Efficacy and safety of early drain removal following pancreatic resections: a meta-analysis.

BACKGROUND: No consensus was reached with regard to the effect of EDR on postoperative outcomes after pancreatic surgery. The meta-analysis was designed to explore the efficacy and safety of early drain removal (EDR). METHODS: Systematic literature search was performed. Data extraction and correction were performed by three researchers. For dichotomous and continuous outcomes, we calculated the pooled risk difference and mean difference with 95% confidence intervals, respectively. The heterogeneity of included studies was evaluated using Cochran's Q and I2 test. The stratified analyses of pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) were performed. RESULTS: A total of 10 studies including 3 RCTs and 7 non RCTs were included for meta-analysis, among which 1780 patients with EDR and 5613 patients with late drain removal (LDR) were enrolled. The meta-analysis of both all the available studies and studies only with selected low risk patients indicated that EDR group had significantly lower incidences of Grade B/C postoperative pancreatic fistula (POPF) and total complications for both PD and DP. However, no advantages of EDR were observed in the meta-analysis of the 3 RCTs. In addition, EDR was associated with a lower incidence of intra-abdominal infection after PD. While for DP, EDR group had decreased risk of delayed gastric emptying and re-operation, and shorter postoperative in-hospital stay. CONCLUSIONS: The meta-analysis demonstrates that EDR is effective and safe for both PD and DP considering POPF and total complications, especially for patients with low concentration of postoperative drain fluid amylase.

Clinical Features of 69 Cases With Coronavirus Disease 2019 in Wuhan, China.

BACKGROUND: From December 2019 to February 2020, 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a serious outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China. Related clinical features are needed. METHODS: We reviewed 69 patients who were hospitalized in Union hospital in Wuhan between 16 January and 29 January 2020. All patients were confirmed to be infected with SARS-CoV-2, and the final date of follow-up was 4 February 2020. RESULTS: The median age of 69 enrolled patients was 42.0 years (interquartile range 35.0-62.0), and 32 patients (46%) were men. The most common symptoms were fever (60 [87%]), cough (38 [55%]), and fatigue (29 [42%]). Most patients received antiviral therapy (66 [98.5%] of 67 patients) and antibiotic therapy (66 [98.5%] of 67 patients). As of 4 February 2020, 18 (26.9%) of 67 patients had been discharged, and 5 patients had died, with a mortality rate of 7.5%. According to the lowest SpO2 during admission, cases were divided into the SpO2 ≥ 90% group (n = 55) and the SpO2 < 90% group (n = 14). All 5 deaths occurred in the SpO2 < 90% group. Compared with SpO2 ≥ 90% group, patients of the SpO2 < 90% group were older and showed more comorbidities and higher plasma levels of interleukin (IL) 6, IL10, lactate dehydrogenase, and C reactive protein. Arbidol treatment showed tendency to improve the discharging rate and decrease the mortality rate. CONCLUSIONS: COVID-19 appears to show frequent fever, dry cough, and increase of inflammatory cytokines, and induced a mortality rate of 7.5%. Older patients or those with underlying comorbidities are at higher risk of death.

Species profiles, in-situ photochemistry and health risk of volatile organic compounds in the gasoline service station in China.

Accompanying with increases in vehicle population and gasoline consumption, gasoline evaporation accounted for an enlarged portion of total volatile organic compound (VOC) emissions in China, raising increasing environmental concerns especially in megacities. In this study, an intensive sampling campaign was performed in a gasoline service station, to reveal emission characteristics, environmental and health impacts of VOCs. It was strikingly found that 24 % of air samples exceeded the national standard of 4 mg/m3 for non-methane hydrocarbons (NMHCs) on the boundary of the station, with the equipment of Stage I and II controls. VOC groups and species profiles showed that alkanes dominated total VOCs. As typical markers of evaporative loss of gasoline, C4-5 species (i-pentane, n-pentane and n-butane) as well as methyl tert-butyl ether (MTBE) accounted for 49.6 % of VOCs. Species profile and diagnostic ratios indicated the prominent contribution of gasoline evaporative losses from refueling or breathing processes, as well as the interference of vehicle exhaust in the ambient air at the site. Intensive O3 production was reproduced by the photochemical box model, demonstrating that O3 formation was co-limited by both VOCs (especially trans-2-butene) and NOx. Inhalation health risk assessment proved that exposure to hazardous VOCs caused non-cancer risk (HQ = 3.08) and definitely posed cancer risks at a probability of 1.3 × 10-4 to workers. Remarkable health risks were mainly imposed by halocarbons, aromatics and alkenes, in which 1,2-dichloropropane caused the highest non-cancer risk (HQ = 1.3) and acted as the primary carcinogen (ICR = 5.1 × 10-5). This study elucidated the high unqualified rate in gasoline service stations after the implementation of latest standards in China, where new regulations targeted halocarbons and updates in existing vapor recovery systems were suggested for VOC mitigation.