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15. Enhanced recovery after surgery for laparoscopic gastrectomy in gastric cancer

Author

Liang, Yanrui, Liu, Hao, Nurse, Li Zhen, Zhu, Yu, Zhao, Mingli, Hu, Yanfeng, Yu, Jiang, Li, Cai, Liu, Kexuan, and Li, Guoxin

Subjects
Adult, Male, gastric cancer, post-operative hospital stay, Clinical Trial/Experimental Study, Length of Stay, Middle Aged, post-operative complication, Postoperative Complications, enhanced recovery after surgery, laparoscopic distal gastrectomy, Gastrectomy, Stomach Neoplasms, Humans, Female, Laparoscopy, Prospective Studies, Research Article
Abstract

Background: Laparoscopic distal gastrectomy (LDG) has been highlighted for its safety and better short-term clinical outcomes in treating gastric cancer. However, only a slight reduction of the post-operative hospital stay was observed in gastric cancer patients undergoing LDG with conventional perioperative management, compared to patients undergoing open surgery. Thus, an enhanced recovery after surgery (ERAS) program for LDG is needed to further reduce the post-operative hospital stays. This prospective, open-label, single-arm cohort study aimed to assess the safety and efficacy of the ERAS program for gastric cancer patients undergoing LDG. Material and Methods: All patients with gastric cancer indicated for LDG were consecutively enrolled from December 2016 to January 2018. The ERAS program included short fasting time, effective perioperative pain management, early, goal-oriented ambulation, and oral feeding. The safety assessment was the incidence of post-operative complications, mortality, and readmission in 30 days. The primary efficacy assessment was recovery time defined by post-operative hospital stays and rehabilitative rate on post-operative day 4. Results: Ninety-eight of 114 patients were finally enrolled. The incidence of post-operative complication, mortality, and readmission in 30 days was 20. 4%, 0%, 7.1%, respectively. The Clavien-Dindo grade III complication rate was 6.1%, while the pulmonary complication rate was 1% only. The median post-operative stay was 6 days (5.0-7.0 days), and the rehabilitative rate on post-operative day 4 was 78%. Conclusions: The ERAS program might be optimal perioperative management for gastric cancer patients after LDG without compromising safety. Trial number: NCT03016026

Published
2021

26. Digoxin Use and Adverse Outcomes in Patients With Atrial Fibrillation

Author

Wu-Tao Zeng, Zhu-Yu Li, Yun-Jiu Cheng, Zhi-Hao Liu, and Ming Zhang

Subjects
Risk, medicine.medical_specialty, Digoxin, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Cause of Death, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Stroke, Survival rate, Cause of death, business.industry, Absolute risk reduction, Atrial fibrillation, General Medicine, medicine.disease, Confidence interval, Survival Rate, Relative risk, Cardiology, business, Systematic Review and Meta-Analysis, medicine.drug, Research Article
Abstract

Digoxin has long been used for rate control in atrial fibrillation (AF); its safety remains controversial. We performed a literature search using MEDLINE (source PubMed, January 1, 1966, to July 31, 2015) and EMBASE (January 1, 1980, to July 31, 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the associations of interest were included. Pooled effect estimates were obtained by using random-effects meta-analysis. Twenty-two studies involving 586,594 patients were identified. Patients taking digoxin, as compared with those who took no digoxin, experienced an increased risk of death from any cause (RR: 1.29[95% CI 1.16–1.43]), even after reported adjustment for propensity scores (RR: 1.28[95% CI 1.18–1.39]). The risk of death was increased with patients with or without heart failure (RR: 1.12[95% CI 1.02–1.23] and RR: 1.26[95% CI 1.15–1.29], respectively), and patients taking or not taking beta blockers (RR: 1.17 [95% CI 1.06–1.30] and RR: 1.28 [95% CI 1.08–1.51], respectively). Digoxin use was also associated with increased risk of cardiovascular death (RR: 1.32 [95% CI 1.07–1.64]), arrhythmic death (RR: 1.38 [95% CI 1.07–1.79]), and stroke (RR: 1.20 [95% CI 1.004–1.44]). Digoxin treatment is associated with an absolute risk increase of 19 (95% CI 13–26) additional deaths from any cause per 1000 person-years. Digoxin use is associated with a significant increased risk for death from any cause in patients with AF. This finding suggests a need for reconsideration of present treatment recommendations on use of digoxin in AF.

Published
2016

30. An Invert U-Shaped Curve

Author

Li, Haibo, primary, Zha, Xiaojuan, additional, Zhu, Yu, additional, Liu, Mengxue, additional, Guo, Rui, additional, and Wen, Yufeng, additional

Published
2016
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