Objective To investigate the detection of peritoneal free cancer cells and its clinical significance. Methods The peritoneal free cancer cells, the positive rates of CK20 protein and CK20 mRNA expressions of peritoneal lavage fluid were detected by peritoneal lavage cytology (PLC), flow cytometry (FCM) and real-time fluorescent quantitative RT-PCR in 50 cases of gastric cancer patients, respectively. The sensitivity of three kinds of detection method to peritoneal free cancer cells was compared. Results The positive rates of peritoneal free cancer cells, CK20 protein and mRNA expression of peritoneal lavage fluid were 20.0% (10/50), 36.0% (18/50) and 58.0% (29/50), respectively. The positive rate of CK20 mRNA expression detected by real-time fluorescencequantitative RT-PCR in peritoneal lavage fluid was significantly higher than those of the CK20 protein expression detected by FCM and peritoneal free cancer cells detected by PLC (Plt;0.05 or Plt;0.001). The difference of positive rate of CK20 protein expression and peritoneal free cancer cells was not significant (Pgt;0.05). The positive rate of CK20 mRNA expression of peritoneal lavage fluid was related to the tumor invasion depth, differentiation degree, TNM stage, and lymph node metastasis (Plt;0.05). Conclusion Real-time fluorescence quantitative RT-PCR is an effective method for the detection of peritoneal free cancer cells.
Objective To use a meta-analytic technique to estimate the survival of implants between immediate loading/early loading and delayed loading. Methods We carried out a systematic search of electronic databases for all prospective trials comparing conventional delayed implant loading with early or immediate implant loading, reported between 1997 and 2007. The outcome of interest was implant failure rate. Quality assessment was performed for prospective trials that met the eligibility criteria and the data were then extracted and analyzed. Results Sixteen articles were found to meet the eligibility criteria, but two studies were reported in four articles, so that 14 articles were analyzed. There were five randomized controlled trials (RCTs). Compared to delayed loading, implant failure occurred sl ightly, but not statistically significant,less often with early implant loading (OR=0.54, 95%CI 0.22 to 1.33, P =0.18). We combined all cohort studies and this analysis was consistent with this result. Immediate implant loading was associated with slightly, but not statistically significant, worse outcomes (OR=1.51, 95%CI 0.53 to 4.25, P =0.44). We only pooled the RCTs and results showed better implant success rate with immediate implant loading, but with no significant difference. When sensitivity analyses were performed by the sequential dropping of a single study, no significant differences were observed except when the study of Jo et al was excluded. Conclusion Early implant loading was associated with better outcomes compared to delayed loading when the implants were placed into good quality bone. There was no significant difference of the implant success rate between immediate loading and delayed loading. Further evaluations in adequately powered large RCTs are needed to confirm these findings.
ObjectiveTo explore the clinical efficacy and application significance of continuous irrigation and drainage for intestinal fistula combined with abdominal infection.MethodsClinical data of 62 patients with intestinafistula combined with abdominal infection admitted by Department of General Surgery of The 940th Hospital of The People’s Liberation Army Joint Service Support Force from March 2012 to March 2017 were retrospectively analyzed. All patients were treated with continuous abdominal flushing and drainage after emergency surgery. The duration of peritoneal flushing, antibiotic use, blood picture recovery, fistula healing, and total hospitalization were summarized.ResultsAll 62 patients were treated successfully without death or septic shock. Among them, 49 cases of intestinal fistula were treated with continuous abdominal flushing and drainage, and 13 cases of intestinal fistula were treated by continuous flushing and drainage of the abdominal cavity. There were 6 cases of abdominal abscess, 5 cases of incision infection, 5 cases of pleural effusion, and 2 cases of pulmonary infection after surgery. The continuous abdominal cavity washing time was (45±21) d, antibiotic use time was (14±7) d, blood image recovery time was (16±8) d, the healing time of fistula was (47±24) d, total length of hospital stay was (56±27) d.ConclusionsFor intestinal fistula combined with abdominal cavity infection, peritoneal continuous flushing and drainage is related with curative effect, high cure rate, fewer complications, simple washing equipment, simple technology, lower cost, and convenient nursing, which can create a good condition for the complexity or refractory patients with intestinal fistula, and has a high clinical application significance.
Objective To study the effect of glucocorticoid-containing triple therapy on the acute exacerbation frequency of patients with moderate to severe chronic obstructive pulmonary disease (COPD) with different blood eosinophil percentage (EOS%). Methods One hundred and twenty-four patients who were admitted to the hospital with moderate to severe COPD from January 2020 to March 2020 in the Department of Respiratory and Critical Care Medicine in this hospital were selected as the research subjects, and the patients were divided into group A according to EOS% (EOS%<2%) and B group (EOS%≥2%). Then the A and B groups were randomly divided into four subgroups A1, A2 and B1, B2, and the patients in groups A1 and B1 were treated with dual long-acting bronchodilation. The medication for the patients in groups A2 and B2 was a triple preparation containing glucocorticoids. Namely A1 group (EOS%<2%, dual therapy), A2 group (EOS%<2%, triple therapy), B1 group (EOS%≥2%, dual therapy), B2 group (EOS%≥2%, triple therapy). The patients were instructed to take medication regularly as in hospital after discharge. After discharge, patients were followed up by telephone every two weeks for a period of one year. The number of acute exacerbations, the change of forced expiratory volume in the first second as a percentage of the expected value (FEV1%pred) and the incidence of pneumonia were compared between group A and group B during the follow-up period of one year. Results In the patients with EOS%≥2%, triple therapy reduced the number of acute attacks by 40% during treatment compared with dual therapy patients (average 0.875 vs. 1.471 times per patient per year, P=0.0278). While in the patients with EOS%<2%, it was reduced by 4% (1.080 vs. 1.125 times, P=0.3527). In the same use of glucocorticoid-containing triple preparations, the number of acute exacerbations in the patients with EOS%≥2% during medication was 19% less than that of the patients with EOS%<2% (an average of 0.875 to 1.080 times per patient per year, P=0.0462). Regardless of EOS%≥2% or <2%, there was no significant difference in the changes of FEV1%pred between triple therapy and double therapy patients before and after treatment (P>0.05). Regardless of EOS%≥2% or <2%, there was no statistically significant difference in the incidence of pneumonia between patients with triple therapy and double therapy during medication (P>0.05). Conclusion Inhaled glucocorticoid triple therapy is suitable for moderate to severe COPD patients with high percentages of blood eosinophils.
ObjectiveTo review the impact of perineural invasion (PNI) on the occurrence, development, and prognosis of colorectal cancer (CRC), providing a reference for the diagnosis and treatment of CRC. MethodThe latest literature relevant researches on the mechanism, diagnosis, treatment, and prognosis of PNI in CRC both domestically and internationally was reviewed. ResultsThe current studies revealed that the mechanisms underlying PNI involved nerve growth factors, chemokines, and other signaling molecules, which regulated the interactions between the nerves and cancer cells, promoting the tumor invasion and metastasis. The diagnostic approaches primarily relied on the histopathological examination, with immunohistochemistry, and radiomics enhancing detection accuracy. Therapeutically, the PNI-positive patients benefited from surgical intervention in combination with neoadjuvant or adjuvant treatments. The FOLFOX regimen markedly improved disease-free survival. Targeting neural pathways and immune checkpoint inhibitors (such as programmed cell death 1 and cytotoxic T lymphocyte associated protein 4 inhibitors) showed potentials in reducing neural invasion and tumor progression. Emerging strategies that disrupted tumor-nerve interactions also represented promising therapeutic avenues. PNI was recognized as a critical prognostic indicator for CRC, providing guidance in risk assessment and individualized treatment planning. ConclusionsPNI serves as an important indicator for evaluating the prognosis of CRC, it has a guiding value for therapy decision-making. Further research of molecular mechanisms and diagnostic methods relevant PNI can potentially yield more effective therapeutic options and is expected to improve prognosis of patients with CRC.
ObjectiveTo detect level of circulating tumor cells (CTCs) in peripheral venous blood of fasting patients with gastric cancer (GC) and to analyze relationships between CTCs and clinicopathologic features and prognosis of patients with GC.MethodsOne hundred patients with GC were selected (GC group), who underwent the surgery and confirmed by the histopathology in the 940 Hospital of Joint Service of PLA, from August 2015 to December 2016. Thirty-eight patients with gastric benign lesions who were treated in this hospital at the same time were selected as the control group. The 7 mL peripheral venous blood of the elbow in the morning was taken from the fasting patients and the CTCs were detected by the immunomagnetic microparticle negative enrichment combined with immunofluorescence in situ hybridization within 24 h. The positive rate of CTCs was calculated and its relationships with the clinicopathologic features (tumor location, tumor invasion depth, degree of differentiation, TNM stage, lymph node metastasis, and vascular tumor thrombus) and the progression-free survival of the patients with GC were analyzed.ResultsThe positive rate of peripheral venous blood CTCs in the GC group was 89.0% (89/100), which was higher than that in the control group (10.5%, 4/38), and the difference was statistically significant (P<0.001). The levels of CTCs in the patients with GC were significantly correlated with the tumor invasion depth (P=0.017), lymph node metastasis (P=0.038), and TNM stage (P=0.016), which were not associated with the age, gender, tumor location, degree of differentiation, and vascular tumor thrombus (P>0.050). The predictive value of CTCs for the diagnosis of GC was significantly superior to that of the tumor markers CEA, CA19-9, or CA125. The progression-free survival of patients with low CTCs expression was significantly longer than that in the patients with high CTCs expression (χ2=5.172, P=0.023).ConclusionsDetecting CTCs of patients with GC by immunomagnetic particle negative enrichment combined with immunofluorescence in situ hybridization has a high sensitivity. And it can improve early diagnosis of patients with GC. Preoperative CTCs detection has a certain value in guiding staging of GC and predicting prognosis of patients with GC.
ObjectiveTo summarize the advantages and disadvantages of different surgical approaches in thyroidectomy using the da Vinci robotic surgical system. MethodThe relevant to articles about da Vinci robotic thyroidectomy via different surgical approaches at home and abroad were retrieved and reviewed. ResultsThe robot-assisted transaxillary thyroidectomy had a definite curative effect and was a mature technology. The bilateral axillary-breast approach thyroidectomy had a wide range of applications and was suitable for beginners. The robotic retroauricular approach thyroidectomy had great advantages in the dissection of lateral cervical lymph nodes. The transoral robotic thyroidectomy was a surgical approach that conformed to the minimally invasive concept. Conclusions Da Vinci robotic thyroidectomy via different surgical approaches has its corresponding application scope and advantages. Clinical surgeons should choose an optimal surgical approach according to the tumor location, size and number of patients and the advantages of the operator, so as to achieve the therapeutic effect of radical cure of tumors and reduction of injury.