Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study

BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1 RA)are effective in diabetes and obesity,reducing hyperglycemia by increasing insulin release and delaying gastric emptying.However,they can cause gastroparesis,raising concerns about aspiration during procedures.Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration.AIM To evaluate the effect of GLP-1 RAs on gastric residual contents during endosco-pic procedures.METHODS A retrospective chart review at BronxCare Health System,New York,from January 2019 to October 2023,assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures.Two groups were compared based on dietary status before the procedure.Data included demographics,symptoms of gastroparesis,opiate use,hemoglobin A1c,GLP-1 agonist indication,endo-scopic details,and aspiration occurrence.IBM SPSS was used for analysis,cal-culating means,standard deviations,and applying Pearson’s chi-square and t-tests for associations,with P<0.05 as being significant.RESULTS During the study,306 patients were included,with 41.2%on a clear liquid/low residue diet and 58.8%on a regular diet before endoscopy.Most patients(63.1%)were male,with a mean age of 60±12 years.The majority(85.6%)were on GLP-1 RAs for diabetes,and 10.1%reported digestive symptoms before endoscopy.Among those on a clear liquid diet,1.5%had residual food at endoscopy compared to 10%on a regular diet,which was statistically significant(P=0.03).Out of 31 patients with digestive symptoms,13%had residual food,all from the regular diet group(P=0.130).No complications were reported during or after the procedures.CONCLUSION The study reflects a significant rise in GLP-1 RA use for diabetes and obesity.A 24-hour liquid diet seems safe for endoscopic procedures without aspiration.Patients with upper gastrointestinal symptoms might have a higher residual food risk,though not statistically significant.Further research is needed to assess risks based on diabetes duration,gastroparesis,and GLP-1 RA dosing,aiming to minimize interruptions in therapy during procedures.

Endoscopic clipping of gastrojejunostomy leakage following Whipple procedure: A case report

BACKGROUND Currently,perioperative complications of classic Whipple surgery occur at a rate of approximately 40%.Common complications include delayed gastric emptying,pancreatic fistula,and bile leakage,whereas gastrojejunostomy(GJ)leakage is rare.CASE SUMMARY This case report will assess the management of a GJ leak in a 71-year-old male patient following the Whipple procedure.After surgery,the patient was trans-ferred to the clinic after four days of intensive care,where vacuum therapy was used to handle a developing subcutaneous collection.The patient,who had bile in the drains and incision during follow-up,underwent endoscopic examination on the 21st day after the operation.An opening of approximately 4 mm was observed in the GJ anastomosis during endoscopy.Five titanium clips were used to close the openings.The drainage of bile decreased to less than 50 mL on the first day after the procedure,and the patient's oral intake was opened.CONCLUSION Current literature reports a GJ leakage rate of 0.54%following Whipple surgery,with clinical findings lasting on average between 4-34 days.Surgery was the main form of therapy for this case,with a success rate of 84%,and percutaneous drai-nage was also utilized as a treatment option.This case report is the first to docu-ment endoscopic treatment of GJ leaks following the classic Whipple procedure.

Optimization of Open-cast Mining Procedure Based on RSR Method

To explore the optimal evaluation mechanism of open-cast mining procedure,this paper takes the actual operation status of Huolinhe No.1 Open-cast Mine as the research basis,and makes a deep analysis of the four representative mining procedures proposed by this mine.A detailed and comprehensive evaluation system is constructed using rank-sum ratio(RSR)method.The system covers 17 key indicators and aims to evaluate the advantages and disadvantages of each scheme in an all-round and multi-angle manner.Through the calculation and analysis by RSR method,the comprehensive evaluation of the four types of mining procedure schemes is carried out,and finally the secondary river improvement project is determined as the optimal mining implementation scheme,and the joint mining scheme of the south and north areas is the alternative strategy.The research results of this paper are objective,clear and definite,can not only reveal the effectiveness and feasibility of RSR method in solving the problem of open-cast mining procedure optimization,but also provide a strong technical support and decision-making basis for the future production development of Huolinhe No.1 Open-cast Mine.Thus,this study is expected to further promote the scientific and refined process of mining operations.

Hysteroscopic cervical biopsy for women with persistent human papillomavirus infection after loop electrosurgical excision procedure: A case report

BACKGROUNDAlmost all cases of cervical cancer can be attributed to human papillomavirus(HPV) infection. The loop electrosurgical excision procedure (LEEP) is widelyused to treat HPV-mediated disease;thus, cervical cancer is highly preventable.However, LEEP does not necessarily clear HPV rapidly and may affect theaccuracy of the results of ThinPrep cytology test (TCT) and cervical biopsy due tothe formation of cervical scars.CASE SUMMARYA 40-year-old woman underwent LEEP for cervical intraepithelial neoplasia grade1 approximately 10 years ago. Subsequent standard cervical cancer screeningsuggested persistent HPV-52 infection, but TCT results were negative. Cervicalbiopsy under colposcopy was performed thrice over a 10-year period, yieldingnegative pathology results. She developed abnormal vaginal bleeding after sexualactivity, persisting for approximately 1 year, and underwent hysteroscopy in ourhospital. Histopathologic evaluation confirmed adenocarcinoma in situ of theuterine cervix.CONCLUSIONPatients with long-term persistent, high-risk HPV infection and negative pathologyresults of cervical biopsy after LEEP are at risk of cervical cancer. Hysteroscopicresection of cervical canal tissue is recommended as a supplement tocervical biopsy because it helps define the lesion site and may yield a pathologicdiagnosis.

Coordinated Mining Procedures of Open Pit Mines Based on River Management

This paper primarily concerns the effective coordination of the procedures and methods employed in open pit mining operations under the background of river management.The central objective of this study is to identify a viable approach for ensuring rational and efficient development of open pit mineral resources while simultaneously protecting and restoring the ecological environment of the river.This approach should facilitate the realization of a harmonious symbiosis between mining and river management.The intricate mutual influence relationship between river management and open pit mining is first analyzed in depth,which provides a solid foundation for the subsequent coordination strategy development.In light of the aforementioned considerations,a set of coordination procedures for open pit mining based on river management conditions is proposed.These procedures emphasize the integration of river protection into the overall layout of mining at the planning stage.The implementation of scientific mining schemes,accompanied by rigorous control of the scope and depth of mining operations,has proven to be an effective means of reducing the impact of mining activities on river environments.This approach has also facilitated the achievement of a balance and coordination between mining and river management.

Education Programs for Invasive Procedures Involving Nurses: A Scoping Review

Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.

Invasive Procedures for Prenatal Diagnosis in Salmaniya Medical Complex in Bahrain: A Retrospective Cross-Sectional Descriptive Study

Background: Prenatal diagnosis is the process of evaluating the presence of disease or potential disease in the fetus, this enables families to be better prepared before the birth of the baby. There are non-invasive prenatal diagnosis procedures and invasive prenatal diagnosis procedures. The invasive prenatal diagnosis procedures are CVS (chorionic villus sampling) and amniocentesis. The American College of Obstetricians and Gynecologists states that invasive diagnostic testing should be available to all women, regardless of age or risk. Objective: To determine the indications, outcome and results of diagnostic invasive prenatal procedures. Study setting: The obstetrics and Gynecology Department in Salmaniya Medical Complex in Kingdom of Bahrain. Study design: Retrospective descriptive study. Study subjects and Methods: This retrospective descriptive study was conducted on 175 pregnant women who underwent invasive prenatal procedures (CVS and amniocentesis) between January 2013 and December 2018 at SMC in Kingdom of Bahrain. All medical records of the participants were reviewed and entered the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The study subject will include indications of the procedures which are advanced maternal age, hematological disorders, genetic disorders, metabolic disorders, abnormal structural findings in fetal ultrasound and previous child with aneuploidy. In addition, the study will address the complications, outcome and results of procedures. Results: About half of our indications of the procedures were due to hematological disorders (47.6%) followed by abnormal structural findings in fetal ultrasound (30.1%) then genetic disorders (15.7%), metabolic disorders (4.8%) and advanced maternal age (1.8%). Regarding complications of the procedure;threatened miscarriage or loss of pregnancy within 3 weeks was (2.3%), amniotic fluid leakage (0.7%), abdominal cramps (0.7%) and Insufficient or contaminated sample (6.2%). Regarding outcome of the pregnancy, our results showed that the loss of pregnancy was (4.8%), intrauterine fetal death or still birth was (13.9%), live birth was (63.9%), preterm delivery was (7.8%), preterm premature rupture of membrane (PPROM) was (1.8%), limbs reduction was (0.0%). Termination of pregnancy outside the country was (7.8%) of chorionic villus sampling and amniocentesis. Conclusion: CVS and amniocentesis are useful outpatient procedures to detect diagnosis or to assess whether a patient is at increased risk of having an affected fetus and that will minimize the psychological impact on the patient and to provide a proper antenatal care to the pregnant women by her obstetrician and follow up to the baby by pediatrician. In this study it was observed that most of the patients who underwent the procedure were couples either carrier or affected to sickle cell disease or Beta thalassemia.

Clinical Study on the Treatment of Low Anal Fistula in Infants and Young Children by Anal Gland Excision and Virtual Hanging Procedure

Objective:To compare the efficacy of anal adenectomy with virtual hanging wire and anal fistulotomy in the treatment of low anal fistula in infants and children.Methods:60 children with low anal fistula who were admitted to our hospital from October 2021 to March 2022 and met the inclusion criteria were randomly divided into two groups of 30 cases each;the treatment group was treated with anal adenectomy and virtual hanging wire surgery,and the control group was treated with anal fistula resection.The clinical efficacy after treatment was compared.Results:The total effective rate of both groups was 96.67%and the difference between the two groups was not statistically significant(P>0.05).The postoperative pain score of the treatment group was lower than that of the control group(P<0.05).The length of hospitalization and healing time of the treatment group was lower than that of the control group(P<0.05).The anal function of the patients in both groups was normal,and there was no adverse reaction.Conclusion:Anal gland excision and virtual hanging surgery for the treatment of low anal fistula in infants and children have the advantages of mild pain,reduced length of hospitalization,short healing time,and better patient experience as compared to anal fistula excision.

Standard Operating Procedure of Houttuynia cordata Thunb.Plastic Greenhouse Cultivation

This standard operating procedure stipulated the natural condition of pro- ducing area, cultivation technique, disease and pest control, harvest, quality stan- dard, packaging, transportation and storage of H. cordata, in order to provide a ba- sis for the standard cultivation of H. cordata.

线粒体自噬、铁死亡、铜死亡和双硫死亡在阿尔茨海默病中的作用机制及进展

背景:近年来,随着对细胞程序性死亡的深入研究,阿尔茨海默病损伤涉及的新型程序性死亡模型(线粒体自噬、铁死亡、铜死亡及双硫死亡)正逐渐兴起并且未来具有较大研究空间。目的:对新型程序性细胞死亡模式(线粒体自噬、铁死亡、铜死亡和双硫死亡)的分子机制、新型细胞死亡模式的串扰机制、临床转化等在阿尔茨海默病的研究进展进行综述,为探索新型细胞死亡模式在阿尔茨海默病中的作用机制和药物靶点提供新视角。方法:由第一作者应用计算机检索1991-2024年中国知网和PubMed数据库收录的文献,最终纳入101篇文章进行综述分析。结果与结论:①细胞程序性死亡作为维持细胞正常更新和内环境稳态的必要调节途径,其中线粒体自噬、铁死亡、铜死亡和双硫死亡等新型细胞程序性死亡是目前生命科学的热门研究领域。②线粒体自噬能够清除阿尔茨海默病神经元中受损线粒体,降低细胞内活性氧,恢复阿尔茨海默病中神经元细胞的能量代谢和信号转导,在调控神经元健康和功能中起着至关重要的作用。③铁死亡在阿尔茨海默病中的研究备受关注,能够通过胱氨酸/谷氨酸、铁代谢及多不饱和脂肪酸等多种途径调控阿尔茨海默病,从而影响Aβ沉积及Tau蛋白磷酸化,近期研究显示天然多酚、酸枣仁汤、茯苓酸和维生素E等可在阿尔茨海默病中抑制铁死亡。④铜死亡是涉及铜的依赖、脂酰化蛋白的积累以及铁硫簇蛋白减少的一种新型独特细胞死亡形式,其过量铜暴露可能会直接与Aβ斑块和淀粉样蛋白前体蛋白相互作用,加重阿尔茨海默病的认知障碍,目前铜死亡研究领域正兴起,作用机制尚未完全阐明。⑤双硫死亡作为一种新兴细胞程序死亡形式,由胱氨酸过量积累以及葡萄糖饥饿引起二硫化物应激,导致对与阿尔茨海默病有关的肌动蛋白骨架受损。⑥各类细胞程序性死亡模式在阿尔茨海默病发病机制中存在串联机制,形成了以自噬为核心的各类程序性死亡的相互作用网络,为多层次、多靶点调控阿尔茨海默病提供了巨大潜力,“自噬-坏死性凋亡-焦亡/铁死亡”之间的串扰网络机制共同调控阿尔茨海默病。⑦铜死亡和双硫死亡作为一种新的程序性死亡方式,目前在阿尔茨海默病中报导不够深入,未来仍然需要进一步的研究及持续关注。⑧由于线粒体自噬、铁死亡、铜死亡和双硫死亡大多数研究都基于基础实验或生物信息学分析,缺乏大规模及长期的临床研究验证,未来需进一步深入探讨,以期为治疗阿尔茨海默病提供新思路和有效策略。

Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation

AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.

Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications

Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important waysof preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management.

Comparison of Two Procedures for Extraction and Clean-up of Organophosphorus and Pyrethroid Pesticides in Sediment

Two procedures were compared for extraction and clean-up of 20organophosphorus and 19 pyrethroid pesticides in sediment to identify the more effective procedurefor groups of pesticides or individual compounds. In Procedure I, methanol/water and n-hexane wereused for extraction, and 1:10 (v/v) dichloromethane in n-hexane and acetone were used as eluents foreluting the analyte through the cartridge, with one evaporating steps on a rotary evaporator andtwo eluting steps on the cartridge. n-hexane/acetone (2:1, v/v) was used for extraction and elutionin Procedure II with one evaporating step on a rotary evaporator and one eluting step on thecartridge. All extractions were performed under an ultrasonic bath and gas chromatography and massspectrometry were utilized for measurements. Procedure II was developed as a rapid, timesaving, lesscostly and safer substitute for Procedure I which was an old method. Procedure II was moreeffective for almost all the organophosphorus pesticides tested and 11of the 19 pyrethroidpesticides, while Procedure I was more appropriate for analysis of 5 pyrethroid pesticides. However,recoveries of most pyrethroid pesticides were fairly low. Thus, further studies should focus onadjustment and formulation of solvents for more efficient extraction and clean-up of pyrethroidpesticides from sediment samples.

Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to predict that outcome. METHODS： We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS： Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD （12.8 ＋ 3.9 vs 12.6 ＋ 4.7, P = 0.9） or in the mean CTP （7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8） between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures （MELD： 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP： 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008）. The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them （AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3）. CONCLUSION： The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Role of Kasai procedure in surgery of hilar bile duct strictures

AIM:To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures.METHODS:Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed.Kasai portoenterostomy with the placement of biliary stents was performed in all patients.Clinical characteristics,postoperative complications,and long-term outcomes were analyzed.All patients were followed up for 2-60 mo postoperatively.RESULTS:Patients were classified according to the Bismuth classification of biliary strictures.There were two Bismuth Ⅲ and eight Bismuth Ⅳ lesions.Six lesions were benign and four were malignant.Of the benign lesions,three were due to post-cholecystectomy injury,one to trauma,one to inflammation,and one to inflammatory pseudotumor.Of the malignant lesions,four were due to hilar cholangiocarcinoma.All patients underwent Kasai portoenterostomy with the placement of biliary stents.There were no perioperative deaths.One patient experienced anastomotic leak and was managed conservatively.No other complications occurred perioperatively.During the follow-up period,all patients reported a good quality of life.CONCLUSION:The Kasai procedure combined with biliary stents may be appropriate for patients with hilar biliary stricture that cannot be managed by standard surgical methods.

Shortcut Procedure for Inverted Batch Distillation Column (I) Multicomponent Ideal System

Inverted batch distillation column(stripper) is opposed to a conventional batch distillation col-umn(rectifier). It has a storage vessel at the top and products leave the column at the bottom. The batch stripper is favourable to separate mixtures with a small amount of light components by removing the heavy components as bottom products. In this paper, we are presenting a shortcut procedure based on our earlier work for design and simulation of the inverted batch distillation column, which is equivalent to the Fenske-Underwood-Gilliland procedure for continuous distillation. Given a separation task, we propose to compute the minimum number of stages(Nbmin) and the minimum reboil ratio(Rbmin) required in a batch stripper,which are the stages and reboil ratio required in a hypothetical inverted batch distillation column operating in total reboil ratio or having an infinite number of stages, respectively. Then, it is shown that the performance of inverted batch columns with a finite number of stages and reboil ratios could be correlated in Gilliland coordinates with the minimum stages Nbmin and the minimum reboil ratio Rbmin.

Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

AIM: To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis(CP) and patient selection.METHODS: All consecutive patients undergoingduodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index(BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index(white blood cells, interleukin(IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data(postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients.RESULTS: Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male(85%) and seven were female(16%). The etiology of CP was alcohol in 32 patients(70%) and idiopathic in 14 patients(30%). Stones were found in 38 patients(83%). An inflammatory mass was found in five patients(11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19(9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7(17.8-22.4) kg/m2 and was 20.6 ± 2.9(15.4-27.7) kg/m2 in the opengroup. Allpatientsrequired analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients(43%). Pre-operative complications due to pancreatitis were observed in 18 patients(39%). Pancreatic functional insufficiency was observed in 14 patients(30%). Two laparoscopic patients(2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29(290-370) min. Estimated intra-operativeblood loss was 57 ± 14(40-80) m L. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2(5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass(P < 0.001) and acute exacerbation(P < 0.001) were risk factors for intra-operative blood loss. CONCLUSION: The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.

Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction

BACKGROUND Hemorrhoidal prolapse is a common benign disease with a high incidence.The treatment procedure for prolapse and hemorrhoids(PPH)remains an operative method used for internal hemorrhoid prolapse.Although it is related to less posoperative pain,faster recovery and shorter hospital stays,the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy(MMH).We have considered that recurrence could be due to shortage of the pulling-up effect.This issue may be overcome by using lower purse-string sutures[modified-PPH(M-PPH)].AIM To compare the therapeutic effects and the patients’satisfaction after M-PPH,PPH and MMH.METHODS This retrospective cohort study included 1163 patients(M-PPH,461;original PPH,321;MMH,381)with severe hemorrhoids(stage III/IV)who were admitted to The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2012 to 2014.Early postoperative complications,efficacy,postoperative anal dysfunction and patient satisfaction were compared among the three groups.Established criteria were used to assess short-and long-term postoperative complications.A visual analog scale was used to evaluate postoperative pain.Follow-up was conducted 5 years postoperatively.RESULT Length of hospital stay and operating time were significantly longer in the MMH group(8.05±2.50 d,19.98±4.21 min;P<0.0001)than in other groups.The incidence of postoperative anastomotic bleeding was significantly lower after MPPH than after PPH or MMH(1.9%,5.1%and 3.7%;n=9,16 and 14;respectively).There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH(15%,8%and 10%;n=69,30 and 32;respectively).There was a significantly lower rate of recurrence after M-PPH than after PPH(8.7%and 18.8%,n=40 and 61;P<0.0001).The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups(1.3%and 4.3%,n=5 and 20;P=0.04).Patient satisfaction was significantly greater after M-PPH than after other surgeries.CONCLUSION M-PPH has many advantages for severe hemorrhoids(Goligher stage III/IV),with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction.

Sudden sensorineural hearing loss(SSHL) following a local anesthetic dental procedure

Acute sensorineural hearing loss is an uncommon phenomenon in dentistry.We describe the case of a 79-year-old male who presented with acute sensorineural hearing loss occurring 2 days after a tooth extraction procedure under local anesthesia.Possible mechanisms are discussed.He was treated with vasodilators(Ginaton and Alprostadil Injection)and Mecobalamin injection with benefit.High dose oral steroids(1 mg/kg)and low molecular weight dextran were used.