Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general...Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists,many clinical problems remain to be overcome.The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus.This document specifies the indications,contraindications,preoperative preparations,operational procedures,complication prevention measures,and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.展开更多
Objective Sacral dural arteriovenous fistula(SDAVF)is a rare spinal vascular malformation and often misdiagnosed or even mistreated.This study delved into the clinical characteristics,vascular architecture and treatme...Objective Sacral dural arteriovenous fistula(SDAVF)is a rare spinal vascular malformation and often misdiagnosed or even mistreated.This study delved into the clinical characteristics,vascular architecture and treatment results of SDAVF,with the goal of enhancing upcoming diagnostic and therapeutic methodologies.Methods From March 2014 to March 2022,consecutive patients with SDAVF were retrospectively analysed.The data on demographics,symptom resolution,angioarchitectural features and postoperative course were studied.Spinal cord function was evaluated by modified Aminoff-Logue scale.Results A total of 36 patients with 36 SDAVFs were enrolled,12 of whom were misdiagnosed on their initial visit.The SDAVFs were located at S1 in 24(66.7%),S2 in 10(27.8%)and S3 in 2(5.6%)cases,respectively.The primary feeding arteries included lateral sacral artery(LSA)of internal iliac artery(31/36,86.1%),the branches of external iliac artery(2/36,5.6%)and median artery(3/36,8.3%),most of which are straight.Venae terminalisis is the sole drainage vein,flowing back into perimedullary venous network.Endovascular embolisation is the main therapy method for 30 cases,while the other 6 cases were treated with microsurgical fistulectomy.MRI tests showed that the abnormal vascular signals around the medulla disappeared,and the spinal cord oedema was alleviated in the majority of cases(32/36,88.9%).Six patients,who all were treated by endovascular embolisation at first time,had residual or recurrent and two of them were performed by microsurgical fistulectomy again.All patients by microsurgical fistulectomy had no residual or recurrent during follow-up.According to the spinal cord functional assessment,the Aminoff-Logue score was significantly decreased(Z=−3.449,p=0.001)postoperatively.Conclusion The misdiagnosis rate of SDAVF is very high.The most feeding artery of SDAVF came from the LSA,which was thicker and more straight,making it easier for microcatheters to reach the fistula site.So,endovascular embolism has become the first choice of treatment with minimal invasion,and safe and effective results.展开更多
BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy o...BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.展开更多
文摘Apical microsurgery is accurate and minimally invasive,produces few complications,and has a success rate of more than 90%.However,due to the lack of awareness and understanding of apical microsurgery by dental general practitioners and even endodontists,many clinical problems remain to be overcome.The consensus has gathered well-known domestic experts to hold a series of special discussions and reached the consensus.This document specifies the indications,contraindications,preoperative preparations,operational procedures,complication prevention measures,and efficacy evaluation of apical microsurgery and is applicable to dentists who perform apical microsurgery after systematic training.
基金provided by the Natural Science Foundation of China(No.82071313),ChinaThe Innovation Foundation of Huashan hospital(NO.2024CX04).
文摘Objective Sacral dural arteriovenous fistula(SDAVF)is a rare spinal vascular malformation and often misdiagnosed or even mistreated.This study delved into the clinical characteristics,vascular architecture and treatment results of SDAVF,with the goal of enhancing upcoming diagnostic and therapeutic methodologies.Methods From March 2014 to March 2022,consecutive patients with SDAVF were retrospectively analysed.The data on demographics,symptom resolution,angioarchitectural features and postoperative course were studied.Spinal cord function was evaluated by modified Aminoff-Logue scale.Results A total of 36 patients with 36 SDAVFs were enrolled,12 of whom were misdiagnosed on their initial visit.The SDAVFs were located at S1 in 24(66.7%),S2 in 10(27.8%)and S3 in 2(5.6%)cases,respectively.The primary feeding arteries included lateral sacral artery(LSA)of internal iliac artery(31/36,86.1%),the branches of external iliac artery(2/36,5.6%)and median artery(3/36,8.3%),most of which are straight.Venae terminalisis is the sole drainage vein,flowing back into perimedullary venous network.Endovascular embolisation is the main therapy method for 30 cases,while the other 6 cases were treated with microsurgical fistulectomy.MRI tests showed that the abnormal vascular signals around the medulla disappeared,and the spinal cord oedema was alleviated in the majority of cases(32/36,88.9%).Six patients,who all were treated by endovascular embolisation at first time,had residual or recurrent and two of them were performed by microsurgical fistulectomy again.All patients by microsurgical fistulectomy had no residual or recurrent during follow-up.According to the spinal cord functional assessment,the Aminoff-Logue score was significantly decreased(Z=−3.449,p=0.001)postoperatively.Conclusion The misdiagnosis rate of SDAVF is very high.The most feeding artery of SDAVF came from the LSA,which was thicker and more straight,making it easier for microcatheters to reach the fistula site.So,endovascular embolism has become the first choice of treatment with minimal invasion,and safe and effective results.
基金Supported by the Basic and Applied Basic Research Foundation of Guangzhou,No.202201011331the National Natural Science Foundation of China,No.82373118the Natural Science Foundation of Guangdong Province,No.2023A1515010828.
文摘BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.
