Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical expe...Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical experience and recovery.This mini review aims to evaluate the impact of preoperative anxiety in children,identify contributing factors,and explore effective strategies to manage this anxiety during day surgery.Methods:A literature review was conducted,focusing on studies that assess anxiety levels in pediatric patients before day surgery and the interventions designed to alleviate this anxiety.The review included both psychological and procedural strategies.Results:Preoperative anxiety in children can be influenced by a variety of factors,including age,previous medical experiences,parental anxiety,and the hospital environment.Untreated anxiety may lead to increased postoperative pain,behavioral changes,and extended recovery times.Several strategies,including psychological preparation,family centered approaches,and the involvement of child life specialists,have been shown to effectively reduce anxiety.Conclusions:Managing anxiety in pediatric day surgery is vital to improving both surgical outcomes and the overall experience for children and their families.Healthcare professionals can play a key role in reducing anxiety through targeted interventions and supportive care.展开更多
CASTLEMAN＇S disease（CD）,a rare lymphoproliferative disorder of unknown etiology, was first described in 1956 as a benign mass in the mediastinum. Although CD can present anywhere in the body, 70% of the cases are ...CASTLEMAN＇S disease（CD）,a rare lymphoproliferative disorder of unknown etiology, was first described in 1956 as a benign mass in the mediastinum. Although CD can present anywhere in the body, 70% of the cases are in the chest along the tracheobronchial tree or hilum of the lung in the middle mediastinum; however, they can also occur in the anterior or posterior compartments. CD is classi-fied as unicentric （UCD） or multicentric （MCD） based on the anatomical distribution, and histologically as hya-line-vascular, plasma cell, or mixed subtypes.1 Although MCD is less common than UCD, it can be rapidly pro-gressive and often fatal.展开更多
AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane...AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P<0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma insitu component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.展开更多
BACKGROUND Gastrointestinal involvement in Behçet's disease(GIBD)and Crohn’s disease(CD)are inflammatory diseases sharing a considerable number of similarities.However,different from CD,the operative and pos...BACKGROUND Gastrointestinal involvement in Behçet's disease(GIBD)and Crohn’s disease(CD)are inflammatory diseases sharing a considerable number of similarities.However,different from CD,the operative and postoperative management of GIBD remains largely empirical because of the lack of comprehensive treatment guidelines.AIM To compare surgical patients with GIBD and those with CD in a medical center and identify notable clinical features and effective postoperative treatment for surgical patients with GIBD.METHODS We searched patients diagnosed with CD and GIBD who underwent operations for gastrointestinal complications from 2009 to 2015 at West China Hospital of Sichuan University.A total of 10 surgical patients with GIBD and 106 surgical patients with CD were recruited.Information including demographic data,medication,and operative and postoperative parameters were collected and analyzed.As the incidence of surgical GIBD is low,their detailed medical records were reviewed and compared to previous studies.Moreover,the prognoses of CD and GIBD were evaluated respectively between groups treated with biological and non-biological agents.RESULTS Indication for first surgery was often acute intestinal perforation for GIBDpatients (7/10 vs 0/106, P < 0.001), whereas intestinal fistulae (0/10 vs 44/106, P =0.013) and ileus (0/10 vs 40/106, P = 0.015) were the indications for surgical CDpatients. Approximately 40% of patients with GIBD and 23.6% of patients withCD developed postoperative complications, 50% of patients with GIBD and 38.7%of patients with CD had recurrence postoperatively, and 40% (4/10) of patientswith GIBD and 26.4% (28/106) of patients with CD underwent reoperations. Theaverage period of postoperative recurrence was 7.87 mo in patients with Behçet'sdisease (BD) and 10.43 mo in patients with CD, whereas the mean duration fromfirst surgery to reoperation was 5.75 mo in BD patients and 18.04 mo in CDpatients. Surgical patients with GIBD more often used corticosteroids (6/10 vs7/106, P < 0.001) and thalidomide (7/10 vs 9/106, P < 0.001) postoperatively,whereas surgical patients with CD often used infliximab (27/106), azathioprine,or 6-mercaptopurine (74/106) for maintenance therapy.CONCLUSIONPatients suffering GIBD require surgery mostly under emergency situations,which may be more susceptible to recurrence and reoperation and need moreaggressive postoperative treatment than patients with CD.展开更多
We read with interest the study from Jolissaint et al.recently issued in the Annals of Surgery(1).In this single center retrospective study,the authors compared oncological outcomes in patients with pancreatic ductal ...We read with interest the study from Jolissaint et al.recently issued in the Annals of Surgery(1).In this single center retrospective study,the authors compared oncological outcomes in patients with pancreatic ductal adenocarcinoma(PDAC)and vascular involvement who underwent pancreatectomy(n=105)vs.high dose ablative radiation(A-RT,n=104).All patients received induction chemotherapy first,over a recent study period[2014-2018].While the rationale for submitting patients to pancreatectomy or A-RT was not clearly stated in the Methods section,comparison between the two groups showed that patients allocated to A-RT were frailer with higher Charlson Comorbidity indexes and Eastern Cooperative Oncology Group(ECOG)scores and harbored significantly larger tumors,more often left-sided,with more arterial involvement as compared to patients in the pancreatectomy group.展开更多
文摘Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical experience and recovery.This mini review aims to evaluate the impact of preoperative anxiety in children,identify contributing factors,and explore effective strategies to manage this anxiety during day surgery.Methods:A literature review was conducted,focusing on studies that assess anxiety levels in pediatric patients before day surgery and the interventions designed to alleviate this anxiety.The review included both psychological and procedural strategies.Results:Preoperative anxiety in children can be influenced by a variety of factors,including age,previous medical experiences,parental anxiety,and the hospital environment.Untreated anxiety may lead to increased postoperative pain,behavioral changes,and extended recovery times.Several strategies,including psychological preparation,family centered approaches,and the involvement of child life specialists,have been shown to effectively reduce anxiety.Conclusions:Managing anxiety in pediatric day surgery is vital to improving both surgical outcomes and the overall experience for children and their families.Healthcare professionals can play a key role in reducing anxiety through targeted interventions and supportive care.
文摘CASTLEMAN＇S disease（CD）,a rare lymphoproliferative disorder of unknown etiology, was first described in 1956 as a benign mass in the mediastinum. Although CD can present anywhere in the body, 70% of the cases are in the chest along the tracheobronchial tree or hilum of the lung in the middle mediastinum; however, they can also occur in the anterior or posterior compartments. CD is classi-fied as unicentric （UCD） or multicentric （MCD） based on the anatomical distribution, and histologically as hya-line-vascular, plasma cell, or mixed subtypes.1 Although MCD is less common than UCD, it can be rapidly pro-gressive and often fatal.
文摘AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P<0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma insitu component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.
基金National Natural Science Foundation of China,No.81270447.
文摘BACKGROUND Gastrointestinal involvement in Behçet's disease(GIBD)and Crohn’s disease(CD)are inflammatory diseases sharing a considerable number of similarities.However,different from CD,the operative and postoperative management of GIBD remains largely empirical because of the lack of comprehensive treatment guidelines.AIM To compare surgical patients with GIBD and those with CD in a medical center and identify notable clinical features and effective postoperative treatment for surgical patients with GIBD.METHODS We searched patients diagnosed with CD and GIBD who underwent operations for gastrointestinal complications from 2009 to 2015 at West China Hospital of Sichuan University.A total of 10 surgical patients with GIBD and 106 surgical patients with CD were recruited.Information including demographic data,medication,and operative and postoperative parameters were collected and analyzed.As the incidence of surgical GIBD is low,their detailed medical records were reviewed and compared to previous studies.Moreover,the prognoses of CD and GIBD were evaluated respectively between groups treated with biological and non-biological agents.RESULTS Indication for first surgery was often acute intestinal perforation for GIBDpatients (7/10 vs 0/106, P < 0.001), whereas intestinal fistulae (0/10 vs 44/106, P =0.013) and ileus (0/10 vs 40/106, P = 0.015) were the indications for surgical CDpatients. Approximately 40% of patients with GIBD and 23.6% of patients withCD developed postoperative complications, 50% of patients with GIBD and 38.7%of patients with CD had recurrence postoperatively, and 40% (4/10) of patientswith GIBD and 26.4% (28/106) of patients with CD underwent reoperations. Theaverage period of postoperative recurrence was 7.87 mo in patients with Behçet'sdisease (BD) and 10.43 mo in patients with CD, whereas the mean duration fromfirst surgery to reoperation was 5.75 mo in BD patients and 18.04 mo in CDpatients. Surgical patients with GIBD more often used corticosteroids (6/10 vs7/106, P < 0.001) and thalidomide (7/10 vs 9/106, P < 0.001) postoperatively,whereas surgical patients with CD often used infliximab (27/106), azathioprine,or 6-mercaptopurine (74/106) for maintenance therapy.CONCLUSIONPatients suffering GIBD require surgery mostly under emergency situations,which may be more susceptible to recurrence and reoperation and need moreaggressive postoperative treatment than patients with CD.
文摘We read with interest the study from Jolissaint et al.recently issued in the Annals of Surgery(1).In this single center retrospective study,the authors compared oncological outcomes in patients with pancreatic ductal adenocarcinoma(PDAC)and vascular involvement who underwent pancreatectomy(n=105)vs.high dose ablative radiation(A-RT,n=104).All patients received induction chemotherapy first,over a recent study period[2014-2018].While the rationale for submitting patients to pancreatectomy or A-RT was not clearly stated in the Methods section,comparison between the two groups showed that patients allocated to A-RT were frailer with higher Charlson Comorbidity indexes and Eastern Cooperative Oncology Group(ECOG)scores and harbored significantly larger tumors,more often left-sided,with more arterial involvement as compared to patients in the pancreatectomy group.
