Objective: To assess the operation indications, preoperative evaluation, technique essential and clinical prospective of Endovascular Graft Exclusion for thoracic aortic dissection. Methods: Since September 1998, Endo...Objective: To assess the operation indications, preoperative evaluation, technique essential and clinical prospective of Endovascular Graft Exclusion for thoracic aortic dissection. Methods: Since September 1998, Endovascular Graft Exclusion for thoracic aortic dissection has been performed on 10 patients. Graft was constructed from self-expanding Z-stents covered with a woven Dacron polyester fabric graft. Ged dimensions were determined ftom spiral computed tomographic scans. All operations were performed under DSA guidance. Results: There was one early death resulting from endoleaks. Proedures in the other 9 patients succeeded. No complications such as myocardial infarction, lung failure, kidney failureand paralysis that commonly occurred ther conventional operations were obsered. Immediate thrombosis in false lumen was achieved in 6 patients, and late thrombosis occurred in 3 patients. Mean follow-up duration was 3 months, the aneurysmal diameter was decreased obviously. Conclusion: These early results support the hypothesis that Endovascular Graft Exclusion may be a safe and durable treatment for selected patients with theracic aortic dissection. Endoleak may allow continued aneurysmal expansion and rupture. Further follow-up is necessary to evaluate the true long-term effectiveness of this procedure.展开更多
Non-A non-B aortic dissection(AAD)is an infrequently documented condition,comprising of only a small proportion of all AADs.The unique anatomy of the aortic arch and the failure of the existing classifications to adeq...Non-A non-B aortic dissection(AAD)is an infrequently documented condition,comprising of only a small proportion of all AADs.The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD,have led to an ongoing controversy around the topic.It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections,frequently leading to serious complications and thus mandating early intervention.Currently,the available treatment methods in the surgical armamentarium are conventional open,endovascular techniques and combined hybrid methods.The optimum approach is tailored in every individual case and may be determined by the dissection’s location,extent,the aortic diameter,the associated complications and the patient’s status.The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached.In an attempt to provide further insight into this perplexing entity,we performed a minireview of the literature,aiming to elucidate the epidemiology,clinical course and the optimal treatment modality.展开更多
Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Method...Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P【0.01], plaque burden [(52±12)% vs (36±15)%, P【0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P【0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P【0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P【0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P【0.01) and residual plaque burden≥50% (OR=7.3, P【0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.展开更多
In any urologic cancer surgery, lymph node dissection and its processing play a significant role in staging and management of the patients. Accordingly, precise handling of the dissected lymph nodes is important for h...In any urologic cancer surgery, lymph node dissection and its processing play a significant role in staging and management of the patients. Accordingly, precise handling of the dissected lymph nodes is important for histopathological work-up. The authors have developed a lymph node plastic tray shaping the abdomen and pelvis in which the dissected lymph nodes are placed in its determined location. This can be applied for any urologic cancer surgery. The research was designed to test the usage of a new histological tray. The objective was to assess how helpful it was for the surgical team and in the pathological process. The newly developed lymph node tray has been applied in 150 urological cancer surgeries and its efficacy and outcome have been evaluated in all these cases by involved doctors and assistants. This new tray simplifies lymph node removing and identification (staging), making it safer and quicker in any uro-oncological surgery. It facilitates the work of the pathologist and the flow of reliable information along the surgeon—pathologist-oncologist team. With usage of the tray, lymph node dissections are more structured by methodical means compared to any of the present methods.展开更多
Background Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent im...Background Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography （OCT） to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent （DES） implantation. Methods Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study. Results Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study： （1） superficial intimal tears （n=3）, （2） subintimal dissections （n=4）, （3） split of media （n=1）, （4） disruption of the fibrotic cap of plaque （n=1）. Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections （1.682±0.425 vs. 1.229±0.285, P=0.0290; 1.507±0.445 vs. 1.174±0.265, P=0.0072）. Conclusions The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.展开更多
BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate se...BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.展开更多
Objective To investigate the clinical and radiologic features of patients with spontaneous cerebral arterial dissections(CADs)presenting with ischemic stroke and to explore the effect of gender and age on those featur...Objective To investigate the clinical and radiologic features of patients with spontaneous cerebral arterial dissections(CADs)presenting with ischemic stroke and to explore the effect of gender and age on those features.Methods Patients admitted to our stroke center diagnosed as ischemic stroke secondary to CADs from August 2008to April 2015 were prospectively registered.展开更多
Objective:Patients are increasingly turning to the Internet as a source of healthcare information.Given that neck dissection is a common procedure within the field of Otolaryngology-Head and Neck Surgery,the aim of th...Objective:Patients are increasingly turning to the Internet as a source of healthcare information.Given that neck dissection is a common procedure within the field of Otolaryngology-Head and Neck Surgery,the aim of this study was to evaluate the quality and readability of online patient education materials on neck dissection.Methods:A Google search was performed using the term"neck dissection."The first 10 pages of a Google search using the term"neck dissection"were analyzed.The DISCERN instrument was used to assess quality of information.Readability was calculated using the Flesch-Reading Ease,Flesch-Kincaid Grade Level,Gunning-Fog Index,Coleman-Liau Index,and Simple Measure of Gobbledygook Index.Results:Thirty-one online patient education materials were included.Fifty-five percent(n=17)of results originated from academic institutions or hospitals.The mean Flesch-Reading Ease score was 61.2±11.9.Fifty-two percent(n=16)of patient education materials had Flesch-Reading Ease scores above the recommended score of 65.The average reading grade level was 10.5±2.1.The average total DISCERN score was 43.6±10.1.Only 26%of patient education materials(PEMs)had DISCERN scores corresponding to a"good quality"rating.There was a significant positive correlation between DISCERN scores and both Flesch-Reading Ease scores and average reading grade level.Conclusions:The majority of patient education materials were written above the recommended sixth-grade reading level and the quality of online information pertaining to neck dissections was found to be suboptimal.This research highlights the need for patient education materials regarding neck dissection that are high quality and easily understandable by patients.展开更多
Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm （TAAA） have recently been proposed as a less invasive alte...Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm （TAAA） have recently been proposed as a less invasive alternative to conventional TAAA surgery. This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients. Methods Between September 1998 and May 2012, 32 high-risk TAAA patients （five females, median age 61.5 years） underwent hybrid procedures at a single institution. Simultaneous approach and staged approach were performed on the basis of patients＇ conditions. Follow-up computed tomography angiography （CTA） was routinely performed before discharge and at 6, 12 months and annually thereafter. Results Procedural success was achieved in all cases. The median hospital stay was （21.5＋2.3） days, and the median procedure time was （420＋31） minutes. Blood loss averaged （2100_＋261） ml. A total of 124 visceral artery bypasses was performed. Two patients （6.3%） died within 30 days. One patient exhibited complete paraplegia （3.1%）. The visceral graft patency was 96.1% at 3 years. All-cause survival rates were 93.8%, 87.5%, 81.3% and 53.1% at 1, 2, 3 and 5 years, respectively. No patient died due to aortic events. The freedom rates from aortic events were 96.9%, 93.6%, 87.5%, 68.8% at 1,2, 3 and 5 years, respectively. Conclusions The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging. However, the procedure is still a significant physiological insult to patients. Until branched and fenestrated endovascular repair become more common, hybrid procedure will continue to have a role in high-risk patients.展开更多
Objective To evaluate the safety and effectiveness of endovascular stent-graft placement for treatment of type B dissection. Methods From April 2002 to December 2005,180 patients with type B dissection underwent endov...Objective To evaluate the safety and effectiveness of endovascular stent-graft placement for treatment of type B dissection. Methods From April 2002 to December 2005,180 patients with type B dissection underwent endovascular stent-graft placement. There were 158 men and 22 women with mean age of 50. 4±10. 9 years. All patients were diagnosed by computed tomography(CT) or magnetic resonance imaging (MRI) scans.展开更多
Transradial access (TRA) has emerged as the preferred vascular access route forcoronary angiography and percutaneous coronary interventions due to itssuperior safety profile compared to transfemoral access. However, i...Transradial access (TRA) has emerged as the preferred vascular access route forcoronary angiography and percutaneous coronary interventions due to itssuperior safety profile compared to transfemoral access. However, its widespreadadoption raises concerns regarding structural alterations in the radial artery,which may impact long-term vascular health and future procedural feasibility.TRA is associated with histopathologic changes in the arterial wall, such asintimal injury and hyperplasia, medial remodeling and adventitial inflammation,collectively contributing to radial artery remodeling. Moreover, TRA can inducechanges in radial artery lumen diameter driven by an inflammatory response dueto arterial puncture and mechanical friction during the procedure. Nonetheless, amore clinically significant consequence is radial artery occlusion, which is influencedby various procedural and patient-related factors. Strategies to minimizeremodeling include meticulous pre-procedural ultrasound assessment to ensureappropriate sheath-to-artery size matching, periprocedural pharmacologicalinterventions and implementation of patent hemostasis techniques. This reviewsynthesizes current knowledge regarding the mechanisms, clinical implications,and preventive strategies related to radial artery remodeling following TRA. Further research is needed toelucidate the long-term consequences of radial artery remodeling and to refine preventive strategies for preservingradial artery patency and its suitability for future interventions.展开更多
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
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 Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the fact...BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors.METHODS The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected.According to radical resection criteria,the patients were further divided into curative resection group(n=143)and NCR group(n=30).Clinical information was collected,including surgical method,tumor diameter,tumor site,ulcer formation,depth of invasion,pathological type,and lymph node metastasis.Logistic regression analysis was used to explore the factors affecting non-curable resection.RESULTS Multivariate logistic regression analysis showed that ulcer formation[odds ratio(OR)=3.53;95%confidence interval(CI):1.55-8.01,P=0.003],pathological type(OR=3.73;95%CI:1.60-8.74,P=0.002),tumor diameter(OR=3.15;95%CI:1.40-7.05,P=0.005),tumor location(OR=3.50;95%CI:1.16-10.58,P=0.027),lymph node metastasis(OR=4.40;95%CI:1.83-10.57,P=0.001),and depth of penetration(OR=3.75;95%CI:1.60-8.74,P=0.002)were all risk factors for NCR in EGC patients.Predictive analysis showed varying area under the curve values for factors such as tumor diameter(0.636),tumor location(0.608),ulcer formation(0.652),infiltration depth(0.658),pathological type(0.656),and lymph node metastasis(0.674).CONCLUSION The results suggest that factors such as tumor diameter,tumor location,ulcer formation,depth of invasion,pathological type,and lymph node metastasis increase the risk of NCR in EGC patients.展开更多
BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particu...BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.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
Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screen...Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screening endoscopy are small,measuring<10 mm.Current guidelines recommend endoscopic resection for small,well-differentiated rNET using modified endoscopic submucosal resection(mEMR)or endoscopic submucosal dissection.However,the optimal endoscopic treatment method remains uncertain.This paper summarizes the evidence on mEMR with submucosal stretching,mEMR without submucosal stretching,endoscopic submucosal dissection and endoscopic full-thickness resection.Given that rNETs often exhibit submucosal invasion,achieving adequate resection depth is crucial to ensure histological complete resection.mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection,safety and convenience.Risk factors associated with lymph node and distant metastases are also discussed.A treatment algorithm is proposed to facilitate clinical decision-making.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 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
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
文摘Objective: To assess the operation indications, preoperative evaluation, technique essential and clinical prospective of Endovascular Graft Exclusion for thoracic aortic dissection. Methods: Since September 1998, Endovascular Graft Exclusion for thoracic aortic dissection has been performed on 10 patients. Graft was constructed from self-expanding Z-stents covered with a woven Dacron polyester fabric graft. Ged dimensions were determined ftom spiral computed tomographic scans. All operations were performed under DSA guidance. Results: There was one early death resulting from endoleaks. Proedures in the other 9 patients succeeded. No complications such as myocardial infarction, lung failure, kidney failureand paralysis that commonly occurred ther conventional operations were obsered. Immediate thrombosis in false lumen was achieved in 6 patients, and late thrombosis occurred in 3 patients. Mean follow-up duration was 3 months, the aneurysmal diameter was decreased obviously. Conclusion: These early results support the hypothesis that Endovascular Graft Exclusion may be a safe and durable treatment for selected patients with theracic aortic dissection. Endoleak may allow continued aneurysmal expansion and rupture. Further follow-up is necessary to evaluate the true long-term effectiveness of this procedure.
文摘Non-A non-B aortic dissection(AAD)is an infrequently documented condition,comprising of only a small proportion of all AADs.The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD,have led to an ongoing controversy around the topic.It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections,frequently leading to serious complications and thus mandating early intervention.Currently,the available treatment methods in the surgical armamentarium are conventional open,endovascular techniques and combined hybrid methods.The optimum approach is tailored in every individual case and may be determined by the dissection’s location,extent,the aortic diameter,the associated complications and the patient’s status.The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached.In an attempt to provide further insight into this perplexing entity,we performed a minireview of the literature,aiming to elucidate the epidemiology,clinical course and the optimal treatment modality.
文摘Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P【0.01], plaque burden [(52±12)% vs (36±15)%, P【0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P【0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P【0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P【0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P【0.01) and residual plaque burden≥50% (OR=7.3, P【0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.
文摘In any urologic cancer surgery, lymph node dissection and its processing play a significant role in staging and management of the patients. Accordingly, precise handling of the dissected lymph nodes is important for histopathological work-up. The authors have developed a lymph node plastic tray shaping the abdomen and pelvis in which the dissected lymph nodes are placed in its determined location. This can be applied for any urologic cancer surgery. The research was designed to test the usage of a new histological tray. The objective was to assess how helpful it was for the surgical team and in the pathological process. The newly developed lymph node tray has been applied in 150 urological cancer surgeries and its efficacy and outcome have been evaluated in all these cases by involved doctors and assistants. This new tray simplifies lymph node removing and identification (staging), making it safer and quicker in any uro-oncological surgery. It facilitates the work of the pathologist and the flow of reliable information along the surgeon—pathologist-oncologist team. With usage of the tray, lymph node dissections are more structured by methodical means compared to any of the present methods.
文摘Background Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography （OCT） to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent （DES） implantation. Methods Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study. Results Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study： （1） superficial intimal tears （n=3）, （2） subintimal dissections （n=4）, （3） split of media （n=1）, （4） disruption of the fibrotic cap of plaque （n=1）. Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections （1.682±0.425 vs. 1.229±0.285, P=0.0290; 1.507±0.445 vs. 1.174±0.265, P=0.0072）. Conclusions The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.
基金Supported by China Health&Medical Development Foundation,No.M2021551.
文摘BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.
文摘Objective To investigate the clinical and radiologic features of patients with spontaneous cerebral arterial dissections(CADs)presenting with ischemic stroke and to explore the effect of gender and age on those features.Methods Patients admitted to our stroke center diagnosed as ischemic stroke secondary to CADs from August 2008to April 2015 were prospectively registered.
文摘Objective:Patients are increasingly turning to the Internet as a source of healthcare information.Given that neck dissection is a common procedure within the field of Otolaryngology-Head and Neck Surgery,the aim of this study was to evaluate the quality and readability of online patient education materials on neck dissection.Methods:A Google search was performed using the term"neck dissection."The first 10 pages of a Google search using the term"neck dissection"were analyzed.The DISCERN instrument was used to assess quality of information.Readability was calculated using the Flesch-Reading Ease,Flesch-Kincaid Grade Level,Gunning-Fog Index,Coleman-Liau Index,and Simple Measure of Gobbledygook Index.Results:Thirty-one online patient education materials were included.Fifty-five percent(n=17)of results originated from academic institutions or hospitals.The mean Flesch-Reading Ease score was 61.2±11.9.Fifty-two percent(n=16)of patient education materials had Flesch-Reading Ease scores above the recommended score of 65.The average reading grade level was 10.5±2.1.The average total DISCERN score was 43.6±10.1.Only 26%of patient education materials(PEMs)had DISCERN scores corresponding to a"good quality"rating.There was a significant positive correlation between DISCERN scores and both Flesch-Reading Ease scores and average reading grade level.Conclusions:The majority of patient education materials were written above the recommended sixth-grade reading level and the quality of online information pertaining to neck dissections was found to be suboptimal.This research highlights the need for patient education materials regarding neck dissection that are high quality and easily understandable by patients.
文摘Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm （TAAA） have recently been proposed as a less invasive alternative to conventional TAAA surgery. This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients. Methods Between September 1998 and May 2012, 32 high-risk TAAA patients （five females, median age 61.5 years） underwent hybrid procedures at a single institution. Simultaneous approach and staged approach were performed on the basis of patients＇ conditions. Follow-up computed tomography angiography （CTA） was routinely performed before discharge and at 6, 12 months and annually thereafter. Results Procedural success was achieved in all cases. The median hospital stay was （21.5＋2.3） days, and the median procedure time was （420＋31） minutes. Blood loss averaged （2100_＋261） ml. A total of 124 visceral artery bypasses was performed. Two patients （6.3%） died within 30 days. One patient exhibited complete paraplegia （3.1%）. The visceral graft patency was 96.1% at 3 years. All-cause survival rates were 93.8%, 87.5%, 81.3% and 53.1% at 1, 2, 3 and 5 years, respectively. No patient died due to aortic events. The freedom rates from aortic events were 96.9%, 93.6%, 87.5%, 68.8% at 1,2, 3 and 5 years, respectively. Conclusions The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging. However, the procedure is still a significant physiological insult to patients. Until branched and fenestrated endovascular repair become more common, hybrid procedure will continue to have a role in high-risk patients.
文摘Objective To evaluate the safety and effectiveness of endovascular stent-graft placement for treatment of type B dissection. Methods From April 2002 to December 2005,180 patients with type B dissection underwent endovascular stent-graft placement. There were 158 men and 22 women with mean age of 50. 4±10. 9 years. All patients were diagnosed by computed tomography(CT) or magnetic resonance imaging (MRI) scans.
文摘Transradial access (TRA) has emerged as the preferred vascular access route forcoronary angiography and percutaneous coronary interventions due to itssuperior safety profile compared to transfemoral access. However, its widespreadadoption raises concerns regarding structural alterations in the radial artery,which may impact long-term vascular health and future procedural feasibility.TRA is associated with histopathologic changes in the arterial wall, such asintimal injury and hyperplasia, medial remodeling and adventitial inflammation,collectively contributing to radial artery remodeling. Moreover, TRA can inducechanges in radial artery lumen diameter driven by an inflammatory response dueto arterial puncture and mechanical friction during the procedure. Nonetheless, amore clinically significant consequence is radial artery occlusion, which is influencedby various procedural and patient-related factors. Strategies to minimizeremodeling include meticulous pre-procedural ultrasound assessment to ensureappropriate sheath-to-artery size matching, periprocedural pharmacologicalinterventions and implementation of patent hemostasis techniques. This reviewsynthesizes current knowledge regarding the mechanisms, clinical implications,and preventive strategies related to radial artery remodeling following TRA. Further research is needed toelucidate the long-term consequences of radial artery remodeling and to refine preventive strategies for preservingradial artery patency and its suitability for future interventions.
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.
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.
文摘BACKGROUND Identifying factors that influence non-curative resection(NCR)is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer(EGC).AIM To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors.METHODS The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected.According to radical resection criteria,the patients were further divided into curative resection group(n=143)and NCR group(n=30).Clinical information was collected,including surgical method,tumor diameter,tumor site,ulcer formation,depth of invasion,pathological type,and lymph node metastasis.Logistic regression analysis was used to explore the factors affecting non-curable resection.RESULTS Multivariate logistic regression analysis showed that ulcer formation[odds ratio(OR)=3.53;95%confidence interval(CI):1.55-8.01,P=0.003],pathological type(OR=3.73;95%CI:1.60-8.74,P=0.002),tumor diameter(OR=3.15;95%CI:1.40-7.05,P=0.005),tumor location(OR=3.50;95%CI:1.16-10.58,P=0.027),lymph node metastasis(OR=4.40;95%CI:1.83-10.57,P=0.001),and depth of penetration(OR=3.75;95%CI:1.60-8.74,P=0.002)were all risk factors for NCR in EGC patients.Predictive analysis showed varying area under the curve values for factors such as tumor diameter(0.636),tumor location(0.608),ulcer formation(0.652),infiltration depth(0.658),pathological type(0.656),and lymph node metastasis(0.674).CONCLUSION The results suggest that factors such as tumor diameter,tumor location,ulcer formation,depth of invasion,pathological type,and lymph node metastasis increase the risk of NCR in EGC patients.
基金Supported by National Natural Science Foundation of China,No.82004298Jiangsu Graduate Research and Practice Innovation Program,China,No.KYCX23_2090.
文摘BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.
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.
基金Supported by Nanchang High-Level Scientific and Technological Innovation Talents‘Double Hundred Plan’Project,China,No.2022-312.
文摘Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screening endoscopy are small,measuring<10 mm.Current guidelines recommend endoscopic resection for small,well-differentiated rNET using modified endoscopic submucosal resection(mEMR)or endoscopic submucosal dissection.However,the optimal endoscopic treatment method remains uncertain.This paper summarizes the evidence on mEMR with submucosal stretching,mEMR without submucosal stretching,endoscopic submucosal dissection and endoscopic full-thickness resection.Given that rNETs often exhibit submucosal invasion,achieving adequate resection depth is crucial to ensure histological complete resection.mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection,safety and convenience.Risk factors associated with lymph node and distant metastases are also discussed.A treatment algorithm is proposed to facilitate clinical decision-making.
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 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.
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.
