Outcomes for jejunal interposition reconstruction compared with Roux-en-Y anastomosis:A meta-analysis

AIM:To compare the clinical outcomes between jejunal interposition reconstruction and Roux-en-Y anastomosis after total gastrostomy in patients with gastric cancer.METHODS:A systematic literature search was conducted by two independent researchers on Pub Med,EMBASE,the Cochrane Library,Google Scholar,and other English literature databases,as well as the Chinese Academic Journal,Chinese Biomedical Literature Database,and other Chinese literature databases using "Gastrostomy","Roux-en-Y",and "Interposition" as keywords.Data extraction and verification were performed on the literature included in this study.Rev Man 5.2 software was used for data processing.A fixed-effects model was applied in the absence of heterogeneity between studies.A random effects model was applied in the presence of heterogeneity between studies.RESULTS:Ten studies with a total of 762 gastric cancer patients who underwent total gastrostomy were included in this study.Among them,357 received jejunal interposition reconstruction after total gastrostomy,and 405 received Roux-en-Y anastomosis.Compared with Roux-en-Y anastomosis,jejunal interposition reconstruction significantly decreased the incidence of dumping syndrome(OR = 0.18,95%CI:0.10-0.31;P < 0.001),increased the prognostic nutritional index [weighted mean difference(WMD) = 6.02,95%CI:1.82-10.22;P < 0.001],and improved the degree of postoperative weight loss [WMD = 2.47,95%CI:-3.19-(-1.75);P < 0.001].However,there is no statistically significant difference in operative time,hospital stay,or incidence of reflux esophagitis.CONCLUSION:Compared with Roux-en-Y anastomosis,patients who underwent jejunal interposition reconstruction after total gastrostomy had a lower risk of postoperative long-term complications and improvedlife quality.

Effect of Nephritis Rehabilitation Tablets combined with tacrolimus in treatment of idiopathic membranous nephropathy

BACKGROUND Idiopathic membranous nephropathy(IMN)has a high incidence in the middleaged and elderly population,and poses a great threat to the physical and mental health and quality of life of patients.Nephritis Rehabilitation Tablets have many potential effects,such as clearing residual toxins,tumefying the kidney and spleen,replenishing qi,and nourishing yin,and have played an important role in the treatment of a variety of kidney diseases.AIM To investigate the efficacy and safety of Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN.METHODS Eighty-four patients with IMN recruited from January 2017 to September 2020 were randomly divided into a study group(n=42)and a control group(n=42).On the basis of routine symptomatic treatment,both groups were treated with tacrolimus,and the study group was additionally treated with Nephritis Rehabilitation Tablets.Both groups were treated for 12 wk.The therapeutic effect,the levels of renal function indexes[serum creatinine(Scr),serum albumin,and 24-h urinary protein],urinary immunoglobulin(IgG4),membrane attack complex(C5b-9),and the incidence of adverse reactions were measured before and after 12 wk of treatment.RESULTS The total effective rate in the study group was significantly higher than that of the control group.Before treatment,there was no significant difference in Scr,serum albumin,or 24 h urinary protein between the two groups.After 12 wk of treatment,the levels of Scr and 24-h urinary protein in both groups were significantly lower and serum albumin was significantly higher than those before treatment(P<0.05),and the levels of Scr and 24-h urinary protein were significantly lower(P=0.003 and 0.000,respectively),and the level of serum albumin was significantly higher(P=0.00)in the study group than in the control group.Before treatment,there was no significant difference in urinary IgG4 and C5b-9 levels between the study group and the control group(P=0.336 and 0.438,respectively).After 12 wk of treatment,the levels of urinary IgG4 and C5b-9 in the two groups were lower than those before treatment,and the levels of urinary IgG4 and C5b-9 in the study group were significantly lower than those in the control group(P=0.000).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.710).CONCLUSION Based on routine intervention,Nephritis Rehabilitation Tablets combined with tacrolimus in the treatment of IMN can effectively improve the renal function of patients and downregulate the expression of urinary IgG4 and C5b-9.In addition,they can improve the overall therapeutic effect while not increasing the risk of adverse reactions.

Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism

BACKGROUND Superior mesenteric artery embolism(SMAE)has acute onset and fast progression,which seriously threatens the life of patients.Multidetector computed tomography(MDCT)is one of the most important diagnostic methods for SMAE,which plays an important role in the diagnosis and prognosis of SMAE.AIM To evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.METHODS Data from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected.Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.RESULTS Univariate Cox regression model showed that intestinal wall thinning,intestinal wall pneumatosis,blood lactate>2.1 mmol/L and blood pH<7.35 increased the risk of death in patients with SMAE.After adjusting for age,sex,embolic involvement length and embolic distribution region,multivariate Cox regression model I showed that blood lactate>2.1 mmol/L(HR=5.26,95%CI:1.04-26.69,P=0.045)and intestinal wall thinning(HR=9.40,95%CI:1.05-83.46,P=0.044)were significantly increases the risk of death in patients with SMAE.CONCLUSION For patients with SAME,increased blood lactate and intestinal wall thinning are the risk factors for death;hence,close monitoring may reduce the mortality rate.Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.

Study on the Effect of Ginaton on Reducing Cerebral Vasospasm and Early Brain Injury after Hemorrhagic Stroke by Inhibiting Inflammatory Response

Objective:The objective of this study was to investigate the effects and possible mechanisms of action of ginseng on cerebral vasospasm and early brain injury(EBI)following hemorrhagic stroke.Materials and Methods:Sprague-Dawley(SD)rats(n=48)were randomly divided into sham operation(sham group),subarachnoid hemorrhage(SAH)model(SAH group),normal saline(NS group),and Ginaton(Extract of Ginkgo Biloba Leaves Drops)intervention(gin group)groups.MCP-1 m RNA and tumor necrosis factor levels were detected using reverse transcription-polymerase chain reaction.The relative expression of m RNA was detected by Western blotting.Results:(1)Compared with the sham group,the SAH,NS,and gin groups had different degrees of neurological dysfunction.Compared with the SAH and NS groups,the neurological deficits in the gin group were significantly improved(P<0.05).(2)Compared with the sham group,the relative expression levels of MCP-1 m RNA in the SAH,NS,and gin groups were 5.1±0.9,3.4±0.6,and 2.5±0.4,respectively;the relative expression levels of m RNA were 13.3±2.4,11.2±1.8,and 3.8±0.6,respectively.(3)The apoptosis rates of brain tissue in the sham,SAH,NS,and gin groups were 4.8±0.7,54.2±10.3,50.1±7.4,and 28.4±4.5,respectively.(4)Western blot showed that the relative expression levels of toll-like receptor-4(TLR-4)protein in the sham,SAH,NS,and gin groups were 0.29±0.03,0.87±0.15,0.65±0.13,and 0.41±0.17,respectively;the relative expression levels of B protein were 0.21±0.04,0.96±0.14,0.73±0.18,and 0.30±0.05,respectively.Gin treatment could inhibit TLR-4 and nuclear factor-κB(NF-κB)protein expression.Conclusions:Dona tablets may inhibit activation of the NF-κB signaling pathway,and SAH-induced inflammatory response,so as to reduce cerebral vasospasm and EBI.

Lack of association between integrin αvβ3 gene polymorphisms and hemorrhagic fever with renal syndrome in Han Chinese from Hubei, China

Hantaviruses belong to the family Bunyaviridae and cause hemorrhagic fever with renal syndrome(HFRS) in humans. β_3 integrins, including α_Vβ_3 and α_(Ⅱb)β_3 integrins, act as receptors on endothelial cells and play key roles in cellular entry during the pathogenesis of hantaviruses. Previous study demonstrated that the polymorphisms of integrin α_(Ⅱb)β_3are associated with susceptibility to hantavirus infection and the disease severity of HFRS in Shaanxi Province of China, rather than in Finland. However, the polymorphisms of integrin α_vβ_3 in patients with HFRS was incompletely understood. Here, we aimed to investigate the associations between polymorphisms in human integrin α_vβ_3 and HFRS in Han Chinese individuals. Ninety patients with HFRS and 101 healthy controls were enrolled in this study. Analysis of five single nucleotide polymorphism(SNP) sites(rs3768777 and rs3738919 on ITGAV; rs13306487, rs5921, and rs5918 on ITGB3) was performed by Taq Man SNP genotyping assays and bi-directional PCR allele-specific amplification method. No significant differences were observed between the HFRS group and controls regarding the genotype and allele frequency distributions of any of the five SNP sites, and no associations were found between ITGAV polymorphisms/genotypes and disease severity. In conclusion, our results implied that these five SNPs in the integrin α_vβ_3 gene were not associated with HFRS susceptibility or severity in Han Chinese individuals in Hubei Province.