BACKGROUND:Sepsis may increase the risk of long-term cardiovascular outcomes.This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.METHODS:We c...BACKGROUND:Sepsis may increase the risk of long-term cardiovascular outcomes.This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.METHODS:We conducted a comprehensive systematic search of MEDLINE,EMBASE,the Cochrane Library,Wanfang,and CNKI from database inception through May 2025,without language restrictions.The primary outcome was a composite of myocardial infarction,stroke,congestive heart failure,or cardiovascular death.To evaluate the association between sepsis survivors and cardiovascular outcomes,we calculated cumulative incidence rates and hazard ratios(HRs)with corresponding 95%confi dence intervals(95%CIs).RESULTS:Twenty-fi ve observational studies comprising 7,525,271 participants were included.The pooled cumulative incidence of major cardiovascular events was 9.0%(95%CI:6.1%-11.9%),myocardial infarction 2.4%(95%CI:1.6%-3.1%),stroke 4.9%(95%CI:3.8%-6.1%),and congestive heart failure 8.6%(95%CI:4.6%-12.6%).Compared with non-sepsis controls,sepsis survivors had a signifi cantly higher risk of major cardiovascular events(HR:1.54;95%CI:1.32-1.79),myocardial infarction(HR:1.41;95%CI:1.29-1.54),stroke(HR:1.45;95%CI:1.32-1.60),and congestive heart failure(HR:1.51;95%CI:1.46-1.56).Risk factors associated with increased cardiovascular events in sepsis survivors included age≤45 years,male,hyperlipidemia,and multiple comorbidities.CONCLUSION:Adult sepsis survivors may face significantly increased risks of long-term cardiovascular outcomes.Both common cardiovascular risk factors and sepsis-related pathophysiological changes contribute to this association.展开更多
BACKGROUND Meniscal tears are one of the most common knee injuries.After the diagnosis of a meniscal tear has been made,there are several factors physicians use to guide clinical decision-making.The influence of time ...BACKGROUND Meniscal tears are one of the most common knee injuries.After the diagnosis of a meniscal tear has been made,there are several factors physicians use to guide clinical decision-making.The influence of time between injury and isolated meniscus repair on patient outcomes is not well described.Assessing this relationship is important as it may influence clinical decision-making and can add to the preoperative patient education process.We hypothesized that increasing the time from injury to meniscus surgery would worsen postoperative outcomes.AIM To investigate the current literature for data on the relationship between time between meniscus injury and repair on patient outcomes.METHODS PubMed,Academic Search Complete,MEDLINE,CINAHL,and SPORTDiscus were searched for studies published between January 1,1995 and July 13,2023 on isolated meniscus repair.Exclusion criteria included concomitant ligament surgery,incomplete outcomes or time to surgery data,and meniscectomies.Patient demographics,time to injury,and postoperative outcomes from each study were abstracted and analyzed.RESULTS Five studies met all inclusion and exclusion criteria.There were 204(121 male,83 female)patients included.Three of five(60%)studies determined that time between injury and surgery was not statistically significant for postoperative Lysholm scores(P=0.62),Tegner scores(P=0.46),failure rate(P=0.45,P=0.86),and International Knee Documentation Committee scores(P=0.65).Two of five(40%)studies found a statistically significant increase in Lysholm scores with shorter time to surgery(P=0.03)and a statistically significant association between progression of medial meniscus extrusion ratio(P=0.01)and increasing time to surgery.CONCLUSION Our results do not support the hypothesis that increased time from injury to isolated meniscus surgery worsens postoperative outcomes.Decision-making primarily based on injury interval is thus not recommended.展开更多
Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data dat...Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.展开更多
BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain uncle...BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain unclear.AIM To evaluate the long-term outcomes for early TIPS compared with standard treatment in patients with cirrhosis and AVB.METHODS We retrospectively analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment between January 2014 and December 2023.The primary outcome was overall survival(OS).RESULTS A total of 37 patients with AVB underwent early TIPS,while 65 patients received standard treatment.Compared with the standard treatment group,the rates of uncontrolled bleeding or rebleeding in the early TIPS group were significantly lower(10.8%vs 50.8%,P<0.001).Over a median follow-up of 46 months,no statistically significant differences were observed in terms of OS(P=0.507).The presence of comorbidities was identified as an independent predictor of OS(adjusted hazard ratio=3.81;95%confidence interval:1.16-12.46).Notably,new or worsening ascites occurred less frequently in the early TIPS group(13.5%vs 38.5%,P=0.008).There was no significant difference in the rate of overt hepatic encephalopathy between the two groups(45.9%vs 36.9%,P=0.372).CONCLUSION While early TIPS is not associated with a long-term survival benefit compared with standard treatment for AVB,it is associated with reduced risks of rebleeding and ascites.展开更多
BACKGROUND Proximal gastrectomy(PG)with double tract reconstruction(DTR)has recently emerged as a function-preserving alternative to total gastrectomy(TG)with Rouxen-Y(RNY)reconstruction in patients with proximally lo...BACKGROUND Proximal gastrectomy(PG)with double tract reconstruction(DTR)has recently emerged as a function-preserving alternative to total gastrectomy(TG)with Rouxen-Y(RNY)reconstruction in patients with proximally located gastric cancer.AIM To evaluate the current evidence comparing PG-DTR with TG-RNY in terms of perioperative outcomes,long-term survival,complication rates,nutritional status and reflux esophagitis.METHODS A systematic literature search was conducted using PubMed,MEDLINE,Web of Science and the Cochrane Library for studies published between 2010 and January 2025.Search terms included gastric cancer,DTR and TG.Trials comparing PGDTR with TG-RNY or PG-esophagogastrostomy(EG)were included.Data on operative details,lymph node yield,complications(Clavien-Dindo≥III),nutritional markers and incidence of reflux were extracted.Nineteen trials met the inclusion criteria.The review followed the PRISMA guidelines.RESULTS PG-DTR was found to have comparable long-term oncological outcomes to TGRNY,despite a lower extent of lymph node dissection.Operative time and intraoperative blood loss were generally similar,with some studies favouring PGDTR.Rates of major postoperative complications were comparable between techniques.Notably,PG-DTR showed a significantly lower incidence of reflux esophagitis than PG-EG and was comparable or superior to TG-RNY in reflux control.Nutritionally,PG-DTR was associated with better post-operative weight maintenance and biochemical parameters such as haemoglobin,albumin and vitamin B12 levels compared to TG-RNY.No significant nutritional differences were observed between PG-DTR and PG-EG.PG-DTR appears to offer a balanced approach to the surgical treatment of proximal gastric cancer,combining oncological safety with functional and nutritional benefits.CONCLUSION Its superiority over TG-RNY in postoperative nutrition and reflux prevention,together with comparable complication rates and survival,supports its consideration as a preferred reconstruction method in selected patients.展开更多
Dear Editor,Rosacea is characterized by persistent or transient erythema,papules,pustules,telangiectasia,and/or phymatous lesions[1].Although multiple treatments are available for rosacea,the advent of biological agen...Dear Editor,Rosacea is characterized by persistent or transient erythema,papules,pustules,telangiectasia,and/or phymatous lesions[1].Although multiple treatments are available for rosacea,the advent of biological agents and small-molecule agents has significantly advanced our ability to target the disease more effectively[2].In the current review,we summarize the outcomes of targeted therapies in rosacea,mainly focusing on interleukin(IL)-17 inhibitors and Janus kinase(JAK)inhibitors.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has had profound physical,psychological,and social consequences,with lasting effects on health-related quality of life(HRQoL)among people with a history of COV...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has had profound physical,psychological,and social consequences,with lasting effects on health-related quality of life(HRQoL)among people with a history of COVID-19.AIM To synthesize the current evidence on HRQoL and long-term health outcomes among people with a history of COVID-19 in India.METHODS We incorporated studies from India reporting post-COVID HRQoL outcomes using validated instruments,including the 5-level EuroQol 5-Dimensional questionnaire,the EuroQol Visual Analogue Scale,the Short Form-36 Health Survey,the World Health Organization Quality of Life-Brief Version,and the European Health Interview Survey-Quality of Life.Pooled mean 5-level EuroQol 5-Dimensional questionnaire scores with 95%CIs were calculated for HRQoL.Adjusted odds ratios were pooled for comorbidity,disease severity,intensive care unit admission,age,sex,and vaccination status using random-effects models.RESULTS Three studies(n=1526)reported EuroQol instruments,with the 5-level EuroQol 5-Dimensional questionnaire utility scores suitable for quantitative pooling.The pooled mean utility was 0.83(95%CI:0.75-0.92),although heterogeneity was high because the included studies represented clinically distinct populations.Across all studies,several determinants were consistently associated with impaired HRQoL.Older adults(≥60 years)had higher odds of poor HRQoL[pooled odds ratio(OR)=1.83,95%CI:1.43-2.35],and females were more likely to experience impaired HRQoL(pooled OR=1.74,95%CI:1.44-2.10),whereas males had a lower risk(pooled OR=0.58,95%CI:0.48-0.70).Being unvaccinated increased the likelihood of persistent symptoms or reduced HRQoL(pooled OR=1.60,95%CI:1.21-2.14).Comorbidity(pooled OR=1.94,95%CI:1.43-2.63)and severe acute COVID-19 or intensive care unit admission(pooled OR=2.77,95%CI:2.13-3.59)were also strongly associated with poorer HRQoL Six additional studies utilizing disparate instruments(EuroQol Visual Analogue Scale,Short Form-36 Health Survey,World Health Organization Quality of Life-Brief Version,European Health Interview Survey-Quality of Life)were excluded from quantitative synthesis due to measurement heterogeneity.CONCLUSION Post-COVID HRQoL in people with a history of COVID-19 in India is suboptimal,with greater impairment observed among older adults,females,patients with comorbidities or severe disease,and unvaccinated individuals.These findings highlight the need for targeted rehabilitation and preventive strategies.展开更多
BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pe...BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pediatric populations remains under-researched,with challenges in diagnosis and management AIM To synthesize the current literature on FND in children,focusing on clinical presentation,diagnostic approaches,treatment strategies,and outcomes.METHODS A comprehensive literature search was conducted across multiple databases,including PubMed,Scopus,and Web of Science,for articles published up to August 2024.Studies were included if they addressed FND in pediatric populations,specifically focusing on review articles,research articles,systematic reviews,meta-analyses,case reports,guidelines,expert opinions,and editorials.Data extraction and quality assessment were performed according to PRISMA guidelines.A total of 308 articles were included in the final analysis.RESULTS The analysis included 189 review articles,57 research articles,3 systematic reviews and meta-analyses,5 case reports,2 guidelines,5 expert opinions,and 2 editorials.Key findings revealed a broad spectrum of symptoms,including motor and sensory disturbances and psychological factors contributing to the onset and persistence of FND.Diagnostic challenges were frequently highlighted,emphasizing the need for interdisciplinary approaches.Treatment strategies varied,with cognitive-behavioral therapy(CBT)and multidisciplinary care emerging as the most effective approaches.The outcomes varied,with early intervention being critical for a better prognosis.CONCLUSION Early diagnosis and multidisciplinary care,including CBT,are critical for improving outcomes in pediatric FND.Standardized diagnostic criteria and treatment protocols are needed to enhance clinical management.展开更多
BACKGROUND The beneficial effects of sodium-glucose co-transporter-2 inhibitors(SGLT2i)on adverse cardiac outcomes in diabetic patients are well-established.However,the effects of SGLT2i against cancer therapy-related...BACKGROUND The beneficial effects of sodium-glucose co-transporter-2 inhibitors(SGLT2i)on adverse cardiac outcomes in diabetic patients are well-established.However,the effects of SGLT2i against cancer therapy-related cardiotoxicity remain understudied.We investigated the association between SGLT2i and cardiac outcomes in cancer patients.METHODS PubMed,Embase,and the Cochrane Library were searched from their inception until September 30,2024 for studies evaluating the effects of SGLT2i in patients with cancer.The primary outcomes included incident heart failure(HF),HF exacerbation,HF hospitalization,atrial fibrillation/atrial flutter(AF/AFL),myocardial infarction,and all-cause mortality.The secondary outcomes included acute kidney injury and sepsis.Odds ratio(OR)with 95%CI was pooled.RESULTS Thirteen studies with 85,596 patients were included.Compared to non-SGLT2i use,SGLT2i treatment was associated with lower risks of incident HF(OR=0.51,95%CI:0.32-0.79,P=0.003),HF exacerbation(OR=0.74,95%CI:0.63-0.87,P<0.001),AF/AFL(OR=0.67,95%CI:0.55-0.82,P<0.001),myocardial infarction(OR=0.61,95%CI:0.41-0.90,P=0.01),and all-cause mortality(OR=0.44,95%CI:0.28-0.69,P<0.001),but not for HF hospitalization(OR=0.58,95%CI:0.22-1.55,P=0.28).As for safety outcomes,SGLT2i use was associated with lower risks of acute kidney injury(OR=0.68,95%CI:0.57-0.81,P<0.001)and sepsis(OR=0.32,95%CI:0.23-0.44,P<0.001).CONCLUSIONS SGLT2i were associated with lower risks of incident HF,HF exacerbation,AF/AFL,myocardial infarction,allcause mortality,acute kidney injury,and sepsis in cancer patients.展开更多
BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the a...BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.展开更多
BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant rec...BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.展开更多
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of pr...BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of prognosis.AIM To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.METHODS A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People’s Hospital from January 2021 to June 2024 were retrospectively analyzed.Patients were divided into the abdominal[visceral fat area(VFA)≥100.00 cm^(2),n=80]and non-abdominal(VFA<100.00 cm^(2),n=70)obesity groups according to the VFA measured by preoperative computed tomography.The two groups showed no significant differences in age,sex,tumor location,tumor-node-metastasis stage,and underlying disease(P>0.05).All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management.Complications,nutritional status,changes in biochemical indicators,and tumor recurrence and metastasis were evaluated postoperatively.RESULTS The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group(P<0.05).The pulmonary infection on postoperative day(POD)3(P=0.038),anastomotic leakage on POD 7(P=0.042),and moderate-to-severe complications(Clavien-Dindo class III,P=0.03)were significantly different.With respect to biochemical indicators,the white blood cell count,neutrophil percentage,and C-reactive protein level in the abdominal obesity group continuously increased after surgery(P<0.05);the albumin level on POD 1 was even lower(P=0.024).Regarding tumor markers,carcinoembryonic antigen(P=0.039)and carbohydrate antigen 19-9(P=0.048)levels were significantly higher in the abdominal obesity group at 3 months after surgery,and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery(P<0.05).Abdominal obesity was an independent risk factor for postoperative complications(odds ratio:3.843,P=0.001),overall survival[hazard ratio(HR):1.937,P=0.011],and disease-free survival(HR:1.769,P=0.018).CONCLUSION Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis.Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.展开更多
BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges f...BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.展开更多
BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burde...BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burden are limited.Electroacupuncture has been proposed as a potential adjunctive therapy,but its psychological benefits remain inadequately studied.AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS,and to explore its potential advantages in psychologically vulnerable subgroups.METHODS We conducted a retrospective,controlled study involving 100 patients with moderate to severe LARS(LARS score≥21)treated at two tertiary hospitals in China between January 2022 and December 2024.Patients received either standard postoperative care alone(n=50)or in combination with a standardized 4-week electroacupuncture protocol(n=50).Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale(HADS),Body Image Scale(BIS),General Self-Efficacy Scale,Perceived Social Support Scale(PSSS),LARS score,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points.The primary endpoint was emotional remission,defined as a≥3-point reduction in HADS-Anxiety subscale(HADS-A).Analyses included repeated-measures comparisons,Kaplan-Meier survival curves,Cox regression models,and subgroup-interaction testing.RESULTS At baseline,demographic,surgical,and psychosocial characteristics were comparable among groups.By week 4,patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety(HADS-A:4.8±2.6 vs 7.3±3.0;P<0.001),depression,and body-image disturbance(BIS:8.7±3.6 vs 11.9±4.2;P<0.001),alongside enhanced coping capacity(Brief Coping Orientation to Problems Experienced),perceived social support(PSSS),and bowel function(LARS score).Emotional remission-defined as a≥3-point HADS-A reduction-was achieved more rapidly in the electroacupuncture group,as confirmed by Kaplan-Meier analysis(log-rank P<0.001;odds ratio=4.7).Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery.Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety(HADS-A≥8),elevated body-image disturbance(BIS≥12),or low perceived social support(PSSS<60),with consistent interaction effects(P for interaction<0.05 across subgroups).CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS.Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.展开更多
Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was co...Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.展开更多
With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failu...With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failure.Kidney allograft dysfunction is well known to be associated with increased adverse outcomes post solitary kidney transplant however,outcomes for patients and the kidney allograft are somewhat understudied in the setting of kidney transplantation when combined with other solid organ transplantation such as in a simultaneous liverkidney transplant.We will provide an overview of the current literature available on kidney allograft clinical outcome measures in combined solid organ transplant recipients such as delayed kidney allograft function,kidney allograft rejection,kidney allograft and patient survival metrics and how they compare to patients with kidney transplants alone.Worse kidney allograft survival outcomes were noted in most combined other organ with kidney transplantation(liver-kidney,heart-kidney,and lung-kidney)due to comorbidities attributed to non-renal organ dysfunction whereas improved kidney allograft survival outcomes were noted for pancreas-kidney transplantation.展开更多
BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite imp...BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.展开更多
AIM: To perform a systematic review and metaanalysis on robotic-assisted vs laparoscopic liver resections.METHODS: A systematic literature search was performed using Pub Med, Scopus and the Cochrane Library Central. P...AIM: To perform a systematic review and metaanalysis on robotic-assisted vs laparoscopic liver resections.METHODS: A systematic literature search was performed using Pub Med, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria:(1) studies comparing robotic and laparoscopic liver resection;(2) studies reporting at least one perioperative outcome; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy rates.RESULTS: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time(MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital stay.CONCLUSION: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay.展开更多
基金supported by Zhejiang Province Medical and Health Science and Technology Plan Project(2022KY241)Hangzhou Health Science and Technology Plan Project(ZD20230017).
文摘BACKGROUND:Sepsis may increase the risk of long-term cardiovascular outcomes.This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.METHODS:We conducted a comprehensive systematic search of MEDLINE,EMBASE,the Cochrane Library,Wanfang,and CNKI from database inception through May 2025,without language restrictions.The primary outcome was a composite of myocardial infarction,stroke,congestive heart failure,or cardiovascular death.To evaluate the association between sepsis survivors and cardiovascular outcomes,we calculated cumulative incidence rates and hazard ratios(HRs)with corresponding 95%confi dence intervals(95%CIs).RESULTS:Twenty-fi ve observational studies comprising 7,525,271 participants were included.The pooled cumulative incidence of major cardiovascular events was 9.0%(95%CI:6.1%-11.9%),myocardial infarction 2.4%(95%CI:1.6%-3.1%),stroke 4.9%(95%CI:3.8%-6.1%),and congestive heart failure 8.6%(95%CI:4.6%-12.6%).Compared with non-sepsis controls,sepsis survivors had a signifi cantly higher risk of major cardiovascular events(HR:1.54;95%CI:1.32-1.79),myocardial infarction(HR:1.41;95%CI:1.29-1.54),stroke(HR:1.45;95%CI:1.32-1.60),and congestive heart failure(HR:1.51;95%CI:1.46-1.56).Risk factors associated with increased cardiovascular events in sepsis survivors included age≤45 years,male,hyperlipidemia,and multiple comorbidities.CONCLUSION:Adult sepsis survivors may face significantly increased risks of long-term cardiovascular outcomes.Both common cardiovascular risk factors and sepsis-related pathophysiological changes contribute to this association.
文摘BACKGROUND Meniscal tears are one of the most common knee injuries.After the diagnosis of a meniscal tear has been made,there are several factors physicians use to guide clinical decision-making.The influence of time between injury and isolated meniscus repair on patient outcomes is not well described.Assessing this relationship is important as it may influence clinical decision-making and can add to the preoperative patient education process.We hypothesized that increasing the time from injury to meniscus surgery would worsen postoperative outcomes.AIM To investigate the current literature for data on the relationship between time between meniscus injury and repair on patient outcomes.METHODS PubMed,Academic Search Complete,MEDLINE,CINAHL,and SPORTDiscus were searched for studies published between January 1,1995 and July 13,2023 on isolated meniscus repair.Exclusion criteria included concomitant ligament surgery,incomplete outcomes or time to surgery data,and meniscectomies.Patient demographics,time to injury,and postoperative outcomes from each study were abstracted and analyzed.RESULTS Five studies met all inclusion and exclusion criteria.There were 204(121 male,83 female)patients included.Three of five(60%)studies determined that time between injury and surgery was not statistically significant for postoperative Lysholm scores(P=0.62),Tegner scores(P=0.46),failure rate(P=0.45,P=0.86),and International Knee Documentation Committee scores(P=0.65).Two of five(40%)studies found a statistically significant increase in Lysholm scores with shorter time to surgery(P=0.03)and a statistically significant association between progression of medial meniscus extrusion ratio(P=0.01)and increasing time to surgery.CONCLUSION Our results do not support the hypothesis that increased time from injury to isolated meniscus surgery worsens postoperative outcomes.Decision-making primarily based on injury interval is thus not recommended.
文摘Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.
基金Supported by the Natural Science Foundation of the Science and Technology Commission of Shanghai Municipality,No.23ZR1458300the Key Discipline Project of Shanghai Municipal Health System,No.2024ZDXK0004the Doctoral Innovation Talent Base Project for Diagnosis and Treatment of Chronic Liver Diseases,No.RCJD2021B02.
文摘BACKGROUND Early transjugular intrahepatic portosystemic shunts(TIPS)is a therapeutic option for acute variceal bleeding(AVB),offering a low risk of rebleeding.However,the long-term outcomes of early TIPS remain unclear.AIM To evaluate the long-term outcomes for early TIPS compared with standard treatment in patients with cirrhosis and AVB.METHODS We retrospectively analyzed the clinical data of patients with AVB who underwent early TIPS or standard treatment between January 2014 and December 2023.The primary outcome was overall survival(OS).RESULTS A total of 37 patients with AVB underwent early TIPS,while 65 patients received standard treatment.Compared with the standard treatment group,the rates of uncontrolled bleeding or rebleeding in the early TIPS group were significantly lower(10.8%vs 50.8%,P<0.001).Over a median follow-up of 46 months,no statistically significant differences were observed in terms of OS(P=0.507).The presence of comorbidities was identified as an independent predictor of OS(adjusted hazard ratio=3.81;95%confidence interval:1.16-12.46).Notably,new or worsening ascites occurred less frequently in the early TIPS group(13.5%vs 38.5%,P=0.008).There was no significant difference in the rate of overt hepatic encephalopathy between the two groups(45.9%vs 36.9%,P=0.372).CONCLUSION While early TIPS is not associated with a long-term survival benefit compared with standard treatment for AVB,it is associated with reduced risks of rebleeding and ascites.
文摘BACKGROUND Proximal gastrectomy(PG)with double tract reconstruction(DTR)has recently emerged as a function-preserving alternative to total gastrectomy(TG)with Rouxen-Y(RNY)reconstruction in patients with proximally located gastric cancer.AIM To evaluate the current evidence comparing PG-DTR with TG-RNY in terms of perioperative outcomes,long-term survival,complication rates,nutritional status and reflux esophagitis.METHODS A systematic literature search was conducted using PubMed,MEDLINE,Web of Science and the Cochrane Library for studies published between 2010 and January 2025.Search terms included gastric cancer,DTR and TG.Trials comparing PGDTR with TG-RNY or PG-esophagogastrostomy(EG)were included.Data on operative details,lymph node yield,complications(Clavien-Dindo≥III),nutritional markers and incidence of reflux were extracted.Nineteen trials met the inclusion criteria.The review followed the PRISMA guidelines.RESULTS PG-DTR was found to have comparable long-term oncological outcomes to TGRNY,despite a lower extent of lymph node dissection.Operative time and intraoperative blood loss were generally similar,with some studies favouring PGDTR.Rates of major postoperative complications were comparable between techniques.Notably,PG-DTR showed a significantly lower incidence of reflux esophagitis than PG-EG and was comparable or superior to TG-RNY in reflux control.Nutritionally,PG-DTR was associated with better post-operative weight maintenance and biochemical parameters such as haemoglobin,albumin and vitamin B12 levels compared to TG-RNY.No significant nutritional differences were observed between PG-DTR and PG-EG.PG-DTR appears to offer a balanced approach to the surgical treatment of proximal gastric cancer,combining oncological safety with functional and nutritional benefits.CONCLUSION Its superiority over TG-RNY in postoperative nutrition and reflux prevention,together with comparable complication rates and survival,supports its consideration as a preferred reconstruction method in selected patients.
文摘Dear Editor,Rosacea is characterized by persistent or transient erythema,papules,pustules,telangiectasia,and/or phymatous lesions[1].Although multiple treatments are available for rosacea,the advent of biological agents and small-molecule agents has significantly advanced our ability to target the disease more effectively[2].In the current review,we summarize the outcomes of targeted therapies in rosacea,mainly focusing on interleukin(IL)-17 inhibitors and Janus kinase(JAK)inhibitors.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has had profound physical,psychological,and social consequences,with lasting effects on health-related quality of life(HRQoL)among people with a history of COVID-19.AIM To synthesize the current evidence on HRQoL and long-term health outcomes among people with a history of COVID-19 in India.METHODS We incorporated studies from India reporting post-COVID HRQoL outcomes using validated instruments,including the 5-level EuroQol 5-Dimensional questionnaire,the EuroQol Visual Analogue Scale,the Short Form-36 Health Survey,the World Health Organization Quality of Life-Brief Version,and the European Health Interview Survey-Quality of Life.Pooled mean 5-level EuroQol 5-Dimensional questionnaire scores with 95%CIs were calculated for HRQoL.Adjusted odds ratios were pooled for comorbidity,disease severity,intensive care unit admission,age,sex,and vaccination status using random-effects models.RESULTS Three studies(n=1526)reported EuroQol instruments,with the 5-level EuroQol 5-Dimensional questionnaire utility scores suitable for quantitative pooling.The pooled mean utility was 0.83(95%CI:0.75-0.92),although heterogeneity was high because the included studies represented clinically distinct populations.Across all studies,several determinants were consistently associated with impaired HRQoL.Older adults(≥60 years)had higher odds of poor HRQoL[pooled odds ratio(OR)=1.83,95%CI:1.43-2.35],and females were more likely to experience impaired HRQoL(pooled OR=1.74,95%CI:1.44-2.10),whereas males had a lower risk(pooled OR=0.58,95%CI:0.48-0.70).Being unvaccinated increased the likelihood of persistent symptoms or reduced HRQoL(pooled OR=1.60,95%CI:1.21-2.14).Comorbidity(pooled OR=1.94,95%CI:1.43-2.63)and severe acute COVID-19 or intensive care unit admission(pooled OR=2.77,95%CI:2.13-3.59)were also strongly associated with poorer HRQoL Six additional studies utilizing disparate instruments(EuroQol Visual Analogue Scale,Short Form-36 Health Survey,World Health Organization Quality of Life-Brief Version,European Health Interview Survey-Quality of Life)were excluded from quantitative synthesis due to measurement heterogeneity.CONCLUSION Post-COVID HRQoL in people with a history of COVID-19 in India is suboptimal,with greater impairment observed among older adults,females,patients with comorbidities or severe disease,and unvaccinated individuals.These findings highlight the need for targeted rehabilitation and preventive strategies.
文摘BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pediatric populations remains under-researched,with challenges in diagnosis and management AIM To synthesize the current literature on FND in children,focusing on clinical presentation,diagnostic approaches,treatment strategies,and outcomes.METHODS A comprehensive literature search was conducted across multiple databases,including PubMed,Scopus,and Web of Science,for articles published up to August 2024.Studies were included if they addressed FND in pediatric populations,specifically focusing on review articles,research articles,systematic reviews,meta-analyses,case reports,guidelines,expert opinions,and editorials.Data extraction and quality assessment were performed according to PRISMA guidelines.A total of 308 articles were included in the final analysis.RESULTS The analysis included 189 review articles,57 research articles,3 systematic reviews and meta-analyses,5 case reports,2 guidelines,5 expert opinions,and 2 editorials.Key findings revealed a broad spectrum of symptoms,including motor and sensory disturbances and psychological factors contributing to the onset and persistence of FND.Diagnostic challenges were frequently highlighted,emphasizing the need for interdisciplinary approaches.Treatment strategies varied,with cognitive-behavioral therapy(CBT)and multidisciplinary care emerging as the most effective approaches.The outcomes varied,with early intervention being critical for a better prognosis.CONCLUSION Early diagnosis and multidisciplinary care,including CBT,are critical for improving outcomes in pediatric FND.Standardized diagnostic criteria and treatment protocols are needed to enhance clinical management.
基金supported by the National Natural Science Foundation of China(No.82170327&No.82370332)the Tianjin Key Medical Discipline(Specialty)Construction Project(TJYXZDXK-029A).
文摘BACKGROUND The beneficial effects of sodium-glucose co-transporter-2 inhibitors(SGLT2i)on adverse cardiac outcomes in diabetic patients are well-established.However,the effects of SGLT2i against cancer therapy-related cardiotoxicity remain understudied.We investigated the association between SGLT2i and cardiac outcomes in cancer patients.METHODS PubMed,Embase,and the Cochrane Library were searched from their inception until September 30,2024 for studies evaluating the effects of SGLT2i in patients with cancer.The primary outcomes included incident heart failure(HF),HF exacerbation,HF hospitalization,atrial fibrillation/atrial flutter(AF/AFL),myocardial infarction,and all-cause mortality.The secondary outcomes included acute kidney injury and sepsis.Odds ratio(OR)with 95%CI was pooled.RESULTS Thirteen studies with 85,596 patients were included.Compared to non-SGLT2i use,SGLT2i treatment was associated with lower risks of incident HF(OR=0.51,95%CI:0.32-0.79,P=0.003),HF exacerbation(OR=0.74,95%CI:0.63-0.87,P<0.001),AF/AFL(OR=0.67,95%CI:0.55-0.82,P<0.001),myocardial infarction(OR=0.61,95%CI:0.41-0.90,P=0.01),and all-cause mortality(OR=0.44,95%CI:0.28-0.69,P<0.001),but not for HF hospitalization(OR=0.58,95%CI:0.22-1.55,P=0.28).As for safety outcomes,SGLT2i use was associated with lower risks of acute kidney injury(OR=0.68,95%CI:0.57-0.81,P<0.001)and sepsis(OR=0.32,95%CI:0.23-0.44,P<0.001).CONCLUSIONS SGLT2i were associated with lower risks of incident HF,HF exacerbation,AF/AFL,myocardial infarction,allcause mortality,acute kidney injury,and sepsis in cancer patients.
文摘BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.
文摘BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
文摘BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of prognosis.AIM To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.METHODS A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People’s Hospital from January 2021 to June 2024 were retrospectively analyzed.Patients were divided into the abdominal[visceral fat area(VFA)≥100.00 cm^(2),n=80]and non-abdominal(VFA<100.00 cm^(2),n=70)obesity groups according to the VFA measured by preoperative computed tomography.The two groups showed no significant differences in age,sex,tumor location,tumor-node-metastasis stage,and underlying disease(P>0.05).All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management.Complications,nutritional status,changes in biochemical indicators,and tumor recurrence and metastasis were evaluated postoperatively.RESULTS The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group(P<0.05).The pulmonary infection on postoperative day(POD)3(P=0.038),anastomotic leakage on POD 7(P=0.042),and moderate-to-severe complications(Clavien-Dindo class III,P=0.03)were significantly different.With respect to biochemical indicators,the white blood cell count,neutrophil percentage,and C-reactive protein level in the abdominal obesity group continuously increased after surgery(P<0.05);the albumin level on POD 1 was even lower(P=0.024).Regarding tumor markers,carcinoembryonic antigen(P=0.039)and carbohydrate antigen 19-9(P=0.048)levels were significantly higher in the abdominal obesity group at 3 months after surgery,and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery(P<0.05).Abdominal obesity was an independent risk factor for postoperative complications(odds ratio:3.843,P=0.001),overall survival[hazard ratio(HR):1.937,P=0.011],and disease-free survival(HR:1.769,P=0.018).CONCLUSION Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis.Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.
基金approved by King Abdullah International Medical Research Center Ethics Committee(approval No.0000074524).
文摘BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.
文摘BACKGROUND Low anterior resection syndrome(LARS)is a prevalent and debilitating complication following sphincter-preserving surgery for rectal cancer.Evidence-based interventions for the concurrent psychological burden are limited.Electroacupuncture has been proposed as a potential adjunctive therapy,but its psychological benefits remain inadequately studied.AIM To investigate the therapeutic effect of electroacupuncture on emotional recovery and gastrointestinal function in patients with moderate to severe LARS,and to explore its potential advantages in psychologically vulnerable subgroups.METHODS We conducted a retrospective,controlled study involving 100 patients with moderate to severe LARS(LARS score≥21)treated at two tertiary hospitals in China between January 2022 and December 2024.Patients received either standard postoperative care alone(n=50)or in combination with a standardized 4-week electroacupuncture protocol(n=50).Psychological and functional outcomes were assessed using validated instruments including Hospital Anxiety and Depression Scale(HADS),Body Image Scale(BIS),General Self-Efficacy Scale,Perceived Social Support Scale(PSSS),LARS score,and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at four time points.The primary endpoint was emotional remission,defined as a≥3-point reduction in HADS-Anxiety subscale(HADS-A).Analyses included repeated-measures comparisons,Kaplan-Meier survival curves,Cox regression models,and subgroup-interaction testing.RESULTS At baseline,demographic,surgical,and psychosocial characteristics were comparable among groups.By week 4,patients receiving electroacupuncture demonstrated significantly greater reductions in anxiety(HADS-A:4.8±2.6 vs 7.3±3.0;P<0.001),depression,and body-image disturbance(BIS:8.7±3.6 vs 11.9±4.2;P<0.001),alongside enhanced coping capacity(Brief Coping Orientation to Problems Experienced),perceived social support(PSSS),and bowel function(LARS score).Emotional remission-defined as a≥3-point HADS-A reduction-was achieved more rapidly in the electroacupuncture group,as confirmed by Kaplan-Meier analysis(log-rank P<0.001;odds ratio=4.7).Multivariate Cox regression identified higher baseline LARS and BIS scores as independent predictors of delayed emotional recovery.Subgroup analyses revealed significantly amplified treatment benefits in patients with high baseline anxiety(HADS-A≥8),elevated body-image disturbance(BIS≥12),or low perceived social support(PSSS<60),with consistent interaction effects(P for interaction<0.05 across subgroups).CONCLUSION Electroacupuncture may accelerate emotional recovery and improve functional and psychosocial outcomes in patients with LARS.Its integration into postoperative care may offer particular benefits for psychologically vulnerable subgroups.
文摘Objective:To characterize placental morphologic features in Moroccan women with adverse outcomes,across different clinical contexts,based on the Amsterdam consensus classification.Methods:A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1,2024 and July 15,2024 from women with adverse pregnancy outcomes.Clinical data(age,parity,gravidity,complications)were retrieved.Macroscopic parameters(weight,dimensions,cord insertion,membranes,lesions)were assessed,followed by systematic sampling.Tissue was processed by standard histology(formalin fixation,paraffin embedding,hematoxylin and eosin staining),and lesions were classified per Amsterdam criteria.Results:16 placentas from patients with adverse pregnancy outcomes were included.The median maternal age was 30 years.Adverse conditions included placental abruption(50%),intrauterine growth restriction(IUGR,38%),intrauterine fetal death(IUFD,31%),pre-eclampsia/eclampsia(19%),premature rupture of membranes(13%),and oligohydramnios(13%).Several placentas were associated with more than one adverse condition.Histopathology revealed maternal vascular malperfusion lesions in 94%,particularly in pre-eclampsia,IUGR,and IUFD.Fetal vascular malperfusion was found in 88%,mainly in IUGR and IUFD.Inflammatory lesions,dominated by acute maternal and fetal responses stage 3(necrotizing chorioamnionitis and funisitis),were primarily linked to IUFD.Conclusions:Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes,supports diagnostic confirmation,and guides preventive strategies for recurrence.This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.
文摘With advances in solid organ transplantation,the option of combined kidney with other solid organ transplantation is an enticing option for patients with advanced kidney disease and concomitant other solid organ failure.Kidney allograft dysfunction is well known to be associated with increased adverse outcomes post solitary kidney transplant however,outcomes for patients and the kidney allograft are somewhat understudied in the setting of kidney transplantation when combined with other solid organ transplantation such as in a simultaneous liverkidney transplant.We will provide an overview of the current literature available on kidney allograft clinical outcome measures in combined solid organ transplant recipients such as delayed kidney allograft function,kidney allograft rejection,kidney allograft and patient survival metrics and how they compare to patients with kidney transplants alone.Worse kidney allograft survival outcomes were noted in most combined other organ with kidney transplantation(liver-kidney,heart-kidney,and lung-kidney)due to comorbidities attributed to non-renal organ dysfunction whereas improved kidney allograft survival outcomes were noted for pancreas-kidney transplantation.
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
文摘BACKGROUND Post-transplant tertiary hyperparathyroidism(PT-tHPT)is a well-recognized complication following kidney transplantation,characterized by persistent excessive secretion of parathyroid hormone(PTH)despite improved renal function.It is potentially associated with an increased risk of cardiovascular events,renal osteodystrophy,pathologic fractures,graft loss,and mortality.AIM To evaluate the incidence,risk factors,and outcomes of PT-tHPT amongst kidney transplant recipients.METHODS A total of 887 transplant recipients who underwent transplantation between 2000 and 2020 were evaluated.Univariable and multivariable logistic regression was performed to determine the predictors of tertiary hyperparathyroidism.Graft and recipient outcomes were assessed using multivariable Cox regression.A separate multivariable Cox regression was performed to determine the effect of treatment strategies on outcomes.RESULTS PT-tHPT,defined as elevated PTH(>65 ng/L)and persistent hypercalcemia(>2.60 mmol/L),was diagnosed in 14%of recipients.Risk factors for PT-tHPT included older age[odds ratio(OR)=1.36,P<0.001],Asian ethnicity(OR=0.33,P=0.006),total ischemia time(OR=1.03,P=0.048 per hour),pre-transplant serum calcium(OR=1.38,P<0.001)per decile increase,pre-transplant PTH level(OR=1.31,P<0.001)per decile increase,longer dialysis duration(OR=1.12,P=0.002)per year,history of acute rejection(OR=2.37,P=0.012),and slope of estimated glomerular filtration rate change(OR=0.91,P=0.001).There were a 3.4-fold higher risk of death-censored graft loss and a 1.9-fold greater risk of recipient death with PT-tHPT.The three treatment strategies of conservative management,calcimimetic and parathyroidectomy did not significantly change the graft or patient outcome.CONCLUSION Pretransplant elevated calcium and PTH levels,older age and dialysis duration are associated with PT-tHPT.While PT-tHPT significantly affects graft and recipient survival,the treatment strategies did not affect survival.
文摘AIM: To perform a systematic review and metaanalysis on robotic-assisted vs laparoscopic liver resections.METHODS: A systematic literature search was performed using Pub Med, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria:(1) studies comparing robotic and laparoscopic liver resection;(2) studies reporting at least one perioperative outcome; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy rates.RESULTS: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time(MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital stay.CONCLUSION: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay.
