AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist...AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.展开更多
BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the u...BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous(IO) access and central venous catheterization(CVC) in critically ill Chinese patients.METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above.RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group(91.7% vs. 50.0%, P<0.001;52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion(1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups.CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.展开更多
AIM To examine the influence of night duty(ND) on endoscopic therapy for biliary duct stones.METHODS The subjects consisted of 133 patients who received initial endoscopic therapy for biliary duct stones performed by ...AIM To examine the influence of night duty(ND) on endoscopic therapy for biliary duct stones.METHODS The subjects consisted of 133 patients who received initial endoscopic therapy for biliary duct stones performed by eight endoscopists after they had been on(ND group, n = 34 patients) or not [day duty(DD) group, n = 99 patients]. Patient characteristics(age, gender, history of abdominal surgery, transverse diameter of the largest stone, number of stones), years of experience of the endoscopists, endoscopic procedures [sphincterotomy, papillary balloon dilation(EPBD), papillary large balloon dilation(EPLBD)], and outcomes of initial endoscopy(procedure time; rate of stone removal by the first endoscopist; proceduresuccess rate by the first endoscopist: removal of stones or endoscopic retrograde biliary drainage; rate of final stone removal; final procedure success rate; complications; hospitalization after the procedure) were compared retrospectively between the two groups. History of abdominal surgery and treatment outcomes were also compared between the groups for each of the four endoscopists who performed most of the procedures in the ND group.RESULTS There were no significant differences regarding the number of treatments performed by each endoscopist or the years of experience between the ND and DD groups. The frequency of endoscopic retrograde cholangiopancreatography procedures did not differ significantly between the groups. There were also no significant differences regarding patient characteristics: age, gender, history of abdominal surgery(ND 7: Billroth II 4, R-Y 3; DD 18: double tract reconstruction 1, Billroth I 3, Billroth II 6, R-Y 7, duodenoduodenostomy for annular pancreas 1), transverse diameter of largest stone, and number of stones between the two groups. Among the treatment procedures, the endoscopic s p h i n c t e r o t o m y a n d E P B D r a t e s d i d n o t d i f f e r significantly between the groups. However, EPLBD was performed more frequently in the ND group [47.1%(16/34) v s 19.2%(19/99)]. Regarding outcomes, there were no significant differences in the rate of stone removal, procedure success rate, complications(ND: pancreatitis 1; DD: pancreatitis 6, duodenal bleeding 1, decreased blood pressure 1, hypoxia 2), or hospitalization after the procedure. However, the procedure time was significantly longer in the ND group(71.5 ± 44.7 vs 54.2 ± 28.8). Among the four endoscopists, there were no significant differences in patient history of abdominal surgery, removal of stones, or procedure success rate. However, the procedure time for one endoscopist was significantly longer in the ND group.CONCLUSION The time required for endoscopic therapy for bile duct stones might be influenced by ND.展开更多
Interval timing is involved in a variety of cognitive behaviors such as associative learning and decision-making.While it has been shown that time estimation is adaptive to the temporal context,it remains unclear how ...Interval timing is involved in a variety of cognitive behaviors such as associative learning and decision-making.While it has been shown that time estimation is adaptive to the temporal context,it remains unclear how interval timing behavior is influenced by recent trial history.Here we found that,in mice trained to perform a licking-based interval timing task,a decrease of inter-reinforcement interval in the previous trial rapidly shifted the time of anticipatory licking earlier.Optogenetic inactivation of the anterior lateral motor cortex(ALM),but not the medial prefrontal cortex,for a short time before reward delivery caused a decrease in the peak time of anticipatory licking in the next trial.Electrophysiological recordings from the ALM showed that the response profiles preceded by short and long inter-reinforcement intervals exhibited task-engagement-dependent temporal scaling.Thus,interval timing is adaptive to recent experience of the temporal interval,and ALM activity during time estimation reflects recent experience of interval.展开更多
Aim:The present study evaluated the duration of chemoembolization in patients with hepatocellular carcinoma,analyzing possible factors affecting the procedural time.Methods:In total,175 patients who underwent chemoemb...Aim:The present study evaluated the duration of chemoembolization in patients with hepatocellular carcinoma,analyzing possible factors affecting the procedural time.Methods:In total,175 patients who underwent chemoembolization have been prospectively enrolled.The procedural length was considered the time between the insertion and the removal of the angiographic sheath.The features related to the tumor burden and angiographic procedures,which could be related to the procedural time,were recorded.Results:The chemoembolization time resulted in a mean of 58.1 min.The longer procedural time was associated with a number of nodules treated per patient≥2(P<0.001),a number of segments with nodules≥2(P<0.001),the presence of more than 1 nodule in the same segment(P<0.001),the location of the tumor in the left lobe(P=0.001),the exclusion from the Milan criteria(P<0.001),and a number of segments treated≥2(P<0.001).Only the number of nodules treated per patient resulted significantly in multivariate analysis(OR 2.927,95%CI:2.015-4.251,P<0.001).Conclusion:The factors related to longer procedural time are the number of nodules treated≥2,the number of segments with nodules≥2,the involvement of the left lobe,the tumor burden outside the Milan criteria,and the number of segments treated≥2.All these characteristics,known in the pre-procedural phase,represent useful tools for a correct planning of the angiographic room’s workflow during the pandemic era as well as in the future to reduce downtime and increase productivity.展开更多
Background The controversy on the treatment strategy for severe acute pancreatitis （SAP） has never stopped for the past century.Even now surgical procedures play a decisive role in the treatment of SAP,especially in...Background The controversy on the treatment strategy for severe acute pancreatitis （SAP） has never stopped for the past century.Even now surgical procedures play a decisive role in the treatment of SAP,especially in managing the related complications,but the rational indications,timing,and approaches of surgical intervention for SAP are still inconclusive.Methods Clinical data of 308 SAP patients recruited during January 2000-January 2013,including 96 conservatively treated cases plus 212 surgically intervened cases,were comparatively analyzed.Based on the initial surgical intervention time,the surgical intervention group was split into two：early intervention group （within 2 weeks） 103 cases,and late intervention group （after 2 weeks） 109 cases.Results In the conservative treatment group,the cure rate was 82.29% （79/96）,the death rate was 13.54% （13/96）,and 4 cases self-discharged,while in the surgical intervention group,the cure rate was 84.43% （179/212） and the death rate was 10.85% （23/212） with 10 cases self-discharged.The difference was of no statistical significance between these two groups （P 〉0.05）.In surgical intervention group,the death rate 15.53% （16/103） in the early surgical intervention group was higher than that of late surgical intervention group 6.42% （7/109）,and the difference was statistically significant （P 〈0.05）.Conclusions Both conservative treatment and surgical intervention play important roles in the treatment of SAP,and the indication,timing,and procedure should be strictly followed.Surgery earlier than 2 weeks after onset of the disease is not recommended in patients with necrotizing pancreatitis only when there are specific indications,such as multiple organ failure,which does not improve despite active treatment,and in those who develop abdominal compartment syndrome.展开更多
文摘AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.
基金supported by the Capital Clinical Characteristic Applied Research Project(z151100004015118)the Fostering and Exploring Project of Key Clinical Projects in the Peking University Third Hospital(BYSY2014006)the Health Science Promotion Project of Beijing(TG-2017-83)。
文摘BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous(IO) access and central venous catheterization(CVC) in critically ill Chinese patients.METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above.RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group(91.7% vs. 50.0%, P<0.001;52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion(1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups.CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.
文摘AIM To examine the influence of night duty(ND) on endoscopic therapy for biliary duct stones.METHODS The subjects consisted of 133 patients who received initial endoscopic therapy for biliary duct stones performed by eight endoscopists after they had been on(ND group, n = 34 patients) or not [day duty(DD) group, n = 99 patients]. Patient characteristics(age, gender, history of abdominal surgery, transverse diameter of the largest stone, number of stones), years of experience of the endoscopists, endoscopic procedures [sphincterotomy, papillary balloon dilation(EPBD), papillary large balloon dilation(EPLBD)], and outcomes of initial endoscopy(procedure time; rate of stone removal by the first endoscopist; proceduresuccess rate by the first endoscopist: removal of stones or endoscopic retrograde biliary drainage; rate of final stone removal; final procedure success rate; complications; hospitalization after the procedure) were compared retrospectively between the two groups. History of abdominal surgery and treatment outcomes were also compared between the groups for each of the four endoscopists who performed most of the procedures in the ND group.RESULTS There were no significant differences regarding the number of treatments performed by each endoscopist or the years of experience between the ND and DD groups. The frequency of endoscopic retrograde cholangiopancreatography procedures did not differ significantly between the groups. There were also no significant differences regarding patient characteristics: age, gender, history of abdominal surgery(ND 7: Billroth II 4, R-Y 3; DD 18: double tract reconstruction 1, Billroth I 3, Billroth II 6, R-Y 7, duodenoduodenostomy for annular pancreas 1), transverse diameter of largest stone, and number of stones between the two groups. Among the treatment procedures, the endoscopic s p h i n c t e r o t o m y a n d E P B D r a t e s d i d n o t d i f f e r significantly between the groups. However, EPLBD was performed more frequently in the ND group [47.1%(16/34) v s 19.2%(19/99)]. Regarding outcomes, there were no significant differences in the rate of stone removal, procedure success rate, complications(ND: pancreatitis 1; DD: pancreatitis 6, duodenal bleeding 1, decreased blood pressure 1, hypoxia 2), or hospitalization after the procedure. However, the procedure time was significantly longer in the ND group(71.5 ± 44.7 vs 54.2 ± 28.8). Among the four endoscopists, there were no significant differences in patient history of abdominal surgery, removal of stones, or procedure success rate. However, the procedure time for one endoscopist was significantly longer in the ND group.CONCLUSION The time required for endoscopic therapy for bile duct stones might be influenced by ND.
基金supported by the National Science and Technology Innovation 2030 Major Program of China(2021ZD0203700/2021ZD0203703)the National Natural Science Foundation of China(31771151 and 32171030)+2 种基金Lingang Lab(LG202104-01-03)a Shanghai Municipal Science and Technology Major Project(2018SHZDZX05)the Strategic Priority Research Program of the Chinese Academy of Sciences(XDB32010200)。
文摘Interval timing is involved in a variety of cognitive behaviors such as associative learning and decision-making.While it has been shown that time estimation is adaptive to the temporal context,it remains unclear how interval timing behavior is influenced by recent trial history.Here we found that,in mice trained to perform a licking-based interval timing task,a decrease of inter-reinforcement interval in the previous trial rapidly shifted the time of anticipatory licking earlier.Optogenetic inactivation of the anterior lateral motor cortex(ALM),but not the medial prefrontal cortex,for a short time before reward delivery caused a decrease in the peak time of anticipatory licking in the next trial.Electrophysiological recordings from the ALM showed that the response profiles preceded by short and long inter-reinforcement intervals exhibited task-engagement-dependent temporal scaling.Thus,interval timing is adaptive to recent experience of the temporal interval,and ALM activity during time estimation reflects recent experience of interval.
文摘Aim:The present study evaluated the duration of chemoembolization in patients with hepatocellular carcinoma,analyzing possible factors affecting the procedural time.Methods:In total,175 patients who underwent chemoembolization have been prospectively enrolled.The procedural length was considered the time between the insertion and the removal of the angiographic sheath.The features related to the tumor burden and angiographic procedures,which could be related to the procedural time,were recorded.Results:The chemoembolization time resulted in a mean of 58.1 min.The longer procedural time was associated with a number of nodules treated per patient≥2(P<0.001),a number of segments with nodules≥2(P<0.001),the presence of more than 1 nodule in the same segment(P<0.001),the location of the tumor in the left lobe(P=0.001),the exclusion from the Milan criteria(P<0.001),and a number of segments treated≥2(P<0.001).Only the number of nodules treated per patient resulted significantly in multivariate analysis(OR 2.927,95%CI:2.015-4.251,P<0.001).Conclusion:The factors related to longer procedural time are the number of nodules treated≥2,the number of segments with nodules≥2,the involvement of the left lobe,the tumor burden outside the Milan criteria,and the number of segments treated≥2.All these characteristics,known in the pre-procedural phase,represent useful tools for a correct planning of the angiographic room’s workflow during the pandemic era as well as in the future to reduce downtime and increase productivity.
文摘Background The controversy on the treatment strategy for severe acute pancreatitis （SAP） has never stopped for the past century.Even now surgical procedures play a decisive role in the treatment of SAP,especially in managing the related complications,but the rational indications,timing,and approaches of surgical intervention for SAP are still inconclusive.Methods Clinical data of 308 SAP patients recruited during January 2000-January 2013,including 96 conservatively treated cases plus 212 surgically intervened cases,were comparatively analyzed.Based on the initial surgical intervention time,the surgical intervention group was split into two：early intervention group （within 2 weeks） 103 cases,and late intervention group （after 2 weeks） 109 cases.Results In the conservative treatment group,the cure rate was 82.29% （79/96）,the death rate was 13.54% （13/96）,and 4 cases self-discharged,while in the surgical intervention group,the cure rate was 84.43% （179/212） and the death rate was 10.85% （23/212） with 10 cases self-discharged.The difference was of no statistical significance between these two groups （P 〉0.05）.In surgical intervention group,the death rate 15.53% （16/103） in the early surgical intervention group was higher than that of late surgical intervention group 6.42% （7/109）,and the difference was statistically significant （P 〈0.05）.Conclusions Both conservative treatment and surgical intervention play important roles in the treatment of SAP,and the indication,timing,and procedure should be strictly followed.Surgery earlier than 2 weeks after onset of the disease is not recommended in patients with necrotizing pancreatitis only when there are specific indications,such as multiple organ failure,which does not improve despite active treatment,and in those who develop abdominal compartment syndrome.
