Background: Neoadjuvant therapy can shrink tumors, increase anus preservation rate, and protect anal function. Radical surgery need cut off the diseased bowel, clean up the lymph nodes, and then restore bowel function. It could bring traumatic effect and poor postoperative quality of life to the patient. Local resection requires removal of the diseased bowel with circular negative margin. The surgical trauma is small, and the postoperative quality of life is good. In this meta-analysis, we aimed to evaluate the efficacy and safety between wait and see strategy (WS), radical surgery (RS), and local excision (LE) of rectal cancer patients with clinical complete response (cCR) response after neoadjuvant chemoradiotherapy. Methods: We searched PubMed, Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang databases to compare wait and see strategy with radical surgery and local excision for rectal cancer with cCR response after neoadjuvant chemoradiotherapy up to March 2020. We collected the data of local recurrence, distant metastasis, cancer-related death, overall survival, and disease-free survival and used RevMan 5.0 to carry out the meta-analysis. Continuous data were evaluated by the standardized mean differences (SMD) with 95% confidence intervals (95% CIs), and dichotomous data were evaluated by relative risks (ORs or RRs) with 95% CIs. We aimed to compare the advantages and disadvantages of the three groups. Results: Eleven English studies with 1131 patients were included. There were 412 patients in WS group, 678 patients in RS group, and 41 patients in LE group. WS group had a higher local recurrence rate than RS group (OR 7.32, 95% CI 3.58 to 14.95, P < 0.001). There was no significant difference in the other data between the three groups.
The clinical data of 34 patients show that this is an effective surgical treatment to reduce blood loss and suggest that there is negligible harm to patients and fetuses.
Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is performed increasingly often despite the lack of high-quality evidence confirming its safety, especially for malignant diseases. The aim of this prospective study is to verify that vaginal NOTES (vNOTES) can be performed safely and effectively in early endometrial cancer staging surgery. Materials and Methods: This prospective study was conducted in two tertiary hospitals in southern China from January 2021 to May 2022. A total of 120 patients with stage I endometrial cancer were included. vNOTES or multiport laparoscopic staging surgery was selected according to each patient’s wishes. The primary outcome was the sentinel lymph node detection rate, analyzed by a noninferiority test. The secondary outcomes were perioperative outcomes. Results: Among the 120 patients enrolled, 57 underwent vNOTES, and 63 underwent multiport laparoscopy. The patient-specific detection rates of sentinel lymph nodes were 94.73 and 96.82% in the vNOTES and laparoscopy groups, respectively. Additionally, the bilateral detection rates were 82.46 and 84.13%, and the side-specific detection rates were 88.60 and 90.48% in these two groups, respectively. All three detection rates in the vNOTES group were noninferior to those of laparoscopy group at a noninferiority cutoff of –15%. The median operation times of the vNOTES and laparoscopy groups were 132.35 and 138.73 min (P=0.362), and the median estimated blood loss were 75 and 50 ml (P=0.096), respectively. No intraoperative complications occurred in either group. The pain scores on the Numerical Rating Scale at both 12 h and 24 h after operation were significantly lower in the vNOTES group (P<0.001) and the median postoperative hospital stay was significantly shorter in the vNOTES group (P=0.001). Conclusion: This study illustrates the potential applicability of vNOTES in gynecological malignancy surgery by demonstrating its safety and effectiveness in endometrial cancer staging. However, its long-term survival outcomes require further exploration.
The depressing function of bacteria of LKD on diaspore and kaolinite is studied through flotation experiments, mineral ζ-electric potential and infrared spectroscopy analysis. Waste beer has better selective and depressing effects on diaspore in the range pH 2-10 than starch-like substances do. The analysis of mineral ζ-electric potential and infrared spectra shows that the bacteria of LKD is chemically adsorbed to diaspore via its –COOH and stays on the surface of mineral firmly. Meanwhile, the functional groups -OH of yeast itself and some -COOH are hydrophilic, which helps the mineral being hydrophilic as well. Although the structure of phyllosilicate kaolinite determines its good floatability on the condition of strong acid, the recovery of diaspore by yeast is 30% more than kaolinite when the diaspore is depressed by bacteria of LKD on the condition of weak acid, pH-6. It indicates the possibility of Al-Si separation by reverse-flotation under neutral conditions.
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