Objective To analyze the effectiveness and advantages of the microsurgical repair of flexor tendon rupture with non-knot Kessler suture method in anastomotic stoma by comparing with the method of traditional Kessler suture. Methods Between February 2005 and February 2010, 122 patients (163 fingers with 243 flexor digital tendons) with flexor tendon rupture, were treated with microsurgical repair by non-knot Kessler suture method (treatment group); flexor tendon was sutured, and sodium hyaluronate was used to repair tendon membrane, tendon sheaths, and the tissue surroundingtendons. The cl inical data were analysed, and were compared with ones from 96 patients (130 fingers with 186 flexor digital tendons) with flexor tendon rupture treated with traditional Kessler suture between February 2001 and February 2005 (control group). There was no significant difference in gender, age, cause of injury, injury site, duration, and other general information between 2 groups (P gt; 0.05). Kleinert elastic traction therapy (dynamic-protection) was performed at 3 weeks after surgery, and the finger function exercise was done after 24 hours. Results Infection of incision occurred in 2 cases of the treatment group and in 5 cases of the control group, and were cured after 2 weeks of dressing change; the other incisions healed by first intention. The patients were followed up 6 to 14 months (mean, 9 months). In the treatment group, the total active movement (TAM) was (192.0 ± 13.1)°; the results were excellent in 54 cases, good in 58 cases, moderate in 8 cases, and poor in 2 cases with an excellent and good rate of 92%. In the control group, TAM was (170.0 ± 15.2)°; the results were excellent in 23 cases, good in 30 cases, moderate in 22 cases, and poor in 21 cases with an excellent and good rate of 55%. Significant difference in TAM was found between 2 groups (P lt; 0.01). Conclusion The microsurgical repair of flexor tendon with non-knot Kessler suture method in anastomotic stoma with repair of tendon membrane, tendon sheaths, and the tissue surrounding tendons is more effective than the traditional Kessler suture, but long-term effectiveness still needs further observation.
ObjectivesTo systematically review the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy.MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy from inception to January 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 034 patients were included. The results of meta-analysis showed that: fast track surgery in perioperative patients with adrenalectomy could shorten first exhaust time (MD=−17.16, 95%CI −21.86 to −12.46, P<0.000 01), postoperative catheter indwelling time (MD=−43.44, 95%CI −46.65 to −40.23, P<0.000 01) and drainage tube indwelling time (MD=−39.91, 95%CI −57.58 to −22.23, P<0.000 01), and reduce the incidence of complications after adrenalectomy (OR=0.26, 95%CI 0.1 to 0.39, P<0.000 01). There were no statistically differences in operation time (MD=−1.18, 95%CI −3.22 to 0.86, P=0.26) and blood loss (MD=0.25, 95%CI −2.84 to 3.34, P=0.88) between two groups.ConclusionsCurrent evidence shows that, compared with the conventional rehabilitation group, fast track surgery can promote postoperative recovery of patients with adrenalectomy more safely and effectively, which has clinical promotion value. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
Objective To investigate expressions of silence signal regulating factor-1 (SIRT-1) and epithelial cadherin (E-cadherin) in gastric cancer and their clinical significances. Methods The immunohistochemistry SP technique was used to detect the expressions of SIRT-1 and E-cadherin in the gastric cancer tissues and their corresponding paracancerous gastric tissues. The relationship between the SIRT-1 expression and E-cadherin expression was analyzed using Spearman. Results The positive rate of the SIRT-1 protein expression in the gastric cancer tissues was significantly higher than that of the corresponding paracancerous gastric tissues (χ2=5.791, P=0.016). The SIRT-1 protein positive expression was related to the Lauren histological type of gastric cancer (χ2=4.941, P=0.026), in other words, in the intestinal type was significantly higher than that of the diffuse type, but which was not related to the age, gender, tumor size, tumor site, differentiation degree, TNM stage, or lymph node metastasis (P>0.05). While the positive rate of the E-cadherin protein expression in the gastric cancer tissues was significantly lower than that of the corresponding paracancerous gastric tissues (χ2=10.868, P=0.001), which in the intestinal type of gastric cancer was significantly lower than that in the diffuse type of gastric cancer (χ2=5.203, P=0.023), also not related to the age, gender, tumor size, tumor site, differentiation degree, TNM stage, or lymph node metastasis (P>0.05). There was a negative correlation between the SIRT-1 protein and the E-cadherin protein (rs=–0.381, P=0.013). Conclusions Gastric cancer with higher SIRT-1 expression might be way to achieve tumor development through E-cadherin as a facilitator. Upregulation of SIRT-1 and declining of E-cadherin might play a possible role in intestinal type gastric cancer.