BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD....BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.展开更多
Amyotrophic lateral sclerosis(ALS)is a progressive neurodegenerative disease characterized by the loss of upper and lower motor neurons,clinically marked by muscle atrophy and weakness.Although the clinical course is ...Amyotrophic lateral sclerosis(ALS)is a progressive neurodegenerative disease characterized by the loss of upper and lower motor neurons,clinically marked by muscle atrophy and weakness.Although the clinical course is highly variable,the average time from the onset of symptoms to the need for respiratory support or death is 3-5 years.ALS is the most prevalent motor neuron disease in adults,occurring at a rate of 2 per 100,000 individuals and affecting 5.4 per 100,000 individuals overall.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychologi...BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.展开更多
Background: Wrist pain is prevalent. Activities such as dexterous sports, prolonged use of personal handheld devices, and extensive desktop keyboard usage are common contributors to wrist pain. Intersection syndrome, ...Background: Wrist pain is prevalent. Activities such as dexterous sports, prolonged use of personal handheld devices, and extensive desktop keyboard usage are common contributors to wrist pain. Intersection syndrome, a form of inflammatory tenosynovitis, occurs at the intersection of the first and second dorsal compartments of the wrist. The first dorsal compartment is comprised of the tendons of abductor pollicis longus and extensor pollicis brevis, while the second dorsal compartment contains the tendons of extensor carpi radialis longus and extensor carpi radialis brevis. Intersection syndrome is diagnosed by pain localized to the dorsoradial forearm, approximately five cm proximal to the wrist joint, which worsens with resisted wrist and thumb extension. To date, the use of hydro dissection with 5% dextrose under ultrasound guidance as a treatment for Intersection syndrome has not been reported. This case report presents the first report on ultrasound-guided hydro dissection as a therapeutic approach for intersection syndrome. Methods: A case report, with informed consent, involving a 32-year-old male athlete. The patient, a hurling player, presented with chronic right wrist pain diagnosed as intersection syndrome. The condition significantly affected his work, sporting activities, and daily living activities. Previous conservative management and physiotherapy had failed to alleviate his symptoms. To confirm the diagnosis, relevant imaging was performed, supplemented by dynamic ultrasound assessment. The procedure was performed aseptically. Continuous ultrasound guidance was employed to ensure accurate needle placement. Once the needle tip position was confirmed, an initial injection of 5 mL of 0.25% chirocaine was administered. 10 mL of 5% dextrose was injected under ultrasound guidance for hydro dissection, with good visualization of the solution’s distribution. Conclusion: Ultrasound-guided hydro dissection has not previously been documented as a treatment option for intersection syndrome. In this case, it proved to be an effective pain-relieving therapy with sustained effect at three-month clinical follow-up. Further studies are required.展开更多
BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted end...BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted endoscopic submucosal dissection(p-ESD)technique.AIM To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.METHODS This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023.The study aimed to evaluate differences in dissection time,en bloc resection rate,R0 resection rate,and adverse event rates between the p-ESD and c-ESD groups.RESULTS In total,103 patients were enrolled(49 in the p-ESD group and 54 in the c-ESD group).The p-ESD group exhibited a significantly shorter median dissection time(9.3 minutes vs 14.9 minutes;P<0.001)and a higher R0 resection rate(100%vs 88.9%;P=0.028),while en bloc resection rates were comparable.Rates of minor intraoperative bleeding(10.2%vs 25.9%;P=0.040)and major intraoperative bleeding(4.1%vs 18.5%;P=0.030)were lower in the p-ESD group.No muscularis propria injuries occurred in the p-ESD group vs 16.7%in the c-ESD group(P=0.003).Other adverse events did not differ significantly.CONCLUSION p-ESD is safe and effective for treating rectal NETs.Compared with c-ESD,it is technically easier,requires less dissection time,achieves higher R0 resection rates,reduces intraoperative bleeding,and lowers the risk of muscularis propria injury.展开更多
BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conver...BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conversational artificial intelligence(AI)tools like chat generative pretrained transformer(ChatGPT)are rapidly emerging as sources of medical information.AIM To evaluate ChatGPT’s reliability and usefulness regarding ESD and EMR for patients and healthcare professionals.METHODS In this study,30 specific questions related to ESD and EMR were identified.Then,these questions were repeatedly entered into ChatGPT,with two independent answers generated for each question.A Likert scale was used to rate the accuracy,completeness,and comprehensibility of the responses.Meanwhile,a binary category(high/Low)was used to evaluate each aspect of the two responses generated by ChatGPT and the response retrieved from Google.RESULTS By analyzing the average scores of the three raters,our findings indicated that the responses generated by ChatGPT received high ratings for accuracy(mean score of 5.14 out of 6),completeness(mean score of 2.34 out of 3),and comprehensibility(mean score of 2.96 out of 3).Kendall’s coefficients of concordance indicated good agreement among raters(all P<0.05).For the responses generated by Google,more than half were classified by experts as having low accuracy and low completeness.CONCLUSION ChatGPT provided accurate and reliable answers in response to questions about ESD and EMR.Future studies should address ChatGPT’s current limitations by incorporating more detailed and up-to-date medical information.This could establish AI chatbots as significant resource for both patients and health care professionals.展开更多
BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.展开更多
In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive ove...In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.展开更多
BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(A...BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.展开更多
Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aort...Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aortic dissection admitted to the ICU from January 2020 to December 2023 was selected.Data were collected using a delirium-related questionnaire and the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Results:The incidence of delirium in elderly Stanford B aortic dissection patients was 23.73%.Logistic regression analysis showed that gender,length of stay in the ICU,and duration of sedative drug use were independent risk factors for delirium in elderly patients(P<0.05).The model likelihood ratio test x^(2)=28.462,P<0.001;Hosmer-Lemeshow goodness-of-fit test x^(2)=0.715,P=0.878.Conclusion:The incidence of delirium in elderly patients with Stanford-type B aortic dissection is relatively low.Medical staff should conduct adequate and effective preoperative assessment according to the condition of elderly Stanford-type B aortic dissection patients,and use analgesic and sedative drugs reasonably to create a good treatment environment for patients,thereby minimizing the incidence of delirium in elderly patients with Stanford-type B aortic dissection as much as possible.展开更多
为实现对制丝过程烘丝段出料水分的精准控制,科学、客观地识别并筛选影响水分的关键工艺参数。选取以某牌号卷烟的制丝过程全批次稳态数据为研究对象,在传统逐步回归方法的基础上,引入三种通过添加惩罚项来压缩变量系数的Lasso族方法,即...为实现对制丝过程烘丝段出料水分的精准控制,科学、客观地识别并筛选影响水分的关键工艺参数。选取以某牌号卷烟的制丝过程全批次稳态数据为研究对象,在传统逐步回归方法的基础上,引入三种通过添加惩罚项来压缩变量系数的Lasso族方法,即:Lasso方法、适应性Lasso方法和SCAD方法,分别构建以烘丝段出料水分为因变量的变量选择模型,并采用AIC、BIC和MSE三种评价指标对模型进行比较,最后依据最优模型进行关键工艺参数的筛选及重要性排序。结果表明:① Lasso族方法在模型拟合优度、预测精度和复杂度控制方面均显著优于传统逐步回归方法,其中SCAD方法的综合性能表现最优;② 基于SCAD方法确定了烘丝段的4个关键工艺参数,按其重要性排序依次为:II区筒壁温度、膨胀单元蒸汽体积流量、切叶丝含水率和工艺气速度。To achieve precise control over the moisture content of the discharge in the drying section of the tobacco primary processing, it is essential to scientifically and objectively identify and screen the key process parameters affecting moisture. This study selects steady state data from the entire batch of a specific brand of cigarette production process as the research object. Building on the traditional stepwise regression method, three Lasso family methods—Lasso, Adaptive Lasso, and SCAD are introduced, which compress variable coefficients by adding penalty terms. Variable selection models are constructed with the moisture content of the drying section discharge as the dependent variable. The models are compared using three evaluation metrics: AIC, BIC, and MSE. Finally, the optimal model is used to screen and rank the importance of key process parameters. The results show that: ① The Lasso-family methods significantly outperform the traditional stepwise regression method in terms of model goodness-of-fit, prediction accuracy, and complexity control, with the SCAD method demonstrating the best overall performance;② Based on the SCAD method, four key process parameters for the drying section are identified, ranked in order of importance as follows: Zone II wall temperature, expansion unit steam volumetric flow rate, cut tobacco moisture content, and process air velocity.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this tec...BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this technique,the incidence of complications is expected to increase.The most common complications of ESD are hemorrhage and perforation.Rare cases of obstruction after colorectal ESD have been reported,which are often easily misdiagnosed.Therefore,clinicians should maintain heightened awareness of this complication.CASE SUMMARY We report the case of a 50-year-old male who developed bowel obstruction following ESD.On the second day after the procedure,the patient presented with fever and a mild left lower abdominal pain.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant.Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel.The patient continued to fast and was treated with intravenous antibiotics.On the third postoperative day,he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid,with no bowel movement for two days after the procedure.A diagnosis of obstruction after ESD was made.Continuous gastrointestinal decompression was initiated on the fourth day,resulting in symptomatic improvement.Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging.The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.CONCLUSION Acute intestinal obstruction after ESD is a rare complication.Delayed diagnosis or misdiagnosis may be life-threatening.Clinicians should be vigilant for this condition following ESD.展开更多
BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoi...BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoint may facilitate the skills.AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection(ESD)on hemostasis.METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD,displaying the viewpoint as a circle.In phase 1,videos of three trainees’viewpoints were recorded.After reviewing these,trainees were recorded again in phase 2.The videos from both phases were retrospectively reviewed,and short clips were created to evaluate the hemostasis skills.Outcome measures included the time to recognize the bleeding point,the time to complete hemostasis,and the number of coagulation attempts.RESULTS Eight cases treated with ESD were reviewed,and 10 video clips of hemostasis were created.The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1(8.3±4.1 seconds vs 23.1±19.2 seconds;P=0.049).The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different(15.4±6.8 seconds vs 31.9±21.7 seconds;P=0.056).Significantly fewer coagulation attempts were performed during phase 2(1.8±0.7 vs 3.2±1.0;P=0.004).CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts.Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.展开更多
Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods...Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods:The clinical data of patients who underwent gastric ESD at our center from 2009 to 2024 were retrospectively analyzed.Pain severity was assessed using a visual analogue scale,with a score≥4 defined as postoperative pain.Based on the presence or absence of postoperative pain,patients were divided into a pain group and a control group.Independent factors influencing postoperative pain were identified using multivariate logistic regression analysis.To control for confounding bias,patients in the case and control groups were matched by sex and lesion size,and the matched participants were further analyzed using a conditional logistic regression model.Results:In total,993 patients were analyzed.The incidence of postoperative pain was 9.1%(95%confidence interval[CI],7.3-11.1).In the univariate analysis,sex,operation duration,anesthesia method,intraoperative electrocoagulation,nasogastric tube placement,and postoperative vomiting were significantly associated with postoperative pain.Multivariate analysis identified eight independent factors:male sex(odds ratio[OR],0.61;95%CI,0.37-0.97;p=0.04),operation duration(OR,1.29;95%CI,1.03-1.63;p=0.02),protuberant lesions(OR,0.43;95%CI,0.26-0.71;p<0.01),antral lesions(OR,1.84;95%CI,1.10-3.05;p=0.01),intubation general anesthesia(OR,0.40;95%CI,0.22-0.72;p=0.002),intraoperative electrocoagulation(OR,0.32;95%CI,0.19-0.55;p<0.01),nasogastric tube placement(OR,2.005;95%CI,1.12-3.57;p=0.01),and postoperative vomiting(OR,3.24;95%CI,1.40-7.47;p=0.005).Conditional logistic regression analysis further identified diabetes mellitus(OR,2.50;95%CI,1.03-6.06;p=0.04).Conclusion:Female sex,diabetes mellitus,concave-type lesions,lesions in the gastric antrum,non-intubation general anesthesia,absence of intraoperative electrocoagulation,prolonged operation duration,nasogastric tube placement,and postoperative vomiting were independent factors associated with moderate to severe pain after gastric ESD.For patients at increased risk of postoperative pain,appropriate prophylactic and therapeutic measures during the perioperative period may effectively alleviate pain following gastric ESD.展开更多
Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective anal...Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective analysis of 553 ATAAD patients from Tongji Hospital divided into malperfusion and non-malperfusion groups was conducted.Logistic regression was used to identify independent predictors of the outcome.Model performance via the Hosmer–Lemeshow test,decision curve analysis(DCA),the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,and predictive values.Results Malperfusion was observed in 28.4%of ATAAD patients.Significant predictors included elevated lactate dehydrogenase(LDH)(OR:1.0019,95%CI:1.0002–1.0036,P=0.027),alanine aminotransferase(ALT)(OR:0.9936,95%CI:0.987–1.000,P=0.046)and estimated glomerular filtration rate(eGFR)(OR:0.9877,95%CI:0.977–0.998,P=0.021),suggesting roles for tissue ischemia and impaired renal or hepatic function.Other variables,such as D-dimer,uric acid,creatinine,and NT-proBNP,showed trends toward significance but did not reach the 0.05 threshold.The model demonstrated good calibration(Hosmer–Lemeshow P=0.318),moderate discriminatory power(AUC=0.725),high specificity(93.62%),and low sensitivity(26.75%).Conclusion The model based on routine biochemical markers provides a practical approach for the early identification of malperfusion in ATAAD patients.It shows strong specificity and clinical utility,although its limited sensitivity highlights the need for further refinement.Future improvements should focus on incorporating additional clinical or imaging data to increase diagnostic accuracy.展开更多
The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:W...Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021.Cases were categorized using Current Procedural Terminology(CPT)codes(38571)for extended lymph node dissection and super-extended lymph node dissection(38572).Using logistic regression,we compared the groups on a number of factors,including recurrence.Results:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery.Significant differences were observed in the pathologic T stage and pathology grade group.Time on robot was significantly longer for the super-extended group,while estimated blood loss was lower.No differences were observed in length of stay or any complication-related variable.Super-extended had significantly higher node positivity(36.1%vs.7.6%,p<0.001)and recurrence.10.0%of super-extended cases had node positivity in the aortic bifurcation,the common iliac,or the pre-sacral chains that would have been missed with an extended dissection.2.2%of patients had node positivity in these chains only.Conclusions:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer.Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.展开更多
Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the e...Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.展开更多
基金Supported by Science and Technology Department of Sichuan Province,No.2020YFS0376National Natural Science Foundation of China,No.81900599Science and Technology Program of Hospital of TCM,Southwest Medical University,No.2022-CXTD-01.
文摘BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.
基金funded by Fondazione AriSLA ETS(Fondazione di ricerca per la SLA ETS),ReNicALS project to SAsupported by#NEXTGENERATIONEU(NGEU)and funded by the Ministry of University and Research(MUR),National Recovery and Resilience Plan(NRRP),project MNESYS(PE0000006)-A Multiscale Integrated Approach to the Study of the Nervous System in Health and Disease(DN.1553 October 11,2022)。
文摘Amyotrophic lateral sclerosis(ALS)is a progressive neurodegenerative disease characterized by the loss of upper and lower motor neurons,clinically marked by muscle atrophy and weakness.Although the clinical course is highly variable,the average time from the onset of symptoms to the need for respiratory support or death is 3-5 years.ALS is the most prevalent motor neuron disease in adults,occurring at a rate of 2 per 100,000 individuals and affecting 5.4 per 100,000 individuals overall.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.
文摘Background: Wrist pain is prevalent. Activities such as dexterous sports, prolonged use of personal handheld devices, and extensive desktop keyboard usage are common contributors to wrist pain. Intersection syndrome, a form of inflammatory tenosynovitis, occurs at the intersection of the first and second dorsal compartments of the wrist. The first dorsal compartment is comprised of the tendons of abductor pollicis longus and extensor pollicis brevis, while the second dorsal compartment contains the tendons of extensor carpi radialis longus and extensor carpi radialis brevis. Intersection syndrome is diagnosed by pain localized to the dorsoradial forearm, approximately five cm proximal to the wrist joint, which worsens with resisted wrist and thumb extension. To date, the use of hydro dissection with 5% dextrose under ultrasound guidance as a treatment for Intersection syndrome has not been reported. This case report presents the first report on ultrasound-guided hydro dissection as a therapeutic approach for intersection syndrome. Methods: A case report, with informed consent, involving a 32-year-old male athlete. The patient, a hurling player, presented with chronic right wrist pain diagnosed as intersection syndrome. The condition significantly affected his work, sporting activities, and daily living activities. Previous conservative management and physiotherapy had failed to alleviate his symptoms. To confirm the diagnosis, relevant imaging was performed, supplemented by dynamic ultrasound assessment. The procedure was performed aseptically. Continuous ultrasound guidance was employed to ensure accurate needle placement. Once the needle tip position was confirmed, an initial injection of 5 mL of 0.25% chirocaine was administered. 10 mL of 5% dextrose was injected under ultrasound guidance for hydro dissection, with good visualization of the solution’s distribution. Conclusion: Ultrasound-guided hydro dissection has not previously been documented as a treatment option for intersection syndrome. In this case, it proved to be an effective pain-relieving therapy with sustained effect at three-month clinical follow-up. Further studies are required.
基金Supported by Fujian Province National Key Clinical Specialty Construction Project(Minwei Medical Policy Letter),No.[2023]1594.
文摘BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted endoscopic submucosal dissection(p-ESD)technique.AIM To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.METHODS This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023.The study aimed to evaluate differences in dissection time,en bloc resection rate,R0 resection rate,and adverse event rates between the p-ESD and c-ESD groups.RESULTS In total,103 patients were enrolled(49 in the p-ESD group and 54 in the c-ESD group).The p-ESD group exhibited a significantly shorter median dissection time(9.3 minutes vs 14.9 minutes;P<0.001)and a higher R0 resection rate(100%vs 88.9%;P=0.028),while en bloc resection rates were comparable.Rates of minor intraoperative bleeding(10.2%vs 25.9%;P=0.040)and major intraoperative bleeding(4.1%vs 18.5%;P=0.030)were lower in the p-ESD group.No muscularis propria injuries occurred in the p-ESD group vs 16.7%in the c-ESD group(P=0.003).Other adverse events did not differ significantly.CONCLUSION p-ESD is safe and effective for treating rectal NETs.Compared with c-ESD,it is technically easier,requires less dissection time,achieves higher R0 resection rates,reduces intraoperative bleeding,and lowers the risk of muscularis propria injury.
基金Supported by Ningbo Top Medical and Health Research Program,No.2023020612the Ningbo Leading Medical&Healthy Discipline Project,No.2022-S04+1 种基金the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2022KY315Ningbo Science and Technology Public Welfare Project,No.2023S133.
文摘BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conversational artificial intelligence(AI)tools like chat generative pretrained transformer(ChatGPT)are rapidly emerging as sources of medical information.AIM To evaluate ChatGPT’s reliability and usefulness regarding ESD and EMR for patients and healthcare professionals.METHODS In this study,30 specific questions related to ESD and EMR were identified.Then,these questions were repeatedly entered into ChatGPT,with two independent answers generated for each question.A Likert scale was used to rate the accuracy,completeness,and comprehensibility of the responses.Meanwhile,a binary category(high/Low)was used to evaluate each aspect of the two responses generated by ChatGPT and the response retrieved from Google.RESULTS By analyzing the average scores of the three raters,our findings indicated that the responses generated by ChatGPT received high ratings for accuracy(mean score of 5.14 out of 6),completeness(mean score of 2.34 out of 3),and comprehensibility(mean score of 2.96 out of 3).Kendall’s coefficients of concordance indicated good agreement among raters(all P<0.05).For the responses generated by Google,more than half were classified by experts as having low accuracy and low completeness.CONCLUSION ChatGPT provided accurate and reliable answers in response to questions about ESD and EMR.Future studies should address ChatGPT’s current limitations by incorporating more detailed and up-to-date medical information.This could establish AI chatbots as significant resource for both patients and health care professionals.
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
文摘In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.
基金Supported by Hamad Medical Corporation,No.MRC-01-18-073.
文摘BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.
基金Philosophy and Social Sciences Research Project of the Hubei Provincial Department of Education(Project No.:23D108)。
文摘Objective:To investigate the incidence of delirium in elderly patients with Stanford-type B aortic dissection and analyze its risk factors.Methods:A convenience sample of 767 elderly patients with Stanford-type B aortic dissection admitted to the ICU from January 2020 to December 2023 was selected.Data were collected using a delirium-related questionnaire and the Confusion Assessment Method for the Intensive Care Unit(CAM-ICU).Results:The incidence of delirium in elderly Stanford B aortic dissection patients was 23.73%.Logistic regression analysis showed that gender,length of stay in the ICU,and duration of sedative drug use were independent risk factors for delirium in elderly patients(P<0.05).The model likelihood ratio test x^(2)=28.462,P<0.001;Hosmer-Lemeshow goodness-of-fit test x^(2)=0.715,P=0.878.Conclusion:The incidence of delirium in elderly patients with Stanford-type B aortic dissection is relatively low.Medical staff should conduct adequate and effective preoperative assessment according to the condition of elderly Stanford-type B aortic dissection patients,and use analgesic and sedative drugs reasonably to create a good treatment environment for patients,thereby minimizing the incidence of delirium in elderly patients with Stanford-type B aortic dissection as much as possible.
文摘为实现对制丝过程烘丝段出料水分的精准控制,科学、客观地识别并筛选影响水分的关键工艺参数。选取以某牌号卷烟的制丝过程全批次稳态数据为研究对象,在传统逐步回归方法的基础上,引入三种通过添加惩罚项来压缩变量系数的Lasso族方法,即:Lasso方法、适应性Lasso方法和SCAD方法,分别构建以烘丝段出料水分为因变量的变量选择模型,并采用AIC、BIC和MSE三种评价指标对模型进行比较,最后依据最优模型进行关键工艺参数的筛选及重要性排序。结果表明:① Lasso族方法在模型拟合优度、预测精度和复杂度控制方面均显著优于传统逐步回归方法,其中SCAD方法的综合性能表现最优;② 基于SCAD方法确定了烘丝段的4个关键工艺参数,按其重要性排序依次为:II区筒壁温度、膨胀单元蒸汽体积流量、切叶丝含水率和工艺气速度。To achieve precise control over the moisture content of the discharge in the drying section of the tobacco primary processing, it is essential to scientifically and objectively identify and screen the key process parameters affecting moisture. This study selects steady state data from the entire batch of a specific brand of cigarette production process as the research object. Building on the traditional stepwise regression method, three Lasso family methods—Lasso, Adaptive Lasso, and SCAD are introduced, which compress variable coefficients by adding penalty terms. Variable selection models are constructed with the moisture content of the drying section discharge as the dependent variable. The models are compared using three evaluation metrics: AIC, BIC, and MSE. Finally, the optimal model is used to screen and rank the importance of key process parameters. The results show that: ① The Lasso-family methods significantly outperform the traditional stepwise regression method in terms of model goodness-of-fit, prediction accuracy, and complexity control, with the SCAD method demonstrating the best overall performance;② Based on the SCAD method, four key process parameters for the drying section are identified, ranked in order of importance as follows: Zone II wall temperature, expansion unit steam volumetric flow rate, cut tobacco moisture content, and process air velocity.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this technique,the incidence of complications is expected to increase.The most common complications of ESD are hemorrhage and perforation.Rare cases of obstruction after colorectal ESD have been reported,which are often easily misdiagnosed.Therefore,clinicians should maintain heightened awareness of this complication.CASE SUMMARY We report the case of a 50-year-old male who developed bowel obstruction following ESD.On the second day after the procedure,the patient presented with fever and a mild left lower abdominal pain.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant.Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel.The patient continued to fast and was treated with intravenous antibiotics.On the third postoperative day,he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid,with no bowel movement for two days after the procedure.A diagnosis of obstruction after ESD was made.Continuous gastrointestinal decompression was initiated on the fourth day,resulting in symptomatic improvement.Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging.The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.CONCLUSION Acute intestinal obstruction after ESD is a rare complication.Delayed diagnosis or misdiagnosis may be life-threatening.Clinicians should be vigilant for this condition following ESD.
基金Supported by the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research,No.23K11902.
文摘BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoint may facilitate the skills.AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection(ESD)on hemostasis.METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD,displaying the viewpoint as a circle.In phase 1,videos of three trainees’viewpoints were recorded.After reviewing these,trainees were recorded again in phase 2.The videos from both phases were retrospectively reviewed,and short clips were created to evaluate the hemostasis skills.Outcome measures included the time to recognize the bleeding point,the time to complete hemostasis,and the number of coagulation attempts.RESULTS Eight cases treated with ESD were reviewed,and 10 video clips of hemostasis were created.The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1(8.3±4.1 seconds vs 23.1±19.2 seconds;P=0.049).The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different(15.4±6.8 seconds vs 31.9±21.7 seconds;P=0.056).Significantly fewer coagulation attempts were performed during phase 2(1.8±0.7 vs 3.2±1.0;P=0.004).CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts.Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.
基金supported by Beijing Natural Science Foundation(L232101).
文摘Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods:The clinical data of patients who underwent gastric ESD at our center from 2009 to 2024 were retrospectively analyzed.Pain severity was assessed using a visual analogue scale,with a score≥4 defined as postoperative pain.Based on the presence or absence of postoperative pain,patients were divided into a pain group and a control group.Independent factors influencing postoperative pain were identified using multivariate logistic regression analysis.To control for confounding bias,patients in the case and control groups were matched by sex and lesion size,and the matched participants were further analyzed using a conditional logistic regression model.Results:In total,993 patients were analyzed.The incidence of postoperative pain was 9.1%(95%confidence interval[CI],7.3-11.1).In the univariate analysis,sex,operation duration,anesthesia method,intraoperative electrocoagulation,nasogastric tube placement,and postoperative vomiting were significantly associated with postoperative pain.Multivariate analysis identified eight independent factors:male sex(odds ratio[OR],0.61;95%CI,0.37-0.97;p=0.04),operation duration(OR,1.29;95%CI,1.03-1.63;p=0.02),protuberant lesions(OR,0.43;95%CI,0.26-0.71;p<0.01),antral lesions(OR,1.84;95%CI,1.10-3.05;p=0.01),intubation general anesthesia(OR,0.40;95%CI,0.22-0.72;p=0.002),intraoperative electrocoagulation(OR,0.32;95%CI,0.19-0.55;p<0.01),nasogastric tube placement(OR,2.005;95%CI,1.12-3.57;p=0.01),and postoperative vomiting(OR,3.24;95%CI,1.40-7.47;p=0.005).Conditional logistic regression analysis further identified diabetes mellitus(OR,2.50;95%CI,1.03-6.06;p=0.04).Conclusion:Female sex,diabetes mellitus,concave-type lesions,lesions in the gastric antrum,non-intubation general anesthesia,absence of intraoperative electrocoagulation,prolonged operation duration,nasogastric tube placement,and postoperative vomiting were independent factors associated with moderate to severe pain after gastric ESD.For patients at increased risk of postoperative pain,appropriate prophylactic and therapeutic measures during the perioperative period may effectively alleviate pain following gastric ESD.
文摘Objective To investigate the clinical predictors of malperfusion in patients with acute type A aortic dissection(ATAAD)and to construct a diagnostic model to identify high-risk individuals.Methods A retrospective analysis of 553 ATAAD patients from Tongji Hospital divided into malperfusion and non-malperfusion groups was conducted.Logistic regression was used to identify independent predictors of the outcome.Model performance via the Hosmer–Lemeshow test,decision curve analysis(DCA),the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,and predictive values.Results Malperfusion was observed in 28.4%of ATAAD patients.Significant predictors included elevated lactate dehydrogenase(LDH)(OR:1.0019,95%CI:1.0002–1.0036,P=0.027),alanine aminotransferase(ALT)(OR:0.9936,95%CI:0.987–1.000,P=0.046)and estimated glomerular filtration rate(eGFR)(OR:0.9877,95%CI:0.977–0.998,P=0.021),suggesting roles for tissue ischemia and impaired renal or hepatic function.Other variables,such as D-dimer,uric acid,creatinine,and NT-proBNP,showed trends toward significance but did not reach the 0.05 threshold.The model demonstrated good calibration(Hosmer–Lemeshow P=0.318),moderate discriminatory power(AUC=0.725),high specificity(93.62%),and low sensitivity(26.75%).Conclusion The model based on routine biochemical markers provides a practical approach for the early identification of malperfusion in ATAAD patients.It shows strong specificity and clinical utility,although its limited sensitivity highlights the need for further refinement.Future improvements should focus on incorporating additional clinical or imaging data to increase diagnostic accuracy.
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
文摘Introduction:We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy.Materials and Methods:We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021.Cases were categorized using Current Procedural Terminology(CPT)codes(38571)for extended lymph node dissection and super-extended lymph node dissection(38572).Using logistic regression,we compared the groups on a number of factors,including recurrence.Results:Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery.Significant differences were observed in the pathologic T stage and pathology grade group.Time on robot was significantly longer for the super-extended group,while estimated blood loss was lower.No differences were observed in length of stay or any complication-related variable.Super-extended had significantly higher node positivity(36.1%vs.7.6%,p<0.001)and recurrence.10.0%of super-extended cases had node positivity in the aortic bifurcation,the common iliac,or the pre-sacral chains that would have been missed with an extended dissection.2.2%of patients had node positivity in these chains only.Conclusions:Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer.Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.
文摘Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.
