Abstract: Objective To Evaluate the clinical outcome of gastric tube in radical surgeries to treat esophageal and cardial carcinoma. Methods From January to October 2008, 74 patients with esophageal or cardial carcinoma in Ruijin Hospital were enrolled in our study. Based on the surgical method, they were divided into the gastric tube group and the traditional way group. The gastric tube group had 46 patients, including 36 male patients and 10 female patients, whose age averaged 59.67±9.96 years (36 to 77 years). Among them, 31 patients had esophageal carcinoma with 1 upper, 23 middle and 7 lower esophageal carcinoma, and 15 patients had cardial carcinoma. In this group, 2 patients were treated with anastomosis in the left neck, 19 with anastomosis in the upper aortic arch, 10 with anastomosis in the lower aortic arch and 15 cardial carcinoma patients underwent radical resection. In the traditional way group, there were 28 patients, 25 male patients and 3 female patients, whose age averaged 59.17±11.33 years (37 to 86 years). In these patients, 22 had esophageal carcinoma with 1 in the upper esophagus, 17 in the middle esophagus, 4 in the lower esophagus; and 6 patients had cardial carcinoma. In this group, 2 patients were treated with anastomosis in the left neck , 17 with anastomosis in the upper aortic arch, 3 with anastomosis in the lower aortic arch, and 6 cardial carcinoma patients underwent radical resection. The rate of anastomotic leakage, operation time, and length of stay in hospital of these two groups were observed. Results All surgeries in the two groups were successfully performed. There was no anastomotic leakage case in the gastric tube group, while there were 4 pulmonary infection cases and 1 death case in the traditional way group. There was no statistically difference in the operation time (180.00±10.34 min vs. 185.00±6.23 min, t=1.669, P=0.078) and length of stay in hospital (16.78±9.98 d vs. 16.89±11.53 d, t=1.665, P=0.075) between the gastric tube group and the traditional way group. Conclusion Gastric tube has a good value in clinical application with fewercomplications and without prolonging operation and hospitalization time, which can surely better quality of life of the patients.
Objective To evaluate the effects of robot-assisted Ivor Lewis esophagectomy (RAILE) in surgical treatment of esophageal cancer. Methods We retrospectively analyzed the clinical data of 70 patients diagnosed with mid-lower esophageal cancer undergoing RAILE in the Department of Thoracic Surgery in Ruijin Hospital Affiliated to Shanghai Jiaotong University between May 2015 and April 2018. There were 54 males and 16 females at average age of 62.0±7.6 years. Forty patients underwent circular end-to-end stapled intrathoracic anastomosis and 30 had a double-layered, completely hand-sewn intrathoracic anastomosis. Results The mean operating time was 308.7±60.6 minutes. And blood loss was 190.0±95.1 ml. There were 2 patients who underwent conversion to thoracotomy. There was no in-hospital and 30-day mortality. Overall complications were observed in 24 patients (34.3%), of whom 6 patients (8.6%) had anastomotic leakage. The median length of hospitalization was 9.0 (interquartile range, IQR, 5.0) days. The mean tumor size was 3.2±1.5 cm, and R0 resection was achieved in all patients. The mean number of totally dissected lymph nodes was 19.3±8.7. Conclusion RAILE is safe and technically feasible with satisfactory perioperative outcomes.
ObjectiveTo systematically review the efficacy of moxibustion in the treatment of model rabbits with knee osteoarthritis (KOA).MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect animal experiments on moxibustion in the treatment of model rabbits with KOA from inception to January 31st, 2019. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.3 software.ResultsA total of 13 articles involving 226 model rabbits were included. The results of meta-analysis showed that moxibustion could reduce Mankin score (MD=−6.47, 95%CI −7.63 to −5.32, P<0.000 01), positive expression rate of chondrocyte apoptosis (MD=−22.21, 95%CI −23.22 to −21.21, P<0.000 01), level of IL-1β in joint fluid (SMD=−8.40, 95%CI −15.09 to −1.72, P=0.01), NO content in joint fluid (SMD=−11.03, 95%CI −17.87 to −4.19, P=0.002), the level of serum IL-1β (MD=−19.94, 95%CI −23.61 to −16.27, P<0.05), and serum NO content (MD=−22.69, 95%CI −28.77 to −16.61, P<0.05) of model rabbits with KOA.ConclusionsCurrent evidence shows that moxibustion can improve articular cartilage injury, strengthen chondrocyte activity, inhibit the inflammatory response, and inhibit chondrocyte apoptosis of model rabbits with KOA. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo systematically review the efficacy of acupuncture for PCOS infertility.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of acupuncture for PCOS infertility from inception to January 5th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 28 RCTs involving 2 192 patients were included. The results of meta-analysis showed that compared with western medicine alone, acupuncture could increase the pregnancy rate (RR=1.80, 95%CI 1.45 to 2.23, P<0.000 01) and ovulation rate (RR=1.33, 95%CI 1.15 to 1.54, P=0.000 1), and reduce levels of LH (SMD=−0.62, 95%CI −0.96 to −0.28, P=0.000 4) and LH/FSH (SMD=−0.65, 95%CI −1.02 to −0.29, P=0.000 5). Acupuncture combined with western medicine could increase the pregnancy rate (RR=1.75, 95% CI 1.50 to 2.03, P<0.000 01) and ovulation rate (RR=1.29, 95%CI 1.18 to 1.41, P<0.000 01), decrease levels of LH (SMD=−1.09, 95%CI −1.64 to −0.53, P=0.000 1), LH/FSH (SMD=−1.30, 95%CI −2.35 to −0.25, P=0.02), and levels of T (SMD=−1.13, 95%CI −1.59 to −0.66, P<0.000 01).ConclusionsCurrent evidence shows that acupuncture alone or combined with western medicine can significantly improve ovulation rate, pregnancy rate and reduce hormone level. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo explore the training mode of robotic surgical system for thoracic surgeons.MethodsThirteen surgeons enrolled in the Department of Thoracic Surgery, Ruijin Hospital from May 2015 to December 2019 were targeted for training. Training methods included learning basic knowledge of Da-Vinci robotic system, simulation platform training, physical simulation training, training on animal models, practice of thoracic surgery and video analysis.ResultsThe robotic operation skills of the surgeons were improved. Currently 4 surgeons were qualified for using robotic system to do thoracic surgery, and 9 surgeons had assistant qualification.ConclusionMultiple modes of training can help surgeons learn and master the techniques of robotic surgery, and will provide the basis for robotic training standard.
ObjectiveTo systematically review the efficacy and safety of fire needle in the treatment of post-herpetic neuralgia. MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of fire needle for post-herpetic neuralgia from inception to June 5th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 31 RCTs involving 2 755 patients were included. The results of meta-analysis showed that compared with western medicine, fire needle could reduce VAS score (SMD=−1.00, 95%CI −1.36 to −0.63, P<0.000 01). Fire needle combined with western medicine could improve the total efficiency (RR=1.15, 95%CI 1.06 to 1.23, P=0.000 3), reduce VAS score (SMD=−1.92, 95%CI −2.87 to −0.97, P<0.000 1), and SAS rating (SMD=−0.89, 95%CI −1.20 to −0.59, P<0.000 01). Compared with conventional acupuncture, fire needle could reduce VAS score (SMD=−1.37, 95%CI −2.35 to −0.39, P=0.006), and immediate analgesic time (SMD=−0.64, 95%CI −0.88 to −0.39, P<0.000 01). Compared with the traditional Chinese medicine, fire needle could reduce VAS score (SMD=−1.00, 95%CI −1.53 to −0.47, P=0.000 2), SDS rating (SMD=−1.59, 95%CI −1.18 to −1.31, P<0.000 01), SAS rating (SMD=−1.79, 95%CI −2.08 to −1.49, P<0.000 01). In addition, the incidence of adverse reactions in experimental group was significantly lower than that in the control group. ConclusionCurrent evidence shows that fire needle can significantly reduce pain intensity, relieve anxiety, and improve the quality of life of post-herpetic neuralgia patients. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Uniportal video-assisted thoracic surgery (UniVATS) is a significant approach of mini-invasive surgery for lung cancer. UniVATS was first used for treatment of lung cancer in 2010. The European consensus and the Chinese consensus were published in 2019 and 2020 respectively. The latest Chinese consensus included the definition of UniVATS, indications for lung cancer treatment, safety and feasibility, surgical skills, learning curve, short-term and long-term results, providing suggestions for the standardization of uniportal video-assisted thoracic surgery, which are essential to improve the quality of surgery and reduce the incidence of related complications. The Chinese consensus also summarized the current status of subxiphoid UniVATS and non-intubated UniVATS for lung cancer. Considering the technical difficulties and challenges, the application of both technologies in clinical treatment has certain limitation. This article aims to give an interpretation of the results of the Chinese consensus and the similarities and to compare the differences with the European consensus, and to provide a reference for the majority of thoracic surgery colleagues.
ObjectiveTo explore the correlation between the functional status of upper limb motor neurons and motor function in stroke patients, and provide guidance for rehabilitation assessment and functional prognosis.MethodsThe stroke patients who were hospitalized in Department of Rehabilitation Medicine of Zhongda Hospital of Southeast University between November 2020 and January 2021 were selected. Motor unit number estimation (MUNE) and F wave were examined to evaluate the functional status of motor neuron. The Fugl-Meyer Assessment (FMA) and Modified Ashworth Scale (MAS) were used to evaluate the upper limb motor function. The correlations of electrophysiological parameters with FMA score and MAS score were analyzed respectively.ResultsA total of 42 patients were enrolled, and 16 patients were complicated with carpal flexor spasm on the affected side. Among the 42 stroke patients, the MUNE of the abductor pollicis brevis on the affected side was lower than that on the unaffected side (t=−3.466, P=0.001), and the percentage of F waves with different shapes on the affected side was significantly lower than that on the unaffected side (Z=−5.583, P<0.001). Among the 16 stroke patients with carpal flexor spasm, the F wave amplitude was higher on the affected side than that on the unaffected side (t=2.764, P=0.014), while the F wave latency on the affected side was not statistically significant compared with the unaffected side (Z=−0.595, P=0.552). Among the 42 stroke patients, the affected/unaffected side ratio of the percentage of F waves with different shapes was positively correlated with FMA score (rs=0.377, P=0.014), while the correlation between the affected/unaffected side ratio of MUNE and FMA score was not statistically significant (rs=0.104, P=0.513). Among the 16 stroke patients with carpal flexor spasm, the affected/unaffected side ratio of the F wave amplitude was positively correlated with the MAS score of the carpi flexor muscle (rs=0.550, P=0.027).ConclusionStroke may result into the number of functional motor neurons of the upper limbs of the hemiplegic side decreased and the excitability of motor neurons increased simultaneously, and which were related to motor function and muscle tone.
According to the evidence pyramid model, systematic review (SR)/meta-analysis (MA) is one of the essential sources with a high level of clinical evidence. A high-quality SR/MA can effectively guide clinical decision-making and practice. The preferred reporting items for systematic reviews and meta-analyses extension for Chinese herbal medicines (PRISMA-CHM) were officially published in 2020. In this study, based on research cases, the features of PRISMA-CHM were interpreted in detail, so as to help domestic users accurately grasp the details of the reports, in order to improve the quality of the reports of SR/MA of traditional Chinese medicine.
The precise localization of pulmonary nodules has become an important technical key point in the treatment of pulmonary nodules by thoracoscopic surgery, which is a guarantee for safe margin and avoiding removal of too much normal lung parenchyma. With the development of medical technology and equipment, the methods of locating pulmonary nodules are also becoming less trauma and convenience. There are currently a number of methods applied to the preoperative or intraoperative localization of pulmonary nodules, including preoperative percutaneous puncture localization, preoperative transbronchial localization, intraoperative palpation localization, intraoperative ultrasound localization, and localization according to anatomy. The most appropriate localization method should be selected according to the location of the nodule, available equipment, and surgeon’s experience. According to the published literatures, we have sorted out a variety of different theories and methods of localization of pulmonary nodules in this article, summarizing their advantages and disadvantages for references.