BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different tre...BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.展开更多
BACKGROUND Among patients referred for colonoscopy to evaluate bowel bleeding,many present with hemorrhoidal disease-associated bleeding and prolapse.AIM To compare endoscopic band ligation(EBL)with rigid proctoscope ...BACKGROUND Among patients referred for colonoscopy to evaluate bowel bleeding,many present with hemorrhoidal disease-associated bleeding and prolapse.AIM To compare endoscopic band ligation(EBL)with rigid proctoscope band ligation(RPBL)in patients referred for colonoscopy due to internal hemorrhoids.METHODS This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment.Seventy-five patients underwent EBL,and 96 underwent RPBL.Control of bleeding,prolapse recurrence,pain,tenesmus,overall satisfaction,and cost were analyzed.A log-binomial regression model was used to analyze and compare binary outcomes between the ligation types,which allowed for the direct estimation of relative risks.RESULTS EBL achieved hemorrhoid symptom control in 92%of patients after a single session,compared with 63.5%for RPBL,which typically required three to four sessions(P<0.01).Short-term prolapse was significantly lower with EBL(13.3%)than with RPBL(55.2%,P<0.01),and long-term prolapse recurrence remained lower(8% vs 36.5%,P<0.01).Short-term bleeding was also reduced with EBL(4% vs 19%,P<0.01),while long-term bleeding control was comparable between groups(97.3% vs 92.7%).RPBL patients were more likely to report pain(relative risk=1.29;95%confidence interval:1.08-1.54;P<0.01).Overall satisfaction was markedly higher in the EBL group(86.7%“very satisfied”)than in the RPBL group(24%,P<0.01).CONCLUSION EBL demonstrated superior control of hemorrhoidal symptoms,lower prolapse recurrence,and better short-term bleeding outcomes compared with RPBL.Long-term bleeding control and tenesmus rates were comparable;however,numerical trends favored EBL.Despite a higher per-session cost,the reduced number of sessions made overall expenses similar.EBL appears to be a more effective,efficient,and well-tolerated minimally invasive option for treating symptomatic internal hemorrhoids.展开更多
Graphene,owing to its exceptional electronic,optical,thermal,and mechanical properties,has emerged as a highly promising material.Currently,the synthesis of large-area graphene films on metal substrates via chemical v...Graphene,owing to its exceptional electronic,optical,thermal,and mechanical properties,has emerged as a highly promising material.Currently,the synthesis of large-area graphene films on metal substrates via chemical vapor deposition remains the predominant approach for producing high-quality graphene.To realize the potential applications of graphene,it is essential to transfer graphene films to target substrates in a manner that is non-destructive,clean,and efficient,as this significantly affects the performance of graphene devices.This review examines the current methods for graphene transfer from three perspectives:non-destructive transfer,clean transfer,and high-efficiency transfer.It analyzes and compares the advancements and limitations of various transfer techniques.Finally,the review identifies the key challenges faced by current graphene transfer methods and anticipates future developmental prospects.展开更多
For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions ori...For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.展开更多
Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound iso...Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound isolated from plant species of the genus Aloe,remain unidentified.Here,we investigated the protective effects of Alo against cecal ligation and puncture(CLP)-induced sepsis and microflora in mice.Alo significantly improved CLP-induced sepsis and the survival rate of septic mice,downregulated the expression of proinflammatory factors,and decreased the infiltration of inflammatory cells in tissues.Alo upregulated the proportion of peritoneal macrophages,reduced the number of peritoneal bacteria,decreased the content of short-chain fatty acids and bile acids in the abdominal cavity,and suppressed Toll-like receptor(TLR)-2/4/nuclear factor kappa-B(NF-κB)/NOD-like receptor thermal protein domain associated protein 3(NLRP3)/Caspase-1/3/8 signaling.Furthermore,Alo altered the composition of the microbiome and promoted the growth of Lactobacillus,which showed a stronger anti-inflammatory effect.Whole-genome analysis identified the genes Saa3,Il10,Fpr1,and Eif4a1 associated with the protective effects of Alo in mice with CLP-induced sepsis.Overall,our results provide novel insights into the therapeutic potential and mechanism of action of Alo in the treatment of sepsis.展开更多
Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and periopera...Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and perioperative risks have not been well established.The objective of this study is to compare the peri-and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.Methods A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database.Statistical analysis involved t test,chi-square test,and logistic regression analysis with the use of the random forest algorithm.The primary outcomes were perioperative and postoperative complications.Results Of the total cohort,45,307(91.6%)underwent laparoscopic salpingectomy,and 4138(8.4%)received laparoscopic tubal ligation.There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics,including age,BMI,minority status,and variations in past medical history.These demographic characteristics were controlled for in the multivariate regression analysis.Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation(OR=1.78,95%CI:1.46-2.20,p<0.001).Salpingectomy was associated with a greater risk of longer operation time(OR=2.03,95%CI:2.02-2.04,p<0.001),longer hospital stay(OR=5.26,95%CI:4.57-6.09,p<0.001),increased readmission(OR=3.15,95%CI:1.92-5.65,p<0.001),and increased unplanned reoperation(OR=2.42,95%CI:1.32-5.12,p=0.010).In addition,the occurrence rates of organ space surgical site infection(OR=2.68,95%CI:1.21-7.59,p=0.032)and sepsis(OR=3.93,95%CI:1.48-16.02,p=0.020)were significantly greater in the salpingectomy group than in the tubal ligation group.Conclusions Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception;however,salpingectomy is more likely to be associated with peri-and postoperative complications.These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.展开更多
Through literature analysis and case study, the introduction history, variety selection (high bush, half high bush, low bush) and regional cultivation techniques of blueberry in China were summarized, and the practica...Through literature analysis and case study, the introduction history, variety selection (high bush, half high bush, low bush) and regional cultivation techniques of blueberry in China were summarized, and the practical effects of precision cultivation (water and fertilizer integration, wild planting) and under-forest economic model (forest-blueberry-fungus system, ecological tourism) were evaluated. It provided a technical reference for expanding the planting scale of blueberry and improving the fruit quality.展开更多
The addition of cold flow improvers(CFIs)is considered as the optimum strategy to improve the cold flow properties(CFPs)of diesel fuels,but this strategy is always limited by the required large dosage.To obtain low-do...The addition of cold flow improvers(CFIs)is considered as the optimum strategy to improve the cold flow properties(CFPs)of diesel fuels,but this strategy is always limited by the required large dosage.To obtain low-dosage and high-efficiency CFIs for diesel,1,2,3,6-tetrahydrophthalic anhydride(THPA)was introduced as a third and polar monomer to enhance the depressive effects of alkyl methacrylatetrans anethole copolymers(C_(14)MC-TA).The terpolymers of alkyl methacrylate-trans anethole-1,2,3,6-tetrahydrophthalic anhydride(C_(14)MC-TA-THPA)were synthesized and compared with the binary copolymers of C_(14)MC-TA and alkyl methacrylate-1,2,3,6-tetrahydrophthalic anhydride(C_(14)MC-THPA).Results showed that C_(14)MC-THPA achieved the best depressive effects on the cold filter plugging point(CFPP)and solid point(SP)by 11℃and 16℃at a dosage of 1250 mg/L and monomer ratio of 6:1,while 1500mg/L C_(14)MC-TA(1:1)reached the optimal depressive effects on the CFPP and SP by 12℃and 18℃.THPA introduction significantly improved the depressive effects of C_(14)MC-TA.Lower dosages of C_(14)MCTA-THPA in diesel exerted better improvement effects on the CFPP and SP than that of C_(14)MC-TA and C_(14)MC-THPA.When the monomer ratio and dosage were 6:0.6:0.4 and 1000 mg/L,the improvement effect of C_(14)MC-TA-THPA on diesel reached the optimum level,and the CFPP and SP were reduced by 13℃and 19℃,respectively.A 3D nonlinear surface diagram fitted by a mathematical model was also used for the first time to better understand the relationships of monomer ratios,dosages,and depressive effects of CFIs in diesel.Surface analysis results showed that C_(14)MC-TA-THPA achieved the optimum depressive effects at a monomer ratio of 6:0.66:0.34 and dosage of 1000 mg/L,and the CFPP and SP decreased by 14℃ and 19℃,respectively.The predicted results were consistent with the actual ones.Additionally,the improvement mechanism of these copolymers in diesel was also explored.展开更多
BACKGROUND In hemorrhoidal disease,despite the existence of numerous treatment options to alleviate symptoms,surgical intervention continues to be the gold standard.The advantages and disadvantages of many methods hav...BACKGROUND In hemorrhoidal disease,despite the existence of numerous treatment options to alleviate symptoms,surgical intervention continues to be the gold standard.The advantages and disadvantages of many methods have been shown in numerous studies However,only a few studies have compared the effectiveness of combined methods.AIM To compare the results of a coloproctology clinic that switched to the Doppler-guided hemorrhoidal artery ligation(DG-HAL)+Ferguson hemorrhoidectomy(FH)technique from the FH in the treatment of hemorrhoidal disease.METHODS In this retrospective cohort,data from a total of 45 patients who underwent DG-HAL+FH(n=24)and FH(n=21)for grade III hemorrhoidal disease between 2020 and 2022 were analyzed.Demographic and clinical data,surgical duration,intraoperative blood loss,hospital stay,postoperative analgesic consumption,pain scores using the Visual Analog Scale(VAS),complications,time to return to normal activities,and the recurrence rate were compared in both groups.RESULTS The study included 45 patients,with 75.6%(n=34)male and 24.4%(n=11)female.The rate of intraoperative blood loss was higher in the FH group(P<0.05).The VAS scores and postoperative complication rates were similar in both groups.The need for postoperative analgesics was lower in the DG-HAL+FH group(2 vs 4 days,P<0.05),while the FH group showed a shorter time to return to normal activities(9.5 vs 6.0 days,P=0.02).The recurrence rate(16.7%vs 0%)and Clavien–Dindo Score-1 complications(20.8%vs 9.5%,P=0.29)were higher in the DG-HAL+FH group but were insignificant.CONCLUSION Our study revealed that the addition of the DG-HAL to classical hemorrhoidectomy caused less intraoperative bleeding and a lower postoperative analgesia requirement.展开更多
BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with signifi...BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.展开更多
The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan h...The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results,showing less pain,quicker healing,and lower risk of anal stenosis.TILL reduces tissue tension and controls blood supply,allowing effective removal of diseased tissue while maintaining anal function and structure.However,the study's limitations,including its retrospective,single-center design,small sample size,and short follow-up,restrict the findings'generalizability and ability to assess long-term outcomes like recurrence.Larger,multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.展开更多
BACKGROUND Cirrhosis-related upper gastrointestinal bleeding(UGIB)poses a fatal risk,and endoscopic ligation as a sole intervention shows inadequate effectiveness.AIM To evaluate the therapeutic efficacy of endoscopic...BACKGROUND Cirrhosis-related upper gastrointestinal bleeding(UGIB)poses a fatal risk,and endoscopic ligation as a sole intervention shows inadequate effectiveness.AIM To evaluate the therapeutic efficacy of endoscopic variceal ligation(EVL)plus pro-pranolol vs EVL monotherapy in patients with cirrhosis complicated with acute UGIB and identify predictors for clinical outcomes.METHODS This study enrolled 99 consecutive patients with cirrhosis presenting with acute UGIB between January 2024 and January 2025.Participants were allocated to either the control group(n=49)receiving EVL alone or(2)the research group(n=50)receiving EVL plus propranolol.Primary outcomes included treatment efficacy,venous blood flow[portal venous flow(PVF)/splenic venous flow(SVF)],and postoperative outcomes(hemostasis time,length of hospital stay,and rebleeding rates).Univariate and multivariate regression analyses were conducted to determine independent predictors of treatment response.RESULTS Compared with the control group,the research group demonstrated significantly better outcomes,including higher overall treatment efficacy,greater reductions in PVF and SVF,shorter hemostasis time and hospital stay,and lower rebleeding rates.Univariate analysis demonstrated significant associations between treatment efficacy and age,cirrhosis duration,Child-Pugh grade,bleeding duration,and treatment approach in patients with cirrhosis complicated with acute UGIB.Multivariate logistic regression identified three independent risk factors for poor outcomes,namely,advanced age(>55 years),prolonged cirrhosis duration(≥4 years),and delayed bleeding intervention(>24 hours).CONCLUSION The EVL plus propranolol regimen demonstrates significant efficacy in treating UGIB in cirrhosis,outperforming EVL alone in improving hemodynamics(PVF/SVF),shortening hemostasis and hospitalization duration,and reducing rebleeding rates.Moreover,advanced age,prolonged disease duration,and longer bleeding times are independent risk factors for poor therapeutic outcomes.展开更多
BACKGROUND Routinely separating the ligamentum teres uteri(LTU)intraoperatively remains an unresolved issue for female children undergoing surgery for indirect inguinal hernia(IIH).AIM To identify the effect of LTU pr...BACKGROUND Routinely separating the ligamentum teres uteri(LTU)intraoperatively remains an unresolved issue for female children undergoing surgery for indirect inguinal hernia(IIH).AIM To identify the effect of LTU preservation in laparoscopic high hernia sac ligation(LHSL)in children with IIH.METHODS The participants were 100 female children with unilateral IIH admitted from April 2022 to January 2024 to the Pediatric Surgery Department of Zhangzhou Municipal Hospital of Fujian Province.They were categorized based on LTU retention into the control group(n=45 cases),which underwent LTU ligation intraoperatively,and the experimental group(55 cases),which had the LTU preserved intraoperatively.All children underwent LHSL.RESULTS This study comparatively analyzed the operation time,hospitalization time,blood loss,postoperative recurrence rate,and complications(repeated pain in the inguinal region,foreign body sensation in the inguinal region,bloody exudation at the inguinal incision,and incision infection),which were all comparable between the two groups.CONCLUSION The above results indicate that LTU preservation during LHSL exerts certain therapeutic benefits for children with IIH.LTU preservation does not increase hospitalization time,blood loss,postoperative recurrence rate,and complications,which is safe and feasible,compared with conventional LTU ligation.LHSL with LTU preservation should be performed if conditions permit,which is worth popularizing.展开更多
BACKGROUND Endoscopic variceal band ligation(EVBL)represents a pivotal treatment in the prophylaxis of esophageal varices bleeding in patients with cirrhosis,but in some cases a single session of EVBL is unable to era...BACKGROUND Endoscopic variceal band ligation(EVBL)represents a pivotal treatment in the prophylaxis of esophageal varices bleeding in patients with cirrhosis,but in some cases a single session of EVBL is unable to eradicate esophageal varices completely,and a control endoscopy after 2-4 weeks is required to assess eradication and/or the need for another band ligation.Liver stiffness measurement(LSM)is being increasingly used as a screening non-invasive tool to predict varices according to Baveno VII criteria.However,to date,there are no instruments able to non-invasively predict the outcome of EVBL.AIM To identify non-invasive predictors of varices eradication(VE)after EVBL through multiparametric ultrasound(US).Secondary aim was to develop a prediction model of successful variceal eradication based on non-invasive parameters.METHODS We prospectively enrolled consecutive cirrhotic patients intolerant or with contraindications to beta-blockers undergoing EVBL for bleeding prophylaxis.Patients underwent multiparametric US with LSM,spleen stiffness measurement(SSM)and dynamic contrastenhanced US(DCE-US)on liver parenchyma and portal vein,at baseline(T0)and one month(T1)after EVBL.Each US parameter and their variations from baseline were correlated with VE evaluated by control endoscopy performed at T1.RESULTS We enrolled 41 patients(median age 64 years,75.6%males).At T128 patients(68.3%)reached VE,whereas 13(31.7%)required a second EVBL.Patients who achieved VE showed a significant decrease in SSM(P=0.018),and a significant increase in peak enhancement,area under the curve and wash-in rate of both liver parenchyma and portal vein after treatment(P<0.001).Statistically significant differences between the two groups of patients were incorporated in a multivariate analysis and used to develop three prediction models.CONCLUSION A multimodal US approach based on DCE-US parameters,LSM and SSM might become a reliable predictor of VE and a useful non-invasive alternative to endoscopy.展开更多
BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patie...BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patients with linear and punctate subtypes,with a newer trend of utilization of endoscopic band ligation(EBL).This study evaluates the outcomes of patients undergoing treatment for nodular GAVE.We hypothesize that patients treated initially with EBL will achieve higher rates of clinical remission with fewer endoscopic treatments and a shorter treatment interval.AIM To investigate the effects of EBL as an initial treatment therapy on outcomes associated with nodular GAVE.METHODS A total of 37 patients at a tertiary medical center with nodular GAVE were included in this retrospective study.The study population was divided between those treated initially with EBL(initial EBL)and initial endoscopic thermal therapy.Pretreatment and post-treatment hemoglobin values,the model for end-stage liver disease scores,hospitalization rates,and other outcomes.Additionally,endoscopic treatment modality type and frequency were recorded,including radiofrequency ablation,argon plasma coagulation,and EBL.Continuous variables were compared using a t-test,while categorical variables were compared using Fisher’s exact.RESULTS Linear regression analysis displayed a positive relationship between the time interval from initial therapeutic esophagogastroduodenoscopy to first EBL treatment and overall treatment interval(t=7.39,P<0.001),as well as between the number of endoscopic treatments(t=8.09,P<0.001).Hemoglobin levels increased in both the initial EBL group(8.7 vs 11.4,P<0.001)and the initial endoscopic thermal therapy group(8.6 vs 10.4,P=0.042).Clinical remission rates were higher in the initial EBL group(90%vs 69%P=0.041),with a non-significant trend of higher endoscopic remission rates(57.1%vs 37.5%,P=0.270).CONCLUSION The observed trend favoring EBL,combined with its association with improved clinical remission and reduced treatment burden,supports its consideration as a preferred initial treatment approach.展开更多
BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a procedure used for patients with initially unresectable colorectal liver metastases(CRLM).However,the procedure has bee...BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a procedure used for patients with initially unresectable colorectal liver metastases(CRLM).However,the procedure has been reported to be associated with high morbidity and mortality.Laparoscopic ALPPS has recently been reported as a minimally invasive technique that reduces perioperative risks.AIM To assess the safety and feasibility of full laparoscopic ALPPS in patients with CRLM.METHODS A retrospective analysis was conducted on all consecutive patients with CRLM who underwent full laparoscopic ALPPS at the Sixth Affiliated Hospital of Sun Yat-sen University between March 2021 and July 2024.RESULTS Fifteen patients were included,13 with synchronous liver metastases.Nine patients had more than five liver tumors,with the highest count being 22.The median diameter of the largest lesion was 2.8 cm on preoperative imaging.No extrahepatic metastases were observed.RAS mutations were detected in nine patients,and 14 underwent preoperative chemotherapy.The median increase in future liver remnant volume during the interstage interval was 47.0%.All patients underwent R0 resection.Overall complication rates were 13.3%(stage 1)and 53.3%(stage 2),while major complication rates(Clavien-Dindo≥IIIa)were 13.3%(stage 1)and 33.3%(stage 2).No mortality occurred in either stage.The median hospital stay after stage 2 was 10 days.CONCLUSION Full laparoscopic ALPPS for CRLM is safe and feasible,with the potential for reduced morbidity and mortality,offering radical resection opportunities for patients with initially unresectable CRLM.展开更多
Objective The present study aimed to investigate the electrophysiological properties of wide dynamic range （WDR） neurons in spinal dorsal horn of rats with neuropathic pain induced by lumber 5 （L5） spinal nerve li...Objective The present study aimed to investigate the electrophysiological properties of wide dynamic range （WDR） neurons in spinal dorsal horn of rats with neuropathic pain induced by lumber 5 （L5） spinal nerve ligation （SNL） in a large size of samples.Methods Adult Sprague-Dawley rats were divided into normal and SNL groups.Electrophysiological technique was used to record the characteristics of WDR neurons in the spinal dorsal horn.Results Compared with the WDR neurons in normal rats,the WDR neurons in SNL rats showed an increase in excitability,manifested by an enlargement of the receptive field size,an increase in the proportion of neurons that exhibited spontaneous activities,decreases in the Cresponse threshold and latency,and an increase in the C-response duration.In addition,the numbers of A-and C-fiberevoked discharges were smaller in SNL rats than in normal rats.Conclusion The excitability of spinal WDR neurons increased in rats with neuropathic pain induced by L5 SNL.The increase in excitability of WDR neurons may contribute to the development of neuropathic pain.展开更多
The high-efficiency planting mode for five crops a year of fresh edible ＂faba bean/spring maize＋soybean-autumn maize/autumn soybean＂ was introduced, and its yield and economic benefits were compared with the planti...The high-efficiency planting mode for five crops a year of fresh edible ＂faba bean/spring maize＋soybean-autumn maize/autumn soybean＂ was introduced, and its yield and economic benefits were compared with the planting mode of three crops a year of ＂faba bean-spring maize/red bean＂. The results showed that the planting method for fresh edible ＂faba bean/spring maize＋soybean-autumn maize/autumn soybean＂ was much easier to operate with the input-output ratio of about185.6%, and its yield and economic benefits were 2.09 and 1.83 times of that of the planting mode for three crops a year, significantly improving the agricultural yield and income of farmers. In addition, the cropping index of the planting mode for fresh edible fresh edible ＂faba bean/spring maize ＋soybean-autumn maize/autumn soybean＂ reached up to 350%, and planting faba bean once a year and soybean twice a year could make the biological fixation amount of nitrogen increase 350-450kg/m^2, which equaled to up to 700 kg/m^2 of urea, showing significant ecological and social benefits. Based on the comparison results, the high-yield culture techniques of the planting mode of fresh edible ＂faba bean/spring maize＋soybean-autumn maize/autumn soybean＂ were summarized.展开更多
Rubber band ligation is one of the most important, costeffective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The techniqu...Rubber band ligation is one of the most important, costeffective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vasovagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier's gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis.展开更多
Broadly,complex fistulas are those that are not low transsphincteric or intersphincteric. The objectives of surgical management are to achieve fistula healing,prevent recurrences and maintain continence. The risk of i...Broadly,complex fistulas are those that are not low transsphincteric or intersphincteric. The objectives of surgical management are to achieve fistula healing,prevent recurrences and maintain continence. The risk of incontinence associated with treatment ranges from10% to 57%. The objective of this manuscript is to review the current literature to date on the ligation of the intersphincteric fistula tract procedure(LIFT procedure) as a treatment option in these types of fistula.A search was conducted in Medline,PUBMED,EMBASE and ISI Web of Knowledge,and studies published from January 2009 to May 2013 were included. The primary outcomes were fistula healing rates,mean healing time and patient satisfaction with this surgical technique.Eighteen studies were included in this review. The total number of patients included was 592(65% male).The median age reported was 42.8 years. The most common type of fistula included was transsphincteric(73.3% of cases). The mean healing rate reported was74.6%. The risk factors for failure discovered were obesity,smoking,multiple previous surgeries and the length of the fistula tract. The mean healing time was5.5 wk,and the mean follow-up period was 42.3 wk.The patient satisfaction rates ranged from 72% to 100%. No de novo incontinence developed secondary to the LIFT procedure. There is not enough evidence that variants in the surgical technique achieve better outcomes(Bio-LIFT,LIFT-Plug,LIFT-Plus). This review indicates that the LIFT procedure is primarily effective for transsphincteric fistulas with an overall fistula closure of 74.6% and has a low impact on fecal continence. This procedure produces better outcomes at the first surgical attempt.展开更多
文摘BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.
文摘BACKGROUND Among patients referred for colonoscopy to evaluate bowel bleeding,many present with hemorrhoidal disease-associated bleeding and prolapse.AIM To compare endoscopic band ligation(EBL)with rigid proctoscope band ligation(RPBL)in patients referred for colonoscopy due to internal hemorrhoids.METHODS This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment.Seventy-five patients underwent EBL,and 96 underwent RPBL.Control of bleeding,prolapse recurrence,pain,tenesmus,overall satisfaction,and cost were analyzed.A log-binomial regression model was used to analyze and compare binary outcomes between the ligation types,which allowed for the direct estimation of relative risks.RESULTS EBL achieved hemorrhoid symptom control in 92%of patients after a single session,compared with 63.5%for RPBL,which typically required three to four sessions(P<0.01).Short-term prolapse was significantly lower with EBL(13.3%)than with RPBL(55.2%,P<0.01),and long-term prolapse recurrence remained lower(8% vs 36.5%,P<0.01).Short-term bleeding was also reduced with EBL(4% vs 19%,P<0.01),while long-term bleeding control was comparable between groups(97.3% vs 92.7%).RPBL patients were more likely to report pain(relative risk=1.29;95%confidence interval:1.08-1.54;P<0.01).Overall satisfaction was markedly higher in the EBL group(86.7%“very satisfied”)than in the RPBL group(24%,P<0.01).CONCLUSION EBL demonstrated superior control of hemorrhoidal symptoms,lower prolapse recurrence,and better short-term bleeding outcomes compared with RPBL.Long-term bleeding control and tenesmus rates were comparable;however,numerical trends favored EBL.Despite a higher per-session cost,the reduced number of sessions made overall expenses similar.EBL appears to be a more effective,efficient,and well-tolerated minimally invasive option for treating symptomatic internal hemorrhoids.
基金supported by the National Key R&D Program of China(2020YFB2009002).
文摘Graphene,owing to its exceptional electronic,optical,thermal,and mechanical properties,has emerged as a highly promising material.Currently,the synthesis of large-area graphene films on metal substrates via chemical vapor deposition remains the predominant approach for producing high-quality graphene.To realize the potential applications of graphene,it is essential to transfer graphene films to target substrates in a manner that is non-destructive,clean,and efficient,as this significantly affects the performance of graphene devices.This review examines the current methods for graphene transfer from three perspectives:non-destructive transfer,clean transfer,and high-efficiency transfer.It analyzes and compares the advancements and limitations of various transfer techniques.Finally,the review identifies the key challenges faced by current graphene transfer methods and anticipates future developmental prospects.
文摘For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.
基金supported by the National Natural Science Foundation of China(81803547)the Natural Science Foundation of Fujian Province,China(2021J01204)Fujian Provincial Regional Development Project(2021N3005)。
文摘Most Aloe species are used as new food or functional food ingredient.Even though widely known for its health benefits,the anti-inflammatory effects and underlying mechanisms of Aloin(Alo),an anthraquinone compound isolated from plant species of the genus Aloe,remain unidentified.Here,we investigated the protective effects of Alo against cecal ligation and puncture(CLP)-induced sepsis and microflora in mice.Alo significantly improved CLP-induced sepsis and the survival rate of septic mice,downregulated the expression of proinflammatory factors,and decreased the infiltration of inflammatory cells in tissues.Alo upregulated the proportion of peritoneal macrophages,reduced the number of peritoneal bacteria,decreased the content of short-chain fatty acids and bile acids in the abdominal cavity,and suppressed Toll-like receptor(TLR)-2/4/nuclear factor kappa-B(NF-κB)/NOD-like receptor thermal protein domain associated protein 3(NLRP3)/Caspase-1/3/8 signaling.Furthermore,Alo altered the composition of the microbiome and promoted the growth of Lactobacillus,which showed a stronger anti-inflammatory effect.Whole-genome analysis identified the genes Saa3,Il10,Fpr1,and Eif4a1 associated with the protective effects of Alo in mice with CLP-induced sepsis.Overall,our results provide novel insights into the therapeutic potential and mechanism of action of Alo in the treatment of sepsis.
文摘Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and perioperative risks have not been well established.The objective of this study is to compare the peri-and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.Methods A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database.Statistical analysis involved t test,chi-square test,and logistic regression analysis with the use of the random forest algorithm.The primary outcomes were perioperative and postoperative complications.Results Of the total cohort,45,307(91.6%)underwent laparoscopic salpingectomy,and 4138(8.4%)received laparoscopic tubal ligation.There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics,including age,BMI,minority status,and variations in past medical history.These demographic characteristics were controlled for in the multivariate regression analysis.Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation(OR=1.78,95%CI:1.46-2.20,p<0.001).Salpingectomy was associated with a greater risk of longer operation time(OR=2.03,95%CI:2.02-2.04,p<0.001),longer hospital stay(OR=5.26,95%CI:4.57-6.09,p<0.001),increased readmission(OR=3.15,95%CI:1.92-5.65,p<0.001),and increased unplanned reoperation(OR=2.42,95%CI:1.32-5.12,p=0.010).In addition,the occurrence rates of organ space surgical site infection(OR=2.68,95%CI:1.21-7.59,p=0.032)and sepsis(OR=3.93,95%CI:1.48-16.02,p=0.020)were significantly greater in the salpingectomy group than in the tubal ligation group.Conclusions Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception;however,salpingectomy is more likely to be associated with peri-and postoperative complications.These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.
文摘Through literature analysis and case study, the introduction history, variety selection (high bush, half high bush, low bush) and regional cultivation techniques of blueberry in China were summarized, and the practical effects of precision cultivation (water and fertilizer integration, wild planting) and under-forest economic model (forest-blueberry-fungus system, ecological tourism) were evaluated. It provided a technical reference for expanding the planting scale of blueberry and improving the fruit quality.
基金supported from the Natural Science Foundation Project of Shanghai(Nos.23ZR1425300 and 22ZR1426100)Experimental Technical Team Construction Project of Shanghai Education Commission(No.10110N230080)+1 种基金National Natural Science Foundation of China(No.22075183)Research and Innovation Project of Shanghai Municipal Education Commission(No.2023ZKZD54).
文摘The addition of cold flow improvers(CFIs)is considered as the optimum strategy to improve the cold flow properties(CFPs)of diesel fuels,but this strategy is always limited by the required large dosage.To obtain low-dosage and high-efficiency CFIs for diesel,1,2,3,6-tetrahydrophthalic anhydride(THPA)was introduced as a third and polar monomer to enhance the depressive effects of alkyl methacrylatetrans anethole copolymers(C_(14)MC-TA).The terpolymers of alkyl methacrylate-trans anethole-1,2,3,6-tetrahydrophthalic anhydride(C_(14)MC-TA-THPA)were synthesized and compared with the binary copolymers of C_(14)MC-TA and alkyl methacrylate-1,2,3,6-tetrahydrophthalic anhydride(C_(14)MC-THPA).Results showed that C_(14)MC-THPA achieved the best depressive effects on the cold filter plugging point(CFPP)and solid point(SP)by 11℃and 16℃at a dosage of 1250 mg/L and monomer ratio of 6:1,while 1500mg/L C_(14)MC-TA(1:1)reached the optimal depressive effects on the CFPP and SP by 12℃and 18℃.THPA introduction significantly improved the depressive effects of C_(14)MC-TA.Lower dosages of C_(14)MCTA-THPA in diesel exerted better improvement effects on the CFPP and SP than that of C_(14)MC-TA and C_(14)MC-THPA.When the monomer ratio and dosage were 6:0.6:0.4 and 1000 mg/L,the improvement effect of C_(14)MC-TA-THPA on diesel reached the optimum level,and the CFPP and SP were reduced by 13℃and 19℃,respectively.A 3D nonlinear surface diagram fitted by a mathematical model was also used for the first time to better understand the relationships of monomer ratios,dosages,and depressive effects of CFIs in diesel.Surface analysis results showed that C_(14)MC-TA-THPA achieved the optimum depressive effects at a monomer ratio of 6:0.66:0.34 and dosage of 1000 mg/L,and the CFPP and SP decreased by 14℃ and 19℃,respectively.The predicted results were consistent with the actual ones.Additionally,the improvement mechanism of these copolymers in diesel was also explored.
文摘BACKGROUND In hemorrhoidal disease,despite the existence of numerous treatment options to alleviate symptoms,surgical intervention continues to be the gold standard.The advantages and disadvantages of many methods have been shown in numerous studies However,only a few studies have compared the effectiveness of combined methods.AIM To compare the results of a coloproctology clinic that switched to the Doppler-guided hemorrhoidal artery ligation(DG-HAL)+Ferguson hemorrhoidectomy(FH)technique from the FH in the treatment of hemorrhoidal disease.METHODS In this retrospective cohort,data from a total of 45 patients who underwent DG-HAL+FH(n=24)and FH(n=21)for grade III hemorrhoidal disease between 2020 and 2022 were analyzed.Demographic and clinical data,surgical duration,intraoperative blood loss,hospital stay,postoperative analgesic consumption,pain scores using the Visual Analog Scale(VAS),complications,time to return to normal activities,and the recurrence rate were compared in both groups.RESULTS The study included 45 patients,with 75.6%(n=34)male and 24.4%(n=11)female.The rate of intraoperative blood loss was higher in the FH group(P<0.05).The VAS scores and postoperative complication rates were similar in both groups.The need for postoperative analgesics was lower in the DG-HAL+FH group(2 vs 4 days,P<0.05),while the FH group showed a shorter time to return to normal activities(9.5 vs 6.0 days,P=0.02).The recurrence rate(16.7%vs 0%)and Clavien–Dindo Score-1 complications(20.8%vs 9.5%,P=0.29)were higher in the DG-HAL+FH group but were insignificant.CONCLUSION Our study revealed that the addition of the DG-HAL to classical hemorrhoidectomy caused less intraoperative bleeding and a lower postoperative analgesia requirement.
基金Supported by Scientific Research Fund of China-Japan Friendship Hospital,No.2019-1-QN-53.
文摘BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.
文摘The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results,showing less pain,quicker healing,and lower risk of anal stenosis.TILL reduces tissue tension and controls blood supply,allowing effective removal of diseased tissue while maintaining anal function and structure.However,the study's limitations,including its retrospective,single-center design,small sample size,and short follow-up,restrict the findings'generalizability and ability to assess long-term outcomes like recurrence.Larger,multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.
文摘BACKGROUND Cirrhosis-related upper gastrointestinal bleeding(UGIB)poses a fatal risk,and endoscopic ligation as a sole intervention shows inadequate effectiveness.AIM To evaluate the therapeutic efficacy of endoscopic variceal ligation(EVL)plus pro-pranolol vs EVL monotherapy in patients with cirrhosis complicated with acute UGIB and identify predictors for clinical outcomes.METHODS This study enrolled 99 consecutive patients with cirrhosis presenting with acute UGIB between January 2024 and January 2025.Participants were allocated to either the control group(n=49)receiving EVL alone or(2)the research group(n=50)receiving EVL plus propranolol.Primary outcomes included treatment efficacy,venous blood flow[portal venous flow(PVF)/splenic venous flow(SVF)],and postoperative outcomes(hemostasis time,length of hospital stay,and rebleeding rates).Univariate and multivariate regression analyses were conducted to determine independent predictors of treatment response.RESULTS Compared with the control group,the research group demonstrated significantly better outcomes,including higher overall treatment efficacy,greater reductions in PVF and SVF,shorter hemostasis time and hospital stay,and lower rebleeding rates.Univariate analysis demonstrated significant associations between treatment efficacy and age,cirrhosis duration,Child-Pugh grade,bleeding duration,and treatment approach in patients with cirrhosis complicated with acute UGIB.Multivariate logistic regression identified three independent risk factors for poor outcomes,namely,advanced age(>55 years),prolonged cirrhosis duration(≥4 years),and delayed bleeding intervention(>24 hours).CONCLUSION The EVL plus propranolol regimen demonstrates significant efficacy in treating UGIB in cirrhosis,outperforming EVL alone in improving hemodynamics(PVF/SVF),shortening hemostasis and hospitalization duration,and reducing rebleeding rates.Moreover,advanced age,prolonged disease duration,and longer bleeding times are independent risk factors for poor therapeutic outcomes.
基金Supported by the Startup Fund for Scientific Research,Fujian Medical University,No.2021QH1262.
文摘BACKGROUND Routinely separating the ligamentum teres uteri(LTU)intraoperatively remains an unresolved issue for female children undergoing surgery for indirect inguinal hernia(IIH).AIM To identify the effect of LTU preservation in laparoscopic high hernia sac ligation(LHSL)in children with IIH.METHODS The participants were 100 female children with unilateral IIH admitted from April 2022 to January 2024 to the Pediatric Surgery Department of Zhangzhou Municipal Hospital of Fujian Province.They were categorized based on LTU retention into the control group(n=45 cases),which underwent LTU ligation intraoperatively,and the experimental group(55 cases),which had the LTU preserved intraoperatively.All children underwent LHSL.RESULTS This study comparatively analyzed the operation time,hospitalization time,blood loss,postoperative recurrence rate,and complications(repeated pain in the inguinal region,foreign body sensation in the inguinal region,bloody exudation at the inguinal incision,and incision infection),which were all comparable between the two groups.CONCLUSION The above results indicate that LTU preservation during LHSL exerts certain therapeutic benefits for children with IIH.LTU preservation does not increase hospitalization time,blood loss,postoperative recurrence rate,and complications,which is safe and feasible,compared with conventional LTU ligation.LHSL with LTU preservation should be performed if conditions permit,which is worth popularizing.
文摘BACKGROUND Endoscopic variceal band ligation(EVBL)represents a pivotal treatment in the prophylaxis of esophageal varices bleeding in patients with cirrhosis,but in some cases a single session of EVBL is unable to eradicate esophageal varices completely,and a control endoscopy after 2-4 weeks is required to assess eradication and/or the need for another band ligation.Liver stiffness measurement(LSM)is being increasingly used as a screening non-invasive tool to predict varices according to Baveno VII criteria.However,to date,there are no instruments able to non-invasively predict the outcome of EVBL.AIM To identify non-invasive predictors of varices eradication(VE)after EVBL through multiparametric ultrasound(US).Secondary aim was to develop a prediction model of successful variceal eradication based on non-invasive parameters.METHODS We prospectively enrolled consecutive cirrhotic patients intolerant or with contraindications to beta-blockers undergoing EVBL for bleeding prophylaxis.Patients underwent multiparametric US with LSM,spleen stiffness measurement(SSM)and dynamic contrastenhanced US(DCE-US)on liver parenchyma and portal vein,at baseline(T0)and one month(T1)after EVBL.Each US parameter and their variations from baseline were correlated with VE evaluated by control endoscopy performed at T1.RESULTS We enrolled 41 patients(median age 64 years,75.6%males).At T128 patients(68.3%)reached VE,whereas 13(31.7%)required a second EVBL.Patients who achieved VE showed a significant decrease in SSM(P=0.018),and a significant increase in peak enhancement,area under the curve and wash-in rate of both liver parenchyma and portal vein after treatment(P<0.001).Statistically significant differences between the two groups of patients were incorporated in a multivariate analysis and used to develop three prediction models.CONCLUSION A multimodal US approach based on DCE-US parameters,LSM and SSM might become a reliable predictor of VE and a useful non-invasive alternative to endoscopy.
文摘BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patients with linear and punctate subtypes,with a newer trend of utilization of endoscopic band ligation(EBL).This study evaluates the outcomes of patients undergoing treatment for nodular GAVE.We hypothesize that patients treated initially with EBL will achieve higher rates of clinical remission with fewer endoscopic treatments and a shorter treatment interval.AIM To investigate the effects of EBL as an initial treatment therapy on outcomes associated with nodular GAVE.METHODS A total of 37 patients at a tertiary medical center with nodular GAVE were included in this retrospective study.The study population was divided between those treated initially with EBL(initial EBL)and initial endoscopic thermal therapy.Pretreatment and post-treatment hemoglobin values,the model for end-stage liver disease scores,hospitalization rates,and other outcomes.Additionally,endoscopic treatment modality type and frequency were recorded,including radiofrequency ablation,argon plasma coagulation,and EBL.Continuous variables were compared using a t-test,while categorical variables were compared using Fisher’s exact.RESULTS Linear regression analysis displayed a positive relationship between the time interval from initial therapeutic esophagogastroduodenoscopy to first EBL treatment and overall treatment interval(t=7.39,P<0.001),as well as between the number of endoscopic treatments(t=8.09,P<0.001).Hemoglobin levels increased in both the initial EBL group(8.7 vs 11.4,P<0.001)and the initial endoscopic thermal therapy group(8.6 vs 10.4,P=0.042).Clinical remission rates were higher in the initial EBL group(90%vs 69%P=0.041),with a non-significant trend of higher endoscopic remission rates(57.1%vs 37.5%,P=0.270).CONCLUSION The observed trend favoring EBL,combined with its association with improved clinical remission and reduced treatment burden,supports its consideration as a preferred initial treatment approach.
基金Supported by Natural Science Foundation of Guangdong Province of China,No.2024A1515012862.
文摘BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a procedure used for patients with initially unresectable colorectal liver metastases(CRLM).However,the procedure has been reported to be associated with high morbidity and mortality.Laparoscopic ALPPS has recently been reported as a minimally invasive technique that reduces perioperative risks.AIM To assess the safety and feasibility of full laparoscopic ALPPS in patients with CRLM.METHODS A retrospective analysis was conducted on all consecutive patients with CRLM who underwent full laparoscopic ALPPS at the Sixth Affiliated Hospital of Sun Yat-sen University between March 2021 and July 2024.RESULTS Fifteen patients were included,13 with synchronous liver metastases.Nine patients had more than five liver tumors,with the highest count being 22.The median diameter of the largest lesion was 2.8 cm on preoperative imaging.No extrahepatic metastases were observed.RAS mutations were detected in nine patients,and 14 underwent preoperative chemotherapy.The median increase in future liver remnant volume during the interstage interval was 47.0%.All patients underwent R0 resection.Overall complication rates were 13.3%(stage 1)and 53.3%(stage 2),while major complication rates(Clavien-Dindo≥IIIa)were 13.3%(stage 1)and 33.3%(stage 2).No mortality occurred in either stage.The median hospital stay after stage 2 was 10 days.CONCLUSION Full laparoscopic ALPPS for CRLM is safe and feasible,with the potential for reduced morbidity and mortality,offering radical resection opportunities for patients with initially unresectable CRLM.
基金supported by the grants from National Natural Science Foundation of China(No. 30600173,81070893)the Key Project of China Ministry of Education(No. 109003)+1 种基金the National Basic Research Development Program(973 Program) of China (No.2007CB512501)Beijing Municipal Commission of Education "Special Grants for Outstanding Ph.D Program Tutors"
文摘Objective The present study aimed to investigate the electrophysiological properties of wide dynamic range （WDR） neurons in spinal dorsal horn of rats with neuropathic pain induced by lumber 5 （L5） spinal nerve ligation （SNL） in a large size of samples.Methods Adult Sprague-Dawley rats were divided into normal and SNL groups.Electrophysiological technique was used to record the characteristics of WDR neurons in the spinal dorsal horn.Results Compared with the WDR neurons in normal rats,the WDR neurons in SNL rats showed an increase in excitability,manifested by an enlargement of the receptive field size,an increase in the proportion of neurons that exhibited spontaneous activities,decreases in the Cresponse threshold and latency,and an increase in the C-response duration.In addition,the numbers of A-and C-fiberevoked discharges were smaller in SNL rats than in normal rats.Conclusion The excitability of spinal WDR neurons increased in rats with neuropathic pain induced by L5 SNL.The increase in excitability of WDR neurons may contribute to the development of neuropathic pain.
基金Supported by the China Agriculture Research System(CARS-09)the Technological Innovation and Industrialization Project for the Rural Area of Nantong City,Jiangsu Province(H12014012)~~
文摘The high-efficiency planting mode for five crops a year of fresh edible ＂faba bean/spring maize＋soybean-autumn maize/autumn soybean＂ was introduced, and its yield and economic benefits were compared with the planting mode of three crops a year of ＂faba bean-spring maize/red bean＂. The results showed that the planting method for fresh edible ＂faba bean/spring maize＋soybean-autumn maize/autumn soybean＂ was much easier to operate with the input-output ratio of about185.6%, and its yield and economic benefits were 2.09 and 1.83 times of that of the planting mode for three crops a year, significantly improving the agricultural yield and income of farmers. In addition, the cropping index of the planting mode for fresh edible fresh edible ＂faba bean/spring maize ＋soybean-autumn maize/autumn soybean＂ reached up to 350%, and planting faba bean once a year and soybean twice a year could make the biological fixation amount of nitrogen increase 350-450kg/m^2, which equaled to up to 700 kg/m^2 of urea, showing significant ecological and social benefits. Based on the comparison results, the high-yield culture techniques of the planting mode of fresh edible ＂faba bean/spring maize＋soybean-autumn maize/autumn soybean＂ were summarized.
文摘Rubber band ligation is one of the most important, costeffective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vasovagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier's gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis.
文摘Broadly,complex fistulas are those that are not low transsphincteric or intersphincteric. The objectives of surgical management are to achieve fistula healing,prevent recurrences and maintain continence. The risk of incontinence associated with treatment ranges from10% to 57%. The objective of this manuscript is to review the current literature to date on the ligation of the intersphincteric fistula tract procedure(LIFT procedure) as a treatment option in these types of fistula.A search was conducted in Medline,PUBMED,EMBASE and ISI Web of Knowledge,and studies published from January 2009 to May 2013 were included. The primary outcomes were fistula healing rates,mean healing time and patient satisfaction with this surgical technique.Eighteen studies were included in this review. The total number of patients included was 592(65% male).The median age reported was 42.8 years. The most common type of fistula included was transsphincteric(73.3% of cases). The mean healing rate reported was74.6%. The risk factors for failure discovered were obesity,smoking,multiple previous surgeries and the length of the fistula tract. The mean healing time was5.5 wk,and the mean follow-up period was 42.3 wk.The patient satisfaction rates ranged from 72% to 100%. No de novo incontinence developed secondary to the LIFT procedure. There is not enough evidence that variants in the surgical technique achieve better outcomes(Bio-LIFT,LIFT-Plug,LIFT-Plus). This review indicates that the LIFT procedure is primarily effective for transsphincteric fistulas with an overall fistula closure of 74.6% and has a low impact on fecal continence. This procedure produces better outcomes at the first surgical attempt.
