The ileal pouch anal anastomosis(IPAA)has revolutionised the surgical management of ulcerative colitis(UC)and familial adenomatous polyposis(FAP).Despite refinement in surgical technique(s)and patient selection,IPAA c...The ileal pouch anal anastomosis(IPAA)has revolutionised the surgical management of ulcerative colitis(UC)and familial adenomatous polyposis(FAP).Despite refinement in surgical technique(s)and patient selection,IPAA can be associated with significant morbidity.As the IPAA celebrated its 40th anniversary in 2018,this review provides a timely outline of its history,indications,and complications.IPAA has undergone significant modification since 1978.For both UC and FAP,IPAA surgery aims to definitively cure disease and prevent malignant degeneration,while providing adequate continence and avoiding a permanent stoma.The majority of patients experience long-term success,but“early”and“late”complications are recognised.Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction,but prompt intervention(either radiological or surgical)reduces the risk of pouch failure.Even in the absence of sepsis,pouch dysfunction is a longterm complication that may have a myriad of causes.Pouchitis is a common cause that remains incompletely understood and difficult to manage at times.10%of patients succumb to the diagnosis of pouch failure,which is traditionally associated with the need for pouch excision.This review provides a timely outline of the history,indications,and complications associated with IPAA.Patient selection remains key,and contraindications exist for this surgery.A structured management plan is vital to the successful management of complications following pouch surgery.展开更多
The great vessels of the heart originate from the pharyngeal arch arteries(PAAs).Anomalies of the PAAs often occur together with pharyngeal pouch malfo rmations,but the reasons for this phenomenon are not fully unders...The great vessels of the heart originate from the pharyngeal arch arteries(PAAs).Anomalies of the PAAs often occur together with pharyngeal pouch malfo rmations,but the reasons for this phenomenon are not fully understood.In the current study,we show that platelet-derived growth factor(PDGF)signaling derived from the pharyngeal pouches plays an important function in PAA vasculogenesis,During PAA development in zebrafish embryos,pdgfaa and pdgfab are expressed in the developing pharyngeal pouches.Results from loss-of-function experiments revealed a critical role of these genes in PAA formation.We found that nitroreductase(NTR)-mediated pouch ablation distinctly decreased PDGF receptor tyrosine phosphorylation,yielding a severe loss of PAAs.Importantly,pouch-specific overexpression of pdgfaa in pdgfaa-/-;pdgfab-/-mutants significantly relieved the PAA defects,which indicated a primary role of pharyngeal pouch-expressed PDGF ligands in signal activation and PAA morphogenesis.Our findings further showed that PDGF signaling was indispensable for the proliferation of PAA angioblasts.Together,these results established a role for PDGFaa-and PDGFab-mediated tissuetissue interaction during PAA development.展开更多
In response to the issues posed by non-biodegradable orchard fruit pouches causing environmental pollution,as well as the inefficiency and high cost of manual recovery,a design for an orchard fruit pouch collecting ma...In response to the issues posed by non-biodegradable orchard fruit pouches causing environmental pollution,as well as the inefficiency and high cost of manual recovery,a design for an orchard fruit pouch collecting machine was proposed.The study involved analyzing the structure and working principle of the entire machine,as well as proposing two types of pick-up and recovery devices:a spring-tooth roller type pickup device and an air-suction collecting device.After comparative analysis,the spring-tooth roller type pickup device was selected.Based on the physical characteristics of the fruit pouch,theoretical calculations and kinematic analysis were performed for the key components of the orchard fruit pouch collecting machine.This analysis yielded working parameters for each component,with a focus on roller rotational speed,machine travel speed,and number of spring-tooth rows as critical factors influencing operational effectiveness.Subsequently,the ADAMS simulations were conducted based on these findings.Then the response surface methodology was applied,and an optimal parameter combination for the orchard fruit pouch collecting machine was determined:a machine travel speed of 2 km/h,roller rotational speed of 60 r/min,and five rows of spring teeth.The prototype was made,and the results of orchard experiments indicated that with the optimal parameter combination,the recovery rate predicted by the model was 85.2%and that of the orchard experiment was 80.9%.The relative error between them is 5.3%.These findings confirmed that the designed orchard fruit pouch collecting machine could achieve the expected performance and effectively recover fruit pouches with good efficiency.展开更多
Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(...Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and CDI.Methods:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch Disorders.The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses.Results:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch surgery.After a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions each.Within the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via enemas.All patients tested negative on C.difficile polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity Index.During the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with FMT.Conclusions:FMT appeared to be effective in eradication of CDI in patients with ileal pouches.However,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.展开更多
Background:In symptomatic patients with an ileal pouch,stool studies are often sent to diagnose enteric pathogens.Aim of this study is to find the value of routine stool studies in the evaluation of symptomatic patien...Background:In symptomatic patients with an ileal pouch,stool studies are often sent to diagnose enteric pathogens.Aim of this study is to find the value of routine stool studies in the evaluation of symptomatic patients and the clinical implications of such pathogens in patients with ileal pouches.Methods:Consecutive ileal pouch-anal anastomosis(IPAA)patients who had stool tests out of a 2283-case registry from 2002 to 2015 were included in the study.Patients with positive stool cultures were compared with controls(symptomatic without positive stool culture)in a 1:4 ratio.Response to antibiotic therapy,recurrence rate and rate of hospitalization at 1 and 3 months were assessed.Results:A total of 643(28%)had stool cultures done and only 1.7%(11/643)were found to be positive for stool cultures.Campylobacter spp.(45%)was the most common pathogen followed by Aeromonas spp.(36%).Non-smokers and patients without any antibiotic use in the last 3 months were found to have higher prevalence of positive stool cultures than controls(p<0.001 and p¼0.023).Patients with pathogenic bacteria were found to have a higher risk of acute kidney injury(27.3%vs 4.5%,p¼0.049),hospitalization within 3 months of initial stool testing(36.4%vs 6.8%,p¼0.009)and mortality(18.2%vs 0%,p¼0.040).However,there were no statistically significant differences in the clinical outcomes in patients with positive stool cultures who received pathogen-directed therapy.Conclusions:We found that the yield of stool tests for bacterial pathogens in symptomatic pouch patients was extremely low and the treatment of detected pathogens had a minimum impact on the disease course of pouchitis.The clinical utility of routine stool culture in those patients warrants further study.展开更多
Background:Strictures are a common complication after ileal pouch surgery with the most common locations being at the anasto-mosis,pouch inlet,and stoma closure site.No previous literature has described endoscopic the...Background:Strictures are a common complication after ileal pouch surgery with the most common locations being at the anasto-mosis,pouch inlet,and stoma closure site.No previous literature has described endoscopic therapy of stoma site stricture.This study aimed to assess the safety and efficacy of endoscopic therapy in the treatment of stoma closure site strictures.Method:Patients diagnosed with stoma closure site strictures following ileal pouch surgery who underwent endoscopic treatment at the Center for Colorectal Diseases,Inflammatory Bowel Disease(IBD),and Ileal Pouch between 2018 and 2022 were analysed.Primary outcomes(technical success and surgery-free survival)were compared between endoscopic balloon dilation(EBD)and stricturotomy and/or strictureplasty.Results:A total of 30 consecutive eligible patients were analysed.Most patients were female(66.7%)and most patients were diag-nosed with IBD(93.3%).Twenty patients(66.7%)had end-to-end anastomosis.A total of 52 procedures were performed,with EBD in 16(30.8%)and stricturotomy and/or strictureplasty in 36(69.2%).The mean stricture length was 1.7±1.0 cm.Immediate technical success was achieved in 47 of 52 interventions(90.4%).During a mean follow-up of 12.7±9.9 months,none of the patients underwent surgical intervention for the stricture.Fourteen(46.7%)required endoscopic re-intervention for their strictures with an interval be-tween index and re-interventional pouchoscopy of 8.8±6.3 months.Post-procedural complications were reported in 2(6.7%)with bleeding and none with perforation.Upon follow-up,20(66.7%)patients reported improvement in their symptoms.Conclusion:EBD and endoscopic stricturotomy and/or strictureplasty are safe and effective in treating stoma closure site strictures in patients with ileal pouches,providing symptomatic relief in most patients as well as avoiding surgery.展开更多
Polyacrylic acid(PAA)-based binders have been demonstrated to significantly enhance the cycling stability of pure silicon(Si)anodes compared to other binder types.However,there is a notable lack of systematic and in-d...Polyacrylic acid(PAA)-based binders have been demonstrated to significantly enhance the cycling stability of pure silicon(Si)anodes compared to other binder types.However,there is a notable lack of systematic and in-depth investigation into the relationship between the molecular weight(MW)of PAA and its performance in pure Si anodes,leading to an absence of reliable theoretical guidance for designing and optimizing of PAA-based binders for these anodes.Herein,we select a series of PAA with varying MWs as binders for Si nanoparticle(SiNP)anodes to systematically identify the optimal MW of PAA for enhancing the electrochemical performance of SiNP anodes.The actual MWs of the various PAA were confirmed by gel permeation chromatography to accurately establish the relationship between MW and binder performance.Within an ultrawide weight average molecular weight(M_(w))range of 35.9-4850 kDa,we identify that the PAA binder with a M_(w)of 1250 kDa(PAA125)exhibits the strongest mechanical strength and the highest adhesion strength,attributed to its favorable molecular chain orientation and robust interchain interactions.These characteristics enable the SiNP anodes utilizing PAA125 to maintain the best interfacial chemistry and bulk mechanical structure stability,leading to optimal electrochemical performance.Notably,the enhancement in cycling stability of SiNP anode by PAA125 under practical application conditions is further validated by the 1.1 Ah LLNi_(0.8)Co_(0.1)Mn_(0.1)O_(2)/SiNP@PAA125 pouch cell.展开更多
BACKGROUND Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis.AIM To identify potential risk factors for the development of ch...BACKGROUND Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis.AIM To identify potential risk factors for the development of chronic pouchitis.METHODS Predictors of chronic pouchitis were investigated through a systematic review and meta-analysis.A comprehensive search of the Medline,EMBASE,and PubMed databases was undertaken to identify relevant studies published up to October 2023.Meta-analytic procedures employed random-effects models for the combination of estimates,with the I^(2)statistic used to assess between-study heterogeneity.RESULTS Eleven studies with a total of 3722 patients,comprising 513 with chronic pouchitis and 3209 patients without,were included in the final analysis.Extraintestinal manifestation[odds ratio(OR)=2.11,95%confidence intervals(CI):1.53-2.91,P<0.001,I^(2)=0%],specifically primary sclerosing cholangitis(PSC)(OR=3.69,95%CI:1.40-9.21,P=0.01,I2=48%),and extensive colitis(OR=1.96,95%CI:1.23-3.11,P=0.00,I^(2)=31%)were associated with an increased risk of chronic pouchitis.Other factors,including gender,smoking status,family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis.CONCLUSION Extraintestinal manifestations,PSC and extensive colitis are associated with the development of chronic pouchitis.These findings underscore the importance of comprehensive pre-operative assessment and tailored post operative management strategies.展开更多
Lithium-sulfur(Li-S)batteries are promising next-generation high-energy-density energy storage devices.However,the failure mechanism of 500 Wh kg^(-1)level Li-S pouch cells has not been well understood.Herein,quantita...Lithium-sulfur(Li-S)batteries are promising next-generation high-energy-density energy storage devices.However,the failure mechanism of 500 Wh kg^(-1)level Li-S pouch cells has not been well understood.Herein,quantitative and systematic failure analysis is conducted on 500 Wh kg^(-1)level Li-S pouch cells to understand the underlying failure mechanism.Focusing on electrolyte exhaustion as the primary cause of cell failure,quantitative analysis methods are established to determine electrolyte occupation by physical infiltration of the cathode,separator,and anode as well as chemical consumption by lithium metal.Insufficient physical infiltration of the cathode caused by irreversible cathode volume expansion is identified as the main cause of electrolyte exhaustion.In comparison,chemical consumption of electrolytes by lithium metal and insufficient anode infiltration have limited influence on cell operations.To address the insufficient cathode infiltration,macropore-rich sulfur cathodes are fabricated to suppress the irreversible volume expansion and prolong the cycling lifespan of Li-S pouch cells by 2.4 times.This work elucidates that the sulfur cathode dominates the cycling lifespan of high-energy-density Li-S batteries and highlights cathode structural design to mitigate irreversible volume expansion for cycling performance improvement.展开更多
Solid electrolyte interphase(SEI)plays a critical role in stabilizing zinc batteries,yet insufficient attention has been given to its in-situ growth kinetics and the post-stripping morphology of zinc anodes,both affec...Solid electrolyte interphase(SEI)plays a critical role in stabilizing zinc batteries,yet insufficient attention has been given to its in-situ growth kinetics and the post-stripping morphology of zinc anodes,both affecting the SEI-forming quality.Herein,we showcase a synergistic effect between uniform Zn stripping and rapid SEI formation through introducing tetramethylurea(TMU)into Zn(BF_(4))_(2)-based electrolytes.TMU participates in the Zn^(2+)solvation structure and reshapes the electrolyte hydrogen-bond network,enabling a water-poor electric double layer that mitigates the corrosion-induced stripping inhomogeneity.Subsequently,a multi-component and inorganic-rich SEI with high uniformity is rapidly deposited during the plating process.This SEI with abundant zincophilic sites activates instantaneous nucleation and hence guides dense and uniform Zn deposition.With enhanced Zn stripping/plating symmetry,the long-term effectiveness of SEI is guaranteed,contributing to the high reversibility over 3200 h at 1 mA cm^(-2)/2 mAh cm^(-2).Impressively,the Zn//NaV_(3)O_(8)full cell(4.43 mAh cm^(-2))can be steadily cycled at 0.1 A g^(-1)under an intermittent-rest protocol.The stable operation of an Ah-level pouch cell over 100 cycles further demonstrates the scalability of this strategy and highlights the significance of achieving high stripping/plating symmetry and a long-term effective SEI toward practical zinc batteries.展开更多
High-energy-density lithium metal batteries hold great promise for advancing low-altitude economic development.However,the practical application of ultrathin lithium anodes remains challenging due to significant inter...High-energy-density lithium metal batteries hold great promise for advancing low-altitude economic development.However,the practical application of ultrathin lithium anodes remains challenging due to significant interfacial side reactions,dendrite formation,and substantial volume fluctuations.In this study,lithium metal electrodes were fabricated using a spin-coating process,enabling an in situ reaction between lithium and phenyl disulfide(PDS).The resulting robust organic sulfurization interface,composed of lithium thiophenoxide,facilitates rapid lithium-ion transport and effectively suppresses dendrite formation.Symmetric cells with a 50μm Li@PDS anode exhibited an impressive lifespan exceeding3000 h at 1 mA cm^(-2)and 1 mAh cm^(-2).The Li@PDS anode demonstrated excellent structural stability in a practical LiNi_(0.8)Co_(0.1)Mn_(0.1)O_(2)(NCM811)lILi@PDS pouch cell,maintaining 94.8%of its initial capacity(1.45 Ah)over 260 cycles at a 0.4C rate and 87.30%of its initial capacity(1.1 Ah)over 360 cycles at a 2C rate(1C=200 mA g^(-1)).This work provides a promising pathway for developing durable lithium metal anodes suitable for scalable practical applications.展开更多
Strategic design and synergistic interactions between the electrodes and electroactive materials profoundly influence the energy storage efficiency of supercapacitor devices. Herein, we present the interfacial enginee...Strategic design and synergistic interactions between the electrodes and electroactive materials profoundly influence the energy storage efficiency of supercapacitor devices. Herein, we present the interfacial engineering of CoMoS_(4)-NiS_(2) with a well-defined construction of amorphous/crystalline hetero-phases deposited on carbon cloth using a hydrothermal technique. The optimal in-situ growth of CoMoS_(4)-NiS_(2)@CFC boasts an impressive areal capacity of 1341 mC cm^(-2) and retains ∼91 % capacity after 5000 cycles, attributed to the synergy effect and improved conductivity of multi-metallic sulfide ions over the CFC substrate. Density functional theory (DFT) reveals the metallic nature of CoMoS_(4)-NiS_(2)@CFC and favorable OH- ion adsorption energy of -4.35 eV, enhancing its charge storage capabilities. Furthermore, a hybrid supercapacitor (HSC) and Pouch HSC are assembled utilizing the CoMoS_(4)-NiS_(2)@CFC as a positrode and marine waste jellyfish-derived AC as a negatrode with an aqueous electrolyte. The HSC and PHSC demonstrate superior specific energies of 51.99 and 58.4 W h kg^(-1), respectively, along with corresponding specific powers of 800 and 780 W kg^(-1), maintaining robust stability of ∼90 % stability over 10000 cycles. Additionally, the HSC and PHSC have successfully illuminated several light-emitting diodes (LEDs) demonstrating superior energy storage performance. This work advances the design of hetero-phase multi-metal sulfides, paving the way for high-performance supercapacitor devices.展开更多
To address the challenges of air stability and slurry processability in layered transition metal oxide O_(3)-type NaNi_(1/3)Fe_(1/3)Mn_(1/3)O_(2)(NFM)for sodium-ion batteries(SIBs),we have designed an innovative 500℃...To address the challenges of air stability and slurry processability in layered transition metal oxide O_(3)-type NaNi_(1/3)Fe_(1/3)Mn_(1/3)O_(2)(NFM)for sodium-ion batteries(SIBs),we have designed an innovative 500℃reheating strategy.This method improves the surface properties of NFM without the need for additional coating layers,making it more efficient and suitable for large-scale applications.Pristine NFM(NFM-P)was first synthesized through a high-temperature solid-state method and then modified using this reheating approach(NFM-HT).This strategy significantly enhances air stability and electrochemical performance,yielding an initial discharge specific capacity of 151.46 mAh/g at 0.1C,with a remarkable capacity retention of 95.04%after 100 cycles at 0.5C.Additionally,a 1.7 Ah NFM‖HC(hard carbon)pouch cell demonstrates excellent long-term cycling stability(94.64%retention after 500 cycles at 1C),superior rate capability(86.48%retention at 9C),and strong low-temperature performance(77%retention at-25℃,continuing power supply at-40℃).Notably,even when overcharged to 8.29 V,the pouch cell remained safe without combustion or explosion.This reheating strategy,which eliminates the need for a coating layer,offers a simpler,more scalable solution for industrial production while maintaining outstanding electrochemical performance.These results pave the way for broader commercial adoption of NFM materials.展开更多
Electrolyte additives are pivotal for stable cycling of rechargeable sodium-ion batteries(SIBs),which dictate the creation of the protective interface film on electrodes.Cyclic sulfur-containing additives,such as1,3,2...Electrolyte additives are pivotal for stable cycling of rechargeable sodium-ion batteries(SIBs),which dictate the creation of the protective interface film on electrodes.Cyclic sulfur-containing additives,such as1,3,2-dioxathiolane-2,2-dioxide(DTD),with the structure of sulfur surrounded by four oxygen atoms,have been proposed but less knowledge is available on the relationship between their molecular structures and interfacial stability.This work compares two similar molecule structure of cyclic sulfurcontaining additives,DTD and ethylene sulfite(ES),to investigate their effects on the electrochemical performance of NaNi_(1/3)Fe_(1/3)Mn_(1/3)O_(2)(NFM)||hard carbon(HC)pouch cells.Therein,ES with the structure of sulfur surrounded by three oxygen atoms,as electrolyte additive,is investigated in the SIBs for the first time.It is shown that adding 3.0%ES or 2.0%DTD(the optimal proportion)in the Control electrolyte(1 M NaPF_(6)in EC:EMC=3:7 with 5.0%FEC in weight)can improve cyclic stability and rate performance,respectively.Even under the high-temperature conditions,both ES and DTD exhibit good performance,but DTD is superior.Combinations of electrochemical methods,multi-spectroscopy,and theoretical calculations have been employed to evaluate and compare the effects of ES and DTD on sodium-ion battery.They reveal that ES and DTD can generate different content and composition by redox reaction on cathode and anode surface.The more and effective high-valence sulfur-containing components for DTD are the main reason to explain the better effect on DTD.This work shares new insights into the relationship between cyclic sulfur-containing additive molecule structure and electrolyte-electrode interface films effect,which fills the blanks of previous research.展开更多
Based on the object oriented data structure of Voronoi diagram, the algorithm of the trimmed offset generating and the optimal too l path planning of the pocket machining for multiply connected polygonal domains are ...Based on the object oriented data structure of Voronoi diagram, the algorithm of the trimmed offset generating and the optimal too l path planning of the pocket machining for multiply connected polygonal domains are studied. The intersection state transition rule is improved in this algorithm. The intersection is between the trimmed offsets and Voronoi polygon. On this basis, the trimmed offset generating and the optimal tool path planning are mad e with three stacks(I stack, C stack and P stack)in different monotonous pouches of Voronoi diagram. At the same time, a merging method of Voronoi diagram an d offsets generating for multiply connected polygonal domains is also presented. The above algorithms have been implemented in NC machining successfully, and the efficiency is fully verified.展开更多
Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radi...Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radical cystectomy. Results 5 cases showed satisfactory therapeutic effects with of follow-up range of 6 to 30 months. All patients were continent day and night with easy catherization. The number of micturations was 5 to 6 times in the daytime and 1 to 3 times in the nighttime. Cystography of 4 cases showed that pouches were spheroidic and volumes were between 400 to 500 ml. Conclusion The advantages of the modified Indiana pouch are as follows: easy manipulation; low tension and high volume in pouches; no reflux; satisfactory urinary continence and few complications. Therefore, it is worthy of clinical popularization.展开更多
During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn's disease (CD) patients wil...During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn's disease (CD) patients will undergo an operation during their lifetime. For UC patients requiring surgery, total proctocolectomy and ileoanal pouch anastomosis (IPAA) is the operation of choice as it provides a permanent cure and good quality of life. Nevertheless a permanent stoma is a good option in selected patients, especially the elderly. Minimally invasive surgery has replaced the conventional open approach in many specialized centres worldwide. Laparoscopic colectomy and restorative IPAA is rapidly becoming the standard of care in the treatment of UC requiring surgery, whilst laparoscopic ileo-cecal resection is already the new gold standard in the treatment of complicated CD of terminal ileum. Short term advantages of laparoscopic surgery includes faster recovery time and reduced requirement for analgesics. It is, however, in the long term that minimally invasive surgery has demonstrated its superiority over the open approach. A better cosmesis, a reduced number of incisional hernias and fewer adhesions are the long term advantages of laparoscopy in IBD surgery. A reduction in abdominal adhesions is of great benefit when a second operation is needed in CD and this influences positively the pregnancy rate in young women undergoing restorative IPAA. In developing the therapeutic plan for IBD patients it should be recognized that the surgical approach to the abdomen has changed and that surgical treatment of complicated IBD can be safely performed with a true minimally invasive approach with great patient satisfaction.展开更多
Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch ha...Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence,nature,and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed,the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated,but many remain controversial. Nevertheless,it seems certain that the age of the pouch is important. The risk appears to be 7%to 16% after 5 years,35% to 42% after 10 years,and75% after 15 years. On the other hand,only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years(median,10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low,it is not negligible,and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance,especially using chromoendoscopy,is recommended.展开更多
基金the Mitchell J.Notaras Fellowship in Colorectal Surgery
文摘The ileal pouch anal anastomosis(IPAA)has revolutionised the surgical management of ulcerative colitis(UC)and familial adenomatous polyposis(FAP).Despite refinement in surgical technique(s)and patient selection,IPAA can be associated with significant morbidity.As the IPAA celebrated its 40th anniversary in 2018,this review provides a timely outline of its history,indications,and complications.IPAA has undergone significant modification since 1978.For both UC and FAP,IPAA surgery aims to definitively cure disease and prevent malignant degeneration,while providing adequate continence and avoiding a permanent stoma.The majority of patients experience long-term success,but“early”and“late”complications are recognised.Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction,but prompt intervention(either radiological or surgical)reduces the risk of pouch failure.Even in the absence of sepsis,pouch dysfunction is a longterm complication that may have a myriad of causes.Pouchitis is a common cause that remains incompletely understood and difficult to manage at times.10%of patients succumb to the diagnosis of pouch failure,which is traditionally associated with the need for pouch excision.This review provides a timely outline of the history,indications,and complications associated with IPAA.Patient selection remains key,and contraindications exist for this surgery.A structured management plan is vital to the successful management of complications following pouch surgery.
基金supported by grants from the National Natural Science Foundation of China(91739101 and 81921006)the National Key Research and Development Program of China(2016YFA0100503 and 2018YFA0800200)the Strategic Priority Research Program of the Chinese Academy of Sciences(XDA16000000).
文摘The great vessels of the heart originate from the pharyngeal arch arteries(PAAs).Anomalies of the PAAs often occur together with pharyngeal pouch malfo rmations,but the reasons for this phenomenon are not fully understood.In the current study,we show that platelet-derived growth factor(PDGF)signaling derived from the pharyngeal pouches plays an important function in PAA vasculogenesis,During PAA development in zebrafish embryos,pdgfaa and pdgfab are expressed in the developing pharyngeal pouches.Results from loss-of-function experiments revealed a critical role of these genes in PAA formation.We found that nitroreductase(NTR)-mediated pouch ablation distinctly decreased PDGF receptor tyrosine phosphorylation,yielding a severe loss of PAAs.Importantly,pouch-specific overexpression of pdgfaa in pdgfaa-/-;pdgfab-/-mutants significantly relieved the PAA defects,which indicated a primary role of pharyngeal pouch-expressed PDGF ligands in signal activation and PAA morphogenesis.Our findings further showed that PDGF signaling was indispensable for the proliferation of PAA angioblasts.Together,these results established a role for PDGFaa-and PDGFab-mediated tissuetissue interaction during PAA development.
基金National Natural Science Foundation of China(Grant No.31971801)Shandong Provincial Natural Science Foundation of China(ZR2020ME252,ZR2020ME250)Qingdao Demonstration Project(25-1-5-xdny-33-nsh).
文摘In response to the issues posed by non-biodegradable orchard fruit pouches causing environmental pollution,as well as the inefficiency and high cost of manual recovery,a design for an orchard fruit pouch collecting machine was proposed.The study involved analyzing the structure and working principle of the entire machine,as well as proposing two types of pick-up and recovery devices:a spring-tooth roller type pickup device and an air-suction collecting device.After comparative analysis,the spring-tooth roller type pickup device was selected.Based on the physical characteristics of the fruit pouch,theoretical calculations and kinematic analysis were performed for the key components of the orchard fruit pouch collecting machine.This analysis yielded working parameters for each component,with a focus on roller rotational speed,machine travel speed,and number of spring-tooth rows as critical factors influencing operational effectiveness.Subsequently,the ADAMS simulations were conducted based on these findings.Then the response surface methodology was applied,and an optimal parameter combination for the orchard fruit pouch collecting machine was determined:a machine travel speed of 2 km/h,roller rotational speed of 60 r/min,and five rows of spring teeth.The prototype was made,and the results of orchard experiments indicated that with the optimal parameter combination,the recovery rate predicted by the model was 85.2%and that of the orchard experiment was 80.9%.The relative error between them is 5.3%.These findings confirmed that the designed orchard fruit pouch collecting machine could achieve the expected performance and effectively recover fruit pouches with good efficiency.
文摘Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and CDI.Methods:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch Disorders.The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses.Results:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch surgery.After a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions each.Within the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via enemas.All patients tested negative on C.difficile polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity Index.During the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with FMT.Conclusions:FMT appeared to be effective in eradication of CDI in patients with ileal pouches.However,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.
文摘Background:In symptomatic patients with an ileal pouch,stool studies are often sent to diagnose enteric pathogens.Aim of this study is to find the value of routine stool studies in the evaluation of symptomatic patients and the clinical implications of such pathogens in patients with ileal pouches.Methods:Consecutive ileal pouch-anal anastomosis(IPAA)patients who had stool tests out of a 2283-case registry from 2002 to 2015 were included in the study.Patients with positive stool cultures were compared with controls(symptomatic without positive stool culture)in a 1:4 ratio.Response to antibiotic therapy,recurrence rate and rate of hospitalization at 1 and 3 months were assessed.Results:A total of 643(28%)had stool cultures done and only 1.7%(11/643)were found to be positive for stool cultures.Campylobacter spp.(45%)was the most common pathogen followed by Aeromonas spp.(36%).Non-smokers and patients without any antibiotic use in the last 3 months were found to have higher prevalence of positive stool cultures than controls(p<0.001 and p¼0.023).Patients with pathogenic bacteria were found to have a higher risk of acute kidney injury(27.3%vs 4.5%,p¼0.049),hospitalization within 3 months of initial stool testing(36.4%vs 6.8%,p¼0.009)and mortality(18.2%vs 0%,p¼0.040).However,there were no statistically significant differences in the clinical outcomes in patients with positive stool cultures who received pathogen-directed therapy.Conclusions:We found that the yield of stool tests for bacterial pathogens in symptomatic pouch patients was extremely low and the treatment of detected pathogens had a minimum impact on the disease course of pouchitis.The clinical utility of routine stool culture in those patients warrants further study.
文摘Background:Strictures are a common complication after ileal pouch surgery with the most common locations being at the anasto-mosis,pouch inlet,and stoma closure site.No previous literature has described endoscopic therapy of stoma site stricture.This study aimed to assess the safety and efficacy of endoscopic therapy in the treatment of stoma closure site strictures.Method:Patients diagnosed with stoma closure site strictures following ileal pouch surgery who underwent endoscopic treatment at the Center for Colorectal Diseases,Inflammatory Bowel Disease(IBD),and Ileal Pouch between 2018 and 2022 were analysed.Primary outcomes(technical success and surgery-free survival)were compared between endoscopic balloon dilation(EBD)and stricturotomy and/or strictureplasty.Results:A total of 30 consecutive eligible patients were analysed.Most patients were female(66.7%)and most patients were diag-nosed with IBD(93.3%).Twenty patients(66.7%)had end-to-end anastomosis.A total of 52 procedures were performed,with EBD in 16(30.8%)and stricturotomy and/or strictureplasty in 36(69.2%).The mean stricture length was 1.7±1.0 cm.Immediate technical success was achieved in 47 of 52 interventions(90.4%).During a mean follow-up of 12.7±9.9 months,none of the patients underwent surgical intervention for the stricture.Fourteen(46.7%)required endoscopic re-intervention for their strictures with an interval be-tween index and re-interventional pouchoscopy of 8.8±6.3 months.Post-procedural complications were reported in 2(6.7%)with bleeding and none with perforation.Upon follow-up,20(66.7%)patients reported improvement in their symptoms.Conclusion:EBD and endoscopic stricturotomy and/or strictureplasty are safe and effective in treating stoma closure site strictures in patients with ileal pouches,providing symptomatic relief in most patients as well as avoiding surgery.
基金funding supports of the National Natural Science Foundation of China(52402315,52172244,51874104,and 52172190)the"Leading Innovative and Entrepreneur Team Introduction Program of Zhejiang"(2023R01007)the Zhejiang Provincial"Jianbing"and"Lingyan"R&D Programs(Grant No.2024C01262)。
文摘Polyacrylic acid(PAA)-based binders have been demonstrated to significantly enhance the cycling stability of pure silicon(Si)anodes compared to other binder types.However,there is a notable lack of systematic and in-depth investigation into the relationship between the molecular weight(MW)of PAA and its performance in pure Si anodes,leading to an absence of reliable theoretical guidance for designing and optimizing of PAA-based binders for these anodes.Herein,we select a series of PAA with varying MWs as binders for Si nanoparticle(SiNP)anodes to systematically identify the optimal MW of PAA for enhancing the electrochemical performance of SiNP anodes.The actual MWs of the various PAA were confirmed by gel permeation chromatography to accurately establish the relationship between MW and binder performance.Within an ultrawide weight average molecular weight(M_(w))range of 35.9-4850 kDa,we identify that the PAA binder with a M_(w)of 1250 kDa(PAA125)exhibits the strongest mechanical strength and the highest adhesion strength,attributed to its favorable molecular chain orientation and robust interchain interactions.These characteristics enable the SiNP anodes utilizing PAA125 to maintain the best interfacial chemistry and bulk mechanical structure stability,leading to optimal electrochemical performance.Notably,the enhancement in cycling stability of SiNP anode by PAA125 under practical application conditions is further validated by the 1.1 Ah LLNi_(0.8)Co_(0.1)Mn_(0.1)O_(2)/SiNP@PAA125 pouch cell.
文摘BACKGROUND Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis.AIM To identify potential risk factors for the development of chronic pouchitis.METHODS Predictors of chronic pouchitis were investigated through a systematic review and meta-analysis.A comprehensive search of the Medline,EMBASE,and PubMed databases was undertaken to identify relevant studies published up to October 2023.Meta-analytic procedures employed random-effects models for the combination of estimates,with the I^(2)statistic used to assess between-study heterogeneity.RESULTS Eleven studies with a total of 3722 patients,comprising 513 with chronic pouchitis and 3209 patients without,were included in the final analysis.Extraintestinal manifestation[odds ratio(OR)=2.11,95%confidence intervals(CI):1.53-2.91,P<0.001,I^(2)=0%],specifically primary sclerosing cholangitis(PSC)(OR=3.69,95%CI:1.40-9.21,P=0.01,I2=48%),and extensive colitis(OR=1.96,95%CI:1.23-3.11,P=0.00,I^(2)=31%)were associated with an increased risk of chronic pouchitis.Other factors,including gender,smoking status,family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis.CONCLUSION Extraintestinal manifestations,PSC and extensive colitis are associated with the development of chronic pouchitis.These findings underscore the importance of comprehensive pre-operative assessment and tailored post operative management strategies.
基金supported by the National Key Research and Development Program of China(2023YFE0112902)the National Natural Science Foundation of China(22425901,22409116)+3 种基金the China Postdoctoral Science Foundation(GZB20240346)the Tianjin Natural Science Foundation(S23DYZD11034)the Seed Fund of Shanxi Research Institute for Clean Energy(SXKYJF015)the Shuimu Tsinghua Scholar Program of Tsinghua University。
文摘Lithium-sulfur(Li-S)batteries are promising next-generation high-energy-density energy storage devices.However,the failure mechanism of 500 Wh kg^(-1)level Li-S pouch cells has not been well understood.Herein,quantitative and systematic failure analysis is conducted on 500 Wh kg^(-1)level Li-S pouch cells to understand the underlying failure mechanism.Focusing on electrolyte exhaustion as the primary cause of cell failure,quantitative analysis methods are established to determine electrolyte occupation by physical infiltration of the cathode,separator,and anode as well as chemical consumption by lithium metal.Insufficient physical infiltration of the cathode caused by irreversible cathode volume expansion is identified as the main cause of electrolyte exhaustion.In comparison,chemical consumption of electrolytes by lithium metal and insufficient anode infiltration have limited influence on cell operations.To address the insufficient cathode infiltration,macropore-rich sulfur cathodes are fabricated to suppress the irreversible volume expansion and prolong the cycling lifespan of Li-S pouch cells by 2.4 times.This work elucidates that the sulfur cathode dominates the cycling lifespan of high-energy-density Li-S batteries and highlights cathode structural design to mitigate irreversible volume expansion for cycling performance improvement.
基金supported by the National Natural Science Foundation of China(52372252)the Science and Technology Innovation Program of Hunan Province(2024RC1022)+1 种基金the Hunan Provincial Natural Science Foundation of China(2025JJ60356)the Changsha Municipal Natural Science Foundation(kq2502024).
文摘Solid electrolyte interphase(SEI)plays a critical role in stabilizing zinc batteries,yet insufficient attention has been given to its in-situ growth kinetics and the post-stripping morphology of zinc anodes,both affecting the SEI-forming quality.Herein,we showcase a synergistic effect between uniform Zn stripping and rapid SEI formation through introducing tetramethylurea(TMU)into Zn(BF_(4))_(2)-based electrolytes.TMU participates in the Zn^(2+)solvation structure and reshapes the electrolyte hydrogen-bond network,enabling a water-poor electric double layer that mitigates the corrosion-induced stripping inhomogeneity.Subsequently,a multi-component and inorganic-rich SEI with high uniformity is rapidly deposited during the plating process.This SEI with abundant zincophilic sites activates instantaneous nucleation and hence guides dense and uniform Zn deposition.With enhanced Zn stripping/plating symmetry,the long-term effectiveness of SEI is guaranteed,contributing to the high reversibility over 3200 h at 1 mA cm^(-2)/2 mAh cm^(-2).Impressively,the Zn//NaV_(3)O_(8)full cell(4.43 mAh cm^(-2))can be steadily cycled at 0.1 A g^(-1)under an intermittent-rest protocol.The stable operation of an Ah-level pouch cell over 100 cycles further demonstrates the scalability of this strategy and highlights the significance of achieving high stripping/plating symmetry and a long-term effective SEI toward practical zinc batteries.
基金financially supported by the National Natural Science Foundation of China (No.52471166)the Central South University Graduate-Student Autonomous Exploration Innovative Programme (No.2024ZZTS0373)
文摘High-energy-density lithium metal batteries hold great promise for advancing low-altitude economic development.However,the practical application of ultrathin lithium anodes remains challenging due to significant interfacial side reactions,dendrite formation,and substantial volume fluctuations.In this study,lithium metal electrodes were fabricated using a spin-coating process,enabling an in situ reaction between lithium and phenyl disulfide(PDS).The resulting robust organic sulfurization interface,composed of lithium thiophenoxide,facilitates rapid lithium-ion transport and effectively suppresses dendrite formation.Symmetric cells with a 50μm Li@PDS anode exhibited an impressive lifespan exceeding3000 h at 1 mA cm^(-2)and 1 mAh cm^(-2).The Li@PDS anode demonstrated excellent structural stability in a practical LiNi_(0.8)Co_(0.1)Mn_(0.1)O_(2)(NCM811)lILi@PDS pouch cell,maintaining 94.8%of its initial capacity(1.45 Ah)over 260 cycles at a 0.4C rate and 87.30%of its initial capacity(1.1 Ah)over 360 cycles at a 2C rate(1C=200 mA g^(-1)).This work provides a promising pathway for developing durable lithium metal anodes suitable for scalable practical applications.
基金supported by the Technology Devel-opment Program(No.S3218794)funded by the Ministry of SMEs and Startups(MSS,Korea)supported by the Nano&Material Technology Development Program through the National Research Foundation of Korea(NRF)funded by the Min-istry of Science and ICT(No.RS-2024-00446825).
文摘Strategic design and synergistic interactions between the electrodes and electroactive materials profoundly influence the energy storage efficiency of supercapacitor devices. Herein, we present the interfacial engineering of CoMoS_(4)-NiS_(2) with a well-defined construction of amorphous/crystalline hetero-phases deposited on carbon cloth using a hydrothermal technique. The optimal in-situ growth of CoMoS_(4)-NiS_(2)@CFC boasts an impressive areal capacity of 1341 mC cm^(-2) and retains ∼91 % capacity after 5000 cycles, attributed to the synergy effect and improved conductivity of multi-metallic sulfide ions over the CFC substrate. Density functional theory (DFT) reveals the metallic nature of CoMoS_(4)-NiS_(2)@CFC and favorable OH- ion adsorption energy of -4.35 eV, enhancing its charge storage capabilities. Furthermore, a hybrid supercapacitor (HSC) and Pouch HSC are assembled utilizing the CoMoS_(4)-NiS_(2)@CFC as a positrode and marine waste jellyfish-derived AC as a negatrode with an aqueous electrolyte. The HSC and PHSC demonstrate superior specific energies of 51.99 and 58.4 W h kg^(-1), respectively, along with corresponding specific powers of 800 and 780 W kg^(-1), maintaining robust stability of ∼90 % stability over 10000 cycles. Additionally, the HSC and PHSC have successfully illuminated several light-emitting diodes (LEDs) demonstrating superior energy storage performance. This work advances the design of hetero-phase multi-metal sulfides, paving the way for high-performance supercapacitor devices.
基金the financial support provided by the Longzihu New Energy Laboratory Joint Fund of Henan Province(2023008)the Energy Storage Mater.and Processes Key Laboratory of Henan Province Open Fund(2021003)+1 种基金the Collaborative Innovation Team Project Fund of Industry-University-Research(32214085)the financial support received from Zhejiang Vast Na Technology Co.,Ltd.(24110380)。
文摘To address the challenges of air stability and slurry processability in layered transition metal oxide O_(3)-type NaNi_(1/3)Fe_(1/3)Mn_(1/3)O_(2)(NFM)for sodium-ion batteries(SIBs),we have designed an innovative 500℃reheating strategy.This method improves the surface properties of NFM without the need for additional coating layers,making it more efficient and suitable for large-scale applications.Pristine NFM(NFM-P)was first synthesized through a high-temperature solid-state method and then modified using this reheating approach(NFM-HT).This strategy significantly enhances air stability and electrochemical performance,yielding an initial discharge specific capacity of 151.46 mAh/g at 0.1C,with a remarkable capacity retention of 95.04%after 100 cycles at 0.5C.Additionally,a 1.7 Ah NFM‖HC(hard carbon)pouch cell demonstrates excellent long-term cycling stability(94.64%retention after 500 cycles at 1C),superior rate capability(86.48%retention at 9C),and strong low-temperature performance(77%retention at-25℃,continuing power supply at-40℃).Notably,even when overcharged to 8.29 V,the pouch cell remained safe without combustion or explosion.This reheating strategy,which eliminates the need for a coating layer,offers a simpler,more scalable solution for industrial production while maintaining outstanding electrochemical performance.These results pave the way for broader commercial adoption of NFM materials.
基金supported by the National Natural Science Foundation of China(21875076)the Guangdong Provincial International Joint Research Center for Energy Storage Materials(2023A0505090009)the Science and Technology Planning Project of Guangzhou City(2023B03J1278)。
文摘Electrolyte additives are pivotal for stable cycling of rechargeable sodium-ion batteries(SIBs),which dictate the creation of the protective interface film on electrodes.Cyclic sulfur-containing additives,such as1,3,2-dioxathiolane-2,2-dioxide(DTD),with the structure of sulfur surrounded by four oxygen atoms,have been proposed but less knowledge is available on the relationship between their molecular structures and interfacial stability.This work compares two similar molecule structure of cyclic sulfurcontaining additives,DTD and ethylene sulfite(ES),to investigate their effects on the electrochemical performance of NaNi_(1/3)Fe_(1/3)Mn_(1/3)O_(2)(NFM)||hard carbon(HC)pouch cells.Therein,ES with the structure of sulfur surrounded by three oxygen atoms,as electrolyte additive,is investigated in the SIBs for the first time.It is shown that adding 3.0%ES or 2.0%DTD(the optimal proportion)in the Control electrolyte(1 M NaPF_(6)in EC:EMC=3:7 with 5.0%FEC in weight)can improve cyclic stability and rate performance,respectively.Even under the high-temperature conditions,both ES and DTD exhibit good performance,but DTD is superior.Combinations of electrochemical methods,multi-spectroscopy,and theoretical calculations have been employed to evaluate and compare the effects of ES and DTD on sodium-ion battery.They reveal that ES and DTD can generate different content and composition by redox reaction on cathode and anode surface.The more and effective high-valence sulfur-containing components for DTD are the main reason to explain the better effect on DTD.This work shares new insights into the relationship between cyclic sulfur-containing additive molecule structure and electrolyte-electrode interface films effect,which fills the blanks of previous research.
文摘Based on the object oriented data structure of Voronoi diagram, the algorithm of the trimmed offset generating and the optimal too l path planning of the pocket machining for multiply connected polygonal domains are studied. The intersection state transition rule is improved in this algorithm. The intersection is between the trimmed offsets and Voronoi polygon. On this basis, the trimmed offset generating and the optimal tool path planning are mad e with three stacks(I stack, C stack and P stack)in different monotonous pouches of Voronoi diagram. At the same time, a merging method of Voronoi diagram an d offsets generating for multiply connected polygonal domains is also presented. The above algorithms have been implemented in NC machining successfully, and the efficiency is fully verified.
文摘Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radical cystectomy. Results 5 cases showed satisfactory therapeutic effects with of follow-up range of 6 to 30 months. All patients were continent day and night with easy catherization. The number of micturations was 5 to 6 times in the daytime and 1 to 3 times in the nighttime. Cystography of 4 cases showed that pouches were spheroidic and volumes were between 400 to 500 ml. Conclusion The advantages of the modified Indiana pouch are as follows: easy manipulation; low tension and high volume in pouches; no reflux; satisfactory urinary continence and few complications. Therefore, it is worthy of clinical popularization.
文摘During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn's disease (CD) patients will undergo an operation during their lifetime. For UC patients requiring surgery, total proctocolectomy and ileoanal pouch anastomosis (IPAA) is the operation of choice as it provides a permanent cure and good quality of life. Nevertheless a permanent stoma is a good option in selected patients, especially the elderly. Minimally invasive surgery has replaced the conventional open approach in many specialized centres worldwide. Laparoscopic colectomy and restorative IPAA is rapidly becoming the standard of care in the treatment of UC requiring surgery, whilst laparoscopic ileo-cecal resection is already the new gold standard in the treatment of complicated CD of terminal ileum. Short term advantages of laparoscopic surgery includes faster recovery time and reduced requirement for analgesics. It is, however, in the long term that minimally invasive surgery has demonstrated its superiority over the open approach. A better cosmesis, a reduced number of incisional hernias and fewer adhesions are the long term advantages of laparoscopy in IBD surgery. A reduction in abdominal adhesions is of great benefit when a second operation is needed in CD and this influences positively the pregnancy rate in young women undergoing restorative IPAA. In developing the therapeutic plan for IBD patients it should be recognized that the surgical approach to the abdomen has changed and that surgical treatment of complicated IBD can be safely performed with a true minimally invasive approach with great patient satisfaction.
文摘Restorative proctocolectomy is the most common surgical option for patients with familial adenomatous polyposis(FAP). However,adenomas may develop in the ileal pouch mucosa over time,and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence,nature,and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 25 reports that were reviewed,the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. Several potential factors that favor the development of pouch polyposis have been investigated,but many remain controversial. Nevertheless,it seems certain that the age of the pouch is important. The risk appears to be 7%to 16% after 5 years,35% to 42% after 10 years,and75% after 15 years. On the other hand,only 21 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 20 years(median,10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low,it is not negligible,and the long-term risk cannot presently be well quantified. Regular endoscopic surveillance,especially using chromoendoscopy,is recommended.
