Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 5 Articles
Background: Laparoscopic Nissen fundoplication (LNF) is the most common surgical procedure for the surgical\nmanagement of gastro-esophageal reflux disease (GERD). Laparoscopic Toupet fundoplication (LTF) has been\nreported to have a lower prevalence of postoperative complications yet still obtain a similar level of reflux control.\nWe conducted a meta-analysis to confirm the value of LNF and LTF.\nMethods: PubMed, Medline, Embase, Cochrane Library and Springerlink were searched for randomized controlled\ntrials (RCTs) comparing LNF and LTF. Data regarding the benefits and adverse results of two techniques were\nextracted and compared using a meta-analysis.\nResults: Eight eligible RCTs comparing LNF (n = 625) and LTF (n = 567) were identified. There were no significant\ndifferences between LNF and LTF with regard to hospitalization duration, perioperative complications, patient satisfaction,\npostoperative heartburn, regurgitation, postoperative DeMeester scores, or esophagites. A shorter operative time and\nhigher postoperative lower esophageal sphincter pressure were associated with LNF. Prevalence of postoperative\ndysphagia, gas-bloating, inability to belch, dilatation for dysphagia and reoperation were higher after LNF, but\nsubgroup analyses showed that differences with respect to dysphagia between LNF and LTF disappeared over\ntime. Subgroup analyses did not support ââ?¬Å?tailored therapyââ?¬Â according to preoperative esophageal motility.\nConclusions: LNF and LTF have equivalently good control of GERD and result in a similar prevalence of patient\nsatisfaction. Based on current evidence, it is not rational or advisable to abandon LNF when choosing a surgical\nprocedure for GERD....
Background: Since the biological function of c-Jun N-terminal kinase (JNK) in gastric cancer remains unclear, we\ninvestigated the clinical significance of JNK activation and its association with FOXO1 activation.\nMethods: Immunohistochemical tissue array analysis of 483 human gastric cancer specimens was performed, and\nthe results of the immunostaining were quantified. The correlation between JNK activation (nuclear staining for\npJNK) and clinicopathological features, the proliferation index, prognosis or FOXO1 inactivation (cytoplasmic\nstaining for pFOXO1) was analyzed. The SNU-638 gastric cancer cell line was used for in vitro analysis.\nResults: Nuclear staining of pJNK was found in 38 % of the gastric carcinomas and was higher in the early stages\nof pTNM (P < 0.001). pJNK staining negatively correlated with lymphatic invasion (P = 0.034) and positively correlated\nwith intestinal type by Lauren�s classification (P = 0.037), Ki-67-labeling index (P < 0.001), cyclin D1 (P = 0.045), cyclin\nE (P < 0.001) and pFOXO1 (P < 0.001). JNK activation correlated with a longer patients survival (P =0.008) and\npatients with a JNK-active and FOXO1-inactive tumor had a higher survival rate than the remainder of the\npopulation (P = 0.004). In vitro analysis showed that JNK inhibition by SP600125 in SNU-638 cells decreased cyclin\nD1 protein expression and increased FOXO1 activation. Further, JNK inhibition markedly suppressed colony\nformation, which was partially restored by FOXO1 shRNA expression.\nConclusions: Our results indicate that JNK activation may serve as a valuable prognostic factor in gastric cancer,\nand that it is implicated in gastric tumorigenesis, at least in part, through FOXO1 inhibition...
Once the patients are in the intensive care unit (ICU), they are generally unable to ensure the adequacy of their own nutritional intake. A patient in ICU, who cannot take food orally, requires either enteral or parenteral nutritional support. Enteral nutrition is generally preferred over parenteral nutrition because the former is associated with reduced cost, decreased length of hospital stay, lower incidence of infectious and non-infectious complications. Present study was conducted to assess and compare the enteral feeding associated problems among patients in experimental (continuous naso gastric feeding) and control group (existing enteral feeding practices i.e. bolus naso gastric feeding). A total of 60 patients of intensive care units of Dayanand Medical College and Hospital, Ludhiana, Punjab were selected by the consecutive sampling technique and were then randomized into two groups i.e. experimental and control group by block randomization. Data was collected by interviewing of patient’s relative and the complications of the enteral feeding were recorded in the observational checklist. Results revealed that the high gastric residual volume on day 1 was present only in control group i.e. 9 (30%) patients whereas it was absent among experimental group (p = 0.001). Also, there was no statistically significant difference of mechanical problems among both the groups although tube displacement and hiccups were present among experimental group. However, the tube displacement was not associated with feeding related problems as it was accidental. Furthermore, the present study concluded that the continuous naso gastric feeding is better than bolus naso gastric feeding in reference to the gastrointestinal complications on day 1 and without having any statistical difference among the mechanical problems in both the groups. Hence, initially the continuous naso gastric feeding can be started among the critically ill patients to control gastrointestinal problems....
Background: This study aimed to evaluate the clinical significance of cysteine-rich 61 (Cyr-61/CCN1) and\ncyclooxygenase-2 (COX-2), and further explored their combined prognostic significance in gastric cancer.\nMethods: This retrospective study examined the expressions of Cyr-61 and COX-2 in 82 surgically removed gastric\ncancer specimens and 43 non-tumor gastric mucosa specimens by immunohistochemical staining to identify the\nabnormal expression of Cyr-61 or COX-2 in gastric cancer. Crude survival curves were constructed by the\nKaplan-Meier method and Cox proportional hazards regression analysis was performed to confirm the prognostic\nroles of Cyr-61/COX-2 as well as sex and histological grade.\nResults: The expressions of Cyr-61 (p < 0.001) and COX-2 (p = 0.001) were both significantly up-regulated in gastric\ncancer samples compared with non-tumor gastric mucosa samples. The high expression of Cyr-61 or COX-2 was\nassociated with invasion, lymph node metastasis, distant metastases, poor histological differentiation, advanced\nTNM stage and lower 5-year survival rate (all p < 0.05). Both Cyr-61 and COX-2 high expressions [hazard ratio (HR) = 31.\n8, 95 % confidence interval (CI) 4.09ââ?¬â??246.8] was associated the higher risk of death during 5 years follow up than single\nCyr-61 high [removed]HR = 4.1, 95 % CI 1.5ââ?¬â??11.6) or COX-2 high [removed]HR = 2.9, 95 % CI 1.06ââ?¬â??7.8).\nConclusions: Cyr-61 and COX-2 expressions are associated with the progression of gastric cancer. Additionally,\ncombined expressions of Cyr-61 and COX-2 has a higher prognostic value than single expression....
Background: Colorectal cancer (CRC) is the fourth leading cause of cancer-related death in Europe and the United\nStates. Detecting the disease at an early stage improves outcomes. Risk prediction models which combine multiple\nrisk factors and symptoms have the potential to improve timely diagnosis. The aim of this review is to\nsystematically identify and compare the performance of models that predict the risk of primary CRC among\nsymptomatic individuals.\nMethods: We searched Medline and EMBASE to identify primary research studies reporting, validating or\nassessing the impact of models. For inclusion, models needed to assess a combination of risk factors that\nincluded symptoms, present data on model performance, and be applicable to the general population.\nScreening of studies for inclusion and data extraction were completed independently by at least two\nresearchers.\nResults: Twelve thousand eight hundred eight papers were identified from the literature search and three\nthrough citation searching. 18 papers describing 15 risk models were included. Nine were developed in primary\ncare populations and six in secondary care. Four had good discrimination (AUROC > 0.8) in external validation\nstudies, and sensitivity and specificity ranged from 0.25 and 0.99 to 0.99 and 0.46 depending on the cut-off\nchosen.\nConclusions: Models with good discrimination have been developed in both primary and secondary care\npopulations. Most contain variables that are easily obtainable in a single consultation, but further research is\nneeded to assess clinical utility before they are incorporated into practice....
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