ObjectiveTo summarize the research status of risk factors of chronic postoperative inguinal pain (CPIP).MethodWe searched and summarized the domestic and foreign literatures about the risk factors of CPIP in recent years.ResultsThere was no doubt that the risk factors of CPIP included preoperative pain, acute pain at postoperative, recurrent inguinal hernia, smaller hernia sac, higher body mass index (BMI), and surgical methods. These effects were controversial such as age, gender, and the mesh. In recent years, hypertension and a past history of chronic pain may also be risk factors for the development of CPIP.ConclusionsThe risk factors of CPIP still need the further study.
ObjectiveTo compare the properties of hernia repair mesh of different materials used in clinical practice, so as to provide reference for clinical selection of numerous meshes at present. MethodThe literatures of different materials of hernia mesh in the treatment of abdominal hernia and inguinal hernia at home and abroad were reviewed.ResultsThe synthetic mesh, especially the polypropylene mesh with wide-pore mesh in the midweight mesh, might be the most ideal synthetic mesh. The new coating material improved the defect of polypropylene material to a great extent. The status of biological mesh in complex hernia repair had been waxed, and it had a tendency to be replaced by absorbable synthetic mesh.ConclusionsCurrently, there is no single mesh suitable for all types of hernia repair. Polypropylene mesh is still an effective and low cost mesh material, and there may be more room for the development of absorbable synthetic materials and antimicrobial coatings.
Objective To construct the eukaryotic expressive vector of human tissue factor （TF），and to abserve the effect of TF on invasion and metastasis of gastric cancer cells line. Methods The human TF cDNA was obtained from human placenta by nest PCR, and the constructed eukaryotic expressive vector TF-pcDNA3 was transfected into SGC7901 cells by lipofectamine. Stable-transfected cells were screened by G418. The expressions of TF mRNA and protein on the cells were detected by RT-PCR and Western blot. Cell motility was assessed by using Transwell experiments and wound-healing assays. Results The eukaryotic expressive vector TF-pcDNA3 was successfully constructed and transfected into SGC7901. Compared with blank control group and negative control group, the expressions of TF mRNA and TF protein in transfection group were increased, the cell motility in vitro was enhanced. Conclusion TF can enhance the ability of invasion and metastasis of gastric cancer cells in vitro.
ObjectiveTo systematically evaluate the effects of biological mesh (BM) and non-absorbable synthetic mesh (SM) on the risks of recurrence, complications, and cost-effectiveness after ventral hernia repair. MethodsThe publicly published related researches of BM versus SM for ventral hernia repair were searched in the PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, CBM databases from the establishment of the databases to August 1, 2021. According to the inclusion and exclusion criteria, the literatures were screened and the data were extracted, and the data that met the conditions were merged and analyzed. The meta-analysis was performed by RevMan5.4.1 software. ResultsA total of 26 studies with 3 259 patients were included, including 1 388 patients in the BM group and 1 871 in the SM group. The results of meta-analysis showed that the recurrence, surgical site infection, surgical site occurrence, reoperation rates, and medical costs in the BM group were higher than those in the SM group (P<0.05). There were no significant differences in the patch infection, seroma, hematoma, wound dehiscence, and readmission rates between the two groups (P>0.05). ConclusionsSM during ventral hernia repair is better than BM on postoperative recurrence, surgical site infection, surgical site occurrence, reoperation, etc., and could reduce medical costs. In the future, it is tried to use more SM in patients with complicated ventral hernia such as cleaning pollution and contaminated environment.
Objective To understand the changes of intestinal flora during perioperative period of colorectal cancer and the mechanism affecting the occurrence of postoperative anastomotic leakage, so as to improve perioperative management of patients and find possible measures to decrease the incidence rate of anastomotic leakage. Method The literature related to perioperative intestinal flora assessment, anastomotic healing, and anastomotic leakage of colorectal cancer in recent years was comprehensively searched in the CNKI, PubMed, and Embase databases and made an review. ResultsDue to the various perioperative interventions, the diversity and abundance of intestinal flora had changed after colorectal cancer surgery, and some conditional pathogenic bacteria such as Enterococcus faecalis, Pseudomonas aeruginosa, etc. increased obviously, which led to collagen degradation through the expression of bacterial collagenase or the excessive activation of matrix metalloproteinases in the host intestine, then might lead to the poor anastomotic healing and even the anastomotic leakage. ConclusionAlthough the evidence of effect of intestinal flora on anastomotic leakage mainly comes from animal experiments, it still shows the potential role of intestinal flora in the occurrence of anastomotic leakage after colorectal cancer surgery, and can be regulated by perioperative intervention, which suggests that it may provide a new strategy for prevention of anastomotic leakage.
ObjectiveTo understand the research progress of Aurora kinase A (AURKA) in colorectal cancer, so as to provide new ideas for treatment of colorectal cancer. MethodThe relevant to literature on AURKA and its relation with colorectal cancer was searched and reviewed. ResultsThe AURKA was a member of the polygenic family of mitosis/threonine protein kinases. The studies in recent years had found that the AURKA not only played an important role in the regulation in the cell cycle processes, but also played a different role outside the cell cycle. The AURKA abnormally expressed in a variety of malignancies, including colorectal cancer, and was associated with a poor prognosis in patients, and many inhibitors against AURKA were developed and evaluated at different stages of clinical study. ConclusionAs a key gene in the occurrence and development of colorectal cancer, AURKA should be further studied to clarify its specific mechanism of action, and targeted drugs may be developed.
Objective To summarize the stemness regulation mechanism of microRNA on invasion, metastasis and chemoresistance of gastric cancer stem cells (GCSCs), and to explore the anti-tumor therapy based on miRNA targeting GCSCs. Method The literatures about the research progress of miRNA and GCSCs at home and abroad in recent years were collected and reviewed. Results MiRNA could regulate a series of important cellular processes such as proliferation, apoptosis, differentiation and epithelial-mesenchymal transition of GCSCs by participating in the expression of related target genes, which was associated with poor prognosis and high mortality of gastric cancer patients. Silencing or restoring the expression of candidate miRNA of GCSCs could provide a novel and promising approach for the treatment of gastric cancer. Conclusions GCSCs have an important relationship with the malignant biological behavior of gastric cancer, and studies have confirmed that miRNA play an important regulatory role in GCSCs. Therefore, miRNA can be used as a potential target for the treatment of gastric cancer. By regulating the expression of specific miRNA, it can inhibit tumor invasion and metastasis, and improve the sensitivity of chemotherapy drugs.
ObjectiveTo investigate the risk factors and establish the predictive pattern of the metachronous liver metastasis after curative surgery for patientswith gastric cancer. MethodsThe clinicopathologic data of patients who underwent radical gastric cancer surgery and met the inclusion and exclusion criteria from January 1, 2015 and January 1, 2018 in the First Hospital of Lanzhou University were retrospectively analyzed. The risk factors affecting metachronous liver metastasis of gastric cancer were screened out by univariate and multivariate logistic regression analysis. And a nomogram prediction model based on the risk factors screened out was established and its predictive efficiency was evaluated. ResultsA total of 203 patients were collected in this study, of whom 41 (20.4%) developed metachronous liver metastasis of gastric cancer. The results of multivariate logistic regression analysis showed that the tumor diameter ≥5 cm, increasing intraoperative bleeding, carcinoembryonic antigen (CEA) ≥5 μg/L, and lymphovascular invasion increased the risks of metachronous liver metastasis of gastric cancer (all P<0.05). The area under the receiver operating characteristic curve and its 95% confidence interval (95%CI) of the nomogram based on these risk factors in predicting metachronous liver metastasis of gastric cancer was 0.850 (0.793, 0.908), and the consistency index (95%CI) was 0.812 (0.763, 0.859). The calibration curve for predicting the risk of metachronous liver metastasis in gastric cancer by the nomogram was close to the 45° ideal curve and had a stronger calibration (Hosmer Limeshow goodness-of-fit test, χ2=2.116, P=0.347). ConclusionsThe results of this study conclude metachronous liver metastasis of gastric cancer is not low, and the patient with lymphovascular invasion, higher level of CEA (≥5 μg/L), more intraoperative bleeding, and larger tumor diameter (≥5 cm) has a higher risk of metachronous liver metastasis of gastric cancer. The nomogram prediction model established based on these risk factors has a good predictive efficiency and can provide reference for clinicians to identify high-risk patient and take early interventions.
Objective To compare the clinical effectiveness of different skin closure techniques in stoma reversal using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, Cochrane Library, PubMed, Embase, and Web of Science databases were searched until February 1, 2021, and randomized controlled trials (RCTs) comparing outcomes between different skin closure techniques were included. Data were processed using Stata MP16.0 and R 3.6.1. Results The results demonstrated that 16 RCTs (n=2 139) were eligible for pooling. Six types of skin closure techniques were used: linear closure, purse-string closure, gunsight closure, linear closure and drainage, purse-string closure and drainage, and linear closure and biological mesh. Network meta-analysis indicated that the incidence of postoperative infection with linear closure was higher than that with purse-string closure [RR=6.04, 95%CI (3.11, 16.89), P<0.0001], gunsight closure [RR=10.75, 95%CI (1.12, 152.12), P=0.04], and linear closure and drainage [RR=3.18, 95%CI (1.24, 10.20), P=0.03]. The purse-string closure was superior to linear closure and biological mesh [RR=0.15, 95%CI (0.01, 0.88), P=0.03] in reducing postoperative infection. The length of hospital stay after linear suture was longer than that after linear suture and drainage [MD=1.16, 95%CI (0.29, 2.20), P=0.02]. Conclusions This network meta-analysis suggests that purse-string closure and gunsight closure might be best for reducing postoperative infection, and the addition of drainage could not further reduce the incidence of postoperative infection. In addition, implantation of the biological mesh does not increase the risk of postoperative infection. However, a large-scale RCT is warranted to confirm the results.
Objective To evaluate the clinical effectiveness and safety of different mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) by using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases were retrieved to collect randomized controlled trials (RCTs) studies comparing different fixation methods of patches in laparoscopic TAPP. The retrieval time limit was from the establishment of the database to March 1, 2022. After two researchers independently screened the literatures, extracted the data, and evaluated the bias risk, Bayesian network meta-analysis was conducted by using R4.1.2 software. Results Twenty-nine RCTs were included, including 4 095 patients. The results of network meta-analysis showed that the risk of chronic postoperative inguinal pain was higher in staples fixation than that of no fixation [OR=0.06, 95%CI (0.01, 0.26), P＜0.001], glue fixation [OR=0.21, 95%CI (0.04, 0.53), P=0.001] and self-gripping mesh [OR=0.09, 95%CI (0.01, 0.52), P=0.009], the incidence of chronic postoperative inguinal pain with suture fixation was higher than that with no fixation [OR=0.10, 95%CI (0.01, 0.70), P= 0.020]. Postoperative visual analogue scale of staples fixation was higher than those of no fixation [MD=–0.90, 95%CI (–1.49, –0.33), P=0.002] and glue fixation [MD=–0.92, 95%CI (–1.35, –0.49), P＜0.001], the postoperative visual analogue scale with suture fixation was higher than those of no fixation [MD=–0.83, 95%CI (–1.61, –0.08), P=0.030] and glue fixation [MD=–0.85, 95%CI (–1.56, –0.13), P=0.020]. There was no significant difference in the incidence of seroma and hematoma, hospital stay and hernia recurrence among different fixation methods. Conclusions The network meta-analysis shows that medical glue and self-gripping mesh have certain advantages in reducing chronic pain after surgery, which may be the better patch fixation method in TAPP. The non fixation mesh will not increase the risk of postoperative recurrence, and can be used in clinical practice. This conclusion needs to be further verified by large sample, long-term follow-up and high-quality RCTs.