AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citat...AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.展开更多
AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and m...AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and metaanalyses. METHODS: An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT. RESULTS: Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR ) = 1.01, P = 0.98]. Funnel plot indi-cated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis. CONCLUSION: Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.展开更多
Objective：To investigate effect of Chaiqin Chengqi Decoction（柴芩承气汤,CQCQD） on changes of neuronal acetylcholine receptor alpha 7（nAChRα7） of peritoneal macrophages in acute pancreatitis（AP）.Methods：Eighte...Objective：To investigate effect of Chaiqin Chengqi Decoction（柴芩承气汤,CQCQD） on changes of neuronal acetylcholine receptor alpha 7（nAChRα7） of peritoneal macrophages in acute pancreatitis（AP）.Methods：Eighteen Kunming mice were equally randomized into the control group,AP group and CQCQD treatment group.AP was induced by two intraperitoneal injections of 4 g/kg L-arginine at 1 h apart,while control mice received saline injections.At 72 h after the first injection of L-arginine,mice in the treatment group were intragastrically administered 0.1 mL/10 g CQCQD every 2 h for 3 times,whilst mice in the other two groups received the same amount of saline feeding.Mice were sacrificed by cervical dislocation 2 h after the last feeding of either CQCQD or saline.Peritoneal macrophages were collected for determination of nAChRα7 mRNA and protein expression.Serum was collected for detection of interleukin-6（IL-6）,IL-10 and acetylcholine（ACh）levels,and pancreas was for histopathology analysis.Results：The CQCQD treatment significantly ameliorated the severity of AP as evidenced by reducing the pancreatic histopathology score（4.5 ± 0.5 vs.6.2 ± 1.7,P〈0.05）and the serum IL-6 levels（1228.31419.2 pg/mL vs.1589.6 ±337.3 pg/mL,P〈0.05）.The mRNA and protein expression of nAChRα7 of the peritoneal macrophages in the AP group were similar to the control group（P〉0.05）,but were significantly up-regulated after the CQCQD treatment（P〈0.05）.The serum ACh levels in the AP group were significantly lower than those in the control group（3.1 ± 0.6 μg/mL vs 4.8 ± 0.7 μg/mL P〈0.05）,but were significantly increased after the CQCQD treatment（5.6±1.5 μg/mL vs 3.1 ±0.6 μg/mL,P〈0.05）.Conclusion：CQCQD is protective against L-arginine-induced AP through mechanisms involving nAChR α 7 of peritoneal macrophages.展开更多
Background Intra-abdominal hypertension （IAH） is a recognized prognostic marker for severity of severe acute pancreatitis （SAP） and has a strong impact on the clinical course of SAP. Previous studies indicate that...Background Intra-abdominal hypertension （IAH） is a recognized prognostic marker for severity of severe acute pancreatitis （SAP） and has a strong impact on the clinical course of SAP. Previous studies indicate that a Da-Cheng-Qi Decoction （DCQD） is beneficial in the treatment of SAP. The purpose of this study was to evaluate the effect of modified DCQD on IAH in patients with SAP. Methods Between January 2008 and December 2008, 42 patients from the West China Hospital were randomized into either the DCQD or control group （n=21 in each group）. Mortality, intra-abdominal pressure （lAP）, Acute Physiology and Chronic Health Evaluation II （APACHE II） score, C-reactive protein （CRP）, oxygenation index, Balthazar CT score, rate of renal failure, decompression rate, intensive care unit （ICU） transfer rate, and length of hospital stay （LOS） were compared between the two groups. Results Compared to the control group, the modified DCQD treatment significantly decreased lAP （P 〈0.05） and APACHE II （P 〈0.05） scores on days 4-8, CRP on day 8 （P 〈0.01）, renal failure rate （P 〈0.05）, and LOS （P 〈0.05）. The oxygenation index was significantly improved in the DCQD group compared with the control group （P 〈0.05）. No significant differences in the Balthazar CT score, shock rate, ICU transfer rate, or mortality occurred between the two groups. Conclusions The modified DCQD can effectively relieve IAH and decrease LOS for patients with SAP. Larger clinical trials are needed to confirm these findings.展开更多
文摘AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.
基金Supported by The National Natural Science Foundation of China,No. 81072910
文摘AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and metaanalyses. METHODS: An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT. RESULTS: Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR ) = 1.01, P = 0.98]. Funnel plot indi-cated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P < 0.05). However, the number needed to treat having a minor lower limit of the range (7-5096 patients) implied that certain SAP patients could still potentially prevent death by antibiotic prophylaxis. CONCLUSION: Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations.
基金Supported by National Natural Science Foundation of China(No.81072910)Science and Technology Support Program of Sichuan(No.2011SZ0291,2010SZ0068)
文摘Objective：To investigate effect of Chaiqin Chengqi Decoction（柴芩承气汤,CQCQD） on changes of neuronal acetylcholine receptor alpha 7（nAChRα7） of peritoneal macrophages in acute pancreatitis（AP）.Methods：Eighteen Kunming mice were equally randomized into the control group,AP group and CQCQD treatment group.AP was induced by two intraperitoneal injections of 4 g/kg L-arginine at 1 h apart,while control mice received saline injections.At 72 h after the first injection of L-arginine,mice in the treatment group were intragastrically administered 0.1 mL/10 g CQCQD every 2 h for 3 times,whilst mice in the other two groups received the same amount of saline feeding.Mice were sacrificed by cervical dislocation 2 h after the last feeding of either CQCQD or saline.Peritoneal macrophages were collected for determination of nAChRα7 mRNA and protein expression.Serum was collected for detection of interleukin-6（IL-6）,IL-10 and acetylcholine（ACh）levels,and pancreas was for histopathology analysis.Results：The CQCQD treatment significantly ameliorated the severity of AP as evidenced by reducing the pancreatic histopathology score（4.5 ± 0.5 vs.6.2 ± 1.7,P〈0.05）and the serum IL-6 levels（1228.31419.2 pg/mL vs.1589.6 ±337.3 pg/mL,P〈0.05）.The mRNA and protein expression of nAChRα7 of the peritoneal macrophages in the AP group were similar to the control group（P〉0.05）,but were significantly up-regulated after the CQCQD treatment（P〈0.05）.The serum ACh levels in the AP group were significantly lower than those in the control group（3.1 ± 0.6 μg/mL vs 4.8 ± 0.7 μg/mL P〈0.05）,but were significantly increased after the CQCQD treatment（5.6±1.5 μg/mL vs 3.1 ±0.6 μg/mL,P〈0.05）.Conclusion：CQCQD is protective against L-arginine-induced AP through mechanisms involving nAChR α 7 of peritoneal macrophages.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 30801457）.
文摘Background Intra-abdominal hypertension （IAH） is a recognized prognostic marker for severity of severe acute pancreatitis （SAP） and has a strong impact on the clinical course of SAP. Previous studies indicate that a Da-Cheng-Qi Decoction （DCQD） is beneficial in the treatment of SAP. The purpose of this study was to evaluate the effect of modified DCQD on IAH in patients with SAP. Methods Between January 2008 and December 2008, 42 patients from the West China Hospital were randomized into either the DCQD or control group （n=21 in each group）. Mortality, intra-abdominal pressure （lAP）, Acute Physiology and Chronic Health Evaluation II （APACHE II） score, C-reactive protein （CRP）, oxygenation index, Balthazar CT score, rate of renal failure, decompression rate, intensive care unit （ICU） transfer rate, and length of hospital stay （LOS） were compared between the two groups. Results Compared to the control group, the modified DCQD treatment significantly decreased lAP （P 〈0.05） and APACHE II （P 〈0.05） scores on days 4-8, CRP on day 8 （P 〈0.01）, renal failure rate （P 〈0.05）, and LOS （P 〈0.05）. The oxygenation index was significantly improved in the DCQD group compared with the control group （P 〈0.05）. No significant differences in the Balthazar CT score, shock rate, ICU transfer rate, or mortality occurred between the two groups. Conclusions The modified DCQD can effectively relieve IAH and decrease LOS for patients with SAP. Larger clinical trials are needed to confirm these findings.
