Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children: a systematic review and proportional meta-analysis.

BACKGROUND: Most commonly, cyst excision and Roux-en-Y hepaticojejunostomy reconstruction are the optimal treatment for choledochal cysts (CC). Robotic surgery (RS) is being conducted with increasing frequency to treat CC. It is unclear whether RS can overcome the limitations of laparoscopic surgery (LS) and improve the prognosis of patients. In terms of efficacy, evidence concerning which minimally invasive surgery is preferred is, however, sparse. Our objective is to further compare the efficacy of RS and LS in children with CC and draw a useful clinical conclusion. METHODS: Studies meeting inclusion criteria were identified from a series of databases, consisting of PubMed, Embase, Scopus, Web of Science, the Cochrane Library and their reference list of articles up to May 2022. Eligible articles comprised at least five objects that were younger than 18 years of age and the language was limited to English. Two authors independently evaluated selected studies and extracted data for analysis. RESULTS: Forty studies were selected for analysis, with thirty-six reporting data on LS and eight containing data on RS. The pooled conversion rate and pooled postoperative complication rate of RS were lower than those of LS, but none of them was statistically significant. Moreover, comparisons of the following detailed postoperative complication rates were not statistically significant, such as intestinal obstruction or ileus, anastomotic bleeding, anastomotic or bile leakage, and anastomotic stenosis. However, the intraoperative blood loss and the postoperative hospital stay in RS group were significantly lower than those in LS group. CONCLUSIONS: RS is a safe and feasible option for children with CC. Further studies with more cases, long-term efficacy and health economics analysis are needed to confirm whether RS is more advantageous.

The natural progression of VGAMs and the need for urgent medical attention: a systematic review and meta-analysis.

BACKGROUND: Vein of Galen aneurysmal malformations (VGAMs) are congenital disorders that may require emergency treatment and some may cause sudden death before medical attention is provided. Some patients also have a spontaneous thrombosis. OBJECTIVE: To understand the natural progression of VGAMs through a systematic literature review. METHODS: We examined PubMed to identify studies published between July 1973 and March 2015. We determined the proportion of patients with VGAM who died before receiving medical attention, who received emergency treatment, or had a spontaneous thrombosis. We pooled estimates of proportions with corresponding 95% CIs calculated using the raw (ie, untransformed) proportions. RESULTS: The 31 studies obtained described the outcome of 754 patients with VGAM. The probability of sudden death risk was 4% (95% CI 1% to 7%; I2=51.6%); of an emergency operation was 46% (95% CI 34% to 58%; I2=93.2%); and of spontaneous thromboses 1% (95% CI 0% to 2%; I2=0%) of cases. Differences between age and clinical outcomes of patients with spontaneous thromboses were significant according to the rank test (Mann-Whitney U test, Z=-2.398, p=0.016), both having a linear correlation (χ2 test, p=0.022). CONCLUSIONS: Over time, the rate of preoperative sudden death in patients with VGAM gradually declined and the rate of emergency operations gradually increased. The outcome of patients with early spontaneous thromboses was good. Our study provides a definitive description of the natural progression of VGAMs and the need for urgent medical attention.

[Fasting serum free fatty acid, insulin sensitivity index and serum lipid levels in individuals with different body mass index and glucose tolerance].

OBJECTIVE: To investigate the relationship among fasting serum free fatty acid (FFA), insulin sensitivity index (ISI), serum triglyceride (TG) and total cholesterol (TC) levels in subjects with different body mass index (BMI) and glucose tolerance by using Bergman's minimodel method. METHODS: 26 normal control subjects, 39 obese subjects, 25 impaired glucose tolerance (IGT) subjects and 21 patients with newly diagnosed type 2 diabetes mellitus (DM) were recruited into this study. Serum FFA level was measured with radioimmunoassay and ISI was obtained by using Bergman's minimal model method. RESULTS: (1) In the four groups, serum FFA concentration of the control group was significantly lower than that of the other three groups, although there was no difference among the latter three. (2) ISI level of the control group was significantly higher than that of other three groups, while there was no difference among the latter three. (3) After adjusting with BMI, there was still significant difference in serum FFA levels between the control and the other three groups. (4) ISI, HOMAIR, BMI, waist hip ratio (WHR) and TG were all related to the concentration of serum FFA (r = -0.454, 0.213, 0.241, 0.336 and 0.414 respectively, P < 0.01, < 0.05, < 0.05, < 0.01 and < 0.01 respectively), while age, sex and serum TC levels were not related with serum FFA. (5) According to multivariate stepwise regression, ISI, BMI and TG were the major determinant factors for FFA (R(2) = 0.109, 0.212, 0.156, P < 0.001). CONCLUSIONS: Besides BMI, ISI and serum TG level are the major determinant factors that affect the concentration of serum FFA. As compared with the simple index HOMAIR, ISI level was more significantly related with serum FFA concentration. FFA levels are significantly different in various glucose tolerant states even after adjusting with BMI. FFA levels were obviously higher in subjects with IGT or type 2 diabetes mellitus.

Expression of feeding-related peptide receptors mRNA in GT1-7 cell line and roles of leptin and orexins in control of GnRH secretion.

AIM: To investigate the expression of feeding-related peptide receptors mRNA in GT1-7 cell line and roles of leptin and orexins in the control of GnRH secretion. METHODS: Receptors of bombesin3, cholecystokinin (CCK)-A, CCK-B, glucagon-like peptide (GLP)1, melanin-concentrating hormone (MCH)1, orexin1, orexin2, neuromedin-B, neuropeptide Y (NPY)1 and NPY5, neurotensin (NT)1, NT2, NT3, and leptin receptor long form mRNA in GT1-7 cells were detected by reversed transcriptase-polymerase chain reaction. GT1-7 cells were treated with leptin, orexin A and orexin B at a cohort of concentrations for different lengths of time, and GnRH in medium was determined by radioimmunoassay (RIA). RESULTS: Receptors of bombesin 3, CCK-B, GLP1, MCH1, orexin1, neuromedin-B, NPY1, NPY5, NT1, NT3, and leptin receptor long form mRNA were expressed in GT1-7 cells, of which, receptors of GLP1, neuromedin-B, NPY1, and NT3 were highly expressed. No amplified fragments of orexin2, NT2, and CCK-A receptor cDNA were generated with GT1-7 RNA, indicating that the GT1-7 cells did not express mRNA of them. Leptin induced a significant stimulation of GnRH release, the results being most significant at 0.1 nmol/L for 15 min. In contrast to other studies in hypothalamic explants, neither orexin A nor orexin B affected basal GnRH secretion over a wide range of concentrations ranging from 1 nmol/L to 500 nmol/Lat 15, 30, and 60 min. CONCLUSION: Feeding and reproductive function are closely linked. Many orexigenic and anorexigenic signals may control feeding behavior as well as alter GnRH secretion through their receptors on GnRH neurons.