ObjectiveTo systematically review the effectiveness and safety of laparoscopic total mesorectal excision(LTME) vs. open total mesorectal excision (OTME) in treating rectal cancer. MethodsRandomized controlled trials (RCTs) about LTME vs. OTME for rectal cancer were searched in PubMed, The Cochrane Library (Issue 4, 2014), EMbase, CNKI, CBM and WanFang Data from the date of their establishment to April 2014. Other relevant journals and references of included studies were also searched manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2. ResultsA total of fifteen RCTs involving 2 268 patients were enrolled. The results of meta-analysis indicated that:a) for effectiveness, LTME and OTME were alike in resection length of the intestine (MD=-0.52, 95%CI-1.29 to 0.25, P=0.18), dissection number of lymph nodes (MD=-0.11, 95%CI-0.75 to 0.52, P=0.73), 1-year survival rate (RR=0.99, 95%CI 0.96 to 1.02, P=0.52), and 3-year survival rate (RR=0.99, 95%CI 0.93 to 1.04, P=0.63) with no significant difference. For safety, LTME had longer operation time (MD=29.64, 95%CI 14.90 to 44.39, P < 0.000 1); caused less intra-operative bleeding (MD=-105.51, 95%CI-133.95 to-77.08, P < 0.000 01); and shortened post-operative anal exsufflation time (MD=-0.99, 95%CI-1.35 to-0.62, P < 0.000 01), catheterization time (MD=-2.02, 95%CI-2.20 to-1.83, P < 0.000 01) as well as hospital stay (MD=-3.47, 95%CI-4.20 to-2.74, P < 0.000 01). Besides, LTME had less postoperative complications such as anastomotic leak (RR=0.67, 95%CI 0.37 to 1.22, P=0.19) and wound infection (RR=0.43, 95%CI 0.26 to 0.73, P=0.002). However, LTME and OTME were alike in the incidence of intestinal obstruction (RR=0.53, 95%CI 0.28 to 1.00, P=0.05). ConclusionCurrent evidence indicates that LTME and OTME are alike in effectiveness, but LTME could cause less bleeding, shorten time of catheterization, post-operative anal exsufflation and hospital stay with less post-operative complications. Due to the limited quantity and quality of the included studies, more larger sample, multicenter, high quality RCTs are needed to verify the above conclusion.
ObjectiveTo systematically review the tumor necrosis factor-α (TNF-α) -308G/A polymorphism and the risk of inflammatory bowel disease (IBD). MethodsAll eligible case-control studies published up to Jan 25th 2015 were identified by searching PubMed, EMbase, CNKI, WanFang Data, CBM and VIP databases. Two reviewers independently screened the studies according to the inclusion and exclusion criteria, extracted data and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 and Stata 12.0 softwares. ResultsA total of 20 studies involving 2 860 IBD cases and 5 033 controls were included. The results of meta-analysis showed:Compared with the wild genotype GG, genotype GA, AA and genotype GA+AA were associated with susceptibility of ulcerative colitis (UC) (GA vs. GG:OR=1.45, 95%CI 1.02 to 2.07, P=0.04; AA vs. GG:OR=2.01, 95%CI 1.32 to 3.05, P=0.001; GA+AA vs. GG:OR=1.51, 95%CI 1.07 to 2.13, P=0.02); Compared with genotype GA+AA, genotype AA increased the risk of UC (AA vs. GA+GG:OR=1.92, 95%CI 1.26 to 2.91, P=0.002); allele A did not increase the risk of UC; Compared with genotype GG, genotype AA increased the risk of Crohn disease (CD) (AA vs. GG:OR=1.49, 95%CI 1.07 to 2.08, P=0.02); Compared with genotype GA+GG, while genotype AA increased the risk of CD (AA vs. GA+GG:OR=1.50, 95%CI 1.08 to 2.09, P=0.02); genotype GA, GA+AA and allele A did not increase the risk of CD. In stratification analyses by ethnicity, we found that the TNF-α-308G/A was significat associated with IBD in Europeans. ConclusionCurrent evidence indicates that TNF-α-308G/A polymorphism is associated with the susceptibility of IBD, genotype GA, AA and GA+AA increase the risk of suffering from UC while genotype AA increase the risk of suffering from CD. Due to the limited quantity of the included studies, more researches are needed to verify the above conclusion.
ObjectiveTo investigate the risk factors, prognostic factors and prognosis of Multidrug-Resistant Acinetobacter Baumannii (MDR-AB) infection of lower respiratory tract in Intensive Care Unit (ICU) of the Second Affiliated Hospital of Anhui Medical University. MethodsUsing retrospective analysis, we reviewed and compared clinical data of 77 AB infections in lower respiratory tract cases in ICU from January 2013 to March 2015. According to the resistance, patients were divided into a MDR-AB group and a NMDR-AB group. Then the risk factors, prognostic factors and prognosis of MDR-AB infection were analyzed. ResultsA total of 58 cases in the MDR-AB group, 19 cases in the NMDR-AB group were included. The result showed that, the MDR-AB infection in lower respiratory tract could significantly prolong the length of ICU stay (18.5±16.0 vs. 10.6±9.3 days, P<0.05) and increase the mortality (44.8% vs. 11.1%, P<0.01). Logistic regression analysis showed that the independent risk factors for MDR-AB infection in lower respiratory tract included Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score >15 (OR=0.138, 95%CI 0.03 to 0.625, P=0.01) and use of carbapenems (OR=0.066, 95%CI 0.012 to 0.0346, P=0.001). The independent prognostic factors included placement of drainage tube (OR=8.743, 95%CI 1.528 to 50.018, P=0.015) and use of vasoactive drugs (OR=12.227, 95%CI 2.817 to 53.074, P=0.001). ConclusionThe MDR-AB infection in lower respiratory tract can significantly prolong the length of ICU stay and increase the mortality. The Apache Ⅱ score >15 and use of carbapenems are the risk factors, and the placement of drainage tube and use of vasoactive drugs can increase the mortality of MDR-AB infection of lower respiratory tract in ICU.