AIM: To assess whole-body fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the management of small bowel obstructions (SBOs) secondary to gastric cancer and its role in treatment s...AIM: To assess whole-body fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the management of small bowel obstructions (SBOs) secondary to gastric cancer and its role in treatment strategies. METHODS: The medical records of all of the patients who were admitted for an intestinal obstruction after curative resection for gastric cancer were retrospectively reviewed. PET/CT was performed before a clinical treatment strategy was established for each patient. The patients were divided into 2 groups: patients with no evidence of a tumor recurrence and patients with evidence of a tumor recurrence. Tumor recurrences included a local recurrence, peritoneal carcinomatosis or distant metastases. The primary endpoint was the 1-year survival rate, and other variables included patient demographics, the length of hospital stay, complications, and mortality. RESULTS: The median time between a diagnosis of gastric cancer and the detection of a SBO was 1.4 years. Overall, 31 of 65 patients (47.7%) had evidence of a tumor recurrence on the PET/CT scan, which was the only factor that was associated with poor survival. Open and close surgery was the main type of surgical procedure reported for the patients with tumor recurrences. R0 resections were performed in 2 patients, including 1 who underwent combined adjacent organ resection. In the group with no evidence of a tumor recurrence on PET/CT, bowel resections were performed in 7 patients, adhesiolysis was performed in 7 patients, and a bypass was performed in 1 patient. The 1-year survival curves according to PET/CT evidence of a tumor recurrence vs no PET/CT evidence of a tumor recurrence were significantly different, and the 1-year survival rates were 8.8% vs 93.5%, respectively. There were no significant differences (P = 0.71) in the 1-year survival rates based on surgical vs nonsurgical management (0% with nonoperative treatment vs 20% after exploratory laparotomy). CONCLUSION: 18 F-FDG PET/CT can be used to identify the causes of bowel obstructions in patients with a history of gastric cancer, and this method is useful for planning the surgical management of these patients.展开更多
The present paper studied numerical and experimentally the transesterification reaction between sunflower oil and ethanol with NaO H catalyst in microchannels with circular obstructions. The micromixer design influenc...The present paper studied numerical and experimentally the transesterification reaction between sunflower oil and ethanol with NaO H catalyst in microchannels with circular obstructions. The micromixer design influence on fluid mixing and oil conversion was investigated for a range of operating conditions: Reynolds number(Re = 0.1–100),Temperature(25–75 °C), ethanol/oil molar ratio(6-12), and catalyst concentration(0.75 wt%–1.25 wt%), using three microchannel configurations(Length = 35 mm; Width = 1500 μm; Height = 200 μm): T-shape – channel without obstructions; MCO – channel with 3 obstructions ensemble – equally disposed over longitudinal length;MWO – channel with 7 obstructions ensemble. The MCO micromixer was based on literature work, and the MWO is a totally new micromixer design. Experimental tests were conducted in similar conditions in microreactors using these micromixers(Length = 411 mm) made of polydimethylsiloxane. The MCO configuration presented the highest performance(mixing index of 0.80 at Re = 100), oil conversion of 81.13% at 75 °C, molar ratio of 9 and catalyst concentration of 1%. Experimental results showed high conversions for MCO and MWO configurations(99.99%) at 50 °C, molar ratio of 9 and catalyst concentration of 1%, with a residence time of 12 s.展开更多
The present study focuses on the mitigation of shock wave using novel geometric passages in the flow field.The strategy is to produce multiple shock reflections and diffractions in the passage with minimum flow obstru...The present study focuses on the mitigation of shock wave using novel geometric passages in the flow field.The strategy is to produce multiple shock reflections and diffractions in the passage with minimum flow obstruction,which in turn is expected to reduce the shock wave strength at the target location.In the present study the interaction of a plane shock front(generated from a shock tube)with various geometric designs such as,1)zig-zag geometric passage,2)staggered cylindrical obstructions and 3)zigzag passage with cylindrical obstructions have been investigated using computational technique.It is seen from the numerical simulation that,among the various designs,the maximum shock attenuation is produced by the zig-zag passage with cylindrical obstructions which is then followed by zig-zag passage and staggered cylindrical obstructions.A comprehensive investigation on the shock wave reflection and diffraction phenomena happening in the proposed complex passages have also been carried out.In the new zig-zag design,the initial shock wave undergoes shock wave reflection and diffraction process which swaps alternatively as the shock front moves from one turn to the other turn.This cyclic shock reflection and diffraction process helps in diffusing the shock wave energy with practically no obstruction to the flow field.It is found that by combining the shock attenuation ability of zig-zag passage(using shock reflection and diffraction)with the shock attenuation ability of cylindrical blocks(by flow obstruction),a drastic attenuation in shock strength can be achieved with moderate level of flow blocking.展开更多
AIM To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.METHODS A systematic review and meta-analysis was performed following the PRISMA process. Pub Med(...AIM To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.METHODS A systematic review and meta-analysis was performed following the PRISMA process. Pub Med(Medline),EMBASE(Excerpta Medical Database),AMED(Allied and Complementary medicine Database),Scopus and online content,were searched for studies reporting on the Ni Ti-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = 0.05.RESULTS Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2%(95%CI: 94.8%-98.9%; I2 = 5.8%). Pooled complication rate was 27.6%(95%CI: 20.7%-35.2%; I2 = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was-2.00 [95%CI:-2.29%-(-1.72%); I2 = 87%]. Distal stent migration was documented in 10 out of the 250 cases examined.Pooled stent migration rate was 4.7%(95%CI: 2.5%-7.7%; I2 = 0%). Finally,tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2%(95%CI: 3.7%-22.1%; I2 = 82.2%). No funnel plot asymmetry to suggest publication bias(bias = 0.39,P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects models.CONCLUSION The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour展开更多
In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent(SEMS) placement, with the aim to identify the safety and efficacy o...In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent(SEMS) placement, with the aim to identify the safety and efficacy of this procedure. Baseline patient characteristics, procedure methods, procedure time, technical and clinical success rates, complications, and patient outcomes were obtained. All 3 patients had pancreatic cancer with small bowel strictures. One patient received the SEMS using colonoscopy, while the other 2 patients received SEMS placement via double balloon endoscopy using the through-the-overtube technique. The median procedure time was 104 min. The technical and clinical success rates were 100%. Post-treatment, obstructive symptoms in all patients improved, and a low-residue diet could be tolerated. All stents remained within the patients until their deaths. The median overall survival time(stent patency time) was 76 d. SEMS placement is safe and effective as a palliative treatment for malignant small bowel obstruction.展开更多
AIM To compare(1) quality of life and(2) rate of recurrent small bowel obstructions(SBO) for patients treated with novel manual physiotherapy vs no treatment. METHODS One hundred and three subjects(age 19-89) with a h...AIM To compare(1) quality of life and(2) rate of recurrent small bowel obstructions(SBO) for patients treated with novel manual physiotherapy vs no treatment. METHODS One hundred and three subjects(age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach(CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre-and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO.RESULTS Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls(total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire(SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life(QOL) and pain severity when compared to post CPA treatment were significantly improved(P < 0.0001). The medication domain was not changed in the CPA treated group(P = 0.176).CONCLUSION CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.展开更多
AIM:To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.METHODS:The databases of Medline,Web of Science,Embase,an...AIM:To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.METHODS:The databases of Medline,Web of Science,Embase,and the Cochrane Central Register of Controlled Trials were searched from their inception to July 2012 for studies(prospective,retrospective,randomized controlled trials,and case-control trials)designed as comparative analyses of patients with incurable malignant colorectal obstructions treated by selfexpanding metallic stents(SEMS)or palliative surgery.No language restrictions were imposed.The main outcome measures were hospital stay,intensive care unit admission,clinical success rate,30-d mortality,stoma formation,complications,and overall survival time.The data extraction was conducted by two investigators working independently and using a standardized form.The Mantel-Haenszel 2method was used to estimate the pooled risk ratios with 95%CI under a fixed-effects model;when statistical heterogeneity existed in the pooled data(as evaluated by Q test and I2statistics,where P<0.10 and I2<25%indicated heterogeneity),a random-effects model was used.RESULTS:Thirteen relevant articles,representing837 patients(SEMS group,n=404;surgery group,n=433),were selected for analysis.Compared to the surgery group,the SEMS group showed lower clinical success(99.8%vs 93.1%,P=0.0009)but shorter durations of hospital stay(18.84 d vs 9.55 d,P<0.00001)and time to initiation of chemotherapy(33.36 d vs15.53 d,P<0.00001),and lower rate of stoma formation(54.0%vs 12.7%,P<0.00001).Additionally,the SEMS group experienced a significantly lower rate of30-d mortality(4.2%vs 10.5%,P=0.01).Stent-related complications were not uncommon and included perforation(10.1%),migration(9.2%),and occlusion(18.3%).Surgery-related complications were slightly less common and included wound infection(5.0%)and anastomotic leak(4.7%).The rate of total complications was similar between these two groups(SEMS:34.0%vs surgery:38.1%,P=0.60),but the surgeryrelated complications occurred earlier than stent-related complications(rate of early complications:33.7%vs13.7%,P=0.03;rate of late complications:32.3%vs12.7%,P<0.0001).The overall survival time of SEMSand surgery-treated patients was not significantly different(7.64 mo vs 7.88 mo).CONCLUSION:SEMS is less effective than surgery for palliation of incurable malignant colorectal obstructions,but is associated with a shorter time to chemotherapy and lower 30-d mortality.展开更多
AIM:To study potential predictive factors for early radical resection in two-stage resection for left malignant colonic obstruction.METHODS:Thirty-eight cases of left-sided obstructive colon cancer undergoing two-stag...AIM:To study potential predictive factors for early radical resection in two-stage resection for left malignant colonic obstruction.METHODS:Thirty-eight cases of left-sided obstructive colon cancer undergoing two-stage operations were reviewed between January 1998 and August 2008.Patients were classified into two groups(n = 19 each):early radical resection(interval ≤ 10 d) and late radical resection(interval > 10 d).Baseline demographics,post-diversion outcome,perioperative data,tumor characteristics,outcome and complications were analyzed.RESULTS:The baseline demographics revealed no differences except for less pre-diversion sepsis in the early group(P < 0.001) and more obstruction days in the late group(P = 0.009).The mean intervals of early and late radical resections were 7.9 ± 1.3 d and 17.8 ± 5.5 d,respectively(P < 0.001).After diversion,the presence of bowel sounds,flatus,removal of the nasogastric tube and the resumption of oral feeding occurred earlier in the early group.The operation time and duration of hospital stay were both significant reduced in the early group.Complication rates did not differ between groups.CONCLUSION:The earlier recovery of bowel function seems to be predictive of early radical resection.In contrast,pre-diversion sepsis and more obstruction days were predictive of delayed radical resection.展开更多
AIM:To investigate and evaluate the technical feasibility and clinical effectiveness of fluoroscopically guided peroral uncovered expandable metal stent placement to treat gastric outlet and duodenal obstructions. MET...AIM:To investigate and evaluate the technical feasibility and clinical effectiveness of fluoroscopically guided peroral uncovered expandable metal stent placement to treat gastric outlet and duodenal obstructions. METHODS:Fifteen consecutive patients underwent peroral placement of Wallstent^(TM)Enteral Endoprosthesis to treat gastric outlet and duodenal obstructions(14 malignant,1 benign).All procedures were completed under fluoroscopic guidance without endoscopic assistance.Follow-up was completed until the patients died or were lost,and the clinical outcomes were analyzed. RESULTS:The technique success rate was 100%,and the oral intake was maintained in 12 of 14 patients varying from 7 d to 270 d.Two patients remained unable to resume oral intake,although their stents were proven to be patent with the barium study.One patient with acute necrotizing pancreatitis underwent enteral stenting to treat intestinal obstruction,and nausea and vomiting disappeared.Ten patients died during the follow- up period,and their mean oral intake time was 50 d. No procedure-related complications occurred.Stent migration to the gastric antrum occurred in one patient 1 year after the procedure,a tumor grew at the proximal end of the stent in another patient 38 d post-stent insertion. CONCLUSION:Fluoroscopically guided peroral metal stent implantation is a safe and effective method to treat malignant gastrointestinal obstructions,and complications can be ignored based on our short-term study.Indications for this procedure should be discreetly considered because a few patients may not benefit from gastrointestinal insertion,but some benign gastrointestinal obstructions can be treated using this procedure.展开更多
AIM: To investigate the combined antegraderetrograde endoscopic rendezvous technique for complete oesophageal obstruction and the swallowing outcome.METHODS: This single-centre case series includes consecutive patient...AIM: To investigate the combined antegraderetrograde endoscopic rendezvous technique for complete oesophageal obstruction and the swallowing outcome.METHODS: This single-centre case series includes consecutive patients who were unable to swallow due to complete oesophageal obstruction and underwent combined antegrade-retrograde endoscopic dilation(CARD) within the last 10 years. The patients' demographic characteristics, clinical parameters, endoscopic therapy, adverse events, and outcomes were obtained retrospectively. Technical success was defined as effective restoration of oesophageal patency. Swallowing success was defined as either percutaneous endoscopic gastrostomy(PEG)-tube independency and/or relevant improvement of oral food intake, as assessed by the functional oral intake scale(FOIS)(≥ level 3).RESULTS: The cohort consisted of six patients [five males; mean age 71 years(range, 54-74)]. All but one patient had undergone radiotherapy for head and neck or oesophageal cancer. Technical success was achieved in five out of six patients. After discharge, repeated dilations were performed in all five patients. During follow-up(median 27 mo, range, 2-115), three patients remained PEG-tube dependent. Three of four patients achieved relevant improvement of swallowing(two patients: FOIS 6, one patient: FOIS 7). One patient developed mediastinal emphysema following CARD, without a need for surgery.CONCLUSION: The CARD technique is safe and a viable alternative to high-risk blind antegrade dilation in patients with complete proximal oesophageal obstruction. Although only half of the patients remained PEG-tube independent, the majority improved their ability to swallow.展开更多
The purpose of Federal Aviation Regulations Part 77, entitled ＂Objects Affecting Navigable Airspace＂, is to identify potential hazards and prevent adverse impacts to the safe and efficient use of navigable airspace....The purpose of Federal Aviation Regulations Part 77, entitled ＂Objects Affecting Navigable Airspace＂, is to identify potential hazards and prevent adverse impacts to the safe and efficient use of navigable airspace. The OIS （obstruction identification surfaces） represent these regulations, identify objects that penetrate these imaginary surfaces, evaluate hazardous effects, and ensure safe separations of aircraft from obstructions. The OIS evaluation is often used for selecting airfield locations and runway orientations. More importantly, the OIS evaluation is an airport＇s safeguard against flawed urban development, especially for airports near rapidly expanding cities. Without accurate analysis tools, hand-calculation errors on the OIS can occur and cause adverse impacts to airport safety. Applying the GIS （geographic information system） features of geospatial data and 3D formats, this paper proposes a model named GIS Obstruction Model which is capable of precisely calculating maximum allowable heights and creating visual imagery of penetrating obstructions. The special features of the model include web-based design, adaptability to any airport, user-friendly multiple inquiry methods, quick response to online inquiries, and response with 3D visual reality. The proposed G1S Obstruction Model is useful for airport planning, architecture design, safety management or civil engineering permit review.展开更多
Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using thi...Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction(UPJ)and ureterovesical junction(UVJ)obstructions or vesicoureteral reflux.Methods:A retrospective analysis of 108 patients with hydronephrosis(including two patients with hydroureteronephrosis)who received treatment from March 1998 to March 2020 was carried out,with an average follow-up period of 36 months.Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients(including bilateral in two cases).In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.Results:All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty,and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter.The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis,including those with lesions of the UPJ and UVJ segments.In all cases,it was feasible to achieve a decrease in the degree of hydronephrosis.Postoperative complications were observed in five cases(4.6%),in none of which there were complications associated with the surgical technique,and were eliminated without loss of renal function.Conclusion:Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.展开更多
<strong>Aim:</strong> To assess the epidemiological profile of intestinal obstructions at the Koutiala district hospital. <strong>Patients and Method:</strong> This was a prospective and descri...<strong>Aim:</strong> To assess the epidemiological profile of intestinal obstructions at the Koutiala district hospital. <strong>Patients and Method:</strong> This was a prospective and descriptive study taking place from August 1, 2017 to April 30, 2020. The files of patients with acute intestinal obstruction in the general surgery department of the Koutiala district hospital were collected. In this study, patients operated on for acute intestinal obstruction were included. Non-operated patients were not included in the study. <strong>Result:</strong> The records of 65 patients operated on for acute intestinal obstruction were collected. The mean age was 32 ± 22 with extremes of 1 year and 94 years. 7 infants (10.8%) and 1 4-year-old child (1.5%) were identified. The 16 to 59 age group was more common. Males were the majority with 70.8% (n = 46). The sex ratio was 2.4. The rate of bowel obstruction in the general population in the circle was 8.1 cases per 100,000 population. According to provenance, patients came from inside the circle (rural areas) in 87.7% of the cases (n = 57) and from the city of Koutiala in 12.3% (n = 8). 33.9% of our patients had undergone laparotomy (n = 22). Patients consulted urgently in 93.8%. The etiologies are dominated by post-operative straps (33.8%) and volvulus (24.6%). We noted 12 cases of intestinal necrosis. Postoperative morbidity was 13.8% of cases (n = 9) and mortality of 6.1% of cases (n = 4). <strong>Conclusion:</strong> Bowel obstruction is one of the most frequent surgical emergencies in our circle. They most often affect young subjects and young adult males. The etiologies are dominated by the post-operative flanges. Complications remain elevated.展开更多
Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our s...Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our study was to identify the causes of these bowel obstructions in elderly patients and to expose the results of their surgical management. Patients and Methods: Retrospective and analytical study of patients aged 65 years and over, operated on between January 2013 and December 2019 for acute bowel obstruction at the University Hospital of Bouake. Demographic, diagnostic, therapeutic and evolutionary data were analysed. Results: The study involved 36 men and 23 women (sex ratio = 1.6). The mean age of these patients was 70 ± 4.6 years (65 and 90 years). A history and/or co-morbidities were found in 67.8% of them. Patients were classified as ASA I (20.3%), ASA II (42.4%), ASA III (33.9%) or ASA IV (3.4%). The average consultation time was 5.3 ± 4.1 days (2 days and 28 days). Bowel obstructions were due to colonic volvulus (38.9%), colonic cancer (22%), postoperative adhesions (18.6%), strangulated groin hernia (16.9%) or internal bowel hernia (3.3%). Volvulated or necrotic bowel and resectable cancers were resected followed by immediate anastomosis or stoma. Near upstream stomas were performed for unresectable cancers. A herniorrhaphy for groin hernias and a mesenteric breach suture for internal hernia were performed after bowel disinterment. Adhesions were released. The time to surgery was 22.3 ± 12.4 hours (2 hours and 72 hours). The post-surgery morbidity was 32.2%, marked by parietal suppurations (47.4%). The post-surgery mortality was 16.9%. Hemodynamic or septic shock, ASA score ≥ III, bowel necrosis and ICU stay were the significant risk factors. Conclusion: Acute bowel obstructions in the elderly are dominated by colonic volvulus. The high mortality is related to various factors highlighting the frailty of the elderly. A multidisciplinary management involving the geriatrician could improve the prognosis.展开更多
Due to the directionality of light, the hidden device problem and the obstruction cannot be ignored for carrier sense multiple access with collision avoidance(CSMA/CA)-based uplink visible light communication(VLC). In...Due to the directionality of light, the hidden device problem and the obstruction cannot be ignored for carrier sense multiple access with collision avoidance(CSMA/CA)-based uplink visible light communication(VLC). In this paper, we introduce multipacket reception(MPR) to handle the hidden device problem in VLC system. We model the traffic of the device with on/off Markov source. With the unsaturated traffic, we formulate a two dimensional(2D) Markov chain to model the CSMA/CA-based slotted random access procedure to evaluate the effects of hidden devices and obstructions on the performance of MPR-aided VLC system, which are mapped into the transition probabilities of the Markov chain. Then, we analyze the throughput and the reception power efficiency(RE) of MPR-aided VLC system with the obstructed optical channel. Numerical results show that the effect is negative when hidden devices or obstructions appear solely. But when they appear simultaneously, they will interact with each other to mitigate the negative effects.展开更多
Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).Howev...Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).However,hepatic outflow obstruction is a critical issue,often requiring radiologic intervention because of compression or kinking following graft regeneration of the vessels[1–3].Therefore,preoperative planning is essential to address the challenges of graft placement and vein reconstruction.Despite these complexities,we previously reported techniques using a reversed modified right-lobe(mRL)graft from a donor in a conventional recipient with SIT[2].Here,we successfully applied a similar concept.展开更多
Objective Post tuberculosis lung disease(PTLD)manifests in various forms,including tuberculosisassociated chronic obstructive pulmonary disease(TB-COPD),yet the clinical features of PTLD remain undercharacterized.This...Objective Post tuberculosis lung disease(PTLD)manifests in various forms,including tuberculosisassociated chronic obstructive pulmonary disease(TB-COPD),yet the clinical features of PTLD remain undercharacterized.This study aimed to assess longitudinal changes in lung function over a 5-year period and to identify predictors of airflow obstruction in a cohort of patients treated for active pulmonary TB.Methods Patients with active pulmonary TB were enrolled in this study and were followed during treatment,at treatment completion and five years post-treatment.Assessments included lung function and chest CT,analyzing longitudinal trends and airflow obstruction risk factors.Results Among 53 patients(mean age 36.9±13.9 years;64.2%male),7 patients(13.2%)exhibited airflow obstruction.At the 5-year follow-up,the mean FEV_(1)/FVC declined significantly(76.27%±12.04%vs.80.23%±11.02%,P<0.001)and 9 patients(17.0%)exhibited airflow obstruction.Seven of these patients predominantly showed air trapping consistent with small airway disease on chest CT,aligning with TB-COPD phenotype.Notably,four young-to-middle-aged patients(<60 years old)had persistent obstruction over the five years.Conclusion The initial test revealed that 13.2%of patients presented with airflow obstruction.By the 5-year follow-up,this proportion had increased to 17.0%,with most cases demonstrating imaging findings aligning with TB-COPD,even among younger,non-smoking individuals.These findings emphasize the importance of long-term follow-up and routine lung function assessments in TB survivors.展开更多
Objective:To investigate the quantitative assessment efficacy of chest CT combined with serum Vanin-1 and SPP1 in determining the progression stage of chronic obstructive pulmonary disease(COPD).Methods:A total of 100...Objective:To investigate the quantitative assessment efficacy of chest CT combined with serum Vanin-1 and SPP1 in determining the progression stage of chronic obstructive pulmonary disease(COPD).Methods:A total of 100 COPD subjects from our hospital from January 2020 to December 2023 were included and randomly divided into a healthy control group and an experimental group(50 cases each).The healthy control group underwent slow vital capacity measurement using a spirometer,while the experimental group underwent high-resolution thin-slice CT scans and serum Vanin-1 and SPP1 concentration measurements.Pulmonary function parameters,symptom burden,biomarker concentrations,and imaging characteristics were compared between the two groups.Results:The FEV1/FVC ratio in the experimental group(58.3±7.2)was lower than that in the healthy control group(92.1±4.8);the total CAT score(22.4±3.5)was higher than that in the healthy control group(3.1±1.2);both Vanin-1(18.7±2.3μg/L)and SPP1(25.6±4.1μg/L)levels were higher than those in the healthy control group;LAA%-950(38.7±6.2%)and WA%(68.5±5.3%)were significantly higher than those in the healthy control group(all p<0.001).Conclusion:Chest CT combined with serum Vanin-1 and SPP1 can accurately quantify the pathological progression of COPD,providing a dual basis for clinical staging and individualized intervention.展开更多
Chronic obstructive pulmonary disease(COPD)is one of the leading causes of death and disability worldwide.Its complex etiology involves factors such as smoking,air pollution,genetic susceptibility,and social environme...Chronic obstructive pulmonary disease(COPD)is one of the leading causes of death and disability worldwide.Its complex etiology involves factors such as smoking,air pollution,genetic susceptibility,and social environment.With the accelerating global aging population and urbanization,the incidence and burden of COPD continue to rise.Current treatment strategies for COPD are relatively conservative,primarily focusing on bronchodilators,inhaled corticosteroids,and long-term oxygen therapy.Although these approaches can alleviate symptoms and slow disease progression to some ex-tent,they fail to effectively target the underlying mechanisms of the disease,leaving an unmet clinical need for more-effective therapies.This highlights the urgency of de-veloping innovative drugs that are both safe and efficacious to address the challenges in COPD treatment.As a traditional Chinese medicine with a long history,Colla corii asini has garnered significant attention for its diverse pharmacological effects and fa-vorable safety profile.Research has shown that Colla corii asini possesses multiple bio-logical activities,including hematopoiesis,nourishing the lungs,enhancing immunity,anti-infection,antiaging,antitumor,and antifatigue effects.Moreover,it has demon-strated potential in regulating oxidative stress,immune imbalance,and inflammatory responses.Recent evidence suggests that Colla corii asini may play a protective role in lung function through multitarget and multipathway mechanisms.Based on previ-ous research findings,this paper explores the potential therapeutic value of Colla corii asini in COPD treatment by addressing the current clinical management challenges and identifying potential therapeutic targets.It also integrates the pharmacological effects of Colla corii asini into a broader treatment context,providing new perspec-tives for comprehensive COPD management and laying the theoretical foundation for its modernization and innovative application.展开更多
Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advanc...Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advancements,transurethral approaches continue to pose risks such as urethral strictures and urinary incontinence due to mechanical and thermal stress.To address these limitations,the Suprapubic Transvesical Adenoma Resection of the Prostate(STARP)was developed,offering a direct suprapubic route that bypasses the urethra entirely.Recent studies have validated STAR-P as both feasible and safe,emphasizing advantages such as enhanced visualization of the urinary sphincter,minimized urethral trauma,effective hemostasis,and reduced operative stress.The procedure utilizes specially designed instrumentation,including a large-caliber bipolar resectoscope(42 Fr),allowing the efficient removal of substantial adenoma tissue in fewer resection passes compared to traditional methods.Objectives:This article provides a comprehensive,step-by-step description of the STAR-P technique.The primary objective is to detail patient selection criteria,preoperative assessments,procedural steps including mini-open suprapubic access,specialized instrumentation usage,resection techniques,and postoperative management protocols.Highlighting technical considerations and procedural innovations aims to inform urologists about the potential benefits of STAR-P,particularly in patients at higher risk for urethral complications or those with large prostate volumes.By documenting the procedural intricacies and outcomes clearly and thoroughly,we seek to encourage informed adoption of STAR-P as an alternative,effective surgical approach for managing benign prostatic hyperplasia,thus contributing to the evolving landscape ofminimally invasive urological surgery.展开更多
文摘AIM: To assess whole-body fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the management of small bowel obstructions (SBOs) secondary to gastric cancer and its role in treatment strategies. METHODS: The medical records of all of the patients who were admitted for an intestinal obstruction after curative resection for gastric cancer were retrospectively reviewed. PET/CT was performed before a clinical treatment strategy was established for each patient. The patients were divided into 2 groups: patients with no evidence of a tumor recurrence and patients with evidence of a tumor recurrence. Tumor recurrences included a local recurrence, peritoneal carcinomatosis or distant metastases. The primary endpoint was the 1-year survival rate, and other variables included patient demographics, the length of hospital stay, complications, and mortality. RESULTS: The median time between a diagnosis of gastric cancer and the detection of a SBO was 1.4 years. Overall, 31 of 65 patients (47.7%) had evidence of a tumor recurrence on the PET/CT scan, which was the only factor that was associated with poor survival. Open and close surgery was the main type of surgical procedure reported for the patients with tumor recurrences. R0 resections were performed in 2 patients, including 1 who underwent combined adjacent organ resection. In the group with no evidence of a tumor recurrence on PET/CT, bowel resections were performed in 7 patients, adhesiolysis was performed in 7 patients, and a bypass was performed in 1 patient. The 1-year survival curves according to PET/CT evidence of a tumor recurrence vs no PET/CT evidence of a tumor recurrence were significantly different, and the 1-year survival rates were 8.8% vs 93.5%, respectively. There were no significant differences (P = 0.71) in the 1-year survival rates based on surgical vs nonsurgical management (0% with nonoperative treatment vs 20% after exploratory laparotomy). CONCLUSION: 18 F-FDG PET/CT can be used to identify the causes of bowel obstructions in patients with a history of gastric cancer, and this method is useful for planning the surgical management of these patients.
基金the Unicamp Scholarship Program,CAPES and the financial support provided by FAPESP(Sao Paulo Research Foundation,Process 2013/25850-7)Prof.Dr.Milton Mori for giving space to perform the simulations and the Microfabrication Laboratory(Proposal LMF-19844)
文摘The present paper studied numerical and experimentally the transesterification reaction between sunflower oil and ethanol with NaO H catalyst in microchannels with circular obstructions. The micromixer design influence on fluid mixing and oil conversion was investigated for a range of operating conditions: Reynolds number(Re = 0.1–100),Temperature(25–75 °C), ethanol/oil molar ratio(6-12), and catalyst concentration(0.75 wt%–1.25 wt%), using three microchannel configurations(Length = 35 mm; Width = 1500 μm; Height = 200 μm): T-shape – channel without obstructions; MCO – channel with 3 obstructions ensemble – equally disposed over longitudinal length;MWO – channel with 7 obstructions ensemble. The MCO micromixer was based on literature work, and the MWO is a totally new micromixer design. Experimental tests were conducted in similar conditions in microreactors using these micromixers(Length = 411 mm) made of polydimethylsiloxane. The MCO configuration presented the highest performance(mixing index of 0.80 at Re = 100), oil conversion of 81.13% at 75 °C, molar ratio of 9 and catalyst concentration of 1%. Experimental results showed high conversions for MCO and MWO configurations(99.99%) at 50 °C, molar ratio of 9 and catalyst concentration of 1%, with a residence time of 12 s.
文摘The present study focuses on the mitigation of shock wave using novel geometric passages in the flow field.The strategy is to produce multiple shock reflections and diffractions in the passage with minimum flow obstruction,which in turn is expected to reduce the shock wave strength at the target location.In the present study the interaction of a plane shock front(generated from a shock tube)with various geometric designs such as,1)zig-zag geometric passage,2)staggered cylindrical obstructions and 3)zigzag passage with cylindrical obstructions have been investigated using computational technique.It is seen from the numerical simulation that,among the various designs,the maximum shock attenuation is produced by the zig-zag passage with cylindrical obstructions which is then followed by zig-zag passage and staggered cylindrical obstructions.A comprehensive investigation on the shock wave reflection and diffraction phenomena happening in the proposed complex passages have also been carried out.In the new zig-zag design,the initial shock wave undergoes shock wave reflection and diffraction process which swaps alternatively as the shock front moves from one turn to the other turn.This cyclic shock reflection and diffraction process helps in diffusing the shock wave energy with practically no obstruction to the flow field.It is found that by combining the shock attenuation ability of zig-zag passage(using shock reflection and diffraction)with the shock attenuation ability of cylindrical blocks(by flow obstruction),a drastic attenuation in shock strength can be achieved with moderate level of flow blocking.
文摘AIM To investigate the efficacy of double-layered covered stent in the treatment of malignant oesophageal obstructions.METHODS A systematic review and meta-analysis was performed following the PRISMA process. Pub Med(Medline),EMBASE(Excerpta Medical Database),AMED(Allied and Complementary medicine Database),Scopus and online content,were searched for studies reporting on the Ni Ti-S polyurethane-covered double oesophageal stent for the treatment of malignant dysphagia. Weighted pooled outcomes were synthesized with a random effects model to account for clinical heterogeneity. All studies reporting the outcome of palliative management of dysphagia due to histologically confirmed malignant oesophageal obstruction using double-layered covered nitinol stent were included. The level of statistical significance was set at α = 0.05.RESULTS Six clinical studies comprising 250 patients in total were identified. Pooled technical success of stent insertion was 97.2%(95%CI: 94.8%-98.9%; I2 = 5.8%). Pooled complication rate was 27.6%(95%CI: 20.7%-35.2%; I2 = 41.9%). Weighted improvement of dysphagia on a scale of 0-5 scoring system was-2.00 [95%CI:-2.29%-(-1.72%); I2 = 87%]. Distal stent migration was documented in 10 out of the 250 cases examined.Pooled stent migration rate was 4.7%(95%CI: 2.5%-7.7%; I2 = 0%). Finally,tumour overgrowth was reported in 34 out of the 250 cases with pooled rate of tumour overgrowth of 11.2%(95%CI: 3.7%-22.1%; I2 = 82.2%). No funnel plot asymmetry to suggest publication bias(bias = 0.39,P = 0.78). In the sensitivity analysis all results were largely similar between the fixed and random effects models.CONCLUSION The double-layered nitinol stent provides immediate relief of malignant dysphagia with low rates of stent migration and tumour
文摘In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent(SEMS) placement, with the aim to identify the safety and efficacy of this procedure. Baseline patient characteristics, procedure methods, procedure time, technical and clinical success rates, complications, and patient outcomes were obtained. All 3 patients had pancreatic cancer with small bowel strictures. One patient received the SEMS using colonoscopy, while the other 2 patients received SEMS placement via double balloon endoscopy using the through-the-overtube technique. The median procedure time was 104 min. The technical and clinical success rates were 100%. Post-treatment, obstructive symptoms in all patients improved, and a low-residue diet could be tolerated. All stents remained within the patients until their deaths. The median overall survival time(stent patency time) was 76 d. SEMS placement is safe and effective as a palliative treatment for malignant small bowel obstruction.
文摘AIM To compare(1) quality of life and(2) rate of recurrent small bowel obstructions(SBO) for patients treated with novel manual physiotherapy vs no treatment. METHODS One hundred and three subjects(age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach(CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre-and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO.RESULTS Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls(total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire(SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life(QOL) and pain severity when compared to post CPA treatment were significantly improved(P < 0.0001). The medication domain was not changed in the CPA treated group(P = 0.176).CONCLUSION CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.
基金Supported by A grant from the Innovative Team ProjectNo.CX11to Shi RH
文摘AIM:To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.METHODS:The databases of Medline,Web of Science,Embase,and the Cochrane Central Register of Controlled Trials were searched from their inception to July 2012 for studies(prospective,retrospective,randomized controlled trials,and case-control trials)designed as comparative analyses of patients with incurable malignant colorectal obstructions treated by selfexpanding metallic stents(SEMS)or palliative surgery.No language restrictions were imposed.The main outcome measures were hospital stay,intensive care unit admission,clinical success rate,30-d mortality,stoma formation,complications,and overall survival time.The data extraction was conducted by two investigators working independently and using a standardized form.The Mantel-Haenszel 2method was used to estimate the pooled risk ratios with 95%CI under a fixed-effects model;when statistical heterogeneity existed in the pooled data(as evaluated by Q test and I2statistics,where P<0.10 and I2<25%indicated heterogeneity),a random-effects model was used.RESULTS:Thirteen relevant articles,representing837 patients(SEMS group,n=404;surgery group,n=433),were selected for analysis.Compared to the surgery group,the SEMS group showed lower clinical success(99.8%vs 93.1%,P=0.0009)but shorter durations of hospital stay(18.84 d vs 9.55 d,P<0.00001)and time to initiation of chemotherapy(33.36 d vs15.53 d,P<0.00001),and lower rate of stoma formation(54.0%vs 12.7%,P<0.00001).Additionally,the SEMS group experienced a significantly lower rate of30-d mortality(4.2%vs 10.5%,P=0.01).Stent-related complications were not uncommon and included perforation(10.1%),migration(9.2%),and occlusion(18.3%).Surgery-related complications were slightly less common and included wound infection(5.0%)and anastomotic leak(4.7%).The rate of total complications was similar between these two groups(SEMS:34.0%vs surgery:38.1%,P=0.60),but the surgeryrelated complications occurred earlier than stent-related complications(rate of early complications:33.7%vs13.7%,P=0.03;rate of late complications:32.3%vs12.7%,P<0.0001).The overall survival time of SEMSand surgery-treated patients was not significantly different(7.64 mo vs 7.88 mo).CONCLUSION:SEMS is less effective than surgery for palliation of incurable malignant colorectal obstructions,but is associated with a shorter time to chemotherapy and lower 30-d mortality.
文摘AIM:To study potential predictive factors for early radical resection in two-stage resection for left malignant colonic obstruction.METHODS:Thirty-eight cases of left-sided obstructive colon cancer undergoing two-stage operations were reviewed between January 1998 and August 2008.Patients were classified into two groups(n = 19 each):early radical resection(interval ≤ 10 d) and late radical resection(interval > 10 d).Baseline demographics,post-diversion outcome,perioperative data,tumor characteristics,outcome and complications were analyzed.RESULTS:The baseline demographics revealed no differences except for less pre-diversion sepsis in the early group(P < 0.001) and more obstruction days in the late group(P = 0.009).The mean intervals of early and late radical resections were 7.9 ± 1.3 d and 17.8 ± 5.5 d,respectively(P < 0.001).After diversion,the presence of bowel sounds,flatus,removal of the nasogastric tube and the resumption of oral feeding occurred earlier in the early group.The operation time and duration of hospital stay were both significant reduced in the early group.Complication rates did not differ between groups.CONCLUSION:The earlier recovery of bowel function seems to be predictive of early radical resection.In contrast,pre-diversion sepsis and more obstruction days were predictive of delayed radical resection.
文摘AIM:To investigate and evaluate the technical feasibility and clinical effectiveness of fluoroscopically guided peroral uncovered expandable metal stent placement to treat gastric outlet and duodenal obstructions. METHODS:Fifteen consecutive patients underwent peroral placement of Wallstent^(TM)Enteral Endoprosthesis to treat gastric outlet and duodenal obstructions(14 malignant,1 benign).All procedures were completed under fluoroscopic guidance without endoscopic assistance.Follow-up was completed until the patients died or were lost,and the clinical outcomes were analyzed. RESULTS:The technique success rate was 100%,and the oral intake was maintained in 12 of 14 patients varying from 7 d to 270 d.Two patients remained unable to resume oral intake,although their stents were proven to be patent with the barium study.One patient with acute necrotizing pancreatitis underwent enteral stenting to treat intestinal obstruction,and nausea and vomiting disappeared.Ten patients died during the follow- up period,and their mean oral intake time was 50 d. No procedure-related complications occurred.Stent migration to the gastric antrum occurred in one patient 1 year after the procedure,a tumor grew at the proximal end of the stent in another patient 38 d post-stent insertion. CONCLUSION:Fluoroscopically guided peroral metal stent implantation is a safe and effective method to treat malignant gastrointestinal obstructions,and complications can be ignored based on our short-term study.Indications for this procedure should be discreetly considered because a few patients may not benefit from gastrointestinal insertion,but some benign gastrointestinal obstructions can be treated using this procedure.
文摘AIM: To investigate the combined antegraderetrograde endoscopic rendezvous technique for complete oesophageal obstruction and the swallowing outcome.METHODS: This single-centre case series includes consecutive patients who were unable to swallow due to complete oesophageal obstruction and underwent combined antegrade-retrograde endoscopic dilation(CARD) within the last 10 years. The patients' demographic characteristics, clinical parameters, endoscopic therapy, adverse events, and outcomes were obtained retrospectively. Technical success was defined as effective restoration of oesophageal patency. Swallowing success was defined as either percutaneous endoscopic gastrostomy(PEG)-tube independency and/or relevant improvement of oral food intake, as assessed by the functional oral intake scale(FOIS)(≥ level 3).RESULTS: The cohort consisted of six patients [five males; mean age 71 years(range, 54-74)]. All but one patient had undergone radiotherapy for head and neck or oesophageal cancer. Technical success was achieved in five out of six patients. After discharge, repeated dilations were performed in all five patients. During follow-up(median 27 mo, range, 2-115), three patients remained PEG-tube dependent. Three of four patients achieved relevant improvement of swallowing(two patients: FOIS 6, one patient: FOIS 7). One patient developed mediastinal emphysema following CARD, without a need for surgery.CONCLUSION: The CARD technique is safe and a viable alternative to high-risk blind antegrade dilation in patients with complete proximal oesophageal obstruction. Although only half of the patients remained PEG-tube independent, the majority improved their ability to swallow.
文摘The purpose of Federal Aviation Regulations Part 77, entitled ＂Objects Affecting Navigable Airspace＂, is to identify potential hazards and prevent adverse impacts to the safe and efficient use of navigable airspace. The OIS （obstruction identification surfaces） represent these regulations, identify objects that penetrate these imaginary surfaces, evaluate hazardous effects, and ensure safe separations of aircraft from obstructions. The OIS evaluation is often used for selecting airfield locations and runway orientations. More importantly, the OIS evaluation is an airport＇s safeguard against flawed urban development, especially for airports near rapidly expanding cities. Without accurate analysis tools, hand-calculation errors on the OIS can occur and cause adverse impacts to airport safety. Applying the GIS （geographic information system） features of geospatial data and 3D formats, this paper proposes a model named GIS Obstruction Model which is capable of precisely calculating maximum allowable heights and creating visual imagery of penetrating obstructions. The special features of the model include web-based design, adaptability to any airport, user-friendly multiple inquiry methods, quick response to online inquiries, and response with 3D visual reality. The proposed G1S Obstruction Model is useful for airport planning, architecture design, safety management or civil engineering permit review.
文摘Objective:The aim of our study was to examine results of pyeloplasty using the new methoddsubadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction(UPJ)and ureterovesical junction(UVJ)obstructions or vesicoureteral reflux.Methods:A retrospective analysis of 108 patients with hydronephrosis(including two patients with hydroureteronephrosis)who received treatment from March 1998 to March 2020 was carried out,with an average follow-up period of 36 months.Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients(including bilateral in two cases).In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.Results:All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty,and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter.The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis,including those with lesions of the UPJ and UVJ segments.In all cases,it was feasible to achieve a decrease in the degree of hydronephrosis.Postoperative complications were observed in five cases(4.6%),in none of which there were complications associated with the surgical technique,and were eliminated without loss of renal function.Conclusion:Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.
文摘<strong>Aim:</strong> To assess the epidemiological profile of intestinal obstructions at the Koutiala district hospital. <strong>Patients and Method:</strong> This was a prospective and descriptive study taking place from August 1, 2017 to April 30, 2020. The files of patients with acute intestinal obstruction in the general surgery department of the Koutiala district hospital were collected. In this study, patients operated on for acute intestinal obstruction were included. Non-operated patients were not included in the study. <strong>Result:</strong> The records of 65 patients operated on for acute intestinal obstruction were collected. The mean age was 32 ± 22 with extremes of 1 year and 94 years. 7 infants (10.8%) and 1 4-year-old child (1.5%) were identified. The 16 to 59 age group was more common. Males were the majority with 70.8% (n = 46). The sex ratio was 2.4. The rate of bowel obstruction in the general population in the circle was 8.1 cases per 100,000 population. According to provenance, patients came from inside the circle (rural areas) in 87.7% of the cases (n = 57) and from the city of Koutiala in 12.3% (n = 8). 33.9% of our patients had undergone laparotomy (n = 22). Patients consulted urgently in 93.8%. The etiologies are dominated by post-operative straps (33.8%) and volvulus (24.6%). We noted 12 cases of intestinal necrosis. Postoperative morbidity was 13.8% of cases (n = 9) and mortality of 6.1% of cases (n = 4). <strong>Conclusion:</strong> Bowel obstruction is one of the most frequent surgical emergencies in our circle. They most often affect young subjects and young adult males. The etiologies are dominated by the post-operative flanges. Complications remain elevated.
文摘Background: Acute bowel obstruction is one of the main causes of non-traumatic gastro—intestinal surgical emergencies. When they occur in elderly patients, they seem to induce higher morbi-mortality. The aim of our study was to identify the causes of these bowel obstructions in elderly patients and to expose the results of their surgical management. Patients and Methods: Retrospective and analytical study of patients aged 65 years and over, operated on between January 2013 and December 2019 for acute bowel obstruction at the University Hospital of Bouake. Demographic, diagnostic, therapeutic and evolutionary data were analysed. Results: The study involved 36 men and 23 women (sex ratio = 1.6). The mean age of these patients was 70 ± 4.6 years (65 and 90 years). A history and/or co-morbidities were found in 67.8% of them. Patients were classified as ASA I (20.3%), ASA II (42.4%), ASA III (33.9%) or ASA IV (3.4%). The average consultation time was 5.3 ± 4.1 days (2 days and 28 days). Bowel obstructions were due to colonic volvulus (38.9%), colonic cancer (22%), postoperative adhesions (18.6%), strangulated groin hernia (16.9%) or internal bowel hernia (3.3%). Volvulated or necrotic bowel and resectable cancers were resected followed by immediate anastomosis or stoma. Near upstream stomas were performed for unresectable cancers. A herniorrhaphy for groin hernias and a mesenteric breach suture for internal hernia were performed after bowel disinterment. Adhesions were released. The time to surgery was 22.3 ± 12.4 hours (2 hours and 72 hours). The post-surgery morbidity was 32.2%, marked by parietal suppurations (47.4%). The post-surgery mortality was 16.9%. Hemodynamic or septic shock, ASA score ≥ III, bowel necrosis and ICU stay were the significant risk factors. Conclusion: Acute bowel obstructions in the elderly are dominated by colonic volvulus. The high mortality is related to various factors highlighting the frailty of the elderly. A multidisciplinary management involving the geriatrician could improve the prognosis.
文摘Due to the directionality of light, the hidden device problem and the obstruction cannot be ignored for carrier sense multiple access with collision avoidance(CSMA/CA)-based uplink visible light communication(VLC). In this paper, we introduce multipacket reception(MPR) to handle the hidden device problem in VLC system. We model the traffic of the device with on/off Markov source. With the unsaturated traffic, we formulate a two dimensional(2D) Markov chain to model the CSMA/CA-based slotted random access procedure to evaluate the effects of hidden devices and obstructions on the performance of MPR-aided VLC system, which are mapped into the transition probabilities of the Markov chain. Then, we analyze the throughput and the reception power efficiency(RE) of MPR-aided VLC system with the obstructed optical channel. Numerical results show that the effect is negative when hidden devices or obstructions appear solely. But when they appear simultaneously, they will interact with each other to mitigate the negative effects.
文摘Situs inversus totalis(SIT)is a rare congenital anomaly in which the major organs are reversed from their normal positions.In patients with SIT,the right-lobe graft must be placed in the left upper quadrant(LUQ).However,hepatic outflow obstruction is a critical issue,often requiring radiologic intervention because of compression or kinking following graft regeneration of the vessels[1–3].Therefore,preoperative planning is essential to address the challenges of graft placement and vein reconstruction.Despite these complexities,we previously reported techniques using a reversed modified right-lobe(mRL)graft from a donor in a conventional recipient with SIT[2].Here,we successfully applied a similar concept.
基金supported by the National Science and Technology Major Project for the Prevention and Control of Emerging and Major Infectious Diseases[2025ZD01908702]Peking University Medicine Fund of Fostering Young Scholars’Scientific&Technological innovation[BMU2024YFJHP014]supported by Fundamental Research Funds for the Central Universities+1 种基金Key Clinical Projects of Peking University Third Hospital[BYSYZD2022014]Peking University Third Hospital[2025024].
文摘Objective Post tuberculosis lung disease(PTLD)manifests in various forms,including tuberculosisassociated chronic obstructive pulmonary disease(TB-COPD),yet the clinical features of PTLD remain undercharacterized.This study aimed to assess longitudinal changes in lung function over a 5-year period and to identify predictors of airflow obstruction in a cohort of patients treated for active pulmonary TB.Methods Patients with active pulmonary TB were enrolled in this study and were followed during treatment,at treatment completion and five years post-treatment.Assessments included lung function and chest CT,analyzing longitudinal trends and airflow obstruction risk factors.Results Among 53 patients(mean age 36.9±13.9 years;64.2%male),7 patients(13.2%)exhibited airflow obstruction.At the 5-year follow-up,the mean FEV_(1)/FVC declined significantly(76.27%±12.04%vs.80.23%±11.02%,P<0.001)and 9 patients(17.0%)exhibited airflow obstruction.Seven of these patients predominantly showed air trapping consistent with small airway disease on chest CT,aligning with TB-COPD phenotype.Notably,four young-to-middle-aged patients(<60 years old)had persistent obstruction over the five years.Conclusion The initial test revealed that 13.2%of patients presented with airflow obstruction.By the 5-year follow-up,this proportion had increased to 17.0%,with most cases demonstrating imaging findings aligning with TB-COPD,even among younger,non-smoking individuals.These findings emphasize the importance of long-term follow-up and routine lung function assessments in TB survivors.
基金Baoding Science and Technology Plan Project(Project No.:2341ZF214)。
文摘Objective:To investigate the quantitative assessment efficacy of chest CT combined with serum Vanin-1 and SPP1 in determining the progression stage of chronic obstructive pulmonary disease(COPD).Methods:A total of 100 COPD subjects from our hospital from January 2020 to December 2023 were included and randomly divided into a healthy control group and an experimental group(50 cases each).The healthy control group underwent slow vital capacity measurement using a spirometer,while the experimental group underwent high-resolution thin-slice CT scans and serum Vanin-1 and SPP1 concentration measurements.Pulmonary function parameters,symptom burden,biomarker concentrations,and imaging characteristics were compared between the two groups.Results:The FEV1/FVC ratio in the experimental group(58.3±7.2)was lower than that in the healthy control group(92.1±4.8);the total CAT score(22.4±3.5)was higher than that in the healthy control group(3.1±1.2);both Vanin-1(18.7±2.3μg/L)and SPP1(25.6±4.1μg/L)levels were higher than those in the healthy control group;LAA%-950(38.7±6.2%)and WA%(68.5±5.3%)were significantly higher than those in the healthy control group(all p<0.001).Conclusion:Chest CT combined with serum Vanin-1 and SPP1 can accurately quantify the pathological progression of COPD,providing a dual basis for clinical staging and individualized intervention.
基金The National Natural Science Foundation of China,Grant/Award Number:82074104 and 8247143489the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences,Grant/Award Number:2022-I2M-2-002。
文摘Chronic obstructive pulmonary disease(COPD)is one of the leading causes of death and disability worldwide.Its complex etiology involves factors such as smoking,air pollution,genetic susceptibility,and social environment.With the accelerating global aging population and urbanization,the incidence and burden of COPD continue to rise.Current treatment strategies for COPD are relatively conservative,primarily focusing on bronchodilators,inhaled corticosteroids,and long-term oxygen therapy.Although these approaches can alleviate symptoms and slow disease progression to some ex-tent,they fail to effectively target the underlying mechanisms of the disease,leaving an unmet clinical need for more-effective therapies.This highlights the urgency of de-veloping innovative drugs that are both safe and efficacious to address the challenges in COPD treatment.As a traditional Chinese medicine with a long history,Colla corii asini has garnered significant attention for its diverse pharmacological effects and fa-vorable safety profile.Research has shown that Colla corii asini possesses multiple bio-logical activities,including hematopoiesis,nourishing the lungs,enhancing immunity,anti-infection,antiaging,antitumor,and antifatigue effects.Moreover,it has demon-strated potential in regulating oxidative stress,immune imbalance,and inflammatory responses.Recent evidence suggests that Colla corii asini may play a protective role in lung function through multitarget and multipathway mechanisms.Based on previ-ous research findings,this paper explores the potential therapeutic value of Colla corii asini in COPD treatment by addressing the current clinical management challenges and identifying potential therapeutic targets.It also integrates the pharmacological effects of Colla corii asini into a broader treatment context,providing new perspec-tives for comprehensive COPD management and laying the theoretical foundation for its modernization and innovative application.
文摘Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advancements,transurethral approaches continue to pose risks such as urethral strictures and urinary incontinence due to mechanical and thermal stress.To address these limitations,the Suprapubic Transvesical Adenoma Resection of the Prostate(STARP)was developed,offering a direct suprapubic route that bypasses the urethra entirely.Recent studies have validated STAR-P as both feasible and safe,emphasizing advantages such as enhanced visualization of the urinary sphincter,minimized urethral trauma,effective hemostasis,and reduced operative stress.The procedure utilizes specially designed instrumentation,including a large-caliber bipolar resectoscope(42 Fr),allowing the efficient removal of substantial adenoma tissue in fewer resection passes compared to traditional methods.Objectives:This article provides a comprehensive,step-by-step description of the STAR-P technique.The primary objective is to detail patient selection criteria,preoperative assessments,procedural steps including mini-open suprapubic access,specialized instrumentation usage,resection techniques,and postoperative management protocols.Highlighting technical considerations and procedural innovations aims to inform urologists about the potential benefits of STAR-P,particularly in patients at higher risk for urethral complications or those with large prostate volumes.By documenting the procedural intricacies and outcomes clearly and thoroughly,we seek to encourage informed adoption of STAR-P as an alternative,effective surgical approach for managing benign prostatic hyperplasia,thus contributing to the evolving landscape ofminimally invasive urological surgery.
