Objective:To investigate the correlation of abdominal aorta CT value,renal artery CT value and renal cortex thickness with renal cortex CT value on contrast enhanced 64-slice CT images.Methods:96patients(50 men and 46...Objective:To investigate the correlation of abdominal aorta CT value,renal artery CT value and renal cortex thickness with renal cortex CT value on contrast enhanced 64-slice CT images.Methods:96patients(50 men and 46women;16~74years)with normal kidney function,which was confirmed by kidney function test were enrolled in this study,including bilateral kidneys of 92cases and unilateral kidney of 4cases(total of 188kidneys;92left,96right).After intravenous(IV)injection of contrast agent the kidneys of the selected patients were scanned by MDCT.The scans were performed in arterial,venous and 3min delayed phases.All statistical analyses were performed by using IBM SPSS 20.0.Graphs were generated using Graph Pad Prism 5software.Quantitative data were presented as mean±standard deviation,while qualitative data were presented as frequency(%).P<0.05was considered to be statistically significant.Results:The mean renal cortex thickness was(5.19±0.81)mm in all kidneys.In the arterial phase,a statistically significant positive correlation between renal cortex CT values and abdominal aortic CT values was showed(r=0.584;P<0.001).A statistically significant positive correlation between renal cortex CT values and renal cortex thickness was demonstrated(r=0.533,P<0.0001).Likewise,there was a positive correlation between renal cortex CT value and renal artery CT values(r=0.43,P<0.001).Conclusion:It is a promising approach to assess the individual kidney function by measuring abdominal aorta CT value,renal artery CT value,renal cortex CT value and renal cortex thickness using contrast MDCT.展开更多
Objective:To evaluate the clinical effects of the abdominal aorta block in controlling haemorrhage during operations of the gynecologic tumor. Methods: From July 1965 to January 2005. we collected patients (n = 49) of...Objective:To evaluate the clinical effects of the abdominal aorta block in controlling haemorrhage during operations of the gynecologic tumor. Methods: From July 1965 to January 2005. we collected patients (n = 49) of gynecologic tumor complicated with haemorrhage during operations, who were divided into 3 groups: preventive blocking group (PG, n=12), treatment blocking group (TG, n = 20) used abdominal aorta block technique with sterilized cotton band and silica gel tube, and control group (CG, n = 17) which were used the regular haemostatic methods, such as ligature, suture and ribbon gauze packing. During operations, the vital signs including the amount of bleeding and transfusion were measured. Results: Compared with the CG, the amount of bleeding and transfusion in the PG and TG decreased significantly (P<0. 01). After using the technique, 32 cases of haemorrhage were controlled completely. All patients finished operation smoothly in the end and the vital signs were stable. The vision field of operation was clear and the operating time was shortened dramatically (3. 0 h vs 5. 7 h and 3. 8 h vs 5. 7 h, P< 0. 01). No complications caused by the block occurred in the post-operation. Conclusion: Lower abdominal aorta block is safe and effective in controlling haemorrhage during operations of the gynecologic tumor.展开更多
Objective: It is important to minimize the risk of major vascular injury during pneumoperitoneumestablishment in laparoscopic surgeries for patients with unusual variations in the levels of theabdominal aorta, the inf...Objective: It is important to minimize the risk of major vascular injury during pneumoperitoneumestablishment in laparoscopic surgeries for patients with unusual variations in the levels of theabdominal aorta, the inferior vena cava (IVC), and the left renal vein, which will decrease the morbidityand mortality. The study aims to assess the variations regarding the bifurcation level of the abdominalaorta, formation level of the IVC, and insertion level of the left renal vein into the IVC.Methods: This retrospective study was conducted on 100 patients (50 males and 50 females) referred tothe Department of Radiology, Jordan University Hospital for abdomino-pelvic CT with intra-venouscontrast from January 2018 to December 2019. The three vessels were determined on the axial plane,the coronal plane, and the midsagittal plane. The central vertebral body height as well as the distance ofthe level of the point of interest to the upper end plate of the vertebrae were measured. Afterwards, theresults were classified into the following categories, upper end plate, lower end plate, intervertebral disc,upper half, and lower half of the vertebra.Results: The aortic bifurcation was mainly found at the level of the L4 vertebral body (65, 65%). In theremaining cases, the bifurcation was found to be variably located spanning from L3 in 11 (11%) cases to3 (3%) cases at L5. As for the iliocaval junction, the most common site was also at the level of L4 with41 (41%) cases followed by 39 (39%) cases at the level of L5, and 20 (20%) cases at the intervertebral discof L4/L5. The left renal vein most commonly joined the IVC at the level of L1 with 62 (62%) cases followedby 20 (20%) cases at the intervertebral disc T12/L1. There was wide variation in its entry to the IVCspanning from 4 (4%) cases at T12/L1 to 1 (1%) case at L4.Conclusion: The anatomical variation of the major vessels can be found in the normal population.Therefore, sufficient investigation of the anatomical position of these vessels is essential for patientsbefore laparoscopic surgery.展开更多
In vitro experimental set-up is an important tool for investigating abdominal aortic aneurysm (AAA). Accurate reproduction of the physiological pulsatile flow waveform in the abdominal aorta at various anatomic locati...In vitro experimental set-up is an important tool for investigating abdominal aortic aneurysm (AAA). Accurate reproduction of the physiological pulsatile flow waveform in the abdominal aorta at various anatomic locations is an important component of these experimental methods. The objective of this study is to establish an experimental set-up to generate a physiological pulsatile flow for in vitro simulations of the abdominal aorta. The physiological flow was established by a computer-controlled peristaltic pump and the flow field in a circular straight pipe is measured under pulsatile flow conditions by a 2-dimensional particle image velocimetry system (2D-PIV). Experimental results show that the in vitro experimental set-up provides a flow with a period of 2 s, a reasonable cross-sectional velocity distribution and an approximate inlet velocity profile that is close to the human abdominal aorta.展开更多
A 42-year old woman of middle aortic syndrome presented with severe hypertension for 20 years, whose abdominal aorta angiography revealed long segment and nearly complete occlusion in the mid portion of abdominal aort...A 42-year old woman of middle aortic syndrome presented with severe hypertension for 20 years, whose abdominal aorta angiography revealed long segment and nearly complete occlusion in the mid portion of abdominal aorta, and extensively enlarged collateral vascular supply to the lower portion of abdominal aorta. The pressures proximal and distal to stenosis were 185/110 and 95/70 mmHg, and the pressure gradient across the stenosis was 90/40 mmHg. After the operation of thoraco-abdominal bypass graft, the pressure difference between the upper and lower extremities eventually disappeared.展开更多
Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were t...Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.展开更多
To evaluate the biocompatibility between the domestic stent-graft and abdominal aorta.Methods We made stent-graft with felting of expanding-polytetra- fluroethylene (ePTFE) graft and nitinol stent.They were implanted ...To evaluate the biocompatibility between the domestic stent-graft and abdominal aorta.Methods We made stent-graft with felting of expanding-polytetra- fluroethylene (ePTFE) graft and nitinol stent.They were implanted in the subrenal abdominal aorta.The specimes were taken out 2,4,12 weeks afterwards and underwnet HE/special pigmentation of collagen and elastin,immunohistochemistry of α actin from vascular smooth muscle cells(VSMC),in-situ apoptosis detection and scan of electromicroscopy.The comparison between them and normal abdominal aorta in intimal thickness,relative content of collagen and elastin,density and apoptosis ratio of VSMC in medium was made through the image analysis.Results The stent-graft was covered with intima as early as 2 weeks but suffered more severe intimal hyperplasia all the time (P<0.01).The morphology and distribution of collagen and elastin were generally normal in the experimental group (P>0.05).However,its density and apoptosis ratio of VSMC in medium were significantly higher than in the normal ones (P<0.01) in 2,4 weeks.Conclusion The stent-graft shared fine biocompatibility with the abdominal aorta except for the significant intimal hyperplasia.3 refs.展开更多
A 63-year-old man was admitted to the hospital with a>1-year history of repeated acid reflux and belching and a 1-month history of an abdominal mass.On admission,the patient was in good condition,and his vital sign...A 63-year-old man was admitted to the hospital with a>1-year history of repeated acid reflux and belching and a 1-month history of an abdominal mass.On admission,the patient was in good condition,and his vital signs were stable.Laboratory examinations revealed no significant abnormalities.展开更多
BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have impr...BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.展开更多
Chronic abdominal wall pain is common but often misdiagnosed,frequently mistaken for visceral disease.Abdominal cutaneous nerve entrapment syndrome(ACNES)is increasingly recognized in Western medicine as a major cause...Chronic abdominal wall pain is common but often misdiagnosed,frequently mistaken for visceral disease.Abdominal cutaneous nerve entrapment syndrome(ACNES)is increasingly recognized in Western medicine as a major cause,typically managed with diagnostic nerve blocks and,in refractory cases,surgical neurectomy.In traditional Chinese medicine(TCM),this condition aligns with“collateral disorder”(Luo Bing),in which pathogenic obstruction of superficial collaterals produces localized pain that is neither strictly external nor internal.This review examines conceptual parallels between ACNES and TCM,emphasizing theoretical foundations,modern innovations in minimally invasive acupuncture,and the potential for interdisciplinary integration.Western research on ACNES pathogenesis,diagnosis,and treatment is discussed alongside TCM classical sources and contemporary studies on Pizhen(a flat-head acupuncture needle)therapy.Western medicine provides diagnostic precision through imaging and nerve blocks but offers limited long-term solutions beyond invasive surgery.By contrast,TCM acupuncture,particularly Pizhen therapy,delivers a micro-invasive,precise,and systemic approach to fascial decompression and nerve release.Biomechanical studies indicate that it can relieve high-tension points,restore microcirculation,and regulate neuromuscular activity.Clinical practice highlights the importance of accurate localization of entrapment sites,pattern differentiation,and holistic regulation.Interdisciplinary integration combines the diagnostic strengths of Western medicine with the therapeutic versatility of TCM,reducing misdiagnosis,improving outcomes,and minimizing invasiveness.ACNES remains a treatable but under-recognized source of abdominal pain.Integrating minimally invasive TCM needle techniques with Western diagnostic methods offers a promising pathway toward precision and holistic care.Future priorities include standardizing protocols,conducting rigorous clinical trials,strengthening multidisciplinary collaboration,and enhancing public awareness.Such approaches hold strong potential to improve outcomes and quality of life for patients with chronic abdominal wall pain.展开更多
Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deteriora...Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.展开更多
BACKGROUND Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers,yet the underlying reasons remain unclear.Gastrointestinal motility,a key pat...BACKGROUND Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers,yet the underlying reasons remain unclear.Gastrointestinal motility,a key pathophysiological factor in functional gastrointestinal disorders,may be influenced by body mass index(BMI).AIM To evaluate the impact of BMI on gastric motility parameters in children with functional abdominal pain disorders(FAPDs).METHODS We assessed gastric motility in 176 children with FAPDs(61.4%females,mean age 7.94 years,SD 1.96 years)and 63 healthy controls(57.1%females,mean age 9.17 years,SD 1.90 years)at the Gastroenterology Research Laboratory,University of Kelaniya,Sri Lanka.FAPDs were diagnosed and subtyped using the Rome IV criteria:Functional abdominal pain 97 patients;irritable bowel syndrome 39 patients,functional dyspepsia(FD)25 patients;and abdominal migraine 15 patients.Gastric motility was measured using a validated ultrasound method.Weight and height were measured using sensitive standard scales.RESULTS The BMIs of children with FAPDs and controls were 15.04 and 15.46 kg/m^(2),respectively(P=0.33).Fasting antral area(FAA)and antral area at 1 min(AA1)and 15 min(AA15)were significantly greater in patients with FAPD with a higher BMI(2.71 cm^(2),12.57 cm^(2),and 7.19 cm^(2),respectively)compared with those with a lower BMI(2.12 cm^(2),10.68 cm^(2),and 6.13 cm^(2),respectively)(P<0.01).BMI positively correlated with FAA and AA15(r=0.18 and r=0.19,respectively)(P<0.01)in those with FAPDs.In controls,only AA1 was greater in the higher BMI group(12.51 cm^(2)vs 9.93 cm^(2))and had a positive correlation(r=0.33)(P≤0.01).Subgroup analysis revealed that in patients with FD,BMI negatively correlated with gastric emptying rate(GER)(r=-0.59)and antral motility index(MI)(r=-0.49),while in functional abdominal pain,MI positively correlated(r=0.25)with BMI(P≤0.01).CONCLUSION In children with FAPDs,higher BMI was associated with increased gastric antral distention during fasting and postprandial periods(as indicated by FAA,AA1,and AA15)but not with contractility and transit(MI,GER).However,in the FD subgroup,high BMI correlated with reduced GER and MI.This indicates the possible role of BMI in gastric hypomotility and the pathophysiology of FD.These findings underscore the importance of lifestyle and dietary interventions aimed at optimizing BMI in the management of FAPDs,particularly FD.展开更多
OBJECTIVE:To assess the efficacy and safety of the Qingyanyin formulated granules(轻燕饮配方颗粒,QYY),press needles(PN),and their combined application in addressing abdominal obesity(AO).This trial aims to offer a mor...OBJECTIVE:To assess the efficacy and safety of the Qingyanyin formulated granules(轻燕饮配方颗粒,QYY),press needles(PN),and their combined application in addressing abdominal obesity(AO).This trial aims to offer a more scientifically grounded therapeutic regimen for clinical interventions.METHODS:From March 2021 to July 2021,a multicenter,triple-blind,randomized 2×2 factorial design clinical trial was conducted across 7 centers in 4 major cities within China's mainland.The trial participants were patients diagnosed with AO.The trial followed a 1∶1∶1∶1 random allocation ratio,assigning participants to one of four groups:QYY placebo plus simulated press needles(SPN)(placebo+SPN),QYY plus SPN(QYY+SPN),QYY placebo plus PN(placebo+PN),and QYY plus PN(QYY+PN).The trial participants received treatment for 12 weeks.Observe the changes in waist circumference,body weight,body mass index(BMI),Beck Depression Inventory(BDI),Beck Anxiety Inventory(BAI)scores,and Pittsburgh Sleep Quality Index(PSQI)before and after treatment.RESULTS:The QYY+PN group exhibited significant improvements in waist circumference compared to placebo+PN[Difference=-1.59,95%CI(-3.03,-0.16)]and placebo+SPN groups[Difference=-2.01,95%CI(-3.46,-0.57)].QYY+PN demonstrated a significant advantage over placebo+SPN[Difference=-2.01,95%CI(-3.46,-0.57)],and no statistically significant interaction was observed between the two interventions(P>0.05).In terms of weight and BMI improvements,the QYY+PN,QYY+SPN,and the PN+placebo groups all experienced trending greater reductions in weight compared to the placebo group.In terms of the total scores of PSQI,BAI,and BDI,all four groups exhibited improvements compared to the baseline.Specifically,concerning the change in total PSQI scores,the QYY+PN group exhibited a greater reduction;Regarding the change in total BAI scores,the PN+placebo group demonstrated a greater decrease;As for the change in total BDI scores,the QYY+SPN group displayed a greater reduction.CONCLUSION:This study confirmed that QYY+PN can effectively reduce the waist circumference of patients with AO.Furthermore,the combined approach offers greater benefits than either treatment alone,all without any reported serious adverse events.展开更多
BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel us...BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.展开更多
BACKGROUND Adult-onset Still's disease(AOSD)is a rare autoinflammatory disease charac-terized by nonspecific symptoms such as fever,rash,sore throat and arthralgia.This paper reports a clinical case of AOSD succes...BACKGROUND Adult-onset Still's disease(AOSD)is a rare autoinflammatory disease charac-terized by nonspecific symptoms such as fever,rash,sore throat and arthralgia.This paper reports a clinical case of AOSD successfully treated with Bo’s abdo-minal acupuncture(BAA).CASE SUMMARY We report a 20-year-old man who suffered from cold exposure,presenting with high fever,rash,sore throat,arthralgia,and elevated erythrocyte sedimentation rate,leukocytosis with neutrophilic predominance,elevated ferritin,elevated C-reactive protein,and negative rheumatoid factors.He was diagnosed with AOSD based on the Yamaguchi criteria.After treatment with traditional Chinese medi-cine(TCM)decoction and prednisone acetate tablets,there was some alleviation of sore throat,joint and muscle pain,and fever,but he still had persistent low-grade fever,rash,sore throat and arthralgia.He went to the TCM acupuncture outpatient department to receive BAA.Abdominal acupoints Zhongwan(CV12),Xiawan(CV10),0.5 cm below Xiawan(CV10),Qihai(CV6),Guanyuan(CV4),bilateral Qixue(KI13),bilateral Huaroumen(ST24),bilateral Shangfengshidian(AB1)and bilateral Daheng(SP15)were selected.After 3 months treatment,all symptoms disappeared,and the laboratory examination returned to normal levels.He did not take glucocorticoids or nonsteroidal anti-inflammatory drugs afterwards,and no relapse was observed during the 3-year follow-up period.CONCLUSION BAA can be used as a complementary medical approach for treatment of AOSD.展开更多
Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic ep...Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic epidural block for upper abdominal cancer surgeries. Methods: This prospective study included 60 patients, 18 to 65 years old with ASA class II who underwent gastrectomy and Whipple’s procedures under general anesthesia. Patients were assigned into two groups: Thoracic epidural group, with injection of 0.1 ml/kg of bupivacaine 0.25% in epidural catheter followed by 0.1 ml/kg/h of 0.125% bupivacaine infusion for 48 hrs., and Erector spinae group, with insertion of bilateral erector spinae catheters to inject 0.1 ml/kg of bupivacaine 0.25% followed by bilateral infusion of 0.1 ml/kg/h of bupivacaine 0.125% for 48 hrs. The primary endpoint was postoperative VAS scores at rest and movement. Secondary endpoint included postoperative total opioid consumption, 1st request for analgesia, hemodynamic changes and satisfaction scores. Results: Pain scores and needed rescue analgesia in both groups were comparable. However, 1st request for opioid was significantly longer in TEPI compared to ESI group. Hemodynamics were significantly lower in TEPI group with no differences in the incidence of postoperative complications except for hypotension. Patient satisfaction scores were arbitrarily higher in ESI group without significance. Conclusion: Erector spinae infusion is a highly promising regional technique with comparable effects to thoracic epidural blockade in reducing pain and opioid needs while causing minimal hemodynamic consequences.展开更多
Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola...Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola children’s university hospital (HUDERF) in Brussels. Methods: We retrospectively conducted a study at the Pediatric Surgery Department of HUDERF, Brussels. The studied period was from January 1, 2014, to January 1, 2024;a span of 10 years. All patients with a confirmed diagnosis of cystic lymphangiomas and who underwent laparoscopic surgery were included in our study. Those who have been operated exclusively by open surgery have been excluded. The technique involved either total laparoscopic resection or laparoscopic-assisted with extra-abdominal resection of the tumor. Parameters that were studied included age, sex, weight, symptoms, preoperative diagnosis, imaging assessment, location, size of the tumor, type of mass, surgical procedure, duration of the surgery, conversion to open surgery, morbidity, and histopathology. Data were analyzed using Microsoft Office Excel 2010 and SPSS. Results: We retrieved 10 files of patients presenting with abdominal cystic lymphangiomas within two patients underwent exclusive open surgery and have excluded from our study. Then our sample was constituted with 8 patients. The mean age of the patients was 6.4 years (standard deviation: 3.6 years, range: 1 to 11 years). Male patients were predominant. The mean weight was 26.7 kg (standard deviation: 14.7 kg, range: 10 to 55 kg). The most common symptom was abdominal pain. Preoperative diagnosis of abdominal cystic lymphangioma was made in 8 cases. Abdominal ultrasound was performed in all patients. MRI was done in 5 patients, and CT scan in 2 patients. All patients presented a multicystic mass. Pure laparoscopic resection of the cyst was done in 2 cases. Laparoscopic-assisted resection in 4 cases (with extra-peritoneal with small bowel resection and mesenteric detorsion in 1 case), and conversion in 2 cases due to the complex location of the cyst. After a follow-up period of 5 years, morbidity was noted in one patient (Patient 3) who developed postoperative bowel obstruction 1 month post-surgery. This patient was re-operated on with a favorable clinical outcome following conventional small bowel resection and anastomosis. The other patients (1, 2, 4, 5, 6, 7 and 8) had a simple clinical course, and no recurrence was observed in our series. Conclusion: Laparoscopic-resection of the abdominal cystic lymphangiomas is feasible in Pediatric Surgery. As minimally invasive surgery it gives many advantages even for complex abdominal cystic lymphangiomas with less morbidity as shown in our series.展开更多
Flow diverting stents are braided,metallic endoluminal devices widely used to treat intracranial aneurysms.Bioresorbable flow diverters(BRFDs)are gaining traction as the next generation of flow diverter technology.BRF...Flow diverting stents are braided,metallic endoluminal devices widely used to treat intracranial aneurysms.Bioresorbable flow diverters(BRFDs)are gaining traction as the next generation of flow diverter technology.BRFDs aim to occlude and heal the aneurysm before safely dissolving into the body,mitigating or eliminating complications associated with the permanent presence of conventional flow diverters such as thromboembolism and stenosis.Additional putative advantages of a BRFD include a reduction in metal induced medical imaging artifacts,a restoration of physiological vasoreactivity,and allowing physicians to re-access the aneurysm if an additional procedure is required.In this current study,iron-manganese-nitrogen(FeMnN)alloy BRFDs and permanent control FDs composed of an industry standard Cobalt-Nickel-Chromium alloy were deployed in the rabbit aorta.MicroCT and SEM corrosion analysis determined the FeMnN wire volumes and cross-sectional areas had reduced approximately 85%and 95%after 3-and 6-months implantation duration,respectively.Histo-logical analysis demonstrated the BRFDs exhibited suitable biocompatibility,with no cases of in-stent throm-bosis,clinically significant stenosis,or adverse tissue responses observed.Immunohistochemistry revealed the neointimas surrounding the BRFDs featured a confluent endothelium covering several layers of smooth muscle cells,with macrophages adjacent to the device wires.The macrophages were able to penetrate the corrosion product and were observed transporting corrosion products away from the implant site.This current work provides primary in vivo corrosion and biocompatibility data to the field for FeMn alloys,which we feel will stimulate and inform the design of next-generation bioresorbable endovascular devices.展开更多
The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the ane...The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the anele spanned by the main aorticarc and the diameter of the descending aorta.irect numerical simulations are conducted for nine model aortas with difierencombinations of aorta arc and outlet diameter.Results reveal that the outlet diameter has a sienificant impact on aorta hemodynamics.A smaller outlet diameter compared to the inlet leads to accelerated blood fow in the descending segment,affecting fiowmorphology including the vortex structures,and increasing peak pressure gradient and wall shear stress.However,it reducesthe oscillatory shear index,indicating a more organized fow.Analyses show faster particle transport and reduced accumulativeresidence time for smaller outlet diameters,The arc anele has less sieniicant efiects on these properties.except for delaying thetime to reach the maximum pressure gradient during cjection.The research results may suggest that the diameter of the aorticoutlet has a greater impact on the fiow structures,while the arc angle has a relatively less efiect.These findings provide insightsinto the relation between hemodynamics and aorta geometry,with potential clinical implications.展开更多
BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine lea...BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine learning models would enable rapid and accurate risk assessments to be performed.AIM To assess the potential of machine learning algorithms to develop predictive models of mortality risk after abdominal surgery.METHODS This retrospective study included 230 individuals who underwent abdominal surgery at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between January 2023 and December 2023.Demographic and surgery-related data were collected and used to develop nomogram,decision-tree,random-forest,gradient-boosting,support vector machine,and naïve Bayesian models to predict 30-day mortality risk after abdominal surgery.Models were assessed using receiver operating characteristic curves and compared using the DeLong test.RESULTS Of the 230 included patients,52 died and 178 survived.Models were developed using the training cohort(n=161)and assessed using the validation cohort(n=68).The areas under the receiver operating characteristic curves for the nomogram,decision-tree,random-forest,gradient-boosting tree,support vector machine,and naïve Bayesian models were 0.908[95%confidence interval(CI):0.824-0.992],0.874(95%CI:0.785-0.963),0.928(95%CI:0.869-0.987),0.907(95%CI:0.837-0.976),0.983(95%CI:0.959-1.000),and 0.807(95%CI:0.702-0.911),respectively.CONCLUSION Nomogram,random-forest,gradient-boosting tree,and support vector machine models all demonstrate strong performances for the prediction of postoperative mortality and can be selected based on the clinical circumstances.展开更多
文摘Objective:To investigate the correlation of abdominal aorta CT value,renal artery CT value and renal cortex thickness with renal cortex CT value on contrast enhanced 64-slice CT images.Methods:96patients(50 men and 46women;16~74years)with normal kidney function,which was confirmed by kidney function test were enrolled in this study,including bilateral kidneys of 92cases and unilateral kidney of 4cases(total of 188kidneys;92left,96right).After intravenous(IV)injection of contrast agent the kidneys of the selected patients were scanned by MDCT.The scans were performed in arterial,venous and 3min delayed phases.All statistical analyses were performed by using IBM SPSS 20.0.Graphs were generated using Graph Pad Prism 5software.Quantitative data were presented as mean±standard deviation,while qualitative data were presented as frequency(%).P<0.05was considered to be statistically significant.Results:The mean renal cortex thickness was(5.19±0.81)mm in all kidneys.In the arterial phase,a statistically significant positive correlation between renal cortex CT values and abdominal aortic CT values was showed(r=0.584;P<0.001).A statistically significant positive correlation between renal cortex CT values and renal cortex thickness was demonstrated(r=0.533,P<0.0001).Likewise,there was a positive correlation between renal cortex CT value and renal artery CT values(r=0.43,P<0.001).Conclusion:It is a promising approach to assess the individual kidney function by measuring abdominal aorta CT value,renal artery CT value,renal cortex CT value and renal cortex thickness using contrast MDCT.
文摘Objective:To evaluate the clinical effects of the abdominal aorta block in controlling haemorrhage during operations of the gynecologic tumor. Methods: From July 1965 to January 2005. we collected patients (n = 49) of gynecologic tumor complicated with haemorrhage during operations, who were divided into 3 groups: preventive blocking group (PG, n=12), treatment blocking group (TG, n = 20) used abdominal aorta block technique with sterilized cotton band and silica gel tube, and control group (CG, n = 17) which were used the regular haemostatic methods, such as ligature, suture and ribbon gauze packing. During operations, the vital signs including the amount of bleeding and transfusion were measured. Results: Compared with the CG, the amount of bleeding and transfusion in the PG and TG decreased significantly (P<0. 01). After using the technique, 32 cases of haemorrhage were controlled completely. All patients finished operation smoothly in the end and the vital signs were stable. The vision field of operation was clear and the operating time was shortened dramatically (3. 0 h vs 5. 7 h and 3. 8 h vs 5. 7 h, P< 0. 01). No complications caused by the block occurred in the post-operation. Conclusion: Lower abdominal aorta block is safe and effective in controlling haemorrhage during operations of the gynecologic tumor.
文摘Objective: It is important to minimize the risk of major vascular injury during pneumoperitoneumestablishment in laparoscopic surgeries for patients with unusual variations in the levels of theabdominal aorta, the inferior vena cava (IVC), and the left renal vein, which will decrease the morbidityand mortality. The study aims to assess the variations regarding the bifurcation level of the abdominalaorta, formation level of the IVC, and insertion level of the left renal vein into the IVC.Methods: This retrospective study was conducted on 100 patients (50 males and 50 females) referred tothe Department of Radiology, Jordan University Hospital for abdomino-pelvic CT with intra-venouscontrast from January 2018 to December 2019. The three vessels were determined on the axial plane,the coronal plane, and the midsagittal plane. The central vertebral body height as well as the distance ofthe level of the point of interest to the upper end plate of the vertebrae were measured. Afterwards, theresults were classified into the following categories, upper end plate, lower end plate, intervertebral disc,upper half, and lower half of the vertebra.Results: The aortic bifurcation was mainly found at the level of the L4 vertebral body (65, 65%). In theremaining cases, the bifurcation was found to be variably located spanning from L3 in 11 (11%) cases to3 (3%) cases at L5. As for the iliocaval junction, the most common site was also at the level of L4 with41 (41%) cases followed by 39 (39%) cases at the level of L5, and 20 (20%) cases at the intervertebral discof L4/L5. The left renal vein most commonly joined the IVC at the level of L1 with 62 (62%) cases followedby 20 (20%) cases at the intervertebral disc T12/L1. There was wide variation in its entry to the IVCspanning from 4 (4%) cases at T12/L1 to 1 (1%) case at L4.Conclusion: The anatomical variation of the major vessels can be found in the normal population.Therefore, sufficient investigation of the anatomical position of these vessels is essential for patientsbefore laparoscopic surgery.
文摘In vitro experimental set-up is an important tool for investigating abdominal aortic aneurysm (AAA). Accurate reproduction of the physiological pulsatile flow waveform in the abdominal aorta at various anatomic locations is an important component of these experimental methods. The objective of this study is to establish an experimental set-up to generate a physiological pulsatile flow for in vitro simulations of the abdominal aorta. The physiological flow was established by a computer-controlled peristaltic pump and the flow field in a circular straight pipe is measured under pulsatile flow conditions by a 2-dimensional particle image velocimetry system (2D-PIV). Experimental results show that the in vitro experimental set-up provides a flow with a period of 2 s, a reasonable cross-sectional velocity distribution and an approximate inlet velocity profile that is close to the human abdominal aorta.
文摘A 42-year old woman of middle aortic syndrome presented with severe hypertension for 20 years, whose abdominal aorta angiography revealed long segment and nearly complete occlusion in the mid portion of abdominal aorta, and extensively enlarged collateral vascular supply to the lower portion of abdominal aorta. The pressures proximal and distal to stenosis were 185/110 and 95/70 mmHg, and the pressure gradient across the stenosis was 90/40 mmHg. After the operation of thoraco-abdominal bypass graft, the pressure difference between the upper and lower extremities eventually disappeared.
文摘Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.
文摘To evaluate the biocompatibility between the domestic stent-graft and abdominal aorta.Methods We made stent-graft with felting of expanding-polytetra- fluroethylene (ePTFE) graft and nitinol stent.They were implanted in the subrenal abdominal aorta.The specimes were taken out 2,4,12 weeks afterwards and underwnet HE/special pigmentation of collagen and elastin,immunohistochemistry of α actin from vascular smooth muscle cells(VSMC),in-situ apoptosis detection and scan of electromicroscopy.The comparison between them and normal abdominal aorta in intimal thickness,relative content of collagen and elastin,density and apoptosis ratio of VSMC in medium was made through the image analysis.Results The stent-graft was covered with intima as early as 2 weeks but suffered more severe intimal hyperplasia all the time (P<0.01).The morphology and distribution of collagen and elastin were generally normal in the experimental group (P>0.05).However,its density and apoptosis ratio of VSMC in medium were significantly higher than in the normal ones (P<0.01) in 2,4 weeks.Conclusion The stent-graft shared fine biocompatibility with the abdominal aorta except for the significant intimal hyperplasia.3 refs.
基金supported by the National Natural Science Foundation of China(Project No.82160348)the Yunnan Province Major Special Plan(No.202302AA310018-D-8)+1 种基金the Youth Talent Project of Yunnan Province's“Xingdian Talent Support Program”(No.XDYC-QNRC-2022-0608)the 2024 Senior Health Technology and Medical Discipline Leader of Yunnan Provincial Health Commission(No.D-2024056).
文摘A 63-year-old man was admitted to the hospital with a>1-year history of repeated acid reflux and belching and a 1-month history of an abdominal mass.On admission,the patient was in good condition,and his vital signs were stable.Laboratory examinations revealed no significant abnormalities.
文摘BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.
文摘Chronic abdominal wall pain is common but often misdiagnosed,frequently mistaken for visceral disease.Abdominal cutaneous nerve entrapment syndrome(ACNES)is increasingly recognized in Western medicine as a major cause,typically managed with diagnostic nerve blocks and,in refractory cases,surgical neurectomy.In traditional Chinese medicine(TCM),this condition aligns with“collateral disorder”(Luo Bing),in which pathogenic obstruction of superficial collaterals produces localized pain that is neither strictly external nor internal.This review examines conceptual parallels between ACNES and TCM,emphasizing theoretical foundations,modern innovations in minimally invasive acupuncture,and the potential for interdisciplinary integration.Western research on ACNES pathogenesis,diagnosis,and treatment is discussed alongside TCM classical sources and contemporary studies on Pizhen(a flat-head acupuncture needle)therapy.Western medicine provides diagnostic precision through imaging and nerve blocks but offers limited long-term solutions beyond invasive surgery.By contrast,TCM acupuncture,particularly Pizhen therapy,delivers a micro-invasive,precise,and systemic approach to fascial decompression and nerve release.Biomechanical studies indicate that it can relieve high-tension points,restore microcirculation,and regulate neuromuscular activity.Clinical practice highlights the importance of accurate localization of entrapment sites,pattern differentiation,and holistic regulation.Interdisciplinary integration combines the diagnostic strengths of Western medicine with the therapeutic versatility of TCM,reducing misdiagnosis,improving outcomes,and minimizing invasiveness.ACNES remains a treatable but under-recognized source of abdominal pain.Integrating minimally invasive TCM needle techniques with Western diagnostic methods offers a promising pathway toward precision and holistic care.Future priorities include standardizing protocols,conducting rigorous clinical trials,strengthening multidisciplinary collaboration,and enhancing public awareness.Such approaches hold strong potential to improve outcomes and quality of life for patients with chronic abdominal wall pain.
文摘Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.
基金Supported by The University of Kelaniya,Sri Lanka,Research Council Grant No.G23.
文摘BACKGROUND Overweight children exhibit a higher prevalence of functional gastrointestinal disorders compared with their normal-weight peers,yet the underlying reasons remain unclear.Gastrointestinal motility,a key pathophysiological factor in functional gastrointestinal disorders,may be influenced by body mass index(BMI).AIM To evaluate the impact of BMI on gastric motility parameters in children with functional abdominal pain disorders(FAPDs).METHODS We assessed gastric motility in 176 children with FAPDs(61.4%females,mean age 7.94 years,SD 1.96 years)and 63 healthy controls(57.1%females,mean age 9.17 years,SD 1.90 years)at the Gastroenterology Research Laboratory,University of Kelaniya,Sri Lanka.FAPDs were diagnosed and subtyped using the Rome IV criteria:Functional abdominal pain 97 patients;irritable bowel syndrome 39 patients,functional dyspepsia(FD)25 patients;and abdominal migraine 15 patients.Gastric motility was measured using a validated ultrasound method.Weight and height were measured using sensitive standard scales.RESULTS The BMIs of children with FAPDs and controls were 15.04 and 15.46 kg/m^(2),respectively(P=0.33).Fasting antral area(FAA)and antral area at 1 min(AA1)and 15 min(AA15)were significantly greater in patients with FAPD with a higher BMI(2.71 cm^(2),12.57 cm^(2),and 7.19 cm^(2),respectively)compared with those with a lower BMI(2.12 cm^(2),10.68 cm^(2),and 6.13 cm^(2),respectively)(P<0.01).BMI positively correlated with FAA and AA15(r=0.18 and r=0.19,respectively)(P<0.01)in those with FAPDs.In controls,only AA1 was greater in the higher BMI group(12.51 cm^(2)vs 9.93 cm^(2))and had a positive correlation(r=0.33)(P≤0.01).Subgroup analysis revealed that in patients with FD,BMI negatively correlated with gastric emptying rate(GER)(r=-0.59)and antral motility index(MI)(r=-0.49),while in functional abdominal pain,MI positively correlated(r=0.25)with BMI(P≤0.01).CONCLUSION In children with FAPDs,higher BMI was associated with increased gastric antral distention during fasting and postprandial periods(as indicated by FAA,AA1,and AA15)but not with contractility and transit(MI,GER).However,in the FD subgroup,high BMI correlated with reduced GER and MI.This indicates the possible role of BMI in gastric hypomotility and the pathophysiology of FD.These findings underscore the importance of lifestyle and dietary interventions aimed at optimizing BMI in the management of FAPDs,particularly FD.
基金National Key Research and Development Project:Clinical Evaluation of the Interventional Techniques for Abdominal Obesity(No.2019YFC1710102)。
文摘OBJECTIVE:To assess the efficacy and safety of the Qingyanyin formulated granules(轻燕饮配方颗粒,QYY),press needles(PN),and their combined application in addressing abdominal obesity(AO).This trial aims to offer a more scientifically grounded therapeutic regimen for clinical interventions.METHODS:From March 2021 to July 2021,a multicenter,triple-blind,randomized 2×2 factorial design clinical trial was conducted across 7 centers in 4 major cities within China's mainland.The trial participants were patients diagnosed with AO.The trial followed a 1∶1∶1∶1 random allocation ratio,assigning participants to one of four groups:QYY placebo plus simulated press needles(SPN)(placebo+SPN),QYY plus SPN(QYY+SPN),QYY placebo plus PN(placebo+PN),and QYY plus PN(QYY+PN).The trial participants received treatment for 12 weeks.Observe the changes in waist circumference,body weight,body mass index(BMI),Beck Depression Inventory(BDI),Beck Anxiety Inventory(BAI)scores,and Pittsburgh Sleep Quality Index(PSQI)before and after treatment.RESULTS:The QYY+PN group exhibited significant improvements in waist circumference compared to placebo+PN[Difference=-1.59,95%CI(-3.03,-0.16)]and placebo+SPN groups[Difference=-2.01,95%CI(-3.46,-0.57)].QYY+PN demonstrated a significant advantage over placebo+SPN[Difference=-2.01,95%CI(-3.46,-0.57)],and no statistically significant interaction was observed between the two interventions(P>0.05).In terms of weight and BMI improvements,the QYY+PN,QYY+SPN,and the PN+placebo groups all experienced trending greater reductions in weight compared to the placebo group.In terms of the total scores of PSQI,BAI,and BDI,all four groups exhibited improvements compared to the baseline.Specifically,concerning the change in total PSQI scores,the QYY+PN group exhibited a greater reduction;Regarding the change in total BAI scores,the PN+placebo group demonstrated a greater decrease;As for the change in total BDI scores,the QYY+SPN group displayed a greater reduction.CONCLUSION:This study confirmed that QYY+PN can effectively reduce the waist circumference of patients with AO.Furthermore,the combined approach offers greater benefits than either treatment alone,all without any reported serious adverse events.
基金Supported by the Taichung Veterans General Hospital,No.TCVGH-1125401B.
文摘BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
基金Supported by Beijing Municipal Commission of Education,No.SM202214075001。
文摘BACKGROUND Adult-onset Still's disease(AOSD)is a rare autoinflammatory disease charac-terized by nonspecific symptoms such as fever,rash,sore throat and arthralgia.This paper reports a clinical case of AOSD successfully treated with Bo’s abdo-minal acupuncture(BAA).CASE SUMMARY We report a 20-year-old man who suffered from cold exposure,presenting with high fever,rash,sore throat,arthralgia,and elevated erythrocyte sedimentation rate,leukocytosis with neutrophilic predominance,elevated ferritin,elevated C-reactive protein,and negative rheumatoid factors.He was diagnosed with AOSD based on the Yamaguchi criteria.After treatment with traditional Chinese medi-cine(TCM)decoction and prednisone acetate tablets,there was some alleviation of sore throat,joint and muscle pain,and fever,but he still had persistent low-grade fever,rash,sore throat and arthralgia.He went to the TCM acupuncture outpatient department to receive BAA.Abdominal acupoints Zhongwan(CV12),Xiawan(CV10),0.5 cm below Xiawan(CV10),Qihai(CV6),Guanyuan(CV4),bilateral Qixue(KI13),bilateral Huaroumen(ST24),bilateral Shangfengshidian(AB1)and bilateral Daheng(SP15)were selected.After 3 months treatment,all symptoms disappeared,and the laboratory examination returned to normal levels.He did not take glucocorticoids or nonsteroidal anti-inflammatory drugs afterwards,and no relapse was observed during the 3-year follow-up period.CONCLUSION BAA can be used as a complementary medical approach for treatment of AOSD.
文摘Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic epidural block for upper abdominal cancer surgeries. Methods: This prospective study included 60 patients, 18 to 65 years old with ASA class II who underwent gastrectomy and Whipple’s procedures under general anesthesia. Patients were assigned into two groups: Thoracic epidural group, with injection of 0.1 ml/kg of bupivacaine 0.25% in epidural catheter followed by 0.1 ml/kg/h of 0.125% bupivacaine infusion for 48 hrs., and Erector spinae group, with insertion of bilateral erector spinae catheters to inject 0.1 ml/kg of bupivacaine 0.25% followed by bilateral infusion of 0.1 ml/kg/h of bupivacaine 0.125% for 48 hrs. The primary endpoint was postoperative VAS scores at rest and movement. Secondary endpoint included postoperative total opioid consumption, 1st request for analgesia, hemodynamic changes and satisfaction scores. Results: Pain scores and needed rescue analgesia in both groups were comparable. However, 1st request for opioid was significantly longer in TEPI compared to ESI group. Hemodynamics were significantly lower in TEPI group with no differences in the incidence of postoperative complications except for hypotension. Patient satisfaction scores were arbitrarily higher in ESI group without significance. Conclusion: Erector spinae infusion is a highly promising regional technique with comparable effects to thoracic epidural blockade in reducing pain and opioid needs while causing minimal hemodynamic consequences.
文摘Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola children’s university hospital (HUDERF) in Brussels. Methods: We retrospectively conducted a study at the Pediatric Surgery Department of HUDERF, Brussels. The studied period was from January 1, 2014, to January 1, 2024;a span of 10 years. All patients with a confirmed diagnosis of cystic lymphangiomas and who underwent laparoscopic surgery were included in our study. Those who have been operated exclusively by open surgery have been excluded. The technique involved either total laparoscopic resection or laparoscopic-assisted with extra-abdominal resection of the tumor. Parameters that were studied included age, sex, weight, symptoms, preoperative diagnosis, imaging assessment, location, size of the tumor, type of mass, surgical procedure, duration of the surgery, conversion to open surgery, morbidity, and histopathology. Data were analyzed using Microsoft Office Excel 2010 and SPSS. Results: We retrieved 10 files of patients presenting with abdominal cystic lymphangiomas within two patients underwent exclusive open surgery and have excluded from our study. Then our sample was constituted with 8 patients. The mean age of the patients was 6.4 years (standard deviation: 3.6 years, range: 1 to 11 years). Male patients were predominant. The mean weight was 26.7 kg (standard deviation: 14.7 kg, range: 10 to 55 kg). The most common symptom was abdominal pain. Preoperative diagnosis of abdominal cystic lymphangioma was made in 8 cases. Abdominal ultrasound was performed in all patients. MRI was done in 5 patients, and CT scan in 2 patients. All patients presented a multicystic mass. Pure laparoscopic resection of the cyst was done in 2 cases. Laparoscopic-assisted resection in 4 cases (with extra-peritoneal with small bowel resection and mesenteric detorsion in 1 case), and conversion in 2 cases due to the complex location of the cyst. After a follow-up period of 5 years, morbidity was noted in one patient (Patient 3) who developed postoperative bowel obstruction 1 month post-surgery. This patient was re-operated on with a favorable clinical outcome following conventional small bowel resection and anastomosis. The other patients (1, 2, 4, 5, 6, 7 and 8) had a simple clinical course, and no recurrence was observed in our series. Conclusion: Laparoscopic-resection of the abdominal cystic lymphangiomas is feasible in Pediatric Surgery. As minimally invasive surgery it gives many advantages even for complex abdominal cystic lymphangiomas with less morbidity as shown in our series.
基金National Institutes of Health grant#R01 NS076491supported by American Heart Association grant 23PRE1012781.
文摘Flow diverting stents are braided,metallic endoluminal devices widely used to treat intracranial aneurysms.Bioresorbable flow diverters(BRFDs)are gaining traction as the next generation of flow diverter technology.BRFDs aim to occlude and heal the aneurysm before safely dissolving into the body,mitigating or eliminating complications associated with the permanent presence of conventional flow diverters such as thromboembolism and stenosis.Additional putative advantages of a BRFD include a reduction in metal induced medical imaging artifacts,a restoration of physiological vasoreactivity,and allowing physicians to re-access the aneurysm if an additional procedure is required.In this current study,iron-manganese-nitrogen(FeMnN)alloy BRFDs and permanent control FDs composed of an industry standard Cobalt-Nickel-Chromium alloy were deployed in the rabbit aorta.MicroCT and SEM corrosion analysis determined the FeMnN wire volumes and cross-sectional areas had reduced approximately 85%and 95%after 3-and 6-months implantation duration,respectively.Histo-logical analysis demonstrated the BRFDs exhibited suitable biocompatibility,with no cases of in-stent throm-bosis,clinically significant stenosis,or adverse tissue responses observed.Immunohistochemistry revealed the neointimas surrounding the BRFDs featured a confluent endothelium covering several layers of smooth muscle cells,with macrophages adjacent to the device wires.The macrophages were able to penetrate the corrosion product and were observed transporting corrosion products away from the implant site.This current work provides primary in vivo corrosion and biocompatibility data to the field for FeMn alloys,which we feel will stimulate and inform the design of next-generation bioresorbable endovascular devices.
基金the support of the Clinical Medicine Plus X-Young Scholars Project at Peking University for thiswork.
文摘The present study investigates the infiuences of aorta geometry on hemodynamics and material transport.Based on the observation of the human aorta.two geometric paramelers are examined for a model aorta,savine the anele spanned by the main aorticarc and the diameter of the descending aorta.irect numerical simulations are conducted for nine model aortas with difierencombinations of aorta arc and outlet diameter.Results reveal that the outlet diameter has a sienificant impact on aorta hemodynamics.A smaller outlet diameter compared to the inlet leads to accelerated blood fow in the descending segment,affecting fiowmorphology including the vortex structures,and increasing peak pressure gradient and wall shear stress.However,it reducesthe oscillatory shear index,indicating a more organized fow.Analyses show faster particle transport and reduced accumulativeresidence time for smaller outlet diameters,The arc anele has less sieniicant efiects on these properties.except for delaying thetime to reach the maximum pressure gradient during cjection.The research results may suggest that the diameter of the aorticoutlet has a greater impact on the fiow structures,while the arc angle has a relatively less efiect.These findings provide insightsinto the relation between hemodynamics and aorta geometry,with potential clinical implications.
基金Supported by the Shanghai Municipal Health Commission Project,No.20214Y0284.
文摘BACKGROUND Preoperative risk assessments are vital for identifying patients at high risk of postoperative mortality.However,traditional scoring systems can be time consuming.We hypothesized that the use of machine learning models would enable rapid and accurate risk assessments to be performed.AIM To assess the potential of machine learning algorithms to develop predictive models of mortality risk after abdominal surgery.METHODS This retrospective study included 230 individuals who underwent abdominal surgery at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between January 2023 and December 2023.Demographic and surgery-related data were collected and used to develop nomogram,decision-tree,random-forest,gradient-boosting,support vector machine,and naïve Bayesian models to predict 30-day mortality risk after abdominal surgery.Models were assessed using receiver operating characteristic curves and compared using the DeLong test.RESULTS Of the 230 included patients,52 died and 178 survived.Models were developed using the training cohort(n=161)and assessed using the validation cohort(n=68).The areas under the receiver operating characteristic curves for the nomogram,decision-tree,random-forest,gradient-boosting tree,support vector machine,and naïve Bayesian models were 0.908[95%confidence interval(CI):0.824-0.992],0.874(95%CI:0.785-0.963),0.928(95%CI:0.869-0.987),0.907(95%CI:0.837-0.976),0.983(95%CI:0.959-1.000),and 0.807(95%CI:0.702-0.911),respectively.CONCLUSION Nomogram,random-forest,gradient-boosting tree,and support vector machine models all demonstrate strong performances for the prediction of postoperative mortality and can be selected based on the clinical circumstances.
