Background: The safety and effectiveness of early oral feeding after colorectal surgery has not been determined. We performed a meta-analysis to evaluate surgical outcomes following early oral feeding compared with traditional oral feeding in patients undergoing elective colorectal surgery. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify randomized clinical trials comparing the outcomes following early oral feeding versus traditional oral feeding in patients undergoing elective colorectal surgery. The trials must have reported at least one of the following end points: anastomotic dehiscence, pneumonia, wound infection, nasogastric tube reinsertion, vomiting, mortality, length of hospital stay, hospital costs, and quality of life. Results: Seven trials, which included a total of 587 patients, met our inclusion criteria. Compared with traditional oral feeding, early oral feeding reduced the length of hospital stay (weighted mean difference -1.58 days; 95% CI -2.77 to -0.39; p = 0.009) and the total postoperative complications (relative risk 0.70; 95% CI 0.50-0.98; p = 0.04). There were no significant differences in the risk of anastomotic dehiscence, pneumonia, wound infection, rate of nasogastric tube reinsertion, vomiting, or mortality. Conclusions: Early oral feeding is safe and effective in patients undergoing elective colorectal surgery.

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Background: The study aimed to compare the safety and effectiveness of Enhanced recovery after surgery (ERAS) with conventional care in gastrectomy for gastric cancer. Methods: Search strategy from Pubmed, Embase, Web of science, Cochrane library and reference lists was performed. The collected studies were randomized controlled trials and published only in English, and undergoing ERAS in gastrectomy for gastric cancer from January 1994 to August 2016. Results: A total of eight studies including 801 patients were included. There were 399 cases in the ERAS and 402 cases in the conventional care groups. Meta-analysis showed that time to first passage of flatus (weighted mean difference (WMD)-14.57; 95% confidence interval (CI)-20.31 to-8.83, p<0.00001), level of C-reaction protein (WMD-19.46; 95 % CI-21.74 to-17.18, p<0.00001) and interleukin-6 (WMD-32.16; 95 % CI-33.86 to-30.46,p<0.00001) on postoperative days, postoperative hospital stay (WMD-1.85; 95 % CI-2.35 to-1.35, p<0.00001), hospital charge (WMD −0.94, 95 % CI, −1.40 to 0.49, p<0.0001) were significantly decreased for ERAS, but increased readmission rates (odds ratio (OR), 3.42, 95 % CI, 1.43 to 8.21, P=0.006). There were no statistically significant differences in intraoperative blood loss, operation time, number of retrieved lymph nodes, duration of foley catheter and postoperative complications (p>0.05). Conclusions: ERAS is considered to be safe and effective in gastrectomy for gastric cancer. Further larger, multicenter and randomized trials were needed to beresearched.

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Objectives Gefitinib is mainly used for the treatment of non-small-cell lung cancer. Hepatotoxicity is one of the main side effects of gefitinib, and seriously affects the treatment process of the disease. However, the hepatotoxicity mechanism of gefitinib remains unclear. Methods The hepatotoxicity of different doses of gefitinib was investigated in mice and AML-12 cells, and the possible correlation of hepatotoxicity with CYP450 was analysed. Key findings The toxic effects of gefitinib were confirmed by the increased liver index, decreased body weight and survival rate, injured liver function and histopathology followed 16 days of oral administration. Gefitinib (400 mg/kg) upregulated the hepatic mRNA expression of CYP1A1 and downregulated the CYP2D9 and CYP2D10 in mice. Furthermore, we verified that gefitinib produced cytotoxicity on AML-12 cells in a dose and time-dependent manner, and confirmed that gefitinib (20 μM) induced cell apoptosis, upregulated mRNA expression of CYP1A1 and downregulated CYP2D9 and CYP2D10. Pearson correlation analysis also showed that the hepatotoxicity of gefitinib was positively correlated with CYP1A1 and negatively correlated with CYP2D9 and CYP2D10. Conclusions Our results suggested that the hepatotoxicity gefitinib may be associated with CYP1A1, CYP2D9 and CYP2D10. These findings will contribute to a better understanding of the mechanism of gefitinib hepatotoxicity.

Objective: The main purpose of this paper is to investigate sleep quality in the withdrawal of medical members dispatched to control the Corona Virus Disease 2019(COVID-19) outbreak in Wuhan, Hubei province, China. Methods: Forty-seven medical members (including twenty medical members treating mild COVID-19, seventeen medical members treating severe COVID-19 and ten logistics team members) completed questionnaire using Pittsburgh Sleep Quality Index. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of the medical members. Results: A total of forty-seven medical members participated in the sleep quality survey. The PSQI total scores are 5.6±4.3, 11.0±5.0 and 3.4±2.0 in treating mild COVID-19, treating severe COVID-19 and logistics team members, respectively. Medical members treating patients with severe COVID-19 had significantly higher PSQI total scores than those who facing up to the patients with mild COVID-19 and logistics team members. (P<0.005). The components of PSQI such as sleep duration and sleep medications were significantly higher in medical members treating patients with severe COVID-19 than those who facing up to the patients with mild COVID-19 and logistics team members (P<0.005). The components of PSQI such as sleep quality and daytime dysfunction were worse in medical members treating patients with severe COVID-19 than logistics team members (P<0.005).Conclusions: Findings indicate that medical members treating patients with severe COVID-19 had worse sleep quality than who facing up to the patients with mild COVID-19 and logistics team members.