To examine possible differences in the clinical outcomes of topical anesthesia (TA) and regional anesthesia including retrobulbar anesthesia (RBA) and peribulbar anesthesia (PBA) in ...phacoemulsification.
Systematic review and meta-analysis.
Patients from previously published randomized controlled trials (RCTs) of phacoemulsification under TA and RBA/PBA reporting clinical outcomes.
A comprehensive literature search was performed according to the Cochrane Collaboration method to identify RCTs that compare TA and RBA/PBA in phacoemulsification.
Primary outcome parameters investigated were pain score during and after surgery, intraoperative difficulties and inadvertent ocular movement, intraoperative necessity to administer additional anesthesia, and patient preference. Secondary outcome parameters investigated were postoperative visual acuity, anesthesia-related complications, intraoperative complications, and severe local or systemic complications.
Fifteen studies were identified and analyzed to compare TA (1084 eyes) with RBA/PBA (1121 eyes) in phacoemulsification. Data synthesis showed that intraoperative and postoperative pain perception was significantly higher in the TA group (P < 0.05). The TA group showed more frequent inadvertent ocular movement (P < 0.05) and a greater intraoperative need for supplementary anesthesia (P = 0.03). There was no statistically significant difference between the 2 groups in intraoperative difficulties as assessed by the surgeons (P > 0.05). Patients significantly preferred TA (P < 0.00001). The RBA/PBA group had more frequent anesthesia-related complications, such as chemosis, periorbital hematoma, and subconjunctival hemorrhage (P < 0.05). There was no statistically significant difference in surgery-related complications (P > 0.05).
Compared with RBA/PBA, TA does not provide the same excellent pain relief in cataract surgery; however, it achieves similar surgical outcomes. Topical anesthesia reduces injection-related complications and alleviates patients' fear of injection. The choice of TA is not suitable for patients with a higher initial blood pressure or greater pain perception.
Summary Background Seroprevalence data suggest that a third of the world's population has been infected with the hepatitis E virus. Our aim was to assess efficacy and safety of a recombinant ...hepatitis E vaccine, HEV 239 (Hecolin; Xiamen Innovax Biotech, Xiamen, China) in a randomised, double-blind, placebo-controlled, phase 3 trial. Methods Healthy adults aged 16–65 years in, Jiangsu Province, China were randomly assigned in a 1:1 ratio to receive three doses of HEV 239 (30 μg of purified recombinant hepatitis E antigen adsorbed to 0·8 mg aluminium hydroxide suspended in 0·5 mL buffered saline) or placebo (hepatitis B vaccine) given intramuscularly at 0, 1, and 6 months. Randomisation was done by computer-generated permuted blocks and stratified by age and sex. Participants were followed up for 19 months. The primary endpoint was prevention of hepatitis E during 12 months from the 31st day after the third dose. Analysis was based on participants who received all three doses per protocol. Study participants, care givers, and investigators were all masked to group and vaccine assignments. This trial is registered with ClinicalTrials.gov , number NCT01014845. Findings 11 165 of the trial participants were tested for hepatitis E virus IgG, of which 5285 (47%) were seropositive for hepatitis E virus. Participants were randomly assigned to vaccine (n=56 302) or placebo (n=56 302). 48 693 (86%) participants in the vaccine group and 48 663 participants (86%) in the placebo group received three vaccine doses and were included in the primary efficacy analysis. During the 12 months after 30 days from receipt of the third dose 15 per-protocol participants in the placebo group developed hepatitis E compared with none in the vaccine group. Vaccine efficacy after three doses was 100·0% (95% CI 72·1–100·0). Adverse effects attributable to the vaccine were few and mild. No vaccination-related serious adverse event was noted. Interpretation HEV 239 is well tolerated and effective in the prevention of hepatitis E in the general population in China, including both men and women age 16–65 years. Funding Chinese National High-tech R&D Programme (863 programme), Chinese National Key Technologies R&D Programme, Chinese National Science Fund for Distinguished Young Scholars, Fujian Provincial Department of Sciences and Technology, Xiamen Science and Technology Bureau, and Fujian Provincial Science Fund for Distinguished Young Scholars.
Thoracoscopic anatomic pulmonary segmentectomy and subsegmentectomy have become sophisticated surgical solutions for complex pulmonary diseases. The rapid development of three-dimensional computed ...tomographic angiography (3DCTA) has made it possible to provide more refined individualized anatomic details and has consequently enabled subsubsegmentectomy (SSS). In this study, we report two successful thoracoscopic anatomic SSSs of the left S1+2 aii and S3 aii under the guidance of 3DCTA reconstructed images. To the best of our knowledge, these are the first two cases of SSSs ever detailed reported. The nomenclature of subsubsegments is adopted according to the Japanese Committee on the Nomenclature for Bronchial Branching.
Abstract Objectives MicroRNAs are a class of regulatory molecules involved in a wide variety of biological processes, including growth, development, and apoptosis. Given the widespread roles of ...microRNAs in biological processes, understanding their different expression profiles in normal, adjacent, and tumor tissues will provide insights into the consequences of aberrant expression. Methods With the use of next-generation deep sequencing technology, microRNA profiles in 3 pooled samples from normal, adjacent, and tumor tissues of 19 patients with lung squamous cell carcinoma were characterized comprehensively. Quantitative polymerase chain reaction was used to verify the primary findings in another 38 lung squamous cell carcinoma tumor samples. In situ hybridization also was performed for validation. Results A total of 368, 306, and 231 known microRNAs were identified from tumor, adjacent, and normal pooled samples, respectively, of which 40, 44, and 26 microRNAs displayed dysregulation with 2-fold or greater change in 3 compared groups of tumor versus normal, tumor versus adjacent, and adjacent versus normal, respectively. Sequencing data also showed that some coexpressed microRNAs displayed a pattern of progressive dysregulation. Some of the microRNAs exhibited consistent changes; among them, miR-425-5p and miR-218-5p were confirmed by quantitative polymerase chain reaction and in situ hybridization, and proved that the microRNA expression levels were closely related to tumor stages and sizes. It is suggested that some microRNAs, such as miR-425 and miR-183, might be a driver for tumor formation, growth, and progression to higher staging, whereas others, such as miR-218, might behave as a tumor suppressor in lung cancer. Functional annotation analysis indicated that the proteoglycan pathway in cancer and mitogen-activated protein kinase, Wnt, PI3K-Akt, and transforming growth factor-beta signaling pathways might be involved in the pathogenesis of lung squamous cell carcinoma. Conclusions This study describes the use of deep sequencing for comprehensive profiling of microRNAs in lung squamous cell carcinoma. The identified microRNA signatures may provide biomarkers for early detection, subclassification, and potential therapeutic targets of lung squamous cell carcinoma. This study also provides some insights into the molecular mechanism underlying the development and progression of lung squamous cell carcinoma, which may prove helpful for early diagnosis and treatment of the disease.
Objectives Thoracic sympathectomy is considered the most effective method to treat palmar hyperhidrosis. We developed a novel approach for thoracic sympathectomy in patients with palmar hyperhidrosis ...through the umbilicus, using an ultrathin gastroscope. The aim of this study was to evaluate the continuing efficacy and patient satisfaction of this innovative surgery. Methods All procedures were performed under general anesthesia and the patients were intubated with a dual-lumen endotracheal tube. After a 5-mm umbilical incision, the muscular parts of the diaphragmatic dome were incised with a needle-knife and the nasal gastroscope was advanced into the thoracic cavity. The sympathetic chain was identified at the desired thoracic level and ablated with hot biopsy forceps. All patients were followed up for at least 1 year after the procedure through clinic visits or telephone/e-mail interviews. Results From April 2010 to August 2011, a total of 35 patients underwent a transumbilical thoracic sympathectomy. Fifty-seven percent were male patients, with a mean age of 21.2 years (range, 16-33 years). The success rate after 12 months was 97.1% (34 of 35) for isolated palmar hyperhidrosis and 72.2% (13 of 18) for axillary hyperhidrosis. Compensatory sweating was reported in 28.6% of patients at the 1-year follow-up evaluation. There was no mortality, no diaphragmatic hernia, and no Horner syndrome was observed. Quality of life related to hyperhidrosis improved substantially in 27 (77.1%) patients, and improved in 4 (11.4%) patients at 12 months after surgery. A total of 94.3% of patients were satisfied with the excellent cosmetic results of the surgical incision. Conclusions Transumbilical thoracic sympathectomy is an efficacious alternative to the conventional approach. This technique avoided the chronic pain and chest wall paresthesia associated with the chest incision. In addition, this novel procedure afforded maximum cosmetic benefits.
Abstract Background Nicotine is thought to be an important risk factor for the development of cardiovascular diseases. However, the effects of nicotine on cardiomyocyte hypertrophy are poorly ...understood. The present study was designed to explore the role of nicotine in cardiomyocyte hypertrophy and its underlying mechanism. Methods We used primary cardiomyocytes isolated from Wistar rats to examine the effects of nicotine on intracellular Ca2+ mobilization and hypertrophy determined by immunofluorescence, quantitative polymerase chain reaction, and western blot analysis. A luciferase reporter assay was used to examine the activity of NFAT signalling. Results We found that nicotine caused cardiomyocyte hypertrophy, which was accompanied by increased intracellular Ca2+ . Nicotine-enhanced intracellular Ca2+ concentration (Ca2+ i ) was significantly abolished by store-operated Ca2+ entry (SOCE) and TRPC inhibitors. Knockdown of TRPC3 significantly decreased nicotine-induced SOCE and hypertrophy. Moreover, calcineurin–nuclear factor of activated T cells (NFAT) is involved in TRPC3-mediated Ca2+ signalling and cardiomyocyte hypertrophy. Notably, upregulation of TRPC3 by nicotine requires TRPC3-mediated Ca2+ influx and calcineurin-NFAT signalling activation. Conclusions Our findings demonstrate that the prohypertrophic effect of nicotine on cardiomyocytes is dependent on enhanced TRPC3 expression through a calcium-dependent regulatory loop, which could become a potential target for prevention and treatment of cardiac hypertrophy.
Objective This study aimed to compare the value of sentinel lymph node biopsy (SLNB) with that of elective neck dissection (END) for the prediction of cervical lymph node metastasis in patients with ...clinically diagnosed T1-2 N0 (cT1-2 N0 ) oral tongue squamous cell carcinoma (OTSCC), and it aimed to examine the prognostic value of individualized treatment in sentinel lymph node (SLN)-negative patients. Study Design The study entailed a retrospective review of 82 patients with cT1-2 N0 OTSCC. Thirty patients underwent SLNB, and 52 patients underwent END. Results There was a significant difference between the SLNB and END groups in the incidence of occult cervical lymph node metastasis in initial specimens (30% vs 11.5%; P = .037). However, there were no significant differences between the groups for 10-year overall and cervical recurrence-free survival rates and 10-year overall survival rate. Conclusions SLNB is superior to END for the prediction of cervical lymph node metastasis in patients with cT1-2 N0 OTSCC. Neck dissection may be reduced for SLN-negative patients, owing to the comparable prognosis of SLNB.
A 39-year-old woman was admitted to our hospital for a pure ground-glass opacity that had been detected in the right lung during a regular examination. A computed tomography scan showed a pure ...ground-glass opacity beneath the pleura of the right upper lobe of the lung that had enlarged over time. As a consequence, a lung adenocarcinoma was suspected. Meanwhile, three-dimensional computed tomography scans revealed a tracheal bronchus originating directly from the lateral wall of the trachea. The patient consequently underwent posterior segmental resection and mediastinal lymph node sampling by video-assisted thoracic surgery. During surgery, in addition to the tracheal bronchus, a variable central vein was found entering the left atrium dorsal to the right pulmonary artery trunk. We submit that, to the best of our knowledge, this is the first case of its kind ever reported.
Abstract Study Objective To investigate the effects of stellate ganglion block (SGB) on cardiovascular response and heart rate (HR) variability in elderly patients during anesthesia induction and ...endotracheal intubation. Design A randomized, double-blinded, and placebo-controlled study. Setting University-affiliated teaching hospital. Participants Eighty elderly patients (American Society of Anesthesiologists grades I and II) receiving elective surgery during general anesthesia. Interventions Right stellate ganglion injection (SGB) was performed in all patients using 10 mL of 1% lidocaine or normal saline. Measurements Systolic blood pressure (BP), diastolic BP, HR, and calculated rate pressure product. HR variability at the following time points: conscious status before induction (T0 ); immediately before intubation (T1 ); immediately after intubation (T2 ); and 1, 3, and 5 minutes postintubation (T3 , T4 , and T5 ). Main Results No significant differences in BP and HR were observed between the 2 groups. Rate pressure product values significantly increased in the control group compared with baseline and SGB group values. Low-frequency power (LF) and LF/high-frequency power (HF) significantly increased, and HF and normalized units of HF significantly decreased in the control group compared with baseline values. LF, normalized units of LF, and LF/HF in the SGB group significantly decreased compared with those of the control group. Conclusion SGB protects the myocardium and effectively suppresses stress responses during anesthesia induction and tracheal intubation in elderly patients.
We describe a pursestring stapled anastomotic technique for minimally invasive Ivor Lewis esophagectomy, in which a pursestring is hand sewn through the muscular layer of the intact esophagus by ...using one piece of 3–0 Prolene suture. The anvil of a circular stapler is inserted through an esophageal incision, 2 to 3 cm distal to the pursestring, and secured by the pursestring. The esophagus is transected, and the mucosa of the proximal stump is retained 5 mm longer than the adjacent muscular layer. The gastroesophageal anastomosis is completed and embedded by using the previously reserved 2 cm of mediastinal pleura.
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