BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients ...BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients with T1b GBC.METHODS We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China.The logrank test and Cox proportional hazards model were used to compare the overall survival(OS)of patients who underwent cholecystectomy(Ch)+RL and those who underwent Ch only.To investigate whether combined hepatectomy(Hep)improved OS in T1b patients,we studied patients who underwent Ch+RL to compare the OS of patients who underwent combined Hep and patients who did not.RESULTS Of the 121 patients(aged 61.9±10.1 years),77(63.6%)underwent Ch+RL,and 44(36.4%)underwent Ch only.Seven(9.1%)patients in the Ch+RL group had lymph node metastasis.The 5-year OS rate was significantly higher in the Ch+RL group than in the Ch group(76.3%vs 56.8%,P=0.036).Multivariate analysis showed that Ch+RL was significantly associated with improved OS(hazard ratio:0.51;95%confidence interval:0.26-0.99).Among the 77 patients who underwent Ch+RL,no survival improvement was found in patients who underwent combined Hep(5-year OS rate:79.5%for combined Hep and 76.1%for no Hep;P=0.50).CONCLUSION T1b GBC patients who underwent Ch+RL had a better prognosis than those who underwent Ch.Hep+Ch showed no improvement in prognosis in T1b GBC patients.Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines,RL was only performed in 63.6%of T1b GBC patients.Routine Ch+RL should be advised in T1b GBC.展开更多
BACKGROUND Hepatic hemangioma is the most common benign tumor of the liver.However,patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention.It is nec...BACKGROUND Hepatic hemangioma is the most common benign tumor of the liver.However,patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention.It is necessary to explore additional minimally invasive and personalized treatment options for hemangiomas.CASE SUMMARY A 47-year-old woman was diagnosed with a right hepatic hemangioma for more than 10 years.Abdominal contrast-enhanced computed tomography(CT)and contrast-enhanced ultrasound revealed that there was a large hemangioma in the right liver,with a size of approximately 95 mm×97 mm×117 mm.Due to the patient's refusal of surgical treatment,hepatic artery embolization was performed in the first stage.After 25 d of liver protection treatment,the liver function indexes decreased to normal levels.Then,ultrasound-guided microwave ablation of the giant hepatic hemangioma was performed.Ten days after the treatment,hepatobiliary ultrasonography showed that the hemangioma of the right liver was smaller than the previous size(the volume was reduced by approximately 30%).Then the patient was discharged from the hospital.One year after discharge,CT showed that the hepatic hemangioma had shrunk by about 80%CONCLUSION Transcatheter arterial embolization combined with microwave ablation is a safe and effective minimally invasive treatment for hepatic hemangioma.展开更多
BACKGROUND The management of recurrent gallstone ileus(GSI)is unsatisfactory,and there is no consensus on how to reduce the incidence of recurrent GSI.CASE SUMMARY A 79-year-old man presented to the Emergency Departme...BACKGROUND The management of recurrent gallstone ileus(GSI)is unsatisfactory,and there is no consensus on how to reduce the incidence of recurrent GSI.CASE SUMMARY A 79-year-old man presented to the Emergency Department of our hospital complaining of abdominal pain.An abdominal computed tomography(CT)scan revealed cholecystolithiasis,intrahepatic bile duct dilatation,gas accumulation,small intestinal obstruction,and circular high-density shadow in the intestinal cavity.Emergency surgery revealed that the small intestine had extensive adhesions,unclear gallbladder exposure,obvious adhesions,and difficult separation.The obstruction was located 70 cm between the ileum and the ileocecum,which was incarcerated by gallstones,and a simple enterolithotomy was carried out.On the third day after the operation,he had passed gas and defecated and had begun a liquid diet.On the fifth day after the operation,he suddenly experienced abdominal distension and discomfort.Emergency CT examination revealed recurrent GSI,and the diameter of the stone was approximately 2.0 cm(consistent with the shape of cholecystolithiasis on the abdominal CT scan before the first operation).The patient’s symptoms were not significantly relieved after conservative treatment.On the ninth day after the operation,emergency enterolithotomy was performed again along the original surgical incision.On the twentieth day after the second operation,the patient fully recovered and was discharged from the hospital.CONCLUSION We believe that a thorough examination of the bowel and gallbladder for gallstones based on preoperative imaging during surgery and removal of them as far as possible on the premise of ensuring the safety of patients are an effective strategy to reduce the recurrence of GSI.展开更多
The quantum effect of nano-crystals is an important factor to improve nonlinear optical performance of nanocrystal embedded glasses, while controlling the size distribution and content of nano-crystals in the glass ac...The quantum effect of nano-crystals is an important factor to improve nonlinear optical performance of nanocrystal embedded glasses, while controlling the size distribution and content of nano-crystals in the glass accurately is a key to obtain good quality. The auxiliary direct current electric field, accompanied with heat treatment, was applied on AgCI containing niobic tellurite glass sheet. The nucleation and crystallization of the glass were well controlled under auxiliary electric field. It was found that the average size of AgCI nano-crystal particles in the glass is smaller than that under single heat treatment, and the content of nano- crystals is higher. Therefore the third-order nonlinear optical performance of the glass was increased a lot. The local-area distributed AgCl nano-crystal particles can also be embedded into a glass sheet by using locally applied electric field.展开更多
BACKGROUND Congenital transmesenteric hernia in children is a rare and potentially fatal form of internal abdominal hernia,and no specific clinical symptoms can be observed preoperatively.Therefore,this condition is n...BACKGROUND Congenital transmesenteric hernia in children is a rare and potentially fatal form of internal abdominal hernia,and no specific clinical symptoms can be observed preoperatively.Therefore,this condition is not widely known among clinicians,and it is easily misdiagnosed,resulting in disastrous effects.CASE SUMMARY This report presents the case of a 13-year-old boy with a chief complaint of abdominal pain and vomiting and a history of duodenal ulcer.The patient was misdiagnosed with gastrointestinal bleeding and treated conservatively at first.Then,the patient’s symptoms were aggravated and he presented in a shock-like state.Computed tomography revealed a suspected internal hernia,extensive small intestinal obstruction,and massive effusion in the abdominal and pelvic cavity.Intraoperative exploration found a small mesenteric defect approximately 3.5 cm in diameter near the ileocecal valve,and there was about 1.8 m of herniated small intestine that was treated by resection and anastomosis.The patient recovered well and was followed for more than 5 years without developing short bowel syndrome.CONCLUSION In this report,we review the pathogenesis,presentation,diagnosis,and treatment of congenital transmesenteric hernia in children.展开更多
BACKGROUND Adult duodenal intussusception rarely occurs,and the majority of duodenal adenomas are located in the descending part of the duodenum.Therefore,adenomas in the horizontal part of the duodenum presenting as ...BACKGROUND Adult duodenal intussusception rarely occurs,and the majority of duodenal adenomas are located in the descending part of the duodenum.Therefore,adenomas in the horizontal part of the duodenum presenting as duodenal intussusception in adults are extremely rare.CASE SUMMARY A 36-year-old man complained of abdominal pain for 13 d.Blood analysis showed anemia.Magnetic resonance cholangiopancreatography and computed tomography revealed a tumor in the horizontal part of the duodenum as the main finding,leading to duodeno-duodenal intussusception.No obvious abnormalities were found on endoscopy or upper gastrointestinal radiography.He was diagnosed with duodenal intussusception secondary to duodenal adenoma.Laparotomy showed duodeno-duodenal intussusception and a tumor in the horizontal part of the duodenum near the ascending part.Postoperative pathology revealed tubular-villous adenoma with low-grade glandular intraepithelial neoplasia(local high-grade intraepithelial neoplasia).He was discharged without complications.CONCLUSION This case highlights that rational use of computed tomography,magnetic resonance cholangiopancreatography,endoscopy and upper gastrointestinal radiography for preoperative diagnosis and timely surgery is an effective strategy for the treatment of adult duodenal intussusception with duodenal masses.展开更多
基金National Natural Science Foundation of China(General Program),No.31620103910National Natural Science Foundation of China(Key Program),No.81874181+3 种基金National Health Commission of China,No.2019ZX09301158Shanghai Municipal Commission of Economy and Informatization,No.2019RGZN01096Shanghai Shenkang Hospital Development Center,No.12018107and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,No.19XHCR13D.
文摘BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients with T1b GBC.METHODS We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China.The logrank test and Cox proportional hazards model were used to compare the overall survival(OS)of patients who underwent cholecystectomy(Ch)+RL and those who underwent Ch only.To investigate whether combined hepatectomy(Hep)improved OS in T1b patients,we studied patients who underwent Ch+RL to compare the OS of patients who underwent combined Hep and patients who did not.RESULTS Of the 121 patients(aged 61.9±10.1 years),77(63.6%)underwent Ch+RL,and 44(36.4%)underwent Ch only.Seven(9.1%)patients in the Ch+RL group had lymph node metastasis.The 5-year OS rate was significantly higher in the Ch+RL group than in the Ch group(76.3%vs 56.8%,P=0.036).Multivariate analysis showed that Ch+RL was significantly associated with improved OS(hazard ratio:0.51;95%confidence interval:0.26-0.99).Among the 77 patients who underwent Ch+RL,no survival improvement was found in patients who underwent combined Hep(5-year OS rate:79.5%for combined Hep and 76.1%for no Hep;P=0.50).CONCLUSION T1b GBC patients who underwent Ch+RL had a better prognosis than those who underwent Ch.Hep+Ch showed no improvement in prognosis in T1b GBC patients.Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines,RL was only performed in 63.6%of T1b GBC patients.Routine Ch+RL should be advised in T1b GBC.
基金Zhejiang Province Public Welfare Technology Application Research Project,No.LGF21H160022Project of Taizhou University,No.2018PY057+1 种基金Project of Taizhou Central Hospital,No.2019KT003Taizhou Social Development Science and Technology Plan Project,No.21ywb26 and No.21ywb29.
文摘BACKGROUND Hepatic hemangioma is the most common benign tumor of the liver.However,patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention.It is necessary to explore additional minimally invasive and personalized treatment options for hemangiomas.CASE SUMMARY A 47-year-old woman was diagnosed with a right hepatic hemangioma for more than 10 years.Abdominal contrast-enhanced computed tomography(CT)and contrast-enhanced ultrasound revealed that there was a large hemangioma in the right liver,with a size of approximately 95 mm×97 mm×117 mm.Due to the patient's refusal of surgical treatment,hepatic artery embolization was performed in the first stage.After 25 d of liver protection treatment,the liver function indexes decreased to normal levels.Then,ultrasound-guided microwave ablation of the giant hepatic hemangioma was performed.Ten days after the treatment,hepatobiliary ultrasonography showed that the hemangioma of the right liver was smaller than the previous size(the volume was reduced by approximately 30%).Then the patient was discharged from the hospital.One year after discharge,CT showed that the hepatic hemangioma had shrunk by about 80%CONCLUSION Transcatheter arterial embolization combined with microwave ablation is a safe and effective minimally invasive treatment for hepatic hemangioma.
基金Supported by Project of Taizhou Science and Technology Department,No. 2017KY711Project of Taizhou University,No.2018PY057Project of Taizhou Central Hospital,No. 2019KT003
文摘BACKGROUND The management of recurrent gallstone ileus(GSI)is unsatisfactory,and there is no consensus on how to reduce the incidence of recurrent GSI.CASE SUMMARY A 79-year-old man presented to the Emergency Department of our hospital complaining of abdominal pain.An abdominal computed tomography(CT)scan revealed cholecystolithiasis,intrahepatic bile duct dilatation,gas accumulation,small intestinal obstruction,and circular high-density shadow in the intestinal cavity.Emergency surgery revealed that the small intestine had extensive adhesions,unclear gallbladder exposure,obvious adhesions,and difficult separation.The obstruction was located 70 cm between the ileum and the ileocecum,which was incarcerated by gallstones,and a simple enterolithotomy was carried out.On the third day after the operation,he had passed gas and defecated and had begun a liquid diet.On the fifth day after the operation,he suddenly experienced abdominal distension and discomfort.Emergency CT examination revealed recurrent GSI,and the diameter of the stone was approximately 2.0 cm(consistent with the shape of cholecystolithiasis on the abdominal CT scan before the first operation).The patient’s symptoms were not significantly relieved after conservative treatment.On the ninth day after the operation,emergency enterolithotomy was performed again along the original surgical incision.On the twentieth day after the second operation,the patient fully recovered and was discharged from the hospital.CONCLUSION We believe that a thorough examination of the bowel and gallbladder for gallstones based on preoperative imaging during surgery and removal of them as far as possible on the premise of ensuring the safety of patients are an effective strategy to reduce the recurrence of GSI.
基金supported by the National Nature Science Foundation of China (Grant No.50572069)the Shanghai Science and Technology Committee (Grant Nos.0652nm002 and 0852nm06500).
文摘The quantum effect of nano-crystals is an important factor to improve nonlinear optical performance of nanocrystal embedded glasses, while controlling the size distribution and content of nano-crystals in the glass accurately is a key to obtain good quality. The auxiliary direct current electric field, accompanied with heat treatment, was applied on AgCI containing niobic tellurite glass sheet. The nucleation and crystallization of the glass were well controlled under auxiliary electric field. It was found that the average size of AgCI nano-crystal particles in the glass is smaller than that under single heat treatment, and the content of nano- crystals is higher. Therefore the third-order nonlinear optical performance of the glass was increased a lot. The local-area distributed AgCl nano-crystal particles can also be embedded into a glass sheet by using locally applied electric field.
基金Zhejiang Province Public Welfare Technology Application Research Project,No.LGF21H160022and Project of Taizhou Central Hospital,No.2019KT003.
文摘BACKGROUND Congenital transmesenteric hernia in children is a rare and potentially fatal form of internal abdominal hernia,and no specific clinical symptoms can be observed preoperatively.Therefore,this condition is not widely known among clinicians,and it is easily misdiagnosed,resulting in disastrous effects.CASE SUMMARY This report presents the case of a 13-year-old boy with a chief complaint of abdominal pain and vomiting and a history of duodenal ulcer.The patient was misdiagnosed with gastrointestinal bleeding and treated conservatively at first.Then,the patient’s symptoms were aggravated and he presented in a shock-like state.Computed tomography revealed a suspected internal hernia,extensive small intestinal obstruction,and massive effusion in the abdominal and pelvic cavity.Intraoperative exploration found a small mesenteric defect approximately 3.5 cm in diameter near the ileocecal valve,and there was about 1.8 m of herniated small intestine that was treated by resection and anastomosis.The patient recovered well and was followed for more than 5 years without developing short bowel syndrome.CONCLUSION In this report,we review the pathogenesis,presentation,diagnosis,and treatment of congenital transmesenteric hernia in children.
基金Supported by Project of Taizhou Science and Technology Department,No.1701KY36Project of Taizhou University,No.2018PY057Project of Taizhou Central Hospital,No.2019KT003.
文摘BACKGROUND Adult duodenal intussusception rarely occurs,and the majority of duodenal adenomas are located in the descending part of the duodenum.Therefore,adenomas in the horizontal part of the duodenum presenting as duodenal intussusception in adults are extremely rare.CASE SUMMARY A 36-year-old man complained of abdominal pain for 13 d.Blood analysis showed anemia.Magnetic resonance cholangiopancreatography and computed tomography revealed a tumor in the horizontal part of the duodenum as the main finding,leading to duodeno-duodenal intussusception.No obvious abnormalities were found on endoscopy or upper gastrointestinal radiography.He was diagnosed with duodenal intussusception secondary to duodenal adenoma.Laparotomy showed duodeno-duodenal intussusception and a tumor in the horizontal part of the duodenum near the ascending part.Postoperative pathology revealed tubular-villous adenoma with low-grade glandular intraepithelial neoplasia(local high-grade intraepithelial neoplasia).He was discharged without complications.CONCLUSION This case highlights that rational use of computed tomography,magnetic resonance cholangiopancreatography,endoscopy and upper gastrointestinal radiography for preoperative diagnosis and timely surgery is an effective strategy for the treatment of adult duodenal intussusception with duodenal masses.
