Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.展开更多
The benefits of regular physical activity are well known.Yet,few studies have examined the effectiveness of integrating physical activity(PA)into curricula within a post-secondary setting.To investigate the incorporat...The benefits of regular physical activity are well known.Yet,few studies have examined the effectiveness of integrating physical activity(PA)into curricula within a post-secondary setting.To investigate the incorporation of PA into medical curriculum,we developed a series of optional exercise-based review sessions designed to reinforce musculoskeletal(MSK)anatomy course material.These synchronous sessions were co-taught by a group fitness instructor and an anatomy instructor.The fitness instructor would lead students through both strength and yoga style exercises,while the anatomy instructor asked questions about relevant anatomical structures related to course material previously covered.After the sessions,participants were asked to evaluate the classes on their self-reported exam preparedness in improving MSK anatomy knowledge,PA levels,and mental wellbeing.Thirty participants completed surveys;a majority agreed that the classes increased understanding of MSK concepts(90.0%)and activity levels(97.7%).Many(70.0%)felt that the classes helped reduce stress.The majority of respondents(90.0%)agreed that the classes contributed to increased feelings of social connectedness.Overall,medical students saw benefit in PA based interventions to supplement MSK course concepts.Along with increasing activity levels and promoting health behaviours,integrating PA into medical curriculum may improve comprehension of learning material,alleviate stress and foster social connectivity among medical students.展开更多
The first metatarsophalangeal(MTP)joint plays a crucial role in foot biomechanics,particularly in weight-bearing activities such as walking and running.It is frequently affected by conditions like hallux valgus(HV)and...The first metatarsophalangeal(MTP)joint plays a crucial role in foot biomechanics,particularly in weight-bearing activities such as walking and running.It is frequently affected by conditions like hallux valgus(HV)and hallux rigidus,with HV impacting approximately 23%-35% of the population.This narrative review explores the embryology,anatomy,and biomechanics of the first MTP joint(MTPJ),highlighting its significance in maintaining foot stability and function.A comprehensive literature search was conducted using PubMed,Scopus,and Google Scholar,analyzing 50 relevant studies,including 12 clinical trials.The joint’s complex structure and mechanical demands make it susceptible to degenerative and structural disorders.Studies indicate that 25%-40%of individuals with HV experience significant pain and functional impairment,affecting mobility and quality of life.Biomechanical stress,abnormal gait patterns,and joint instability contribute to disease progression.Understanding the anatomical and biomechanical properties of the first MTPJ is essential for improving diagnostic and therapeutic approaches.Emerging surgical techniques,such as osteotomy and joint resurfacing,show promise in reducing recurrence rates and enhancing longterm outcomes.Further research is needed to refine minimally invasive interventions and optimize treatment strategies for first MTPJ disorders.展开更多
Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,partic...Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,particularly nonobstructive azoospermia(NOA),which affects 10%–15%of infertile men,represents a significant challenge in male infertility.The advent of assisted reproductive technology(ART),specifically microdissection testicular sperm extraction(micro-TESE)followed by intracytoplasmic sperm injection(ICSI),offers a possibility for men with NOA to father biological children.Recent studies have focused on the predictors of sperm retrieval in NOA patients,such as age,testicular volume,and follicle-stimulating hormone(FSH)level.This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE,thereby enhancing understanding and improving outcomes for this challenging condition.展开更多
BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP ins...BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP instruments can be used.Therefore,MSE-ERCP appears to be the optimal solution for postsurgical patients,especially with Roux-en-Y anatomy.AIM To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.METHODS We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.RESULTS We identified 26 MSE-ERCPs:(1)18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation(n=11)or gastrectomy(n=2);and(2)Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass.Overall success of reaching the biliary entry was 88%and further interventions were successful in 83%of patients.In very long alimentary limb situations,success of reaching the biliary entry was not-significantly lower compared to“standard”Roux-en-Y(75%vs 94%,P=0.215).ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy(63%vs 93%,P=0.103).Mean intervention time was 105 minutes.Intervention times were longer in very long limb situations(133 minutes vs 91 minutes;P=0.032).Overall,we observed three adverse events(n=1 caused by enteroscopy,n=1 caused by the biliary intervention,n=1 unrelated to the procedure).In 15/26 cases(58%)MSE-ERCP was carried out on an outpatient basis.CONCLUSION MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions.However,MSE was recently withdrawn from the market due to severe safety concerns,which were not observed in this study.展开更多
BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)ha...BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.展开更多
Objective To explore how to organically integrate the human anatomy curriculum with medical imaging,thereby enhancing medical students'spatial understanding and 3D reconstruction skills,and strengthening their ana...Objective To explore how to organically integrate the human anatomy curriculum with medical imaging,thereby enhancing medical students'spatial understanding and 3D reconstruction skills,and strengthening their anatomical foundation and clinical competence.This approach aims to bridge the gap between basic science and clinical practice while cultivating clinical thinking abilities.Methods In this study,the medical imaging knowledge was introduced into the anatomy curriculum in Peking University,enabling students to better understand the human body structure and its relationship to the clinical practice with aid of the ultrasound and MRI method.After the course concluded,we evaluated the examination result and learning satisfaction data from the anatomy course.Results The result showed that students provided positive feedback,showing increased interest in learning,enhanced initiative,significant improvement in their anatomy grades(P<0.01),and a notable enhancement in their ability to apply basic knowledge to solve clinical problems(P<0.05).Conclusion The integrated teaching approach of medical imaging and human anatomy courses provides innovative ideas and practical method for medical students to learn the basic medical course and enhance their clinical skills in the future.展开更多
In the vast field of medical education,systematic anatomy serves as a solid cornerstone,firmly supporting medical students in their journey towards clinical professional knowledge.It is not just a course but also a ke...In the vast field of medical education,systematic anatomy serves as a solid cornerstone,firmly supporting medical students in their journey towards clinical professional knowledge.It is not just a course but also a key to unlocking the mysteries of medicine.This course is as rich as a vast treasure trove of knowledge,covering the fine structures and functions of various human body systems.Each knowledge point is like a bright pearl in the treasure trove.It is the foundation of clinical professional courses.Many subsequent clinical courses,such as diagnostics and surgery,rely on the basic understanding provided by systematic anatomy.Its professional vocabulary is also an important source of medical field terminologies,acting as the root of medical language and constructing the entire edifice of medical communication.Although the vocabulary of this course is rich,it is not complex.It is like a set of orderly-arranged jigsaw puzzles.As long as the correct methods are mastered,it is easy to piece them together.However,in the current teaching environment,the traditional cramming-style teaching method is like an old-fashioned carriage,showing obvious disadvantages on the road of the times.The pre-study link is like a rehearsal for a wonderful performance,having a direct and crucial impact on students’listening efficiency in class.Nevertheless,such an important teaching link is often overlooked,like a precious treasure forgotten in the corner.High-quality pre-study,for lecturers,is like giving wings to classroom teaching,which can greatly improve the efficiency of classroom teaching and make the teaching process smoother and more efficient.For students,it is like a magnifying glass that can deepen their understanding of knowledge points and their impression of the text,making the knowledge more clearly engraved in their minds.This article will focus on exploring the methods to achieve effective pre-study for systematic anatomy,hoping to contribute to the development of medical education.展开更多
Human anatomy is a fundamental and core course in medical education.However,in the educational process of traditional Chinese medicine colleges and universities,the realistic predicament of emphasizing classics over f...Human anatomy is a fundamental and core course in medical education.However,in the educational process of traditional Chinese medicine colleges and universities,the realistic predicament of emphasizing classics over forms often appears.Based on the perspective of the integration and connection of traditional Chinese medicine and modern medicine,this research proposes that the curriculum reconstruction should take“morphological support for clinical practice and classic correlation structure”as the main principle.By using strategies such as modular integration,the combination of virtual and real practices,and interdisciplinary evaluation,a human anatomy curriculum system that meets the needs of cultivating talents in traditional Chinese medicine in the new era is proposed.This study provides a reference for the modernization of traditional Chinese medicine education.展开更多
Background Anatomy is a required course for all medicine-related industries.In recent decades,the teaching quality and effect of anatomy have been compromised by factors including a decrease in human body specimens,da...Background Anatomy is a required course for all medicine-related industries.In recent decades,the teaching quality and effect of anatomy have been compromised by factors including a decrease in human body specimens,dampened enthusiasm for the discipline,reduced teaching hours of anatomy,scale expansion of medical education,and obstacles in performing field autopsies and observations.Methods Based on China's digitalized visible human research achievements,this article extracts the boundary information of anatomic structures from tomographic images,constructs three dimensional(3D)digital anatomical models with authentic texture information,and develops an anatomy assistive teaching system for teachers and students based on the knowledge points of anatomy,to meet the anatomy teaching requirements of different majors at various levels.Results This scientific,complete,and holistic system has produced over 60003D digital anatomical models,5000 anatomy knowledge points,50 anatomical operation videos,and 150 micro demonstration classes,with teaching contents for different majors and levels,such as systematic anatomy,topographic anatomy,sectional anatomy,anatomy of motion,and virtual anatomical operation table.Ranging from network terminals,desktops,touchscreen 3D displays,desktops,and projection 3D volumetric displays to augmented reality,its diversified interactive forms meet the requirements for a learning environment in different settings.Conclusions With multiple teaching and learning links covered,such as teaching environment,teaching resources,instructional slides,autonomous learning,and learning effect evaluation,this novel teaching system serves as a vital component and a necessary resource in anatomy teaching and functions as an important supplement to traditional anatomy teaching.Applied and promoted in most medical colleges and schools in China,this system has been recognized and approved by anatomy teachers and students,and plays a positive role in guaranteeing the effect and quality of anatomy teaching.展开更多
[Objective] To utilize the germplasm resources,new systematic evidence for the classification of sect.Paracamellia,genus Camellia is found in this article.[Method] Fruit anatomy of 10 species representing sect.Paracam...[Objective] To utilize the germplasm resources,new systematic evidence for the classification of sect.Paracamellia,genus Camellia is found in this article.[Method] Fruit anatomy of 10 species representing sect.Paracamellia was investigated.And the main component of sect.Paracamellia in the genus Camellia was studied by MVSP software.[Result] The exocarp was thin;mesocarp was broad,having a large number of stone cells;endocarp was lignified,and separated easily from seed.The principle components analysis suggested that the distance between species was far,showing far relation;the current study did not support the formation of Camellia grijsii（C.grijsii）and Camellia yuhsienensis（C.yuhsienensis）,Camellia shensiensis（C.shensiensis）should not be recognized as a variety of C.yuhsienensis.In addition,it also proved Ming＇s combining of Camellia confusa（C.confusa）and Camellia kissi（C.kissi）was unnatural.[Conclusion] The study provided theoretical basis for the development and application of sect.Paracamellia in the genus Camellia.展开更多
[Objective] This study was to reveal the anatomic structure of Premna microphylla Turcz.stem and leaf.[Method] Using plant anatomy method,we performed anatomic analysis of Premna microphylla Turcz.stem and leaf.[Resul...[Objective] This study was to reveal the anatomic structure of Premna microphylla Turcz.stem and leaf.[Method] Using plant anatomy method,we performed anatomic analysis of Premna microphylla Turcz.stem and leaf.[Result] The stem of Premna microphylla Turcz.is axially symmetric organ,its primary structure consists of three parts of epidermis,cortex and vascular cylinder.The petiole consists of epidermis,cortex and vascular cylinder,of which epidermis is a layer of cells with cuticle and epidermal hair.The sun leaf in Premna microphylla is dorsi-ventral leaf,wich is consist of palisade tissue and spongy tissue;while its shade leaf of Premna microphylla almost are isobilateral leaf.[Conclusion] Our results provided reference for further the exploitation and utilization of Premna microphylla Turcz.resources.展开更多
Specimen observation and dissection have been regarded as the best approach to teach anatomy,but due to the severe lack of anatomical specimens in recent years,the quality of anatomy teaching has been seriously affect...Specimen observation and dissection have been regarded as the best approach to teach anatomy,but due to the severe lack of anatomical specimens in recent years,the quality of anatomy teaching has been seriously affected.In order to disseminate anatomical knowledge effectively under such circumstances,this study discusses three key factors(modeling,perception,and interaction)involved in constructing virtual anatomy teaching systems in detail.To ensure the authenticity,integrity,and accuracy of modeling,detailed three-dimensional(3D)digital anatomical models are constructed using multi-scale data,such as the Chinese Visible Human dataset,clinical imaging data,tissue sections,and other sources.The anatomical knowledge ontology is built according to the needs of the particular teaching purposes.Various kinds of anatomical knowledge and 3D digital anatomical models are organically combined to construct virtual anatomy teaching system by means of virtual reality equipment and technology.The perception of knowledge is realized by the Yi Chuang Digital Human Anatomy Teaching System that we have created.The virtual interaction mode,which is similar to actual anatomical specimen observation and dissection,can enhance the transmissibility of anatomical knowledge.This virtual anatomy teaching system captures the three key factors.It can provide realistic and reusable teaching resources,expand the new medical education model,and effectively improve the quality of anatomy teaching.展开更多
Henry Vandyke Carter(1831–1897),physician and illustrator from Saint George’s Hospital in London,England.He worked with Henry Williamson Gray(1827–1861)on anatomical dissections and Carter’s illustrations contribu...Henry Vandyke Carter(1831–1897),physician and illustrator from Saint George’s Hospital in London,England.He worked with Henry Williamson Gray(1827–1861)on anatomical dissections and Carter’s illustrations contributed significantly to the success of the Treaty of Anatomy,Descriptive and Surgical.Henry Carter never achieved any credit or royalty for his work.This book is currently regarded as one of the most influential human anatomy textbooks.The paper aims to present a brief review of Henry Carter’s contributions to the medical field.展开更多
characteristics,complex content,and it is difficult to understand.In view of the nature of the subject,many different models and specimens are required during teaching,increasing the difficulty of its teaching.Althoug...characteristics,complex content,and it is difficult to understand.In view of the nature of the subject,many different models and specimens are required during teaching,increasing the difficulty of its teaching.Although the mode of medical teaching is constantly updating,anatomical specimens are still important in the teaching of anatomy,as they help students to understand the organs,their positions,and structural forms as well as to better grasp the theoretical aspect.In addition,anatomical specimens and medical students contact condition can affect the teaching effect.Therefore,it is imperative to give full play to the role of anatomical specimens in anatomy teaching to improve the teaching effect.This paper summarizes the research on the use of anatomical specimens in the teaching of anatomy.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types o...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed.展开更多
AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anato...AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups(concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.RESULTS: There were 205 patients with a concentrated type(64.7%) and 112 patients with a distributed type(35.3%) Sp A. There were 22 patients(6.9%) with a single branch of the splenic lobar vessels, 250(78.9%) with 2 branches, 43(13.6%) with 3 branches, and 2 patients(0.6%) with multiple branches. Eighty sevenpatients(27.4%) had type?Ⅰ?splenic artery trunk, 211(66.6%) had type Ⅱ, 13(4.1%) had type Ⅲ, and 6(1.9%) had type Ⅳ. The mean splenic hilar lymphadenectomy time(23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy(14.78 ± 11.09 vs 17.37 ± 10.62 m L; P = 0.044), and number of vascular clamps used at the splenic hilum(9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups(P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups(P > 0.05).CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type Sp A may be optimal patients for training new surgeons.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine.Recently,many studies have reported that balloonenteroscope-assisted ERC...Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine.Recently,many studies have reported that balloonenteroscope-assisted ERCP(BEA-ERCP) is a safe and effective procedure.However,further improvements in outcomes and the development of simplified procedures are required.Percutaneous treatment,Laparoscopy-assisted ERCP,endoscopic ultrasoundguided anterograde intervention,and open surgery are effective treatments.However,treatment should be noninvasive,effective,and safe.We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications.BEA-ERCP still requires high expertiselevel techniques and is far from a routinely performed procedure.Various techniques have been proposed to facilitate scope insertion(insertion with percutaneous transhepatic biliary drainage(PTBD) rendezvous technique,Short type single-balloon enteroscopes with passive bending section,Intraluminal injection of indigo carmine,CO2 inflation guidance),cannulation(PTBD or percutaneous transgallbladder drainage rendezvous technique,Dilation using screw drill,Rendezvous technique combining DBE with a cholangioscope,endoscopic ultrasound-guided rendezvous technique),and treatment(overtube-assisted technique,Short type balloon enteroscopes) during BEA-ERCP.The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients.A standard procedure for ERCP yet to be established for patients with a reconstructed intestine.At present,BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as firstline treatment.In this article,we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.展开更多
The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical...The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.展开更多
Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90%...Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anat-omy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.展开更多
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
文摘The benefits of regular physical activity are well known.Yet,few studies have examined the effectiveness of integrating physical activity(PA)into curricula within a post-secondary setting.To investigate the incorporation of PA into medical curriculum,we developed a series of optional exercise-based review sessions designed to reinforce musculoskeletal(MSK)anatomy course material.These synchronous sessions were co-taught by a group fitness instructor and an anatomy instructor.The fitness instructor would lead students through both strength and yoga style exercises,while the anatomy instructor asked questions about relevant anatomical structures related to course material previously covered.After the sessions,participants were asked to evaluate the classes on their self-reported exam preparedness in improving MSK anatomy knowledge,PA levels,and mental wellbeing.Thirty participants completed surveys;a majority agreed that the classes increased understanding of MSK concepts(90.0%)and activity levels(97.7%).Many(70.0%)felt that the classes helped reduce stress.The majority of respondents(90.0%)agreed that the classes contributed to increased feelings of social connectedness.Overall,medical students saw benefit in PA based interventions to supplement MSK course concepts.Along with increasing activity levels and promoting health behaviours,integrating PA into medical curriculum may improve comprehension of learning material,alleviate stress and foster social connectivity among medical students.
文摘The first metatarsophalangeal(MTP)joint plays a crucial role in foot biomechanics,particularly in weight-bearing activities such as walking and running.It is frequently affected by conditions like hallux valgus(HV)and hallux rigidus,with HV impacting approximately 23%-35% of the population.This narrative review explores the embryology,anatomy,and biomechanics of the first MTP joint(MTPJ),highlighting its significance in maintaining foot stability and function.A comprehensive literature search was conducted using PubMed,Scopus,and Google Scholar,analyzing 50 relevant studies,including 12 clinical trials.The joint’s complex structure and mechanical demands make it susceptible to degenerative and structural disorders.Studies indicate that 25%-40%of individuals with HV experience significant pain and functional impairment,affecting mobility and quality of life.Biomechanical stress,abnormal gait patterns,and joint instability contribute to disease progression.Understanding the anatomical and biomechanical properties of the first MTPJ is essential for improving diagnostic and therapeutic approaches.Emerging surgical techniques,such as osteotomy and joint resurfacing,show promise in reducing recurrence rates and enhancing longterm outcomes.Further research is needed to refine minimally invasive interventions and optimize treatment strategies for first MTPJ disorders.
文摘Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,particularly nonobstructive azoospermia(NOA),which affects 10%–15%of infertile men,represents a significant challenge in male infertility.The advent of assisted reproductive technology(ART),specifically microdissection testicular sperm extraction(micro-TESE)followed by intracytoplasmic sperm injection(ICSI),offers a possibility for men with NOA to father biological children.Recent studies have focused on the predictors of sperm retrieval in NOA patients,such as age,testicular volume,and follicle-stimulating hormone(FSH)level.This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE,thereby enhancing understanding and improving outcomes for this challenging condition.
文摘BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP instruments can be used.Therefore,MSE-ERCP appears to be the optimal solution for postsurgical patients,especially with Roux-en-Y anatomy.AIM To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.METHODS We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.RESULTS We identified 26 MSE-ERCPs:(1)18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation(n=11)or gastrectomy(n=2);and(2)Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass.Overall success of reaching the biliary entry was 88%and further interventions were successful in 83%of patients.In very long alimentary limb situations,success of reaching the biliary entry was not-significantly lower compared to“standard”Roux-en-Y(75%vs 94%,P=0.215).ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy(63%vs 93%,P=0.103).Mean intervention time was 105 minutes.Intervention times were longer in very long limb situations(133 minutes vs 91 minutes;P=0.032).Overall,we observed three adverse events(n=1 caused by enteroscopy,n=1 caused by the biliary intervention,n=1 unrelated to the procedure).In 15/26 cases(58%)MSE-ERCP was carried out on an outpatient basis.CONCLUSION MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions.However,MSE was recently withdrawn from the market due to severe safety concerns,which were not observed in this study.
基金Supported by Department of Science and Technology of Liaoning Province,No.2024JH2/102600288 and No.2022JH2/101500013。
文摘BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.
基金2024 Higher Education Science Research Planning Project(24KC0413)Peking University Health Science Center Medical Education Research Funding Project(2023YB43)+3 种基金The University-Industry Collaborative Education Program of the Ministry of Education(220903132204624)2022 Peking University Graduate Course Construction Funding2023 Peking University Medical Graduate Course Ideological and Political Construction ProjectZhejiang Natural Science Foundation Exploration Project Q-class Funding Project(242szhfhYB25)。
文摘Objective To explore how to organically integrate the human anatomy curriculum with medical imaging,thereby enhancing medical students'spatial understanding and 3D reconstruction skills,and strengthening their anatomical foundation and clinical competence.This approach aims to bridge the gap between basic science and clinical practice while cultivating clinical thinking abilities.Methods In this study,the medical imaging knowledge was introduced into the anatomy curriculum in Peking University,enabling students to better understand the human body structure and its relationship to the clinical practice with aid of the ultrasound and MRI method.After the course concluded,we evaluated the examination result and learning satisfaction data from the anatomy course.Results The result showed that students provided positive feedback,showing increased interest in learning,enhanced initiative,significant improvement in their anatomy grades(P<0.01),and a notable enhancement in their ability to apply basic knowledge to solve clinical problems(P<0.05).Conclusion The integrated teaching approach of medical imaging and human anatomy courses provides innovative ideas and practical method for medical students to learn the basic medical course and enhance their clinical skills in the future.
文摘In the vast field of medical education,systematic anatomy serves as a solid cornerstone,firmly supporting medical students in their journey towards clinical professional knowledge.It is not just a course but also a key to unlocking the mysteries of medicine.This course is as rich as a vast treasure trove of knowledge,covering the fine structures and functions of various human body systems.Each knowledge point is like a bright pearl in the treasure trove.It is the foundation of clinical professional courses.Many subsequent clinical courses,such as diagnostics and surgery,rely on the basic understanding provided by systematic anatomy.Its professional vocabulary is also an important source of medical field terminologies,acting as the root of medical language and constructing the entire edifice of medical communication.Although the vocabulary of this course is rich,it is not complex.It is like a set of orderly-arranged jigsaw puzzles.As long as the correct methods are mastered,it is easy to piece them together.However,in the current teaching environment,the traditional cramming-style teaching method is like an old-fashioned carriage,showing obvious disadvantages on the road of the times.The pre-study link is like a rehearsal for a wonderful performance,having a direct and crucial impact on students’listening efficiency in class.Nevertheless,such an important teaching link is often overlooked,like a precious treasure forgotten in the corner.High-quality pre-study,for lecturers,is like giving wings to classroom teaching,which can greatly improve the efficiency of classroom teaching and make the teaching process smoother and more efficient.For students,it is like a magnifying glass that can deepen their understanding of knowledge points and their impression of the text,making the knowledge more clearly engraved in their minds.This article will focus on exploring the methods to achieve effective pre-study for systematic anatomy,hoping to contribute to the development of medical education.
基金The teaching reform project of Yunnan University of Traditional Chinese Medicine:The synergy of medical education to meet the needs of new medical science for the cultivation of clinical application-oriented talents in both traditional Chinese and Western medicine(JG202324)。
文摘Human anatomy is a fundamental and core course in medical education.However,in the educational process of traditional Chinese medicine colleges and universities,the realistic predicament of emphasizing classics over forms often appears.Based on the perspective of the integration and connection of traditional Chinese medicine and modern medicine,this research proposes that the curriculum reconstruction should take“morphological support for clinical practice and classic correlation structure”as the main principle.By using strategies such as modular integration,the combination of virtual and real practices,and interdisciplinary evaluation,a human anatomy curriculum system that meets the needs of cultivating talents in traditional Chinese medicine in the new era is proposed.This study provides a reference for the modernization of traditional Chinese medicine education.
基金Major Science and Technology Special Project of Shandong Province(Emerging Industry)(2015ZDXX0201A02)Key R&D Plan of Shandong Province in 2019(2019JZZY020106).
文摘Background Anatomy is a required course for all medicine-related industries.In recent decades,the teaching quality and effect of anatomy have been compromised by factors including a decrease in human body specimens,dampened enthusiasm for the discipline,reduced teaching hours of anatomy,scale expansion of medical education,and obstacles in performing field autopsies and observations.Methods Based on China's digitalized visible human research achievements,this article extracts the boundary information of anatomic structures from tomographic images,constructs three dimensional(3D)digital anatomical models with authentic texture information,and develops an anatomy assistive teaching system for teachers and students based on the knowledge points of anatomy,to meet the anatomy teaching requirements of different majors at various levels.Results This scientific,complete,and holistic system has produced over 60003D digital anatomical models,5000 anatomy knowledge points,50 anatomical operation videos,and 150 micro demonstration classes,with teaching contents for different majors and levels,such as systematic anatomy,topographic anatomy,sectional anatomy,anatomy of motion,and virtual anatomical operation table.Ranging from network terminals,desktops,touchscreen 3D displays,desktops,and projection 3D volumetric displays to augmented reality,its diversified interactive forms meet the requirements for a learning environment in different settings.Conclusions With multiple teaching and learning links covered,such as teaching environment,teaching resources,instructional slides,autonomous learning,and learning effect evaluation,this novel teaching system serves as a vital component and a necessary resource in anatomy teaching and functions as an important supplement to traditional anatomy teaching.Applied and promoted in most medical colleges and schools in China,this system has been recognized and approved by anatomy teachers and students,and plays a positive role in guaranteeing the effect and quality of anatomy teaching.
基金Supported by General Program of Jinhua City Science and Technology Bureau(2009-2-020)~~
文摘[Objective] To utilize the germplasm resources,new systematic evidence for the classification of sect.Paracamellia,genus Camellia is found in this article.[Method] Fruit anatomy of 10 species representing sect.Paracamellia was investigated.And the main component of sect.Paracamellia in the genus Camellia was studied by MVSP software.[Result] The exocarp was thin;mesocarp was broad,having a large number of stone cells;endocarp was lignified,and separated easily from seed.The principle components analysis suggested that the distance between species was far,showing far relation;the current study did not support the formation of Camellia grijsii（C.grijsii）and Camellia yuhsienensis（C.yuhsienensis）,Camellia shensiensis（C.shensiensis）should not be recognized as a variety of C.yuhsienensis.In addition,it also proved Ming＇s combining of Camellia confusa（C.confusa）and Camellia kissi（C.kissi）was unnatural.[Conclusion] The study provided theoretical basis for the development and application of sect.Paracamellia in the genus Camellia.
基金Supported by the Supporting Program of the"Eleventh Five-year Plan"for Sci&Tech Research of China(2007BAD87B06)Major Fund of Anhui Province Education Department(KJ2010A114)~~
文摘[Objective] This study was to reveal the anatomic structure of Premna microphylla Turcz.stem and leaf.[Method] Using plant anatomy method,we performed anatomic analysis of Premna microphylla Turcz.stem and leaf.[Result] The stem of Premna microphylla Turcz.is axially symmetric organ,its primary structure consists of three parts of epidermis,cortex and vascular cylinder.The petiole consists of epidermis,cortex and vascular cylinder,of which epidermis is a layer of cells with cuticle and epidermal hair.The sun leaf in Premna microphylla is dorsi-ventral leaf,wich is consist of palisade tissue and spongy tissue;while its shade leaf of Premna microphylla almost are isobilateral leaf.[Conclusion] Our results provided reference for further the exploitation and utilization of Premna microphylla Turcz.resources.
基金This work was funded by the National Natural Science Foundation of China(No.61190122).
文摘Specimen observation and dissection have been regarded as the best approach to teach anatomy,but due to the severe lack of anatomical specimens in recent years,the quality of anatomy teaching has been seriously affected.In order to disseminate anatomical knowledge effectively under such circumstances,this study discusses three key factors(modeling,perception,and interaction)involved in constructing virtual anatomy teaching systems in detail.To ensure the authenticity,integrity,and accuracy of modeling,detailed three-dimensional(3D)digital anatomical models are constructed using multi-scale data,such as the Chinese Visible Human dataset,clinical imaging data,tissue sections,and other sources.The anatomical knowledge ontology is built according to the needs of the particular teaching purposes.Various kinds of anatomical knowledge and 3D digital anatomical models are organically combined to construct virtual anatomy teaching system by means of virtual reality equipment and technology.The perception of knowledge is realized by the Yi Chuang Digital Human Anatomy Teaching System that we have created.The virtual interaction mode,which is similar to actual anatomical specimen observation and dissection,can enhance the transmissibility of anatomical knowledge.This virtual anatomy teaching system captures the three key factors.It can provide realistic and reusable teaching resources,expand the new medical education model,and effectively improve the quality of anatomy teaching.
文摘Henry Vandyke Carter(1831–1897),physician and illustrator from Saint George’s Hospital in London,England.He worked with Henry Williamson Gray(1827–1861)on anatomical dissections and Carter’s illustrations contributed significantly to the success of the Treaty of Anatomy,Descriptive and Surgical.Henry Carter never achieved any credit or royalty for his work.This book is currently regarded as one of the most influential human anatomy textbooks.The paper aims to present a brief review of Henry Carter’s contributions to the medical field.
文摘characteristics,complex content,and it is difficult to understand.In view of the nature of the subject,many different models and specimens are required during teaching,increasing the difficulty of its teaching.Although the mode of medical teaching is constantly updating,anatomical specimens are still important in the teaching of anatomy,as they help students to understand the organs,their positions,and structural forms as well as to better grasp the theoretical aspect.In addition,anatomical specimens and medical students contact condition can affect the teaching effect.Therefore,it is imperative to give full play to the role of anatomical specimens in anatomy teaching to improve the teaching effect.This paper summarizes the research on the use of anatomical specimens in the teaching of anatomy.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced endoscopist.The challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic accessories.The development of endoscopic techniques has led to higher success rates in this group of patients.Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb reconstruction.ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled endoscopist.Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy.Laparoscopic-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard accessories.This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy.This review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction types.Emerging new techniques and their outcomes are also discussed.
基金Supported by National Key Clinical Specialty Discipline Construction Program of China,No.[2012]649Key Project of Science and Technology Plan of Fujian Province,China,No.2014Y0025
文摘AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups(concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.RESULTS: There were 205 patients with a concentrated type(64.7%) and 112 patients with a distributed type(35.3%) Sp A. There were 22 patients(6.9%) with a single branch of the splenic lobar vessels, 250(78.9%) with 2 branches, 43(13.6%) with 3 branches, and 2 patients(0.6%) with multiple branches. Eighty sevenpatients(27.4%) had type?Ⅰ?splenic artery trunk, 211(66.6%) had type Ⅱ, 13(4.1%) had type Ⅲ, and 6(1.9%) had type Ⅳ. The mean splenic hilar lymphadenectomy time(23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy(14.78 ± 11.09 vs 17.37 ± 10.62 m L; P = 0.044), and number of vascular clamps used at the splenic hilum(9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups(P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups(P > 0.05).CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type Sp A may be optimal patients for training new surgeons.
文摘Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine.Recently,many studies have reported that balloonenteroscope-assisted ERCP(BEA-ERCP) is a safe and effective procedure.However,further improvements in outcomes and the development of simplified procedures are required.Percutaneous treatment,Laparoscopy-assisted ERCP,endoscopic ultrasoundguided anterograde intervention,and open surgery are effective treatments.However,treatment should be noninvasive,effective,and safe.We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications.BEA-ERCP still requires high expertiselevel techniques and is far from a routinely performed procedure.Various techniques have been proposed to facilitate scope insertion(insertion with percutaneous transhepatic biliary drainage(PTBD) rendezvous technique,Short type single-balloon enteroscopes with passive bending section,Intraluminal injection of indigo carmine,CO2 inflation guidance),cannulation(PTBD or percutaneous transgallbladder drainage rendezvous technique,Dilation using screw drill,Rendezvous technique combining DBE with a cholangioscope,endoscopic ultrasound-guided rendezvous technique),and treatment(overtube-assisted technique,Short type balloon enteroscopes) during BEA-ERCP.The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients.A standard procedure for ERCP yet to be established for patients with a reconstructed intestine.At present,BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as firstline treatment.In this article,we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.
文摘The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.
文摘Carpal tunnel syndrome(CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anat-omy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.
