Background Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans...Background Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones. Methods From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively. Results All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was （8.3±2.5） minutes, and the operative duration was （105.4±23.1） minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones （〈0.5 cm） and dilated cystic duct （〉0.3 cm）, dilated common bile duct （〉0.8 cm）, history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients （5.2%） by intra-operative cholangiography. The post-operative hospital stay was （4.7±2.2） days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3-7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 （0.7%） presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leaka展开更多
Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong r...Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.展开更多
AIM: To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never eval...AIM: To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP). METHODS: Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized "tailored" RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire. RESULTS: The feasibility was 97.5% and the effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone’s recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the cases.CONCLUSION: Simultaneous RV carries higheffectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.展开更多
Over the past decade,enhanced preoperative imaging and visualization,improved delineation of the complex anatomical structures of the liver and pancreas,and intra-operative technological advances have helped deliver t...Over the past decade,enhanced preoperative imaging and visualization,improved delineation of the complex anatomical structures of the liver and pancreas,and intra-operative technological advances have helped deliver the liver and pancreatic surgery with increased safety and better postoperative outcomes.Artificial intelligence(AI)has a major role to play in 3D visualization,virtual simulation,augmented reality that helps in the training of surgeons and the future delivery of conventional,laparoscopic,and robotic hepatobiliary and pancreatic(HPB)surgery;artificial neural networks and machine learning has the potential to revolutionize individualized patient care during the preoperative imaging,and postoperative surveillance.In this paper,we reviewed the existing evidence and outlined the potential for applying AI in the perioperative care of patients undergoing HPB surgery.展开更多
The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspe...The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.Intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.展开更多
BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications o...BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,展开更多
Background:The effect of intra-operative chemotherapy(IOC)on the long-term survival of patients with colorectal cancer(CRC)remains unclear.In this study,we evaluated the independent effect of intra-operative infusion ...Background:The effect of intra-operative chemotherapy(IOC)on the long-term survival of patients with colorectal cancer(CRC)remains unclear.In this study,we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.Methods:1820 patients were recruited,and 1263 received IOC and 557 did not.Clinical and demographic data were collected,including overall survival(OS),clinicopathological features,and treatment strategies.Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models.A regression model was developed to analyze the independent effects of IOC.Results:Proportional hazard regression analysis showed that IOC(hazard ratio[HR]=0.53,95%confidence intervals[CI][0.43,0.65],P<0.001)was a protective factor for the survival of patients.The mean overall survival time in IOC group was 82.50(95%CI[80.52,84.49])months,and 71.21(95%CI[67.92,74.50])months in non-IOC group.The OS in IOC-treated patients were significantly higher than non-IOC-treated patients(P<0.001,log-rank test).Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model(HR=0.53,95%CI[0.43,0.65],P<0.001),model 2(adjusted for age and gender,HR=0.52,95%CI[0.43,0.64],P<0.001),and model 3(adjusted for all factors,95%CI 0.71[0.55,0.90],P=0.006).The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II(HR=0.46,95%CI[0.31,0.67])or III disease(HR=0.59,95%CI[0.45,0.76]),regardless of pre-operative radiotherapy(HR=0.55,95%CI[0.45,0.68])or pre-operative chemotherapy(HR=0.54,95%CI[0.44,0.66]).Conclusions:IOC is an independent factor that influences the survival of CRC patients.It improved the OS of patients with stages II and III CRC after radical surgery.Trial registration:chictr.org.cn,ChiCTR 2100043775.展开更多
Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography （r-TEG） is a comprehensive assessment of coagulation abnormalities and also an...Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography （r-TEG） is a comprehensive assessment of coagulation abnormalities and also an effective way for constructing blood transfusion. This study attempts to investigate the correlation of r-TEG indices with intra-operative hemorrhage. Methods Patients who underwent transphenoidal hypophysectomy and craniotomy from January 15 to April 30, 2013 in Peking Union Medical College hospital were recruited. All patients had pre- and post-operative r-TEG and conventional coagulation tests （CCTs）. Patients’ information and intra-operative blood loss as a percentage of estimated blood volume were recorded. Spearman’s correlation analyses were used for discovering the relationship between indices in r-TEG or CCTs and the intra-operative blood loss. The significant correlated index of r-TEG was further investigated using linear regression analysis. Results A total of 181 patients participated in this study. Intra-operative change of α-angle, which reflects the fibrinogen level and function, was the only r-TEG index that correlated with blood loss significantly （P=0.013, r= ？0.184）, thus challenging the current empirical cognition of the effects of intra-operative hemorrhage on coagulation. As intra-operative blood loss increased, α-angle decreased, and every 1% loss of estimated blood volume （EBV） led to 0.60 degree decrease of α-angle. As for CCT results, changes of fibrinogen and platelet count were also significantly correlated with blood loss （P=0.015 and P=0.001, respectively）.Conclusions Peri-operative change of α-angle, as an index of r-TEG, exhibited a significant negative correlation with intra-operative blood loss. The impact of hemorrhage on fibrinogen, instead of clotting factors, should be scrutinized.展开更多
Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, ...Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.展开更多
OBJECTIVE To summarize a common pathogenefic condition, the pathologic characteristics shown in frozen section and our experience utilizing 2 different common thyroid diseases （TD）. diagnostic methods in cases of ME...OBJECTIVE To summarize a common pathogenefic condition, the pathologic characteristics shown in frozen section and our experience utilizing 2 different common thyroid diseases （TD）. diagnostic methods in cases of METHODS Data from 638 cases with frozen sections from thyroid tissue were retrospectively analyzed. The intraoperative frozen sections of the patients and postoperative diagnostic results of routine paraffin sections were compared. RESULTS In the 683 patients, the gender ratio of females to males was 2.64 ： 1, and the ratio between the patients with nodular goiter （NG） and the patients with thyroid adenoma was 1.5 ： 1. The oldest age group of patients with thyroid cancer （TC） ranged from 40 to 49 years. Frozen section pathologic examination has been employed more and more in the diagnosis of thyroid diseases, and the detection rate of TC has increased year by year, i.e., the rate increased to 6.45%, 7.58%, 14.55% and 16.57%, respectively, in 2005, 2006, 2007 and 2008. Thyroid papillary carcinoma （TPC） was the most commonly seen malignant tumor of the thyroid （MTT）, which accounted for approximately 94.8% of MTTs and 11.44% of the total TDs. Micropapillary carcinoma accounted for 27.4% of TPC, and multifocal carcinomas accounted for 15.58% of TCs. Many of the TCs （19.48%） were complicated by benign diseases such as adenoma, NG and thyroiditis. The coincidence rate of diagnoses made by frozen section and paraffin embedding for thyroid disease was 98.59%. Calcification was rather common in NG and TPC, and there were significant differences in psammoma bodies （PMB） between the calcifications of TPC and NG （P 〈 0.01）. CONCLUSION TPC ranks first in the incidence of MTTs and accounts for 94.8% of all MTTs. About 1/4 of TPCs are micropapillary carcinoma, while 1/5 are accompanied by benign disease, such as adenorna, NG and thyroiditis. PMB are of importance and of significance in the diagnosis of TPC.展开更多
BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual dec...BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual decompression and subtotal colectomy.AIM To compare the peri-operative outcomes of IOCL to other procedures.METHODS Electronic databases were searched for articles employing IOCL from inception till July 13,2020.Odds ratio and weighted mean differences(WMD)were estimated for dichotomous and continuous outcomes respectively.Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.RESULTS Of 28 studies were included in this meta-analysis,involving 1142 undergoing IOCL,and 634 other interventions.IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure,and anastomotic leak and wound infection when compared to manual decompression.There was a decreased length of hospital stay(WMD=-7.750;95%CI:-13.504 to-1.996;P=0.008)compared to manual decompression and an increased operating time.Single-arm meta-analysis found that overall mortality rates with IOCL was 4%(CI:0.03-0.05).Rates of anastomotic leak and wound infection were 3%(CI:0.02-0.04)and 12%(CI:0.09-0.16)respectively.CONCLUSION IOCL leads to similar rates of post-operative complications compared to other procedures.More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.展开更多
AIM: To evaluate the feasibility of using therapeutic ultrasound as an alternative treatment option for organconfined prostate cancer. METHODS: In this study, a trans-urethral therapeutic ultrasound applicator in comb...AIM: To evaluate the feasibility of using therapeutic ultrasound as an alternative treatment option for organconfined prostate cancer. METHODS: In this study, a trans-urethral therapeutic ultrasound applicator in combination with 3T magnetic resonance imaging(MRI) guidance was used for realtime multi-planar MRI-based temperature monitoring and temperature feedback control of prostatic tissue thermal ablation in vivo. We evaluated the feasibility and safety of MRI-guided trans-urethral ultrasound to effectively and accurately ablate prostate tissue while minimizing the damage to surrounding tissues in eight canine prostates. MRI was used to plan sonications, monitor temperature changes during therapy, and to evaluate treatment outcome. Real-time temperature and thermal dose maps were calculated using the proton resonance frequency shift technique and were displayed as two-dimensional color-coded overlays on top of the anatomical images. After ultrasound treatment, an evaluation of the integrity of cavernosal nerves was performed during prostatectomy with a nerve stimulator that measured tumescence response quantitatively and indicated intact cavernous nerve functionality. Planned sonication volumes were visually correlated to MRI ablation volumes and corresponding histo-pathological sections after prostatectomy. RESULTS: A total of 16 sonications were performed in 8 canines. MR images acquired before ultrasound treatment were used to localize the prostate and to prescribe sonication targets in all canines. Temperature elevations corresponded within 1 degree of the targeted sonication angle, as well as with the width and length of the active transducer elements. The ultrasound treatment procedures were automatically interrupted when the temperature in the target zone reached 56 ℃. In all canines erectile responses were evaluated with a cavernous nerve stimulator post-treatment and showed a tumescence response after stimulation with an electric current. These results indicated intact cavernous nerve functionality.展开更多
ECAPs are the summary of multiple neurons’ spikes which could be recorded by a bidirectional stimulation-recording system via the cochlear implant,with the artifact elimination paradigms of forward-masking subtractio...ECAPs are the summary of multiple neurons’ spikes which could be recorded by a bidirectional stimulation-recording system via the cochlear implant,with the artifact elimination paradigms of forward-masking subtraction paradigm or alternating polarity paradigm.Three kinds of FDA approved cochlear implants support ECAP testing.This article is to summarize the clinical application of ECAP lest.ECAP test after insertion of electrode during implant operation has been widely used during cochlear implant surgery.In recent years.ECAP thresholds are also used to estimate the T levels and C levels helping programming.However,correlation between ECAP thresholds and psychophysical thresholds is affected by many factors.So far,ECAPs cannot yet be a good indicator of post-operative hearing and speech performance.展开更多
BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to ...BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.展开更多
Lipodermoids are abnormal epibulbar growths of the adipose tissue. A conjunctival lesion, the lipodermoid (dermolipoma) is usually located near the temporal fornix and is composed of adipose tissue and dense connectiv...Lipodermoids are abnormal epibulbar growths of the adipose tissue. A conjunctival lesion, the lipodermoid (dermolipoma) is usually located near the temporal fornix and is composed of adipose tissue and dense connective tissue. The overlying conjunctival epithelium is normal, and hair follicles are absent. Lipodermoids may be extensive, sometimes involving orbital tissue, lacrimal gland, and extraocular muscle. Surgical treatment is only indicated when the existing lipodermoid disturbs the patient either functionally or aesthetically. Purpose The main purpose of this study is to present our experience on the surgical treatment of lipodermoids in those cases when lipodermoids cause functional and aesthetic problem to the patient. Materials and Methods In our study we have included two cases of male gender, one with bilateral lipodermoid (in both eyes) while the other with a mono lateral lipodermoid (only in one eye). The treatment was surgical, where we carefully removed the lipodermoid lesion inside palpebral fissures, to fully preserve the bulbar conjunctiva and Tenon’s membrane during the removal of the conjunctival lipodermoid.Surgery was performed under local anesthesia (lidocaine 2% and adrenaline). The surgical area was set ready by using betadine 5%. Results In both cases there were neither intra-operative nor extra-operative complications and the results were positive.Also the functional and aesthetic problems were corrected. There was no recurrence encountered.Conclusions In conclusion, based on the results of this study, in the rare cases of lipodermoids where surgical treatment is necessary, it is very important to perform a careful surgical intervention, in order to prevent any intra-operative injuries of the lacrimal gland and the lateral and superior rectus muscles. In general the surgical treatment is a successful method on treating lipodermoids, in cases when they concern the patient both functionally and aesthetically.展开更多
文摘Background Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones. Methods From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively. Results All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was （8.3±2.5） minutes, and the operative duration was （105.4±23.1） minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones （〈0.5 cm） and dilated cystic duct （〉0.3 cm）, dilated common bile duct （〉0.8 cm）, history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients （5.2%） by intra-operative cholangiography. The post-operative hospital stay was （4.7±2.2） days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3-7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 （0.7%） presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leaka
文摘Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.
文摘AIM: To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP). METHODS: Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized "tailored" RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire. RESULTS: The feasibility was 97.5% and the effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone’s recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the cases.CONCLUSION: Simultaneous RV carries higheffectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.
文摘Over the past decade,enhanced preoperative imaging and visualization,improved delineation of the complex anatomical structures of the liver and pancreas,and intra-operative technological advances have helped deliver the liver and pancreatic surgery with increased safety and better postoperative outcomes.Artificial intelligence(AI)has a major role to play in 3D visualization,virtual simulation,augmented reality that helps in the training of surgeons and the future delivery of conventional,laparoscopic,and robotic hepatobiliary and pancreatic(HPB)surgery;artificial neural networks and machine learning has the potential to revolutionize individualized patient care during the preoperative imaging,and postoperative surveillance.In this paper,we reviewed the existing evidence and outlined the potential for applying AI in the perioperative care of patients undergoing HPB surgery.
文摘The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.Intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.
文摘BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,
基金Youth Science and Technology Project of Hebei Health Commission(No.20210029)Hebei Provincial Natural Science Foundation Precision Medicine Joint Project(No.H2020206485)Hebei Provincial Department of Science and Technology Key Project(No.206Z7705G)
文摘Background:The effect of intra-operative chemotherapy(IOC)on the long-term survival of patients with colorectal cancer(CRC)remains unclear.In this study,we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.Methods:1820 patients were recruited,and 1263 received IOC and 557 did not.Clinical and demographic data were collected,including overall survival(OS),clinicopathological features,and treatment strategies.Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models.A regression model was developed to analyze the independent effects of IOC.Results:Proportional hazard regression analysis showed that IOC(hazard ratio[HR]=0.53,95%confidence intervals[CI][0.43,0.65],P<0.001)was a protective factor for the survival of patients.The mean overall survival time in IOC group was 82.50(95%CI[80.52,84.49])months,and 71.21(95%CI[67.92,74.50])months in non-IOC group.The OS in IOC-treated patients were significantly higher than non-IOC-treated patients(P<0.001,log-rank test).Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model(HR=0.53,95%CI[0.43,0.65],P<0.001),model 2(adjusted for age and gender,HR=0.52,95%CI[0.43,0.64],P<0.001),and model 3(adjusted for all factors,95%CI 0.71[0.55,0.90],P=0.006).The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II(HR=0.46,95%CI[0.31,0.67])or III disease(HR=0.59,95%CI[0.45,0.76]),regardless of pre-operative radiotherapy(HR=0.55,95%CI[0.45,0.68])or pre-operative chemotherapy(HR=0.54,95%CI[0.44,0.66]).Conclusions:IOC is an independent factor that influences the survival of CRC patients.It improved the OS of patients with stages II and III CRC after radical surgery.Trial registration:chictr.org.cn,ChiCTR 2100043775.
文摘Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography （r-TEG） is a comprehensive assessment of coagulation abnormalities and also an effective way for constructing blood transfusion. This study attempts to investigate the correlation of r-TEG indices with intra-operative hemorrhage. Methods Patients who underwent transphenoidal hypophysectomy and craniotomy from January 15 to April 30, 2013 in Peking Union Medical College hospital were recruited. All patients had pre- and post-operative r-TEG and conventional coagulation tests （CCTs）. Patients’ information and intra-operative blood loss as a percentage of estimated blood volume were recorded. Spearman’s correlation analyses were used for discovering the relationship between indices in r-TEG or CCTs and the intra-operative blood loss. The significant correlated index of r-TEG was further investigated using linear regression analysis. Results A total of 181 patients participated in this study. Intra-operative change of α-angle, which reflects the fibrinogen level and function, was the only r-TEG index that correlated with blood loss significantly （P=0.013, r= ？0.184）, thus challenging the current empirical cognition of the effects of intra-operative hemorrhage on coagulation. As intra-operative blood loss increased, α-angle decreased, and every 1% loss of estimated blood volume （EBV） led to 0.60 degree decrease of α-angle. As for CCT results, changes of fibrinogen and platelet count were also significantly correlated with blood loss （P=0.015 and P=0.001, respectively）.Conclusions Peri-operative change of α-angle, as an index of r-TEG, exhibited a significant negative correlation with intra-operative blood loss. The impact of hemorrhage on fibrinogen, instead of clotting factors, should be scrutinized.
文摘Purpose: To investigate the dosimetric characteristics of a low energy photon intra-operative radiotherapy (IORT) system and explore its potential limitation in clinical application. Methods: A special water phantom, a parallel-plate ionization chamber and an electrometer were used to measure the depth dose rate, isotropy of dose distribution in X/Y plane, dosimetry reproducibility of bare probe and spherical applicators of different size which were used in comparison with the system data. Results: The difference in depth dose rate between the measurement and system data for bare probe is -2.16% ± 1.36%, the range of the relative deviation for isotropy in the X/Y plane is between -1.9% and 2.1%. The difference in depth dose rate, transfer coefficient, isotropy in X/Y plane between the measurement and system data for the whole set of spherical applicators is -10.0% - 2.3%, -8.9% - 4.2% and -1.6% - 2.6%, respectively. Higher surface dose rate and steeper gradient depth dose are observed in smaller spherical applicators. The depth dose rate and isotropy for bare probe and spherical applicators have been shown good reproducibility. The uncertainty of measurement is associated with the positioning accuracy, energy response, noise current and correction function f’(R). Conclusions: Thorough commissioning of the low energy photon IORT system helps us better understand the dosimetry characteristics, verify the system data, obtain adequate data for clinical application and routine quality assurance. The steep gradient depth dose and limited treatment range may restrain its potential in clinical application.
文摘OBJECTIVE To summarize a common pathogenefic condition, the pathologic characteristics shown in frozen section and our experience utilizing 2 different common thyroid diseases （TD）. diagnostic methods in cases of METHODS Data from 638 cases with frozen sections from thyroid tissue were retrospectively analyzed. The intraoperative frozen sections of the patients and postoperative diagnostic results of routine paraffin sections were compared. RESULTS In the 683 patients, the gender ratio of females to males was 2.64 ： 1, and the ratio between the patients with nodular goiter （NG） and the patients with thyroid adenoma was 1.5 ： 1. The oldest age group of patients with thyroid cancer （TC） ranged from 40 to 49 years. Frozen section pathologic examination has been employed more and more in the diagnosis of thyroid diseases, and the detection rate of TC has increased year by year, i.e., the rate increased to 6.45%, 7.58%, 14.55% and 16.57%, respectively, in 2005, 2006, 2007 and 2008. Thyroid papillary carcinoma （TPC） was the most commonly seen malignant tumor of the thyroid （MTT）, which accounted for approximately 94.8% of MTTs and 11.44% of the total TDs. Micropapillary carcinoma accounted for 27.4% of TPC, and multifocal carcinomas accounted for 15.58% of TCs. Many of the TCs （19.48%） were complicated by benign diseases such as adenoma, NG and thyroiditis. The coincidence rate of diagnoses made by frozen section and paraffin embedding for thyroid disease was 98.59%. Calcification was rather common in NG and TPC, and there were significant differences in psammoma bodies （PMB） between the calcifications of TPC and NG （P 〈 0.01）. CONCLUSION TPC ranks first in the incidence of MTTs and accounts for 94.8% of all MTTs. About 1/4 of TPCs are micropapillary carcinoma, while 1/5 are accompanied by benign disease, such as adenorna, NG and thyroiditis. PMB are of importance and of significance in the diagnosis of TPC.
文摘BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual decompression and subtotal colectomy.AIM To compare the peri-operative outcomes of IOCL to other procedures.METHODS Electronic databases were searched for articles employing IOCL from inception till July 13,2020.Odds ratio and weighted mean differences(WMD)were estimated for dichotomous and continuous outcomes respectively.Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.RESULTS Of 28 studies were included in this meta-analysis,involving 1142 undergoing IOCL,and 634 other interventions.IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure,and anastomotic leak and wound infection when compared to manual decompression.There was a decreased length of hospital stay(WMD=-7.750;95%CI:-13.504 to-1.996;P=0.008)compared to manual decompression and an increased operating time.Single-arm meta-analysis found that overall mortality rates with IOCL was 4%(CI:0.03-0.05).Rates of anastomotic leak and wound infection were 3%(CI:0.02-0.04)and 12%(CI:0.09-0.16)respectively.CONCLUSION IOCL leads to similar rates of post-operative complications compared to other procedures.More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.
基金The National Cancer Institute Education and Career Development program R25 Cancer Nanotechnology in Imaging and Radiotherapy(5R25CA132822-04)in partthe Cancer Research Foundation+1 种基金the University of Chicago Comprehensive Cancer CenterPhilips Healthcare
文摘AIM: To evaluate the feasibility of using therapeutic ultrasound as an alternative treatment option for organconfined prostate cancer. METHODS: In this study, a trans-urethral therapeutic ultrasound applicator in combination with 3T magnetic resonance imaging(MRI) guidance was used for realtime multi-planar MRI-based temperature monitoring and temperature feedback control of prostatic tissue thermal ablation in vivo. We evaluated the feasibility and safety of MRI-guided trans-urethral ultrasound to effectively and accurately ablate prostate tissue while minimizing the damage to surrounding tissues in eight canine prostates. MRI was used to plan sonications, monitor temperature changes during therapy, and to evaluate treatment outcome. Real-time temperature and thermal dose maps were calculated using the proton resonance frequency shift technique and were displayed as two-dimensional color-coded overlays on top of the anatomical images. After ultrasound treatment, an evaluation of the integrity of cavernosal nerves was performed during prostatectomy with a nerve stimulator that measured tumescence response quantitatively and indicated intact cavernous nerve functionality. Planned sonication volumes were visually correlated to MRI ablation volumes and corresponding histo-pathological sections after prostatectomy. RESULTS: A total of 16 sonications were performed in 8 canines. MR images acquired before ultrasound treatment were used to localize the prostate and to prescribe sonication targets in all canines. Temperature elevations corresponded within 1 degree of the targeted sonication angle, as well as with the width and length of the active transducer elements. The ultrasound treatment procedures were automatically interrupted when the temperature in the target zone reached 56 ℃. In all canines erectile responses were evaluated with a cavernous nerve stimulator post-treatment and showed a tumescence response after stimulation with an electric current. These results indicated intact cavernous nerve functionality.
基金supported by grants from the National Basic Research Program of China(973 Program)(#2012CB967900)Science and Technology Innovation Nursery Foundation of PLA General Hospital(13KMM14)Clinical Research Supporting Foundation of PLA General Hospital(2012FC-TSYS-3056)
文摘ECAPs are the summary of multiple neurons’ spikes which could be recorded by a bidirectional stimulation-recording system via the cochlear implant,with the artifact elimination paradigms of forward-masking subtraction paradigm or alternating polarity paradigm.Three kinds of FDA approved cochlear implants support ECAP testing.This article is to summarize the clinical application of ECAP lest.ECAP test after insertion of electrode during implant operation has been widely used during cochlear implant surgery.In recent years.ECAP thresholds are also used to estimate the T levels and C levels helping programming.However,correlation between ECAP thresholds and psychophysical thresholds is affected by many factors.So far,ECAPs cannot yet be a good indicator of post-operative hearing and speech performance.
基金supported by grants from the Foundation for Innovative Research Groups of the National Natural Science Foundation of China(81121002)Zhejiang Provincial Program for the Cultivation of High-Level Innovative Health Talents(2012-236)+1 种基金Zhejiang Provincial Education Department Project(Y201018972)Zhejiang Provincial Natural Science Foundation of China(LQ12H03002)
文摘BACKGROUND: Living donor liver transplantation(LDLT)has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intraoperative cholangiography(IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in influencing the biliary complications and improving the overall outcome.METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin(TB), alanine aminotransferase(ALT), aspartate aminotransferase(AST),alkaline phosphatase(ALP) and γ-glutamyl transpeptidase(GGT)at different time points were compared, and the follow-up data and the biliary complications were also analyzed.RESULTS: The ALT and AST values were significantly increased after IOC(P<0.001) and parenchymal resection(P<0.001).However, the median values of TB, ALP and GGT were not significantly influenced by IOC(P>0.05) or parenchymal resection(P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up.CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover,the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.
文摘Lipodermoids are abnormal epibulbar growths of the adipose tissue. A conjunctival lesion, the lipodermoid (dermolipoma) is usually located near the temporal fornix and is composed of adipose tissue and dense connective tissue. The overlying conjunctival epithelium is normal, and hair follicles are absent. Lipodermoids may be extensive, sometimes involving orbital tissue, lacrimal gland, and extraocular muscle. Surgical treatment is only indicated when the existing lipodermoid disturbs the patient either functionally or aesthetically. Purpose The main purpose of this study is to present our experience on the surgical treatment of lipodermoids in those cases when lipodermoids cause functional and aesthetic problem to the patient. Materials and Methods In our study we have included two cases of male gender, one with bilateral lipodermoid (in both eyes) while the other with a mono lateral lipodermoid (only in one eye). The treatment was surgical, where we carefully removed the lipodermoid lesion inside palpebral fissures, to fully preserve the bulbar conjunctiva and Tenon’s membrane during the removal of the conjunctival lipodermoid.Surgery was performed under local anesthesia (lidocaine 2% and adrenaline). The surgical area was set ready by using betadine 5%. Results In both cases there were neither intra-operative nor extra-operative complications and the results were positive.Also the functional and aesthetic problems were corrected. There was no recurrence encountered.Conclusions In conclusion, based on the results of this study, in the rare cases of lipodermoids where surgical treatment is necessary, it is very important to perform a careful surgical intervention, in order to prevent any intra-operative injuries of the lacrimal gland and the lateral and superior rectus muscles. In general the surgical treatment is a successful method on treating lipodermoids, in cases when they concern the patient both functionally and aesthetically.
