Intrathoracic versus cervical anastomosis in esophagectomy for esophageal cancer: A meta-analysis of randomized controlled trials.

BACKGROUND: Intrathoracic anastomosis and cervical anastomosis are very common in the esophagectomy of esophageal cancer; we aimed to evaluate the effects and safety of intrathoracic anastomosis versus cervical anastomosis in the esophagectomy. METHODS: We searched PubMed, EMBASE, Cochrane Library, Web of Knowledge, China National Knowledge Infrastructure, and WanFang databases up to September 30, 2021, for randomized controlled trials focused on cervical anastomosis versus intrathoracic anastomosis for the treatment of esophageal cancer. RESULTS: In total, 12 randomized controlled trials involving 1,493 patients were finally included. The incidence of anastomotic leak [relative risk = 2.76, 95% confidence interval (1.94∼3.94), P < .001] and recurrent laryngeal nerve injury [relative risk = 6.12, 95% confidence interval (3.02∼12.41), P < .001] in the intrathoracic anastomosis group were less than that of the cervical anastomosis group. There were no significant differences in the incidence of anastomotic stenosis [relative risk = 1.33, 95% confidence interval (0.88∼2.00), P = .18], pneumonia [relative risk = 1.31, 95% confidence interval (0.82∼2.09), P = .25], postoperative chylothorax [relative risk = 1.01, 95% confidence interval (0.40∼2.52), P = .99], and mortality [relative risk = 0.93, 95% confidence interval (0.52∼1.68), P = .82] between the 2 groups. CONCLUSION: Intrathoracic anastomosis is associated with significantly reduced risk of leak and recurrent laryngeal nerve injury compared with cervical anastomosis.

The efficacy and safety of bevacizumab combined with FOLFOX regimen in the treatment of advanced colorectal cancer: A systematic review and meta-analysis.

BACKGROUND: It is necessary to systematically evaluate the clinical efficacy and safety of bevacizumab (BEV) combined with 5-fluorouracil + leucovorin + oxaliplatin (FOLFOX) regimen in the treatment of advanced colorectal cancer. METHODS: We searched the PubMed et al databases for randomized controlled trials (RCTs) on the BEV combined with the FOLFOX regimen in the treatment of advanced colorectal cancer up to January 20, 2021. The Cochrane Collaborations' risk of bias tool was used for the quality assessment of included RCTs. Revman5.3 software was used for meta-analysis. RESULTS: Eleven RCTs with a total of 3178 patients with advanced colorectal cancer were included, meta-analysis results showed that the objective response rate (odds ratio [OR] = 3.15, 95% confidence intervals [CI]: 2.25-4.40, P < .001) and cancer control rate (OR = 2.73, 95% CI: 1.91-3.90, P < .001) of BEV + FOLFOX were higher than that of FOLFOX group. And the incidence of gastrointestinal adverse reactions (OR = 1.29, 95% CI: 1.07-1.55, P = .008) in the BEV + FOLFOX group was higher than that of the FOLFOX group, there were no significant differences in the incidence of leukopenia (OR = 1.04, 95% CI: 0.72-1.50, P = .83), hypertension (OR = 3.92, 95% CI: 0.81-18.88, P = .09) and neurotoxicity (OR = 1.00, 95% CI: 0.8-1.27, P = .98) between the 2 groups. CONCLUSION: BEV combined with the FOLFOX regimen is more effective than the FOLFOX regimen alone in the treatment of advanced colorectal cancer, but it may also increase the risk of gastrointestinal adverse reactions.

Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis.

BACKGROUND: Previous randomized controlled trials have compared the efficacy and safety of single chest drain (SCD) and double chest drains (DCD) in the patients undergone pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients undergone pulmonary lobectomy. METHODS: PubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu, and China Biomedical Literature databases were searched up to February 28, 2020, to identify the potential RCTs on SCD and DCD in the patients undergone pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage (days), the length of hospital stay (days), and the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes. RESULTS: A total of 11 RCTs with 1214 patients were included, in which 589 patients received SCD treatment and 625 patients DCD treatment. The verbal pain score (MD = - 0.54, 95%CI (- 0.87, - 0.21)), the duration of drainage (MD = - 0.65, 95%CI (- 1.04, - 0.26)), and the length of hospital stay (MD = - 0.55, 95%CI (- 0.80, - 0.29)) in SCD group were significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR = 1.35, 95%CI (0.86, 2.11)) and re-drainage (OR = 0.88, 95%CI (0.41, 1.90)) among the two groups. CONCLUSIONS: SCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain, and reduced length of hospital stay when compared with DCD in the patients undergone pulmonary lobectomy.

Curcumin induces therapeutic angiogenesis in a diabetic mouse hindlimb ischemia model via modulating the function of endothelial progenitor cells.

BACKGROUND: Neovascularization is impaired in diabetes mellitus, which leads to the development of peripheral arterial disease and is mainly attributed to the dysfunction of endothelial progenitor cells (EPCs). Previous studies proved the promotional effect of curcumin on neovascularization in wound healing of diabetes. Thus, we hypothesize that curcumin could promote neovascularization at sites of hindlimb ischemia in diabetes and might take effect via modulating the function of EPCs. METHODS: Streptozotocin-induced type 1 diabetic mice and nondiabetic mice both received unilateral hindlimb ischemic surgery. Curcumin was then administrated to the mice by lavage for 14 days consecutively. Laser Doppler perfusion imaging was conducted to demonstrate the blood flow reperfusion. Capillary density was measured in the ischemic gastrocnemius muscle. In addition, angiogenesis, migration, proliferation abilities, and senescence were determined in EPCs isolated from diabetic and nondiabetic mice. Quantitative PCR was then used to determine the mRNA expression of vascular endothelial growth factor (VEGF) and angiopoetin-1 (Ang-1) in EPCs. RESULTS: Curcumin application to type 1 diabetic mice significantly improved blood reperfusion and increased the capillary density in ischemic hindlimbs. The in-vitro study also revealed that the angiogenesis, migration, and proliferation abilities of EPCs and the number of senescent EPCs were reversed by curcumin application. Quantitative PCR confirmed the overexpression of VEGF-A and Ang-1 in EPCs after curcumin treatment. CONCLUSION: Curcumin could enhance neovascularization via promoting the function of EPCs in a diabetic mouse hindlimb ischemia model.

[Effects of shuang shen tong guan decoction on the blood flow dynamics in rat model with myocardial infarction].

OBJECTIVE: To research the effects of Shuang Shen Tong Guan Decoction (SSTGD) on hemodynamics in rats with acute myocardial infarction (AMI). METHODS: SD rats were divided into sham operation group,model group, SSTGD low-dose group (2.5 g/kg), SSTGD middle-dose group (5 g/kg) and SSTGD high-dose group (7.5 g/kg). The levels of HR, MAP, LVSP, LVEDP, LVdp/ dt(max) and LVdp/dt(min) were detected by PowerLab at 0, 15, 30, 60, 90, 120, 180 min after administration. RESULTS: Compared with the sham operated group, the levels of HR, MAP were increased, the levels of LVSP, LVEDP, LVdp/dt(max) and LVdp/dt(min) were reduced at each detected point in model group, the difference was significant (P < 0.05). Compared with the model group, HR and MAP were decreased in SSTGD low-dose group, SSTGD middle-dose group and SSTGD high-dose group after 15 min; LVSP, LVEDP, LVdp/dt(max) and LVdp/dt(min) were higher, there was significantly difference (P < 0.05). Compared with SSTGD low-dose group and SSTGD middle-dose group, the difference of LVSP, LVEDP, LVdp/dt(max) and LVdp/dt(min) was statistically significant in SSTGD high-dose group (P < 0.05). CONCLUSION: SSTGD can improve cardiac function by increasing heart stroke volume, decreasing cardiac oxygen consumption and total peripheral vascular resistance.