BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be...BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.展开更多
Coptis chinensis Franch.and Panax ginseng C.A.Mey.are traditional herbal medicines with millennia of documented use and broad therapeutic applications,including anti-diabetic properties.However,the synergistic effect ...Coptis chinensis Franch.and Panax ginseng C.A.Mey.are traditional herbal medicines with millennia of documented use and broad therapeutic applications,including anti-diabetic properties.However,the synergistic effect of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng on type 2 diabetes mellitus(T2DM)and its underlying mechanism remain unclear.The research demonstrated that the optimal ratio of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng was 4∶1,exhibiting maximal efficacy in improving insulin resistance and gluconeogenesis in primary mouse hepatocytes.This combination demonstrated significant synergistic effects in improving glucose tolerance,reducing fasting blood glucose(FBG),the weight ratio of epididymal white adipose tissue(eWAT),and the homeostasis model assessment of insulin resistance(HOMA-IR)in leptin receptor-deficient(db/db)mice.Subsequently,a T2DM liver-specific network was constructed based on RNA sequencing(RNA-seq)experiments and public databases by integrating transcriptional properties of disease-associated proteins and protein-protein interactions(PPIs).The network recovery index(NRI)score of the combined treatment group with a 4∶1 ratio exceeded that of groups treated with individual components.The research identified that activated adenosine 5'-monophosphate-activated protein kinase(AMPK)/acetyl-CoA carboxylase(ACC)signaling in the liver played a crucial role in the synergistic treatment of T2DM,as verified by western blot experiment in db/db mice.These findings demonstrate that the 4∶1 combination of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng significantly improves insulin resistance and glucose and lipid metabolism disorders in db/db mice,surpassing the efficacy of individual treatments.The synergistic mechanism correlates with enhanced AMPK/ACC signaling pathway activity.展开更多
BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vesse...BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.展开更多
The alpine ecosystem has great potential for carbon sequestration.Soil organic carbon(SOC)and total nitrogen(TN)are highly sensitive to climate change,and their dynamics are crucial to revealing the effect of climate ...The alpine ecosystem has great potential for carbon sequestration.Soil organic carbon(SOC)and total nitrogen(TN)are highly sensitive to climate change,and their dynamics are crucial to revealing the effect of climate change on the structure,function,and services of the ecosystem.However,the spatial distribution and controlling factors of SOC and TN across various soil layers and vegetation types within this unique ecosystem remain inadequately understood.In this study,256 soil samples in 89 sites were collected from the Three River Headwaters Region(TRHR)in China to investigate SOC and TN and to explore the primary factors affecting their distribution,including soil,vegetation,climate,and geography factors.The results show that SOC and TN contents in 0-20,20-40,40-60,and 60-80 cm soil layers are 24.40,18.03,14.04,12.40 g/kg and 2.46,1.90,1.51,1.17 g/kg,respectively;with higher concentrations observed in the southeastern region compared to the northwest of the TRHR.One-way analysis of variance reveals that SOC and TN levels are elevated in the alpine meadow and the alpine shrub relative to the alpine steppe in the 0-60 cm soil layers.The structural equation model explores that soil water content is the main controlling factor affecting the variation of SOC and TN.Moreover,the geography,climate,and vegetation factors notably indirectly affect SOC and TN through soil factors.Therefore,it can effectively improve soil water and nutrient conditions through vegetation restoration,soil improvement,and grazing management,and the change of SOC and TN can be fully understood by establishing monitoring networks to better protect soil carbon and nitrogen.展开更多
Continuous research on Cephalotaxus plants has ultimately led to the US food and drug administration (FDA) ap-provalof homoharringtonine in 2012 for the treatment of chronic myeloid leukemia. Additionally, another imp...Continuous research on Cephalotaxus plants has ultimately led to the US food and drug administration (FDA) ap-provalof homoharringtonine in 2012 for the treatment of chronic myeloid leukemia. Additionally, another important class of natural products from Cephalotaxus plants is cephalotane diterpenoids. Since the discovery of the first member, harring-tonolide,in 1978, cephalotane diterpenoids have garnered significant attention from the scientific community due to their re-markableanti-cancer activity. The unique structural features of cephalotane diterpenoids, a 7/6/5/6-fused tetracyclic carbon skeleton and a bridged lactone, make them ideal targets for synthetic chemists. Successfully synthesizing these complex diterpenoids is of great importance for the discovery and development of anti-tumor drugs. To date, ten research groups have completed the total synthesis of 24 cephalotane diterpenoids. The latest progress in the total synthesis of cephalotane diterpe-noidsis reviewed, showcasing the importance of these innovative synthetic strategies in the efficient synthesis of complex natural products and their potential significance in advancing the field of drug discovery.展开更多
BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many p...BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.展开更多
BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rate...BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rates remain significant.AIM To determine whether ankle symptoms are associated with inferior results of functional recovery of the knee following TKA.METHODS This prospective study included all patients with advanced knee osteoarthritis who underwent a primary unilateral TKA between August 2019 and December 2019 with data documented by the treating surgeon and outpatient physical therapists.Patients were categorized based on ankle symptoms using the Ame-rican Orthopaedic Foot and Ankle Society(AOFAS)score:(1)Group 1(AOFAS≤85,n=30);and(2)Group 2(AOFAS>85,n=49).Active range of motion(ROM),the Knee Injury and Osteoarthritis Outcome Score(KOOS),and the visual ana-logue scale(VAS)were compared between two groups.RESULTS Postoperative KOOS,ROM,and VAS significantly improved in both groups(P<0.001).However,at three months,KOOS(P=0.02)and extension motion(P=0.01)improvements were significantly greater in group 2.CONCLUSION These findings suggest that preoperative ankle symptoms may negatively impact early knee functional recovery,particularly in KOOS scores and extension motion.展开更多
Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On ...Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On August 27,2024,a literature search was performed in PubMed using“TKA retrieval analysis”as keywords.A total of 160 articles were found,of which only 19 were analyzed because they were directly related to the subject of this article.Rotating-platform(mobile-bearing)TKA has no surface damage advantage over fixed-bearing TKA.TKAs with central locking mechanisms are more prone to debond from the cement mantle.No major wear of the polyethylene(PE)component in TKA using oxidized zirconium components occurs.Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components.The use of a polished tibial tray over an unpolished design is advised.At short-run assessment(15 months on average),antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage,density of crosslinking,or oxidation compared to standard remelted highly crosslinked PE components.A correlation between implant position and PE component surface damage has been reported.It shows the importance of optimizing component position to reduce PE component damage.Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge.Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform.Such information can help to improve future prosthetic designs to increase prosthetic survival.展开更多
A category of highly fused diterpenoid natural products possessing a characteristic perhydropyrene-like or rearranged tetracyclic skeleton structure are distributed in different life forms.Compared to traditional poly...A category of highly fused diterpenoid natural products possessing a characteristic perhydropyrene-like or rearranged tetracyclic skeleton structure are distributed in different life forms.Compared to traditional polycyclic diterpenoids,their biosynthetic pathways are quite unique and diverse.Chemists have pinpointed a range of this type of unusual diterpenoids:cycloamphilectanes and isocycloamphilectanes,kempenes and rippertanes,hydropyrene and hydropyrenol,along with recently disclosed cephalotanes.This review describes developments in this field and discusses the challenges associated with synthesizing this class of highly complex compounds.展开更多
BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the p...BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the postoperative life of the patient.Currently,the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC.However,more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure,with more reconstruction steps and longer reconstruction time,and the incidence of postoperative complications such as adhesive intestinal obstruction,internal abdominal hernia and volvulus is high.Moreover,the incidence of Roux stasis syndrome is 10%-30%after traditional Roux-en-Y reconstruction.Thus,we modified the traditional Roux-en-Y alimentary tract reconstruction,and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.AIM To evaluate the clinical advantages,feasibility,and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy(total gastrectomy)for GC were divided into two groups:fifty-four in the conventional Roux-en-Y reconstruction group(Orr group)and forty-three in the modified Roux-en-Y reconstruction group(the modified group).Perioperative and short-term outcomes were analyzed,including complications,postoperative weight loss,hemoglobin levels,and nutritional status.RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics.Compared with the Orr group,the modified group had shorter digestive tract reconstruction and operation times,less intraoperative bleeding,and shorter postoperative hospital stays compared to the Orr group.Although both groups had similar amounts of intraoperative blood loss,postoperative recovery times,and hospital expenses,the Orr group experienced longer operation times and digestive tract reconstruction times.Furthermore,the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications,with a reduced incidence of reflux esophagitis and improved nutritional status.CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety,simplicity,and a reduction in bile reflux.This method shortens operation times and minimizes postoperative complications,aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival.This method warrants further clinical application and promotion.展开更多
Total nitrogen(TN)removal is one of the key issues in improving water quality,while the traditional nitrification-denitrification process with its high energy consumption is unsustainable,due to greenhouse gas(GHG)emi...Total nitrogen(TN)removal is one of the key issues in improving water quality,while the traditional nitrification-denitrification process with its high energy consumption is unsustainable,due to greenhouse gas(GHG)emission.A method using organic-inorganic pellets and selectedmicroalgae that can operate without electricity consumption was designed for TN removal in actual wastewater treatment.The results showed that the TN removal efficiencies with different pellets were 88.2%±2.2%,86.6%±3.0%,85.4%±4.3%,and 82.3%±6.5%,respectively.Microalgae assimilated inorganic nitrogen within cells,resulting in a significant positive relationship with TN(P<0.05),and effectively removed TNthrough sedimentation.The pellets adsorbed nitrogen andmicroorganisms,released organic substances to regulate the ratio of water chemical oxygen demand(COD)to TN,and correspondingly influenced microbial growth.Microalgae and bacteria such as Romboutsia,Proteiniclasticum,and Rhodopseudomonas cooperated to form a mixed aerobic(water)-anaerobic(pellets)environment in the devices,and acted synergistically to remove TN.This study verifies the feasibility of TN removal with only solar energy in a low flow application in large spaces,benefiting carbon neutrality in wastewater treatment.展开更多
Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb align...Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb alignment.While studies have shown how TKA improves knee symptoms,the relationship between the operated knee with the hip and ankle remains understudied.A prospective study by Buterin et al showed a significant relationship between reduced ankle symptoms and better TKA recovery.The objective of this paper is to explore ways to expand the completed study to make it more widely applicable.These include sampling patients from multiple surgical centers in different cultural backgrounds,including different etiologies of OA,extending the study time points,and evaluating the contralateral limb.Together,the study by Buterin et al combined with future work can elucidate new TKA rehabilitation techniques which focus on the entire lower extremity.展开更多
BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of sali...BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of salivary fistula remains a major complication.This study aims to compare the stapler and hand-sewn techniques for esophageal closure and evaluate their impact on fistula formation.AIM To compare stapler-assisted and hand-sewn esophageal closure techniques after laryngectomy regarding their impact on salivary fistula formation.METHODS A total of 52 patients(44 men,8 women),aged 43 to 77 years,underwent total laryngectomy.Esophageal reconstruction was performed using either a stapler(29 patients)or a hand-sewn technique(23 patients).A surgical stapler TA was used for esophageal closure in the stapler group.Patients were clinically monitored for fistula formation during the first 7 days postoperatively and again two weeks after discharge using fiberoptic examination.RESULTS A total of 22 salivary fistulas were recorded:17(77.3%)occurred following the hand-sewn technique,while 5(22.7%)developed in the stapler group.Addi-tionally,preoperative radiotherapy was identified as a statistically significant risk factor for fistula formation.No technical complications related to the stapler device were observed.CONCLUSION Although hand-sewn closure is commonly used after total laryngectomy,stapler-assisted closure shows lower fistula rates and is a viable esophageal reconstruction alternative.展开更多
BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival...BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.AIM To assess the potential of preoperative total bilirubin-albumin(B/A)ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.METHODS A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study.Normality test,t-test,Wilcoxon test,χ2 test,or Fisher’s exact test was employed to analyze the intraoperative and postoperative conditions of the patients.Receiver operating characteristic(ROC)curve analysis was utilized to depict the 10-year overall survival rate.RESULTS During the follow-up period,85.99%of the patients survived,with a median survival time of 64.6 months.Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival(P=0.037).ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value.Consequently,the patients were categorized into two groups:High B/A group(n=64)and low B/A group(n=193).The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months,respectively(P=0.045).Notably,the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group(P<0.001).Patients with hepatocellular carcinoma(HCC)had lower overall survival rates.Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not,early Child-Pugh grade,low albumin-bilirubin grade,and model for end-stage liver disease score≥10(log-rank test,P<0.001 for all).CONCLUSION The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virusrelated cirrhosis following splenectomy,and a higher B/A ratio may suggest a poorer prognosis.展开更多
The authors regret that in the original article,the structure of(–)-swainsonine(1)in Graphical abstract,Fig.1,Schemes 1 and 3 was incorrect.The correct structure is shown here.
BACKGROUND For patients with advanced gastric cancer,surgical resection remains the main treatment option.Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can signif...BACKGROUND For patients with advanced gastric cancer,surgical resection remains the main treatment option.Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can significantly prolong the survival of patients.Digestive tract reconstruction after total gastrectomy is essential to maintain gastrointestinal function and optimize postoperative recovery.Therefore,it is very important to choose a suitable reconstruction method to improve the quality of life of total gastrectomy patients.AIM To evaluate the effects of different digestive tract reconstruction methods in gastric cancer patients undergoing total gastrectomy.METHODS This retrospective study included 172 patients who underwent total gastrectomy for gastric cancer at The First Hospital of Hebei Medical University for analysis.The patients were categorized into two groups:Group A,consisting of 90 patients who underwent modified Roux-en-Y gastrojejunostomy,and group B,consisting of 82 patients who underwent uncut Roux-en-Y gastrojejunostomy.The general patient characteristics,perioperative indicators,postoperative gastrointestinal mucosal barrier function,nutritional status,immunological markers,and occurrence of complications were compared between the two groups.RESULTS Group A showed shorter digestive tract reconstruction time than group B(P<0.05).On the first postoperative day,group A showed lower serum levels of D-lactate,diamine oxidase,and endotoxin than group B(P<0.05).One month postoperatively,group A showed higher prognostic nutritional index,serum albumin,total protein,and body weight than group B(P<0.05).One month postoperatively,the levels of cluster of differentiation(CD)3+,CD4+,and CD8+cells were not significantly different between two groups(P>0.05).The complication rates were 10.00%in group A and 24.39%in group B;group A had a significantly lower complication rate than group B(P<0.05).CONCLUSION Using modified Roux-en-Y gastrojejunostomy during total gastrectomy shortens the time required for gastrointestinal anastomosis,reduces surgery-induced gastrointestinal mucosal damage,and mitigates postoperative declines in nutritional status.展开更多
BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migr...BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migration near the esophagojejunal anastomosis(EJA),resulting in persistent drainage and mimicking EJAL after total gastrectomy.CASE SUMMARY A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma,with two silicone drains placed near the EJA.On postoperative day(POD)4,the patient developed signs of peritonitis and sepsis,necessitating surgical re-exploration abscess drainage,peritoneal lavage,and drain repositioning.A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection.Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59,which revealed approximately 5 cm of the drain within the esophagus,with the perforation site located 2 cm distal to the intact EJA.The drain was repositioned under endoscopic guidance.A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain.The patient was subsequently discharged without further incident.CONCLUSION Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.展开更多
Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the ra...Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the rapid development of digital technology,AR has been increasingly adopted in orthopedic surgeries across the globe,especially in total knee arthroplasty procedures which demand high precision.By overlaying digital information onto the surgeon's field of view,AR systems enhance precision,improve alignment accuracy,and reduce the risk of complications associated with malalignment.Some concerns have been raised despite accuracy,including the learning curve,long-term outcomes,and technical limitations.Furthermore,it is essential for health practitioners to gain trust in the utilisation of AR.展开更多
BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the firs...BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA,hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.METHODS We conducted an observational,descriptive and analytic,retrospective cohort study involving patients over 65 years old who were indicated for TKA.Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires,between June 2015 and July 2019.Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9,while functional ability was evaluated using the Knee Society Score(KSS).RESULTS Of the 100 patients analyzed,22(22%)screened positive for depression.The mean age was 80 years±6.3 years,with an average of 77.6 years±6 years in the depressed group and 80.6 years±6.3 years in the non-depressed group(P=0.05).Depressed patients showed significantly greater cognitive impairment[clock-face drawing test median:5(3-6)vs 6(5-7),P=0.06]and more risk factors for confusional syndrome(mean:8±2 vs 6.5±2.2,P=0.006).Frailty was also more prevalent in depressed patients[Edmonton:15(68%)vs 33(42%),P=0.05;Fried:17(77%)vs 42(54%),P=0.05].Postoperative Functional KSS were similar between groups(depressed:65±22.1 vs non-depressed:66.3±20.3,P=0.8).Linear regression analysis revealed no association between depression and changes in KSS.Spearman’s rank correlation coefficients were-0.0304(P=0.8)for Functional KSS variation and-0.1(P=0.3)for KSS variation.CONCLUSION Depression in patients with osteoarthritis should not hinder surgical planning.Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome,cognitive impairment,and frailty.展开更多
BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in th...BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis,hips,and knees,the inverse relationship concerning knee pathology undergoing total knee arthroplasty(TKA)has been examined by a limited number of studies,yielding inconclusive results.AIM To generate evidence of the effect of TKA on the SSA from existing literature.METHODS Databases like PubMed,EMBASE,and Scopus were used to identify articles related to the“knee spine syndrome”phenomenon using a combination of subject terms and keywords such as“spinopelvic parameters”,“sagittal spinal balance”,and“total knee arthroplasty”were used with appropriate Boolean operators.Studies measuring the SSA following TKA were included,and research was conducted as per preferred reporting items for systematic review and metaanalysis guidelines.RESULTS A total of 475 participants had undergone TKA,and six studies measuring SSA were analysed.Following TKA,pelvic tilt was the only parameter that showed significant changes,while lumbar lordosis(LL),pelvic incidence,and sacral slope were non-significant,as evident from the forest plots.CONCLUSION The body's sagittal alignment is a complex balance between pelvic,spine,and lower extremity parameters.TKA,while having the potential to correct the flexion contracture,can also correct it.Still,the primary SSA for spinal pathology,i.e.,LL,may not be corrected in patients with co-existent spinal degenerative disease.展开更多
基金Supported by Health Research Project of Hunan Provincial Health Commission,No.D202315018915.
文摘BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.
基金supported by the Pioneer and Leading Goose R&D Program of Zhejiang Province(No.2024C03106)the National Natural Science Foundation of China(No.U23A20513)+1 种基金Ningbo Top Medical and Health Research Program(No.2022030309)the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine(No.ZYYCXTD-D-202002).
文摘Coptis chinensis Franch.and Panax ginseng C.A.Mey.are traditional herbal medicines with millennia of documented use and broad therapeutic applications,including anti-diabetic properties.However,the synergistic effect of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng on type 2 diabetes mellitus(T2DM)and its underlying mechanism remain unclear.The research demonstrated that the optimal ratio of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng was 4∶1,exhibiting maximal efficacy in improving insulin resistance and gluconeogenesis in primary mouse hepatocytes.This combination demonstrated significant synergistic effects in improving glucose tolerance,reducing fasting blood glucose(FBG),the weight ratio of epididymal white adipose tissue(eWAT),and the homeostasis model assessment of insulin resistance(HOMA-IR)in leptin receptor-deficient(db/db)mice.Subsequently,a T2DM liver-specific network was constructed based on RNA sequencing(RNA-seq)experiments and public databases by integrating transcriptional properties of disease-associated proteins and protein-protein interactions(PPIs).The network recovery index(NRI)score of the combined treatment group with a 4∶1 ratio exceeded that of groups treated with individual components.The research identified that activated adenosine 5'-monophosphate-activated protein kinase(AMPK)/acetyl-CoA carboxylase(ACC)signaling in the liver played a crucial role in the synergistic treatment of T2DM,as verified by western blot experiment in db/db mice.These findings demonstrate that the 4∶1 combination of total alkaloids from Coptis chinensis and total ginsenosides from Panax ginseng significantly improves insulin resistance and glucose and lipid metabolism disorders in db/db mice,surpassing the efficacy of individual treatments.The synergistic mechanism correlates with enhanced AMPK/ACC signaling pathway activity.
基金supported by the CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-008)the National High Level Hospital Clinical Research Funding(No.2023-GSP-GG-2&No.2023-GSP-QN-34&No.2023-GSPRC-05).
文摘BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.
基金supported by the National Science Foundation for Distinguished Young Scholars(No.42425107)Ecological Civilization Special Project of Key Research&and Development Program in Gansu Province(No.24YFFA009)the Top Talent Project of Gansu Province,Chinese Academy of Sciences Young Crossover Team Project(No.JCTD-2022-18)。
文摘The alpine ecosystem has great potential for carbon sequestration.Soil organic carbon(SOC)and total nitrogen(TN)are highly sensitive to climate change,and their dynamics are crucial to revealing the effect of climate change on the structure,function,and services of the ecosystem.However,the spatial distribution and controlling factors of SOC and TN across various soil layers and vegetation types within this unique ecosystem remain inadequately understood.In this study,256 soil samples in 89 sites were collected from the Three River Headwaters Region(TRHR)in China to investigate SOC and TN and to explore the primary factors affecting their distribution,including soil,vegetation,climate,and geography factors.The results show that SOC and TN contents in 0-20,20-40,40-60,and 60-80 cm soil layers are 24.40,18.03,14.04,12.40 g/kg and 2.46,1.90,1.51,1.17 g/kg,respectively;with higher concentrations observed in the southeastern region compared to the northwest of the TRHR.One-way analysis of variance reveals that SOC and TN levels are elevated in the alpine meadow and the alpine shrub relative to the alpine steppe in the 0-60 cm soil layers.The structural equation model explores that soil water content is the main controlling factor affecting the variation of SOC and TN.Moreover,the geography,climate,and vegetation factors notably indirectly affect SOC and TN through soil factors.Therefore,it can effectively improve soil water and nutrient conditions through vegetation restoration,soil improvement,and grazing management,and the change of SOC and TN can be fully understood by establishing monitoring networks to better protect soil carbon and nitrogen.
文摘Continuous research on Cephalotaxus plants has ultimately led to the US food and drug administration (FDA) ap-provalof homoharringtonine in 2012 for the treatment of chronic myeloid leukemia. Additionally, another important class of natural products from Cephalotaxus plants is cephalotane diterpenoids. Since the discovery of the first member, harring-tonolide,in 1978, cephalotane diterpenoids have garnered significant attention from the scientific community due to their re-markableanti-cancer activity. The unique structural features of cephalotane diterpenoids, a 7/6/5/6-fused tetracyclic carbon skeleton and a bridged lactone, make them ideal targets for synthetic chemists. Successfully synthesizing these complex diterpenoids is of great importance for the discovery and development of anti-tumor drugs. To date, ten research groups have completed the total synthesis of 24 cephalotane diterpenoids. The latest progress in the total synthesis of cephalotane diterpe-noidsis reviewed, showcasing the importance of these innovative synthetic strategies in the efficient synthesis of complex natural products and their potential significance in advancing the field of drug discovery.
文摘BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.
文摘BACKGROUND Total knee arthroplasty(TKA)aims to restore motion and alleviate pain,enabling patients to return to daily activities.Despite advances in implants,surgery,and perioperative care,patient dissatisfaction rates remain significant.AIM To determine whether ankle symptoms are associated with inferior results of functional recovery of the knee following TKA.METHODS This prospective study included all patients with advanced knee osteoarthritis who underwent a primary unilateral TKA between August 2019 and December 2019 with data documented by the treating surgeon and outpatient physical therapists.Patients were categorized based on ankle symptoms using the Ame-rican Orthopaedic Foot and Ankle Society(AOFAS)score:(1)Group 1(AOFAS≤85,n=30);and(2)Group 2(AOFAS>85,n=49).Active range of motion(ROM),the Knee Injury and Osteoarthritis Outcome Score(KOOS),and the visual ana-logue scale(VAS)were compared between two groups.RESULTS Postoperative KOOS,ROM,and VAS significantly improved in both groups(P<0.001).However,at three months,KOOS(P=0.02)and extension motion(P=0.01)improvements were significantly greater in group 2.CONCLUSION These findings suggest that preoperative ankle symptoms may negatively impact early knee functional recovery,particularly in KOOS scores and extension motion.
文摘Retrieval analysis in total knee arthroplasty(TKA)has been little studied in the literature.A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted.On August 27,2024,a literature search was performed in PubMed using“TKA retrieval analysis”as keywords.A total of 160 articles were found,of which only 19 were analyzed because they were directly related to the subject of this article.Rotating-platform(mobile-bearing)TKA has no surface damage advantage over fixed-bearing TKA.TKAs with central locking mechanisms are more prone to debond from the cement mantle.No major wear of the polyethylene(PE)component in TKA using oxidized zirconium components occurs.Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components.The use of a polished tibial tray over an unpolished design is advised.At short-run assessment(15 months on average),antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage,density of crosslinking,or oxidation compared to standard remelted highly crosslinked PE components.A correlation between implant position and PE component surface damage has been reported.It shows the importance of optimizing component position to reduce PE component damage.Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge.Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform.Such information can help to improve future prosthetic designs to increase prosthetic survival.
基金the National Natural Science Foundation of China(No.22471224)。
文摘A category of highly fused diterpenoid natural products possessing a characteristic perhydropyrene-like or rearranged tetracyclic skeleton structure are distributed in different life forms.Compared to traditional polycyclic diterpenoids,their biosynthetic pathways are quite unique and diverse.Chemists have pinpointed a range of this type of unusual diterpenoids:cycloamphilectanes and isocycloamphilectanes,kempenes and rippertanes,hydropyrene and hydropyrenol,along with recently disclosed cephalotanes.This review describes developments in this field and discusses the challenges associated with synthesizing this class of highly complex compounds.
文摘BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the postoperative life of the patient.Currently,the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC.However,more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure,with more reconstruction steps and longer reconstruction time,and the incidence of postoperative complications such as adhesive intestinal obstruction,internal abdominal hernia and volvulus is high.Moreover,the incidence of Roux stasis syndrome is 10%-30%after traditional Roux-en-Y reconstruction.Thus,we modified the traditional Roux-en-Y alimentary tract reconstruction,and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.AIM To evaluate the clinical advantages,feasibility,and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy(total gastrectomy)for GC were divided into two groups:fifty-four in the conventional Roux-en-Y reconstruction group(Orr group)and forty-three in the modified Roux-en-Y reconstruction group(the modified group).Perioperative and short-term outcomes were analyzed,including complications,postoperative weight loss,hemoglobin levels,and nutritional status.RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics.Compared with the Orr group,the modified group had shorter digestive tract reconstruction and operation times,less intraoperative bleeding,and shorter postoperative hospital stays compared to the Orr group.Although both groups had similar amounts of intraoperative blood loss,postoperative recovery times,and hospital expenses,the Orr group experienced longer operation times and digestive tract reconstruction times.Furthermore,the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications,with a reduced incidence of reflux esophagitis and improved nutritional status.CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety,simplicity,and a reduction in bile reflux.This method shortens operation times and minimizes postoperative complications,aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival.This method warrants further clinical application and promotion.
文摘Total nitrogen(TN)removal is one of the key issues in improving water quality,while the traditional nitrification-denitrification process with its high energy consumption is unsustainable,due to greenhouse gas(GHG)emission.A method using organic-inorganic pellets and selectedmicroalgae that can operate without electricity consumption was designed for TN removal in actual wastewater treatment.The results showed that the TN removal efficiencies with different pellets were 88.2%±2.2%,86.6%±3.0%,85.4%±4.3%,and 82.3%±6.5%,respectively.Microalgae assimilated inorganic nitrogen within cells,resulting in a significant positive relationship with TN(P<0.05),and effectively removed TNthrough sedimentation.The pellets adsorbed nitrogen andmicroorganisms,released organic substances to regulate the ratio of water chemical oxygen demand(COD)to TN,and correspondingly influenced microbial growth.Microalgae and bacteria such as Romboutsia,Proteiniclasticum,and Rhodopseudomonas cooperated to form a mixed aerobic(water)-anaerobic(pellets)environment in the devices,and acted synergistically to remove TN.This study verifies the feasibility of TN removal with only solar energy in a low flow application in large spaces,benefiting carbon neutrality in wastewater treatment.
文摘Osteoarthritis(OA)is an extremely prevalent degenerative joint disease which commonly occurs in the knee.In severe cases of knee OA,total knee arthroplasty(TKA)is often indicated to relieve pain and restore limb alignment.While studies have shown how TKA improves knee symptoms,the relationship between the operated knee with the hip and ankle remains understudied.A prospective study by Buterin et al showed a significant relationship between reduced ankle symptoms and better TKA recovery.The objective of this paper is to explore ways to expand the completed study to make it more widely applicable.These include sampling patients from multiple surgical centers in different cultural backgrounds,including different etiologies of OA,extending the study time points,and evaluating the contralateral limb.Together,the study by Buterin et al combined with future work can elucidate new TKA rehabilitation techniques which focus on the entire lower extremity.
文摘BACKGROUND The rising incidence of laryngeal cancer has led to an increasing number of total laryngectomy procedures.While voice prostheses have significantly improved post-laryngectomy rehabilitation,the risk of salivary fistula remains a major complication.This study aims to compare the stapler and hand-sewn techniques for esophageal closure and evaluate their impact on fistula formation.AIM To compare stapler-assisted and hand-sewn esophageal closure techniques after laryngectomy regarding their impact on salivary fistula formation.METHODS A total of 52 patients(44 men,8 women),aged 43 to 77 years,underwent total laryngectomy.Esophageal reconstruction was performed using either a stapler(29 patients)or a hand-sewn technique(23 patients).A surgical stapler TA was used for esophageal closure in the stapler group.Patients were clinically monitored for fistula formation during the first 7 days postoperatively and again two weeks after discharge using fiberoptic examination.RESULTS A total of 22 salivary fistulas were recorded:17(77.3%)occurred following the hand-sewn technique,while 5(22.7%)developed in the stapler group.Addi-tionally,preoperative radiotherapy was identified as a statistically significant risk factor for fistula formation.No technical complications related to the stapler device were observed.CONCLUSION Although hand-sewn closure is commonly used after total laryngectomy,stapler-assisted closure shows lower fistula rates and is a viable esophageal reconstruction alternative.
文摘BACKGROUND Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis.However,the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.AIM To assess the potential of preoperative total bilirubin-albumin(B/A)ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.METHODS A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study.Normality test,t-test,Wilcoxon test,χ2 test,or Fisher’s exact test was employed to analyze the intraoperative and postoperative conditions of the patients.Receiver operating characteristic(ROC)curve analysis was utilized to depict the 10-year overall survival rate.RESULTS During the follow-up period,85.99%of the patients survived,with a median survival time of 64.6 months.Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival(P=0.037).ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value.Consequently,the patients were categorized into two groups:High B/A group(n=64)and low B/A group(n=193).The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months,respectively(P=0.045).Notably,the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group(P<0.001).Patients with hepatocellular carcinoma(HCC)had lower overall survival rates.Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not,early Child-Pugh grade,low albumin-bilirubin grade,and model for end-stage liver disease score≥10(log-rank test,P<0.001 for all).CONCLUSION The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virusrelated cirrhosis following splenectomy,and a higher B/A ratio may suggest a poorer prognosis.
文摘The authors regret that in the original article,the structure of(–)-swainsonine(1)in Graphical abstract,Fig.1,Schemes 1 and 3 was incorrect.The correct structure is shown here.
文摘BACKGROUND For patients with advanced gastric cancer,surgical resection remains the main treatment option.Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can significantly prolong the survival of patients.Digestive tract reconstruction after total gastrectomy is essential to maintain gastrointestinal function and optimize postoperative recovery.Therefore,it is very important to choose a suitable reconstruction method to improve the quality of life of total gastrectomy patients.AIM To evaluate the effects of different digestive tract reconstruction methods in gastric cancer patients undergoing total gastrectomy.METHODS This retrospective study included 172 patients who underwent total gastrectomy for gastric cancer at The First Hospital of Hebei Medical University for analysis.The patients were categorized into two groups:Group A,consisting of 90 patients who underwent modified Roux-en-Y gastrojejunostomy,and group B,consisting of 82 patients who underwent uncut Roux-en-Y gastrojejunostomy.The general patient characteristics,perioperative indicators,postoperative gastrointestinal mucosal barrier function,nutritional status,immunological markers,and occurrence of complications were compared between the two groups.RESULTS Group A showed shorter digestive tract reconstruction time than group B(P<0.05).On the first postoperative day,group A showed lower serum levels of D-lactate,diamine oxidase,and endotoxin than group B(P<0.05).One month postoperatively,group A showed higher prognostic nutritional index,serum albumin,total protein,and body weight than group B(P<0.05).One month postoperatively,the levels of cluster of differentiation(CD)3+,CD4+,and CD8+cells were not significantly different between two groups(P>0.05).The complication rates were 10.00%in group A and 24.39%in group B;group A had a significantly lower complication rate than group B(P<0.05).CONCLUSION Using modified Roux-en-Y gastrojejunostomy during total gastrectomy shortens the time required for gastrointestinal anastomosis,reduces surgery-induced gastrointestinal mucosal damage,and mitigates postoperative declines in nutritional status.
文摘BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migration near the esophagojejunal anastomosis(EJA),resulting in persistent drainage and mimicking EJAL after total gastrectomy.CASE SUMMARY A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma,with two silicone drains placed near the EJA.On postoperative day(POD)4,the patient developed signs of peritonitis and sepsis,necessitating surgical re-exploration abscess drainage,peritoneal lavage,and drain repositioning.A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection.Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59,which revealed approximately 5 cm of the drain within the esophagus,with the perforation site located 2 cm distal to the intact EJA.The drain was repositioned under endoscopic guidance.A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain.The patient was subsequently discharged without further incident.CONCLUSION Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.
基金Supported by The Hunan Provincial Natural Science Foundation of China,No.2023JJ30773,No.2025JJ60480,and No.2025JJ60552The Scientific Research Program of The Hunan Provincial Health Commission,No.202204072544+4 种基金The Science and Technology Innovation Program of Hunan Province,No.2024RC3053The CBT ECR/MCR Scheme,No.324910-0028/07National Natural Science Foundation of China,No.32300652The Scientific Research Program of Hunan Provincial Health Commission,No.W20243023The Scientific Research Launch Project for New Employees of The Second Xiangya Hospital of Central South University.
文摘Augmented reality(AR)is a technology that superimposes digital information onto real-world objects via head-mounted display devices to improve surgical finesse through visually enhanced medical information.With the rapid development of digital technology,AR has been increasingly adopted in orthopedic surgeries across the globe,especially in total knee arthroplasty procedures which demand high precision.By overlaying digital information onto the surgeon's field of view,AR systems enhance precision,improve alignment accuracy,and reduce the risk of complications associated with malalignment.Some concerns have been raised despite accuracy,including the learning curve,long-term outcomes,and technical limitations.Furthermore,it is essential for health practitioners to gain trust in the utilisation of AR.
文摘BACKGROUND The prevalence of depressive symptoms in patients undergoing total knee arthroplasty(TKA)ranges from 22%to 26%.The impact of depression on functional status post-TKA remains controversial.AIM To be the first study in Latin American population to evaluate the association between depression and functional status one year after TKA,hypothesizing that elderly patients with depression will demonstrate lower rates of functional improvement.METHODS We conducted an observational,descriptive and analytic,retrospective cohort study involving patients over 65 years old who were indicated for TKA.Assessments were made via the Program for Determination and Management of Risks for Practices and Procedures of the Division of Geriatric Medicine at the Italian Hospital of Buenos Aires,between June 2015 and July 2019.Depression screening was conducted using Yesavage’s abbreviated score and Patient Health Questionnaire-9,while functional ability was evaluated using the Knee Society Score(KSS).RESULTS Of the 100 patients analyzed,22(22%)screened positive for depression.The mean age was 80 years±6.3 years,with an average of 77.6 years±6 years in the depressed group and 80.6 years±6.3 years in the non-depressed group(P=0.05).Depressed patients showed significantly greater cognitive impairment[clock-face drawing test median:5(3-6)vs 6(5-7),P=0.06]and more risk factors for confusional syndrome(mean:8±2 vs 6.5±2.2,P=0.006).Frailty was also more prevalent in depressed patients[Edmonton:15(68%)vs 33(42%),P=0.05;Fried:17(77%)vs 42(54%),P=0.05].Postoperative Functional KSS were similar between groups(depressed:65±22.1 vs non-depressed:66.3±20.3,P=0.8).Linear regression analysis revealed no association between depression and changes in KSS.Spearman’s rank correlation coefficients were-0.0304(P=0.8)for Functional KSS variation and-0.1(P=0.3)for KSS variation.CONCLUSION Depression in patients with osteoarthritis should not hinder surgical planning.Identifying and treating depression preoperatively may enhance outcomes such as pain relief and reduce risks of acute confusional syndrome,cognitive impairment,and frailty.
文摘BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis,hips,and knees,the inverse relationship concerning knee pathology undergoing total knee arthroplasty(TKA)has been examined by a limited number of studies,yielding inconclusive results.AIM To generate evidence of the effect of TKA on the SSA from existing literature.METHODS Databases like PubMed,EMBASE,and Scopus were used to identify articles related to the“knee spine syndrome”phenomenon using a combination of subject terms and keywords such as“spinopelvic parameters”,“sagittal spinal balance”,and“total knee arthroplasty”were used with appropriate Boolean operators.Studies measuring the SSA following TKA were included,and research was conducted as per preferred reporting items for systematic review and metaanalysis guidelines.RESULTS A total of 475 participants had undergone TKA,and six studies measuring SSA were analysed.Following TKA,pelvic tilt was the only parameter that showed significant changes,while lumbar lordosis(LL),pelvic incidence,and sacral slope were non-significant,as evident from the forest plots.CONCLUSION The body's sagittal alignment is a complex balance between pelvic,spine,and lower extremity parameters.TKA,while having the potential to correct the flexion contracture,can also correct it.Still,the primary SSA for spinal pathology,i.e.,LL,may not be corrected in patients with co-existent spinal degenerative disease.
