Surgical management of inflammatory bowel disease in China: a systematic review of two decades

BACKGROUND/AIMS: The past decades have seen increasing incidence and prevalence of inflammatory bowel disease (IBD) in China. This article aimed to summarize the current status and characteristics of surgical management for IBD in China. METHODS: We searched PubMed, Embase, and Chinese databases from January 1, 1990 to July 1, 2014 for all relevant studies on the surgical treatment IBD in China. Eligible studies with sufficient defined variables were further reviewed for primary and secondary outcome measures. RESULTS: A total of 74 studies comprising 2,007 subjects with Crohn's disease (CD) and 1,085 subjects with ulcerative colitis (UC) were included. The percentage of CD patients misdiagnosed before surgery, including misdiagnosis as appendicitis or UC, was 50.8%±30.9% (578/1,268). The overall postoperative complication rate was 22.3%±13.0% (267/1,501). For studies of UC, the overall postoperative complication rate was 22.2%±27.9% (176/725). In large research centers (n>50 surgical cases), the rates of emergency operations for CD (P=0.032) and in-hospital mortalities resulting from both CD and UC were much lower than those in smaller research centers (n≤50 surgical cases) (P=0.026 and P <0.001, respectively). Regarding the changes in CD and UC surgery over time, postoperative complications (P=0.045 for CD; P=0.020 for UC) and postoperative in-hospital mortality (P=0.0002 for CD; P=0.0160 for UC) both significantly improved after the year 2010. CONCLUSIONS: The surgical management of IBD in China has improved over time. However, the rates of misdiagnosis and postoperative complications over the past two decades have remained high. Large research centers were found to have relatively better capacity for surgical management than the smaller ones. Higher quality prospective studies are needed in China.

Surgical management of inflammatory bowel disease in China: a systematic review of two decades

BACKGROUND/AIMS: The past decades have seen increasing incidence and prevalence of inflammatory bowel disease (IBD) in China. This article aimed to summarize the current status and characteristics of surgical management for IBD in China. METHODS: We searched PubMed, Embase, and Chinese databases from January 1, 1990 to July 1, 2014 for all relevant studies on the surgical treatment IBD in China. Eligible studies with sufficient defined variables were further reviewed for primary and secondary outcome measures. RESULTS: A total of 74 studies comprising 2,007 subjects with Crohn's disease (CD) and 1,085 subjects with ulcerative colitis (UC) were included. The percentage of CD patients misdiagnosed before surgery, including misdiagnosis as appendicitis or UC, was 50.8%±30.9% (578/1,268). The overall postoperative complication rate was 22.3%±13.0% (267/1,501). For studies of UC, the overall postoperative complication rate was 22.2%±27.9% (176/725). In large research centers (n>50 surgical cases), the rates of emergency operations for CD (P=0.032) and in-hospital mortalities resulting from both CD and UC were much lower than those in smaller research centers (n≤50 surgical cases) (P=0.026 and P <0.001, respectively). Regarding the changes in CD and UC surgery over time, postoperative complications (P=0.045 for CD; P=0.020 for UC) and postoperative in-hospital mortality (P=0.0002 for CD; P=0.0160 for UC) both significantly improved after the year 2010. CONCLUSIONS: The surgical management of IBD in China has improved over time. However, the rates of misdiagnosis and postoperative complications over the past two decades have remained high. Large research centers were found to have relatively better capacity for surgical management than the smaller ones. Higher quality prospective studies are needed in China.

Efficacy analysis of laparoscopic surgery for primary local gastric and intestinal gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors(GIST).</p><p><b>METHODS</b>Clinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed.</p><p><b>RESULTS</b>Hand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST, while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types, gastric local resection was performed in 18 cases, distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was (4.5±1.6) cm. The mean operational time was(96.2±28.2) min, with a mean blood loss of (49.6±38.6) ml. Postoperative bowel function recovery time was (2.3±0.7) d and the length of postoperative hospital stay was (6.8±1.9) d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1(3.8%), low risk in 13(50.0%), intermediate in 9(34.6%) and high risk in 3(11.5%) patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found.</p><p><b>CONCLUSION</b>Laparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.</p>

Effect of exposure to trace elements in the soil on the prevalence of neural tube defects in a high-risk area of China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Our objective is to build a model that explains the association between the exposure to trace elements in the soil and the risk of neural tube defects.</p><p><b>METHODS</b>We built a function with different parameters to describe the effects of trace elements on neural tube defects. The association between neural tube defects and trace element levels was transformed into an optimization problem using the maximum likelihood method.</p><p><b>RESULTS</b>Tin, lead, nickel, iron, copper, and aluminum had typical layered effects (dosage effects) on the prevalence of neural tube defects. Arsenic, selenium, zinc, strontium, and vanadium had no effect, and molybdenum had one threshold value that affected the prevalence of birth defects.</p><p><b>CONCLUSION</b>As an exploratory research work, our model can be used to determine the direction of the effect of the trace element content of cultivated soil on the risk of neural tube defects, which shows the clues by the dosage effect of their toxicological characteristics. Based on our findings, future biogeochemical research should focus on the direct effects of trace elements on human health.</p>

Health inequalities during 20 years of rapid economic development in China (1980-2000): a mortality analysis / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To examine the influence of China's economic reforms on population health and regional mortality rates.</p><p><b>METHODS</b>Longitudinal study measuring the mortality trends and their regional variations. Using data from the three most recent national censuses, we used the model life table to adjust the mortality levels within the population for each census, and to calculate life expectancy. We then examined the variation in patterns of mortality and population health by economic status, region and gender from 1980-2000.</p><p><b>RESULTS</b>Life expectancy varied with economic status, province, and gender. Results showed that, although life expectancy in China had increased overall since the early 1980s, regional differences became more pronounced. Life expectancy for populations who live in the eastern coastal provinces are greater than those in the western regions.</p><p><b>CONCLUSION</b>Differences in life expectancy are primarily related to differences in regional economic development, which in turn exacerbate regional health inequalities. Therefore, it is necessary to improve economic development in less developed regions and to improve health policies and the public health system that address the needs of everyone.</p>

Pelvic autonomic nerve preservation in 96 female patients of rectal carcinoma undergoing radical resection / 中国普通外科杂志

ObjectiveTo evaluate the effect on postoperative urinary and sexual function of radical resection with pelvic autonomic nerve preservation for female rectal cancer patients.MethodsPostoperative sex and urination disorders were compared between groups of pelvic autonomic nerve preservation and conventional procedure in 120 female cases of middle-lower rectal carcinoma undergoing radical resection. ResultsThe venery decline、sexual climax slip、vagina wetness degree slip and the coition pain rate were 12.5%、10.5%、8.33%、4.15% in autonomic nerve preservation group and 54.1%、45.9%、41.7%、37.5% in control group, respectively(all P0.05).ConclusionPelvic autonomic nerve preservation is effective to reduce postoperative sex and urination disorders in female rectal cancer cases undergoing radical resection though it does not seem to benift cases receiving posterior pelvic exenteration.

A study on the relationship between vascular endothelial growth factor-D, endostatin and the progress of colorectal cancer / 中国普通外科杂志

Objective To investigate if vascular endothelial growth factor-D(VEGF-D) and endostatin(ES) promote angiogenesis in colorectal cancer(CRC). Methods One hundred and five patients undergoing CRC surgery were enrolled in this study. CRC and normal tissue microarray were produced and measured for VEGF-D and ES by immunohistochemmical staining.Results VEGF-D and ES expression were stronger in CRC tissues than in control normal mucosa. MVD was higher in cancer tissues than in normal ones. ES down-regulated expression was associated with less invasiveness, positive lymph node metastasis, distant metastasis and in cases of early Dukes′ stage, while the expression of VEGF-D in corresponding tissues was on the opposite to ES. MVD increased along with tumor invasion, lymph involvement, distant metastasis and late Dukes′ stage. Conclusions VEGF-D in accord with ES promotes the angiogenesis and progression of CRC.