Publications by authors named "Bing Cheng Zhao"

32 Publications

Microcomputed Tomography and Histological Study of Bone Regeneration Using Tooth Biomaterial with BMP-2 in Rabbit Calvarial Defects.

Scanning 2021 10;2021:6690221. Epub 2021 May 10.

Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University Guro Hospital, Seoul 08308, Republic of Korea.

Our study was aimed to analyze the osteoinductive effect of powdered and block type autogenous bone graft along with bone morphogenetic protein (BMP-2) as compared to synthetic bone graft. Three circular bicortical defects were made in the calvaria of each rabbit and randomly divided into three groups as follows: powdered tooth biomaterial+BMP-2, block tooth biomaterial+BMP-2, and control group: synthetic bone+BMP-2. The samples taken from these defects after 4 and 8 weeks were analyzed histologically along with micro CT analysis. In our study, both powered and block type tooth autogenous bone graft successfully stimulated mesenchymal cells leading to endochondral ossification and bone regeneration. We observed that the powered bone graft material which is acid insoluble especially is preferable as a carrier for BMP-2.
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http://dx.doi.org/10.1155/2021/6690221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131161PMC
May 2021

Histomorphometric Evaluation of Socket Preservation Using Autogenous Tooth Biomaterial and BM-MSC in Dogs.

Scanning 2021 12;2021:6676149. Epub 2021 May 12.

Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University, Seoul 08308, Republic of Korea.

This study is aimed at assessing the dimensional alterations occurring in the alveolar bone after premolar extraction in dogs with histomorphometric and histological analysis. After atraumatic premolar extraction, tooth-derived bone graft material was grafted in the extraction socket of the premolar region in the lower jaws of six dogs in two experimental groups. In the second experimental group, BM-MSCs were added together with the graft. The control was left untreated on the opposite side. After twelve weeks, all six animals were sacrificed. Differences in alveolar bone height crests lingually and buccally, and alveolar bone width at 1, 3, and 5 mm infracrestally, were examined. Histologic study revealed osteoconductive properties of tooth biomaterial. A statistically significant difference was detected between the test and control groups. In the test groups, a reduced loss of vertical and horizontal alveolar bone dimensions compared with the control group was observed. Tooth bone graft material may be considered useful for alveolar ridge preservation after tooth extraction, as it could limit the natural bone resorption process.
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http://dx.doi.org/10.1155/2021/6676149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137288PMC
May 2021

Micro-CT and Histomorphometric Study of Bone Regeneration Effect with Autogenous Tooth Biomaterial Enriched with Platelet-Rich Fibrin in an Animal Model.

Scanning 2021 11;2021:6656791. Epub 2021 May 11.

Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University, Seoul 08308, Republic of Korea.

The aim of this study was to evaluate the potential of tooth biomaterials as bone graft biomaterials for bone healing in rabbits. We prepared tooth biomaterial and platelet-rich fibrin (PRF) to fill the round-shaped defect in the skull of New Zealand white rabbits. These cranial defects were treated with different conditions as follows: group 1, a mixture of tooth biomaterials and platelet-rich fibrin (PRF); group 2, only tooth biomaterials; group 3, only PRF; and group 4, the unfilled control group. Specimens of the filled sites were harvested for analysis with microscopic computerized tomography (micro-CT) and histomorphology at 4 and 8 weeks. As a result of micro-CT, at 4 weeks, the bone volume percentages in groups 1 and 2 were 50.33 ± 6.35 and 57.74 ± 3.13, respectively, and that in the unfilled control group was 42.20 ± 10.53 ( = 0.001). At 8 weeks, the bone volume percentages in groups 1 and 2 were 53.73 ± 9.60 and 54.56 ± 8.44, respectively, and that in the unfilled control group was 37.86 ± 7.66 ( = 0.002). The difference between the experimental group 3 and the unfilled control group was not statistically significant. Histomorphologically, the total new bone was statistically different.
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http://dx.doi.org/10.1155/2021/6656791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133871PMC
May 2021

Corrosion Evaluation of Pure Mg Coated by Fluorination in 0.1 M Fluoride Electrolyte.

Scanning 2021 13;2021:5574946. Epub 2021 May 13.

The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China.

In the ongoing research on the application of biodegradable materials, surface treatment of is considered to be a relatively effective solution to the excessive degradation rates of Mg alloys. In this study, to further optimize the proven effective surface coatings of fluoride, a low-voltage preparation fluorination method was used to achieve coating effectiveness under safer conditions. Optical observation, scanning electron microscopy (SEM), X-ray diffraction (XRD), energy-dispersive spectroscopy (EDS), and potential dynamic polarization (PDP) experiments were used for the analysis and evaluation. The coating characteristics of the MgF coatings treated in the 10-90 V voltage range, including the structure, chemical conformation, and electrochemical corrosion assessment, were fully defined. The anodic fluoridation results showed that a pore structure of 1-14 m thickness was formed on the Mg alloy substrate, and the coating was composed of Mg fluoride. The results of immersion corrosion and electrochemical corrosion experiments showed that compared with pure Mg, anodic fluorinated samples below 40 V exhibited better corrosion resistance, the prepared MgF coating was more uniform, and the surface mostly exhibited point corrosion. When the voltage reached or exceeded 60 V, the prepared coating exhibited poor corrosion resistance, fracture, and protrusions. After corrosion, it mostly exhibited surface corrosion. The results indicate that idealized coatings can be obtained at relatively low and safe voltage ranges. This finding may enable more economical, environmentally friendly, and safe preparation of coatings.
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http://dx.doi.org/10.1155/2021/5574946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140829PMC
June 2021

Dexmedetomidine attenuates one-lung ventilation associated lung injury by suppressing inflammatory responses: A systematic review and meta-analysis.

Clin Exp Pharmacol Physiol 2021 May 27. Epub 2021 May 27.

Department of Anesthesiology, Tangshan Maternity and Child Health Care Hospital, Tangshan, China.

One-lung ventilation (OLV), a common ventilation technique, is associated with perioperative lung injury, tightly connected with inflammatory responses. Dexmedetomidine has shown positive anti-inflammatory effects in lung tissues in pre-clinical models. This study investigated the efficacy of dexmedetomidine for suppressing inflammatory responses in patients requiring OLV. We searched PubMed, MEDLINE, Embase, Scopus, Ovid, and Cochrane Library for randomized controlled trials focusing on dexmedetomidine's anti-inflammatory effects on patients requiring OLV without any limitation on the year of publication or languages. 20 clinical trials were assessed with 870 patients in the dexmedetomidine group and 844 in the control group. Our meta-analysis investigated the anti-inflammatory property of dexmedetomidine perioperatively [T1 (30-min OLV), T2 (90-min OLV), T3 (end of surgery) and T4 (postoperative day 1)], demonstrating that dexmedetomidine's intraoperative administration resulted in a significant reduction in serum concentration of interleukin-6, tumor necrosis factor-α and other inflammatory cytokines perioperatively. By calculating specific I index, significant heterogeneity was observed on all occasions, with I index ranging from 95% to 99%. For IL-6 changes, sensitivity analysis showed that the exclusion of a single study led to a significant decrease of heterogeneity (96%-0%; p < 0.00001). Besides, pulmonary oxygenation was ameliorated in the dexmedetomidine group comparing with the control group. In conclusion, perioperative administration of dexmedetomidine can attenuate OLV induced inflammation, ameliorate pulmonary oxygenation, and may be conducive to a decreased occurrence of postoperative complications and better prognosis. However, the results should be prudently interpreted due to the evidence of heterogeneity and the limited number of studies.
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http://dx.doi.org/10.1111/1440-1681.13525DOI Listing
May 2021

Corrosion Behavior of Biodegradable Magnesium Alloy by MAF Treatment.

Scanning 2021 3;2021:5530788. Epub 2021 May 3.

The Conversationalist Club, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China.

Coating treatment plays an irreplaceable role in propelling the clinical application of magnesium alloys. This experiment was designed in order to observe the anticorrosion behavior of magnesium fluoride coating in rats. The MgF layer was prepared on the surface of AZ31 magnesium alloy in saturated NHHF solution by microarc fluorination (MAF) at 190 V. The cross-sectional SEM, EDS, and XRD analysis indicated that the alloy surface was covered with MgF. Meanwhile, SEM observation was used to compare the magnesium alloy samples before and after treatment, and it was found that the samples after coating were flatter and smoother. Two sets of experiments were carried out with the subjects, 6-week-old male rats. So that the untreated AZ31 samples and the microarc fluorinated AZ31 samples could be buried under the muscle layer individually. The volume changes and surface morphology of the corroded samples were monitored dynamically using micro-CT over a 16-week period . Comparison of results between the two sets of samples presented that the corrosion of the microarc fluoridated samples was much slower than that of the untreated ones. The MAF coating was shown to be effective in controlling the corrosion rate and progression of the magnesium alloy.
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http://dx.doi.org/10.1155/2021/5530788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112943PMC
May 2021

Comparison of Autogenous Tooth Materials and Other Bone Grafts.

Tissue Eng Regen Med 2021 Jun 30;18(3):327-341. Epub 2021 Apr 30.

Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University, Seoul, 02841, Republic of Korea.

Autogenous odontogenic materials are a new, highly biocompatible option for jaw restoration. The inorganic component of autogenous teeth acts as a scaffold to maintain the volume and enable donor cell attachment and proliferation; the organic component contains various growth factors that promote bone reconstruction and repair. The composition of dentin is similar to that of bone, which can be a rationale for promoting bone reconstruction. Recent advances have been made in the field of autogenous odontogenic materials, and studies have confirmed their safety and feasibility after successful clinical application. Autogenous odontogenic materials have unique characteristics compared with other bone-repair materials, such as the conventional autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes. To encourage further research into odontogenic bone grafts, we compared the composition, osteogenesis, and development of autogenous odontogenic materials with those of other bone grafts. In conclusion, odontogenic bone grafts should be classified as a novel bone substitute.
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http://dx.doi.org/10.1007/s13770-021-00333-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169722PMC
June 2021

Effects of Physical Stimulation in the Field of Oral Health.

Scanning 2021 7;2021:5517567. Epub 2021 Apr 7.

Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China.

Physical stimulation has been widely used in clinical medicine and healthcare due to its noninvasiveness. The main applications of physical stimulation in the oral cavity include laser, ultrasound, magnetic field, and vibration, which have photothermal, cavitation, magnetocaloric, and mechanical effects, respectively. In addition, the above four stimulations with their unique biological effects, which can play a role at the gene, protein, and cell levels, can provide new methods for the treatment and prevention of common oral diseases. These four physical stimulations have been used as important auxiliary treatment methods in the field of orthodontics, implants, periodontal, dental pulp, maxillofacial surgery, and oral mucosa. This paper systematically describes the application of physical stimulation as a therapeutic method in the field of stomatology to provide guidance for clinicians. In addition, some applications of physical stimulation in specific directions are still at the research stage, and the specific mechanism has not been fully elucidated. To encourage further research on the oral applications of physical stimulation, we elaborate the research results and development history of various physical stimuli in the field of oral health.
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http://dx.doi.org/10.1155/2021/5517567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049832PMC
April 2021

Design of a Single-Tooth Model and Its Application in Oral Scan System Assessment.

Scanning 2021 21;2021:8891396. Epub 2021 Mar 21.

Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China.

Intraoral scanners have been widely used in the application of dentistry. Accuracy includes trueness and precision; they have an important position in the assessment of intraoral scanners. The existing standard models are divided into the inlay and the crown, but the operation is relatively complicated. In this study, in order to simplify the current standard model, we designed a new integration model to compare the accuracy of two intraoral scanners (CEREC and TRIOS) and an extraoral scanner (SHINING). The coordinate measuring machine measured value is the gold standard. Values of the length and angle were analyzed by converting the scanned digital impressions into an STL (standard triangulation language) format to evaluate the accuracy of the intraoral scanner and to verify the feasibility of the designed model. The result shows that the integration model can be successfully scanned and imaged. In the case of the powder-free integration model, intraoral scanner precision, trueness, 3D fitting, and imaging are better than the extraoral scanner. It can be seen straightly from the measurement result and the 3D fitting result that the intraoral scanner can acquire the shape of the standard model integrally with good repeatability. Therefore, it can be concluded that TRIOS is superior to CEREC and SHINING in accuracy, and the integration model is feasible as a reference in the examination of intraoral scanners. The performance of the newly designed integration model that can be scanned is clinically significant, suggesting that this model can be used as a standard reference model.
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http://dx.doi.org/10.1155/2021/8891396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009709PMC
March 2021

The gut microbiota metabolite capsiate promotes Gpx4 expression by activating to inhibit intestinal ischemia reperfusion-induced ferroptosis.

Gut Microbes 2021 Jan-Dec;13(1):1-21

Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

Ferroptosis, a new type of cell death has been found to aggravate intestinal ischemia/reperfusion (I/R) injury. However, little is known about the changes of gut microbiota and metabolites in intestinal I/R and the role of gut microbiota metabolites on ferroptosis-induced intestinal I/R injury. This study aimed to establish a mouse intestinal I/R model and ileum organoid hypoxia/reoxygenation (H/R) model to explore the changes of the gut microbiota and metabolites during intestinal I/R and protective ability of capsiate (CAT) against ferroptosis-dependent intestinal I/R injury. Intestinal I/R induced disturbance of gut microbiota and significant changes in metabolites. We found that CAT is a metabolite of the gut microbiota and that CAT levels in the preoperative stool of patients undergoing cardiopulmonary bypass were negatively correlated with intestinal I/R injury. Furthermore, CAT reduced ferroptosis-dependent intestinal I/R injury in vivo and in vitro. However, the protective effects of CAT against ferroptosis-dependent intestinal I/R injury were abolished by RSL3, an inhibitor of glutathione peroxidase 4 (Gpx4), which is a negative regulator of ferroptosis. We also found that the ability of CAT to promote Gpx4 expression and inhibit ferroptosis-dependent intestinal I/R injury was abrogated by JNJ-17203212, an antagonist of transient receptor potential cation channel subfamily V member 1 (TRPV1). This study suggests that the gut microbiota metabolite CAT enhances Gpx4 expression and inhibits ferroptosis by activating TRPV1 in intestinal I/R injury, providing a potential avenue for the management of intestinal I/R injury.
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http://dx.doi.org/10.1080/19490976.2021.1902719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009132PMC
March 2021

Pre-operative N-terminal pro-B-type natriuretic peptide for prediction of acute kidney injury after noncardiac surgery: A retrospective cohort study.

Eur J Anaesthesiol 2021 06;38(6):591-599

From the Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China (B-CZ, P-PZ, S-HL, S-DQ, XY, CL, W-FL, K-XL).

Background: Acute kidney injury (AKI) is associated with poor outcomes after noncardiac surgery. Whether pre-operative N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts AKI after noncardiac surgery is unclear.

Objective: To investigate the predictive role of pre-operative NT-proBNP on postoperative AKI.

Design: Retrospective cohort study.

Setting: Nanfang Hospital, Southern Medical University, China.

Patients: Adult patients who had a serum creatinine and NT-proBNP measurement within 30 pre-operative days and at least one serum creatinine measurement within 7 days after noncardiac surgery between February 2008 and May 2018 were identified.

Main Outcome Measures: The primary outcome was postoperative AKI, defined by the kidney disease: improving global outcomes creatinine criteria.

Results: In all, 6.1% (444 of 7248) of patients developed AKI within 1 week after surgery. Pre-operative NT-proBNP was an independent predictor of AKI after adjustment for clinical variables (OR comparing top to bottom quintiles 2.29, 95% CI, 1.47 to 3.65, P < 0.001 for trend; OR per 1-unit increment in natural log transformed NT-proBNP 1.27, 95% CI, 1.16 to 1.39). Compared with clinical variables alone, the addition of NT-proBNP improved model fit, modestly improved the discrimination (change in area under the curve from 0.764 to 0.773, P = 0.005) and reclassification (continuous net reclassification improvement 0.210, 95% CI, 0.111 to 0.308, improved integrated discrimination 0.0044, 95% CI, 0.0016 to 0.0072) of AKI and non-AKI cases, and achieved higher net benefit in decision curve analysis.

Conclusions: Pre-operative NT-proBNP concentrations provided predictive information for AKI in a cohort of patients undergoing noncardiac surgery, independent of and incremental to conventional risk factors. Prospective studies are required to confirm this finding and examine its clinical impact.

Trial Registration: Chinese Clinical Trial Registry, ChiCTR1900024056. www.chictr.org.cn/showproj.aspx?proj=40385.
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http://dx.doi.org/10.1097/EJA.0000000000001495DOI Listing
June 2021

Assessment of prognostic value of intraoperative oliguria for postoperative acute kidney injury: a retrospective cohort study.

Br J Anaesth 2021 04 17;126(4):799-807. Epub 2020 Dec 17.

Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address:

Background: Oliguria is often viewed as a sign of renal hypoperfusion and an indicator for volume expansion during surgery. However, the prognostic association and the predictive utility of intraoperative oliguria for postoperative acute kidney injury (AKI) are unclear.

Methods: We conducted a retrospective cohort study on patients undergoing major thoracic surgery in an academic hospital to assess the association of intraoperative oliguria with postoperative AKI and its predictive value. To contextualise our findings, we included our results in a meta-analysis of observational studies on the importance of oliguria during noncardiac surgery.

Results: In our cohort study, 3862 patients were included; 205 (5.3%) developed AKI after surgery. Intraoperative urine output of 0.3 ml kg h was the optimal threshold for oliguria in multivariable analysis. Patients with oliguria had an increased risk of AKI (adjusted odds ratio: 2.60; 95% confidence interval: 1.24-5.05). However, intraoperative oliguria had a sensitivity of 5.9%, specificity of 98%, positive likelihood ratio of 2.74, and negative likelihood ratio of 0.96, suggesting poor predictive ability. Moreover, it did not improve upon the predictive performance of a multivariable model, based on discrimination and reclassification indices. Our findings were generally consistent with the results of a systematic review and meta-analysis, including six additional studies.

Conclusions: Intraoperative oliguria has moderate association with, but poor predictive ability for, postoperative AKI. It remains of clinical interest as a risk factor potentially modifiable to interventions.
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http://dx.doi.org/10.1016/j.bja.2020.11.018DOI Listing
April 2021

Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis.

J Intensive Care 2020 Nov 23;8(1):88. Epub 2020 Nov 23.

Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China.

Background: The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality.

Methods: Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models.

Results: Fifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8-25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08-3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54-0.65), and the specificity was 0.83 (0.77-0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up.

Conclusion: Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings.

Systematic Review Registration: PROSPERO CRD42020176747.
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http://dx.doi.org/10.1186/s40560-020-00508-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682759PMC
November 2020

Relationships of sleep disturbance, intestinal microbiota, and postoperative pain in breast cancer patients: a prospective observational study.

Sleep Breath 2020 Nov 19. Epub 2020 Nov 19.

Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.

Purpose: Our study was designed to examine the possible relationship between gut microbiota, sleep disturbances, and acute postoperative pain.

Methods: Using 16S rRNA sequencing, we analyzed preoperative fecal samples from women undergoing breast cancer surgery. Preoperative sleep disturbance was evaluated with the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Peak and average pain at rest and movement were evaluated 24 h after surgery, using a numerical rating scale (NRS). Preoperative symptoms of depression and anxiety were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Inflammation was measured using white blood cell and neutrophil counts, together with platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio.

Results: Preoperative sleep disturbance was associated with more severe acute postoperative pain. At the phylum level, women with poor sleep quality had higher relative abundance of Firmicutes (p = 0.021) and lower relative abundance of Bacteroidetes (p = 0.013). At the genus level, women with poor sleep quality harbored higher relative abundance of Acidaminococcus and lower relative abundance of several genera. The genus Alloprevotella was negatively associated with peak pain at movement during the first 24 h (r = - 0.592, p < 0.001). The genus Desulfovibrio was negatively associated with symptoms of anxiety (r = - 0.448, p = 0.006). However, partial correlations suggested that the relationship between Alloprevotella and peak pain at movement during the first 24 h was not statistically significant after controlling for sleep (r = - 0.134, p = 0.443).

Conclusion: These findings suggest that the changed gut microbiota may be involved in sleep-pain interaction and could be applied as a potential preventive method for postoperative pain.

Trial Registration: The present clinical study has been registered on Chinese Clinical Trial Registry ( www.chictr.org.cn ); the clinical trial registration number is ChiCTR1900021730; the date of registration is March 7, 2019.
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http://dx.doi.org/10.1007/s11325-020-02246-3DOI Listing
November 2020

Surface Characterization and Corrosion Resistance of Biomedical AZ31 Mg Alloy Treated by Microarc Fluorination.

Scanning 2020 27;2020:5936789. Epub 2020 Oct 27.

Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University, Seoul 08308, Republic of Korea.

The application prospect of biodegradable materials is being studied extensively. However, the high corrosion rate and its alloys in body fluids have been major limitations of the application of pure Mg (magnesium). To improve corrosion resistance of biodegradable AZ31 Mg alloy, we adopted microarc fluorination within a voltage range of 100-300 V in 46% hydrofluoric acid. To obtain morphologies, chemical compositions, and structural characteristics, field-emission scanning electron microscopy (FE-SEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray diffraction (XRD) were performed, respectively. Results showed that the coating was mainly composed of MgF. Electrochemical corrosion and immersion tests proved that the corrosion resistance of MAF-treated AZ31 Mg alloy was significantly improved compared with untreated AZ31 Mg alloy in HBSS (Hank's Balanced Salt Solution). Current densities of AZ31, MAF100, MAF150, MAF200, MAF250, and MAF300 were 342.4, 0.295, 0.228, 0.177, 0.199, and 0.212 A/cm, respectively. The roughness test indicated that samples under MAF treatment of 200 V, 250 V, and 300 V had large surface roughness. Meanwhile, the contact angle measurement and surface free energy test suggested that those samples had smaller contact angle and higher SFE than Ti. Thus, MAF-treated AZ31 Mg alloy might have promising application in various fields.
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http://dx.doi.org/10.1155/2020/5936789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641723PMC
October 2020

Incidence and risk factors of postoperative ileus after hysterectomy for benign indications.

Int J Colorectal Dis 2020 Nov 22;35(11):2105-2112. Epub 2020 Jul 22.

Department of Anesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China.

Purpose: Postoperative ileus (POI) after abdominal surgery is associated with prolonged hospital stay and increased costs. The aim of this study is to investigate the incidence of, risk factors for, and outcomes associated with POI in patients undergoing hysterectomy for benign indications.

Methods: A retrospective review of 1017 consecutive patients undergoing benign hysterectomy over the period 2012-2017 in a single center was performed. POI was predefined as absence of flatus and defecation for more than 2 days with the presence of one or more of the following symptoms: nausea, vomiting, and abdominal distention. The association between perioperative variables and the risk of POI was evaluated by univariate analysis. Independent risk factors were identified by multivariate logistic regression analysis.

Results: Overall incidence of POI was 9.2%. Incidence of POI did not differ significantly among three different surgical approaches (abdominal hysterectomy, 10.6%; laparoscopic hysterectomy, 7.8%; vaginal hysterectomy, 11.3%; P = 0.279). Independent risk factors of POI identified by multivariate analysis included anesthesia technique (odds ratio [OR] 2.662, 95% interval [CI] 1.533-4.622, P = 0.001), adhesiolysis (odds ratio [OR] 1.818, 95% interval [CI] 1.533-4.622, P = 0.011), duration of operation (odds ratio [OR] 1.005, 95% interval [CI] 0.942-6.190, P = 0.029), previous cancer (odds ratio [OR] 4.789, 95% interval [CI] 1.232-18.626, P = 0.024), and dysmenorrhea (odds ratio [OR] 1.859, 95% interval [CI] 1.182-2.925, P = 0.007).

Conclusion: POI is a common complication after hysterectomy. This study identified risk factors of POI specifically for gynecologic patients. Patients exposed to these factors should be monitored closely for the development POI.
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http://dx.doi.org/10.1007/s00384-020-03698-5DOI Listing
November 2020

Intraoperative ventilation strategies to prevent postoperative pulmonary complications: a network meta-analysis of randomised controlled trials.

Br J Anaesth 2020 Mar 30;124(3):324-335. Epub 2020 Jan 30.

Department of Anaesthesiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. Electronic address:

Background: The debate on lung-protective ventilation strategies for surgical patients is ongoing. Evidence suggests that the use of low tidal volume V improves clinical outcomes. However, the optimal levels of PEEP and recruitment manoeuvre (RM) strategies incorporated into low V ventilation remain unclear.

Methods: Several electronic databases were searched to identify RCTs that focused on comparison between low V strategy and conventional mechanical ventilation (CMV), or between two different low V strategies in surgical patients. The primary outcome was postoperative pulmonary complications (PPCs). The secondary outcomes were atelectasis, pneumonia, acute respiratory distress syndrome, and short-term mortality. Bayesian network meta-analyses were performed using WinBUGS. The odds ratios (ORs) and corresponding 95% credible intervals (CrIs) were estimated.

Results: Compared with CMV, low V ventilation with moderate-to-high PEEP reduced the risk of PPCs (moderate PEEP [5-8 cm HO]: OR 0.50 [95% CrI: 0.28, 0.89]; moderate PEEP+RMs: 0.39 [0.19, 0.78]; and high PEEP [≥9 cm HO]+RMs: 0.34 [0.14, 0.79]). Low V ventilation with moderate-to-high PEEP and RMs also specifically reduced the risk of atelectasis compared with CMV (moderate PEEP+RMs: OR 0.36 [95% CrI: 0.16, 0.87]; and high PEEP+RMs: 0.41 [0.15, 0.97]), whilst low V ventilation with moderate PEEP was superior to CMV in reducing the risk of pneumonia (OR 0.46 [95% CrI: 0.15, 0.94]).

Conclusions: The combination of low V ventilation and moderate-to-high PEEP (≥5 cm HO) seems to confer lung protection in surgical patients undergoing general anaesthesia.

Clinical Trial Registration: PROSPERO (CRD42019144561).
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http://dx.doi.org/10.1016/j.bja.2019.10.024DOI Listing
March 2020

6-Gingerol attenuates macrophages pyroptosis via the inhibition of MAPK signaling pathways and predicts a good prognosis in sepsis.

Cytokine 2020 01 17;125:154854. Epub 2019 Sep 17.

Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. Electronic address:

Background: Sepsis is a major cause of death for ICU patients. Sepsis development depends heavily on the presence of mature IL-1β cytokine. This study evaluates the potential therapeutic properties of a bioactive compound known as 6-gingerol on sepsis. This compound has previously been demonstrated to possess anti-inflammatory properties both in vivo and in vitro.

Methods: C57BL/6 mice was used to establish models of sepsis by means of cecal ligation and puncture (CLP). Upon treatment with 6-gingerol, we assessed the survival rate of mice and measured the levels of key pro-inflammatory cytokines in serum and colon tissues. Sepsis pathogenesis was further explored using the RAW264.7 cell line and bone marrow-derived macrophages (BMDMs) treated with ATP and lipopolysaccharide (LPS). The impact of 6-gingerol on pyroptosis was also examined. In addition, we assessed the role of MAPK signaling in 6-gingerol-induced effects in BMDMs and RAW264.7 cells.

Results: In CLP mice, 6-gingerol significantly ameliorated sepsis development, which was associated with the reduction of serum IL-1β. In BMDMs and RAW264.7 cells, 6-gingerol strongly attenuated pyroptosis as well as the release of caspase-1p20, HMGB1, mature IL-1β, IL-18 in response to ATP and LPS treatment. 6-Gingerol conferred these effects by blocking MAPK activation. Exposure to an ERK agonist (EGF) reversed effects of 6-gingerol, causing pyroptosis, LDH and caspase-1p20 release.

Conclusions: By targeting MAPK signaling, 6-gingerol significantly suppressed secretion of pro-inflammatory cytokines and inhibited macrophage cells pyroptosis resulting in overall inhibition of sepsis development.
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http://dx.doi.org/10.1016/j.cyto.2019.154854DOI Listing
January 2020

Is goal-directed fluid therapy based on dynamic variables alone sufficient to improve clinical outcomes among patients undergoing surgery? A meta-analysis.

Crit Care 2018 Nov 14;22(1):298. Epub 2018 Nov 14.

Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, No.58, Zhongshan 2nd Road, Guangzhou, 510080, China.

Background: Whether goal-directed fluid therapy based on dynamic predictors of fluid responsiveness (GDFTdyn) alone improves clinical outcomes in comparison with standard fluid therapy among patients undergoing surgery remains unclear.

Methods: PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched for relevant studies. Studies comparing the effects of GDFTdyn with that of standard fluid therapy on clinical outcomes among adult patients undergoing surgery were considered eligible. Two analyses were performed separately: GDFTdyn alone versus standard fluid therapy and GDFTdyn with other optimization goals versus standard fluid therapy. The primary outcomes were short-term mortality and overall morbidity, while the secondary outcomes were serum lactate concentration, organ-specific morbidity, and length of stay in the intensive care unit (ICU) and in hospital.

Results: We included 37 studies with 2910 patients. Although GDFTdyn alone lowered serum lactate concentration (mean difference (MD) - 0.21 mmol/L, 95% confidence interval (CI) (- 0.39, - 0.03), P = 0.02), no significant difference was found between groups in short-term mortality (odds ratio (OR) 0.85, 95% CI (0.32, 2.24), P = 0.74), overall morbidity (OR 1.03, 95% CI (0.31, 3.37), P = 0.97), organ-specific morbidity, or length of stay in the ICU and in hospital. Analysis of trials involving the combination of GDFTdyn and other optimization goals (mainly cardiac output (CO) or cardiac index (CIx)) showed a significant reduction in short-term mortality (OR 0.45, 95% CI (0.24, 0.85), P = 0.01), overall morbidity (OR 0.41, 95% CI (0.28, 0.58), P < 0.00001), serum lactate concentration (MD - 0.60 mmol/L, 95% CI (- 1.04, - 0.15), P = 0.009), cardiopulmonary complications (cardiac arrhythmia (OR 0.58, 95% CI (0.37, 0.92), P = 0.02), myocardial infarction (OR 0.35, 95% CI (0.16, 0.76), P = 0.008), heart failure/cardiovascular dysfunction (OR 0.31, 95% CI (0.14, 0.67), P = 0.003), acute lung injury/acute respiratory distress syndrome (OR 0.13, 95% CI (0.02, 0.74), P = 0.02), pneumonia (OR 0.4, 95% CI (0.24, 0.65), P = 0.0002)), length of stay in the ICU (MD - 0.77 days, 95% CI (- 1.07, - 0.46), P < 0.00001) and in hospital (MD - 1.18 days, 95% CI (- 1.90, - 0.46), P = 0.001).

Conclusions: It was not the optimization of fluid responsiveness by GDFTdyn alone but rather the optimization of tissue and organ perfusion by GDFTdyn and other optimization goals that benefited patients undergoing surgery. Patients managed with the combination of GDFTdyn and CO/CI goals might derive most benefit.
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http://dx.doi.org/10.1186/s13054-018-2251-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237035PMC
November 2018

Association of pre-operative troponin levels with major adverse cardiac events and mortality after noncardiac surgery: A systematic review and meta-analysis.

Eur J Anaesthesiol 2018 11;35(11):815-824

Background: Circulating cardiac troponin levels are powerful predictors of prognosis in many clinical settings, but their association with outcomes after noncardiac surgery is unclear.

Objectives: The aim of this systematic review was to summarise current evidence on the association of pre-operative troponin elevation with postoperative major adverse cardiac events (MACE) and mortality in patients undergoing noncardiac surgery.

Design: Systematic review of observational studies with meta-analysis.

Data Sources: PubMed, EMBASE and Science Citation Index Expanded (ISI Web of Science) from their inception to 1 October 2017.

Eligibility Criteria: Observational studies reporting the associations between pre-operative troponin levels and MACE and all-cause mortality after noncardiac surgeries were included.

Results: Ten studies met the eligibility criteria. The entire body of evidence addressing the research question was based on a total of 10 371 patients: 4.7 to 68.3% (median 23.8%) of patients had elevated troponin levels before surgery. Elevated pre-operative troponin was significantly associated with short-term MACE (seven studies, 5180 patients: odds ratio (OR) 6.92, 95% confidence interval (CI) 3.85 to 12.42), short-term mortality (five studies, 6103 patients: OR 4.23, 95% CI 2.27 to 7.89) and long-term mortality (two studies, 760 patients: OR 2.51, 95% CI 1.47 to 4.29). The associations remained significant when only multivariate-adjusted results were analysed. Overall, the reviewers' certainty about the summary estimates of the associations was very low.

Conclusion: Current evidence suggests that pre-operative high troponin levels are significantly associated with adverse cardiac events and mortality after noncardiac surgery.

Trial Registration: This systematic review was registered in the International Prospective Register of Systematic Reviews (Centre for Reviews and Dissemination 42017077837).
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http://dx.doi.org/10.1097/EJA.0000000000000868DOI Listing
November 2018

Obstructive Sleep Apnea and Postoperative Major Adverse Cardiac or Cerebrovascular Events: Was the Composite End Point Appropriate and Valid?

Anesth Analg 2018 07;127(1):314-315

Department of Anesthesiology, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China,

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http://dx.doi.org/10.1213/ANE.0000000000003382DOI Listing
July 2018

Risk factors for postoperative acute mesenteric ischemia among adult patients undergoing cardiac surgery: A systematic review and meta-analysis.

J Crit Care 2017 12 12;42:294-303. Epub 2017 Aug 12.

Department of Anesthesiology, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, Guangzhou 510515, China. Electronic address:

Purpose: We aimed to seek risk factors for AMI among adult patients undergoing cardiac surgery.

Materials And Methods: We searched electronic bibliographic databases for studies reporting risk factors for AMI among adult patients undergoing cardiac surgery. Pooled odds ratios (OR) and standard mean differences (SMD or MD) for risk factors between AMI and control group were estimated.

Results: 11 studies with 67,195 patients met the inclusion criteria. 14 risk factors were found to be statistically significant: preoperative factors including age (MD 4.62years, 95% CI (1.97,7.27)), cardiac shock (OR 5.17, (1.17,22.81)), peripheral vascular disease (OR 3.53, (2.05,6.09)), need for intra-aortic balloon pump (IABP) (OR 5.89, (3.26,10.65)), emergency surgery (OR 3.75, (1.69,8.33)), and postoperative factors including atrial fibrillation (OR 2.41, (1.79,3.24)), CK-MB level (SMD 1.06, (0.62 to 1.50)), serum creatinine >200μmol/L (OR 23.39, (11.61,47.12)), blood loss (MD 358.32mL, (53.56,663.07)), prolonged ventilation (OR 9.04, (5.24,15.62)), need for IABP (OR 6.32, (3.19,12.54)), inotropic treatment (OR 8.40, (3.19,22.14)), blood transfusion (OR 9.15, (4.79,17.48)), reoperation (OR 3.30, (1.55,7.04)).

Conclusions: 14 risk factors were associated with an increased risk of AMI, which indicated that AMI might occur via stenosis or occlusion of mesenteric vessels, reduced blood volume or maldistribution of blood flow.
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http://dx.doi.org/10.1016/j.jcrc.2017.08.018DOI Listing
December 2017

Perioperative Statins Do Not Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.

J Cardiothorac Vasc Anesth 2017 Dec 21;31(6):2086-2092. Epub 2017 Apr 21.

Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address:

Objectives: To evaluate whether perioperative statins reduce the risk of acute kidney injury (AKI) after cardiac surgery.

Design: Systematic review and meta-analysis of randomized trials.

Setting: Perioperative management in hospitals that perform cardiac surgery.

Participants: Adult patients undergoing cardiac surgery.

Interventions: PubMed, EMBASE, and the Cochrane Library databases were searched for randomized trials. Random-effects meta-analyses were performed to compare the effects of statins versus placebo/control. Trial sequential analysis was conducted to confirm the results.

Measurements And Main Results: The primary outcome was incidence of postoperative AKI. Eight trials enrolling 3,204 patients were included. The statin arms and the control arms were comparable in incidence of postoperative AKI (risk ratio [RR] = 1.02, 95% confidence interval [CI] = 0.82-1.28), need for renal replacement therapy (RR = 1.09, 95% CI = 0.45-2.66), mechanical ventilation duration (mean difference [MD] = 24.84 min, 95% CI = -55.53-105.20), intensive care unit length of stay (MD = 0.04 days, 95% CI = -3.13-3.20), hospital length of stay (MD = -0.08 days, 95% CI = -0.31-0.15), and in-hospital mortality (RR = 3.76, 95% CI = 0.93-15.14). Trial sequential analysis confirmed that it is unlikely that perioperative statin therapy could achieve a 20% or more relative risk reduction in AKI incidence.

Conclusions: Among patients undergoing cardiac surgery, perioperative statin treatment did not reduce the risk of AKI. Statin therapy should not be initiated to prevent AKI following cardiac surgery.
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http://dx.doi.org/10.1053/j.jvca.2017.04.038DOI Listing
December 2017

Video laryngoscopy for ICU intubation: a meta-analysis of randomised trials.

Intensive Care Med 2017 06 4;43(6):947-948. Epub 2017 Mar 4.

Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China.

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http://dx.doi.org/10.1007/s00134-017-4741-0DOI Listing
June 2017

Prophylaxis Against Atrial Fibrillation After General Thoracic Surgery: Trial Sequential Analysis and Network Meta-Analysis.

Chest 2017 Jan 8;151(1):149-159. Epub 2016 Oct 8.

Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address:

Background: Postoperative atrial fibrillation/flutter (POAF) is associated with significant morbidity and mortality after general thoracic surgery, but the need for and the best agent for prophylaxis remains obscure.

Methods: A systematic literature search was performed to identify randomized controlled trials that compared regimens for POAF prophylaxis after general thoracic surgery. Random-effects meta-analyses with trial sequential analyses were performed to compare the effects of medical prophylaxis vs placebo/usual care. The risk of POAF among patients receiving various prophylactic regimens was subjected to Bayesian network meta-analysis.

Results: Twenty-two trials (2,891 patients and 11 regimens) were included. Overall, medical prophylaxis reduced the incidence of POAF (OR, 0.33; 95% CI, 0.22-0.49) but not short-term mortality (OR, 0.85; 95% CI, 0.41-1.73). There was no significant difference in patient withdrawal due to adverse events (OR, 1.67; 95% CI, 0.67-4.16). Trial sequential analysis showed that as of 2012, sufficient evidence had accrued in support of the effectiveness of medical prophylaxis in reducing POAF after general thoracic surgery. In network meta-analysis, β-blockers, angiotensin-converting enzyme inhibitors, amiodarone, magnesium, and calcium channel blockers significantly reduced the risk of POAF compared with placebo/usual care. β-Blockers had the highest probability of being the most effective agents (OR, 0.12; 95% credible interval [CrI], 0.05-0.27; probability of being best, 77.7%; number needed to treat, 5.2).

Conclusions: The current literature supports the effectiveness and tolerability of medical prophylaxis and the superiority of β-blockers in preventing POAF after general thoracic surgery. β-Blockers are recommended, taking into consideration the status of the bronchopulmonary system.
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http://dx.doi.org/10.1016/j.chest.2016.08.1476DOI Listing
January 2017

Albendazole and Corticosteroids for the Treatment of Solitary Cysticercus Granuloma: A Network Meta-analysis.

PLoS Negl Trop Dis 2016 Feb 5;10(2):e0004418. Epub 2016 Feb 5.

Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China.

Background: Solitary cysticercus granuloma (SCG) is the commonest form of neurocysticercosis in the Indian subcontinent and in travelers. Several different treatment options exist for SCG. We conducted a Bayesian network meta-analysis of randomized clinical trials (RCTs) to identify the best treatment option to prevent seizure recurrence and promote lesion resolution for patients with SCG.

Methods And Principal Findings: PubMed, EMBASE and the Cochrane Library databases (up to June 1, 2015) were searched for RCTs that compared any anthelmintics or corticosteroids, alone or in combination, with placebo or head to head and reported on seizure recurrence and lesion resolution in patients with SCG. A total of 14 RCTs (1277 patients) were included in the quantitative analysis focusing on four different treatment options. A Bayesian network model computing odds ratios (OR) with 95% credible intervals (CrI) and probability of being best (Pbest) was used to compare all interventions simultaneously. Albendazole and corticosteroids combination therapy was the only regimen that significantly decreased the risk of seizure recurrence compared with conservative treatment (OR 0.32, 95% CrI 0.10-0.93, Pbest 73.3%). Albendazole and corticosteroids alone or in combination were all efficacious in hastening granuloma resolution, but the combined therapy remained the best option based on probability analysis (OR 3.05, 95% CrI 1.24-7.95, Pbest 53.9%). The superiority of the combination therapy changed little in RCTs with different follow-up durations and in sensitivity analyses. The limitations of this study include high risk of bias and short follow-up duration in most studies.

Conclusions: Dual therapy of albendazole and corticosteroids was the most efficacious regimen that could prevent seizure recurrence and promote lesion resolution in a follow-up period of around one year. It should be recommended for the management of SCG until more high-quality evidence is available.
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http://dx.doi.org/10.1371/journal.pntd.0004418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744042PMC
February 2016

Alcohol drinking as an unfavorable prognostic factor for male patients with nasopharyngeal carcinoma.

Sci Rep 2016 Jan 18;6:19290. Epub 2016 Jan 18.

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China.

The relationship between alcohol drinking and the prognosis of nasopharyngeal carcinoma (NPC) is unknown. To investigate the prognostic value of alcohol drinking on NPC, this retrospective study was conducted on 1923 male NPC patients. Patients were classified as current, former and non-drinkers according to their drinking status. Furthermore, they were categorized as heavy drinkers and mild/none drinkers based on the intensity and duration of alcohol drinking. Survival outcomes were compared using Kaplan-Meier analysis and Cox proportional hazards model. We found that current drinkers had significantly lower overall survival (OS) rate (5-year OS: 70.2% vs. 76.4%, P < 0.001) and locoregional recurrence-free survival (LRFS) rate (5-year LRFS: 69.3% vs. 77.5%, P < 0.001) compared with non-drinkers. Drinking ≥14 drinks/week, and drinking ≥20 years were both independent unfavorable prognostic factors for OS (hazard ratio [HR] = 1.38, 95% confidence interval [CI] 1.05-1.81, P = 0.022; HR = 1.38, 95% CI 1.09-1.75, P = 0.007). Stratified analyses further revealed that the negative impacts of alcohol were manifested mainly among older patients and among smokers. In conclusion, alcohol drinking is a useful predictor of prognosis in male NPC patients; drinkers, especially heavy drinkers have poorer prognosis.
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http://dx.doi.org/10.1038/srep19290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725964PMC
January 2016

Remote ischemic preconditioning for preventing acute kidney injury following cardiovascular surgery: A meta-analysis with trial sequential analysis.

Int J Cardiol 2016 Jan 10;203:842-4. Epub 2015 Nov 10.

Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China. Electronic address:

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http://dx.doi.org/10.1016/j.ijcard.2015.11.081DOI Listing
January 2016

Pretreatment platelet count improves the prognostic performance of the TNM staging system and aids in planning therapeutic regimens for nasopharyngeal carcinoma: a single-institutional study of 2,626 patients.

Chin J Cancer 2015 Mar 5;34(3):137-46. Epub 2015 Mar 5.

Department of Radiation Oncology, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China.

Introduction: Thrombocytosis has been identified as an unfavorable prognostic factor in several types of cancer. This study aimed to evaluate the prognostic value of pretreatment platelet count in association with the TNM staging system and therapeutic regimens in patients with nasopharyngeal carcinoma (NPC).

Methods: A total of 2,626 patients with NPC were retrospectively analyzed. Platelet count >300 × 10(9)/L was defined as thrombocytosis. Matched-pair analysis was performed between patients receiving chemoradiotherapy and radiotherapy.

Results: Multivariate analysis showed that platelet count was an independent unfavorable prognostic factor for overall survival (OS) [hazard ratio (HR) = 1.810, 95% confidence interval (CI) = 1.531-2.140, P < 0.001] and distant metastasis-free survival (DMFS) (HR = 1.873, 95% CI = 1.475-2.379, P < 0.001) in the entire patient cohort. Further subgroup analysis revealed that increased platelet count was an independent unfavorable prognostic factor for OS and DMFS in patients with NPC stratified by early and advanced T category, N category, or TNM classification (all P ≤ 0.001). Receiver operating characteristic (ROC) curves verified that the predictive value of TNM classification for OS was improved when combined with pretreatment platelet count (P = 0.030). Matched-pair analysis showed that chemoradiotherapy significantly improved OS only in advanced-stage NPC with thrombocytosis (HR = 0.416, 95% CI = 0.226-0.765, P = 0.005).

Conclusions: Pretreatment platelet count, when combined with TNM classification, is a useful indicator for metastasis and survival in patients with NPC. It may improve the predictive value of the TNM classification and help to identify patients likely to benefit from more aggressive therapeutic regimens.
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http://dx.doi.org/10.1186/s40880-015-0006-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593390PMC
March 2015

Pretreatment platelet count as a predictor for survival and distant metastasis in nasopharyngeal carcinoma patients.

Oncol Lett 2015 Mar 13;9(3):1458-1466. Epub 2015 Jan 13.

State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China ; Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China.

The aim of the present study was to investigate the prognostic value of different pretreatment platelet (PLT) counts on the treatment outcome in nasopharyngeal carcinoma (NPC) patients receiving concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) alone. A total of 1,501 NPC patients, including 412 receiving CCRT and 1,089 receiving RT, were enrolled in the present study. The PLT count cut-off points for the CCRT and RT groups were 150 and 300×10/l, respectively, and the PLT counts were categorized it into three groups: Low (PLT≤150×10/l), moderate (150×10/l300×10/l). To identify independent predictors of overall survival (OS), the Cox proportional hazards model was used to determine local-regional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) rates in the CCRT and RT patients. Furthermore, univariate and multivariate analysis indicated that compared with a moderate PLT count, a low PLT count was an independent unfavorable prognostic factor for OS rate in CCRT patients [hazard ratio (HR), 2.024; 95% confidence interval (CI), 1.165-3.516], and a high PLT count was an independent unfavorable prognostic factor for OS and DMFS rates in CCRT (OS: HR, 1.742; 95% CI, 1.090-2.786; DFMS: HR, 2.110; 95%CI, 1.084-4.108) and RT (OS: HR, 1.740; 95%CI, 1.283-2.362; DMFS: HR, 2.819; 95% CI, 1.766-4.497) patients. Compared with a low PLT count, a high PLT count was significantly and independently associated with a poor DMFS rate in the RT patients (P=0.025; HR, 2.454; 95% CI, 1.121-5.372). Therefore, the present study indicates that low and high PLT counts may be useful indicators of survival and distant metastasis in NPC patients who have undergone radiation treatment.
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http://dx.doi.org/10.3892/ol.2015.2872DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314978PMC
March 2015