ObjectiveTo systematically review the correlation of diabetes mellitus (DM) with periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). MethodsStudies related to DM with PJI after TJA were collected from PubMed, EMbase and The Cochrane Library from inception to September 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 13.0 software. ResultsA total of 26 studies involving 1 750 118 patients were included. The results of meta-analysis showed that the risk of PJI after TJA in DM patients was significantly higher than that in non-DM patients (OR=1.42, 95%CI 1.32 to 1.52, P<0.000 1). ConclusionCurrent evidence indicates a higher risk of PJI for DM patients than non-DM patients after TJA. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To explore the risk factors of recurrence and metastasis in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical gastrectomy. Methods A retrospective study was conducted to collect the clinical data of 146 patients with type Ⅱ and Ⅲ AEG who underwent radical gastrectomy from January 2010 to January 2013 in the Nanjing First Hospital of Nanjing Medical University. The factors affected the recurrence and metastasis of the patients after the radical gastrectomy were analyzed by the unconditional logistic regression analysis. Results The 146 AEG patients were followed up for 3–84 months, with the median follow-up time of 48 months. During the follow-up period, there were 59 cases suffered from recurrence and metastasis. The recurrence and metastasis time was 1–50 months after radical gastrectomy, with the median time of 17 months after radical gastrectomy. The results of multivariate logistic regression analysis showed that, the histological grade (OR=4.478, P=0.015), the number of positive lymph nodes (OR=2.886, P<0.001), and vascular invasion (OR=5.334, P=0.003) were independent risk factors for the recurrence and metastasis of AEG patients after radical gastrectomy. Patients with low tumor histological grade (G3+G4), a large number of positive lymph nodes, and vascular invasion were more likely to have recurrence and metastasis after radical gastrectomy. Conclusions The histological grade of tissue, number of positive lymph nodes, and vascular invasion are important factors in predicting the recurrence and metastasis of Siewert Ⅱ/Ⅲ AEG patients after radical gastrectomy.
Objective This study was conducted to evaluate and analyze the clinical effect between subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and pylorus-preserving pancreaticoduodenectomy (PPPD), especially compare the incidences of delayed gastric emptying (DGE) between them. Methods The documents about SSPPD and PPPD were searched in Cochrane Library, PubMed database, Embase database, Web of Science, Chinese biomedicine database, CNKI database, VIP database, and WanFang database. The quality of included studies was assessed according to the Cochrane systematic review methods, and statistical analysis of data was performed by using RevMan 5.3 software. Firstly, comparison of incidence of DGE and other effective indexes between SSPPD group and PPPD group was performed by enrolling all included studies, whether met the DGE standards of International Study Group of Pancreatic Surgery (ISGPS) or not, and then comparison of incidence of DGE and clinical DGE was performed by enrolling included studies that met the DGE standards of ISGPS. Results Ten studies were included, with a total of 804 patients, in which, 433 cases underwent SSPPD and 371 cases underwent PPPD. The results of meta-analysis indicated that, in all the included studies, the total incidence of DGE〔OR = 0.33, 95%CI is (0.17, 0.63),P = 0.000 9〕, and the time of nasogastric tube〔MD = –2.65，95%CI is (–4.49, –0.80),P = 0.005〕, and time of stared liquid diet〔MD = –4.13, 95%CI is (–7.35, –0.91),P = 0.01〕 showed significant differences. The total incidence of DGE, the time of nasogastric tube, and time of stared liquid diet were less in SSPPD group. But there was no significant difference between the SSPPD group and PPPD group in operating time, intraoperative blood loss, time of started solid diet, hospital stay, and incidences of reinsertion of nasogastric tube, pancreatic fistula, intra-abdominal abscess, reoperation, wound infection, postoperative hemorrhage, and mortality (P>0.05). In the 8 studies adopted DGE standard of ISGPS, the total incidence of DGE〔OR = 0.31, 95%CI is (0.15, 0.65)，P = 0.002〕 and incidence of clinical DGE 〔OR = 0.13，95%CI is (0.05, 0.40),P = 0.000 3〕showed significant differences. The total incidence of DGE and incidence of clinical DGE were both lower in SSPPD group. Conclusions Compared with PPPD group, SSPPD group was associated with significantly less incidence of DGE. Meanwhile, the time of the nasogastric tube and started liquid diet are shorter than those of SSPPD. And there is no significant difference in the other aspects.
ObjectiveTo explore the potential relationship between sleep apnea characterized by different Sleep Apnea subtype and cardiac structure and function.MethodsBased on the composition of sleep respiratory events, this study aimed to analyze whether patients with different subtype of sleep apnea exhibit specific cardiac structural characteristics. A retrospective analysis was conducted on 223 patients admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine between 2018 and 2024 who completed polysomnography (PSG) and echocardiography. Participants were categorized into four groups based on respiratory event: ① with Cheyne-Stokes respiration Events (CSB), ② with central sleep apnea events and without CSB Event (ICA), ③ with obstructive sleep apnea events mainly (IOA), ④ non-sleep apnea controls (NSA), and observed the correlation of PSG parameters and echocardiographic.ResultsPatients with sleep apnea accompanied by CSR were older (χ2=36.014, P<0.001) and exhibited significantly larger left atrial diameter (χ2=41.823, P<0.001) and left ventricular end-systolic diameter (χ2=20.397, P<0.001) compared to other groups. Other sleep apnea subtypes demonstrated varying degrees of increased interventricular septal thickness (χ2=25.272, P<0.001) and left ventricular wall thickness (χ2=21.650, P<0.001) relative to non-apneic controls.ConclusionsAll sleep apnea subtypes are associated with hypertension-related cardiac structural alterations. Notably, patients with CSR-complicated sleep apnea exhibit more severe cardiac remodeling, leading to impaired systolic and diastolic functions.