit for screw insertion. A total of 74 screws were placed successfully. One-time success rate of screw insertion was 95.95% (71/74). The total accuracy rate was 91.89% (68/74). Six screws penetrated (8.11%). According to the Richter penetrating classification: grade one was 6.76% (5/74) and grade two was 1.35% (1/74). There were significant differences (P lt; 0.05) in penetrated rate between our study and anatomic landmark local ization (47.37%), Miller methods (25.00%), and there was no significant difference (P gt; 0.05) when compared with Abumi method (6.70%), hopper method (7.10%), pipel ine deoppilation method (5.20%) and navigation technique (11.30%). In cl inical 28 cases, 121 screws were inserted; one pedicle was clausura and one was fissure fracture, which all were unfit for insert screw in preoperative plan, the surgery project was adjusted. After operation, 17 patients (76 screws) were given MSCT scanning again. A total of 67 screws (88.16%) were placed successfully. Nine screws (11.84%) penetrated, grade one was 7.89% (6/76) and grade two was 3.95% (3/76). Conclusion It is accurate to apply MSCT 3D reconstruction techniques to measure the ideal screw canal in preoperative individual ized plan. Strictly following individual quantitative data, the safety and accuracy of the surgery can be improved. And it is feasible and available to use MSCT MPR imaging to evaluate the accuracy of pedicle screw insertion.
Objective To evaluate the efficacy and safety of percutaneous ethanol injection for hepatocellular carcinomas of 3 cm or less. Methods Randomized controlled trials (RCTs) from the Cochrane Controlled Trials Register (Cochrane Library issue 2, 2008), PubMed (1966 to 2008), EMbase (1966 to 2008), CBMdisc (1978 to 2008), and CNKI (1979 to 2008) were electronically searched. We hand searched related published and unpublished data and their references. Randomized controlled trials of percutaneous ethanol injection to treat hepatocellular carcinomas of 3 cm or less were included. Data were extracted and evaluated by two reviewers independently using a designed extraction form. RevMan 4.2.10 software was used for data analysis. Results Seven RCTs involving 891 patients were included. We conducted subgroup analyses based on outcome measures and interventions. Compared with RFA, for treatment of hepatocellular carcinomas of 3 cm or less, PEI showed statistical differences in one and three-year survival rates and one and three-year local recurrence rates after treatment(RR=0.95, 95%CI 0.91 to 1.00; RR=0.80, 95%CI 0.71 to 0.91; RR=2.18, 95%CI 1.11 to 4.30; RR=2.59, 95%CI 1.55 to 4.32). As for hepatocellular carcinomas of 2-3 cm, PEI showed statistical difference in three year cancer free survival rates after treatment (RR=0.47, 95%CI 0.24 to 0.93) .Conclusion Considering the relatively poor quality of most included trials and small sample size, insufficient evidence was obtained in this systematic review. Therefore, more randomized controlled trials with high quality are still needed to assess and verify the efficacy and safety of this treatment.
【摘要】 目的 比较密度梯度离心法及全骨髓培养法分离培养内皮祖细胞的差异。方法 取4周雄性近交系C57BL/6J小鼠骨髓,分别使用密度梯度离心法及全骨髓培养法培养,观察细胞贴壁情况和细胞形态,并行DiIacLDL及FITCUEAI双染、vWF、eNOS及细胞表面标志检测。结果 密度梯度离心法培养细胞可形成典型铺路石样改变及形成血管样结构;而全骨髓培养法贴壁细胞形态多样,较多呈长梭形铺展生长,部分细胞呈类圆形及纺锤形。比较两种方法培养细胞摄取DiIacLDL、结合FITCUEAI双阳性率以及vWF、eNOS及细胞表面标志表达阳性率,差别均有统计学意义(Plt;005)。应用密度梯度离心法,随着培养时间延长,表达CD34、CD133及FLk1细胞逐渐增多(Plt;005)。结论 密度梯度离心法及全骨髓培养法在EGM2MV培养体系下均可培养出内皮祖细胞,但密度梯度离心法较全骨髓培养法培养的内皮祖细胞纯度高。
Objective To evaluate the efficacy of the subtotal splenectomy versus total splenectomy with gastroesophageal devascularization for patients of hepatic cirrhosis and portal hypertension. Methods We searched the Cochrane Library (Issue 2, 2008), MEDLINE (1966 to August, 2008), EMbase (1966 to August, 2008), the China Biological Medicine Database (1978 to August, 2008), Chinese Sci-tech Periodical Full-text Database (1989 to August, 2008) and Chinese Periodical Full-text Database (1994 to August, 2008), as well as hand-searched several related journals and conference proceedings for the randomized controlled trials involving the comparison of the efficacy of the subtotal splenectomy with the total splenectomy for the patients of the hepatic cirrhosis and portal hypertension. Results Three studies involving 136 patients were identified. The results of two studies indicated that both of the subtotal splenectomy increased less the peripheral platelet count and there was a statistically significant difference between the two groups [WMD= – 39.27, 95%CI (– 62.57, – 15.97)]. Two studies indicated that the serum tuftsin level was increased significantly after the subtotal splenectomy [WMD= 165.28, 95%CI (159.36, 171.21)]. One study indicated that both of the subtotal splenectomy and total splenectomy with gastroesophageal devascularization increased the peripheral white blood cell count and there was statistical difference between the two groups [WMD= – 0.93, 95%CI (– 1.52, – 0.34)]. There was no statistical difference in serum IgA level between the two groups. One study indicated the average fever time after the total splenectomy was longer than the subtotal splenectomy; there was statistical differences in 5 years survival rate between the two groups (Plt;0.05). Conclusions After the subtotal splenectomy the hypersplenism of patients suffered from hepatic cirrhosis and portal hypertension was corrected obviously and the blood cells were increased smoothly so that high blood viscosity was prevented and occurrence of the thrombotic diseases was decreased. And the immune system reserve functions of the patients with hepatic cirrhosis and portal hypertension were maintained. More randomized controlled trials, with large sample sizes, may lead to more accurate results.
Objective To investigate the current status of disease uncertainty and alexithymia in elderly hospitalized patients with chronic obstructive pulmonary disease (COPD). Methods By using the convenience sampling method, a total of 165 elderly patients with COPD were investigated by using general information questionnaire, Mishel's uncertainty in illness Scale (MUIS) and Toronto alexithymia scale (TAS-20). Results The disease course of the elderly hospitalized patients with COPD was mostly 3 - 6 years (40.0%), and most of them had 1 - 2 chronic diseases (59.4%). More than half of the elderly had a history of smoking and drinking. The severity of COPD in the elderly was moderate (57.0%), and the number of hospitalization in the year was more than 2 times (58.8%). The score of disease uncertainty in the elderly hospitalized patients with COPD was 89.49±9.45, and the score of uncertainty was the highest (36.59±4.08), followed by the lack of information (18.51±1.86). The score of alexithymia in the elderly hospitalized patients with COPD was 55.32±6.37, and the score of all dimensions was the highest (21.87±2.93), followed by affective recognition disorder (18.27±2.55). The results of correlation analysis showed that the total score and scores of each dimension were positively correlated (P<0.01). The results of multi-factor analysis showed that age and course of disease and severity of COPD were the main influencing factors of disease uncertainty in elderly hospitalized patients with COPD (P<0.05). Conclusions The elderly hospitalized patients with COPD have a moderate level of disease uncertainty and a high degree of alexithymia. Besides, the greater the disease uncertainty is, the more serious the alexithymia. Therefore, clinical doctors and nurses should pay more attention to give emotional and psychological support and education guidance to the elderly patients with COPD, in order to improve their clinical efficacy and quality of life.