Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and t...Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.展开更多
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadi...This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.展开更多
Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur si...Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur simultaneously.Closed-globe injuries can damage one or more ocular structures.展开更多
BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male pa...BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.展开更多
The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan h...The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results,showing less pain,quicker healing,and lower risk of anal stenosis.TILL reduces tissue tension and controls blood supply,allowing effective removal of diseased tissue while maintaining anal function and structure.However,the study's limitations,including its retrospective,single-center design,small sample size,and short follow-up,restrict the findings'generalizability and ability to assess long-term outcomes like recurrence.Larger,multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.展开更多
BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with signifi...BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.展开更多
In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA ...In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA repeats,of which 496762 and 495977 were identified on the forward and reverse DNA strands,respectively.The detected DRs were,on average,374 bp in length and occupied 66.4%of the O.sativa genome.Totally 61%of DRs,identified by the IP method,overlapped with previously annotated dispersed repeats(ADRs)detected using the Extensive De Novo TE Annotator(EDTA)pipeline.展开更多
BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development...BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development worldwide.Traditionally,cell apoptosis is identified using morphological,biochemical,and cell cycle experiments,which is time consuming,and experimental materials are not from the same group,and it is very hard to ensure the identity and veracity of results of former and latter experiments.AIM To establish a selective,instant,and practical protocol to identify cell apoptosis induced by natural products.METHODS A one transient cell processing procedure(OTCPP)was used to detect human colorectal cancer LoVo cell apoptosis after treatment with Pinus massoniana bark extract(PMBE)at the morphological,biochemical,and cell cycle levels.The methods used included treatment with DNA gel electrophoresis,fluorescence microscopy,and flow cytometry.RESULTS In PMBE-treated LoVo cells,we observed a DNA ladder on gel electrophoresis and fluorescence microscopy revealed"nuclear shrinkage,chromatin condensation or fragmentation".In addition,flow cytometry showed an"obvious apoptosis curve".Thus OTCPP achieved synchronous detection of the morphology,biochemistry,cell cycle,and the DNA content of the cells.CONCLUSION OTCPP can quickly identify apoptosis and measure the apoptosis rate,thereby unifying qualitative and quantitative analysis.展开更多
Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic...Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic of China(the“Civil Procedure Law”)is a major innovation in terms of values and methodology.Practical jurisprudence focuses more on practical issues,Chinese characteristics,and major needs,while strengthening the practical nature of the Civil Procedure Law.China’s traditional education system for juris masters(for non-law graduates)(“non-law JMs”)emphasizes the development of foundational legal theoretical knowledge.However,it has not fully achieved its goal of cultivating interdisciplinary and practical legal professionals.Therefore,the traditional education system for the Civil Procedure Law needs reconstruction and supplementation through the practical jurisprudence teaching system in the following areas:(a)System composition:The focus should be on the eight tertiary subsystems under the two secondary subsystems—“the knowledge teaching system and the practical teaching system”of practical jurisprudence in the Civil Procedure Law,as well as the management of their interrelationships.(b)Credit structure:The proportion of credits for“practical teaching and training”should be increased.(c)Practical ability requirements:Legal professionals should be cultivated according to the standards for juris masters(for law graduates)as stipulated by the Law of the People’s Republic of China on Academic Degrees.(d)Practice evaluation:“Formalization of the evaluations,”“homogeneity of the evaluators,”and“reliance on written formats”should be avoided.展开更多
BACKGROUND Postoperative pulmonary complications(PPCs)are the most common complications following major upper abdominal surgeries,particularly hepatobiliary procedures,and significantly compromise surgical outcomes an...BACKGROUND Postoperative pulmonary complications(PPCs)are the most common complications following major upper abdominal surgeries,particularly hepatobiliary procedures,and significantly compromise surgical outcomes and patients’quality of life.Although the adoption of laparoscopy has lowered their incidence,PPCs remain a frequent and serious concern after hepatobiliary surgery.Existing research on risk factors specific to hepatobiliary surgeries is limited,particularly regarding the epidemiology and risk factors of PPCs in liver and gallbladder surgeries in China.Therefore,this study aimed to investigate the risk factors for PPCs in a large hepatobiliary center.AIM To identify the incidence and risk factors for PPCs following hepatobiliary surgery based on perioperative variables.METHODS Retrospective data were collected from patients who underwent liver,gallbladder,or pancreatic surgery at a hepatobiliary center in China between May 2023 and December 2023.We retrospectively reviewed comprehensive medical records to extract demographic and hospital admission information for determining PPC incidence.Statistically significant variables were initially screened through univariate analysis,followed by binary logistic regression modeling to identify independent predictors of PPCs.Hospitalization expenditures and duration of stay were further contrasted across the study cohorts.RESULTS This study included 1941 patients who underwent liver,gallbladder,or pancreatic surgery,of whom 78 developed PPCs,resulting in an incidence rate of 4.02%.Logistic regression analysis revealed two independent predictors of PPCs in hepatobiliary surgery patients:Age≥75 year(odds ratio=8.350,95%CI:3.521-19.798,P<0.001)and prolonged anesthesia(odds ratio=1.052,95%CI:1.015-1.091,P=0.006).Patients with PPCs had significantly elevated healthcare resource utilization,including higher total hospitalization costs,increased medication expenses,longer hospital stays,and extended postoperative admissions(all P<0.001).CONCLUSION Age≥75 years and prolonged anesthesia emerged as independent predictors of PPCs following hepatobiliary surgery.These complications were correlated with protracted hospitalization and increased healthcare costs.展开更多
Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing...Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing its role as a primary treatment with excellent long-term outcomes and minimal adverse events.The evolution of POEM underscores the need for precision in myotomy techniques and the importance of interdisciplinary collaboration,especially regar-ding anesthetic considerations.Despite significant advances,challenges remain in standardizing safety protocols and managing complications.As POEM appli-cations expand,precision endoscopy continues to enhance therapeutic outcomes,promising a transformative impact on gastrointestinal motility disorder manage-ment.展开更多
This standard operating procedure stipulated the natural condition of pro- ducing area, cultivation technique, disease and pest control, harvest, quality stan- dard, packaging, transportation and storage of H. cordata...This standard operating procedure stipulated the natural condition of pro- ducing area, cultivation technique, disease and pest control, harvest, quality stan- dard, packaging, transportation and storage of H. cordata, in order to provide a ba- sis for the standard cultivation of H. cordata.展开更多
To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old...To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old woman with a history of chronic pancreatitis due to pancreas divisum. Four years preceding this event, the patient had undergone a Whipple procedure, and three years prior to that, a Puestow operation. The patient was successfully treated with bowel resection and a side-to-side anastomosis between the most distal aspect of the bowel and the most distal Roux-en-Y reconstruction, which preserved both Roux-en-Y reconstructions.展开更多
<strong>Introduction:</strong> Bone marrow aspiration and biopsies are carried out principally to permit cytological assessment of marrow. The procedure is also indicated for immunophenotypic, cytogenetic,...<strong>Introduction:</strong> Bone marrow aspiration and biopsies are carried out principally to permit cytological assessment of marrow. The procedure is also indicated for immunophenotypic, cytogenetic, molecular and other specialized investigations. The skill to perform bone marrow aspirate and biopsy is usually acquired by the medical personnel through apprenticeship during their training. The training includes performing the procedure, indications, contraindications, and associated hazards. Moi Teaching and Referral Hospital (MTRH) being a specialized Hospital in Western Kenya has several staff trained on performing the procedure. <strong>Objective:</strong> To assess the performance of bone marrow procedure by clinicians at a teaching and referral hospital. <strong>Materials and </strong><strong>methods: </strong>A descriptive cross-sectional study was done involving 40 clinicians working in the hematology clinic and medical wards from June to December 2019. A structured questionnaire was used to collect the data and data analysis was done using frequency tables. Approval to carry out the study was sought from the institutional IRB. <strong>Results:</strong> Patients attended to were predominantly adults 33 (83%). The superior posterior iliac crest was the commonest site for the procedure and disposable needles were routinely used in 33 (83%) of the patients. Pain and excessive bleeding 18 (45%) were the commonest complications associated with the procedure. <strong>Conclusion:</strong> Most of the clinicians involved doing the procedure were residents/registrars. Most of the patients attended to were adults (83%) and majority of the clinicians performed the procedure on the posterior iliac site (96%) using disposable needles (83%). Local anesthesia was commonly used during the procedure (88%). The common complications associated with the bone marrow procedure were pain and excessive bleeding (45%).展开更多
AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obs...AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.展开更多
Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature...Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important waysof preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management.展开更多
An augmented flight dynamics model is developed to extend the existing flight dynamics model of tilt-rotor aircraft for optimal landing procedure analysis in the event of one engine failure.Compared with the existing ...An augmented flight dynamics model is developed to extend the existing flight dynamics model of tilt-rotor aircraft for optimal landing procedure analysis in the event of one engine failure.Compared with the existing flight dynamics model, the augmented model involves with more pilot control information in cockpit and is validated against the flight test data. Based on the augmented flight dynamics model, the optimal landing procedure of XV-15 tilt-rotor aircraft after one engine failure is formulated into a Nonlinear Optimal Control Problem(NOCP), solved by collocation and numerical optimization method. The time histories of pilot controls in cockpit during the optimal landing procedure are obtained for the evaluation of pilot workload. An evaluation method which can synthetically quantify the pilot workload in time and frequency domains is proposed with metrics of aggressiveness and cutoff frequencies of pilot controls. The scale of the pilot workload is compared with those of the shipboard landing procedures, bob-up/bob-down and dash/quickstop maneuvers of UH-60 helicopter. The results show that the aggressiveness of pilot collective and longitudinal controls for the tilt-rotor aircraft optimal landing procedure after one engine failure are higher than those for UH-60 helicopter shipboard landing procedures up to the condition of sea state 4, while the pilot cutoff frequency of collective control is lower than that of the bob-up/bob-down maneuver but the pilot cutoff frequency of longitudinal control is higher than that of the dash/quick-stop maneuver. The evaluated pilot workload level is between Cooper–Harper HQR Level 2 and Level 3.展开更多
Two procedures were compared for extraction and clean-up of 20organophosphorus and 19 pyrethroid pesticides in sediment to identify the more effective procedurefor groups of pesticides or individual compounds. In Proc...Two procedures were compared for extraction and clean-up of 20organophosphorus and 19 pyrethroid pesticides in sediment to identify the more effective procedurefor groups of pesticides or individual compounds. In Procedure I, methanol/water and n-hexane wereused for extraction, and 1:10 (v/v) dichloromethane in n-hexane and acetone were used as eluents foreluting the analyte through the cartridge, with one evaporating steps on a rotary evaporator andtwo eluting steps on the cartridge. n-hexane/acetone (2:1, v/v) was used for extraction and elutionin Procedure II with one evaporating step on a rotary evaporator and one eluting step on thecartridge. All extractions were performed under an ultrasonic bath and gas chromatography and massspectrometry were utilized for measurements. Procedure II was developed as a rapid, timesaving, lesscostly and safer substitute for Procedure I which was an old method. Procedure II was moreeffective for almost all the organophosphorus pesticides tested and 11of the 19 pyrethroidpesticides, while Procedure I was more appropriate for analysis of 5 pyrethroid pesticides. However,recoveries of most pyrethroid pesticides were fairly low. Thus, further studies should focus onadjustment and formulation of solvents for more efficient extraction and clean-up of pyrethroidpesticides from sediment samples.展开更多
AIM:To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures.METHODS:Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Ka...AIM:To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures.METHODS:Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed.Kasai portoenterostomy with the placement of biliary stents was performed in all patients.Clinical characteristics,postoperative complications,and long-term outcomes were analyzed.All patients were followed up for 2-60 mo postoperatively.RESULTS:Patients were classified according to the Bismuth classification of biliary strictures.There were two Bismuth Ⅲ and eight Bismuth Ⅳ lesions.Six lesions were benign and four were malignant.Of the benign lesions,three were due to post-cholecystectomy injury,one to trauma,one to inflammation,and one to inflammatory pseudotumor.Of the malignant lesions,four were due to hilar cholangiocarcinoma.All patients underwent Kasai portoenterostomy with the placement of biliary stents.There were no perioperative deaths.One patient experienced anastomotic leak and was managed conservatively.No other complications occurred perioperatively.During the follow-up period,all patients reported a good quality of life.CONCLUSION:The Kasai procedure combined with biliary stents may be appropriate for patients with hilar biliary stricture that cannot be managed by standard surgical methods.展开更多
文摘Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.
基金supported by funding from the Medical Research Funding of Guangdong(No.A2022499 to QGX)the National Natural Science Foundation of China(No.82301796 to PL)the Guangdong Province Regional Joint Fund-Youth Fund Project of China(No.2022A1515111201 to PL).
文摘This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.
文摘Dear Editor,We report a relatively safe and effective triple procedure for traumatic aphakia,glaucoma,and mydriasis.Blunt eye trauma can lead to various anterior-and posterior-segment conditions[1],that often occur simultaneously.Closed-globe injuries can damage one or more ocular structures.
文摘BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.
文摘The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results,showing less pain,quicker healing,and lower risk of anal stenosis.TILL reduces tissue tension and controls blood supply,allowing effective removal of diseased tissue while maintaining anal function and structure.However,the study's limitations,including its retrospective,single-center design,small sample size,and short follow-up,restrict the findings'generalizability and ability to assess long-term outcomes like recurrence.Larger,multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.
基金Supported by Scientific Research Fund of China-Japan Friendship Hospital,No.2019-1-QN-53.
文摘BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.
基金supported by the Russian Science Foundation,Russia(Grant No.24-24-00031).
文摘In this study,we searched for dispersed repeats(DRs)in the rice(Oryza sativa)genome using the iterative procedure(IP)method.The results revealed that the O.sativa genome contained 79 DR families,comprising 992739 DNA repeats,of which 496762 and 495977 were identified on the forward and reverse DNA strands,respectively.The detected DRs were,on average,374 bp in length and occupied 66.4%of the O.sativa genome.Totally 61%of DRs,identified by the IP method,overlapped with previously annotated dispersed repeats(ADRs)detected using the Extensive De Novo TE Annotator(EDTA)pipeline.
基金Supported by 2023 Key R&D Projects of Tongji University,No.150029607160-24323Industrial Key Program Foundation of Guangdong Province:R&D of Natural Novel Anticancer Drugs,No.2004B10401033。
文摘BACKGROUND Recently,the identification of cell apoptosis induced by natural products has become research hotspot and frontier in the biopharmaceutical and food industries under the umbrella of global green development worldwide.Traditionally,cell apoptosis is identified using morphological,biochemical,and cell cycle experiments,which is time consuming,and experimental materials are not from the same group,and it is very hard to ensure the identity and veracity of results of former and latter experiments.AIM To establish a selective,instant,and practical protocol to identify cell apoptosis induced by natural products.METHODS A one transient cell processing procedure(OTCPP)was used to detect human colorectal cancer LoVo cell apoptosis after treatment with Pinus massoniana bark extract(PMBE)at the morphological,biochemical,and cell cycle levels.The methods used included treatment with DNA gel electrophoresis,fluorescence microscopy,and flow cytometry.RESULTS In PMBE-treated LoVo cells,we observed a DNA ladder on gel electrophoresis and fluorescence microscopy revealed"nuclear shrinkage,chromatin condensation or fragmentation".In addition,flow cytometry showed an"obvious apoptosis curve".Thus OTCPP achieved synchronous detection of the morphology,biochemistry,cell cycle,and the DNA content of the cells.CONCLUSION OTCPP can quickly identify apoptosis and measure the apoptosis rate,thereby unifying qualitative and quantitative analysis.
文摘Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic of China(the“Civil Procedure Law”)is a major innovation in terms of values and methodology.Practical jurisprudence focuses more on practical issues,Chinese characteristics,and major needs,while strengthening the practical nature of the Civil Procedure Law.China’s traditional education system for juris masters(for non-law graduates)(“non-law JMs”)emphasizes the development of foundational legal theoretical knowledge.However,it has not fully achieved its goal of cultivating interdisciplinary and practical legal professionals.Therefore,the traditional education system for the Civil Procedure Law needs reconstruction and supplementation through the practical jurisprudence teaching system in the following areas:(a)System composition:The focus should be on the eight tertiary subsystems under the two secondary subsystems—“the knowledge teaching system and the practical teaching system”of practical jurisprudence in the Civil Procedure Law,as well as the management of their interrelationships.(b)Credit structure:The proportion of credits for“practical teaching and training”should be increased.(c)Practical ability requirements:Legal professionals should be cultivated according to the standards for juris masters(for law graduates)as stipulated by the Law of the People’s Republic of China on Academic Degrees.(d)Practice evaluation:“Formalization of the evaluations,”“homogeneity of the evaluators,”and“reliance on written formats”should be avoided.
基金Supported by the Beijing Tsinghua Changgung Hospital Fund,China,No.12023C01005.
文摘BACKGROUND Postoperative pulmonary complications(PPCs)are the most common complications following major upper abdominal surgeries,particularly hepatobiliary procedures,and significantly compromise surgical outcomes and patients’quality of life.Although the adoption of laparoscopy has lowered their incidence,PPCs remain a frequent and serious concern after hepatobiliary surgery.Existing research on risk factors specific to hepatobiliary surgeries is limited,particularly regarding the epidemiology and risk factors of PPCs in liver and gallbladder surgeries in China.Therefore,this study aimed to investigate the risk factors for PPCs in a large hepatobiliary center.AIM To identify the incidence and risk factors for PPCs following hepatobiliary surgery based on perioperative variables.METHODS Retrospective data were collected from patients who underwent liver,gallbladder,or pancreatic surgery at a hepatobiliary center in China between May 2023 and December 2023.We retrospectively reviewed comprehensive medical records to extract demographic and hospital admission information for determining PPC incidence.Statistically significant variables were initially screened through univariate analysis,followed by binary logistic regression modeling to identify independent predictors of PPCs.Hospitalization expenditures and duration of stay were further contrasted across the study cohorts.RESULTS This study included 1941 patients who underwent liver,gallbladder,or pancreatic surgery,of whom 78 developed PPCs,resulting in an incidence rate of 4.02%.Logistic regression analysis revealed two independent predictors of PPCs in hepatobiliary surgery patients:Age≥75 year(odds ratio=8.350,95%CI:3.521-19.798,P<0.001)and prolonged anesthesia(odds ratio=1.052,95%CI:1.015-1.091,P=0.006).Patients with PPCs had significantly elevated healthcare resource utilization,including higher total hospitalization costs,increased medication expenses,longer hospital stays,and extended postoperative admissions(all P<0.001).CONCLUSION Age≥75 years and prolonged anesthesia emerged as independent predictors of PPCs following hepatobiliary surgery.These complications were correlated with protracted hospitalization and increased healthcare costs.
文摘Peroral endoscopic myotomy(POEM)has revolutionized the treatment of upper gastrointestinal tract motility disorders,particularly achalasia.This editorial explores the efficacy,safety,and challenges of POEM,emphasizing its role as a primary treatment with excellent long-term outcomes and minimal adverse events.The evolution of POEM underscores the need for precision in myotomy techniques and the importance of interdisciplinary collaboration,especially regar-ding anesthetic considerations.Despite significant advances,challenges remain in standardizing safety protocols and managing complications.As POEM appli-cations expand,precision endoscopy continues to enhance therapeutic outcomes,promising a transformative impact on gastrointestinal motility disorder manage-ment.
基金Supported by Key Research and Development Plan(Agricultural Support Field)of Hunan Province in 2015(2015NK3016)
文摘This standard operating procedure stipulated the natural condition of pro- ducing area, cultivation technique, disease and pest control, harvest, quality stan- dard, packaging, transportation and storage of H. cordata, in order to provide a ba- sis for the standard cultivation of H. cordata.
文摘To date, antegrade intussusception involving a Roux-en-Y reconstruction has been reported only once. We report a case of acute bowel obstruction due to an intussusception involving two Roux-en-Y limbs in a 40-year-old woman with a history of chronic pancreatitis due to pancreas divisum. Four years preceding this event, the patient had undergone a Whipple procedure, and three years prior to that, a Puestow operation. The patient was successfully treated with bowel resection and a side-to-side anastomosis between the most distal aspect of the bowel and the most distal Roux-en-Y reconstruction, which preserved both Roux-en-Y reconstructions.
文摘<strong>Introduction:</strong> Bone marrow aspiration and biopsies are carried out principally to permit cytological assessment of marrow. The procedure is also indicated for immunophenotypic, cytogenetic, molecular and other specialized investigations. The skill to perform bone marrow aspirate and biopsy is usually acquired by the medical personnel through apprenticeship during their training. The training includes performing the procedure, indications, contraindications, and associated hazards. Moi Teaching and Referral Hospital (MTRH) being a specialized Hospital in Western Kenya has several staff trained on performing the procedure. <strong>Objective:</strong> To assess the performance of bone marrow procedure by clinicians at a teaching and referral hospital. <strong>Materials and </strong><strong>methods: </strong>A descriptive cross-sectional study was done involving 40 clinicians working in the hematology clinic and medical wards from June to December 2019. A structured questionnaire was used to collect the data and data analysis was done using frequency tables. Approval to carry out the study was sought from the institutional IRB. <strong>Results:</strong> Patients attended to were predominantly adults 33 (83%). The superior posterior iliac crest was the commonest site for the procedure and disposable needles were routinely used in 33 (83%) of the patients. Pain and excessive bleeding 18 (45%) were the commonest complications associated with the procedure. <strong>Conclusion:</strong> Most of the clinicians involved doing the procedure were residents/registrars. Most of the patients attended to were adults (83%) and majority of the clinicians performed the procedure on the posterior iliac site (96%) using disposable needles (83%). Local anesthesia was commonly used during the procedure (88%). The common complications associated with the bone marrow procedure were pain and excessive bleeding (45%).
文摘AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.
文摘Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important waysof preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management.
基金supported by the National Natural Science Foundation of China (No. 11672128)
文摘An augmented flight dynamics model is developed to extend the existing flight dynamics model of tilt-rotor aircraft for optimal landing procedure analysis in the event of one engine failure.Compared with the existing flight dynamics model, the augmented model involves with more pilot control information in cockpit and is validated against the flight test data. Based on the augmented flight dynamics model, the optimal landing procedure of XV-15 tilt-rotor aircraft after one engine failure is formulated into a Nonlinear Optimal Control Problem(NOCP), solved by collocation and numerical optimization method. The time histories of pilot controls in cockpit during the optimal landing procedure are obtained for the evaluation of pilot workload. An evaluation method which can synthetically quantify the pilot workload in time and frequency domains is proposed with metrics of aggressiveness and cutoff frequencies of pilot controls. The scale of the pilot workload is compared with those of the shipboard landing procedures, bob-up/bob-down and dash/quickstop maneuvers of UH-60 helicopter. The results show that the aggressiveness of pilot collective and longitudinal controls for the tilt-rotor aircraft optimal landing procedure after one engine failure are higher than those for UH-60 helicopter shipboard landing procedures up to the condition of sea state 4, while the pilot cutoff frequency of collective control is lower than that of the bob-up/bob-down maneuver but the pilot cutoff frequency of longitudinal control is higher than that of the dash/quick-stop maneuver. The evaluated pilot workload level is between Cooper–Harper HQR Level 2 and Level 3.
基金Project supported by the Outstanding Youth Fund of National Natural Science Foundation of China, the National Key Basic Research Support Foundation (NKBRSF) of China (No. 2002CB410805) and the Federal Ministry of Education and Research, Germany.
文摘Two procedures were compared for extraction and clean-up of 20organophosphorus and 19 pyrethroid pesticides in sediment to identify the more effective procedurefor groups of pesticides or individual compounds. In Procedure I, methanol/water and n-hexane wereused for extraction, and 1:10 (v/v) dichloromethane in n-hexane and acetone were used as eluents foreluting the analyte through the cartridge, with one evaporating steps on a rotary evaporator andtwo eluting steps on the cartridge. n-hexane/acetone (2:1, v/v) was used for extraction and elutionin Procedure II with one evaporating step on a rotary evaporator and one eluting step on thecartridge. All extractions were performed under an ultrasonic bath and gas chromatography and massspectrometry were utilized for measurements. Procedure II was developed as a rapid, timesaving, lesscostly and safer substitute for Procedure I which was an old method. Procedure II was moreeffective for almost all the organophosphorus pesticides tested and 11of the 19 pyrethroidpesticides, while Procedure I was more appropriate for analysis of 5 pyrethroid pesticides. However,recoveries of most pyrethroid pesticides were fairly low. Thus, further studies should focus onadjustment and formulation of solvents for more efficient extraction and clean-up of pyrethroidpesticides from sediment samples.
文摘AIM:To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures.METHODS:Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed.Kasai portoenterostomy with the placement of biliary stents was performed in all patients.Clinical characteristics,postoperative complications,and long-term outcomes were analyzed.All patients were followed up for 2-60 mo postoperatively.RESULTS:Patients were classified according to the Bismuth classification of biliary strictures.There were two Bismuth Ⅲ and eight Bismuth Ⅳ lesions.Six lesions were benign and four were malignant.Of the benign lesions,three were due to post-cholecystectomy injury,one to trauma,one to inflammation,and one to inflammatory pseudotumor.Of the malignant lesions,four were due to hilar cholangiocarcinoma.All patients underwent Kasai portoenterostomy with the placement of biliary stents.There were no perioperative deaths.One patient experienced anastomotic leak and was managed conservatively.No other complications occurred perioperatively.During the follow-up period,all patients reported a good quality of life.CONCLUSION:The Kasai procedure combined with biliary stents may be appropriate for patients with hilar biliary stricture that cannot be managed by standard surgical methods.
