BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in ...BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.展开更多
Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of...Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of patients with PDAC after R0 resection.Methods:PDAC patients from six centers in China undergoing R0 resection from 2015 to 2022 were included.Patients were categorized as long-term diabetes(LTD),NOD,or non-diabetes mellitus(non-DM)based on the timing of diagnosis relative to pancreatic resection.We compared the effects of diabetes status on perioperative and oncological outcomes of PDAC.Results:Of 1211 patients,602(49.7%),127(10.5%),and 482(39.8%)were in the non-DM,LTD,and NOD groups,respectively.Patients with NOD suffered from higher rates of fatty pancreas and postoperative pancreatic fistula(POPF)(both P<0.05).When compared with the non-DM group,the NOD group had worse median overall survival(OS)(24.6 vs.29.4 months,P<0.001)and recurrence-free survival(RFS)(13.3 vs.15.8 months,P<0.001);and the LTD group also had worse median OS(25.2 vs.29.4 months,P=0.041)and RFS(13.8 vs.15.8 months,P=0.007)compared with non-DM group.However,there were no significant differences in survival between the NOD and the LTD groups.Multivariate analysis indicated that NOD,LTD,largest tumor size,and poor tumor differentiation were independently associated with worse OS and RFS(all P<0.05).Conclusions:Patients with PDAC undergoing R0 resection experienced a higher probability of POPF in the presence of concurrent NOD.Long-term survival prognosis was worse in NOD or LTD patients than in non-DM patients.展开更多
BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improveme...BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.展开更多
Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shor...Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shortand long-term outcomes of RG and laparoscopic gastrectomy(LG)in the treatment of stage cT4a gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of patients with stage cT4a gastric cancer diagnosed and treated at eight high-volume tertiary teaching hospitals in China from 2016 to 2019.Propensity score matching(PSM)analysis and inverse probability of treatment weighting(IPTW)analysis was used to adjust for the imbalance in baseline characteristics.The primary research endpoint was the 3-year overall survival(OS)and disease-free survival(DFS).The secondary research endpoint was intraoperative outcomes and postoperative complications.Results:After IPTW and PSM adjustments,baseline characteristics between the RG and LG groups were comparable[standardized mean difference(SMD)<0.10].Post-PSM analysis revealed that the RG group exhibited longer operative time(P<0.001),lower postoperative complication rates(P<0.001),shorter postoperative hospital stays(P=0.037),and earlier initiation of adjuvant chemotherapy(P=0.041)compared with the LG group.Survival analysis demonstrated comparable 3-year OS(P=0.110)and DFS(P=0.088)in the PSM cohort,whereas the IPTW cohort showed superior OS(P=0.030)and DFS(P=0.046)for RG.No significant differences were observed in overall recurrence rates or recurrence sites between groups.Conclusions:For patients with stage cT4a gastric cancer,compared with the LG group,the RG group had shorter postoperative hospital stay,lower incidence of postoperative complications,earlier postoperative adjuvant chemotherapy,and no worse long-term efficacy.展开更多
BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MC...BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MCN are particularly important.AIM To investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma(MCA)and mucinous cystadenocarcinoma(MCC).METHODS The clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively analyzed.RESULTS Of the 82 patients included in this study,70 had MCA and 12 had MCC.Tumor size of MCC was larger than that of MCA(P=0.049).Age and serum levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,and CA12-5 were significantly higher in MCC than in MCA patients(P=0.005,0.026,and 0.037,respectively).MCA tumor size was positively correlated with serum CA19-9 levels(r=0.389,P=0.001).Compared with MCC,MCA had a higher minimally invasive surgery rate(P=0.014).In the MCA group,the rate of major complications was 5.7%and that of clinically relevant pancreatic fistula was 8.6%;the corresponding rates in the MCC group were 16.7%and 16.7%,respectively.CONCLUSION Tumor size,age,and serum CEA,CA19-9,and CA12-5 levels may contribute to management of patients with MCN.Surgical resection is the primary treatment modality for MCC and MCA.展开更多
BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical fea...BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.展开更多
Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield.The military medical research on battlefield internal diseases focuses on the patho...Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield.The military medical research on battlefield internal diseases focuses on the pathogenesis,clinical management,and prevention of internal diseases under military war conditions.In both wartime and peacetime,the soldiers suffer from more internal diseases than surgical wounds.With the introduction of high-tech weapons,including chemical,physical,and biological agents,a large number of special internal illnesses and casualties will appear in future wars.The battles often occur in special environments,such as high or low temperatures,plateau or polar areas,and micro-or hyper-gravity.The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare.Therefore,the military medical research on battlefield internal medicine should be based on contemporary military situations,focus on the purpose of treating battlefield internal diseases,and adhere to the actual needs of the troops in peacetime and wartime.We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine.This review highlights new concepts,demands,challenges,and opportunities for the further development of military medical research on battlefield internal medicine.展开更多
Background: Robotic pancreaticoduodenectomy(RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma(PDAC) of the pancreatic head. This study aimed to analyze the surgical outc...Background: Robotic pancreaticoduodenectomy(RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma(PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients. Methods: Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival(OS), and an online nomogram calculator was developed based on the independent prognostic factors. Results: Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 m L, the median OS was 23.6 months, and the median recurrence-free survival(RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19-9(CA19-9) [hazard ratio(HR) = 2.607, 95% confidence interval(CI): 1.560-4.354, P < 0.001], lymph node metastasis(HR = 1.429, 95% CI: 1.005-2.034, P = 0.047), tumor moderately(HR = 3.190, 95% CI: 1.813-5.614, P < 0.001) or poorly differentiated(HR = 5.114, 95% CI: 2.839-9.212, P < 0.001), and Clavien-Dindo grade ≥ Ⅲ(HR = 1.657, 95% CI: 1.079-2.546, P = 0.021) were independent prognostic factors for OS. The concordance index(C-index) of the nomogram constructed based on the above four independent prognostic factors was 0.685(95% CI: 0.640-0.729), which was significantly higher than that of the AJCC staging(8th edition): 0.541(95% CI: 0.493-0.589)( P < 0.001). Conclusions: This large-scale study indicated that RPD was feasible for PDAC of pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥ Ⅲ were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.展开更多
Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with ...Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with splenic vessel preservation(Kimura’s procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura’s procedure. Methods: The clinical data of consecutive patients who underwent robotic SPDP with Kimura’s procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy(P-F) group and a “tunnel-first” strategy(T-F) group and analyzed. Results: A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time(146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0(20.0–55.0) m L vs. 50.0(20.0–100.0) m L, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the TF group and 2.4% in the P-F group( P = 0.14). The grade 3/4 complications were similar between the two groups( P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. Conclusions: The pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura’s procedure.展开更多
Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colore...Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.展开更多
Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the C...Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone.Two hundred and twenty-two patients who underwent transrectal prostate biopsy(TRB)and 216 patients who underwent transperineal prostate biopsy(TPB)between June 2016 and September 2022 were reviewed in this study.In addition,110 patients who received additional targeted biopsies following the systematic TPB were identified.Clinical parameters,including age,PSA derivative,prostate volume(PV),and needle core count,were recorded.The data were fitted via propensity score matching(PSM),adjusting for potential confounders.TPB outperformed TRB in terms of the CDR(49.6%vs 28.3%,P=0.001).The clinically significant prostate cancer(csPCa)detection rate was not significantly different between TPB and TRB(78.6%vs 68.8%,P=0.306).In stratified analysis,TPB outperformed TRB in CDR when the age of patients was 65–75 years(59.0%vs 22.0%,P<0.001),when PV was 25.00–50.00 ml(63.2%vs 28.3%,P<0.001),and when needle core count was no more than 12(58.5%vs 31.5%,P=0.005).The CDR(P=0.712)and detection rate of csPCa(P=0.993)did not significantly differ among the systematic,targeted,and combined biopsies.TPB outperformed TRB in CDR for patients with gray-zone PSA.Moreover,performing target biopsy after systematic TPB provided no additional benefits in CDR.展开更多
The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided foc...The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided focused ultrasound system in Chinese mainland was installed at the First Medical Center of the PLA General Hospital.This prospective,single center,open-label,single-arm study was part of a worldwide prospective multicenter clinical trial(ClinicalTrials.gov Identifier:NCT03253991)conducted to confirm the safety and efficacy of magnetic resonance-guided focused ultrasound for treating essential tremor in the local population.From 2019 to 2020,10 patients with medication refractory essential tremor were recruited into this open-label,single arm study.The treatment efficacy was determined using the Clinical Rating Scale for Tremor.Safety was evaluated according to the incidence and severity of adverse events.All of the subjects underwent a unilateral thalamotomy targeting the ventral intermediate nucleus.At the baseline assessment,the estimated marginal mean of the Clinical Rating Scale for Tremor total score was 58.3±3.6,and this improved after treatment to 23.1±6.4 at a 12-month follow-up assessment.A total of 50 adverse events were recorded,and 2 were defined as serious.The most common intraoperative adverse events were nausea and headache.The most frequent postoperative adverse events were paresthesia and equilibrium disorder.Most of the adverse events were mild and usually disappeared within a few days.Our findings suggest that magnetic resonance-guided focused ultrasound for the treatment of essential tremor is effective,with a good safety profile,for patients in Chinese mainland.展开更多
BACKGROUND Nab-paclitaxel plus gemcitabine(AG)has resulted in higher tumor response and survival rates for metastatic or advanced pancreatic ductal adenocarcinoma(PDAC)compared with gemcitabine(GEM)alone.AIM To examin...BACKGROUND Nab-paclitaxel plus gemcitabine(AG)has resulted in higher tumor response and survival rates for metastatic or advanced pancreatic ductal adenocarcinoma(PDAC)compared with gemcitabine(GEM)alone.AIM To examine the feasibility and safety of AG adjuvant chemotherapy of resectable PDAC.METHODS We retrospectively analyzed patients with resected PDAC who received AG or GEM as postoperative adjuvant treatment between January 2013 and December 2016 at the Chinese People’s Liberation Army General Hospital,Beijing,China.The patients adopted combined nab-paclitaxel(125 mg/m^2)and GEM(1 g/m^2)or GEM(1 g/m^2)alone treatment,on days 1 and 8 every 3 wk for six cycles,unless intolerable adverse events or disease progression occurred.The disease-free survival,overall survival(OS)and adverse events of the two groups were statistically analyzed.RESULTS Compared with GEM,median disease-free survival(12.2 mo vs 15.8 mo,P=0.039)and OS(20.6 mo vs 28.3 mo,P=0.028)were significantly improved in the AG group.The 2-year OS rates were 63.3%and 43.3%in the AG and GEM groups,respectively.However,the incidence of sensory neuropathy was increased significantly in the AG than the GEM group(53.3%vs 23.3%,P<0.001).CONCLUSION In our initial experience,AG significantly improved disease-free survival and OS of patients with resected PDAC.AG may be a potential option for postoperative adjuvant chemotherapy of resectable PDAC.展开更多
Background:Snakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide.However,few Chinese military medics know the proper first aid procedures for snakebites.Th...Background:Snakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide.However,few Chinese military medics know the proper first aid procedures for snakebites.Therefore,this study aimed to explore the impact of the Standard Operation Procedure(SOP)and checklist on Chinese military medics’ability to manage snakebite first aid.Methods:This study was a prospective single-blind randomized controlled trial conducted in a military medical university of China from May to June 2017.A questionnaire-based survey was performed to collect the participants’socio-demographic profiles before the baseline measurement.During the baseline measurement,participants were requested to provide corresponding first aid that was responsive to the simulative situation portrayed by the standardized patients(SPs)and the evaluators then scored their performances according to a checklist for snakebite first aid scoring table.After the baseline measurement,they were randomly assigned to one of three intervention groups after stratification according to their baseline performance scores:group A received a self-learning course with textbooks(n=27),group B received a self-learning training on the SOP and checklist(n=27)and group C was engaged in an interactive discussion panel regarding the SOP and checklist(n=26).After the interventions,participants received outcome measurements about snakebite first aid key points capability from the same evaluator and SP for each group to avoid observational error.The reviewers were blinded about the grouping in the trial.Results:The baseline measurement yielded no significant difference(H=1.647,P=0.439)among the three groups.The post-intervention scores were higher than the pre-intervention scores for all three(A,B and C)groups(P=0.008,P<0.001 and P<0.001,respectively).There was significant difference of the post-intervention scores among the three groups(F=8.841,P<0.001).Both post-intervention scores of group B and group C were higher than that of group A(P<0.001 and P=0.001,respectively),but no difference was found between group B and C(P=0.695).The acceptance questionnaire score of SOP and checklist was mostly very satisfied,as the final scores of group B and group C were 4.62±0.61 and 4.82±0.45,respectively.Conclusions:In this study,the implementation of an SOP and checklist for snakebite first aid was shown to update and improve first aid treatment concepts in military medics.These intervention methods played an important role in improving the medics’cognition and understanding of snakebite first aid.Therefore,this finding suggests that SOP and checklist training should be further implemented in Chinese troops for snakebite care.展开更多
Background:Although oral health-related quality of life(OHRQoL)in orthodontic patients has been assessed in the past,to date,no study has compared the OHRQoL between two nations.We aimed to compare the OHRQoL between ...Background:Although oral health-related quality of life(OHRQoL)in orthodontic patients has been assessed in the past,to date,no study has compared the OHRQoL between two nations.We aimed to compare the OHRQoL between Chinese and American orthodontic patients.Methods:We conducted a two-center questionnaire-based cross-sectional study among patients who underwent orthodontic treatments at the Chinese PLA General Hospital(PLAGH)in Beijing,China and Massachusetts General Hospital(MGH)in Boston,Massachusetts,United States.Candidate variables included the participating center,patients’age,sex,Angle’s classification of malocclusion,evaluation stage,and appliances used.The primary outcome was patients’OHRQoL assessed with the Oral Health Impact Profile-14(OHIP-14).Descriptive statistics,stratification,and univariate and multivariate analyses were performed.Results:The average age was lower for PLAGH patients than for MGH patients(21.1±7.9 vs.33.1±14.6 years,P<0.001).The most common type of malocclusion was Angle’s Class III malocclusion at PLAGH(39%)and Class I malocclusion at MGH(59.5%).Clear aligners were used in 34.1%and 2.7%of the patients at MGH and PLAGH,respectively.OHIP-14 scores were lower for PLAGH patients than for MGH patients(18.4±4.7 vs.22.3±7.4,P<0.001),particularly in functional limitation,psychological discomfort/disability,and handicap.Univariate regression analysis demonstrated that participating center,age,Class I malocclusion,and the use of clear aligners were significantly associated with overall OHIP-14 scores.Multivariate regression analysis demonstrated that patients at PLAGH were associated with lower OHIP-14 scores(coefficient:-3;95%CI:-5,-1.3;P=0.001),and age was positively associated with OHIP-14 scores(coefficient:0.1;95%CI:0.004,0.13;P=0.038).Conclusion:Chinese orthodontic patients had lower OHIP-14 scores,indicating a higher OHRQoL than American patients.In addition to the younger age,this difference may be attributed to the different ethical,cultural,educational,and socioeconomic background of Chinese and American orthodontic patients.展开更多
BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To ...BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.展开更多
BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the cli...BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms.展开更多
Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) a...Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.展开更多
Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in...Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.展开更多
Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation sys...Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation systems face challenges such as high equipment costs,complex operation,bulky size,and insufficient anti-interference performance.To address these limitations,our study developed and validated a novel portable electromagnetic neuronavigation system designed to improve the precision,accessibility,and clinical applicability of electromagnetic navigation technology in cranial surgery.Methods The software and hardware architecture of a portable neural magnetic navigation system was designed.The key technologies of the system were analysed,including electromagnetic positioning algorithms,miniaturized sensor design,optimization of electromagnetic positioning and navigation algorithms,anti-interference signal processing methods,and fast three-dimensional reconstruction algorithms.A prototype was developed,and its accuracy was tested.Finally,a preliminary clinical application evaluation was conducted.Results This study successfully developed a comprehensive portable electromagnetic neuronavigation system capable of achieving preoperative planning,intraoperative real-time positioning and navigation,and postoperative evaluation of navigation outcomes.Through rigorous collaborative testing of the system’s software and hardware,the accuracy of electromagnetic neuronavigation has been validated to meet clinical requirements.Conclusions This study developed a portable neuroelectromagnetic navigation system and validated its effectiveness and safety through rigorous model testing and preliminary clinical applications.The system is characterized by its compact size,high precision,excellent portability,and user-friendly operation,making it highly valuable for promoting navigation technology and advancing the precision and minimally invasive nature of neurosurgical procedures.展开更多
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.
基金supported by grants from the Young Elite Sci-entists Sponsorship Program by CAST(2023QNRC001)the Young Elite Scientists Sponsorship Program by BAST(BYESS2024001)the National Key Research and Development Program of China(2022YFC2407402).
文摘Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of patients with PDAC after R0 resection.Methods:PDAC patients from six centers in China undergoing R0 resection from 2015 to 2022 were included.Patients were categorized as long-term diabetes(LTD),NOD,or non-diabetes mellitus(non-DM)based on the timing of diagnosis relative to pancreatic resection.We compared the effects of diabetes status on perioperative and oncological outcomes of PDAC.Results:Of 1211 patients,602(49.7%),127(10.5%),and 482(39.8%)were in the non-DM,LTD,and NOD groups,respectively.Patients with NOD suffered from higher rates of fatty pancreas and postoperative pancreatic fistula(POPF)(both P<0.05).When compared with the non-DM group,the NOD group had worse median overall survival(OS)(24.6 vs.29.4 months,P<0.001)and recurrence-free survival(RFS)(13.3 vs.15.8 months,P<0.001);and the LTD group also had worse median OS(25.2 vs.29.4 months,P=0.041)and RFS(13.8 vs.15.8 months,P=0.007)compared with non-DM group.However,there were no significant differences in survival between the NOD and the LTD groups.Multivariate analysis indicated that NOD,LTD,largest tumor size,and poor tumor differentiation were independently associated with worse OS and RFS(all P<0.05).Conclusions:Patients with PDAC undergoing R0 resection experienced a higher probability of POPF in the presence of concurrent NOD.Long-term survival prognosis was worse in NOD or LTD patients than in non-DM patients.
基金Supported by the National Key Research and Development Program,China,No.2022YFC2503603.
文摘BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.
基金supported by Fujian Provincial Medical“Building High-level Hospitals,High-level Clinical Medical Centers and Key Clinical Specialty Projects”([2021]No.76)Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare(No.[2022]954)。
文摘Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shortand long-term outcomes of RG and laparoscopic gastrectomy(LG)in the treatment of stage cT4a gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of patients with stage cT4a gastric cancer diagnosed and treated at eight high-volume tertiary teaching hospitals in China from 2016 to 2019.Propensity score matching(PSM)analysis and inverse probability of treatment weighting(IPTW)analysis was used to adjust for the imbalance in baseline characteristics.The primary research endpoint was the 3-year overall survival(OS)and disease-free survival(DFS).The secondary research endpoint was intraoperative outcomes and postoperative complications.Results:After IPTW and PSM adjustments,baseline characteristics between the RG and LG groups were comparable[standardized mean difference(SMD)<0.10].Post-PSM analysis revealed that the RG group exhibited longer operative time(P<0.001),lower postoperative complication rates(P<0.001),shorter postoperative hospital stays(P=0.037),and earlier initiation of adjuvant chemotherapy(P=0.041)compared with the LG group.Survival analysis demonstrated comparable 3-year OS(P=0.110)and DFS(P=0.088)in the PSM cohort,whereas the IPTW cohort showed superior OS(P=0.030)and DFS(P=0.046)for RG.No significant differences were observed in overall recurrence rates or recurrence sites between groups.Conclusions:For patients with stage cT4a gastric cancer,compared with the LG group,the RG group had shorter postoperative hospital stay,lower incidence of postoperative complications,earlier postoperative adjuvant chemotherapy,and no worse long-term efficacy.
文摘BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MCN are particularly important.AIM To investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma(MCA)and mucinous cystadenocarcinoma(MCC).METHODS The clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively analyzed.RESULTS Of the 82 patients included in this study,70 had MCA and 12 had MCC.Tumor size of MCC was larger than that of MCA(P=0.049).Age and serum levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,and CA12-5 were significantly higher in MCC than in MCA patients(P=0.005,0.026,and 0.037,respectively).MCA tumor size was positively correlated with serum CA19-9 levels(r=0.389,P=0.001).Compared with MCC,MCA had a higher minimally invasive surgery rate(P=0.014).In the MCA group,the rate of major complications was 5.7%and that of clinically relevant pancreatic fistula was 8.6%;the corresponding rates in the MCC group were 16.7%and 16.7%,respectively.CONCLUSION Tumor size,age,and serum CEA,CA19-9,and CA12-5 levels may contribute to management of patients with MCN.Surgical resection is the primary treatment modality for MCC and MCA.
基金Young Scholar Independent Innovation Science Fund of Chinese PLA General Hospital,No.22QNCZ020National Key Research and Development Program,No.2022YFC2504003.
文摘BACKGROUND Autoimmune pancreatitis(AIP)has been linked with elevated immunoglobulin(Ig)G4 levels.The characteristics and outcomes of AIP based on serum markers have not been fully evaluated.AIM To compare clinical features,treatment efficacy,and outcome of AIP based on serum IgG4 levels and analyze predictors of relapse.METHODS A total of 213 patients with AIP were consecutively reviewed in our hospital from 2006 to 2021.According to the serum IgG4 level,all patients were divided into two groups,the abnormal group(n=148)with a high level of IgG4[>2×upper limit of normal(ULN)]and the normal group(n=65).The t-test or Mann-Whitney U test was used to compare continuous variables.Categorical parameters were compared by theχ^(2) test or Fisher’s exact test.Kaplan-Meier curves Zhou GZ et al.Clinical characteristics and outcome of AIP WJG https://www.wjgnet.com 5126 September 21,2023 Volume 29 Issue 35 and log-rank tests were established to assess the cumulative relapse rates.Univariate and multivariate analyses were used to investigate potential risk factors of AIP relapse.RESULTS Compared with the normal group,the abnormal group had a higher average male age(60.3±10.4 vs 56.5±12.9 years,P=0.047);higher level of serum total protein(72.5±7.9 g/L vs 67.2±7.5 g/L,P<0.001),IgG4(1420.5±1110.9 mg/dL vs 252.7±106.6 mg/dL,P<0.001),and IgE(635.6±958.1 IU/mL vs 231.7±352.5 IU/mL,P=0.002);and a lower level of serum complement C3(100.6±36.2 mg/dL vs 119.0±45.7 mg/dL,P=0.050).In addition,a lower number of cases with abnormal pancreatic duct and pancreatic atrophy(23.6%vs 37.9%,P=0.045;1.6%vs 8.6%,P=0.020,respectively)and a higher rate of relapse(17.6%vs 6.2%,P=0.030)were seen in the abnormal group.Multivariate analyses revealed that serum IgG4[(>2×ULN),hazard ratio(HR):3.583;95%confidence interval(CI):1.218–10.545;P=0.020]and IgA(>1×ULN;HR:5.908;95%CI:1.199–29.120;P=0.029)and age>55 years(HR:2.383;95%CI:1.056–5.378;P=0.036)were independent risk factors of relapse.CONCLUSION AIP patients with high IgG4 levels have clinical features including a more active immune system and higher relapse rate.Several factors,such as IgG4 and IgA,are associated with relapse.
基金the National Natural Science Foundation of China(81871516 and 81571841)the Youth Special Project of Chinese PLA General Hospital(QNC19052).
文摘Battlefield internal medicine aims at the treatment of combatants and noncombatants with various internal diseases on the battlefield.The military medical research on battlefield internal diseases focuses on the pathogenesis,clinical management,and prevention of internal diseases under military war conditions.In both wartime and peacetime,the soldiers suffer from more internal diseases than surgical wounds.With the introduction of high-tech weapons,including chemical,physical,and biological agents,a large number of special internal illnesses and casualties will appear in future wars.The battles often occur in special environments,such as high or low temperatures,plateau or polar areas,and micro-or hyper-gravity.The current theories of battlefield internal medicine are mainly derived from wars decades ago and cannot meet the needs of military medical support under the conditions of modern warfare.Therefore,the military medical research on battlefield internal medicine should be based on contemporary military situations,focus on the purpose of treating battlefield internal diseases,and adhere to the actual needs of the troops in peacetime and wartime.We should investigate the pathogenesis of battlefield internal diseases and explore the threats that may arise in future wars to ensure the advancement of battlefield internal medicine.This review highlights new concepts,demands,challenges,and opportunities for the further development of military medical research on battlefield internal medicine.
文摘Background: Robotic pancreaticoduodenectomy(RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma(PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients. Methods: Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival(OS), and an online nomogram calculator was developed based on the independent prognostic factors. Results: Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 m L, the median OS was 23.6 months, and the median recurrence-free survival(RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19-9(CA19-9) [hazard ratio(HR) = 2.607, 95% confidence interval(CI): 1.560-4.354, P < 0.001], lymph node metastasis(HR = 1.429, 95% CI: 1.005-2.034, P = 0.047), tumor moderately(HR = 3.190, 95% CI: 1.813-5.614, P < 0.001) or poorly differentiated(HR = 5.114, 95% CI: 2.839-9.212, P < 0.001), and Clavien-Dindo grade ≥ Ⅲ(HR = 1.657, 95% CI: 1.079-2.546, P = 0.021) were independent prognostic factors for OS. The concordance index(C-index) of the nomogram constructed based on the above four independent prognostic factors was 0.685(95% CI: 0.640-0.729), which was significantly higher than that of the AJCC staging(8th edition): 0.541(95% CI: 0.493-0.589)( P < 0.001). Conclusions: This large-scale study indicated that RPD was feasible for PDAC of pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥ Ⅲ were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.
基金the Ethics Committee of Chinese PLA General Hospital(S2022-530-01).
文摘Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection(“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy(SPDP) with splenic vessel preservation(Kimura’s procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura’s procedure. Methods: The clinical data of consecutive patients who underwent robotic SPDP with Kimura’s procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy(P-F) group and a “tunnel-first” strategy(T-F) group and analyzed. Results: A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time(146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0(20.0–55.0) m L vs. 50.0(20.0–100.0) m L, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the TF group and 2.4% in the P-F group( P = 0.14). The grade 3/4 complications were similar between the two groups( P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. Conclusions: The pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura’s procedure.
基金supported by the Beijing Municipal Science and Technology Commission(BMSTC,No.D171100002617001).
文摘Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.
文摘Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone.Two hundred and twenty-two patients who underwent transrectal prostate biopsy(TRB)and 216 patients who underwent transperineal prostate biopsy(TPB)between June 2016 and September 2022 were reviewed in this study.In addition,110 patients who received additional targeted biopsies following the systematic TPB were identified.Clinical parameters,including age,PSA derivative,prostate volume(PV),and needle core count,were recorded.The data were fitted via propensity score matching(PSM),adjusting for potential confounders.TPB outperformed TRB in terms of the CDR(49.6%vs 28.3%,P=0.001).The clinically significant prostate cancer(csPCa)detection rate was not significantly different between TPB and TRB(78.6%vs 68.8%,P=0.306).In stratified analysis,TPB outperformed TRB in CDR when the age of patients was 65–75 years(59.0%vs 22.0%,P<0.001),when PV was 25.00–50.00 ml(63.2%vs 28.3%,P<0.001),and when needle core count was no more than 12(58.5%vs 31.5%,P=0.005).The CDR(P=0.712)and detection rate of csPCa(P=0.993)did not significantly differ among the systematic,targeted,and combined biopsies.TPB outperformed TRB in CDR for patients with gray-zone PSA.Moreover,performing target biopsy after systematic TPB provided no additional benefits in CDR.
基金sponsored by Insightec Co.Ltd.(Israel)China National Clinical Research Center for Geriatrics,No.NCRCG-PLAGH-2019005 (to LP)
文摘The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided focused ultrasound system in Chinese mainland was installed at the First Medical Center of the PLA General Hospital.This prospective,single center,open-label,single-arm study was part of a worldwide prospective multicenter clinical trial(ClinicalTrials.gov Identifier:NCT03253991)conducted to confirm the safety and efficacy of magnetic resonance-guided focused ultrasound for treating essential tremor in the local population.From 2019 to 2020,10 patients with medication refractory essential tremor were recruited into this open-label,single arm study.The treatment efficacy was determined using the Clinical Rating Scale for Tremor.Safety was evaluated according to the incidence and severity of adverse events.All of the subjects underwent a unilateral thalamotomy targeting the ventral intermediate nucleus.At the baseline assessment,the estimated marginal mean of the Clinical Rating Scale for Tremor total score was 58.3±3.6,and this improved after treatment to 23.1±6.4 at a 12-month follow-up assessment.A total of 50 adverse events were recorded,and 2 were defined as serious.The most common intraoperative adverse events were nausea and headache.The most frequent postoperative adverse events were paresthesia and equilibrium disorder.Most of the adverse events were mild and usually disappeared within a few days.Our findings suggest that magnetic resonance-guided focused ultrasound for the treatment of essential tremor is effective,with a good safety profile,for patients in Chinese mainland.
基金Supported by the China Postdoctoral Science Foundation,No.2015M582853.
文摘BACKGROUND Nab-paclitaxel plus gemcitabine(AG)has resulted in higher tumor response and survival rates for metastatic or advanced pancreatic ductal adenocarcinoma(PDAC)compared with gemcitabine(GEM)alone.AIM To examine the feasibility and safety of AG adjuvant chemotherapy of resectable PDAC.METHODS We retrospectively analyzed patients with resected PDAC who received AG or GEM as postoperative adjuvant treatment between January 2013 and December 2016 at the Chinese People’s Liberation Army General Hospital,Beijing,China.The patients adopted combined nab-paclitaxel(125 mg/m^2)and GEM(1 g/m^2)or GEM(1 g/m^2)alone treatment,on days 1 and 8 every 3 wk for six cycles,unless intolerable adverse events or disease progression occurred.The disease-free survival,overall survival(OS)and adverse events of the two groups were statistically analyzed.RESULTS Compared with GEM,median disease-free survival(12.2 mo vs 15.8 mo,P=0.039)and OS(20.6 mo vs 28.3 mo,P=0.028)were significantly improved in the AG group.The 2-year OS rates were 63.3%and 43.3%in the AG and GEM groups,respectively.However,the incidence of sensory neuropathy was increased significantly in the AG than the GEM group(53.3%vs 23.3%,P<0.001).CONCLUSION In our initial experience,AG significantly improved disease-free survival and OS of patients with resected PDAC.AG may be a potential option for postoperative adjuvant chemotherapy of resectable PDAC.
基金supported by the Clinical Support program of General Hospital of PLA(No.2018FC-WJFWZX-2-19)Military Medical Innovation Program(18CXZ009)。
文摘Background:Snakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide.However,few Chinese military medics know the proper first aid procedures for snakebites.Therefore,this study aimed to explore the impact of the Standard Operation Procedure(SOP)and checklist on Chinese military medics’ability to manage snakebite first aid.Methods:This study was a prospective single-blind randomized controlled trial conducted in a military medical university of China from May to June 2017.A questionnaire-based survey was performed to collect the participants’socio-demographic profiles before the baseline measurement.During the baseline measurement,participants were requested to provide corresponding first aid that was responsive to the simulative situation portrayed by the standardized patients(SPs)and the evaluators then scored their performances according to a checklist for snakebite first aid scoring table.After the baseline measurement,they were randomly assigned to one of three intervention groups after stratification according to their baseline performance scores:group A received a self-learning course with textbooks(n=27),group B received a self-learning training on the SOP and checklist(n=27)and group C was engaged in an interactive discussion panel regarding the SOP and checklist(n=26).After the interventions,participants received outcome measurements about snakebite first aid key points capability from the same evaluator and SP for each group to avoid observational error.The reviewers were blinded about the grouping in the trial.Results:The baseline measurement yielded no significant difference(H=1.647,P=0.439)among the three groups.The post-intervention scores were higher than the pre-intervention scores for all three(A,B and C)groups(P=0.008,P<0.001 and P<0.001,respectively).There was significant difference of the post-intervention scores among the three groups(F=8.841,P<0.001).Both post-intervention scores of group B and group C were higher than that of group A(P<0.001 and P=0.001,respectively),but no difference was found between group B and C(P=0.695).The acceptance questionnaire score of SOP and checklist was mostly very satisfied,as the final scores of group B and group C were 4.62±0.61 and 4.82±0.45,respectively.Conclusions:In this study,the implementation of an SOP and checklist for snakebite first aid was shown to update and improve first aid treatment concepts in military medics.These intervention methods played an important role in improving the medics’cognition and understanding of snakebite first aid.Therefore,this finding suggests that SOP and checklist training should be further implemented in Chinese troops for snakebite care.
文摘Background:Although oral health-related quality of life(OHRQoL)in orthodontic patients has been assessed in the past,to date,no study has compared the OHRQoL between two nations.We aimed to compare the OHRQoL between Chinese and American orthodontic patients.Methods:We conducted a two-center questionnaire-based cross-sectional study among patients who underwent orthodontic treatments at the Chinese PLA General Hospital(PLAGH)in Beijing,China and Massachusetts General Hospital(MGH)in Boston,Massachusetts,United States.Candidate variables included the participating center,patients’age,sex,Angle’s classification of malocclusion,evaluation stage,and appliances used.The primary outcome was patients’OHRQoL assessed with the Oral Health Impact Profile-14(OHIP-14).Descriptive statistics,stratification,and univariate and multivariate analyses were performed.Results:The average age was lower for PLAGH patients than for MGH patients(21.1±7.9 vs.33.1±14.6 years,P<0.001).The most common type of malocclusion was Angle’s Class III malocclusion at PLAGH(39%)and Class I malocclusion at MGH(59.5%).Clear aligners were used in 34.1%and 2.7%of the patients at MGH and PLAGH,respectively.OHIP-14 scores were lower for PLAGH patients than for MGH patients(18.4±4.7 vs.22.3±7.4,P<0.001),particularly in functional limitation,psychological discomfort/disability,and handicap.Univariate regression analysis demonstrated that participating center,age,Class I malocclusion,and the use of clear aligners were significantly associated with overall OHIP-14 scores.Multivariate regression analysis demonstrated that patients at PLAGH were associated with lower OHIP-14 scores(coefficient:-3;95%CI:-5,-1.3;P=0.001),and age was positively associated with OHIP-14 scores(coefficient:0.1;95%CI:0.004,0.13;P=0.038).Conclusion:Chinese orthodontic patients had lower OHIP-14 scores,indicating a higher OHRQoL than American patients.In addition to the younger age,this difference may be attributed to the different ethical,cultural,educational,and socioeconomic background of Chinese and American orthodontic patients.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2503600。
文摘BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.
文摘BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms.
文摘Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.
文摘Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.
基金funded by National Natural Science Foundation of China(No.82272134)Innovative Research Group Project of the National Natural Science Foundation of China(No.82272134,Xiao-lei Chen).
文摘Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation systems face challenges such as high equipment costs,complex operation,bulky size,and insufficient anti-interference performance.To address these limitations,our study developed and validated a novel portable electromagnetic neuronavigation system designed to improve the precision,accessibility,and clinical applicability of electromagnetic navigation technology in cranial surgery.Methods The software and hardware architecture of a portable neural magnetic navigation system was designed.The key technologies of the system were analysed,including electromagnetic positioning algorithms,miniaturized sensor design,optimization of electromagnetic positioning and navigation algorithms,anti-interference signal processing methods,and fast three-dimensional reconstruction algorithms.A prototype was developed,and its accuracy was tested.Finally,a preliminary clinical application evaluation was conducted.Results This study successfully developed a comprehensive portable electromagnetic neuronavigation system capable of achieving preoperative planning,intraoperative real-time positioning and navigation,and postoperative evaluation of navigation outcomes.Through rigorous collaborative testing of the system’s software and hardware,the accuracy of electromagnetic neuronavigation has been validated to meet clinical requirements.Conclusions This study developed a portable neuroelectromagnetic navigation system and validated its effectiveness and safety through rigorous model testing and preliminary clinical applications.The system is characterized by its compact size,high precision,excellent portability,and user-friendly operation,making it highly valuable for promoting navigation technology and advancing the precision and minimally invasive nature of neurosurgical procedures.
