Objective:To investigate the quantitative assessment efficacy of chest CT combined with serum Vanin-1 and SPP1 in determining the progression stage of chronic obstructive pulmonary disease(COPD).Methods:A total of 100...Objective:To investigate the quantitative assessment efficacy of chest CT combined with serum Vanin-1 and SPP1 in determining the progression stage of chronic obstructive pulmonary disease(COPD).Methods:A total of 100 COPD subjects from our hospital from January 2020 to December 2023 were included and randomly divided into a healthy control group and an experimental group(50 cases each).The healthy control group underwent slow vital capacity measurement using a spirometer,while the experimental group underwent high-resolution thin-slice CT scans and serum Vanin-1 and SPP1 concentration measurements.Pulmonary function parameters,symptom burden,biomarker concentrations,and imaging characteristics were compared between the two groups.Results:The FEV1/FVC ratio in the experimental group(58.3±7.2)was lower than that in the healthy control group(92.1±4.8);the total CAT score(22.4±3.5)was higher than that in the healthy control group(3.1±1.2);both Vanin-1(18.7±2.3μg/L)and SPP1(25.6±4.1μg/L)levels were higher than those in the healthy control group;LAA%-950(38.7±6.2%)and WA%(68.5±5.3%)were significantly higher than those in the healthy control group(all p<0.001).Conclusion:Chest CT combined with serum Vanin-1 and SPP1 can accurately quantify the pathological progression of COPD,providing a dual basis for clinical staging and individualized intervention.展开更多
AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records...AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records of pediatric patients,36mo old or younger,diagnosed with CNLDO between the years 2016-2022,were retrospectively reviewed.In all children,HPA was performed by a pediatric ophthalmologist.Success was defined as the resolution of epiphora and discharge within 48h of the intervention.RESULTS:A total of 281 eyes(194 patients)with CNLDO underwent HPA.Follow-up data were available for 261 eyes(179 patients,50.3%male)and these patients were included in the analysis.The mean follow-up time was 11.6±13mo.Ninety-seven patients(54.2%)had unilateral nasolacrimal duct obstruction,while 82 patients(45.8%)had bilateral CNLDO.The mean age at the time of HPA was 5.8±5.9mo.Complete resolution of symptoms was achieved in 102(39.1%)eyes.Patients 6mo old or younger at the time of HPA had a significantly higher success rate compared to patients older than 6mo(43.7%vs 30.9%,P=0.04).Younger age at the time of pressure application was associated with a higher resolution rate of CNLDO(OR 0.93,P=0.004).Sex assigned at birth,prematurity,laterality of the obstruction and type of symptoms(epiphora,discharge)were not correlated with success.A second HPA was performed in 46 eyes,with resolution of symptoms in 12 eyes(26.1%).CONCLUSION:Hydrostatic pressure applied on the lacrimal sac by an experienced ophthalmologist or an experienced pediatrician may be an effective treatment for CNLDO.We recommend HPA as an initial active conservative approach in all pediatric patients with CNLDO,especially those younger than 6mo.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both co...BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both conditions markedly reduce survival and increase therapeutic complexity.Recently,hepatic artery infusion chemotherapy(HAIC)in combination with targeted immunotherapy has shown promise for advanced HCC.CASE SUMMARY We report a 47-year-old male with advanced HCC complicated by PVTT and OJ,who was admitted with marked jaundice of the skin and sclera.Imaging revealed a large hepatic mass(14.5 cm×11.3 cm)in the right lobe with associated portal vein tumor thrombus.The tertiary bile duct was only mildly dilated,making percutaneous transhepatic cholangiography drainage infeasible.The patient underwent reduced-dose HAIC,which resulted in significant tumor shrinkage and marked reduction in serum bilirubin.This improvement enabled sequential treatment with lenvatinib and camrelizumab.After six cycles,both liver function and alphafetoprotein levels improved.The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.CONCLUSION HAIC can treat high-bilirubin HCC with PVTT and OJ,allowing for subsequent targeted immunotherapy.展开更多
Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions accou...Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.展开更多
BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is ...BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.展开更多
Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecys...Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecystoduodenal fistula.Since the rarity of gallstone ileus is associated with relatively high rates of morbidity and mortality in elderly patients with multiple comorbidities,making an early and accurate diagnosis in emergency settings crucial.展开更多
BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can ca...BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can cause complications ranging from mild symptoms to severe issues like gastric outlet obstruction(GOO).This report discusses a 39-year-old woman who presented with clinical and radiological features of GOO post Silimed IGB placement.CASE SUMMARY A 39-year-old woman presented to our institution with two-week history of abdominal pain,nausea and vomiting post prandially.This was in the context of a Silimed IGB placement two weeks prior to presentation for weight loss in the context of obesity.A computed tomography of the abdomen demonstrated the IGB device in the body and prepyloric region,with proximal dilatation of the body and fundus of the stomach which contained gastric contents.Due to concerns for GOO,the IGB was removed endoscopically with subsequent symptom alleviation.In addition to this,we performed a literature search of cases of IGB related GOO using the PubMed and Web of Science databases from inception date to the August 26,2024.A total of 27 articles were included in the analysis,identifying 29 cases of IGB-related GOO.These patients commonly presented with nausea,vomiting and abdominal pain,with symptom onset varying from 3 days to 18 months post IGB insertion.Abdominal computed tomography was the primary diagnostic tool and endoscopic removal was the standard treatment modality.CONCLUSION This is the first reported case of GOO caused by Silimed IGB.While effective for weight reduction,IGB-related GOO is a rare but serious complication,usually requiring endoscopic retrieval.Future research should aim to identify patient factors linked to this complication to enhance clinical-decision making and outcomes.展开更多
Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic s...Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.展开更多
Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,a...Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].展开更多
BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains ...BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.展开更多
Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between ...Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).Although less common when compared to NOA,OA can represent upward 20%–40%of cases of azoospermia.While there are a multitude of etiologies responsible for causing NOA and OA,correctly distinguishing between the two types of azoospermia has profound implications in managing the infertile male.This review represents an amalgamation of the current guidelines and literature which will supply the reproductive physician with a diagnostic armamentarium to properly distinguish between NOA and OA,therefore providing the best possible care to the infertile couple.展开更多
Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis ...Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.展开更多
BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles inve...To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTSNo consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSIONFuture research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.展开更多
OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the man...OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the management of the disease.METHODS:In our single-blind randomized controlled study,120 patients with AIO who were hospitalized in The Affiliated Hospital of China West Normal University Nan Chong Gaoping District People's Hospital from January 2021 to June 2022 and met the inclusion criteria were categorized into the treatment group and the control group.Patients from the control group were administered basic Western Medicine therapy,whereas patients from the treatment group were administered basic Western Medicine therapy plus CSS by gastric tube injection.Subsequently,the time to first anal exhaustion and defecation,time to relief of abdominal distension and pain,days of hospitalization,Traditional Chinese Medicine(TCM)symptom scores,interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)levels in the 2 groups were recorded and compared.RESULTS:The comparison of clinical efficacy of the treatment group were better than the control group.The TCM symptom score was considerably lower in the treatment group;the inflammation indicators CRP,IL-6,and PCT also decreased statistically when comparing the control group.Furthermore,there were significantly reduced in the time to first exhaustion,time to first defecation,time to relief of abdominal pain and distension,and days of hospitalization in the treatment group versus the control group.CONCLUSION:CSS could suppress the inflammatory reaction,reduce days of hospitalization,relieve clinical symptoms in AIO patients with reliable efficacy and high safety and is worthy of clinical application.展开更多
Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 ...Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.展开更多
This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obst...This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.展开更多
BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status o...BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status of self-management,psychological cognitive impairment,and QoL in elderly patients with COPD.METHODS Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024.The study utilized demographic information and clinical characteristics,selfmanagement behavior,occurrence of psychological cognitive impairment,and QoL as evaluated through general information questionnaires,the COPD patient self-management scale,simple frailty scale,simple mental status scale,clinical dementia assessment scale,and the clinical COPD assessment test questionnaire.This research aims to describe the current status and correlations among selfmanagement behavior,cognitive impairment occurrence,and QoL.RESULTS The average score for self-management behavior in elderly COPD patients was 136.00(119.00,164.50),indicating a moderate level overall.There were 98 cases of cognitive impairment,accounting for 31.4%,with a mental status score of 3(2,3.75).The average QoL score was 24(19,28),indicating a low level.Additionally,there was a negative correlation between total self-management behavior score and cognitive impairment occurrence(r=-0.589,P<0.001),and QoL total score(r=-0.409,P<0.001).Cognitive impairment occurrence was positively correlated with QoL total score(r=0.345,P<0.001).Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients(P<0.05).CONCLUSION The self-management behavior of elderly patients with COPD is at a moderate level.However,the occurrence of cognitive impairment is high and significantly influenced by disease course,level of self-management,and mental status.The QoL is low,emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients,actively reduce the occurrence of cognitive impairment,and mitigate the impact of the disease on QoL.展开更多
BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care....BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.展开更多
This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the au...This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.展开更多
基金Baoding Science and Technology Plan Project(Project No.:2341ZF214)。
文摘Objective:To investigate the quantitative assessment efficacy of chest CT combined with serum Vanin-1 and SPP1 in determining the progression stage of chronic obstructive pulmonary disease(COPD).Methods:A total of 100 COPD subjects from our hospital from January 2020 to December 2023 were included and randomly divided into a healthy control group and an experimental group(50 cases each).The healthy control group underwent slow vital capacity measurement using a spirometer,while the experimental group underwent high-resolution thin-slice CT scans and serum Vanin-1 and SPP1 concentration measurements.Pulmonary function parameters,symptom burden,biomarker concentrations,and imaging characteristics were compared between the two groups.Results:The FEV1/FVC ratio in the experimental group(58.3±7.2)was lower than that in the healthy control group(92.1±4.8);the total CAT score(22.4±3.5)was higher than that in the healthy control group(3.1±1.2);both Vanin-1(18.7±2.3μg/L)and SPP1(25.6±4.1μg/L)levels were higher than those in the healthy control group;LAA%-950(38.7±6.2%)and WA%(68.5±5.3%)were significantly higher than those in the healthy control group(all p<0.001).Conclusion:Chest CT combined with serum Vanin-1 and SPP1 can accurately quantify the pathological progression of COPD,providing a dual basis for clinical staging and individualized intervention.
文摘AIM:To assess the success rate of lacrimal sac hydrostatic pressure application(HPA)maneuver,a conservative office procedure for treatment of congenital nasolacrimal duct obstruction(CNLDO).METHODS:The medical records of pediatric patients,36mo old or younger,diagnosed with CNLDO between the years 2016-2022,were retrospectively reviewed.In all children,HPA was performed by a pediatric ophthalmologist.Success was defined as the resolution of epiphora and discharge within 48h of the intervention.RESULTS:A total of 281 eyes(194 patients)with CNLDO underwent HPA.Follow-up data were available for 261 eyes(179 patients,50.3%male)and these patients were included in the analysis.The mean follow-up time was 11.6±13mo.Ninety-seven patients(54.2%)had unilateral nasolacrimal duct obstruction,while 82 patients(45.8%)had bilateral CNLDO.The mean age at the time of HPA was 5.8±5.9mo.Complete resolution of symptoms was achieved in 102(39.1%)eyes.Patients 6mo old or younger at the time of HPA had a significantly higher success rate compared to patients older than 6mo(43.7%vs 30.9%,P=0.04).Younger age at the time of pressure application was associated with a higher resolution rate of CNLDO(OR 0.93,P=0.004).Sex assigned at birth,prematurity,laterality of the obstruction and type of symptoms(epiphora,discharge)were not correlated with success.A second HPA was performed in 46 eyes,with resolution of symptoms in 12 eyes(26.1%).CONCLUSION:Hydrostatic pressure applied on the lacrimal sac by an experienced ophthalmologist or an experienced pediatrician may be an effective treatment for CNLDO.We recommend HPA as an initial active conservative approach in all pediatric patients with CNLDO,especially those younger than 6mo.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a major type of liver cancer worldwide.In advanced stages,portal vein tumor thrombosis(PVTT)and jaundice are common,whereas obstructive jaundice(OJ)is relatively rare.Both conditions markedly reduce survival and increase therapeutic complexity.Recently,hepatic artery infusion chemotherapy(HAIC)in combination with targeted immunotherapy has shown promise for advanced HCC.CASE SUMMARY We report a 47-year-old male with advanced HCC complicated by PVTT and OJ,who was admitted with marked jaundice of the skin and sclera.Imaging revealed a large hepatic mass(14.5 cm×11.3 cm)in the right lobe with associated portal vein tumor thrombus.The tertiary bile duct was only mildly dilated,making percutaneous transhepatic cholangiography drainage infeasible.The patient underwent reduced-dose HAIC,which resulted in significant tumor shrinkage and marked reduction in serum bilirubin.This improvement enabled sequential treatment with lenvatinib and camrelizumab.After six cycles,both liver function and alphafetoprotein levels improved.The patient achieved a progression-free survival of 20 months and an overall survival of 29 months.CONCLUSION HAIC can treat high-bilirubin HCC with PVTT and OJ,allowing for subsequent targeted immunotherapy.
文摘Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.
基金the Youth Foundation of Fujian Provincial Health Commission,No.2021QNA014the Construction Project of Fujian Province Minimally Invasive Medical Center,No.[2021]76.
文摘BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.
基金National Natural Science Foundation of China(81902379)Chenguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Commission(21CGA20)Cultivation Foundation of Renji Hospital(RJPY-LX-011).
文摘Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecystoduodenal fistula.Since the rarity of gallstone ileus is associated with relatively high rates of morbidity and mortality in elderly patients with multiple comorbidities,making an early and accurate diagnosis in emergency settings crucial.
文摘BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can cause complications ranging from mild symptoms to severe issues like gastric outlet obstruction(GOO).This report discusses a 39-year-old woman who presented with clinical and radiological features of GOO post Silimed IGB placement.CASE SUMMARY A 39-year-old woman presented to our institution with two-week history of abdominal pain,nausea and vomiting post prandially.This was in the context of a Silimed IGB placement two weeks prior to presentation for weight loss in the context of obesity.A computed tomography of the abdomen demonstrated the IGB device in the body and prepyloric region,with proximal dilatation of the body and fundus of the stomach which contained gastric contents.Due to concerns for GOO,the IGB was removed endoscopically with subsequent symptom alleviation.In addition to this,we performed a literature search of cases of IGB related GOO using the PubMed and Web of Science databases from inception date to the August 26,2024.A total of 27 articles were included in the analysis,identifying 29 cases of IGB-related GOO.These patients commonly presented with nausea,vomiting and abdominal pain,with symptom onset varying from 3 days to 18 months post IGB insertion.Abdominal computed tomography was the primary diagnostic tool and endoscopic removal was the standard treatment modality.CONCLUSION This is the first reported case of GOO caused by Silimed IGB.While effective for weight reduction,IGB-related GOO is a rare but serious complication,usually requiring endoscopic retrieval.Future research should aim to identify patient factors linked to this complication to enhance clinical-decision making and outcomes.
基金supported by the National Key R&D Program of China(No.2022YFC2702701)Shanghai Scientific and Technological Project(No.20Y11907600)Clinical Research Innovation Plan of Shanghai General Hospital(No.CTCCR-2021C17).
文摘Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.
文摘Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].
文摘BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.
文摘Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).Although less common when compared to NOA,OA can represent upward 20%–40%of cases of azoospermia.While there are a multitude of etiologies responsible for causing NOA and OA,correctly distinguishing between the two types of azoospermia has profound implications in managing the infertile male.This review represents an amalgamation of the current guidelines and literature which will supply the reproductive physician with a diagnostic armamentarium to properly distinguish between NOA and OA,therefore providing the best possible care to the infertile couple.
基金Supported by(Entirely)Thomas Jefferson University HospitalUniversity of Utah through existing intramural funds and salary support
文摘Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
文摘To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTSNo consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSIONFuture research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.
基金Nanchong City Science and Technology Plan Project:the Application of Tongli Shugan Liqi Method in the Treatment of Adhesive Intestinal Obstruction and its Effect on Inflammatory Indicators Interleukin-6,C-reactive protein and Procalcitonin(21YFZJ0108)。
文摘OBJECTIVE:To explore the treatment efficacy of integrated Chinese medicine(Chaihu Shugan San,柴胡疏肝散,CSS)and western therapy in the treatment of adhesive intestinal obstruction(AIO),to provide new ideas for the management of the disease.METHODS:In our single-blind randomized controlled study,120 patients with AIO who were hospitalized in The Affiliated Hospital of China West Normal University Nan Chong Gaoping District People's Hospital from January 2021 to June 2022 and met the inclusion criteria were categorized into the treatment group and the control group.Patients from the control group were administered basic Western Medicine therapy,whereas patients from the treatment group were administered basic Western Medicine therapy plus CSS by gastric tube injection.Subsequently,the time to first anal exhaustion and defecation,time to relief of abdominal distension and pain,days of hospitalization,Traditional Chinese Medicine(TCM)symptom scores,interleukin-6(IL-6),C-reactive protein(CRP)and procalcitonin(PCT)levels in the 2 groups were recorded and compared.RESULTS:The comparison of clinical efficacy of the treatment group were better than the control group.The TCM symptom score was considerably lower in the treatment group;the inflammation indicators CRP,IL-6,and PCT also decreased statistically when comparing the control group.Furthermore,there were significantly reduced in the time to first exhaustion,time to first defecation,time to relief of abdominal pain and distension,and days of hospitalization in the treatment group versus the control group.CONCLUSION:CSS could suppress the inflammatory reaction,reduce days of hospitalization,relieve clinical symptoms in AIO patients with reliable efficacy and high safety and is worthy of clinical application.
文摘Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.
文摘This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.
文摘BACKGROUND The correlation conclusions between self-management,frailty,and quality of life(QoL)of chronic obstructive pulmonary disease(COPD)patients are inconsistent.AIM To comprehensively assess the current status of self-management,psychological cognitive impairment,and QoL in elderly patients with COPD.METHODS Convenient sampling was employed to select 312 elderly patients with COPD who were receiving treatment in the respiratory and critical care medicine department of a tertiary grade A hospital from November 2023 to February 2024.The study utilized demographic information and clinical characteristics,selfmanagement behavior,occurrence of psychological cognitive impairment,and QoL as evaluated through general information questionnaires,the COPD patient self-management scale,simple frailty scale,simple mental status scale,clinical dementia assessment scale,and the clinical COPD assessment test questionnaire.This research aims to describe the current status and correlations among selfmanagement behavior,cognitive impairment occurrence,and QoL.RESULTS The average score for self-management behavior in elderly COPD patients was 136.00(119.00,164.50),indicating a moderate level overall.There were 98 cases of cognitive impairment,accounting for 31.4%,with a mental status score of 3(2,3.75).The average QoL score was 24(19,28),indicating a low level.Additionally,there was a negative correlation between total self-management behavior score and cognitive impairment occurrence(r=-0.589,P<0.001),and QoL total score(r=-0.409,P<0.001).Cognitive impairment occurrence was positively correlated with QoL total score(r=0.345,P<0.001).Disease course and self-management behavior score were independent factors affecting the total QoL score in elderly COPD patients(P<0.05).CONCLUSION The self-management behavior of elderly patients with COPD is at a moderate level.However,the occurrence of cognitive impairment is high and significantly influenced by disease course,level of self-management,and mental status.The QoL is low,emphasizing the urgent need to intervene in the self-management behaviors of elderly COPD patients,actively reduce the occurrence of cognitive impairment,and mitigate the impact of the disease on QoL.
文摘BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.
文摘This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.
