The benefits of regular physical activity are well known.Yet,few studies have examined the effectiveness of integrating physical activity(PA)into curricula within a post-secondary setting.To investigate the incorporat...The benefits of regular physical activity are well known.Yet,few studies have examined the effectiveness of integrating physical activity(PA)into curricula within a post-secondary setting.To investigate the incorporation of PA into medical curriculum,we developed a series of optional exercise-based review sessions designed to reinforce musculoskeletal(MSK)anatomy course material.These synchronous sessions were co-taught by a group fitness instructor and an anatomy instructor.The fitness instructor would lead students through both strength and yoga style exercises,while the anatomy instructor asked questions about relevant anatomical structures related to course material previously covered.After the sessions,participants were asked to evaluate the classes on their self-reported exam preparedness in improving MSK anatomy knowledge,PA levels,and mental wellbeing.Thirty participants completed surveys;a majority agreed that the classes increased understanding of MSK concepts(90.0%)and activity levels(97.7%).Many(70.0%)felt that the classes helped reduce stress.The majority of respondents(90.0%)agreed that the classes contributed to increased feelings of social connectedness.Overall,medical students saw benefit in PA based interventions to supplement MSK course concepts.Along with increasing activity levels and promoting health behaviours,integrating PA into medical curriculum may improve comprehension of learning material,alleviate stress and foster social connectivity among medical students.展开更多
Peanut is a major cash crop in the world. In recent years, peanut pod rot has become increasingly prevalent,resulting in significant yield and quality losses. Resistance breeding is considered a cost-effective approac...Peanut is a major cash crop in the world. In recent years, peanut pod rot has become increasingly prevalent,resulting in significant yield and quality losses. Resistance breeding is considered a cost-effective approach for managing pod rot. Previous research in the United States identified significant anatomical differences in leaves and shells among peanut cultivars with varying responses to pod rot caused by Pythium myriotylum Drechs. and Rhizoctonia solani Kuhn. However, whether similar anatomical features correlate with resistance to peanut pod rot in Laixi, Qingdao, remained unknown, where the primary causal pathogen for the disease was F. solani. In this study, nine peanut varieties with differing disease reactions to peanut pod rot were planted in the same plots.Paraffin sections of leaves and shells were prepared and stained to evaluate anatomical features, and the main agronomic traits were assessed alongside leaf spot disease ratings. All the four anatomical features, leaf palisade cell number, palisade cell width, index(palisade cell number per mm × cell width in μm), and shell lignin staining area, were measured before the onset of pod rot and were found to be negatively correlated with pod rot scores.Given the consistent and strong correlation of these anatomical features with pod rot resistance and their high heritability estimates, the pre-existing resistance could be identified even in the absence of the disease, which is particularly valuable for fields where pod rot may not occur every year. This study provided useful anatomical indicators for selecting resistance to peanut pod rot, predominantly caused by F. solani.展开更多
The first metatarsophalangeal(MTP)joint plays a crucial role in foot biomechanics,particularly in weight-bearing activities such as walking and running.It is frequently affected by conditions like hallux valgus(HV)and...The first metatarsophalangeal(MTP)joint plays a crucial role in foot biomechanics,particularly in weight-bearing activities such as walking and running.It is frequently affected by conditions like hallux valgus(HV)and hallux rigidus,with HV impacting approximately 23%-35% of the population.This narrative review explores the embryology,anatomy,and biomechanics of the first MTP joint(MTPJ),highlighting its significance in maintaining foot stability and function.A comprehensive literature search was conducted using PubMed,Scopus,and Google Scholar,analyzing 50 relevant studies,including 12 clinical trials.The joint’s complex structure and mechanical demands make it susceptible to degenerative and structural disorders.Studies indicate that 25%-40%of individuals with HV experience significant pain and functional impairment,affecting mobility and quality of life.Biomechanical stress,abnormal gait patterns,and joint instability contribute to disease progression.Understanding the anatomical and biomechanical properties of the first MTPJ is essential for improving diagnostic and therapeutic approaches.Emerging surgical techniques,such as osteotomy and joint resurfacing,show promise in reducing recurrence rates and enhancing longterm outcomes.Further research is needed to refine minimally invasive interventions and optimize treatment strategies for first MTPJ disorders.展开更多
Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,partic...Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,particularly nonobstructive azoospermia(NOA),which affects 10%–15%of infertile men,represents a significant challenge in male infertility.The advent of assisted reproductive technology(ART),specifically microdissection testicular sperm extraction(micro-TESE)followed by intracytoplasmic sperm injection(ICSI),offers a possibility for men with NOA to father biological children.Recent studies have focused on the predictors of sperm retrieval in NOA patients,such as age,testicular volume,and follicle-stimulating hormone(FSH)level.This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE,thereby enhancing understanding and improving outcomes for this challenging condition.展开更多
A morphology-based growth stage system should describe the growth and development of a crop and thereby help farmers and agronomists in formulating reasonable managementmeasures conducive to the development of marketa...A morphology-based growth stage system should describe the growth and development of a crop and thereby help farmers and agronomists in formulating reasonable managementmeasures conducive to the development of marketable products.However,existing growth stage systems for soybean are either based on plant growth or covered particular phases of flower or pod development,making it difficult to use for tracking the entire growth period of individual flowers and pods.Therefore,the first flower and pod,located at the base of the primary raceme in the eighth trifoliate node of the main stem,were chosen to illustrate growth dynamics during the full reproductive period.The size and fresh weight of the primary raceme in the eighth trifoliate leaf axil,the first flower and pod,the pistils in the first flower,and seeds in the first pod were examined,and the growth of these organs was depicted.Integrating the morphological characteristics and growth features of flowers and pods,as well as existing growth stage systems,the growth and development were delineated in 13 stages.In detail,we classified the flower phase based on the relative positions of floral components,inspired by the ratio of bract to flower used for staging,refined the lag phase proposed previously,retained the use of pod length to define the early pod phase,and innovatively described the late pod phase by the seed appearance.The developmental events in each stage of flower and pod were distinctive and closely connected to the corresponding morphology.Taken together,a more detailed growth stage system for describing individual flowers and pods in soybean was established.This system will serve as a valuable research tool for describing the development,gene expression,and cellular metabolism associated with the formation of flowers,pods,and seeds.展开更多
Glaucoma,a visual thief,is characterized by elevated intraocular pressure(IOP)and the loss of retinal ganglion cells(RGCs).Selecting suitable animals for preclinical models is of great significance in research on the ...Glaucoma,a visual thief,is characterized by elevated intraocular pressure(IOP)and the loss of retinal ganglion cells(RGCs).Selecting suitable animals for preclinical models is of great significance in research on the prevention,early screening,and effective treatments of glaucoma.Rabbit eyeballs possess similar vascularity and aqueous humor outflow pathways to those of humans.Thus,they are among the earliest in vivo models used in glaucoma research.Over the years,rabbit models have made substantial contributions to understanding glaucomatous pathophysiology,surgical adaptations,biomedical device development,and drug development for reducing IOP,protecting RGCs,and inhibiting fibrosis.Compared to other animals,rabbits fit better with surgical operations and cost less.This review summarizes the merits and demerits of different ways to produce glaucomatous rabbit models,such as intracameral injection,vortex vein obstruction,Trendelenburg position,laser photo-coagulation,glucocorticoid induction,limbal buckling induction,retinal ischemia–reperfusion models,and spontaneous models.We analyzed their mechanisms in the hope of providing more references for experimental design and promoting the understanding of glaucoma treatment strategies.展开更多
BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP ins...BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP instruments can be used.Therefore,MSE-ERCP appears to be the optimal solution for postsurgical patients,especially with Roux-en-Y anatomy.AIM To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.METHODS We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.RESULTS We identified 26 MSE-ERCPs:(1)18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation(n=11)or gastrectomy(n=2);and(2)Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass.Overall success of reaching the biliary entry was 88%and further interventions were successful in 83%of patients.In very long alimentary limb situations,success of reaching the biliary entry was not-significantly lower compared to“standard”Roux-en-Y(75%vs 94%,P=0.215).ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy(63%vs 93%,P=0.103).Mean intervention time was 105 minutes.Intervention times were longer in very long limb situations(133 minutes vs 91 minutes;P=0.032).Overall,we observed three adverse events(n=1 caused by enteroscopy,n=1 caused by the biliary intervention,n=1 unrelated to the procedure).In 15/26 cases(58%)MSE-ERCP was carried out on an outpatient basis.CONCLUSION MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions.However,MSE was recently withdrawn from the market due to severe safety concerns,which were not observed in this study.展开更多
BACKGROUND Gastric cancer(GC)is one of the most common malignancies and types of cancer worldwide.AIM To compare the differences in tumor markers of GC with GC dissection,we evaluated the efficacy of recent tumor remo...BACKGROUND Gastric cancer(GC)is one of the most common malignancies and types of cancer worldwide.AIM To compare the differences in tumor markers of GC with GC dissection,we evaluated the efficacy of recent tumor removal.METHODS A prospective cohort study was conducted to analyze the clinical data of patients with GC.Patients were divided into two groups based on the surgical approach:The membrane dissection(MD)group,which underwent membrane-guided laparoscopic radical gastrectomy with D2 lymph node dissection plus complete mesocolic excision,and the D2 group,which underwent traditional laparoscopic radical gastrectomy with D2 lymph node dissection.Abdominal lavage fluid was collected pre-and postoperatively from patients in both groups.The expression of carcinoembryonic antigen(CEA)and cytokeratin-19(CK-19)message RNAs in the abdominal lavage fluid was detected using reverse transcription polymerase chain reaction.The factors influencing the increase of the tumor markers were analyzed,and the short-term efficacy of the two surgery types was compared.RESULTS In total,135 eligible patients were included in this study,with 69 and 66 cases in the MD and D2 groups,respectively.Fourteen patients with benign gastric lesions were selected to detect tumor marker expression.After excluding patients positive for preoperative cancer leakage,we found that 9.52%and 26.67%of patients in the MD and D2 groups developed postoperative CEA positivity,respectively.Multivariate analysis revealed that the degree of differentiation and surgical approach were independent risk factors for postoperative CEA positivity.The surgical approach was an independent risk factor affecting postoperative CK-19 positivity and postoperative CEA and CK-19 positivity.Surgical time,intraoperative blood loss,number of lymph nodes dissected,time to first postoperative flatus,and time to first liquid intake were all significantly different between the two surgical approaches.There were no significant differences in the incision length,duration of postoperative hospital stays,or postoperative complications.CONCLUSION MD is a better radical surgical treatment than traditional D2 surgery and is worthy of further clinical promotion and application.展开更多
The karst forest in southwestern China is characterized by thin soil layers,numerous fissures and holes,resulting in low soil water availability and poor water retention,making it challenging for plant growth and surv...The karst forest in southwestern China is characterized by thin soil layers,numerous fissures and holes,resulting in low soil water availability and poor water retention,making it challenging for plant growth and survival.While the relationship between plant functional traits and tree growth performance has been extensively studied,the links between tree seasonal growth and drought-tolerant traits in tree species with different leaf habit remains poorly understood.This study evaluated the associations between four-year averaged rainy season stem diameter growth rate and 17 branch and leaf traits across evergreen and deciduous species in a tropical karst forest in southwest China.The cross-species variations in tree growth rates were related to plant hydraulic traits(e.g.,vessel lumen diameter,xylem vessel density,stomatal density,and stomatal size)and leaf anatomical traits(e.g.,total leaf thickness,lower/upper epidermis thickness,and spongy thickness).The growth of evergreen trees exhibited lower hydraulic efficiency but greater drought tolerance than deciduous tree,which enabled them to maintain higher persistence under low soil water availability and consequently a relatively longer growing season.In contrast,deciduous species showed no correlation between their functional traits and growth rate.The distinct water use strategies of evergreen and deciduous trees may offer a potential explanation for their co-existence in the tropical karst forests.展开更多
In the vast field of medical education,systematic anatomy serves as a solid cornerstone,firmly supporting medical students in their journey towards clinical professional knowledge.It is not just a course but also a ke...In the vast field of medical education,systematic anatomy serves as a solid cornerstone,firmly supporting medical students in their journey towards clinical professional knowledge.It is not just a course but also a key to unlocking the mysteries of medicine.This course is as rich as a vast treasure trove of knowledge,covering the fine structures and functions of various human body systems.Each knowledge point is like a bright pearl in the treasure trove.It is the foundation of clinical professional courses.Many subsequent clinical courses,such as diagnostics and surgery,rely on the basic understanding provided by systematic anatomy.Its professional vocabulary is also an important source of medical field terminologies,acting as the root of medical language and constructing the entire edifice of medical communication.Although the vocabulary of this course is rich,it is not complex.It is like a set of orderly-arranged jigsaw puzzles.As long as the correct methods are mastered,it is easy to piece them together.However,in the current teaching environment,the traditional cramming-style teaching method is like an old-fashioned carriage,showing obvious disadvantages on the road of the times.The pre-study link is like a rehearsal for a wonderful performance,having a direct and crucial impact on students’listening efficiency in class.Nevertheless,such an important teaching link is often overlooked,like a precious treasure forgotten in the corner.High-quality pre-study,for lecturers,is like giving wings to classroom teaching,which can greatly improve the efficiency of classroom teaching and make the teaching process smoother and more efficient.For students,it is like a magnifying glass that can deepen their understanding of knowledge points and their impression of the text,making the knowledge more clearly engraved in their minds.This article will focus on exploring the methods to achieve effective pre-study for systematic anatomy,hoping to contribute to the development of medical education.展开更多
BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)ha...BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.展开更多
When examining the exchange between Chinese and Western medicine during the late Ming and early Qing dynasties,Wang Honghan(王宏翰)stands out as the only Chinese physician who has been thoroughly discussed to date.How...When examining the exchange between Chinese and Western medicine during the late Ming and early Qing dynasties,Wang Honghan(王宏翰)stands out as the only Chinese physician who has been thoroughly discussed to date.However,Zhu Shi(祝石)holds a distinct position as the earliest known Chinese to receive Western medical training,extensively practice Western medicine in China,and leave behind medical writings.Drawing on Western anatomical knowledge,Zhu Shi reevaluated traditional Chinese medicine(TCM)and even incorporated distillation techniques into his clinical practice.This paper primarily focuses on Zhu Shi,with comparative reference to Wang Honghan,exploring their medical learning journeys,reflections on TCM,attitudes toward anatomy,Zhu Shi’s influence on Wang Honghan,and their respective medical practices.Through such comparative analysis,this study provides deeper insights into the integration of Chinese and Western medicine during the early Qing dynasty.展开更多
Neural machine interface technology is a pioneering approach that aims to address the complex challenges of neurological dysfunctions and disabilities resulting from conditions such as congenital disorders,traumatic i...Neural machine interface technology is a pioneering approach that aims to address the complex challenges of neurological dysfunctions and disabilities resulting from conditions such as congenital disorders,traumatic injuries,and neurological diseases.Neural machine interface technology establishes direct connections with the brain or peripheral nervous system to restore impaired motor,sensory,and cognitive functions,significantly improving patients'quality of life.This review analyzes the chronological development and integration of various neural machine interface technologies,including regenerative peripheral nerve interfaces,targeted muscle and sensory reinnervation,agonist–antagonist myoneural interfaces,and brain–machine interfaces.Recent advancements in flexible electronics and bioengineering have led to the development of more biocompatible and highresolution electrodes,which enhance the performance and longevity of neural machine interface technology.However,significant challenges remain,such as signal interference,fibrous tissue encapsulation,and the need for precise anatomical localization and reconstruction.The integration of advanced signal processing algorithms,particularly those utilizing artificial intelligence and machine learning,has the potential to improve the accuracy and reliability of neural signal interpretation,which will make neural machine interface technologies more intuitive and effective.These technologies have broad,impactful clinical applications,ranging from motor restoration and sensory feedback in prosthetics to neurological disorder treatment and neurorehabilitation.This review suggests that multidisciplinary collaboration will play a critical role in advancing neural machine interface technologies by combining insights from biomedical engineering,clinical surgery,and neuroengineering to develop more sophisticated and reliable interfaces.By addressing existing limitations and exploring new technological frontiers,neural machine interface technologies have the potential to revolutionize neuroprosthetics and neurorehabilitation,promising enhanced mobility,independence,and quality of life for individuals with neurological impairments.By leveraging detailed anatomical knowledge and integrating cutting-edge neuroengineering principles,researchers and clinicians can push the boundaries of what is possible and create increasingly sophisticated and long-lasting prosthetic devices that provide sustained benefits for users.展开更多
Human anatomy is a fundamental and core course in medical education.However,in the educational process of traditional Chinese medicine colleges and universities,the realistic predicament of emphasizing classics over f...Human anatomy is a fundamental and core course in medical education.However,in the educational process of traditional Chinese medicine colleges and universities,the realistic predicament of emphasizing classics over forms often appears.Based on the perspective of the integration and connection of traditional Chinese medicine and modern medicine,this research proposes that the curriculum reconstruction should take“morphological support for clinical practice and classic correlation structure”as the main principle.By using strategies such as modular integration,the combination of virtual and real practices,and interdisciplinary evaluation,a human anatomy curriculum system that meets the needs of cultivating talents in traditional Chinese medicine in the new era is proposed.This study provides a reference for the modernization of traditional Chinese medicine education.展开更多
Dear Editor,We read with great interest the article by Aboutaleb et al.[1]titled“Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy?”and would lik...Dear Editor,We read with great interest the article by Aboutaleb et al.[1]titled“Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy?”and would like to commend the authors for their insightful study on the feasibility of fluoroscopy-free single-use flexible ureteroscopy in the treatment of kidney stones,particularly in patients with abnormal renal anatomy.This area of research is highly relevant,given the increasing concerns about radiation exposure to both patients and healthcare providers.The increasing attention to fluoroscopy-free procedures in recent years is justified,as we seek to minimize the risks associated with prolonged radiation use[2].展开更多
Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is ...Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system’s anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.展开更多
Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of si...Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.展开更多
Coronary angiography has long been the standard for coronary imaging,but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention(PCI).Intracoronary imaging techniques like in...Coronary angiography has long been the standard for coronary imaging,but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention(PCI).Intracoronary imaging techniques like intravascular ultrasound(IVUS)and optical coherence tomography(OCT)can overcome these limitations.IVUS uses ultrasound and OCT uses near-infrared light to visualize coronary pathology in unique ways due to differences in temporal and spatial resolution.These techniques have evolved to offer clinical utility in plaque characterization and vessel assessment during PCI.Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone.While IVUS demonstrates consistent clinical outcome benefits,OCT evidence is less robust.IVUS has progressed from early motion detection to high-resolution systems,with smaller compatible catheters.OCT utilizes near infrared light to achieve unparalleled resolutions,but requires temporary blood clearance for optimal imaging.Enhanced visualization and guidance make IVUS and OCT well-suited for higher risk PCI in patients with diabetes and chronic kidney disease by allowing detailed visualization of complex lesions and ensuring optimal stent deployment and positioning in PCI for patients with type 2 diabetes and chronic kidney disease,improving outcomes.IVUS and recent advancements in zero-and low-contrast OCT techniques can reduce nephrotoxic contrast exposure,thus helping to minimize PCI complications in these high-risk patient groups.IVUS and OCT provide valuable insights into coronary pathophysiology and guide interventions precisely compared to angiography alone.Both have comparable clinical outcomes,emphasizing the need for tailored imaging choices based on clinical scenarios.Continued refinement and integration of intravascular imaging will likely play a pivotal role in optimizing coronary interventions and outcomes.This systematic review aims to delve into the nuances of IVUS and OCT,highlighting their strengths and limitations as PCI adjuncts.展开更多
BACKGROUND Laparoscopic anatomical liver resection has become more challenging because some subsegmental Glissonean pedicles are hard to dissect.Here,we introduce how to dissect every(sub)segmental Glissonean pedicle ...BACKGROUND Laparoscopic anatomical liver resection has become more challenging because some subsegmental Glissonean pedicles are hard to dissect.Here,we introduce how to dissect every(sub)segmental Glissonean pedicle from the first porta hepatis and perform standardized(sub)segmentectomy[from segment 1(S1)to S8].AIM To summarize our methods of laparoscopic anatomical segmental and subseg-mental liver resection.METHODS The Glisson sheath and liver capsule were separated along the Laennec mem-brane.The Glissonean pedicle could be isolated and transected with little or no parenchymal damage through this extra-Glissonean dissection approach.The basin of the(sub)segment was determined by the ischemia demarcation line or indocyanine green staining.The hepatic vein or intersegmental vein was also used to guide the plane of parenchymal transection.RESULTS All segmental or subsegmental pedicles or even the pedicle of the cone unit could be dissected along the Laennec membrane using our novel technique through the first porta hepatis.The dorsal branches of S8,the branches of S4a and the paracaval portion branches(b/c vein)of the caudate lobe were the most difficult to dissect.CONCLUSION The novel techniques of liver segmental and subsegmental pedicle anatomy is feasible for laparoscopic liver resection and can help accurately guide(sub)segmentectomy from S1 to S8.展开更多
文摘The benefits of regular physical activity are well known.Yet,few studies have examined the effectiveness of integrating physical activity(PA)into curricula within a post-secondary setting.To investigate the incorporation of PA into medical curriculum,we developed a series of optional exercise-based review sessions designed to reinforce musculoskeletal(MSK)anatomy course material.These synchronous sessions were co-taught by a group fitness instructor and an anatomy instructor.The fitness instructor would lead students through both strength and yoga style exercises,while the anatomy instructor asked questions about relevant anatomical structures related to course material previously covered.After the sessions,participants were asked to evaluate the classes on their self-reported exam preparedness in improving MSK anatomy knowledge,PA levels,and mental wellbeing.Thirty participants completed surveys;a majority agreed that the classes increased understanding of MSK concepts(90.0%)and activity levels(97.7%).Many(70.0%)felt that the classes helped reduce stress.The majority of respondents(90.0%)agreed that the classes contributed to increased feelings of social connectedness.Overall,medical students saw benefit in PA based interventions to supplement MSK course concepts.Along with increasing activity levels and promoting health behaviours,integrating PA into medical curriculum may improve comprehension of learning material,alleviate stress and foster social connectivity among medical students.
基金support from Mining Stress Tolerant Early Maturing Peanut Genetic Resources and Breeding Processing Type Peanut Varieties in Xinjiang(2022A02008-3)China Agricultural Research System(CARS-13)+1 种基金Agricultural Science&Technology Innovation Project of Shandong Academy of Agricultural Sciences(CXGC2024D19)Key Research&Development Program of Shandong Province(2024TSGC0532).
文摘Peanut is a major cash crop in the world. In recent years, peanut pod rot has become increasingly prevalent,resulting in significant yield and quality losses. Resistance breeding is considered a cost-effective approach for managing pod rot. Previous research in the United States identified significant anatomical differences in leaves and shells among peanut cultivars with varying responses to pod rot caused by Pythium myriotylum Drechs. and Rhizoctonia solani Kuhn. However, whether similar anatomical features correlate with resistance to peanut pod rot in Laixi, Qingdao, remained unknown, where the primary causal pathogen for the disease was F. solani. In this study, nine peanut varieties with differing disease reactions to peanut pod rot were planted in the same plots.Paraffin sections of leaves and shells were prepared and stained to evaluate anatomical features, and the main agronomic traits were assessed alongside leaf spot disease ratings. All the four anatomical features, leaf palisade cell number, palisade cell width, index(palisade cell number per mm × cell width in μm), and shell lignin staining area, were measured before the onset of pod rot and were found to be negatively correlated with pod rot scores.Given the consistent and strong correlation of these anatomical features with pod rot resistance and their high heritability estimates, the pre-existing resistance could be identified even in the absence of the disease, which is particularly valuable for fields where pod rot may not occur every year. This study provided useful anatomical indicators for selecting resistance to peanut pod rot, predominantly caused by F. solani.
文摘The first metatarsophalangeal(MTP)joint plays a crucial role in foot biomechanics,particularly in weight-bearing activities such as walking and running.It is frequently affected by conditions like hallux valgus(HV)and hallux rigidus,with HV impacting approximately 23%-35% of the population.This narrative review explores the embryology,anatomy,and biomechanics of the first MTP joint(MTPJ),highlighting its significance in maintaining foot stability and function.A comprehensive literature search was conducted using PubMed,Scopus,and Google Scholar,analyzing 50 relevant studies,including 12 clinical trials.The joint’s complex structure and mechanical demands make it susceptible to degenerative and structural disorders.Studies indicate that 25%-40%of individuals with HV experience significant pain and functional impairment,affecting mobility and quality of life.Biomechanical stress,abnormal gait patterns,and joint instability contribute to disease progression.Understanding the anatomical and biomechanical properties of the first MTPJ is essential for improving diagnostic and therapeutic approaches.Emerging surgical techniques,such as osteotomy and joint resurfacing,show promise in reducing recurrence rates and enhancing longterm outcomes.Further research is needed to refine minimally invasive interventions and optimize treatment strategies for first MTPJ disorders.
文摘Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,particularly nonobstructive azoospermia(NOA),which affects 10%–15%of infertile men,represents a significant challenge in male infertility.The advent of assisted reproductive technology(ART),specifically microdissection testicular sperm extraction(micro-TESE)followed by intracytoplasmic sperm injection(ICSI),offers a possibility for men with NOA to father biological children.Recent studies have focused on the predictors of sperm retrieval in NOA patients,such as age,testicular volume,and follicle-stimulating hormone(FSH)level.This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE,thereby enhancing understanding and improving outcomes for this challenging condition.
基金supported by the National Key Research and Development Program of China(2023YFD2301500).
文摘A morphology-based growth stage system should describe the growth and development of a crop and thereby help farmers and agronomists in formulating reasonable managementmeasures conducive to the development of marketable products.However,existing growth stage systems for soybean are either based on plant growth or covered particular phases of flower or pod development,making it difficult to use for tracking the entire growth period of individual flowers and pods.Therefore,the first flower and pod,located at the base of the primary raceme in the eighth trifoliate node of the main stem,were chosen to illustrate growth dynamics during the full reproductive period.The size and fresh weight of the primary raceme in the eighth trifoliate leaf axil,the first flower and pod,the pistils in the first flower,and seeds in the first pod were examined,and the growth of these organs was depicted.Integrating the morphological characteristics and growth features of flowers and pods,as well as existing growth stage systems,the growth and development were delineated in 13 stages.In detail,we classified the flower phase based on the relative positions of floral components,inspired by the ratio of bract to flower used for staging,refined the lag phase proposed previously,retained the use of pod length to define the early pod phase,and innovatively described the late pod phase by the seed appearance.The developmental events in each stage of flower and pod were distinctive and closely connected to the corresponding morphology.Taken together,a more detailed growth stage system for describing individual flowers and pods in soybean was established.This system will serve as a valuable research tool for describing the development,gene expression,and cellular metabolism associated with the formation of flowers,pods,and seeds.
基金The 64th batch of China Postdoctoral Science Foundation,Grant/Award Number:2018M640754National Natural Science Foundation of China,Grant/Award Number:81860870The“Wang Heng xin Scientific Research Fund”project of Hunan University of Chinese Medicine,Grant/Award Number:2023HX007。
文摘Glaucoma,a visual thief,is characterized by elevated intraocular pressure(IOP)and the loss of retinal ganglion cells(RGCs).Selecting suitable animals for preclinical models is of great significance in research on the prevention,early screening,and effective treatments of glaucoma.Rabbit eyeballs possess similar vascularity and aqueous humor outflow pathways to those of humans.Thus,they are among the earliest in vivo models used in glaucoma research.Over the years,rabbit models have made substantial contributions to understanding glaucomatous pathophysiology,surgical adaptations,biomedical device development,and drug development for reducing IOP,protecting RGCs,and inhibiting fibrosis.Compared to other animals,rabbits fit better with surgical operations and cost less.This review summarizes the merits and demerits of different ways to produce glaucomatous rabbit models,such as intracameral injection,vortex vein obstruction,Trendelenburg position,laser photo-coagulation,glucocorticoid induction,limbal buckling induction,retinal ischemia–reperfusion models,and spontaneous models.We analyzed their mechanisms in the hope of providing more references for experimental design and promoting the understanding of glaucoma treatment strategies.
文摘BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP instruments can be used.Therefore,MSE-ERCP appears to be the optimal solution for postsurgical patients,especially with Roux-en-Y anatomy.AIM To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.METHODS We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.RESULTS We identified 26 MSE-ERCPs:(1)18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation(n=11)or gastrectomy(n=2);and(2)Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass.Overall success of reaching the biliary entry was 88%and further interventions were successful in 83%of patients.In very long alimentary limb situations,success of reaching the biliary entry was not-significantly lower compared to“standard”Roux-en-Y(75%vs 94%,P=0.215).ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy(63%vs 93%,P=0.103).Mean intervention time was 105 minutes.Intervention times were longer in very long limb situations(133 minutes vs 91 minutes;P=0.032).Overall,we observed three adverse events(n=1 caused by enteroscopy,n=1 caused by the biliary intervention,n=1 unrelated to the procedure).In 15/26 cases(58%)MSE-ERCP was carried out on an outpatient basis.CONCLUSION MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions.However,MSE was recently withdrawn from the market due to severe safety concerns,which were not observed in this study.
基金Supported by Putian Science and Technology Plan Project,No.2022SY003.
文摘BACKGROUND Gastric cancer(GC)is one of the most common malignancies and types of cancer worldwide.AIM To compare the differences in tumor markers of GC with GC dissection,we evaluated the efficacy of recent tumor removal.METHODS A prospective cohort study was conducted to analyze the clinical data of patients with GC.Patients were divided into two groups based on the surgical approach:The membrane dissection(MD)group,which underwent membrane-guided laparoscopic radical gastrectomy with D2 lymph node dissection plus complete mesocolic excision,and the D2 group,which underwent traditional laparoscopic radical gastrectomy with D2 lymph node dissection.Abdominal lavage fluid was collected pre-and postoperatively from patients in both groups.The expression of carcinoembryonic antigen(CEA)and cytokeratin-19(CK-19)message RNAs in the abdominal lavage fluid was detected using reverse transcription polymerase chain reaction.The factors influencing the increase of the tumor markers were analyzed,and the short-term efficacy of the two surgery types was compared.RESULTS In total,135 eligible patients were included in this study,with 69 and 66 cases in the MD and D2 groups,respectively.Fourteen patients with benign gastric lesions were selected to detect tumor marker expression.After excluding patients positive for preoperative cancer leakage,we found that 9.52%and 26.67%of patients in the MD and D2 groups developed postoperative CEA positivity,respectively.Multivariate analysis revealed that the degree of differentiation and surgical approach were independent risk factors for postoperative CEA positivity.The surgical approach was an independent risk factor affecting postoperative CK-19 positivity and postoperative CEA and CK-19 positivity.Surgical time,intraoperative blood loss,number of lymph nodes dissected,time to first postoperative flatus,and time to first liquid intake were all significantly different between the two surgical approaches.There were no significant differences in the incision length,duration of postoperative hospital stays,or postoperative complications.CONCLUSION MD is a better radical surgical treatment than traditional D2 surgery and is worthy of further clinical promotion and application.
基金financially funded by the National Natural Science Foundation of China(3186113307,31770533,31870591)the West Light Talent Program of the Chinese Academy of Sciences(xbzg-zdsys-202218).
文摘The karst forest in southwestern China is characterized by thin soil layers,numerous fissures and holes,resulting in low soil water availability and poor water retention,making it challenging for plant growth and survival.While the relationship between plant functional traits and tree growth performance has been extensively studied,the links between tree seasonal growth and drought-tolerant traits in tree species with different leaf habit remains poorly understood.This study evaluated the associations between four-year averaged rainy season stem diameter growth rate and 17 branch and leaf traits across evergreen and deciduous species in a tropical karst forest in southwest China.The cross-species variations in tree growth rates were related to plant hydraulic traits(e.g.,vessel lumen diameter,xylem vessel density,stomatal density,and stomatal size)and leaf anatomical traits(e.g.,total leaf thickness,lower/upper epidermis thickness,and spongy thickness).The growth of evergreen trees exhibited lower hydraulic efficiency but greater drought tolerance than deciduous tree,which enabled them to maintain higher persistence under low soil water availability and consequently a relatively longer growing season.In contrast,deciduous species showed no correlation between their functional traits and growth rate.The distinct water use strategies of evergreen and deciduous trees may offer a potential explanation for their co-existence in the tropical karst forests.
文摘In the vast field of medical education,systematic anatomy serves as a solid cornerstone,firmly supporting medical students in their journey towards clinical professional knowledge.It is not just a course but also a key to unlocking the mysteries of medicine.This course is as rich as a vast treasure trove of knowledge,covering the fine structures and functions of various human body systems.Each knowledge point is like a bright pearl in the treasure trove.It is the foundation of clinical professional courses.Many subsequent clinical courses,such as diagnostics and surgery,rely on the basic understanding provided by systematic anatomy.Its professional vocabulary is also an important source of medical field terminologies,acting as the root of medical language and constructing the entire edifice of medical communication.Although the vocabulary of this course is rich,it is not complex.It is like a set of orderly-arranged jigsaw puzzles.As long as the correct methods are mastered,it is easy to piece them together.However,in the current teaching environment,the traditional cramming-style teaching method is like an old-fashioned carriage,showing obvious disadvantages on the road of the times.The pre-study link is like a rehearsal for a wonderful performance,having a direct and crucial impact on students’listening efficiency in class.Nevertheless,such an important teaching link is often overlooked,like a precious treasure forgotten in the corner.High-quality pre-study,for lecturers,is like giving wings to classroom teaching,which can greatly improve the efficiency of classroom teaching and make the teaching process smoother and more efficient.For students,it is like a magnifying glass that can deepen their understanding of knowledge points and their impression of the text,making the knowledge more clearly engraved in their minds.This article will focus on exploring the methods to achieve effective pre-study for systematic anatomy,hoping to contribute to the development of medical education.
基金Supported by Department of Science and Technology of Liaoning Province,No.2024JH2/102600288 and No.2022JH2/101500013。
文摘BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.
基金financed by the grant from the 2024 Tianjin Philosophy and Social Science Planning Annual Program(No.TJZLQN24-002).
文摘When examining the exchange between Chinese and Western medicine during the late Ming and early Qing dynasties,Wang Honghan(王宏翰)stands out as the only Chinese physician who has been thoroughly discussed to date.However,Zhu Shi(祝石)holds a distinct position as the earliest known Chinese to receive Western medical training,extensively practice Western medicine in China,and leave behind medical writings.Drawing on Western anatomical knowledge,Zhu Shi reevaluated traditional Chinese medicine(TCM)and even incorporated distillation techniques into his clinical practice.This paper primarily focuses on Zhu Shi,with comparative reference to Wang Honghan,exploring their medical learning journeys,reflections on TCM,attitudes toward anatomy,Zhu Shi’s influence on Wang Honghan,and their respective medical practices.Through such comparative analysis,this study provides deeper insights into the integration of Chinese and Western medicine during the early Qing dynasty.
基金supported in part by the National Natural Science Foundation of China,Nos.81927804(to GL),82260456(to LY),U21A20479(to LY)Science and Technology Planning Project of Shenzhen,No.JCYJ20230807140559047(to LY)+3 种基金Key-Area Research and Development Program of Guangdong Province,No.2020B0909020004(to GL)Guangdong Basic and Applied Research Foundation,No.2023A1515011478(to LY)the Science and Technology Program of Guangdong Province,No.2022A0505090007(to GL)Ministry of Science and Technology,Shenzhen,No.QN2022032013L(to LY)。
文摘Neural machine interface technology is a pioneering approach that aims to address the complex challenges of neurological dysfunctions and disabilities resulting from conditions such as congenital disorders,traumatic injuries,and neurological diseases.Neural machine interface technology establishes direct connections with the brain or peripheral nervous system to restore impaired motor,sensory,and cognitive functions,significantly improving patients'quality of life.This review analyzes the chronological development and integration of various neural machine interface technologies,including regenerative peripheral nerve interfaces,targeted muscle and sensory reinnervation,agonist–antagonist myoneural interfaces,and brain–machine interfaces.Recent advancements in flexible electronics and bioengineering have led to the development of more biocompatible and highresolution electrodes,which enhance the performance and longevity of neural machine interface technology.However,significant challenges remain,such as signal interference,fibrous tissue encapsulation,and the need for precise anatomical localization and reconstruction.The integration of advanced signal processing algorithms,particularly those utilizing artificial intelligence and machine learning,has the potential to improve the accuracy and reliability of neural signal interpretation,which will make neural machine interface technologies more intuitive and effective.These technologies have broad,impactful clinical applications,ranging from motor restoration and sensory feedback in prosthetics to neurological disorder treatment and neurorehabilitation.This review suggests that multidisciplinary collaboration will play a critical role in advancing neural machine interface technologies by combining insights from biomedical engineering,clinical surgery,and neuroengineering to develop more sophisticated and reliable interfaces.By addressing existing limitations and exploring new technological frontiers,neural machine interface technologies have the potential to revolutionize neuroprosthetics and neurorehabilitation,promising enhanced mobility,independence,and quality of life for individuals with neurological impairments.By leveraging detailed anatomical knowledge and integrating cutting-edge neuroengineering principles,researchers and clinicians can push the boundaries of what is possible and create increasingly sophisticated and long-lasting prosthetic devices that provide sustained benefits for users.
基金The teaching reform project of Yunnan University of Traditional Chinese Medicine:The synergy of medical education to meet the needs of new medical science for the cultivation of clinical application-oriented talents in both traditional Chinese and Western medicine(JG202324)。
文摘Human anatomy is a fundamental and core course in medical education.However,in the educational process of traditional Chinese medicine colleges and universities,the realistic predicament of emphasizing classics over forms often appears.Based on the perspective of the integration and connection of traditional Chinese medicine and modern medicine,this research proposes that the curriculum reconstruction should take“morphological support for clinical practice and classic correlation structure”as the main principle.By using strategies such as modular integration,the combination of virtual and real practices,and interdisciplinary evaluation,a human anatomy curriculum system that meets the needs of cultivating talents in traditional Chinese medicine in the new era is proposed.This study provides a reference for the modernization of traditional Chinese medicine education.
文摘Dear Editor,We read with great interest the article by Aboutaleb et al.[1]titled“Is fluoroscopy-free single-use flexible ureteroscopy a feasible treatment for kidney stones with abnormal renal anatomy?”and would like to commend the authors for their insightful study on the feasibility of fluoroscopy-free single-use flexible ureteroscopy in the treatment of kidney stones,particularly in patients with abnormal renal anatomy.This area of research is highly relevant,given the increasing concerns about radiation exposure to both patients and healthcare providers.The increasing attention to fluoroscopy-free procedures in recent years is justified,as we seek to minimize the risks associated with prolonged radiation use[2].
文摘Endodontic diseases are a kind of chronic infectious oral disease. Common endodontic treatment concepts are based on the removal of inflamed or necrotic pulp tissue and the replacement by gutta-percha. However, it is very essential for endodontic treatment to debride the root canal system and prevent the root canal system from bacterial reinfection after root canal therapy(RCT). Recent research, encompassing bacterial etiology and advanced imaging techniques, contributes to our understanding of the root canal system’s anatomy intricacies and the technique sensitivity of RCT. Success in RCT hinges on factors like patients, infection severity, root canal anatomy, and treatment techniques. Therefore, improving disease management is a key issue to combat endodontic diseases and cure periapical lesions. The clinical difficulty assessment system of RCT is established based on patient conditions, tooth conditions, root canal configuration, and root canal needing retreatment, and emphasizes pre-treatment risk assessment for optimal outcomes. The findings suggest that the presence of risk factors may correlate with the challenge of achieving the high standard required for RCT. These insights contribute not only to improve education but also aid practitioners in treatment planning and referral decision-making within the field of endodontics.
文摘Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.
文摘Coronary angiography has long been the standard for coronary imaging,but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention(PCI).Intracoronary imaging techniques like intravascular ultrasound(IVUS)and optical coherence tomography(OCT)can overcome these limitations.IVUS uses ultrasound and OCT uses near-infrared light to visualize coronary pathology in unique ways due to differences in temporal and spatial resolution.These techniques have evolved to offer clinical utility in plaque characterization and vessel assessment during PCI.Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone.While IVUS demonstrates consistent clinical outcome benefits,OCT evidence is less robust.IVUS has progressed from early motion detection to high-resolution systems,with smaller compatible catheters.OCT utilizes near infrared light to achieve unparalleled resolutions,but requires temporary blood clearance for optimal imaging.Enhanced visualization and guidance make IVUS and OCT well-suited for higher risk PCI in patients with diabetes and chronic kidney disease by allowing detailed visualization of complex lesions and ensuring optimal stent deployment and positioning in PCI for patients with type 2 diabetes and chronic kidney disease,improving outcomes.IVUS and recent advancements in zero-and low-contrast OCT techniques can reduce nephrotoxic contrast exposure,thus helping to minimize PCI complications in these high-risk patient groups.IVUS and OCT provide valuable insights into coronary pathophysiology and guide interventions precisely compared to angiography alone.Both have comparable clinical outcomes,emphasizing the need for tailored imaging choices based on clinical scenarios.Continued refinement and integration of intravascular imaging will likely play a pivotal role in optimizing coronary interventions and outcomes.This systematic review aims to delve into the nuances of IVUS and OCT,highlighting their strengths and limitations as PCI adjuncts.
基金Supported by General Project of Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604Chongqing Doctoral“Through Train”Research Program,No.CSTB2022BSXM-JCX0045.
文摘BACKGROUND Laparoscopic anatomical liver resection has become more challenging because some subsegmental Glissonean pedicles are hard to dissect.Here,we introduce how to dissect every(sub)segmental Glissonean pedicle from the first porta hepatis and perform standardized(sub)segmentectomy[from segment 1(S1)to S8].AIM To summarize our methods of laparoscopic anatomical segmental and subseg-mental liver resection.METHODS The Glisson sheath and liver capsule were separated along the Laennec mem-brane.The Glissonean pedicle could be isolated and transected with little or no parenchymal damage through this extra-Glissonean dissection approach.The basin of the(sub)segment was determined by the ischemia demarcation line or indocyanine green staining.The hepatic vein or intersegmental vein was also used to guide the plane of parenchymal transection.RESULTS All segmental or subsegmental pedicles or even the pedicle of the cone unit could be dissected along the Laennec membrane using our novel technique through the first porta hepatis.The dorsal branches of S8,the branches of S4a and the paracaval portion branches(b/c vein)of the caudate lobe were the most difficult to dissect.CONCLUSION The novel techniques of liver segmental and subsegmental pedicle anatomy is feasible for laparoscopic liver resection and can help accurately guide(sub)segmentectomy from S1 to S8.
