Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.展开更多
Soil compaction often imposes stress on root development and plant survival.However,root anatomical responses that enable persistent root growth and functioning under soil compaction remain unclear.We grew 10 herbaceo...Soil compaction often imposes stress on root development and plant survival.However,root anatomical responses that enable persistent root growth and functioning under soil compaction remain unclear.We grew 10 herbaceous species differing substantially in lateral root diameter,in soils with low(1.0 g cm^(-3))and high(1.4 g cm^(-3))bulk density,and assessed root traits including root biomass,anatomical structures,and respiration rates.Greater root thickening upon soil compaction was found in species with thicker first-order lateral roots,mainly due to larger cortical cell size.Both xylem vessel diameter and wall thickness increased more in compacted soils in these species.Despite these anatomical shifts,root respiration rate responded little to soil compaction across most species,likely due to the opposite investment in cortical cells and xylem vessels.Notably,root biomass,independent of root respiration rate and anatomical structures,determined whole-plant growth under soil compaction.Our study reveals two independent strategies of root response to soil compaction:anatomical remodeling for mechanical and metabolic maintenance,and root biomass investment for resource acquisition.These findings offer new insights for breeding and selecting species tolerant to soil compaction and highlight multidimensional strategies of plant adaptation to physical stress.展开更多
Objective To clearly delineate the microanatomy of the upper thoracic sympathetic trunk and its syntopy in order to provide anatomical basis for the selection of precise clinical surgical approaches.Methods Totally 55...Objective To clearly delineate the microanatomy of the upper thoracic sympathetic trunk and its syntopy in order to provide anatomical basis for the selection of precise clinical surgical approaches.Methods Totally 55 sympathetic trunks available in 28 Chinese adult cadavers(18 males and 10 females)were investigated in this study.The thoracic cavity was thoroughly exposed and then sympathetic ganglia and its affiliated rami were observed and measured with microscopic instruments.Results Rami from thoracic nerve 1(T1)intercostal nerve entered the stellate ganglion above the upper border of the second rib in all specimens,The distance between the rami and the upper border of the second rib was(5.1±1.4)mm.The incidence that T2⁃T5 ganglions located at the corresponding intercostal space was 92.7%,85.5%,40.0%and 36.4%,respectively.The rami communicantes were classified into 3 types(type a,b and c)according to the anatomical relationship between the thoracic sympathetic ganglia and the intercostal nerves.The distance from 3 types of rami communicantes to lateral sympathetic trunk at the middle point of relative rib was(10.2±3.4)mm(type a),(9.5±2.6)mm(type b)and(8.4±2.0)mm(type c),respectively.We found that 74.5%superior intercostal artery crossed the neck of the first rib.The distance between the superior intercostal artery and the lateral sympathetic trunk was(3.4±1.3)mm.Conclusion Sympathectomy performed at rib level should be the ideal choice for clinical surgical treatment of palmar or craniofacial hyperhidrosis with less denervation scope to achieve more definite therapeutic effect.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
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
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
Objective:This study aimed to investigate the anatomy of the accessory pudendal artery(APA)in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy(RARP).Methods:APA was def...Objective:This study aimed to investigate the anatomy of the accessory pudendal artery(APA)in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy(RARP).Methods:APA was defined as“any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudally toward the anterior perineum”.The anatomical variations of the APA were reviewed in 589 consecutive Japanese men who underwent conventional RARP at our institution between April 2019 and November 2023,including the number,laterality,side,size,and local distribution(apical vs.lateral).The apical APA emerges near the prostatic apical region,whereas the lateral APA courses along the lateral aspect of the prostate.They are further classified as the prostatic,fascial,and pubic APAs.Our APA identification and preservation techniques were described based on this classification.Results:Of the 589 Japanese men,299(51%)men were with one or more APAs:169 with one APA,115 with two APAs,14 with three APAs,and one with four APAs;and a total of 445 APAs were found.Approximately 97% of the APAs(432/445)were preserved.More lateral APAs were found than apical APAs(243/589[41%]vs.79/589[13%];p<0.001).Lateral APAs had a higher proportion of large-caliber arteries than apical APAs(59/359[16%]vs.1/86[1.2%];p<0.001),particularly prostatic and fascial APAs(14/59[24%]and 40/163[25%],respectively).Conclusion:This study identified anatomical variations of APAs in Japanese men and demonstrated that nearly all could be preserved during RARP.Further research is needed to evaluate the clinical benefits of APA preservation.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
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
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 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
Objective To explore how to organically integrate the human anatomy curriculum with medical imaging,thereby enhancing medical students'spatial understanding and 3D reconstruction skills,and strengthening their ana...Objective To explore how to organically integrate the human anatomy curriculum with medical imaging,thereby enhancing medical students'spatial understanding and 3D reconstruction skills,and strengthening their anatomical foundation and clinical competence.This approach aims to bridge the gap between basic science and clinical practice while cultivating clinical thinking abilities.Methods In this study,the medical imaging knowledge was introduced into the anatomy curriculum in Peking University,enabling students to better understand the human body structure and its relationship to the clinical practice with aid of the ultrasound and MRI method.After the course concluded,we evaluated the examination result and learning satisfaction data from the anatomy course.Results The result showed that students provided positive feedback,showing increased interest in learning,enhanced initiative,significant improvement in their anatomy grades(P<0.01),and a notable enhancement in their ability to apply basic knowledge to solve clinical problems(P<0.05).Conclusion The integrated teaching approach of medical imaging and human anatomy courses provides innovative ideas and practical method for medical students to learn the basic medical course and enhance their clinical skills in the future.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 The trigeminal nerve(TN)is frequently implicated in neurovascular conflicts,most commonly with the superior cerebellar artery(SCA),its predominant arterial counterpart in the cerebellopontine angle.AIM To e...BACKGROUND The trigeminal nerve(TN)is frequently implicated in neurovascular conflicts,most commonly with the superior cerebellar artery(SCA),its predominant arterial counterpart in the cerebellopontine angle.AIM To examine the relationship between the SCA and TN utilizing high-resolution magnetic resonance imaging and evaluated whether particular anatomical configurations predispose to clinically significant contact.METHODS Magnetic resonance imaging scans from 80 patients(160 sides)were retrospectively analyzed,excluding cases with pathological processes affecting the TN.Using multiplanar reconstruction,the TN root was identified and its spatial relationship with the SCA was evaluated.RESULTS Eight distinct topographic patterns were identified.The SCA most commonly coursed superior(30.6%),lateral(18.8%),or superolateral(17.5%)to the TN.Medial configurations,although less frequent,were associated with the shortest artery-nerve distance(mean 1.85±1.28 mm)and significantly higher contact rates(P<0.001).Overall,SCA-TN contact was observed in 14.4%of sides,but only 20%of these patients reported ipsilateral facial numbness.Variations in SCA origin(basilar artery,posterior cerebral artery,or common origin)and duplication did not significantly influence the artery-nerve distance.CONCLUSION Although SCA-TN contact is relatively frequent,only particular medial and superior configurations seem to predispose individuals to symptomatic compression.These observations are consistent with cadaveric and surgical evidence highlighting the significance of root entry zone contact in trigeminal neuralgia.Vascular contact alone should not serve as a diagnostic criterion;instead,geometric configuration and related nerve alterations must also be incorporated into preoperative assessment.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
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
基金funded by the National Natural Science Foundation of China(32471824,32171746,31870522,42477227,and 32560282)the leading talents of basic research in Henan Province(24XM0375)+6 种基金Excellent Youth Creative Research Group Project in Henan Province(252300421002)Foreign Scientists Studio in Henan Province(GZS2025011)MOHRSS National Foreign Expert Individual Projectsand(110000264820258001)Natural Science Foundation of Henan(242300420604)supported by the Guangdong Provincial Key Laboratory of Soil and Groundwater Pollution Control(2023B1212060002)the High-level University Special Fund(G03050K001)the China Postdoctoral Science Foundation(No.2021M690922).
文摘Soil compaction often imposes stress on root development and plant survival.However,root anatomical responses that enable persistent root growth and functioning under soil compaction remain unclear.We grew 10 herbaceous species differing substantially in lateral root diameter,in soils with low(1.0 g cm^(-3))and high(1.4 g cm^(-3))bulk density,and assessed root traits including root biomass,anatomical structures,and respiration rates.Greater root thickening upon soil compaction was found in species with thicker first-order lateral roots,mainly due to larger cortical cell size.Both xylem vessel diameter and wall thickness increased more in compacted soils in these species.Despite these anatomical shifts,root respiration rate responded little to soil compaction across most species,likely due to the opposite investment in cortical cells and xylem vessels.Notably,root biomass,independent of root respiration rate and anatomical structures,determined whole-plant growth under soil compaction.Our study reveals two independent strategies of root response to soil compaction:anatomical remodeling for mechanical and metabolic maintenance,and root biomass investment for resource acquisition.These findings offer new insights for breeding and selecting species tolerant to soil compaction and highlight multidimensional strategies of plant adaptation to physical stress.
文摘Objective To clearly delineate the microanatomy of the upper thoracic sympathetic trunk and its syntopy in order to provide anatomical basis for the selection of precise clinical surgical approaches.Methods Totally 55 sympathetic trunks available in 28 Chinese adult cadavers(18 males and 10 females)were investigated in this study.The thoracic cavity was thoroughly exposed and then sympathetic ganglia and its affiliated rami were observed and measured with microscopic instruments.Results Rami from thoracic nerve 1(T1)intercostal nerve entered the stellate ganglion above the upper border of the second rib in all specimens,The distance between the rami and the upper border of the second rib was(5.1±1.4)mm.The incidence that T2⁃T5 ganglions located at the corresponding intercostal space was 92.7%,85.5%,40.0%and 36.4%,respectively.The rami communicantes were classified into 3 types(type a,b and c)according to the anatomical relationship between the thoracic sympathetic ganglia and the intercostal nerves.The distance from 3 types of rami communicantes to lateral sympathetic trunk at the middle point of relative rib was(10.2±3.4)mm(type a),(9.5±2.6)mm(type b)and(8.4±2.0)mm(type c),respectively.We found that 74.5%superior intercostal artery crossed the neck of the first rib.The distance between the superior intercostal artery and the lateral sympathetic trunk was(3.4±1.3)mm.Conclusion Sympathectomy performed at rib level should be the ideal choice for clinical surgical treatment of palmar or craniofacial hyperhidrosis with less denervation scope to achieve more definite therapeutic effect.
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Objective:This study aimed to investigate the anatomy of the accessory pudendal artery(APA)in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy(RARP).Methods:APA was defined as“any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudally toward the anterior perineum”.The anatomical variations of the APA were reviewed in 589 consecutive Japanese men who underwent conventional RARP at our institution between April 2019 and November 2023,including the number,laterality,side,size,and local distribution(apical vs.lateral).The apical APA emerges near the prostatic apical region,whereas the lateral APA courses along the lateral aspect of the prostate.They are further classified as the prostatic,fascial,and pubic APAs.Our APA identification and preservation techniques were described based on this classification.Results:Of the 589 Japanese men,299(51%)men were with one or more APAs:169 with one APA,115 with two APAs,14 with three APAs,and one with four APAs;and a total of 445 APAs were found.Approximately 97% of the APAs(432/445)were preserved.More lateral APAs were found than apical APAs(243/589[41%]vs.79/589[13%];p<0.001).Lateral APAs had a higher proportion of large-caliber arteries than apical APAs(59/359[16%]vs.1/86[1.2%];p<0.001),particularly prostatic and fascial APAs(14/59[24%]and 40/163[25%],respectively).Conclusion:This study identified anatomical variations of APAs in Japanese men and demonstrated that nearly all could be preserved during RARP.Further research is needed to evaluate the clinical benefits of APA preservation.
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.
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.
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2024 Higher Education Science Research Planning Project(24KC0413)Peking University Health Science Center Medical Education Research Funding Project(2023YB43)+3 种基金The University-Industry Collaborative Education Program of the Ministry of Education(220903132204624)2022 Peking University Graduate Course Construction Funding2023 Peking University Medical Graduate Course Ideological and Political Construction ProjectZhejiang Natural Science Foundation Exploration Project Q-class Funding Project(242szhfhYB25)。
文摘Objective To explore how to organically integrate the human anatomy curriculum with medical imaging,thereby enhancing medical students'spatial understanding and 3D reconstruction skills,and strengthening their anatomical foundation and clinical competence.This approach aims to bridge the gap between basic science and clinical practice while cultivating clinical thinking abilities.Methods In this study,the medical imaging knowledge was introduced into the anatomy curriculum in Peking University,enabling students to better understand the human body structure and its relationship to the clinical practice with aid of the ultrasound and MRI method.After the course concluded,we evaluated the examination result and learning satisfaction data from the anatomy course.Results The result showed that students provided positive feedback,showing increased interest in learning,enhanced initiative,significant improvement in their anatomy grades(P<0.01),and a notable enhancement in their ability to apply basic knowledge to solve clinical problems(P<0.05).Conclusion The integrated teaching approach of medical imaging and human anatomy courses provides innovative ideas and practical method for medical students to learn the basic medical course and enhance their clinical skills in the future.
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.
文摘BACKGROUND The trigeminal nerve(TN)is frequently implicated in neurovascular conflicts,most commonly with the superior cerebellar artery(SCA),its predominant arterial counterpart in the cerebellopontine angle.AIM To examine the relationship between the SCA and TN utilizing high-resolution magnetic resonance imaging and evaluated whether particular anatomical configurations predispose to clinically significant contact.METHODS Magnetic resonance imaging scans from 80 patients(160 sides)were retrospectively analyzed,excluding cases with pathological processes affecting the TN.Using multiplanar reconstruction,the TN root was identified and its spatial relationship with the SCA was evaluated.RESULTS Eight distinct topographic patterns were identified.The SCA most commonly coursed superior(30.6%),lateral(18.8%),or superolateral(17.5%)to the TN.Medial configurations,although less frequent,were associated with the shortest artery-nerve distance(mean 1.85±1.28 mm)and significantly higher contact rates(P<0.001).Overall,SCA-TN contact was observed in 14.4%of sides,but only 20%of these patients reported ipsilateral facial numbness.Variations in SCA origin(basilar artery,posterior cerebral artery,or common origin)and duplication did not significantly influence the artery-nerve distance.CONCLUSION Although SCA-TN contact is relatively frequent,only particular medial and superior configurations seem to predispose individuals to symptomatic compression.These observations are consistent with cadaveric and surgical evidence highlighting the significance of root entry zone contact in trigeminal neuralgia.Vascular contact alone should not serve as a diagnostic criterion;instead,geometric configuration and related nerve alterations must also be incorporated into preoperative assessment.
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.
