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
Hilar cholangiocarcinoma(HC)is a common biliary tract malignancy;however,its postoperative prognosis remains suboptimal.Recent advancements in surgical management include preoperative biliary drainage,selection of hep...Hilar cholangiocarcinoma(HC)is a common biliary tract malignancy;however,its postoperative prognosis remains suboptimal.Recent advancements in surgical management include preoperative biliary drainage,selection of hepatic resection approaches,innovations in bilioenteric anastomosis techniques,and perioperative chemotherapy.This review summarizes the current literature on these developments and highlighting their clinical implications,unresolved challenges,and prospected the future research direction.展开更多
Objective Adaptive immune responses play a critical role in the pathogenesis of amyotrophic lateral sclerosis(ALS).In this study,we investigated the functional mechanisms of T cell subtypes and assessed the causal lin...Objective Adaptive immune responses play a critical role in the pathogenesis of amyotrophic lateral sclerosis(ALS).In this study,we investigated the functional mechanisms of T cell subtypes and assessed the causal links between CD4+cytotoxic T cell-related genes and ALS risk.Methods Single-cell RNA sequencing(scRNA-seq)of peripheral blood mononuclear cells(PBMCs)from patients with ALS and healthy controls(HC)was used to identify differentially expressed genes(DEGs)in CD4+cytotoxic T cells.Comprehensive analyses of CD4+cytotoxic T cells,including pseudotemporal trajectory,intercellular communication,and metabolic pathway analysis,were performed.Mendelian randomization(MR)analysis evaluated the causal effects of DEGs on ALS risk,with validation using independent genome-wide association study(GWAS)data.Expression patterns of the causal genes were further verified using scRNA-seq,bulk-seq,and clinical samples.Results CD4+cytotoxic T cells were significantly expanded in patients with ALS.The upregulated genes S100A6,SERPINB6,SMAD7,and TPST2 were positively correlated with ALS susceptibility,whereas DIP2A showed a protective association.Conclusion S100A6,SERPINB6,SMAD7,TPST2,and DIP2A were identified as causal genes and potential therapeutic targets in ALS,implicating CD4+cytotoxic T cells in the disease mechanisms.Further studies targeting these genes and neuroinflammatory pathways are warranted.展开更多
Scar-related ventricular tachycardia(VT)is a malignant arrhythmia with high mortality rates in patients with cardiomyopathies such as ischemic and dilated cardiomyopathy.[1]While implantable cardioverter defibrillator...Scar-related ventricular tachycardia(VT)is a malignant arrhythmia with high mortality rates in patients with cardiomyopathies such as ischemic and dilated cardiomyopathy.[1]While implantable cardioverter defibrillators(ICD)effectively terminate VT episodes and prevent sudden cardiac death,recurrent ICD discharges may precipitate electrical storms and severely impair quality of life.Radiofrequency catheter ablation is another available treatment for VT but faces challenges in rapidly mapping the critical isthmus during hemodynamically unstable VT.Stereotactic arrhythmia radioablation(STAR)has emerged as a novel,non-invasive,and effective approach for refractory VT over the past decade.展开更多
Objective The associations of serum trace element levels with disease progression and survival duration were assessed in individuals diagnosed with sporadic amyotrophic lateral sclerosis(sALS)in China.Methods Clinical...Objective The associations of serum trace element levels with disease progression and survival duration were assessed in individuals diagnosed with sporadic amyotrophic lateral sclerosis(sALS)in China.Methods Clinical data,including diagnostic indicators,clinical characteristics,Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)scores,and serum concentrations of calcium(Ca),magnesium(Mg),iron(Fe),copper(Cu),and zinc(Zn),were collected for hospitalized patients with sALS between 2018 and 2021.Correlation analysis,random forest analysis,and the Gehan-Breslow-Wilcoxon test were used to evaluate the relations between serum trace element levels,disease progression,and survival duration.Results Lower serum Ca levels and higher Mg levels were observed in patients with ALSFRS-R scores<39.Serum Mg was significantly negatively correlated with ALSFRS-R,trunk,and respiratory scores.Serum Cu and Zn also showed significant negative correlations with the respiratory score,whereas Ca and Fe were not significantly correlated with the ALSFRS-R score.The serum levels of Ca,Mg,Cu,Zn,and Fe remained consistent regardless of the site of disease onset.ALSFRS-R analysis revealed that serum Ca and Mg had a substantial effect on the total ALSFRS-R score,with serum Mg significantly influencing the course of the disease.Notably,low serum Mg levels were associated with extended survival times in patients with sALS.Conclusion Serum levels of Ca and Mg play critical roles in the progression of sALS,and a reduced serum Mg level is related to an extended survival time.展开更多
Objective:Clinical use of stimulator of interferon genes(STING)agonists has challenges due to poor responsiveness and variable efficacy.Therefore,identifying tumor types that are sensitive to these agents and clarifyi...Objective:Clinical use of stimulator of interferon genes(STING)agonists has challenges due to poor responsiveness and variable efficacy.Therefore,identifying tumor types that are sensitive to these agents and clarifying the underlying mechanisms are essential.Methods:In vitro screening was performed to identify tumor types that are sensitive to STING agonists.The non-nucleotide agonist,SR-717,and the macrocyclic agonist,E7766,were compared for efficacy.Complementary in vivo and in vitro studies,including gene-knockout models,HMGN2-knockout Neuro-2A and CT-2A cells apoptosis assays,and murine tumor models,were then performed.These experiments focused on the mechanism by which SR-717 mediates antitumor effects and emphasized the role of STING signaling-induced high-mobility group nucleosome-binding protein 2(HMGN2).In addition,the potential of HMGN2 as a prognostic biomarker was assessed.Results:Neuroblastomas and glioblastomas,two nervous system tumors,were shown to be sensitive to STING agonists.SR-717 exhibited greater antitumor efficacy compared to E7766.Mechanistic studies indicated that STING agonists promote apoptosis through activation of the intrinsic STING-signal transducer and activator of transcription 1(STAT1)-HMGN2 axis within tumor cells.Ectopic expression of HMGN2 in melanoma cells,which naturally lack HMGN2,led to significant apoptosis.Furthermore,analysis of The Cancer Genome Atlas and Gene Expression Omnibus databases revealed positive correlation between elevated HMGN2 expression and patient survival,supporting the utility of HMGN2 as a prognostic biomarker.Conclusions:This study clarified the mechanism underlying the potent antitumor activity of SR-717 in nervous system tumors through activation of the STING-STAT1-HMGN2 signaling pathway and demonstrated that SR-717 has superior efficacy compared to E7766.In addition,HMGN2 was shown to exhibit translational potential as a prognostic biomarker for patient survival.展开更多
Pulmonary rehabilitation(PR)aims to improve lung function in patients with chronic respiratory disease(CRD).In recent years,significant advancements have been made in pulmonary rehabilitation technologies,demonstratin...Pulmonary rehabilitation(PR)aims to improve lung function in patients with chronic respiratory disease(CRD).In recent years,significant advancements have been made in pulmonary rehabilitation technologies,demonstrating their potential for enhancing lung function in patients with respiratory diseases.The purpose of this study is to outline recent developments in the field of pulmonary rehabilitation guided by pulmonary rehabilitation robots,which has not been previously addressed in earlier reviews.To fill this gap,this paper first provides a systematic summary of the monitoring and actuation technologies of pulmonary rehabilitation robot systems and evaluates these technologies from multiple dimensions,including portability,wearability potential,invasiveness,and clinical applications,analyzing the potential for integrating various technologies into pulmonary rehabilitation robot systems.Furthermore,three technical directions are proposed:real-time precise monitoring,suitable structure and actuation strategies,and the intelligence of pulmonary rehabilitation robot systems.On the basis of these directions,this paper presents a comprehensive technical outlook for a soft wearable pulmonary rehabilitation robot system,providing reference and guidance for future research.To our knowledge,this is the first review of pulmonary rehabilitation robot systems and their key technologies.Additionally,the review section on respiratory assistive technologies simultaneously covers key technologies such as mechanical ventilation(MV),exoskeleton robots,and functional electrical stimulation(FES)for the first time.It also summarizes the respiratory assistive technology paradigm from the innovative perspectives of respiratory assistive modalities,targeted body sites,and types of ventilation for the first time.This study offers a broader perspective and a deeper understanding of pulmonary re-habilitation robots,with a technical outlook encompassing multimodal data fusion perception,respiratory event detection and intention recognition,full-phase assistance strategies,modeling,decoupling,and quantification of multipleinput multiple-output(MIMO)systems,as well as model-based interactive control strategies.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
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Hilar cholangiocarcinoma(HC)is a common biliary tract malignancy;however,its postoperative prognosis remains suboptimal.Recent advancements in surgical management include preoperative biliary drainage,selection of hepatic resection approaches,innovations in bilioenteric anastomosis techniques,and perioperative chemotherapy.This review summarizes the current literature on these developments and highlighting their clinical implications,unresolved challenges,and prospected the future research direction.
文摘Objective Adaptive immune responses play a critical role in the pathogenesis of amyotrophic lateral sclerosis(ALS).In this study,we investigated the functional mechanisms of T cell subtypes and assessed the causal links between CD4+cytotoxic T cell-related genes and ALS risk.Methods Single-cell RNA sequencing(scRNA-seq)of peripheral blood mononuclear cells(PBMCs)from patients with ALS and healthy controls(HC)was used to identify differentially expressed genes(DEGs)in CD4+cytotoxic T cells.Comprehensive analyses of CD4+cytotoxic T cells,including pseudotemporal trajectory,intercellular communication,and metabolic pathway analysis,were performed.Mendelian randomization(MR)analysis evaluated the causal effects of DEGs on ALS risk,with validation using independent genome-wide association study(GWAS)data.Expression patterns of the causal genes were further verified using scRNA-seq,bulk-seq,and clinical samples.Results CD4+cytotoxic T cells were significantly expanded in patients with ALS.The upregulated genes S100A6,SERPINB6,SMAD7,and TPST2 were positively correlated with ALS susceptibility,whereas DIP2A showed a protective association.Conclusion S100A6,SERPINB6,SMAD7,TPST2,and DIP2A were identified as causal genes and potential therapeutic targets in ALS,implicating CD4+cytotoxic T cells in the disease mechanisms.Further studies targeting these genes and neuroinflammatory pathways are warranted.
文摘Scar-related ventricular tachycardia(VT)is a malignant arrhythmia with high mortality rates in patients with cardiomyopathies such as ischemic and dilated cardiomyopathy.[1]While implantable cardioverter defibrillators(ICD)effectively terminate VT episodes and prevent sudden cardiac death,recurrent ICD discharges may precipitate electrical storms and severely impair quality of life.Radiofrequency catheter ablation is another available treatment for VT but faces challenges in rapidly mapping the critical isthmus during hemodynamically unstable VT.Stereotactic arrhythmia radioablation(STAR)has emerged as a novel,non-invasive,and effective approach for refractory VT over the past decade.
文摘Objective The associations of serum trace element levels with disease progression and survival duration were assessed in individuals diagnosed with sporadic amyotrophic lateral sclerosis(sALS)in China.Methods Clinical data,including diagnostic indicators,clinical characteristics,Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised(ALSFRS-R)scores,and serum concentrations of calcium(Ca),magnesium(Mg),iron(Fe),copper(Cu),and zinc(Zn),were collected for hospitalized patients with sALS between 2018 and 2021.Correlation analysis,random forest analysis,and the Gehan-Breslow-Wilcoxon test were used to evaluate the relations between serum trace element levels,disease progression,and survival duration.Results Lower serum Ca levels and higher Mg levels were observed in patients with ALSFRS-R scores<39.Serum Mg was significantly negatively correlated with ALSFRS-R,trunk,and respiratory scores.Serum Cu and Zn also showed significant negative correlations with the respiratory score,whereas Ca and Fe were not significantly correlated with the ALSFRS-R score.The serum levels of Ca,Mg,Cu,Zn,and Fe remained consistent regardless of the site of disease onset.ALSFRS-R analysis revealed that serum Ca and Mg had a substantial effect on the total ALSFRS-R score,with serum Mg significantly influencing the course of the disease.Notably,low serum Mg levels were associated with extended survival times in patients with sALS.Conclusion Serum levels of Ca and Mg play critical roles in the progression of sALS,and a reduced serum Mg level is related to an extended survival time.
文摘Objective:Clinical use of stimulator of interferon genes(STING)agonists has challenges due to poor responsiveness and variable efficacy.Therefore,identifying tumor types that are sensitive to these agents and clarifying the underlying mechanisms are essential.Methods:In vitro screening was performed to identify tumor types that are sensitive to STING agonists.The non-nucleotide agonist,SR-717,and the macrocyclic agonist,E7766,were compared for efficacy.Complementary in vivo and in vitro studies,including gene-knockout models,HMGN2-knockout Neuro-2A and CT-2A cells apoptosis assays,and murine tumor models,were then performed.These experiments focused on the mechanism by which SR-717 mediates antitumor effects and emphasized the role of STING signaling-induced high-mobility group nucleosome-binding protein 2(HMGN2).In addition,the potential of HMGN2 as a prognostic biomarker was assessed.Results:Neuroblastomas and glioblastomas,two nervous system tumors,were shown to be sensitive to STING agonists.SR-717 exhibited greater antitumor efficacy compared to E7766.Mechanistic studies indicated that STING agonists promote apoptosis through activation of the intrinsic STING-signal transducer and activator of transcription 1(STAT1)-HMGN2 axis within tumor cells.Ectopic expression of HMGN2 in melanoma cells,which naturally lack HMGN2,led to significant apoptosis.Furthermore,analysis of The Cancer Genome Atlas and Gene Expression Omnibus databases revealed positive correlation between elevated HMGN2 expression and patient survival,supporting the utility of HMGN2 as a prognostic biomarker.Conclusions:This study clarified the mechanism underlying the potent antitumor activity of SR-717 in nervous system tumors through activation of the STING-STAT1-HMGN2 signaling pathway and demonstrated that SR-717 has superior efficacy compared to E7766.In addition,HMGN2 was shown to exhibit translational potential as a prognostic biomarker for patient survival.
基金supported by the National Key Research and Development Project(2022YFB4703200)。
文摘Pulmonary rehabilitation(PR)aims to improve lung function in patients with chronic respiratory disease(CRD).In recent years,significant advancements have been made in pulmonary rehabilitation technologies,demonstrating their potential for enhancing lung function in patients with respiratory diseases.The purpose of this study is to outline recent developments in the field of pulmonary rehabilitation guided by pulmonary rehabilitation robots,which has not been previously addressed in earlier reviews.To fill this gap,this paper first provides a systematic summary of the monitoring and actuation technologies of pulmonary rehabilitation robot systems and evaluates these technologies from multiple dimensions,including portability,wearability potential,invasiveness,and clinical applications,analyzing the potential for integrating various technologies into pulmonary rehabilitation robot systems.Furthermore,three technical directions are proposed:real-time precise monitoring,suitable structure and actuation strategies,and the intelligence of pulmonary rehabilitation robot systems.On the basis of these directions,this paper presents a comprehensive technical outlook for a soft wearable pulmonary rehabilitation robot system,providing reference and guidance for future research.To our knowledge,this is the first review of pulmonary rehabilitation robot systems and their key technologies.Additionally,the review section on respiratory assistive technologies simultaneously covers key technologies such as mechanical ventilation(MV),exoskeleton robots,and functional electrical stimulation(FES)for the first time.It also summarizes the respiratory assistive technology paradigm from the innovative perspectives of respiratory assistive modalities,targeted body sites,and types of ventilation for the first time.This study offers a broader perspective and a deeper understanding of pulmonary re-habilitation robots,with a technical outlook encompassing multimodal data fusion perception,respiratory event detection and intention recognition,full-phase assistance strategies,modeling,decoupling,and quantification of multipleinput multiple-output(MIMO)systems,as well as model-based interactive control strategies.
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.
