Background: Right upper lobectomy(RUL) for lung cancer with di erent dissecting orders involves the most vari?able anatomical structures, but no studies have analyzed its e ects on postoperative recovery. This study c...Background: Right upper lobectomy(RUL) for lung cancer with di erent dissecting orders involves the most vari?able anatomical structures, but no studies have analyzed its e ects on postoperative recovery. This study compared the conventional surgical approach, VAB(dissecting pulmonary vessels first, followed by the bronchus), and the alter?native surgical approach, a BVA(dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients.Methods: According to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into a BVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare periop?erative outcomes.Results: Three hundred one patients were selected(109 in the a BVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the a BVA cohort than in the VAB cohort(164 vs. 221 min, P < 0.001), and less blood loss occurred in the a BVA cohort(92 vs. 141 m L, P < 0.001). The rate of conversion to thoracotomy was lower in the a BVA cohort than in the VAB cohort(0% vs. 11.5%, P < 0.001). The mean duration of postoperative chest drainage was shorter in the a BVA cohort than in the VAB cohort(3.6 vs. 4.5 days, P rvival was n= 0.001). The rates of postoperative complica?tions were comparable(P = 0.629). The median overall suot arrived in both cohorts(P > 0.05). The median disease?free survival was comparable for all patients in the two cohorts(not arrived vs. 41.97 months) and for patients with disease recurrences(13.25 vs. 9.44 months)(both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences(6.4% vs. 7.8%), distant metastases(10.1% vs. 8.3%), and both(1.8% vs. 1.6%)(all P > 0.05).Conclusions: Dissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the a BVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.展开更多
Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive t...Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive treatment have not been well established.Objective:To evaluate the safety and efficacy of reconstructive endovascular treatment(EVT)for symptomatic VADAs with Willis covered stent.Methods:We evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent,compared with stent-assisted coiling(SAC)on the characteristics,posttreatment course,angiographic and clinical follow-up outcomes at an average of 14.4 months(range,3-48 months).Results:A total of 33 patients with symptomatic VADAs were reviewed,23 of these patients with ruptured VADAs.The technical successful rate is 100%respectively in Willis covered stent(Group A)and SAC(Group B,n=20).The initial complete occlusion rate was significant higher in group A(100%)than group B(30%)(p<0.01).Major procedure-related complications were not significant different in the two groups.Serial follow-up angiograms revealed 5 recurrent VADAs in group B and no recurrence in group A(p>0.05).No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period.The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A(100%)than group B(80%),but no significant statistical difference(p>0.05).Clinical outcomes were favorable in 31(93.9%),severe disability occurred in one in group B,and only one death in group A.The final clinical outcomes were also not significant difference in the two groups(p>0.05).Conclusions:Our initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments,which is similar to favorable results with SAC.However,an expanded clinical experiences and larger cohort studies are needed.展开更多
Stent-graft implantation is an important means of clinical treatment for aortic dissecting aneurysm （ADA）. However, researches on fluid dynamics effects of stent were rare. Computer simulation was used to investigat...Stent-graft implantation is an important means of clinical treatment for aortic dissecting aneurysm （ADA）. However, researches on fluid dynamics effects of stent were rare. Computer simulation was used to investigate the interactions between bloodstream and vascular structure in a stented ADA, which endures the periodic pulse velocity and pressure. We obtained and analyzed the flow velocity distribution, the wall displacement and wall stress in the ADA. By comparing the different results between a non-stented and a stented ADA, we found that the insertion of a vascular graft can make the location of maximum stress and displacement move from the aneurysm lumen wall to the artery wall, accompanied with a greatly decrease in value. These results imply that the placement of a stent-graft of any kind to oc-clude ADA will result in a decreased chance of rupture.展开更多
An 80-year-old woman visited emergency room because of resting chest pain for one hour. She had history of hypertension for 10 years. The blood pressure was 80/50 mmHg and the pulse rate was 51 beats/min. The electroc...An 80-year-old woman visited emergency room because of resting chest pain for one hour. She had history of hypertension for 10 years. The blood pressure was 80/50 mmHg and the pulse rate was 51 beats/min. The electrocardiogram demonstrated Junctional bradycardia and ST elevation in lead Ⅱ, Ⅲ and aVF. Chest X-ray indicated cardiomegaly （Figure 1A）. Coronary angiography revealed near total occlusion of proximal right coronary artery （RCA）. She underwent percutaneous coronary intervention （PCI） for the RCA lesion successfully. Echocardiography showed hypokinesia of RCA territory （Figure 2A）.展开更多
BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-n...BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-necked and fusiform aneurysms.Here,we present two cases of extracranial internal carotid artery dissecting aneurysms treated successfully using the SUPERA stent.CASE SUMMARY Case 1 was a 57-year-old male patient with sudden right limb weakness and vague speech and diagnosed with cerebral infarction in February 2019.Cervical computed tomographic angiography(CTA)revealed left internal carotid artery dissection with stenosis.CTA at 2 mo showed an eccentric wide-necked dissecting aneurysm(5 mm×5 mm×12 mm,10-mm neck)that was enlarged at 4 mo(7 mm×6 mm×12 mm,11-mm neck).The patient underwent SUPERA stent implantation.His condition was stable in July 2020.Case 2 was a 57-year-old man who suddenly felt dizzy and developed unsteady walking in November 2019.Cervical CTA suggested right internal carotid artery dissecting aneurysm(11 mm×9 mm×31 mm)complicated with severe lumen stenosis(95%).The patient underwent SUPERA stent implantation.The patient had no residual symptoms and was stable in December 2020.CONCLUSION SUPERA stent implantation might achieve good results in treating wide-necked or long fusiform internal carotid artery dissecting aneurysms.展开更多
BACKGROUND Large intracranial dissecting aneurysm(IDA)in the anterior cerebral circulation is rare in children.There has been no consensus on the diagnosis and treatment for IDA in children.CASE SUMMARY We report a 3-...BACKGROUND Large intracranial dissecting aneurysm(IDA)in the anterior cerebral circulation is rare in children.There has been no consensus on the diagnosis and treatment for IDA in children.CASE SUMMARY We report a 3-year-old boy with a large ruptured IDA in the right middle cerebral artery(16 mm×14 mm).The IDA was successfully managed with clipping and angioplasty.Next-generation sequencing of the blood sample followed by bioinformatics analysis suggested that the rs78977446 variant of the ADAMTS13 gene is a risk for pediatric IDA.Three years after surgery,the boy was developmentally normal.CONCLUSION Clipping and angioplasty are effective treatments for ruptured IDA in the anterior cerebral circulation.ADAMTS13 rs78977446 is a risk factor for pediatric IDA.展开更多
Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate....Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate. With the development of imaging technology, especially echocardiography, this complication has been gradually recognized. Case Presentation: The patient had intermittent chest and back pain without obvious inducement and did not seek medical treatment in time. One month later, the patient came to the hospital for treatment due to the aggravation of the condition. Transthoracic echocardiography (TTE) in the other hospital showed segmental wall motion abnormality and hypoechoic mass in the left ventricular apex, which was considered thrombosis. In our hospital, the diagnosis by Transthoracic echocardiography combined with left ventricular opacification (LVO) was: segmental wall motion abnormality, left ventricular apex hypoecho mass, intramyocardial dissecting with hematoma formation were considered. Later, the diagnosis of Intramyocardial dissecting with hematoma formation was confirmed by cardiac magnetic resonance (CMR) examination in a superior hospital. Conclusion: In this case report, by analyzing the ultrasound imaging manifestations of left ventricular intramyocardial dissecting hematoma after myocardial infarction and its differential diagnosis with left ventricular mural thrombosis, we deepened the understanding of this rare complication and provided a reliable basis for clinical treatment decisions.展开更多
Objective To analyze the clinical features of intracranial dissecting aneurysm and summarize the experience of its endovascular embolization. Methods 16 cases of intracranial dissecting aneurysm were treated by endova...Objective To analyze the clinical features of intracranial dissecting aneurysm and summarize the experience of its endovascular embolization. Methods 16 cases of intracranial dissecting aneurysm were treated by endovascular embolization. Among these 16 patients,3 patients were treated with single stent or double展开更多
Dear Editor Through the efficient use of heterosis, hybrid rice varieties generally have higher grain yield potential than inbred varieties. With the significant advantage in grain yield, over the past 30 years approx...Dear Editor Through the efficient use of heterosis, hybrid rice varieties generally have higher grain yield potential than inbred varieties. With the significant advantage in grain yield, over the past 30 years approximately half of China＇s total rice-growing area is planted with rice hybrids. However, grain quality has now become one of the most important targets in hybrid rice breeding for meeting consumer demands. Grain shape and chalkiness are two important components of rice grain quality, in which slender grains （typically, grain length-to-width ratio 〉3） with low chatkiness are preferred by most consumers of hybrid rice.展开更多
Background： The endovascular strategy of the huge dissecting aneurysms involving the basilar artery （BA） is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the...Background： The endovascular strategy of the huge dissecting aneurysms involving the basilar artery （BA） is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping （IT） technique. Methods： We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results： All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months alter the endovascular treatment （median 8 months）, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions： The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.展开更多
Backgroud:We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PA...Backgroud:We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PAO).Methods:From June 2006 to July 2013,26 patients with PCA dissecting aneurysms were planned to be treated via endovascular PAO in our institution.Fourteen patients had ruptured aneurysms,and twelve patients had unruptured aneurysms.The endovascular modalities were the following:1) PAO (n =19),2) palliative embolization (n =5),and 3) proximal PAO (n =2).Glasgow Outcome Scale (GOS) was used to assess the clinical outcome.Results:The procedure was technically successful in all cases.In the PAO and proximal PAO group,all of the immediate angiography showed occlusion of the parent vessel,and follow-up imaging showed no recurrence of the aneurysms.In the palliative embolization group,one of five patients was died of rebleeding after the procedure,and follow-up digital subtraction angiography (DSA) showed the other four aneurysms recurred.Five procedure related complications occurred totally:rebleeding (n =1),hemiparesis (n =2),and hemianopsia (n =2).Conclusion:Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and a thorough treatment is warranted.Sacrificing the parent artery appears to be well tolerated for distal segment of PCA.We propose that this technique could be the first treatment option in treating dissecting aneurysms in this location.However,palliative occlusion of distal PCA dissecting aneurysms is not an advisable treatment option.展开更多
BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate se...BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.展开更多
China’s actual utilized foreign investment amounted to $383 billion dur-ing the 10th Five-Year Plan period (2001-05). This capital influx from out-side the country has been one of the major financial sources sustaini...China’s actual utilized foreign investment amounted to $383 billion dur-ing the 10th Five-Year Plan period (2001-05). This capital influx from out-side the country has been one of the major financial sources sustaining thecountry’s development. However, calls for an upgraded foreign investmentstructure that is technology intensive have been on the rise in recent years. Hence, late last year, the National Development and Reform Commission(NDRC), China’s top economic planning agency, came out with a blueprintoutlining the broad policy intention concerning foreign direct investment(FDI) in the next five years, starting from 2006. The new program requires amore efficient utilization of FDI, shifting to a “quality, instead of quantity”approach. Specifically, the Chinese Government will encourage moreimports of advanced technology, management expertise and high-caliberprofessionals. Meanwhile, it is willing to channel more foreign capital to eco-logical development, environmental protection, and energy and resource con-servation projects, hoping foreign investors will help upgrade China’s indus-trial structure and improve its technical levels. 21st Century Business Herald, a leading Chinese business newspaper, invit-ed Zhang Yansheng, Director of the Institute for International EconomicResearch under the NDRC, and Zhao Jinping, Deputy Director of theForeign Economic Department under the Development Research Center ofthe State Council, to take an in-depth look into China’s future policy changestoward foreign investment. Some excerpts from their observations follow:展开更多
A 62-year-old male patient was presented to the First Affiliated Hospital,Zhejiang University,School of Medicine with right hemiparesis and aphasia.No obvious infections were found.The magnetic resonance imaging demon...A 62-year-old male patient was presented to the First Affiliated Hospital,Zhejiang University,School of Medicine with right hemiparesis and aphasia.No obvious infections were found.The magnetic resonance imaging demonstrated multiple infarctions in the area supplied by the left middle cerebral artery.The diagnosis was made as left middle cerebral artery dissecting aneurysm with stenosis.After adequate preoperative preparation,the patient received interventional therapy and then exhibited good prognosis.This paper introduces the interventional procedures for the treatment of the left middle cerebral artery dissecting aneurysm with stenosis.展开更多
BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD....BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.展开更多
In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive ove...In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.展开更多
BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the fact...BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors.METHODS The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected.According to radical resection criteria,the patients were further divided into curative resection group(n=143)and NCR group(n=30).Clinical information was collected,including surgical method,tumor diameter,tumor site,ulcer formation,depth of invasion,pathological type,and lymph node metastasis.Logistic regression analysis was used to explore the factors affecting non-curable resection.RESULTS Multivariate logistic regression analysis showed that ulcer formation[odds ratio(OR)=3.53;95%confidence interval(CI):1.55-8.01,P=0.003],pathological type(OR=3.73;95%CI:1.60-8.74,P=0.002),tumor diameter(OR=3.15;95%CI:1.40-7.05,P=0.005),tumor location(OR=3.50;95%CI:1.16-10.58,P=0.027),lymph node metastasis(OR=4.40;95%CI:1.83-10.57,P=0.001),and depth of penetration(OR=3.75;95%CI:1.60-8.74,P=0.002)were all risk factors for NCR in EGC patients.Predictive analysis showed varying area under the curve values for factors such as tumor diameter(0.636),tumor location(0.608),ulcer formation(0.652),infiltration depth(0.658),pathological type(0.656),and lymph node metastasis(0.674).CONCLUSION The results suggest that factors such as tumor diameter,tumor location,ulcer formation,depth of invasion,pathological type,and lymph node metastasis increase the risk of NCR in EGC patients.展开更多
BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particu...BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychologi...BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.展开更多
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.81673031,81001031,81372285)
文摘Background: Right upper lobectomy(RUL) for lung cancer with di erent dissecting orders involves the most vari?able anatomical structures, but no studies have analyzed its e ects on postoperative recovery. This study compared the conventional surgical approach, VAB(dissecting pulmonary vessels first, followed by the bronchus), and the alter?native surgical approach, a BVA(dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients.Methods: According to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into a BVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare periop?erative outcomes.Results: Three hundred one patients were selected(109 in the a BVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the a BVA cohort than in the VAB cohort(164 vs. 221 min, P < 0.001), and less blood loss occurred in the a BVA cohort(92 vs. 141 m L, P < 0.001). The rate of conversion to thoracotomy was lower in the a BVA cohort than in the VAB cohort(0% vs. 11.5%, P < 0.001). The mean duration of postoperative chest drainage was shorter in the a BVA cohort than in the VAB cohort(3.6 vs. 4.5 days, P rvival was n= 0.001). The rates of postoperative complica?tions were comparable(P = 0.629). The median overall suot arrived in both cohorts(P > 0.05). The median disease?free survival was comparable for all patients in the two cohorts(not arrived vs. 41.97 months) and for patients with disease recurrences(13.25 vs. 9.44 months)(both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences(6.4% vs. 7.8%), distant metastases(10.1% vs. 8.3%), and both(1.8% vs. 1.6%)(all P > 0.05).Conclusions: Dissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the a BVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.
基金financially supported by the National Natural Science Foundation of China[grant numbers 81771951]
文摘Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive treatment have not been well established.Objective:To evaluate the safety and efficacy of reconstructive endovascular treatment(EVT)for symptomatic VADAs with Willis covered stent.Methods:We evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent,compared with stent-assisted coiling(SAC)on the characteristics,posttreatment course,angiographic and clinical follow-up outcomes at an average of 14.4 months(range,3-48 months).Results:A total of 33 patients with symptomatic VADAs were reviewed,23 of these patients with ruptured VADAs.The technical successful rate is 100%respectively in Willis covered stent(Group A)and SAC(Group B,n=20).The initial complete occlusion rate was significant higher in group A(100%)than group B(30%)(p<0.01).Major procedure-related complications were not significant different in the two groups.Serial follow-up angiograms revealed 5 recurrent VADAs in group B and no recurrence in group A(p>0.05).No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period.The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A(100%)than group B(80%),but no significant statistical difference(p>0.05).Clinical outcomes were favorable in 31(93.9%),severe disability occurred in one in group B,and only one death in group A.The final clinical outcomes were also not significant difference in the two groups(p>0.05).Conclusions:Our initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments,which is similar to favorable results with SAC.However,an expanded clinical experiences and larger cohort studies are needed.
基金supported by the National Natural Science Foundation of China (11172156 and 30970822)the National Science Foundation for Post-doctoral Scientists of China (2012M510021)
文摘Stent-graft implantation is an important means of clinical treatment for aortic dissecting aneurysm （ADA）. However, researches on fluid dynamics effects of stent were rare. Computer simulation was used to investigate the interactions between bloodstream and vascular structure in a stented ADA, which endures the periodic pulse velocity and pressure. We obtained and analyzed the flow velocity distribution, the wall displacement and wall stress in the ADA. By comparing the different results between a non-stented and a stented ADA, we found that the insertion of a vascular graft can make the location of maximum stress and displacement move from the aneurysm lumen wall to the artery wall, accompanied with a greatly decrease in value. These results imply that the placement of a stent-graft of any kind to oc-clude ADA will result in a decreased chance of rupture.
文摘An 80-year-old woman visited emergency room because of resting chest pain for one hour. She had history of hypertension for 10 years. The blood pressure was 80/50 mmHg and the pulse rate was 51 beats/min. The electrocardiogram demonstrated Junctional bradycardia and ST elevation in lead Ⅱ, Ⅲ and aVF. Chest X-ray indicated cardiomegaly （Figure 1A）. Coronary angiography revealed near total occlusion of proximal right coronary artery （RCA）. She underwent percutaneous coronary intervention （PCI） for the RCA lesion successfully. Echocardiography showed hypokinesia of RCA territory （Figure 2A）.
文摘BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-necked and fusiform aneurysms.Here,we present two cases of extracranial internal carotid artery dissecting aneurysms treated successfully using the SUPERA stent.CASE SUMMARY Case 1 was a 57-year-old male patient with sudden right limb weakness and vague speech and diagnosed with cerebral infarction in February 2019.Cervical computed tomographic angiography(CTA)revealed left internal carotid artery dissection with stenosis.CTA at 2 mo showed an eccentric wide-necked dissecting aneurysm(5 mm×5 mm×12 mm,10-mm neck)that was enlarged at 4 mo(7 mm×6 mm×12 mm,11-mm neck).The patient underwent SUPERA stent implantation.His condition was stable in July 2020.Case 2 was a 57-year-old man who suddenly felt dizzy and developed unsteady walking in November 2019.Cervical CTA suggested right internal carotid artery dissecting aneurysm(11 mm×9 mm×31 mm)complicated with severe lumen stenosis(95%).The patient underwent SUPERA stent implantation.The patient had no residual symptoms and was stable in December 2020.CONCLUSION SUPERA stent implantation might achieve good results in treating wide-necked or long fusiform internal carotid artery dissecting aneurysms.
基金Supported by National Natural Science Foundation of China,No.81571144。
文摘BACKGROUND Large intracranial dissecting aneurysm(IDA)in the anterior cerebral circulation is rare in children.There has been no consensus on the diagnosis and treatment for IDA in children.CASE SUMMARY We report a 3-year-old boy with a large ruptured IDA in the right middle cerebral artery(16 mm×14 mm).The IDA was successfully managed with clipping and angioplasty.Next-generation sequencing of the blood sample followed by bioinformatics analysis suggested that the rs78977446 variant of the ADAMTS13 gene is a risk for pediatric IDA.Three years after surgery,the boy was developmentally normal.CONCLUSION Clipping and angioplasty are effective treatments for ruptured IDA in the anterior cerebral circulation.ADAMTS13 rs78977446 is a risk factor for pediatric IDA.
文摘Background: Intramyocardial Dissecting Hematoma (IDH) is one of the serious and rare complications of acute myocardial infarction (AMI). It is a manifestation of subacute cardiac rupture and has a high mortality rate. With the development of imaging technology, especially echocardiography, this complication has been gradually recognized. Case Presentation: The patient had intermittent chest and back pain without obvious inducement and did not seek medical treatment in time. One month later, the patient came to the hospital for treatment due to the aggravation of the condition. Transthoracic echocardiography (TTE) in the other hospital showed segmental wall motion abnormality and hypoechoic mass in the left ventricular apex, which was considered thrombosis. In our hospital, the diagnosis by Transthoracic echocardiography combined with left ventricular opacification (LVO) was: segmental wall motion abnormality, left ventricular apex hypoecho mass, intramyocardial dissecting with hematoma formation were considered. Later, the diagnosis of Intramyocardial dissecting with hematoma formation was confirmed by cardiac magnetic resonance (CMR) examination in a superior hospital. Conclusion: In this case report, by analyzing the ultrasound imaging manifestations of left ventricular intramyocardial dissecting hematoma after myocardial infarction and its differential diagnosis with left ventricular mural thrombosis, we deepened the understanding of this rare complication and provided a reliable basis for clinical treatment decisions.
文摘Objective To analyze the clinical features of intracranial dissecting aneurysm and summarize the experience of its endovascular embolization. Methods 16 cases of intracranial dissecting aneurysm were treated by endovascular embolization. Among these 16 patients,3 patients were treated with single stent or double
文摘Dear Editor Through the efficient use of heterosis, hybrid rice varieties generally have higher grain yield potential than inbred varieties. With the significant advantage in grain yield, over the past 30 years approximately half of China＇s total rice-growing area is planted with rice hybrids. However, grain quality has now become one of the most important targets in hybrid rice breeding for meeting consumer demands. Grain shape and chalkiness are two important components of rice grain quality, in which slender grains （typically, grain length-to-width ratio 〉3） with low chatkiness are preferred by most consumers of hybrid rice.
基金Source of Support： This work was supported by grants from the National Science Foundation of China （No. 81220108007, 81171079, 81371315 and 81471167） and Special Research Project for Capital Health Development （No. 2014-1-1071）. Conflict of Interest： None declared.
文摘Background： The endovascular strategy of the huge dissecting aneurysms involving the basilar artery （BA） is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping （IT） technique. Methods： We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results： All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months alter the endovascular treatment （median 8 months）, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions： The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.
基金This research was supported by the Natural Science Foundation of Beijing,China，Specific Research Projects for Capital Health Development
文摘Backgroud:We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PAO).Methods:From June 2006 to July 2013,26 patients with PCA dissecting aneurysms were planned to be treated via endovascular PAO in our institution.Fourteen patients had ruptured aneurysms,and twelve patients had unruptured aneurysms.The endovascular modalities were the following:1) PAO (n =19),2) palliative embolization (n =5),and 3) proximal PAO (n =2).Glasgow Outcome Scale (GOS) was used to assess the clinical outcome.Results:The procedure was technically successful in all cases.In the PAO and proximal PAO group,all of the immediate angiography showed occlusion of the parent vessel,and follow-up imaging showed no recurrence of the aneurysms.In the palliative embolization group,one of five patients was died of rebleeding after the procedure,and follow-up digital subtraction angiography (DSA) showed the other four aneurysms recurred.Five procedure related complications occurred totally:rebleeding (n =1),hemiparesis (n =2),and hemianopsia (n =2).Conclusion:Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and a thorough treatment is warranted.Sacrificing the parent artery appears to be well tolerated for distal segment of PCA.We propose that this technique could be the first treatment option in treating dissecting aneurysms in this location.However,palliative occlusion of distal PCA dissecting aneurysms is not an advisable treatment option.
基金Supported by China Health&Medical Development Foundation,No.M2021551.
文摘BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.
文摘China’s actual utilized foreign investment amounted to $383 billion dur-ing the 10th Five-Year Plan period (2001-05). This capital influx from out-side the country has been one of the major financial sources sustaining thecountry’s development. However, calls for an upgraded foreign investmentstructure that is technology intensive have been on the rise in recent years. Hence, late last year, the National Development and Reform Commission(NDRC), China’s top economic planning agency, came out with a blueprintoutlining the broad policy intention concerning foreign direct investment(FDI) in the next five years, starting from 2006. The new program requires amore efficient utilization of FDI, shifting to a “quality, instead of quantity”approach. Specifically, the Chinese Government will encourage moreimports of advanced technology, management expertise and high-caliberprofessionals. Meanwhile, it is willing to channel more foreign capital to eco-logical development, environmental protection, and energy and resource con-servation projects, hoping foreign investors will help upgrade China’s indus-trial structure and improve its technical levels. 21st Century Business Herald, a leading Chinese business newspaper, invit-ed Zhang Yansheng, Director of the Institute for International EconomicResearch under the NDRC, and Zhao Jinping, Deputy Director of theForeign Economic Department under the Development Research Center ofthe State Council, to take an in-depth look into China’s future policy changestoward foreign investment. Some excerpts from their observations follow:
文摘A 62-year-old male patient was presented to the First Affiliated Hospital,Zhejiang University,School of Medicine with right hemiparesis and aphasia.No obvious infections were found.The magnetic resonance imaging demonstrated multiple infarctions in the area supplied by the left middle cerebral artery.The diagnosis was made as left middle cerebral artery dissecting aneurysm with stenosis.After adequate preoperative preparation,the patient received interventional therapy and then exhibited good prognosis.This paper introduces the interventional procedures for the treatment of the left middle cerebral artery dissecting aneurysm with stenosis.
基金Supported by Science and Technology Department of Sichuan Province,No.2020YFS0376National Natural Science Foundation of China,No.81900599Science and Technology Program of Hospital of TCM,Southwest Medical University,No.2022-CXTD-01.
文摘BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.
文摘In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.
文摘BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors.METHODS The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected.According to radical resection criteria,the patients were further divided into curative resection group(n=143)and NCR group(n=30).Clinical information was collected,including surgical method,tumor diameter,tumor site,ulcer formation,depth of invasion,pathological type,and lymph node metastasis.Logistic regression analysis was used to explore the factors affecting non-curable resection.RESULTS Multivariate logistic regression analysis showed that ulcer formation[odds ratio(OR)=3.53;95%confidence interval(CI):1.55-8.01,P=0.003],pathological type(OR=3.73;95%CI:1.60-8.74,P=0.002),tumor diameter(OR=3.15;95%CI:1.40-7.05,P=0.005),tumor location(OR=3.50;95%CI:1.16-10.58,P=0.027),lymph node metastasis(OR=4.40;95%CI:1.83-10.57,P=0.001),and depth of penetration(OR=3.75;95%CI:1.60-8.74,P=0.002)were all risk factors for NCR in EGC patients.Predictive analysis showed varying area under the curve values for factors such as tumor diameter(0.636),tumor location(0.608),ulcer formation(0.652),infiltration depth(0.658),pathological type(0.656),and lymph node metastasis(0.674).CONCLUSION The results suggest that factors such as tumor diameter,tumor location,ulcer formation,depth of invasion,pathological type,and lymph node metastasis increase the risk of NCR in EGC patients.
基金Supported by National Natural Science Foundation of China,No.82004298Jiangsu Graduate Research and Practice Innovation Program,China,No.KYCX23_2090.
文摘BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.
