The Academy of Aerospace Liquid Propulsion Technology (AALPT) successfully completed the long-duration captive firing test of a new generation of 120-ton thrust liquid oxygen/kerosene rocket engine. The engine had bee...The Academy of Aerospace Liquid Propulsion Technology (AALPT) successfully completed the long-duration captive firing test of a new generation of 120-ton thrust liquid oxygen/kerosene rocket engine. The engine had been stored for three years展开更多
BACKGROUND Mixed adenoneuroendocrine carcinoma(MANEC)is a rare malignancy that can be effectively treated with surgery in its early stages.However,there is currently no established treatment protocol for metastatic ca...BACKGROUND Mixed adenoneuroendocrine carcinoma(MANEC)is a rare malignancy that can be effectively treated with surgery in its early stages.However,there is currently no established treatment protocol for metastatic cases.CASE SUMMARY We present a case of a patient diagnosed with liver metastasis(LM)from ascending colon MANEC.The patient is a 40-year-old male who was diagnosed to have ascending colon MANEC with LM in March 2014.Following surgical resection of both the primary tumor and the LM,the patient received first-line chemotherapy with the mFOLFOX6 regimen.After six months of the initial treatment,the patient experienced multiple recurrences of LM.These LM were successfully treated by a multidisciplinary approach including chemotherapy,surgical resection,and radiofrequency ablation(RFA).Remarkably,in June 2017,the patient achieved a complete response,which has been maintained to date,resulting in overall long-term survival of ten years.Advanced colorectal MANEC is often associated with LM,and multiple intrahepatic recurrences may be characteristic of this disease.CONCLUSION The use of local treatment modalities,such as surgery and RFA,in conjunction with chemotherapy,has demonstrated promising efficacy and warrants further investigation.展开更多
BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(A...BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.展开更多
The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue ...The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue disorders.There are several classifications for BAV,each with its advantages and drawbacks.The condition can lead to valvular malfunction such as regurgitation and stenosis,but is often associated with dilatation of the aortic root,the ascending aorta,the aortic arch,or a combination.Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development.Published surgical series are usually small and research designs vary,which makes the formulation of universal recommendations for treatment difficult.This narrative review provides data from the most recent series in this respect.Often,the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve.The timing of surgery of the valve depends on the degree of its dysfunction.Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age.The options for valve repair are summarized,including the need for the use as the effective geometric height.The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention.In those cases,a valve replacement should be preferred.If a dilatation of the ascending aorta or the aortic root is present,this should also be addressed surgically,but the threshold for such a procedure varies.Several techniques are available to treat a dilated ascending aorta and root.For the latter,remodeling and reimplantation can be applied.Depending on the patient’s characteristics,the size of the dilatation,and the affected part,the most appropriate technique should be selected.This requires surgical expertise,which can only be obtained in high-volume centers.展开更多
To the Editor:Acute cholangitis,also known as ascending cholangitis,is a po-tentially life-threatening condition resulting from the infection and obstruction of the biliary tract[1].Choledocholithiasis,which in-volves...To the Editor:Acute cholangitis,also known as ascending cholangitis,is a po-tentially life-threatening condition resulting from the infection and obstruction of the biliary tract[1].Choledocholithiasis,which in-volves stones in the common bile duct,is the most frequent cause of such infections,leading to partial or complete blockage of the biliary system[2].During acute episodes,patients may present with abdominal pain,high fever,and jaundice,known as Charcot’s triad,and in severe cases,patients may also exhibit signs of shock and depression[3].An episode of cholangitis can be fatal,and if the underlying obstruction is not addressed,the condition may recur,potentially leading to hepatic abscesses or biliary cirrhosis.Other etiologies of cholangitis include benign biliary strictures,bil-iary malignancies,congenital factors,postoperative complications,inflammatory conditions,and rare causes such as pancreatitis,par-asitic invasion of the biliary tract,external compression,thrombo-sis,and iatrogenic factors.Acute cholecystitis due to the migration of Hem-o-lok clips postoperation is rare.Herein we reported a case of acute cholangitis caused by the migration of surgical Hem-o-lok clips into the bile duct six years after laparoscopic left hemihepa-tectomy.展开更多
Objective To search for effective methods of acupuncture therapy in treating chronic diarrhea. Methods Treatments were carried out on 52 patients with chronic diarrhea by using the left ascending and right descending ...Objective To search for effective methods of acupuncture therapy in treating chronic diarrhea. Methods Treatments were carried out on 52 patients with chronic diarrhea by using the left ascending and right descending method. Three acupoints at the left side, namely Xiàng （陷谷 ST 43）, Zúsānl （足三 里 ST 36） and Qūchí （曲池 LI 11）, and Lièqūe （列缺 LU 7） at the right side were selected, moxibustion was also carried out according to syndrome differentiation. The operation of left ascending and right descending method were firstly left and then right, first down and then up, firstly four limbs and then abdomen; the thumb moved backward and the index finger moved forward during needle twisting for the acupoints at the left side, and it was on the contrary for the right side. The needles were retained for 1 h for deficiency, and the pinholes were pressed when the needles were withdrawn; the needles were retained for 0.5 h for excess syndrome and newly-contracted disease, and the pinholes were enlarged by shaking the needles when they were withdrawn. Except that the needling was carried out twice a day for the patients with desertion following chronic diarrhea, the needling was carried out once a day, five days as a treatment course, the patients were given an interval for two days after every two treatment courses, and the therapeutic effect was observed after five treatment courses. Results totally 36 patients were cured, among which 11 patients were cured after one treatment course, 19 patients were cured after two to three treatment courses and 6 patients were cured after four to five treatment courses; eight patients were improved; six patients were not cured; the total effective rate was 88.0%. Conclusion the acupuncture with left ascending and right descending method has satisfactory therapeutic effect in treating chronic diarrhea.展开更多
AIM To systematically review safety/efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography(ERCP) performed during pregnancy, considering fetal viability, fetal teratogenicity, premature delivery, and f...AIM To systematically review safety/efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography(ERCP) performed during pregnancy, considering fetal viability, fetal teratogenicity, premature delivery, and future postpartum development of the infant.METHODS Systematic computerized literature search performed using PubMed with the key words "ERCP" and "pregnancy". Two clinicians independently reviewed the literature, and decided on which articles to incorporate in this review based on consensus and preassigned priorities. Large clinical trials, meta-analyses, systematic reviews, and controlled trials were assigned higher priority than review articles or small clinical series, and individual case reports were assigned lowest priority. Dr. Cappell has formal training and considerable experience in conducting systematic reviews, with 4 published systematic reviews in peer-reviewed journals indexed in PubM ed during the last 2 years, and with a PhD in neurophysiology that involved 5 years of training and research in biomedical statistics.RESULTS Advances in imaging modalities, including abdominal ultrasound, MRCP, and endoscopic ultrasound, have generally obviated the need for diagnostic ERCP in nonpregnant and pregnant patients. Clinical experience with performing ERCP during pregnancy is burgeoning, with > 500 cases of therapeutic ERCP reported in the literature, aside from a national registry study of 58 patients. These studies show that therapeutic ERCP has a very high rate of technical success in clearing the bile duct of gallstones, and has a relatively low and acceptable rate of maternal and fetal complications. The great majority of births after therapeutic ERCP are full-term, have normal birth weights, and are healthy. A recent trend is performing ERCP without radiation to eliminate radiation teratogenicity. Systematic literature review reveals 147 cases of ERCP without fluoroscopy in 8 clinical series. These studies demonstrate extremely high technical success in endoscopically removing choledocholithiasis, favorable maternal outcomes with rare maternal ERCP complications, and excellent fetal outcomes. ERCP without fluoroscopy generally confirms proper biliary cannulation by aspiration of yellow bile per sphincterotome or leakage of yellow bile around an inserted guide-wire.CONCLUSION This systematic literature review reveals ERCP is relatively safe and efficacious during pregnancy, with relatively favorable maternal and fetal outcomes after ERCP. Recommendations are provided about ERCP indications, special ERCP techniques during pregnancy, and prospects for future research.展开更多
Elucidation of critical brain areas or structures that are responsible for recovery of impaired consciousness in patients with disorders of consciousness is important because it can provide information that is useful ...Elucidation of critical brain areas or structures that are responsible for recovery of impaired consciousness in patients with disorders of consciousness is important because it can provide information that is useful when developing therapeutic strategies for neurorehabilitation or neurointervention in patients with disorders of consciousness.In this review,studies that have demonstrated brain changes during recovery of impaired consciousness were reviewed.These studies used positron emission tomography,electroencephalography/transcranial magnetic stimulation,diffusion tensor tractography,and diffusion tensor tractography/electroencephalography.The majority of these studies reported on the importance of supratentorial areas or structures in the recovery of impaired consciousness.The important brain areas or structures that were identified were the prefrontal cortex,basal forebrain,anterior cingulate cortex,and parietal cortex.These results have a clinically important implication that these brain areas or structures can be target areas for neurorehabilitation or neurointervention in patients with disorders of consciousness.However,most of studies were case reports;therefore,further original studies involving larger numbers of patients with disorders of consciousness are warranted.In addition,more detailed information on the brain areas or structures that are relevant to the recovery of impaired consciousness is needed.展开更多
A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia.An esophagogastroduodenoscopy did not demonstrate any bleeding source,and a colonoscopy showed a massiv...A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia.An esophagogastroduodenoscopy did not demonstrate any bleeding source,and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus.The source of the bleeding could not be found with a mesenteric artery angiography.We performed an enhanced abdominal computed tomography,which revealed a distal ascending colonic varix,and assumed that the varix was the source of the bleeding.We performed a venous coil embolization and histoacryl injection to obliterate the colon varix.The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed.We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization.展开更多
In this paper, a Ritt-Wu＇s characteristic set method for ordinary difference systems is proposed, which is valid for any admissible ordering. New definition for irreducible chains and new zero decomposition algorithm...In this paper, a Ritt-Wu＇s characteristic set method for ordinary difference systems is proposed, which is valid for any admissible ordering. New definition for irreducible chains and new zero decomposition algorithms are also proposed.展开更多
BACKGROUND Colorectal cancer is a common malignant tumor of the digestive tract.The relationship between sentinel polyps(rectal polyps with proximal colon cancer)and proximal colon cancer has received extensive attent...BACKGROUND Colorectal cancer is a common malignant tumor of the digestive tract.The relationship between sentinel polyps(rectal polyps with proximal colon cancer)and proximal colon cancer has received extensive attention in recent years.However,there is still no clear conclusion regarding the relationship.AIM To investigate the clinical characteristics of sentinel polyps and their correlation with proximal colon cancer.METHODS A retrospective analysis of 2587 patients with rectal polyps from January 2006 to December 2017 was performed.According to whether or not proximal colon cancer was diagnosed,the patients were divided into either a sentinel polyp group(192 patients)or a pure rectal polyp group(2395 patients).The endoscopic features,clinicopathological features,therapeutic effects,and short-term prognosis were analyzed and compared between the two groups.RESULTS The mean age of patients in the sentinel polyp group was generally higher than that of the pure rectal polyp group,and the positivity rates of anemia,stool occult blood,and tumor markers of the sentinel polyp group were also significantly higher than those in the rectal polyp group(χ^2=90.56,P<0.01;χ^2=70.30,P<0.01;χ^2=92.80,P<0.01).The majority of the patients in the sentinel polyp group had multiple polyps,large polyps,adenomatous polyps,or sessile polyps(χ^2=195.96,P<0.01;χ^2=460.46,P<0.01;χ^2=94.69,P<0.01;χ^2=48.01,P<0.01).Most of the proximal colon cancers were Duke’s A and B stages in the sentinel polyp group.In the pure rectal polyp group,2203 patients underwent endoscopic treatment,and all of the patients were cured and discharged.In the sentinel polyp group,65 patients underwent radical operation,and 61 patients received endoscopic submucosal dissection or endoscopic mucosal resection.Additionally,21 patients were lost to follow-up after 6-12 mo,and the loss rate was 10.94%.A total of 63.16%of patients experienced remission without tumor recurrence or metastasis,33.33%of patients experienced tumors regression or improved symptoms,and the other 3.51%of the patients died.CONCLUSION If there are multiple,sessile,and adenomatous rectal polyps with a maximum diameter>1 cm,the possibility of the carcinogenesis of the polyps or of the proximal colon should be monitored closely.These patients should be followed in the short-term and should undergo a whole-colon examination.展开更多
This paper presents a comprehensive simulation for a high-altitude dual-balloon system which consists of zero-and super-pressure balloons. Preliminary calculations were established to describe the basic concept of the...This paper presents a comprehensive simulation for a high-altitude dual-balloon system which consists of zero-and super-pressure balloons. Preliminary calculations were established to describe the basic concept of the new integrated system. A mathematical model was investigated to simulate the ascending and floating processes which considered the atmospheric conditions and thermodynamic variations. Based on the simulation, results showed that the floating altitude stability between daytime and nighttime was improved. This integrated system supports higher floating altitude levels than those of ordinary balloons and extends the lifetime of floating balloon systems. Moreover, results demonstrated that the integrated system was lighter than ordinary balloons, saving useful weight for effective payload. Furthermore, exploiting the advantages of both kinds of balloons while avoiding the difficulties was a significant goal in the current design to promote the floating performance of high-altitude balloons technology.展开更多
Acute cholangitis is bacterial infection of the extrahepatic biliary system. As it is caused by gallstones blocking the common bile duct in most of the cases, its prevalence is greater in ethnicities with high prevale...Acute cholangitis is bacterial infection of the extrahepatic biliary system. As it is caused by gallstones blocking the common bile duct in most of the cases, its prevalence is greater in ethnicities with high prevalence of gallstones. Biliary obstruction of any cause is the main predisposing factor. Diagnosis is established by the presence of clinical features, laboratory results and imaging studies. The treatment modalities include administration of intravenous fluid, antibiotics, and drainage of the bile duct. The outcome is good if the treatment is started early, otherwise it could be grave.展开更多
文摘The Academy of Aerospace Liquid Propulsion Technology (AALPT) successfully completed the long-duration captive firing test of a new generation of 120-ton thrust liquid oxygen/kerosene rocket engine. The engine had been stored for three years
文摘BACKGROUND Mixed adenoneuroendocrine carcinoma(MANEC)is a rare malignancy that can be effectively treated with surgery in its early stages.However,there is currently no established treatment protocol for metastatic cases.CASE SUMMARY We present a case of a patient diagnosed with liver metastasis(LM)from ascending colon MANEC.The patient is a 40-year-old male who was diagnosed to have ascending colon MANEC with LM in March 2014.Following surgical resection of both the primary tumor and the LM,the patient received first-line chemotherapy with the mFOLFOX6 regimen.After six months of the initial treatment,the patient experienced multiple recurrences of LM.These LM were successfully treated by a multidisciplinary approach including chemotherapy,surgical resection,and radiofrequency ablation(RFA).Remarkably,in June 2017,the patient achieved a complete response,which has been maintained to date,resulting in overall long-term survival of ten years.Advanced colorectal MANEC is often associated with LM,and multiple intrahepatic recurrences may be characteristic of this disease.CONCLUSION The use of local treatment modalities,such as surgery and RFA,in conjunction with chemotherapy,has demonstrated promising efficacy and warrants further investigation.
基金Supported by Hamad Medical Corporation,No.MRC-01-18-073.
文摘BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.
文摘The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue disorders.There are several classifications for BAV,each with its advantages and drawbacks.The condition can lead to valvular malfunction such as regurgitation and stenosis,but is often associated with dilatation of the aortic root,the ascending aorta,the aortic arch,or a combination.Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development.Published surgical series are usually small and research designs vary,which makes the formulation of universal recommendations for treatment difficult.This narrative review provides data from the most recent series in this respect.Often,the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve.The timing of surgery of the valve depends on the degree of its dysfunction.Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age.The options for valve repair are summarized,including the need for the use as the effective geometric height.The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention.In those cases,a valve replacement should be preferred.If a dilatation of the ascending aorta or the aortic root is present,this should also be addressed surgically,but the threshold for such a procedure varies.Several techniques are available to treat a dilated ascending aorta and root.For the latter,remodeling and reimplantation can be applied.Depending on the patient’s characteristics,the size of the dilatation,and the affected part,the most appropriate technique should be selected.This requires surgical expertise,which can only be obtained in high-volume centers.
文摘To the Editor:Acute cholangitis,also known as ascending cholangitis,is a po-tentially life-threatening condition resulting from the infection and obstruction of the biliary tract[1].Choledocholithiasis,which in-volves stones in the common bile duct,is the most frequent cause of such infections,leading to partial or complete blockage of the biliary system[2].During acute episodes,patients may present with abdominal pain,high fever,and jaundice,known as Charcot’s triad,and in severe cases,patients may also exhibit signs of shock and depression[3].An episode of cholangitis can be fatal,and if the underlying obstruction is not addressed,the condition may recur,potentially leading to hepatic abscesses or biliary cirrhosis.Other etiologies of cholangitis include benign biliary strictures,bil-iary malignancies,congenital factors,postoperative complications,inflammatory conditions,and rare causes such as pancreatitis,par-asitic invasion of the biliary tract,external compression,thrombo-sis,and iatrogenic factors.Acute cholecystitis due to the migration of Hem-o-lok clips postoperation is rare.Herein we reported a case of acute cholangitis caused by the migration of surgical Hem-o-lok clips into the bile duct six years after laparoscopic left hemihepa-tectomy.
文摘Objective To search for effective methods of acupuncture therapy in treating chronic diarrhea. Methods Treatments were carried out on 52 patients with chronic diarrhea by using the left ascending and right descending method. Three acupoints at the left side, namely Xiàng （陷谷 ST 43）, Zúsānl （足三 里 ST 36） and Qūchí （曲池 LI 11）, and Lièqūe （列缺 LU 7） at the right side were selected, moxibustion was also carried out according to syndrome differentiation. The operation of left ascending and right descending method were firstly left and then right, first down and then up, firstly four limbs and then abdomen; the thumb moved backward and the index finger moved forward during needle twisting for the acupoints at the left side, and it was on the contrary for the right side. The needles were retained for 1 h for deficiency, and the pinholes were pressed when the needles were withdrawn; the needles were retained for 0.5 h for excess syndrome and newly-contracted disease, and the pinholes were enlarged by shaking the needles when they were withdrawn. Except that the needling was carried out twice a day for the patients with desertion following chronic diarrhea, the needling was carried out once a day, five days as a treatment course, the patients were given an interval for two days after every two treatment courses, and the therapeutic effect was observed after five treatment courses. Results totally 36 patients were cured, among which 11 patients were cured after one treatment course, 19 patients were cured after two to three treatment courses and 6 patients were cured after four to five treatment courses; eight patients were improved; six patients were not cured; the total effective rate was 88.0%. Conclusion the acupuncture with left ascending and right descending method has satisfactory therapeutic effect in treating chronic diarrhea.
文摘Key Facts Synonyms：Gonadal vein thrombosis.Definition：Rare complication usually associated with ascending postpartum ovarian vein thrombophlebitis.Incidence：1%-2%following cesarean section complicated by endometritis;less than 0.2% following vaginal delivery.
文摘AIM To systematically review safety/efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography(ERCP) performed during pregnancy, considering fetal viability, fetal teratogenicity, premature delivery, and future postpartum development of the infant.METHODS Systematic computerized literature search performed using PubMed with the key words "ERCP" and "pregnancy". Two clinicians independently reviewed the literature, and decided on which articles to incorporate in this review based on consensus and preassigned priorities. Large clinical trials, meta-analyses, systematic reviews, and controlled trials were assigned higher priority than review articles or small clinical series, and individual case reports were assigned lowest priority. Dr. Cappell has formal training and considerable experience in conducting systematic reviews, with 4 published systematic reviews in peer-reviewed journals indexed in PubM ed during the last 2 years, and with a PhD in neurophysiology that involved 5 years of training and research in biomedical statistics.RESULTS Advances in imaging modalities, including abdominal ultrasound, MRCP, and endoscopic ultrasound, have generally obviated the need for diagnostic ERCP in nonpregnant and pregnant patients. Clinical experience with performing ERCP during pregnancy is burgeoning, with > 500 cases of therapeutic ERCP reported in the literature, aside from a national registry study of 58 patients. These studies show that therapeutic ERCP has a very high rate of technical success in clearing the bile duct of gallstones, and has a relatively low and acceptable rate of maternal and fetal complications. The great majority of births after therapeutic ERCP are full-term, have normal birth weights, and are healthy. A recent trend is performing ERCP without radiation to eliminate radiation teratogenicity. Systematic literature review reveals 147 cases of ERCP without fluoroscopy in 8 clinical series. These studies demonstrate extremely high technical success in endoscopically removing choledocholithiasis, favorable maternal outcomes with rare maternal ERCP complications, and excellent fetal outcomes. ERCP without fluoroscopy generally confirms proper biliary cannulation by aspiration of yellow bile per sphincterotome or leakage of yellow bile around an inserted guide-wire.CONCLUSION This systematic literature review reveals ERCP is relatively safe and efficacious during pregnancy, with relatively favorable maternal and fetal outcomes after ERCP. Recommendations are provided about ERCP indications, special ERCP techniques during pregnancy, and prospects for future research.
基金supported by the National Research Foundation of Korea(NRF)grant funded by the Korean Government(MSIP)(No.2018R1A2B6000996to SHJ)
文摘Elucidation of critical brain areas or structures that are responsible for recovery of impaired consciousness in patients with disorders of consciousness is important because it can provide information that is useful when developing therapeutic strategies for neurorehabilitation or neurointervention in patients with disorders of consciousness.In this review,studies that have demonstrated brain changes during recovery of impaired consciousness were reviewed.These studies used positron emission tomography,electroencephalography/transcranial magnetic stimulation,diffusion tensor tractography,and diffusion tensor tractography/electroencephalography.The majority of these studies reported on the importance of supratentorial areas or structures in the recovery of impaired consciousness.The important brain areas or structures that were identified were the prefrontal cortex,basal forebrain,anterior cingulate cortex,and parietal cortex.These results have a clinically important implication that these brain areas or structures can be target areas for neurorehabilitation or neurointervention in patients with disorders of consciousness.However,most of studies were case reports;therefore,further original studies involving larger numbers of patients with disorders of consciousness are warranted.In addition,more detailed information on the brain areas or structures that are relevant to the recovery of impaired consciousness is needed.
文摘A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia.An esophagogastroduodenoscopy did not demonstrate any bleeding source,and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus.The source of the bleeding could not be found with a mesenteric artery angiography.We performed an enhanced abdominal computed tomography,which revealed a distal ascending colonic varix,and assumed that the varix was the source of the bleeding.We performed a venous coil embolization and histoacryl injection to obliterate the colon varix.The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed.We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization.
文摘In this paper, a Ritt-Wu＇s characteristic set method for ordinary difference systems is proposed, which is valid for any admissible ordering. New definition for irreducible chains and new zero decomposition algorithms are also proposed.
文摘BACKGROUND Colorectal cancer is a common malignant tumor of the digestive tract.The relationship between sentinel polyps(rectal polyps with proximal colon cancer)and proximal colon cancer has received extensive attention in recent years.However,there is still no clear conclusion regarding the relationship.AIM To investigate the clinical characteristics of sentinel polyps and their correlation with proximal colon cancer.METHODS A retrospective analysis of 2587 patients with rectal polyps from January 2006 to December 2017 was performed.According to whether or not proximal colon cancer was diagnosed,the patients were divided into either a sentinel polyp group(192 patients)or a pure rectal polyp group(2395 patients).The endoscopic features,clinicopathological features,therapeutic effects,and short-term prognosis were analyzed and compared between the two groups.RESULTS The mean age of patients in the sentinel polyp group was generally higher than that of the pure rectal polyp group,and the positivity rates of anemia,stool occult blood,and tumor markers of the sentinel polyp group were also significantly higher than those in the rectal polyp group(χ^2=90.56,P<0.01;χ^2=70.30,P<0.01;χ^2=92.80,P<0.01).The majority of the patients in the sentinel polyp group had multiple polyps,large polyps,adenomatous polyps,or sessile polyps(χ^2=195.96,P<0.01;χ^2=460.46,P<0.01;χ^2=94.69,P<0.01;χ^2=48.01,P<0.01).Most of the proximal colon cancers were Duke’s A and B stages in the sentinel polyp group.In the pure rectal polyp group,2203 patients underwent endoscopic treatment,and all of the patients were cured and discharged.In the sentinel polyp group,65 patients underwent radical operation,and 61 patients received endoscopic submucosal dissection or endoscopic mucosal resection.Additionally,21 patients were lost to follow-up after 6-12 mo,and the loss rate was 10.94%.A total of 63.16%of patients experienced remission without tumor recurrence or metastasis,33.33%of patients experienced tumors regression or improved symptoms,and the other 3.51%of the patients died.CONCLUSION If there are multiple,sessile,and adenomatous rectal polyps with a maximum diameter>1 cm,the possibility of the carcinogenesis of the polyps or of the proximal colon should be monitored closely.These patients should be followed in the short-term and should undergo a whole-colon examination.
文摘This paper presents a comprehensive simulation for a high-altitude dual-balloon system which consists of zero-and super-pressure balloons. Preliminary calculations were established to describe the basic concept of the new integrated system. A mathematical model was investigated to simulate the ascending and floating processes which considered the atmospheric conditions and thermodynamic variations. Based on the simulation, results showed that the floating altitude stability between daytime and nighttime was improved. This integrated system supports higher floating altitude levels than those of ordinary balloons and extends the lifetime of floating balloon systems. Moreover, results demonstrated that the integrated system was lighter than ordinary balloons, saving useful weight for effective payload. Furthermore, exploiting the advantages of both kinds of balloons while avoiding the difficulties was a significant goal in the current design to promote the floating performance of high-altitude balloons technology.
文摘Acute cholangitis is bacterial infection of the extrahepatic biliary system. As it is caused by gallstones blocking the common bile duct in most of the cases, its prevalence is greater in ethnicities with high prevalence of gallstones. Biliary obstruction of any cause is the main predisposing factor. Diagnosis is established by the presence of clinical features, laboratory results and imaging studies. The treatment modalities include administration of intravenous fluid, antibiotics, and drainage of the bile duct. The outcome is good if the treatment is started early, otherwise it could be grave.
