Integrating finite element analysis in total hip arthroplasty for childhood hip disorders:Enhancing precision and outcomes

Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for these complex cases.This article explores the integration of finite element analysis(FEA)to enhance surgical precision and outcomes.FEA provides detailed biomechanical insights,aiding in preoperative planning,implant design,and surgical technique optimization.By simulating implant configurations and assessing bone quality,FEA helps in customizing implants and evaluating surgical techniques like subtrochanteric shortening osteotomy.Advanced imaging techniques,such as 3D printing,virtual reality,and augmented reality,further enhance total hip arthroplasty precision.Future research should focus on validating FEA models,developing patient-specific simulations,and promoting multidisciplinary collaboration.Integrating FEA and advanced technologies in total hip arthroplasty can improve functional outcomes,reduce complications,and enhance quality of life for patients with childhood hip disorder sequelae.

Analysis of Hupehenine in the Total Alkaloids from Fritillaria hupehensis by HPLC-ELSD

A reverse-phase high pressure liquid chromatography （HPLC） method with evaporative light scattering detection （ELSD） has been developed for the quantitative analysis of hupehenine in the total alkaloids from Fritillaria hupehensis. Samples were analyzed on a reverse-phase column （Hypersil C-18） with a mobile phase of methanol：water：chloroform： triethylamine （85：15：1：0.6）. The ELSD was set at the drift tube temperature of 68.3℃ and gas flow rate of 1.8 L/min. Hupehenine＇s retention time was 13.7 min with an asymmetry factor of 1.2. The validity of the method has been verified with linearity, limit of detection, accuracy and precision. The logarithmic linear curve was obtained from 8.936 to 134.04 μg/mL （r=0.9993）. The detection limit （S/N〉3） of hupehenine was 1.79 μg/mL on the column. Intra-day RSD was 1.42% and inter-day RSD was 2.26% （3 days within a week）. The average recovery of hupehenine was 101.50%, and RSD was 1.62%.

Comparative analysis of the short and medium-term efficacy of the Da Vinci robot versus laparoscopic total mesangectomy for rectal cancer

BACKGROUND The Da Vinci robot-assisted surgery technique has been widely used in laparo-scopic mesangectomy for rectal cancer.However,the short-term efficacy of these procedures compared to traditional laparoscopic surgery remains controversial.The purpose of this study was to compare and analyze the short-and medium-term efficacy of Da Vinci robot and laparoscopic surgery in total mesangectomy(TME)for rectal cancer,so as to provide guidance and reference for clinical practice.AIM To investigate the safety and long-term efficacy of robotic and laparoscopic total mesorectal resection for the treatment of rectal cancer.METHODS The clinicopathologic data of 240 patients who underwent TME for rectal cancer in the Anorectal Department of People’s Hospital of Xinjiang Uygur Autonomous Region from August 2018 to March 2023 were retrospectively analyzed.Among them,112 patients underwent laparoscopic TME(L-TME)group,and 128 patients underwent robotic TME(R-TME)group.The intraoperative,postoperative,and follow-up conditions of the two groups were compared.RESULTS The conversion rate of the L-TME group was greater than that of the R-TME group(5.4%vs 0.8%,χ^(2)=4.417,P=0.036).The complication rate of the L-TME group was greater than that of the R-TME group(32.1%vs 17.2%,χ^(2)=7.290,P=0.007).The percentage of positive annular margins in the L-TME group was greater than that in the R-TME group(7.1%vs 1.6%,χ^(2)=4.658,P=0.031).The 3-year disease-free survival(DFS)rate and overall survival(OS)rate of the L-TME group were lower than those of the R-TME group(74.1%vs 85.2%,χ^(2)=4.962,P=0.026;81.3%vs 91.4%,χ^(2)=5.494,P=0.019);in patients with American Joint Committee on Cancer stage Ⅲ DFS rate and OS rate in the L-TME group were significantly lower than those in the R-TME group(52.5%vs 76.1%,χ^(2)=5.799,P=0.016;65.0%vs 84.8%,χ^(2)=4.787,P=0.029).CONCLUSION Compared with the L-TME group,the R-TME group had a better tumor prognosis and was more favorable for patients with rectal cancer,especially for patients with stage Ⅲ rectal cancer.

Gait Kinematic Analysis Facilitates Rapid Early Recovery Following Total Knee Arthroplasty

Objective: To explore gait kinematics analysis and evaluate the surgical efficacy of total knee arthroplasty (TKA), as well as its guiding significance for postoperative rehabilitation. Method: Fifty patients admitted to TKA treatment for knee osteoarthritis from December 2022 to July 2023 were included, which were divided into an intervention group (gait kinematics analysis group, n = 25) and a control group (conventional rehabilitation program group, n = 25). All patients underwent HSS score and KSS score before surgery (T0), 1 month after surgery (T1), 3 months after surgery (T2), and 6 months after surgery (T3). The intervention group underwent gait kinematics analysis at 1 month after surgery (T1) and 3 months after surgery (T2). Two groups measured the hip knee ankle angle (HKA), distal femoral lateral angle (LDFA), and proximal tibial medial angle (MPTA) on knee joint radiographs before and after surgery. Results: There was no significant difference in general information, preoperative imaging parameters, and functional scores between the two groups of patients. There was no significant difference in functional scores and postoperative prosthesis alignment between the two groups of patients in the first month after surgery. The intervention group showed a significant decrease in gait kinematic scores in the first month, with hip joint scores being particularly prominent (P 0.05). Conclusion: Gait kinematic analysis is helpful in evaluating the postoperative efficacy of TKA and can guide early and rapid recovery after TKA.

Qualitative and Quantitative Analysis of Alkaloids in Cortex Phellodendri by HPLC-ESI-MS/MS and HPLC-DAD

A combined method of high performance liquid chromatograph-elecrtrospray-ionization mass spectrometer（HPLC-ESI-MS/MS） coupled with a photodiode array detector（HPLC-DAD） and principal component analysis（PCA） was applied to the qualitative and quantitative analyses of alkaloids in Cortex Phellodendri（CP） samples, and to the differentiation of two species of CP, Cortex Phellodendri Chinensis（CPC） and Cortex Phellodendri Amurensis（CPA）. Twenty-two peaks appeared in the HPLC-MS base peak chromatogram of CP detected by the HPLC-ESI-MS/MS analysis, and the alkaloids were identified according to the MSn data, the known MS fragmentation rules and the literature data. Five alkaloids including berberine, palmatine, jatrorrhizine, phellodendrine and magnoflorine were simultaneously determinated by the HPLC-DAD. Berberine was the primary component in all CP samples, and the contents of berberine and palmatine were exploited to be two critical parameters for effective discrimination between the two species of CP. The average content of berberine in CPC（58.75 mg/g） was higher than that in CPA（9.16 mg/g）, while the content of palmatine was less, only 0.25 mg/g in CPC and 4.19 mg/g in CPA. With the use of PCA, samples datasets were separated successfully into two different clusters corresponding to the two species, and berberine, pahnatine, phellodendrine and magnoflorine contribute most to the above mentioned calssifying . The proposed method oroved to be a useful tool in the aualitv control of Chinese herbal medicines.

Evaluation of Phytochemical Analysis and Total Phenol Content of Proso Millet and Barnyard Millet

Whole grains of proso and barnyard millets were sequentially extracted using different solvents(hexane,chloroform,ethyl acetate,and methanol).Phytochemical analysis was performed qualitatively,and the total phenolic content in the extracts of proso and barnyard millets was quantified.Alkaloids and cardiac glycosides were identified in all solvent extracts of both millets.Anthraquinone and glycosides yielded negative results in all solvent extracts of both millets.Among all the solvent extracts,methanol extracts of proso and barnyard millets showed the presence of major compounds such as flavonoids,terpenoids,amino acids,tannins,and phenolics compounds.The maximum amount of phenols was found in methanolic extracts of proso and barnyard millets(0.669±0.003 and 0.625±0.003),followed by the chloroform extract of proso and barnyard millets(0.284±0.002 and 0.257±0.003).The minimum amount of phenolics was found in the acetone extract of proso and barnyard millets.The methanol extract of both millets showed the presence of major compounds with high phenolic content.

Synergistic effect of pinellia total alkaloids and uncaria total alkaloids on anticonvulsant action in mice and rats

Aim To investigate the synergistic effect of the combination of pinellia total alkaloid （PTA） and uncaria total alkaloid （UTA）, and explore the mechanism of anticonvulsant action. Methods Anticonvulsant and toxic effect profiles of combinations of PTA with UTA, alone and at three fixed ratios of 1：4, 1 ：1, 4：1, were evaluated in maximal electroshock （MES）-induced seizures and acute toxicity test in mice. Respective ED50 and LD50 were calculated with Bliss＇s method. Their synergistic effect were evaluated by isobolographic analysis and allowed the determination of benefit indices （BI） for respective combinations. The model of convulsive rats kindled by penicillin topically injected into cortex was used to investigated the content of Glu, Asp, Gly and GABA in hippocampus using high performance liquid chromatography （HPLC）. Results Combinations of PTA and UTA at the ratio of 4：1 were synergistic in MES test and antagonistic in acute toxicity test, showing the best profile for combinations of PTA with UTA. In contrast, the ratios of 1 ：4 and 1 ： 1, despite synergistic in MES test, were additive in acute toxicity test. The 4：1 combination and two drugs alone significantly decreased Glu level and increased GABA level in the hippocampus, but the GABA level in the 4：1 combination group was higher than that in the two drugs alone groups. They did not have significant influence on the levels of ASp and Gly. Conclusion Combinations of PTA and UTA at 4：1 ratio demonstrated synergistic effect in anticonvulsant action and antagonistic effect in toxicity. The anticonvulsant mechanism might be related to decreasing the excitability of Glutamatergic neurons and increasing the inhibition of GABAergic neurons.

ANALYSIS OF STRYCHNINE ALKALOIDS IN BIOLOGICAL SAMPLES BY THIN-LAYER CHROMATOGRAPHIC DENSITOMETRY AND DISTRIBUTION STUDY OF STRYCHNINE IN INTOXICATED RATS

A sensitive and rapid analytical procedure was established to detrmine strychnie alkaloids in diverse biological specimens. Samples were treated with hydrochloric acid to precipitate protein and scanned in thin-layer chromatograpic scanner in zig-zag dual-wavelength reflection mode.Detection sensitivity for strychniue was about 0. 05 μg. Quantification recoveries were between89. 2% and 99. 5% with RSD between 2. 92% and 13. 21 %. The method was applied to investigate thedistribution or strychnine in intoxicated rats. The results showed that there were remarkable difference in organs or tissues with the aigaest concentration 4. 56±1. 41μg/g in liver. Diversification experiment proves the method also could be used to analyze other alkaloids in biological samples if theconditions slightly modified.

Determination of the Content of Total Alkaloids in Different Solvent Extracts from Climbing Groundsel Herb Produced in Guizhou Province and Their Antibacterial Activity

[Objective] This study aimed to compare the contents of total alkaloids in different solvent extracts from climbing groundsel herb produced in Guizhou Province and their antibacterial activity. [Method] The content of total alkaloids was measured by UV spectrophotometry, and Oxford cups were used to investigate the antibacterial activity of each solvent extract. [Result] There was a good linear correlation between the absorbance measured by the UV spectrophotometer and the content of total al- kaloids within the concentration of 0.011 0-0.054 8 mg/ml at 207 nm, and the re- gression equation was Y=23.654X＋0.021, R=0. 999 7 and the average recovery rate was 99.2%. The contents of total alkaloids in 60% ethanol extract, 95% ethanol and water ethanol were 38.71, 52.25 and 60.50 mg/g, respectively. The 60% ethanol ex- tract had strong antibacterial activity against Streptococcus pneumoniae, Staphylo- coccus aureus and Escherichia coil; the water extractive had stronger antibacterial activity against Escherichia colr, 95% ethanol extract had weak antibacterial activity, with no inhibition of Pseudomonas aeruginosa. [Conclusion] This method is accurate, simple, with good repeatability, which can be used for the determination of alkaloids content of the climbing groundsel herb; there is no positive correlation between the content of total alkaloids in different solvent extracts of climbing groundsel herb and their antibacterial activity.

Study of Total Alkaloids from Rhizoma Coptis Chinensis on Experimental Gastric Ulcers

Objective： To study the effects of total alkaloids （TA） extracted from Rhizoma Coptis Chinensis on experimental gastric ulcer models. Methods： Four kinds of experimental ulcer models were established respectively by water-immersion stress, intragastric ethanol, acetic acid erosion, and pylorus ligation. The anti-ulcer effects of TA were evaluated, and compared with that of berberine （Bet） and cimetidine （Oim）. Results： TA showed significant inhibitory effects on ulcerative formation induced by water-immersion stress, intragastric ethanol, and pylorus l igation in dose-dependent manner, and showed therapeutic effect on acetic acid erosion-inducing ulcer, in comparison with the control group. The anti-ulcer activity of Bet was less than TA containing equal content of Bet. TA significantly reduced the free acidity, total acidity and total acid output, but didn＇t affect the gastric juice volume, gastric pepsin activity, adherent mucus quantity of stomach wall and free mucus dissolving in gastric juice. The suppressive activities of TA on gastric acid secretion didn＇t occur when it was administered into dodecadactylon at a dose of 360 mg/kg wt. Moreover, when compared with Oim, the inhibitory effect of TA on gastric acid secretion isn＇t proportional to the inhibitory effects on the formation of the 4 kinds of experimental ulcers. Conclusion： TA is a potent candidate in therapeutic drugs for treating gastric ulcer. Its anti-ulcer effective components and mechanism is not only related to Bet and inhibition of gastric acid, but also to other ingredients of TA and mechanism so far unknown.

GC-MS analysis,determination of total phenolics,flavonoid content and free radical scavenging activities of various crude extracts of Moringa peregrina(Forssk.) Fiori leaves

Objective:To perform phytochemical screening,estimate total phenolics,flavonoids and to evaluate antioxidant potential of Moringa peregrina(M.peregrina) leaves.Methods:The dried powdered leaves of M.peregrina(150 g) were extracted exhaustively by Soxhlet with ethanol and then fractionated into hexane,chloroform,ethy alacetate and methanol.All the prepared extracts were also analyzed by gas chromatography-mass spectrometry to identify and characterize the chemical compounds present in the crude extracts.Folin- Ciocalteu reagent and aluminium chloride colorimetric methods were used to estimate total phenolic and flavonoid content of extracts.Hydrogen peroxide and 1,1 diphenyl-2-picrylhydrazyl were used to determine in vitro antioxidant activity.Results:Phytochemical analysis of ethanol extract showed presence of major classes of phytochemicals.Gas chromatography-mass spectrometry results revealed presence of 19 phytoconstituents in hexane extract,6 in ethyl acetate and 7 compounds in methanolic extract.Methanol extract was found to contain the highest phenolic content and flavonoids.In vitro antioxidant activities of all crude extracts were significant and comparable with the standard ascorbic acid.Conclusions:Results of this study show that the leaves of M.peregrina are the rich source of phenolic compounds that can play an important role in preventing the progression of many diseases.

Prediction of Intraoperative Fracture by Hammering Sound Frequency Analysis and Stress Estimation during Total Hip Arthroplasty

When a stem is inserted into the femur during total hip arthroplasty, sufficient fixation depends on the surgeon’s experience. An objective method of evaluating whether the stem has been correctly fixed may aid clinicians in their decision. We examined the relationship between the sound frequency caused by hammering the stem and the internal stress in artificial femurs, and evaluated the utility of sound frequency analysis to prevent intraoperative fracture. Surgeons inserted one of two types of cementless stems (SL-PLUS and modified CLS) using routine operational procedures into 13 artificial femurs. These are the standard Zweymüllers used in Europe. The difference is the lateral shape;SL-PLUS has holes for removal and the modified CLS has fins to prevent rotation. We estimated stress in the femur via finite element analysis, measured the hammering force, and recorded the sound of hammering for frequency analysis. Finite element analysis revealed that the hammering sound frequency decreased as the maximum stress increased. A decrease in frequency suggested that fixation was sufficient and that continued hammering would increase the risk of fracture. Thus, evaluation of the change in sound frequency during stem insertion may indicate when the hammering force should be reduced, thereby preventing intraoperative periprosthetic fractures. Further frequency change may also predict fractures prior to visual confirmation. We concluded that sound frequency analysis has potential as an objective evaluation method to help prevent intraoperative periprosthetic fractures during stem insertion.

Continuous flow analysis of dissolved total phosphorus in seawater by UVK_(2)S_(2)O_(8) online digestion method

Several methods for analysis of dissolved total phosphorus in seawater were reviewed. Discussions were focused on UVirradiation and persulphate oxidation methods which are the most popular dissolved organic phosphorus determinationmethods presently. The compounds used for the phosphorus recovery test were categorized into three groups accordingto their chemical structure. It was found that low power UV irradiation can decompose POC or PC bonds efficientlybut may be inefficient for POP bonds. Heating-bath in acid condition is useful for decomposing POP bonds. Usingthe continuous flow analysis system (Auto-analyzer II), UV digestion and heating-bath, series experiments were carriedout based on the above analysis. Eleven model compounds were employed for the phosphorus recovery test and thefactors influencing the decomposition efficiency of dissolved compounds containing phosphorus were clarified. Finally,the optimal design for determination of dissolved total phosphorus in seawater based on the routine continuous flowanalysis system was presented. For the organic mono-phosphate, the recovery is more than 90% and a recovery of33%~51% was obtained for inorganic or organic polyphosphates. Up to now, this is the highest decompositionefficiency for dissolved phosphorus based on the continuous flow analysis system.

Hammering Sound Frequency Analysis to Fix an Acetabular Cup during Total Hip Arthroplasty: Clinical Trials and Biomechanical Studies

Failure during total hip arthroplasty may lead to bedridden of the elderly. Since the acetabulum cup fix in an anatomically deep region, failures, such as loosening and fracture, occur three times more frequently compared with failures of the stem fix in the femur. We investigated the possibility of evaluating whether fixation was acquired by frequency analysis of the hammering sound of implanting a cup into the acetabulum. The subjects were 11 patients (11 joints) who underwent total hip arthroplasty, biomechanical test materials, and orthopedic models. Surgeries and experiments were performed by orthopedists specialized in the hip. A system was constructed with a tablet PC and directional microphone, the peak frequency at which the amplitude reached the maximum was determined, and judgment processing (stable, unstable) of cup fixability was performed in real time. The stable maximum peak frequency observed in the clinical trials was 4.42 ± 4.02 kHz. The mean stable maximum peak frequency in the biomechanical tests was 4.46 ± 1.19 kHz in biomechanical test materials and 4.56 ± 2.02 kHz in orthopaedicmodels. When hammering was continued, the frequency leading to fracture decreased in both biomechanical test materials and orthopaedicmodels. In conclusion, in clinical trials and biomechanical studies, variation of the maximum peak frequency decreased when fixation was acquired and the frequency stabilized. It was suggested that this method can serve as a fixability evaluation method of acetabular cups because analysis can be performed in real time during surgery, for which prevention of intraoperative fracture can be expected.

Static and Thermal Analysis of Aluminium (413,390,384 and 332) Piston Using Finite Element Method

The main objective of this research was to examine the suitability of aluminium alloy to design a piston of an internal combustion engine for improvement in weight and cost reduction. The piston was modelled using Autodesk Inventor 2017 software. The modelled piston was then imported into Ansys for further analysis. Static structural and thermal analysis were carried out on the pistons of the four different materials namely: Al 413 alloy, Al 384 alloy, Al 390 alloy and Al332 alloy to determine the total deformation, equivalent Von Mises stress, maximum shear stress, and the safety factor. The results of the study revealed that, aluminium 332 alloy piston deformed less compared to the deformations of aluminium 390 alloy piston, aluminium 384 alloy piston and aluminium 413 alloy piston. The induced Von Mises stresses in the pistons of the four different materials were found to be far lower than the yield strengths of all the materials. Hence, all the selected materials including the implementing material have equal properties to withstand the maximum gas load. All the selected materials were observed to have high thermal conductivity enough to be able to withstand the operating temperature in the engine cylinders.

Laparoscopic vs open total gastrectomy for gastric cancer:A meta-analysis

AIM:To conduct a meta-analysis comparing laparoscopic total gastrectomy(LTG)with open total gastrectomy(OTG)for the treatment of gastric cancer.METHODS:Major databases such as Medline(PubMed),Embase,Academic Search Premier(EBSCO),Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL)in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013.Evaluated endpoints were operative,postoperative and oncological outcomes.Operative outcomes included operative time and intraoperative blood loss.Postoperative recovery included time to first fatus,time to first oral intake,hospital stay and analgesics use.Postoperative complications comprised morbidity,anastomotic leakage,anastomotic stenosis,ileus,bleeding,abdominal abscess,wound problems and mortality.Oncological outcomes included positive resection margins,number of retrieved lymph nodes,and proximal and distal resection margins.The pooled effect was calculated using either a fixed effects or a random effects model.RESULTS:Fifteen non-randomized comparative studies with 2022 patients were included(LTG-811,OTG-1211).Both groups had similar short-term oncological outcomes,analgesic use(WMD-0.09;95%CI:-2.39-2.20;P=0.94)and mortality(OR=0.74;95%CI:0.24-2.31;P=0.61).However,LTG was associated with a lower intraoperative blood loss(WMD-201.19 mL;95%CI:-296.50--105.87 mL;P<0.0001)and overall complication rate(OR=0.73;95%CI:0.57-0.92;P=0.009);fewer wound-related complications(OR=0.39;95%CI:0.21-0.72;P=0.002);a quicker recovery of gastrointestinal motility with shorter time to frst fatus(WMD-0.82;95%CI:-1.18--0.45;P<0.0001)and oral intake(WMD-1.30;95%CI:-1.84--0.75;P<0.00001);and a shorter hospital stay(WMD-3.55;95%CI:-5.13--1.96;P<0.0001),albeit with a longer operation time(WMD 48.25 min;95%CI:31.15-65.35;P<0.00001),as compared with OTG.CONCLUSION:LTG is safe and effective,and may offer some advantages over OTG in the treatment of gastric cancer.

Calculations and Sensitivity Analysis of Chlorine-,NO_(x)-,and Bromine-Depleting Cycles of Stratospheric Ozone

This paper presents an engineering system approach using a 2D model of conservation of mass to study the dynamics of ozone and concerned chemical species in the stratosphere.By considering all fourteen photolysis,ozone-generating,and-depleting chemical reactions,the model calculated the transient,spatial changes of ozone under different physical-chemical-radiative conditions.Validation against the measured data demonstrated good accuracy,close match of our model with the observed ozone concentrations at both 20°S and 90°N locations.The deviation in the average concentration was less than 1% and in ozone profiles less than 17%.The impacts of various chlorine-(Cl),nitrogen oxides-(NO_(x)),and bromine-(Br)depleting cycles on ozone concentrations and distribution were investigated.The chlorine catalytic depleting cycle was found to exhibit the most significant impact on ozone dynamics,confirming the key role of chlorine in the problem of ozone depletion.Sensitivity analysis was conducted with levels of 25%,50%,100%,200%,and 400% of the baseline value.The combined cycles(Cl+NO_(x)+Br)showed the most significant influence on ozone behavior.The total ozone abundance above the South Pole could decrease by a small 3%,from 281 DU(Dubson Units)to 273 DU for the 25% level,or by a huge thinning of 60%to 114 DU for the 400% concentration level.When the level of chlorine gases increased beyond 200%,it would cause ozone depletion to a level of ozone hole(below 220 DU).The 2D Ozone Model presented in this paper demonstrates robustness,convenience,efficiency,and executability for analyzing complex ozone phenomena in the stratosphere.

Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer

AIM:To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy(LATG)and open total gastrectomy(OTG)for gastric cancer.METHODS:A comprehensive search of PubMed,Cochrane Library,Web of Science and BIOSIS Previews was performed to identify studies that compared LATG and OTG.The following factors were checked:operating time,blood loss,harvested lymph nodes,flatus time,hospital stay,mortality and morbidity.Data synthesis and statistical analysis were carried out using RevMan 5.1 software.RESULTS:Nine studies with 1221 participants were included(436 LATG and 785 OTG).Compared to OTG,LATG involved a longer operating time[weighted mean difference(WMD)=57.68 min,95%CI:30.48-84.88;P<0.001];less blood loss[standard mean difference(SMD)=-1.71;95%CI:-2.48--0.49;P<0.001];earlier time to flatus(WMD=-0.76 d;95%CI:-1.22--0.30;P<0.001);shorter hospital stay(WMD=-2.67d;95%CI:-3.96--1.38,P<0.001);and a decrease in medical complications(RR=0.41,95%CI:0.19-0.90,P=0.03).The number of harvested lymph nodes,mortality,surgical complications,cancer recurrence rate and long-term survival rate of patients undergoing LATG were similar to those in patients undergoing OTG.CONCLUSION:Despite a longer operation,LATG can be performed safely in experienced surgical centers with a shorter hospital stay and fewer complications than open surgery.

Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A meta-analysis

BACKGROUND Laparoscopy has been widely used in general surgical procedures,but total laparoscopic pancreaticoduodenectomy(TLPD)is still a complex and challenging surgery that is only performed in a small number of patients at a few large academic medical centers.Although the safety and feasibility of TLPD have been established,few studies have compared it with open pancreaticoduodenectomy(OPD)with regard to perioperative and oncological outcomes.Therefore,we carried out a meta-analysis to evaluate whether TLPD is superior to OPD.AIM To compare the treatment outcomes of TLPD and OPD in order to assess the safety and feasibility of TLPD.METHODS We conducted a systematic search of studies comparing TLPD with OPD that were published in the PubMed,EMBASE,and Cochrane Library databases through December 31,2018.The studies comparing TLPD and OPD with at least one of the outcomes we were interested in and with more than 10 cases in each group were included in this analysis.The Newcastle-Ottawa scale was used to assess the quality of the nonrandomized controlled trials and the Jadad scale was used to assess the randomized controlled trials.Intraoperative data,postoperative complications,and oncologic outcomes were evaluated.The metaanalysis was performed using Review Manager Software version 5.3.Random or fixed-effects meta-analyses were undertaken to measure the pooled estimates.RESULTS A total of 4790 articles were initially identified for our study.After screening,4762 articles were excluded and 28 studies representing 39771 patients(3543 undergoing TLPD and 36228 undergoing OPD)were eventually included.Patients who underwent TLPD had less intraoperative blood loss[weighted mean difference(WMD)=-260.08 mL,95%confidence interval(CI):(-336.02,-184.14)mL,P<0.00001],a lower blood transfusion rate[odds ratio(OR)=0.51,95%CI:0.36-0.72,P=0.0001],a lower perioperative overall morbidity(OR=0.82,95%CI:0.73-0.92,P=0.0008),a lower wound infection rate(OR=0.48,95%CI:0.34-0.67,P<0.0001),a lower pneumonia rate(OR=0.72,95%CI:0.60-0.85,P=0.0002),a shorter duration of intensive care unit(ICU)stay[WMD=-0.28 d,95%CI(-2.88,-1.29)d,P<0.00001]and a shorter length of hospital stay[WMD=-3.05 d,95%CI(-3.93,-2.17),P<0.00001],a lower rate of discharge to a new facility(OR=0.55,95%CI:0.39-0.78,P=0.0008),and a lower 30-d readmission rate(OR=0.81,95%CI:0.68-0.95,P=0.10)than those who underwent OPD.In addition,the TLPD group had a higher R0 rate(OR=1.28,95%CI:1.13-1.44,P=0.0001)and more lymph nodes harvested(WMD=1.32,95%CI:0.57-2.06,P=0.0005)than the OPD group.However,the patients who underwent TLPD experienced a significantly longer operative time(WMD=77.92 min,95%CI:40.89-114.95,P<0.0001)and had a smaller tumor size than those who underwent OPD[WMD=-0.32 cm,95%CI:(-0.58,-0.07)cm,P=0.01].There were no significant differences between the two groups in the major morbidity,postoperative pancreatic fistula,delayed gastric emptying,postpancreatectomy hemorrhage,bile leak,gastroenteric anastomosis fistula,intra-abdominal abscess,bowel obstruction,fluid collection,reoperation,ICU admission,or 30-d and 90-d mortality rates.For malignant tumors,the 1-,2-,3-,4-and 5-year overall survival rates were not significantly different between the two groups.CONCLUSION This meta-analysis indicates that TLPD is safe and feasible,and may be a desirable alternative to OPD,although a longer operative time is needed and only smaller tumors can be treated.

Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis

BACKGROUND Laparoscopic radical gastrectomy is currently the most common surgical approach for gastric cancer.The main difference between totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)is the route of digestive tract reconstruction.However,TLTG is currently not widespread as the safety and feasibility of intracorporeal esophagojejunostomy is uncertain.AIM To compare the short-term efficacy of TLTG and LATG for radical gastrectomy of gastric cancer,and to determine the safety and feasibility of intracorporeal esophagojejunostomy.METHODS PubMed,EMBASE,and Web of Science databases were searched for all relevant articles regarding TLTG vs LATG for gastric cancer published up to October 1,2019.Inclusion and exclusion criteria were established.All the basic conditions of patients and important clinical data related to surgery were extracted,and a meta-analysis was performed with RevMan 5.3 software.RESULTS Eight studies involving a total of 1883 cases(869 cases in the TLTG group and 1014 cases in the LATG group)were included.Compared with the LATG group,reduced intraoperative blood loss(weighted mean difference=-35.37,95%CI:-61.69--9.06,P=0.008)and a larger number of retrieved lymph nodes(weighted mean difference=3.11,95%CI:-2.60-12.00,P=0.01)were found in the TLTG group.There were no significant differences in operating time,anastomotic time,tumor size,proximal resection margin length,postoperative pain score,time to first flatus,time to first oral intake,postoperative hospital stay,postoperative anastomosis-related complication rate and overall complication rate between the two groups(P>0.05).CONCLUSION Intracorporeal esophagojejunostomy is safe and feasible.TLTG has the advantages of being minimally invasive,reduced intraoperative blood loss and easier access to lymph nodes compared with LATG.Totally laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.