BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
OBJECTIVE:To reach consensus on the diagnostic criteria of syndrome of dampness obstruction in idiopathic membranous nephropathy(IMN)patients by literature research and expert investigation(interviews and a Delphi met...OBJECTIVE:To reach consensus on the diagnostic criteria of syndrome of dampness obstruction in idiopathic membranous nephropathy(IMN)patients by literature research and expert investigation(interviews and a Delphi method).METHODS:Our study was consistent with T/CACM 1336-2020.We searched the monographs and references published in the past 40 years(1983-2022),and established the diagnostic criteria pool of waterdampness syndrome and dampness-turbidity syndrome in Traditional Chinese Medicine(TCM)based on literature by using frequency statistics and correlation analysis.Expert investigation(interview method and two rounds of Delphi method)was used to form the diagnostic criteria of water-dampness syndrome and dampnessturbidity syndrome of idiopathic membranous nephropathy.Clinical diagnostic test research was carried out,and compared with“Diagnostic Criteria for dampness syndrome”(T/CACM 1454-2023)to evaluate the authenticity,reliability and clinical application value of the standard.RESULTS:A total of 122 relevant guides,standards,monographs and documents were included through searching books and Chinese databases.Four experts were interviewed and two rounds of delphi method(75 experts nationwide)were carried out.The experts'opinions are relatively concentrated and the differences are small.Based on the weight of each index,the diagnostic criteria indexes of water-dampness syndrome and dampness-turbidity syndrome were selected.After discussion by the core group members,the diagnostic model of"necessary symptoms and optional symptoms"was established,and the final diagnostic criteria of waterdampness syndrome and dampness-turbidity syndrome were established.One hundred and ninety-one inpatients and outpatients of Guangdong Provincial Hospital of Chinese Medicine from January 2021 to February 2023 were included in Diagnostic test study.There was no statistical difference in gender,age and course of disease(P>0.05).The sensitivity and specificity of the trial standard were 90.34%and 73.33%respectively,while the sensitivity and specificity of T/CACM 1454-2023 were 99.43%and 6.67%,respectively.CONCLUSIONS:The consensus-based diagnostic criteria for IMN can be widely incorporated in TCM.A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our IMN criteria.展开更多
·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case gro...·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.展开更多
Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions accou...Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.展开更多
BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can ca...BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can cause complications ranging from mild symptoms to severe issues like gastric outlet obstruction(GOO).This report discusses a 39-year-old woman who presented with clinical and radiological features of GOO post Silimed IGB placement.CASE SUMMARY A 39-year-old woman presented to our institution with two-week history of abdominal pain,nausea and vomiting post prandially.This was in the context of a Silimed IGB placement two weeks prior to presentation for weight loss in the context of obesity.A computed tomography of the abdomen demonstrated the IGB device in the body and prepyloric region,with proximal dilatation of the body and fundus of the stomach which contained gastric contents.Due to concerns for GOO,the IGB was removed endoscopically with subsequent symptom alleviation.In addition to this,we performed a literature search of cases of IGB related GOO using the PubMed and Web of Science databases from inception date to the August 26,2024.A total of 27 articles were included in the analysis,identifying 29 cases of IGB-related GOO.These patients commonly presented with nausea,vomiting and abdominal pain,with symptom onset varying from 3 days to 18 months post IGB insertion.Abdominal computed tomography was the primary diagnostic tool and endoscopic removal was the standard treatment modality.CONCLUSION This is the first reported case of GOO caused by Silimed IGB.While effective for weight reduction,IGB-related GOO is a rare but serious complication,usually requiring endoscopic retrieval.Future research should aim to identify patient factors linked to this complication to enhance clinical-decision making and outcomes.展开更多
Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecys...Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecystoduodenal fistula.Since the rarity of gallstone ileus is associated with relatively high rates of morbidity and mortality in elderly patients with multiple comorbidities,making an early and accurate diagnosis in emergency settings crucial.展开更多
Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,a...Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].展开更多
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojeju...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojejunostomy(SGJ)and the minimally invasive nature of endoscopic methods.Compared to enteral stenting,EUS-GE shows superior outcomes,including higher long-term patency,lower symptom recurrence,and fewer reinterventions.It also demonstrates comparable or better efficacy than SGJ,with faster oral intake,shorter hospital stays,and reduced complications.However,EUS-GE requires specialized expertise,and long-term outcome data remain limited,so further research is needed to refine protocols and optimize patient selection.展开更多
BACKGROUND Ileum adenocarcinoma(IA),a type of small bowel adenocarcinoma,is a rather uncommon factor associated with obstruction in small bowel.Owing to its location and indefinite clinical symptoms,the diagnosis of I...BACKGROUND Ileum adenocarcinoma(IA),a type of small bowel adenocarcinoma,is a rather uncommon factor associated with obstruction in small bowel.Owing to its location and indefinite clinical symptoms,the diagnosis of IA is difficult,and survival is usually poor.With respect to the rarity of this disease,very few studies have reported such cases to provide a reference for treatment.CASE SUMMARY In this manuscript,a case of a 48-year-old man presented with chronic right lower abdominal pain and distention,queasiness and emesis.A computed tomography scan revealed intestinal wall thickening and an intestinal obstruction in the terminal ileum.He was diagnosed with inflammatory bowel disease.However,his symptoms were not relieved after conservative treatment.The patient sub-sequently underwent exploratory laparotomy,and a tumour in the ileum measuring approximately 2.0 cm×2.0 cm that was located 20 cm from the ileocolic valve was discovered incidentally and was operatively resected along with the enlarged lymph nodes.Pathological examination revealed a stage IIA(T3N0M0)ulcerative IA.Along with imaging examinations,a diagnosis of primary IA with no lymph or distant metastases was considered.The patient was discharged and recovered well as of the writing of this manuscript.CONCLUSION IA should be considered as a differential diagnosis in cases of intestinal obstruction,and the recommended method for local disease treatment is surgery.展开更多
BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been est...BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been established.AIM To assess the efficacy and safety of combining intestinal stenting with laparoscopic surgery for the management of acute intestinal obstruction.METHODS Clinical data from 74 patients with colorectal cancer and acute intestinal obstruction,who were admitted to the emergency department of the authors’hospital between October 2023 and November 2024,were collected and analyzed.Patients were divided into two groups based on the surgical intervention:A control group(emergency open surgery,n=37)and a study group(intestinal stent implantation combined with laparoscopic surgery,n=37).Observation indicators included stent placement rate,obstruction relief rate,and stent-related complications.RESULTS Intestinal stent placement was 100%successful in the study group,all of whom experienced relief from obstruction while exhibiting a significantly lower rate of ostomy creation and a higher rate of primary anastomosis than in the control group,as well as less intraoperative blood loss,shorter time to flatus,and shorter hospital stay.The complication rate was 5.41%(2/37;bleeding and re-obstruction),with no statistically significant difference between the two groups in terms of operative duration or perioperative mortality.The overall complication rates were 5.41%(2/37)and 21.62%(8/37)in the intervention and control groups,respectively.Tumor recurrence and overall survival rates were 2.70%and 97.30%in the study group and 13.51%and 91.89%in the control group,respectively.CONCLUSION Intestinal stenting relieved acute obstructions,reduced the number of emergency surgeries,and supported laparoscopic procedures while improving primary anastomosis rates,minimizing ostomy occurrence,surgical trauma,and complications,and accelerating recovery.展开更多
Lithopedion is a rare clinical situation characterised by the calcification of a foetus that has died during an ectopic pregnancy, usually in the abdominal cavity. It occurs in 1.5 to 2% of ectopic pregnancies. It can...Lithopedion is a rare clinical situation characterised by the calcification of a foetus that has died during an ectopic pregnancy, usually in the abdominal cavity. It occurs in 1.5 to 2% of ectopic pregnancies. It can be asymptomatic for several years. However, various complications can occur that lead to diagnosis. The authors report a case of lithopedion complicated by acute intestinal obstruction in a 24-year-old woman in her first pregnancy. This complication occurred after 12 months of amenorrhoea. A mass containing a calcified foetus was removed by laparotomy.展开更多
BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic o...BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic or periampullary cancers.In this study,we report a case of GP with the rare symptom of severe gastric outlet obstruction.CASE SUMMARY A 68-year-old man presented to our institution with severe gastric outlet obstruction accompanied by vomiting persisted for 3 days,severe electrolyte imbalance,and altered mental status with cardiac arrest.Differential diagnosis of cancers of the ampulla of Vater or duodenum was difficult due to discordant findings from preoperative imaging and an endoscopic biopsy of the lesion.In addition,the gastric outlet obstruction did not improve with conservative treatment;therefore,pancreatoduodenectomy was performed.Postoperatively,the histological findings revealed multiple cystic lesions in the duodenal wall that were collectively diagnosed as GP.The patient underwent a follow-up 3 years postoperatively and was found to have no postoperative sequelae.CONCLUSION In this case of GP,pancreatoduodenectomy safely treated severe gastric outlet obstruction when a cancer diagnosis could not be excluded.展开更多
Internal herniation(IH)refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic sp...Internal herniation(IH)refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic space within the abdominal cavity.Although the incidence of small bowel obstruction(SBO)caused by IH is very low(approximately 0.2%to 0.9%),its incidence may be increased in certain specific populations or in postoperative patients.Recently Kaw et al shared their 13-year experience of managing IHs in a tertiary care hospital in India.This retrospective study analyzed and determined the clinico-demographic profiles,radiological and operative findings and postoperative course of patients with IH and the association with SBO.The results provide valuable insights into early diagnosis and establishment of a timely treatment regimen for this condition and emphasize the importance of combining rapid imaging evaluation with the traditional therapeutic approach of laparoscopic surgery,thus providing a novel perspective on the diagnosis and treatment of SBO caused by IH.展开更多
The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.Wi...The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.With technical success rates close to 96%,stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents.Understanding the correct concept of palliation is the need of the hour in management.Identifying the right patient for palliation,selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care.Also,newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.展开更多
BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to ...BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to symptom overlap with nor-mal pregnancy,increasing risks of perforation and sepsis.CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation,feculent vomiting,and abdominal distension.She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma.The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings.Interventions included conservative measures(nasogastric tube decompression,enemas)followed by emergency laparotomy with bowel resec-tion/anastomosis.Despite surgical management,the patient succumbed to septic shock.CONCLUSION High clinical suspicion,expedited cross-sectional imaging(computed tomogra-phy/Magnetic resonance imaging),and emergent surgery are critical to reduce mortality.展开更多
Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,...Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.展开更多
BACKGROUND Among all forms of heterotopic ossification,heterotopic mesenteric ossification(HMO)is rare,with fewer than 100 reported cases to date.Postoperative early small bowel obstruction caused by HMO is even rarer...BACKGROUND Among all forms of heterotopic ossification,heterotopic mesenteric ossification(HMO)is rare,with fewer than 100 reported cases to date.Postoperative early small bowel obstruction caused by HMO is even rarer,presenting extremely high surgical risks,the potential for multiple surgeries,and a poor prognosis.There have been no reported cases of conservative treatment for resolving such early postoperative obstruction.CASE SUMMARY A 57-year-old male presented with severe postoperative small bowel obstruction shortly after undergoing open radical resection for transverse colon cancer.Laparotomy revealed extensive adhesions in the proximal jejunum and mesen-tery,making it too difficult to relieve without injuring the small bowel.Addi-tionally,multiple fixed nodules were found in the mesentery during the opera-tion.Pathology confirmed the presence of heterotopic ossification.The patient was treated with methylprednisolone on postoperative day 1,which gradually relieved his symptoms.CONCLUSION Hormone therapy may have a potential role in treating small bowel obstruction caused by early HMO after operative intervention.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this tec...BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this technique,the incidence of complications is expected to increase.The most common complications of ESD are hemorrhage and perforation.Rare cases of obstruction after colorectal ESD have been reported,which are often easily misdiagnosed.Therefore,clinicians should maintain heightened awareness of this complication.CASE SUMMARY We report the case of a 50-year-old male who developed bowel obstruction following ESD.On the second day after the procedure,the patient presented with fever and a mild left lower abdominal pain.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant.Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel.The patient continued to fast and was treated with intravenous antibiotics.On the third postoperative day,he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid,with no bowel movement for two days after the procedure.A diagnosis of obstruction after ESD was made.Continuous gastrointestinal decompression was initiated on the fourth day,resulting in symptomatic improvement.Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging.The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.CONCLUSION Acute intestinal obstruction after ESD is a rare complication.Delayed diagnosis or misdiagnosis may be life-threatening.Clinicians should be vigilant for this condition following ESD.展开更多
[Objectives]To explore the effects of electroacupuncture combined with rehabilitation training on knee joint function,three-dimensional(3D)gait,and inflammatory markers in patients with knee osteoarthritis(KOA)of cold...[Objectives]To explore the effects of electroacupuncture combined with rehabilitation training on knee joint function,three-dimensional(3D)gait,and inflammatory markers in patients with knee osteoarthritis(KOA)of cold-dampness obstruction syndrome.[Methods]A total of 162 KOA patients admitted to Huadong Hospital Affiliated to Fudan University from January 2021 to May 2023 were enrolled and randomly divided into an electroacupuncture group and a control group,with 81 patients in each group.The control group received routine rehabilitation training,while the electroacupuncture group received electroacupuncture treatment in addition to the same rehabilitation training,both for 4 weeks.The efficacy,syndrome scores,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Lysholm Knee Score(LKS),3D gait parameters,and levels of inflammatory markers were compared between the two groups.[Results]Following treatment,the total effective rate in the electroacupuncture group was 92.59%,which was significantly higher than 77.78%observed in the control group(P<0.05).Additionally,the electroacupuncture group exhibited lower TCM syndrome scores(P<0.05),reduced WOMAC scores,and elevated LKS scores compared to the control group(P<0.05).Gait parameters,including step frequency,step speed,stride length,initial ground contact flexion angle,maximum swing phase extension angle,and support phase extension angle,were all higher in the electroacupuncture group.Additionally,the sagittal plane maximum abduction moment was lower in the electroacupuncture group.Inflammatory markers showed that interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were lower in the electroacupuncture group,while transforming growth factor-β1(TGF-β1)was higher(P<0.05).[Conclusions]Electroacupuncture combined with rehabilitation training effectively enhances clinical efficacy,alleviates symptoms,improves knee joint mobility and walking ability,enhances knee function scores,and reduces inflammatory levels,contributing to the rapid recovery of knee joints in KOA patients.展开更多
BACKGROUND In cases of colorectal cancer(CRC)with obstruction,patients experience local tissue edema due to intestinal obstruction.This condition stimulates the accumulation of inflammatory factors,activates cancer ce...BACKGROUND In cases of colorectal cancer(CRC)with obstruction,patients experience local tissue edema due to intestinal obstruction.This condition stimulates the accumulation of inflammatory factors,activates cancer cells,and increases the risk of tumor recurrence.At present,analyses and evaluation tools for factors influencing early postoperative recurrence in patients with CRC and obstruction are limited.AIM To explore the influencing factors and construct a predictive model of the early postoperative recurrence of CRC with obstruction.METHODS Data from 181 patients with CRC and obstruction who underwent surgery in the Department of Gastrointestinal Surgery,Suzhou Ninth Hospital Affiliated to Soochow University,between January 2017 and May 2023 were retrospectively collected.Patients with CRC and obstruction were divided into a recurrence group and a non-recurrence group based on whether recurrence occurred during the 2-year follow-up after surgery.Datasets from the two groups were compared.Subsequently,multiple logistic regression was employed to analyze the influencing factors of the early postoperative recurrence of CRC with obstruction.The nomogram prediction model was drawn using R software,and its performance was evaluated by the goodness of fit test and receiver operating characteristic(ROC)curve analysis.The clinical benefit rate of the model was evaluated by decision curves.RESULTS Among the 181 patients with CRC and obstruction,52(28.73%)experienced tumor recurrence within 2 years after surgery.Significant differences were observed in preoperative carcinoembryonic antigen(CEA),preoperative systemic immuneinflammation index(SII),tumor,node,and metastasis(TNM)stage,differentiation degree,nerve infiltration,and Ki-67 expression between the recurrence and non-recurrence groups(P<0.05).Multivariate logistic regression analysis showed that high preoperative CEA(OR=2.094,P=0.008),high preoperative SII(OR=2.795,P<0.001),TNM stage III(OR=1.644,P=0.027),poor differentiation(OR=1.861,P=0.035),and high Ki-67 expression(OR=2.467,P=0.001)were all influencing factors for early postoperative recurrence of CRC with obstruction.The area under the ROC curve of the nomograph model constructed based on this was 0.890,the goodness of fit deviation test was conducted(χ^(2)=3.903,P=0.866),and the decision curve display model demonstrated practical value in clinical practice.CONCLUSION The early recurrence rate of CRC with obstruction is high.CEA,SII,TNM staging,differentiation degree,and Ki-67 expression are factors related to early postoperative recurrence.A nomogram prediction model incorporating these factors can effectively evaluate the risk of early postoperative recurrence in patients with CRC.展开更多
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
基金the Special Project of State Key Laboratory of Dampness Syndrome of Chinese Medicine:Study on Criteria for Diagnosis of Dampness Syndrome of Idiopathic Membranous Nephropathy,Cohort Study on Pathogenesis and Material Basis of Dampness Syndrome of Idiopathic Membranous Nephropathy,Randomized Controlled Clinical Study of Sanqi Qushi Granule in Treatment of Membranous Nephropathy(No.SZ2021ZZ02,SZ2021ZZ09 and SZ2021ZZ36)the 2020 Guangdong Provincial Science and Technology Innovation Strategy Special Fund:Guangdong-Hong Kong-Macao Joint Lab(No.2020B1212030006)+2 种基金the Natural Science Foundation of Guangdong Province:Study on the Mechanism of Sanqi Qushi Prescription Delaying Podocellular Senescence in Membranous Nephropathy based on Cyclic Guanosine Monophosphate-Adenosine Monophosphate Synthase-Stimulator of Interferon Genes-Nuclear Factor Kappa-B Signaling Pathway(No.2022A1515011628)the Guangzhou Science and Technology Plan Project:to Explore the Mechanism of Treating Membranous Nephropathy from the Perspective of Regulating Amino Acid Metabolism Disorder(No.2023A03J0746)Special Funding for Scientific and Technological Research on Traditional Chinese Medicine,Guangdong Provincial Hospital of Chinese Medicine:a Multimodular Machine Learning Prediction Model based on Pathological Image-transcriptomics and Traditional Chinese Medicine Syndromes was Used to Investigate the Prognostic Correlation of Long non-coding RNA Molecules in Nephropathy and the Intervention Mechanism of Sanqi Qushi Formula,to Investigate the Pathogenesis and Microbiological Mechanism of Dampness Syndrome of Membranous Nephropathy based on the Microecological Changes of Tongue Coating(No.YN2023MB02,YN2023MB10)。
文摘OBJECTIVE:To reach consensus on the diagnostic criteria of syndrome of dampness obstruction in idiopathic membranous nephropathy(IMN)patients by literature research and expert investigation(interviews and a Delphi method).METHODS:Our study was consistent with T/CACM 1336-2020.We searched the monographs and references published in the past 40 years(1983-2022),and established the diagnostic criteria pool of waterdampness syndrome and dampness-turbidity syndrome in Traditional Chinese Medicine(TCM)based on literature by using frequency statistics and correlation analysis.Expert investigation(interview method and two rounds of Delphi method)was used to form the diagnostic criteria of water-dampness syndrome and dampnessturbidity syndrome of idiopathic membranous nephropathy.Clinical diagnostic test research was carried out,and compared with“Diagnostic Criteria for dampness syndrome”(T/CACM 1454-2023)to evaluate the authenticity,reliability and clinical application value of the standard.RESULTS:A total of 122 relevant guides,standards,monographs and documents were included through searching books and Chinese databases.Four experts were interviewed and two rounds of delphi method(75 experts nationwide)were carried out.The experts'opinions are relatively concentrated and the differences are small.Based on the weight of each index,the diagnostic criteria indexes of water-dampness syndrome and dampness-turbidity syndrome were selected.After discussion by the core group members,the diagnostic model of"necessary symptoms and optional symptoms"was established,and the final diagnostic criteria of waterdampness syndrome and dampness-turbidity syndrome were established.One hundred and ninety-one inpatients and outpatients of Guangdong Provincial Hospital of Chinese Medicine from January 2021 to February 2023 were included in Diagnostic test study.There was no statistical difference in gender,age and course of disease(P>0.05).The sensitivity and specificity of the trial standard were 90.34%and 73.33%respectively,while the sensitivity and specificity of T/CACM 1454-2023 were 99.43%and 6.67%,respectively.CONCLUSIONS:The consensus-based diagnostic criteria for IMN can be widely incorporated in TCM.A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our IMN criteria.
文摘·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.
文摘Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.
文摘BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can cause complications ranging from mild symptoms to severe issues like gastric outlet obstruction(GOO).This report discusses a 39-year-old woman who presented with clinical and radiological features of GOO post Silimed IGB placement.CASE SUMMARY A 39-year-old woman presented to our institution with two-week history of abdominal pain,nausea and vomiting post prandially.This was in the context of a Silimed IGB placement two weeks prior to presentation for weight loss in the context of obesity.A computed tomography of the abdomen demonstrated the IGB device in the body and prepyloric region,with proximal dilatation of the body and fundus of the stomach which contained gastric contents.Due to concerns for GOO,the IGB was removed endoscopically with subsequent symptom alleviation.In addition to this,we performed a literature search of cases of IGB related GOO using the PubMed and Web of Science databases from inception date to the August 26,2024.A total of 27 articles were included in the analysis,identifying 29 cases of IGB-related GOO.These patients commonly presented with nausea,vomiting and abdominal pain,with symptom onset varying from 3 days to 18 months post IGB insertion.Abdominal computed tomography was the primary diagnostic tool and endoscopic removal was the standard treatment modality.CONCLUSION This is the first reported case of GOO caused by Silimed IGB.While effective for weight reduction,IGB-related GOO is a rare but serious complication,usually requiring endoscopic retrieval.Future research should aim to identify patient factors linked to this complication to enhance clinical-decision making and outcomes.
基金National Natural Science Foundation of China(81902379)Chenguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Commission(21CGA20)Cultivation Foundation of Renji Hospital(RJPY-LX-011).
文摘Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecystoduodenal fistula.Since the rarity of gallstone ileus is associated with relatively high rates of morbidity and mortality in elderly patients with multiple comorbidities,making an early and accurate diagnosis in emergency settings crucial.
文摘Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].
文摘Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojejunostomy(SGJ)and the minimally invasive nature of endoscopic methods.Compared to enteral stenting,EUS-GE shows superior outcomes,including higher long-term patency,lower symptom recurrence,and fewer reinterventions.It also demonstrates comparable or better efficacy than SGJ,with faster oral intake,shorter hospital stays,and reduced complications.However,EUS-GE requires specialized expertise,and long-term outcome data remain limited,so further research is needed to refine protocols and optimize patient selection.
文摘BACKGROUND Ileum adenocarcinoma(IA),a type of small bowel adenocarcinoma,is a rather uncommon factor associated with obstruction in small bowel.Owing to its location and indefinite clinical symptoms,the diagnosis of IA is difficult,and survival is usually poor.With respect to the rarity of this disease,very few studies have reported such cases to provide a reference for treatment.CASE SUMMARY In this manuscript,a case of a 48-year-old man presented with chronic right lower abdominal pain and distention,queasiness and emesis.A computed tomography scan revealed intestinal wall thickening and an intestinal obstruction in the terminal ileum.He was diagnosed with inflammatory bowel disease.However,his symptoms were not relieved after conservative treatment.The patient sub-sequently underwent exploratory laparotomy,and a tumour in the ileum measuring approximately 2.0 cm×2.0 cm that was located 20 cm from the ileocolic valve was discovered incidentally and was operatively resected along with the enlarged lymph nodes.Pathological examination revealed a stage IIA(T3N0M0)ulcerative IA.Along with imaging examinations,a diagnosis of primary IA with no lymph or distant metastases was considered.The patient was discharged and recovered well as of the writing of this manuscript.CONCLUSION IA should be considered as a differential diagnosis in cases of intestinal obstruction,and the recommended method for local disease treatment is surgery.
文摘BACKGROUND Recently,intestinal stenting combined with laparoscopic surgery has received increasing attention as a treatment option for acute intestinal obstruction.However,its safety and efficacy have not yet been established.AIM To assess the efficacy and safety of combining intestinal stenting with laparoscopic surgery for the management of acute intestinal obstruction.METHODS Clinical data from 74 patients with colorectal cancer and acute intestinal obstruction,who were admitted to the emergency department of the authors’hospital between October 2023 and November 2024,were collected and analyzed.Patients were divided into two groups based on the surgical intervention:A control group(emergency open surgery,n=37)and a study group(intestinal stent implantation combined with laparoscopic surgery,n=37).Observation indicators included stent placement rate,obstruction relief rate,and stent-related complications.RESULTS Intestinal stent placement was 100%successful in the study group,all of whom experienced relief from obstruction while exhibiting a significantly lower rate of ostomy creation and a higher rate of primary anastomosis than in the control group,as well as less intraoperative blood loss,shorter time to flatus,and shorter hospital stay.The complication rate was 5.41%(2/37;bleeding and re-obstruction),with no statistically significant difference between the two groups in terms of operative duration or perioperative mortality.The overall complication rates were 5.41%(2/37)and 21.62%(8/37)in the intervention and control groups,respectively.Tumor recurrence and overall survival rates were 2.70%and 97.30%in the study group and 13.51%and 91.89%in the control group,respectively.CONCLUSION Intestinal stenting relieved acute obstructions,reduced the number of emergency surgeries,and supported laparoscopic procedures while improving primary anastomosis rates,minimizing ostomy occurrence,surgical trauma,and complications,and accelerating recovery.
文摘Lithopedion is a rare clinical situation characterised by the calcification of a foetus that has died during an ectopic pregnancy, usually in the abdominal cavity. It occurs in 1.5 to 2% of ectopic pregnancies. It can be asymptomatic for several years. However, various complications can occur that lead to diagnosis. The authors report a case of lithopedion complicated by acute intestinal obstruction in a 24-year-old woman in her first pregnancy. This complication occurred after 12 months of amenorrhoea. A mass containing a calcified foetus was removed by laparotomy.
文摘BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic or periampullary cancers.In this study,we report a case of GP with the rare symptom of severe gastric outlet obstruction.CASE SUMMARY A 68-year-old man presented to our institution with severe gastric outlet obstruction accompanied by vomiting persisted for 3 days,severe electrolyte imbalance,and altered mental status with cardiac arrest.Differential diagnosis of cancers of the ampulla of Vater or duodenum was difficult due to discordant findings from preoperative imaging and an endoscopic biopsy of the lesion.In addition,the gastric outlet obstruction did not improve with conservative treatment;therefore,pancreatoduodenectomy was performed.Postoperatively,the histological findings revealed multiple cystic lesions in the duodenal wall that were collectively diagnosed as GP.The patient underwent a follow-up 3 years postoperatively and was found to have no postoperative sequelae.CONCLUSION In this case of GP,pancreatoduodenectomy safely treated severe gastric outlet obstruction when a cancer diagnosis could not be excluded.
基金Supported by the Chongqing Fundamental Research Funds,No.jbky20210001Performance Incentive-oriented Project of Chongqing,No.jxjl20220006。
文摘Internal herniation(IH)refers to the movement of intra-abdominal organs or tissues out of their original position through normal or abnormal orifices and fissures in the peritoneum or mesentery and into an anatomic space within the abdominal cavity.Although the incidence of small bowel obstruction(SBO)caused by IH is very low(approximately 0.2%to 0.9%),its incidence may be increased in certain specific populations or in postoperative patients.Recently Kaw et al shared their 13-year experience of managing IHs in a tertiary care hospital in India.This retrospective study analyzed and determined the clinico-demographic profiles,radiological and operative findings and postoperative course of patients with IH and the association with SBO.The results provide valuable insights into early diagnosis and establishment of a timely treatment regimen for this condition and emphasize the importance of combining rapid imaging evaluation with the traditional therapeutic approach of laparoscopic surgery,thus providing a novel perspective on the diagnosis and treatment of SBO caused by IH.
文摘The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.With technical success rates close to 96%,stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents.Understanding the correct concept of palliation is the need of the hour in management.Identifying the right patient for palliation,selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care.Also,newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.
文摘BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to symptom overlap with nor-mal pregnancy,increasing risks of perforation and sepsis.CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation,feculent vomiting,and abdominal distension.She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma.The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings.Interventions included conservative measures(nasogastric tube decompression,enemas)followed by emergency laparotomy with bowel resec-tion/anastomosis.Despite surgical management,the patient succumbed to septic shock.CONCLUSION High clinical suspicion,expedited cross-sectional imaging(computed tomogra-phy/Magnetic resonance imaging),and emergent surgery are critical to reduce mortality.
文摘Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.
基金Supported by Major Basic Research Project of Shanxi Provincial Natural Science Foundation,No.202203021221185 and No.202103021224379.
文摘BACKGROUND Among all forms of heterotopic ossification,heterotopic mesenteric ossification(HMO)is rare,with fewer than 100 reported cases to date.Postoperative early small bowel obstruction caused by HMO is even rarer,presenting extremely high surgical risks,the potential for multiple surgeries,and a poor prognosis.There have been no reported cases of conservative treatment for resolving such early postoperative obstruction.CASE SUMMARY A 57-year-old male presented with severe postoperative small bowel obstruction shortly after undergoing open radical resection for transverse colon cancer.Laparotomy revealed extensive adhesions in the proximal jejunum and mesen-tery,making it too difficult to relieve without injuring the small bowel.Addi-tionally,multiple fixed nodules were found in the mesentery during the opera-tion.Pathology confirmed the presence of heterotopic ossification.The patient was treated with methylprednisolone on postoperative day 1,which gradually relieved his symptoms.CONCLUSION Hormone therapy may have a potential role in treating small bowel obstruction caused by early HMO after operative intervention.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this technique,the incidence of complications is expected to increase.The most common complications of ESD are hemorrhage and perforation.Rare cases of obstruction after colorectal ESD have been reported,which are often easily misdiagnosed.Therefore,clinicians should maintain heightened awareness of this complication.CASE SUMMARY We report the case of a 50-year-old male who developed bowel obstruction following ESD.On the second day after the procedure,the patient presented with fever and a mild left lower abdominal pain.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant.Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel.The patient continued to fast and was treated with intravenous antibiotics.On the third postoperative day,he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid,with no bowel movement for two days after the procedure.A diagnosis of obstruction after ESD was made.Continuous gastrointestinal decompression was initiated on the fourth day,resulting in symptomatic improvement.Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging.The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.CONCLUSION Acute intestinal obstruction after ESD is a rare complication.Delayed diagnosis or misdiagnosis may be life-threatening.Clinicians should be vigilant for this condition following ESD.
基金Supported by General Program of the National Natural Science Foundation of China(81973883)Three-Year Action Plan Project for Enhancing Clinical Skills and Clinical Innovation Capabilities of Municipal Hospitals(SHDC2020CR1010A).
文摘[Objectives]To explore the effects of electroacupuncture combined with rehabilitation training on knee joint function,three-dimensional(3D)gait,and inflammatory markers in patients with knee osteoarthritis(KOA)of cold-dampness obstruction syndrome.[Methods]A total of 162 KOA patients admitted to Huadong Hospital Affiliated to Fudan University from January 2021 to May 2023 were enrolled and randomly divided into an electroacupuncture group and a control group,with 81 patients in each group.The control group received routine rehabilitation training,while the electroacupuncture group received electroacupuncture treatment in addition to the same rehabilitation training,both for 4 weeks.The efficacy,syndrome scores,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC),Lysholm Knee Score(LKS),3D gait parameters,and levels of inflammatory markers were compared between the two groups.[Results]Following treatment,the total effective rate in the electroacupuncture group was 92.59%,which was significantly higher than 77.78%observed in the control group(P<0.05).Additionally,the electroacupuncture group exhibited lower TCM syndrome scores(P<0.05),reduced WOMAC scores,and elevated LKS scores compared to the control group(P<0.05).Gait parameters,including step frequency,step speed,stride length,initial ground contact flexion angle,maximum swing phase extension angle,and support phase extension angle,were all higher in the electroacupuncture group.Additionally,the sagittal plane maximum abduction moment was lower in the electroacupuncture group.Inflammatory markers showed that interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were lower in the electroacupuncture group,while transforming growth factor-β1(TGF-β1)was higher(P<0.05).[Conclusions]Electroacupuncture combined with rehabilitation training effectively enhances clinical efficacy,alleviates symptoms,improves knee joint mobility and walking ability,enhances knee function scores,and reduces inflammatory levels,contributing to the rapid recovery of knee joints in KOA patients.
文摘BACKGROUND In cases of colorectal cancer(CRC)with obstruction,patients experience local tissue edema due to intestinal obstruction.This condition stimulates the accumulation of inflammatory factors,activates cancer cells,and increases the risk of tumor recurrence.At present,analyses and evaluation tools for factors influencing early postoperative recurrence in patients with CRC and obstruction are limited.AIM To explore the influencing factors and construct a predictive model of the early postoperative recurrence of CRC with obstruction.METHODS Data from 181 patients with CRC and obstruction who underwent surgery in the Department of Gastrointestinal Surgery,Suzhou Ninth Hospital Affiliated to Soochow University,between January 2017 and May 2023 were retrospectively collected.Patients with CRC and obstruction were divided into a recurrence group and a non-recurrence group based on whether recurrence occurred during the 2-year follow-up after surgery.Datasets from the two groups were compared.Subsequently,multiple logistic regression was employed to analyze the influencing factors of the early postoperative recurrence of CRC with obstruction.The nomogram prediction model was drawn using R software,and its performance was evaluated by the goodness of fit test and receiver operating characteristic(ROC)curve analysis.The clinical benefit rate of the model was evaluated by decision curves.RESULTS Among the 181 patients with CRC and obstruction,52(28.73%)experienced tumor recurrence within 2 years after surgery.Significant differences were observed in preoperative carcinoembryonic antigen(CEA),preoperative systemic immuneinflammation index(SII),tumor,node,and metastasis(TNM)stage,differentiation degree,nerve infiltration,and Ki-67 expression between the recurrence and non-recurrence groups(P<0.05).Multivariate logistic regression analysis showed that high preoperative CEA(OR=2.094,P=0.008),high preoperative SII(OR=2.795,P<0.001),TNM stage III(OR=1.644,P=0.027),poor differentiation(OR=1.861,P=0.035),and high Ki-67 expression(OR=2.467,P=0.001)were all influencing factors for early postoperative recurrence of CRC with obstruction.The area under the ROC curve of the nomograph model constructed based on this was 0.890,the goodness of fit deviation test was conducted(χ^(2)=3.903,P=0.866),and the decision curve display model demonstrated practical value in clinical practice.CONCLUSION The early recurrence rate of CRC with obstruction is high.CEA,SII,TNM staging,differentiation degree,and Ki-67 expression are factors related to early postoperative recurrence.A nomogram prediction model incorporating these factors can effectively evaluate the risk of early postoperative recurrence in patients with CRC.
