This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemor...This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemorrhoidal disease, to identify the contributing factors, describe the clinical and therapeutic aspects and analyze the surgical consequences. We collected 73 patients with an average age of 37.8 years (range: 19 years and 77 years) with a sex ratio of 2.5 in favor of men. We operated on 49 patients or 67.1% of cases. 71.2% of our patients were married and lived in Bamako. Schoolchildren and middle managers made up 39.8% of cases. 82.2% of patients were seen in ordinary consultation and 69.9% complained of progressive anal pain in 66.7% of cases. This pain was triggered by defecation in 88.2% of our patients. The contributing factors were dominated by constipation (53.4%), working in a seated position (41.1%) and a sedentary lifestyle (16.4%) of cases. Stage IV external hemorrhoids and hemorrhoidal thrombosis represented 53.8% of surgical indications. The most used surgical technique was that of Milligan-Morgan, i.e. 51.9% of cases and 45.2% of patients treated medically received a combination of transit regulator, venotonics and analgesics. The surgical aftermath was marked by hemorrhage (3 cases), delayed healing (5 cases), urinary retention (1 case) and scarring anal stenosis (1 case). The morbidity rate was 5.48% of cases and a zero mortality rate. The average length of hospitalization was 2 days with extremes of 1 and 5 days.展开更多
We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases i...We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic shock and abdominal pain and decrease on blood pressure were the prominent clinical symptoms with 100.0%, and 50.0% of cases, respectively. Abdominal ultrasound and abdominal x-ray without contrast were performed in 67.0% and 18.0% of cases, respectively. Abdominal trauma was divided into two entities: contusion 68% and wounds 32%. Medical treatment was sufficient in 23.00% of cases. Laparotomy as a surgical approach was performed in 77.0% of cases. Local hemostasis plus drainage (27.08%), splenectomy (25.00%), suture (14.58%), hemostasis by tamponade (8.33%) and colostomy (2.08%) were undertaken as surgical procedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative follow-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.展开更多
BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclea...BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclear.AIM To clarify the impact of relevant factors,particularly perirenal fat,on postoperative hypertension resolution.METHODS In this retrospective single-center study,a total of 138 patients with obesity and hypertension were included,all of whom underwent LSG in the hospital and were followed up for one year.Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution.Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution,and their predictive values were compared using fivefold cross-validation.RESULTS After LSG,107 patients(77.5%)experienced hypertension resolution,while 31 patients(22.5%)did not achieve resolution.Both the preoperative perirenal fat area(PrFA)and perirenal fat thickness were independent risk factors for postoperative hypertension resolution(P<0.001 vs P=0.002).These factors are curvilinearly correlated with the hypertension resolution rate,but PrFA has a better predictive value than perirenal fat thickness dose(area under the curve=0.846 vs 0.809).Compared with those with PrFA≥18 cm2,patients with PrFA<18 cm2 had a higher hypertension resolution rate[87%vs 68.1%;odds ratio(95%confidence interval)=3.513(1.367-9.902),P=0.012].CONCLUSION PrFA is a preoperative predictor of postoperative hypertension resolution.It is curvilinearly associated with the resolution rate,and patients with PrFA<18 cm²have better hypertension resolution outcomes after LSG.展开更多
Postoperative complications represent important indicators for the quality of surgical care. The objectives of this work were to study post-operative complications in the general surgery department of the Cs ref of co...Postoperative complications represent important indicators for the quality of surgical care. The objectives of this work were to study post-operative complications in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of post-operative complications, to identify the factors of occurrence, to describe the clinical aspects, diagnostic and therapeutic in order to assess the additional cost linked to post-operative complications. This study was prospective, carried out in the general surgery department on 300 cases of surgical interventions. It covered all patients aged at least 15 years, operated on and hospitalized or not, and who presented complications during the 30 days postoperatively. Patients under the age of 15 were not included (our general surgery department is not a pediatric surgery department). We collected 300 patients among whom 199 (66.33%) were men and 101 (33.66%) women, i.e. a sex ratio = 1.9. The average age was 38 years with extremes of 15 and 87 years. The main initial diagnoses were: acute appendicitis, peritonitis, occlusions, wall hernias, hemorrhoids, uterine prolapse, uterine myomas, ovarian cysts and acute cholecystitis. Emergencies represented 43% (N = 129) of interventions with 6.98% post-operative complications (POC). Postoperative complications were dominated by surgical site infections, 75% of cases (N = 20), wall hemorrhage 5% (N = 1), testicular necrosis 5% (N = 1) and testicular calcification 5% (N = 1), wire rejection 5% (N = 1) and death 5% (N = 1). The management of postoperative complications was surgical in 95% and medical in 100%. Their occurrence extended the hospital stay by 3.65 days and increased the average cost of care by 60541.85 CFA francs. The mortality index lowered by efficient management of complications (IMAGE) calculated in relation to deaths was 95% of cases. Anemia, ASA score ≥ III, Alteimeir II and IV classes, duration of surgery and post-operative hospitalization were factors contributing to post-operative complications.展开更多
Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to stu...Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of cases and hematoma: 1.7%). The immediate consequences were simple in 96.6% of cases. No cases of recurrence occurred during the 6 months after the intervention. The average cost of care was estimated at 69,743 FCFA.展开更多
Introduction: The aim of this study was to report the indications and evaluate the results of vulvectomy in the general surgery department of Ignace Deen Hospital, CHU Conakry. Materials and Methods: This was a retros...Introduction: The aim of this study was to report the indications and evaluate the results of vulvectomy in the general surgery department of Ignace Deen Hospital, CHU Conakry. Materials and Methods: This was a retrospective descriptive study, conducted over a period of five (05) years from January 1, 2018 to December 31, 2022, in the general surgery department of Ignace Deen Hospital, CHU Conakry. We included in our study all patient records in whom vulvectomy was performed. Results: We recorded 15 cases of vulvectomy out of 453 perineal surgeries, i.e. 3.31%, with a mean age of 43.56 years and extremes of 35 and 69 years. Vulvar cancer was the most common diagnosis (46.67%), followed by Buschke-Lowenstein (33.33%) and anal canal cancer extending to the vulva (20%). Six patients had undergone biopsy (40%). Vulvectomy with lymph node dissection was performed in only 9 patients (60%), and all surgical specimens were sent to anatomical pathology (100%). Conclusion: Vulvectomy is a surgical technique most often indicated for the treatment of vulvar cancer.展开更多
Introduction: Intestinal resection is the disconnection or removal of part of the intestine with its meso. The aim was to describe the indications and prognostic factors for intestinal resections at the surgical depar...Introduction: Intestinal resection is the disconnection or removal of part of the intestine with its meso. The aim was to describe the indications and prognostic factors for intestinal resections at the surgical department of Kankan Regional Hospital. Patients and Methods: This was a retrospective descriptive study covering the files of patients who had undergone intestinal resections in the surgery department of the Kankan regional hospital over a period of 4 years from 1st January 2019 to December 31, 2022. Results: We collected 164 cases of intestinal resection representing 4.19% of all surgical procedures. (N = 3909). The average age of our patients was 37.78 years with extremes of 1 and 90 years. The male gender was predominant (64.6%) and the sex ratio was 1.8. The majority of patients consulted after 72 hours. Acute intestinal obstruction was the pathology motivating the most intestinal resection 42.90% followed by acute peritonitis 33%, digestive fistula 4.3%, tumors 3.6% and wounds 2.4%. Intestinal necrosis with 91 cases (56.5%) constituted the first indication for resection in our study followed by intestinal perforations 41 cases (24.9%). We performed an anastomotic resection of the small intestine in 70 cases (42.9%), an ileostomy in 4 cases (2.4%), a right hemi colectomy in 26 cases (15.9%), a left hemi colectomy in 2 cases (1.2%), segmental colectomy plus immediate anastomosis in 57 cases (34.2%) and 5 cases of colostomy. We recorded 48 deaths (29.3%). Conclusion: Intestinal resection is a common procedure in our context. These indications are multiple. An improvement in the prognosis should be achieved by reducing the diagnostic and treatment time associated with the training of surgical staff.展开更多
The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristic...The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.展开更多
Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Ho...Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.展开更多
BACKGROUND The objective of the current study was to elucidate the clinical mechanism through which phospholipase D2(PLD2)exerted a regulatory effect on neutrophil migra-tion,thereby alleviating the progression of acu...BACKGROUND The objective of the current study was to elucidate the clinical mechanism through which phospholipase D2(PLD2)exerted a regulatory effect on neutrophil migra-tion,thereby alleviating the progression of acute pancreatitis.AIM To elucidate the clinical mechanism through which PLD2 exerted a regulatory effect on neutrophil migration,thereby alleviating the progression of acute pan-creatitis.METHODS The study involved 90 patients diagnosed with acute pancreatitis,admitted to our hospital between March 2020 and November 2022.A retrospective analysis was conducted,categorizing patients based on Ranson score severity into mild(n=25),moderate(n=30),and severe(n=35)groups.Relevant data was collected for each group.Western blot analysis assessed PLD2 protein expression in patient serum.Real-time reverse transcription polymerase chain reaction was used to evaluate the mRNA expression of chemokine receptors associated with neutrophil migration.Serum levels of inflammatory factors in patients were detected using enzyme-linked immunosorbent assay.Transwell migration tests were conducted to compare migration of neutrophils across groups and analyze the influence of PLD2 on neutrophil migration.RESULTS Overall data analysis did not find significant differences between patient groups(P>0.05).The expression of PLD2 protein in the severe group was lower than that in the moderate and mild groups(P<0.05).The expression level of PLD2 in the moderate group was also lower than that in the mild group(P<0.05).The severity of acute pancreatitis is negatively correlated with PLD2 expression(r=-0.75,P=0.002).The mRNA levels of C-X-C chemokine receptor type 1,C-X-C chemokine receptor type 2,C-C chemokine receptor type 2,and C-C chemokine receptor type 5 in the severe group are significantly higher than those in the moderate and mild groups(P<0.05),and the expression levels in the moderate group are also higher than those in the mild group(P<0.05).The levels of C-reactive protein,tumor necrosis factor-α,interleukin-1β,and interleukin-6 in the severe group were higher than those in the moderate and mild groups(P<0.05),and the levels in the moderate group were also higher than those in the mild group(P<0.05).The number of migrating neutrophils in the severe group was higher than that in the moderate and mild groups(P<0.05),and the moderate group was also higher than the mild group(P<0.05).In addition,the number of migrating neutrophils in the mild group combined with PLD2 inhibitor was higher than that in the mild group(P<0.05),and the number of migrating neutrophils in the moderate group combined with PLD2 inhibitor was higher than that in the moderate group(P<0.05).The number of migrating neutrophils in the severe group+PLD2 inhibitor group was significantly higher than that in the severe group(P<0.05),indicating that PLD2 inhibitors significantly stimulated neutrophil migration.CONCLUSION PLD2 exerted a crucial regulatory role in the pathological progression of acute pancreatitis.Its protein expression varied among patients based on the severity of the disease,and a negative correlation existed between PLD2 expression and disease severity.Additionally,PLD2 appeared to impede acute pancreatitis progression by limiting neutrophil migration.展开更多
BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological me...Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological mechanisms underlying IPFD remain unclear,with several potential contributing factors,including oxida-tive stress,alterations in the gut microbiota,and hormonal imbalances.IPFD was found to be highly correlated with the occurrence and prognosis of exocrine pan-creatic diseases.Although imaging techniques remain the primary diagnostic approach for IPFD,an expanding array of biomarkers and clinical scoring systems have been identified for screening purposes.Currently,effective treatments for IPFD are not available;however,existing medications,such as glucagon-like peptide-1 receptor agonists,and new therapeutic approaches explored in animal models have shown considerable potential for managing this disease.This paper reviews the pathogenesis of IPFD,its association with exocrine pancreatic disea-ses,and recent advancements in its diagnosis and treatment,emphasizing the significant clinical relevance of IPFD.展开更多
BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literatu...BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.展开更多
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing...BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.展开更多
Introduction: Evaluating the quality of care offered is a reliable indicator of the effectiveness of a health system. Developing countries are still lagging behind in implementing these principles. This work aims to e...Introduction: Evaluating the quality of care offered is a reliable indicator of the effectiveness of a health system. Developing countries are still lagging behind in implementing these principles. This work aims to evaluate the satisfaction of patients operated on and hospitalized in the surgery department at the municipality’s reference health center over a period of 6 months (June 2020 to December 2020). Materials and Methods: This is a quantitative, qualitative, transversal and evaluative study over a period of 6 months based on a self-administered questionnaire to patients who underwent surgery and were hospitalized in the surgery department of the reference health center of commune I upon leaving their hospitalization. The questions are structured around welcome, respect and privacy, care, accommodation conditions as well as overall satisfaction. Results: The survey included 260 patients, 60.8% of whom were male. The 31 - 40 year old age group was in the majority and the majority had completed primary education (42.3%). Married patients were the majority, i.e. 60.4% of cases. Patients were not insured in 66.5% of cases. Almost all of the patients surveyed found that the welcome, care, waiting time, respect and privacy were satisfactory. On the other hand, patients found the rooms and beds uncomfortable. Conclusion: The satisfaction survey reveals worrying data regarding the comfort of patients who must challenge caregivers in healthcare structures. Decision-makers should find useful information there to improve the quality of care.展开更多
Introduction: Omphalocele is an embryopathy of the first ten weeks of gestation. It corresponds to a defect in the abdominal wall through which viscera contained in a sac constituted by the amniotic membrane and cente...Introduction: Omphalocele is an embryopathy of the first ten weeks of gestation. It corresponds to a defect in the abdominal wall through which viscera contained in a sac constituted by the amniotic membrane and centered by the umbilical cord are exteriorized. The objective of this work was to study the diagnostic modalities and the impact of our therapeutic choices on the outcome of the management. Material and Methods: We carried out a prospective study on patients with omphalocele admitted to the pediatric surgery departments of the HND, during a period spread over 4 years, between January 2017 and December 2020. Results: we collected 55 files (i.e., 13.7 cases/year). There were 38 boys and 17 girls (sex ratio 2.2) with an average age of 1.9 days. We found 15 cases (27%) of type I and 40 cases (73%) of type II according to the AITKEN classification. Fifteen cases (27%) benefited from surgical treatment and 45 cases (73%) benefited from conservative treatment (Grob). Two surgical methods were used: Primary parietal closure, which was used in 10 cases (66.7%), and the GROSS method, which was used in 5 cases (33.3%). We obtained an improvement of 40 cases (73%) and 15 cases (27%) of death. Conclusion: our work reported our experience in the management of omphalocele and the difficulties of postoperative resuscitation.展开更多
In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumo...In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumor.GISTs originate from the interstitial cells of Cajal,which are pacemaker cells involved in gut motility.GISTs are most commonly found in the stomach and small intestine,but esophageal involvement is rare.Esophageal GISTs account for<1%of all GISTs.Endoscopic resection remains the mainstay for small,localized tumors with excellent outcomes.However,larger tumors may require multidisciplinary strategies to provide the best oncological outcomes.Here,we discuss the usefulness of endoscopic ultrasound(EUS)of subepithelial tumors of the upper gastrointestinal tract.EUS is a crucial tool in the diagnosis,staging,and management of subepithelial masses.Given the subepithelial nature of these tumors,standard endoscopy is not adequate,making EUS essential for a comprehensive assessment.EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy,for treatment planning.展开更多
BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different tre...BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.展开更多
BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(D...BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.展开更多
An imbalance in adenosine-mediated signaling,particularly the increased A_(2A)R-mediated signaling,plays a role in the pathogenesis of Parkinson's disease.Existing therapeutic approaches fail to alter disease prog...An imbalance in adenosine-mediated signaling,particularly the increased A_(2A)R-mediated signaling,plays a role in the pathogenesis of Parkinson's disease.Existing therapeutic approaches fail to alter disease progression,demonstrating the need for novel approaches in PD.Repetitive transcranial magnetic stimulation is a non-invasive approach that has been shown to improve motor and non-motor symptoms of Parkinson's disease.However,the underlying mechanisms of the beneficial effects of repetitive transcranial magnetic stimulation remain unknown.The purpose of this study is to investigate the extent to which the beneficial effects of prolonged intermittent theta burst stimulation in the 6-hydroxydopamine model of experimental parkinsonism are based on modulation of adenosine-mediated signaling.Animals with unilateral 6-hydroxydopamine lesions underwent intermittent theta burst stimulation for 3 weeks and were tested for motor skills using the Rotarod test.Immunoblot,quantitative reverse transcription polymerase chain reaction,immunohistochemistry,and biochemical analysis of components of adenosine-mediated signaling were performed on the synaptosomal fraction of the lesioned caudate putamen.Prolonged intermittent theta burst stimulation improved motor symptoms in 6-hydroxydopamine-lesioned animals.A 6-hydroxydopamine lesion resulted in progressive loss of dopaminergic neurons in the caudate putamen.Treatment with intermittent theta burst stimulation began 7 days after the lesion,coinciding with the onset of motor symptoms.After treatment with prolonged intermittent theta burst stimulation,complete motor recovery was observed.This improvement was accompanied by downregulation of the e N/CD73-A_(2A)R pathway and a return to physiological levels of A_(1)R-adenosine deaminase 1 after 3 weeks of intermittent theta burst stimulation.Our results demonstrated that 6-hydroxydopamine-induced degeneration reduced the expression of A_(1)R and elevated the expression of A_(2A)R.Intermittent theta burst stimulation reversed these effects by restoring the abundances of A_(1)R and A_(2A)R to control levels.The shift in ARs expression likely restored the balance between dopamine-adenosine signaling,ultimately leading to the recovery of motor control.展开更多
文摘This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemorrhoidal disease, to identify the contributing factors, describe the clinical and therapeutic aspects and analyze the surgical consequences. We collected 73 patients with an average age of 37.8 years (range: 19 years and 77 years) with a sex ratio of 2.5 in favor of men. We operated on 49 patients or 67.1% of cases. 71.2% of our patients were married and lived in Bamako. Schoolchildren and middle managers made up 39.8% of cases. 82.2% of patients were seen in ordinary consultation and 69.9% complained of progressive anal pain in 66.7% of cases. This pain was triggered by defecation in 88.2% of our patients. The contributing factors were dominated by constipation (53.4%), working in a seated position (41.1%) and a sedentary lifestyle (16.4%) of cases. Stage IV external hemorrhoids and hemorrhoidal thrombosis represented 53.8% of surgical indications. The most used surgical technique was that of Milligan-Morgan, i.e. 51.9% of cases and 45.2% of patients treated medically received a combination of transit regulator, venotonics and analgesics. The surgical aftermath was marked by hemorrhage (3 cases), delayed healing (5 cases), urinary retention (1 case) and scarring anal stenosis (1 case). The morbidity rate was 5.48% of cases and a zero mortality rate. The average length of hospitalization was 2 days with extremes of 1 and 5 days.
文摘We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic shock and abdominal pain and decrease on blood pressure were the prominent clinical symptoms with 100.0%, and 50.0% of cases, respectively. Abdominal ultrasound and abdominal x-ray without contrast were performed in 67.0% and 18.0% of cases, respectively. Abdominal trauma was divided into two entities: contusion 68% and wounds 32%. Medical treatment was sufficient in 23.00% of cases. Laparotomy as a surgical approach was performed in 77.0% of cases. Local hemostasis plus drainage (27.08%), splenectomy (25.00%), suture (14.58%), hemostasis by tamponade (8.33%) and colostomy (2.08%) were undertaken as surgical procedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative follow-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.
基金Supported by the National Natural Science Foundation of China,No.82270914 and No.82401043.
文摘BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclear.AIM To clarify the impact of relevant factors,particularly perirenal fat,on postoperative hypertension resolution.METHODS In this retrospective single-center study,a total of 138 patients with obesity and hypertension were included,all of whom underwent LSG in the hospital and were followed up for one year.Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution.Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution,and their predictive values were compared using fivefold cross-validation.RESULTS After LSG,107 patients(77.5%)experienced hypertension resolution,while 31 patients(22.5%)did not achieve resolution.Both the preoperative perirenal fat area(PrFA)and perirenal fat thickness were independent risk factors for postoperative hypertension resolution(P<0.001 vs P=0.002).These factors are curvilinearly correlated with the hypertension resolution rate,but PrFA has a better predictive value than perirenal fat thickness dose(area under the curve=0.846 vs 0.809).Compared with those with PrFA≥18 cm2,patients with PrFA<18 cm2 had a higher hypertension resolution rate[87%vs 68.1%;odds ratio(95%confidence interval)=3.513(1.367-9.902),P=0.012].CONCLUSION PrFA is a preoperative predictor of postoperative hypertension resolution.It is curvilinearly associated with the resolution rate,and patients with PrFA<18 cm²have better hypertension resolution outcomes after LSG.
文摘Postoperative complications represent important indicators for the quality of surgical care. The objectives of this work were to study post-operative complications in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of post-operative complications, to identify the factors of occurrence, to describe the clinical aspects, diagnostic and therapeutic in order to assess the additional cost linked to post-operative complications. This study was prospective, carried out in the general surgery department on 300 cases of surgical interventions. It covered all patients aged at least 15 years, operated on and hospitalized or not, and who presented complications during the 30 days postoperatively. Patients under the age of 15 were not included (our general surgery department is not a pediatric surgery department). We collected 300 patients among whom 199 (66.33%) were men and 101 (33.66%) women, i.e. a sex ratio = 1.9. The average age was 38 years with extremes of 15 and 87 years. The main initial diagnoses were: acute appendicitis, peritonitis, occlusions, wall hernias, hemorrhoids, uterine prolapse, uterine myomas, ovarian cysts and acute cholecystitis. Emergencies represented 43% (N = 129) of interventions with 6.98% post-operative complications (POC). Postoperative complications were dominated by surgical site infections, 75% of cases (N = 20), wall hemorrhage 5% (N = 1), testicular necrosis 5% (N = 1) and testicular calcification 5% (N = 1), wire rejection 5% (N = 1) and death 5% (N = 1). The management of postoperative complications was surgical in 95% and medical in 100%. Their occurrence extended the hospital stay by 3.65 days and increased the average cost of care by 60541.85 CFA francs. The mortality index lowered by efficient management of complications (IMAGE) calculated in relation to deaths was 95% of cases. Anemia, ASA score ≥ III, Alteimeir II and IV classes, duration of surgery and post-operative hospitalization were factors contributing to post-operative complications.
文摘Inguinal hernia in children is a congenital pathology in children linked to the persistence of the peritoneo-vaginal canal in children and the NüCK canal in girls;persisting into adulthood. This work aimed to study inguinal hernia in children in the general surgery department of the Reference Health Center of Commune I of the Bamako District;to determine the frequency of inguinal hernia;describe the epidemiological, clinical and therapeutic aspects of inguinal hernias and in order to evaluate the cost of treatment. This was a prospective study from April 2017 to March 2018 during which 60 children with an inguinal hernia were collected. Inguinal hernias in children represented 9.23% of patients operated on in the department. The average age was 59.23 months with extremes of one month and 180 months and a standard deviation of 49.23 years. The male sex was dominant with a sex ratio equal to 9:1. The notion of prematurity was found in 11.7% and was associated with a testicle not in place in 1.7% of cases. 41.7% of our patients were referred by a doctor and 66.7% of patients presented with painless, intermittent inguino-scrotal swelling (83.3% of cases). The hernia was discovered before one week of life in 50% of cases. Inguinal swelling was absent in 11.7% but observed intraoperatively. The inguinal hernia was unilateral in 91.7% of cases and 70% of hernias were discovered by the parents during pushing efforts. The inguinal hernia was located on the right in 61.7% of cases. The hernia swelling was soft, painless, impulsive and reducible in 78.3% of cases. The swelling was inguino-scrotal in 58.3% of cases. The hernia was simple in 95% of patients and hernial strangulation was observed in 3 cases or 5% of cases. 98.3% of patients were ASA I. The treatment was carried out openly in all our patients including closure of the vaginal peritoneal canal in 95% of cases under general anesthesia in 98.3% of cases. The morbidity rate was 8.4% (surgical site infection: 6.7% of cases and hematoma: 1.7%). The immediate consequences were simple in 96.6% of cases. No cases of recurrence occurred during the 6 months after the intervention. The average cost of care was estimated at 69,743 FCFA.
文摘Introduction: The aim of this study was to report the indications and evaluate the results of vulvectomy in the general surgery department of Ignace Deen Hospital, CHU Conakry. Materials and Methods: This was a retrospective descriptive study, conducted over a period of five (05) years from January 1, 2018 to December 31, 2022, in the general surgery department of Ignace Deen Hospital, CHU Conakry. We included in our study all patient records in whom vulvectomy was performed. Results: We recorded 15 cases of vulvectomy out of 453 perineal surgeries, i.e. 3.31%, with a mean age of 43.56 years and extremes of 35 and 69 years. Vulvar cancer was the most common diagnosis (46.67%), followed by Buschke-Lowenstein (33.33%) and anal canal cancer extending to the vulva (20%). Six patients had undergone biopsy (40%). Vulvectomy with lymph node dissection was performed in only 9 patients (60%), and all surgical specimens were sent to anatomical pathology (100%). Conclusion: Vulvectomy is a surgical technique most often indicated for the treatment of vulvar cancer.
文摘Introduction: Intestinal resection is the disconnection or removal of part of the intestine with its meso. The aim was to describe the indications and prognostic factors for intestinal resections at the surgical department of Kankan Regional Hospital. Patients and Methods: This was a retrospective descriptive study covering the files of patients who had undergone intestinal resections in the surgery department of the Kankan regional hospital over a period of 4 years from 1st January 2019 to December 31, 2022. Results: We collected 164 cases of intestinal resection representing 4.19% of all surgical procedures. (N = 3909). The average age of our patients was 37.78 years with extremes of 1 and 90 years. The male gender was predominant (64.6%) and the sex ratio was 1.8. The majority of patients consulted after 72 hours. Acute intestinal obstruction was the pathology motivating the most intestinal resection 42.90% followed by acute peritonitis 33%, digestive fistula 4.3%, tumors 3.6% and wounds 2.4%. Intestinal necrosis with 91 cases (56.5%) constituted the first indication for resection in our study followed by intestinal perforations 41 cases (24.9%). We performed an anastomotic resection of the small intestine in 70 cases (42.9%), an ileostomy in 4 cases (2.4%), a right hemi colectomy in 26 cases (15.9%), a left hemi colectomy in 2 cases (1.2%), segmental colectomy plus immediate anastomosis in 57 cases (34.2%) and 5 cases of colostomy. We recorded 48 deaths (29.3%). Conclusion: Intestinal resection is a common procedure in our context. These indications are multiple. An improvement in the prognosis should be achieved by reducing the diagnostic and treatment time associated with the training of surgical staff.
文摘The objectives of this work were to evaluate the surgical activities carried out in the general surgery department of the Reference Health Center of Commune I of Bamako, to describe the sociodemographic characteristics of the operated patients, to determine the main pathologies encountered and to evaluate qualitatively the result of the treatment. In order to improve performance, and the quality of care, and to identify common pathologies in the surgical department, we undertook a retrospective study on surgical activities from January 2009 to December 2010. At the end of this study, out of 474 men and 187 women (equal sex ratio 2.53);we were able to determine the frequency of surgical pathologies. Farmers, housewives and pupils/students were the most represented with 25.9% respectively;20% and 13.3%. The most frequently observed pathologies were wall hernia (44.8%), prostate adenoma (12%) and acute appendicitis (10.5%). The average length of hospitalization was 3.43 days. Infectious complications affected 25 patients (3.8% of cases) and a death rate of 0.45% (i.e. 3 patients). The average cost of care was 53,500 FCFA. Indeed, the reality of surgical practice in health centers was not the same because of the level of skills of practicing surgeons.
文摘Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.
文摘BACKGROUND The objective of the current study was to elucidate the clinical mechanism through which phospholipase D2(PLD2)exerted a regulatory effect on neutrophil migra-tion,thereby alleviating the progression of acute pancreatitis.AIM To elucidate the clinical mechanism through which PLD2 exerted a regulatory effect on neutrophil migration,thereby alleviating the progression of acute pan-creatitis.METHODS The study involved 90 patients diagnosed with acute pancreatitis,admitted to our hospital between March 2020 and November 2022.A retrospective analysis was conducted,categorizing patients based on Ranson score severity into mild(n=25),moderate(n=30),and severe(n=35)groups.Relevant data was collected for each group.Western blot analysis assessed PLD2 protein expression in patient serum.Real-time reverse transcription polymerase chain reaction was used to evaluate the mRNA expression of chemokine receptors associated with neutrophil migration.Serum levels of inflammatory factors in patients were detected using enzyme-linked immunosorbent assay.Transwell migration tests were conducted to compare migration of neutrophils across groups and analyze the influence of PLD2 on neutrophil migration.RESULTS Overall data analysis did not find significant differences between patient groups(P>0.05).The expression of PLD2 protein in the severe group was lower than that in the moderate and mild groups(P<0.05).The expression level of PLD2 in the moderate group was also lower than that in the mild group(P<0.05).The severity of acute pancreatitis is negatively correlated with PLD2 expression(r=-0.75,P=0.002).The mRNA levels of C-X-C chemokine receptor type 1,C-X-C chemokine receptor type 2,C-C chemokine receptor type 2,and C-C chemokine receptor type 5 in the severe group are significantly higher than those in the moderate and mild groups(P<0.05),and the expression levels in the moderate group are also higher than those in the mild group(P<0.05).The levels of C-reactive protein,tumor necrosis factor-α,interleukin-1β,and interleukin-6 in the severe group were higher than those in the moderate and mild groups(P<0.05),and the levels in the moderate group were also higher than those in the mild group(P<0.05).The number of migrating neutrophils in the severe group was higher than that in the moderate and mild groups(P<0.05),and the moderate group was also higher than the mild group(P<0.05).In addition,the number of migrating neutrophils in the mild group combined with PLD2 inhibitor was higher than that in the mild group(P<0.05),and the number of migrating neutrophils in the moderate group combined with PLD2 inhibitor was higher than that in the moderate group(P<0.05).The number of migrating neutrophils in the severe group+PLD2 inhibitor group was significantly higher than that in the severe group(P<0.05),indicating that PLD2 inhibitors significantly stimulated neutrophil migration.CONCLUSION PLD2 exerted a crucial regulatory role in the pathological progression of acute pancreatitis.Its protein expression varied among patients based on the severity of the disease,and a negative correlation existed between PLD2 expression and disease severity.Additionally,PLD2 appeared to impede acute pancreatitis progression by limiting neutrophil migration.
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
基金Supported by National Natural Science Foundation of China,No.82170651and the Research Support Fund of Hubei Microcirculation Society,No.HBWXH2024(1)-1.
文摘Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological mechanisms underlying IPFD remain unclear,with several potential contributing factors,including oxida-tive stress,alterations in the gut microbiota,and hormonal imbalances.IPFD was found to be highly correlated with the occurrence and prognosis of exocrine pan-creatic diseases.Although imaging techniques remain the primary diagnostic approach for IPFD,an expanding array of biomarkers and clinical scoring systems have been identified for screening purposes.Currently,effective treatments for IPFD are not available;however,existing medications,such as glucagon-like peptide-1 receptor agonists,and new therapeutic approaches explored in animal models have shown considerable potential for managing this disease.This paper reviews the pathogenesis of IPFD,its association with exocrine pancreatic disea-ses,and recent advancements in its diagnosis and treatment,emphasizing the significant clinical relevance of IPFD.
文摘BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.
文摘BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.
文摘Introduction: Evaluating the quality of care offered is a reliable indicator of the effectiveness of a health system. Developing countries are still lagging behind in implementing these principles. This work aims to evaluate the satisfaction of patients operated on and hospitalized in the surgery department at the municipality’s reference health center over a period of 6 months (June 2020 to December 2020). Materials and Methods: This is a quantitative, qualitative, transversal and evaluative study over a period of 6 months based on a self-administered questionnaire to patients who underwent surgery and were hospitalized in the surgery department of the reference health center of commune I upon leaving their hospitalization. The questions are structured around welcome, respect and privacy, care, accommodation conditions as well as overall satisfaction. Results: The survey included 260 patients, 60.8% of whom were male. The 31 - 40 year old age group was in the majority and the majority had completed primary education (42.3%). Married patients were the majority, i.e. 60.4% of cases. Patients were not insured in 66.5% of cases. Almost all of the patients surveyed found that the welcome, care, waiting time, respect and privacy were satisfactory. On the other hand, patients found the rooms and beds uncomfortable. Conclusion: The satisfaction survey reveals worrying data regarding the comfort of patients who must challenge caregivers in healthcare structures. Decision-makers should find useful information there to improve the quality of care.
文摘Introduction: Omphalocele is an embryopathy of the first ten weeks of gestation. It corresponds to a defect in the abdominal wall through which viscera contained in a sac constituted by the amniotic membrane and centered by the umbilical cord are exteriorized. The objective of this work was to study the diagnostic modalities and the impact of our therapeutic choices on the outcome of the management. Material and Methods: We carried out a prospective study on patients with omphalocele admitted to the pediatric surgery departments of the HND, during a period spread over 4 years, between January 2017 and December 2020. Results: we collected 55 files (i.e., 13.7 cases/year). There were 38 boys and 17 girls (sex ratio 2.2) with an average age of 1.9 days. We found 15 cases (27%) of type I and 40 cases (73%) of type II according to the AITKEN classification. Fifteen cases (27%) benefited from surgical treatment and 45 cases (73%) benefited from conservative treatment (Grob). Two surgical methods were used: Primary parietal closure, which was used in 10 cases (66.7%), and the GROSS method, which was used in 5 cases (33.3%). We obtained an improvement of 40 cases (73%) and 15 cases (27%) of death. Conclusion: our work reported our experience in the management of omphalocele and the difficulties of postoperative resuscitation.
文摘In this article we comment on the paper by Xu et al describing retrospective data on endoscopic treatment outcome of esophageal gastrointestinal stromal tumors(GISTs).Esophageal GIST is a rare type of mesenchymal tumor.GISTs originate from the interstitial cells of Cajal,which are pacemaker cells involved in gut motility.GISTs are most commonly found in the stomach and small intestine,but esophageal involvement is rare.Esophageal GISTs account for<1%of all GISTs.Endoscopic resection remains the mainstay for small,localized tumors with excellent outcomes.However,larger tumors may require multidisciplinary strategies to provide the best oncological outcomes.Here,we discuss the usefulness of endoscopic ultrasound(EUS)of subepithelial tumors of the upper gastrointestinal tract.EUS is a crucial tool in the diagnosis,staging,and management of subepithelial masses.Given the subepithelial nature of these tumors,standard endoscopy is not adequate,making EUS essential for a comprehensive assessment.EUS provides accurate tumor size assessment and enables fine needle aspirations guided biopsy,for treatment planning.
文摘BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.
文摘BACKGROUND Cholangiocarcinoma(CCA)comprises heterogeneous malignancies arising at different anatomical locations:Intrahepatic cholangiocarcinoma(IHCC),perihilar cholangiocarcinoma(PHCC),and distal cholangiocarcinoma(DCC).These subtypes exhibit distinct clinical behaviors,treatment approaches,and outcomes.Despite advances in surgical and adjuvant therapies,the prognostic implications of tumor location remain unclear and inconsistently reported.Understanding these variations is essential for personalized management and staging refinement.We hypothesized that the anatomical subtype of CCA significantly influences prognostic outcomes and pathological features.AIM To compare prognostic outcomes and clinicopathological characteristics among IHCC,PHCC,and DCC based on current evidence.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.PubMed,EMBASE,and the Cochrane Library were searched,yielding 11 eligible retrospective comparative studies involving 14484 patients(IHCC:6260;PHCC:6895;DCC:1329).Outcomes assessed included overall survival(OS),lymph node metastasis,neural invasion,and vascular invasion.Statistical analyses were performed using RevMan 5.3 and Stata 13.0.RESULTS DCC demonstrated the most favorable prognosis among all subtypes.Despite the highest lymph node metastasis rate(DCC:56.9%),it was associated with better OS than PHCC and IHCC.Vascular invasion was more prevalent in IHCC(OR=1.66,95%CI:1.22-2.28,P=0.001).OS comparisons showed no significant difference between PHCC and IHCC(HR=1.02,P=0.88),while DCC showed consistent trends toward better survival against both.CONCLUSION Anatomical subtype is a significant prognostic factor in CCA.DCC patients experience superior outcomes despite aggressive lymphatic spread,suggesting better resectability and surgical outcomes.These insights underscore the need for subtype-specific management strategies and future prospective validation.
基金supported by a grant from Ministry of Science,Technological Development and Innovation,Serbia,No.451-03-68/2022-14/200178(to NN)University of Defence,No.MFVMA/02/22-24(to MN)。
文摘An imbalance in adenosine-mediated signaling,particularly the increased A_(2A)R-mediated signaling,plays a role in the pathogenesis of Parkinson's disease.Existing therapeutic approaches fail to alter disease progression,demonstrating the need for novel approaches in PD.Repetitive transcranial magnetic stimulation is a non-invasive approach that has been shown to improve motor and non-motor symptoms of Parkinson's disease.However,the underlying mechanisms of the beneficial effects of repetitive transcranial magnetic stimulation remain unknown.The purpose of this study is to investigate the extent to which the beneficial effects of prolonged intermittent theta burst stimulation in the 6-hydroxydopamine model of experimental parkinsonism are based on modulation of adenosine-mediated signaling.Animals with unilateral 6-hydroxydopamine lesions underwent intermittent theta burst stimulation for 3 weeks and were tested for motor skills using the Rotarod test.Immunoblot,quantitative reverse transcription polymerase chain reaction,immunohistochemistry,and biochemical analysis of components of adenosine-mediated signaling were performed on the synaptosomal fraction of the lesioned caudate putamen.Prolonged intermittent theta burst stimulation improved motor symptoms in 6-hydroxydopamine-lesioned animals.A 6-hydroxydopamine lesion resulted in progressive loss of dopaminergic neurons in the caudate putamen.Treatment with intermittent theta burst stimulation began 7 days after the lesion,coinciding with the onset of motor symptoms.After treatment with prolonged intermittent theta burst stimulation,complete motor recovery was observed.This improvement was accompanied by downregulation of the e N/CD73-A_(2A)R pathway and a return to physiological levels of A_(1)R-adenosine deaminase 1 after 3 weeks of intermittent theta burst stimulation.Our results demonstrated that 6-hydroxydopamine-induced degeneration reduced the expression of A_(1)R and elevated the expression of A_(2A)R.Intermittent theta burst stimulation reversed these effects by restoring the abundances of A_(1)R and A_(2A)R to control levels.The shift in ARs expression likely restored the balance between dopamine-adenosine signaling,ultimately leading to the recovery of motor control.
