Influence of the water jet system vs cavitron ultrasonic surgical aspirator for liver resection on the remnant liver

BACKGROUND Several methods,such as finger fracture,Pean crush,cavitron ultrasonic surgical aspirator(CUSA),and water jet(WJ),are used for hepatic parenchymal dissection in liver surgery.CUSA is the conventional method in Japan.WJ is a relatively novel method for parenchymal dissection.Although it has several advantages,such as lower volume of blood loss and shorter operative time,the effect of the WJ system for hepatic dissection on the remnant liver has not yet been investigated.AIM To investigate and compare the effect of the WJ method vs CUSA on the remnant liver cut surface.METHODS This observational study compared the two types of parenchymal transection methods(WJ vs CUSA)in liver surgery.In total,24 and 40 patients who underwent hepatectomy using the WJ method and CUSA,respectively,were included in the analysis.Accordingly,the clinicopathological characteristics and clinical outcomes of 24 and 40 patients were compared.Furthermore,postoperative contrast-enhanced computed tomography(CT)scan was performed to assess the cut surface length of the remnant liver and the degenerative thickness of the areas with a reduced contrast effect in the dissected plane.Then,the two groups were compared.RESULTS On CT scan,the median areas of denaturation in the liver dissection planes were 522(range:109.5-1242)mm^(2) in the CUSA group and 324(range:93.6-1529)mm^(2) in the WJ group.The area did not significantly differ between the two groups;however,the denaturation thickness of the WJ group was significantly lower than that of the CUSA group[5.8(range:0.7-11.1)mm vs 3.3(range:1.7-10.4)mm,P<0.001].CONCLUSION The WJ group had significantly thinner contrast-enhanced areas in the post hepatectomy detached section than the CUSA group.

Development of Intellectual Negative Pressure Aspirator

Along with the development of biomedical ergigineering, negative pressure aspirator is more and more widely applied in clinical treatment and patients rescuing. The study of negative pressure aspi- rator is an important goal pursued in emergency treatment, became it can boost aid success. Given this need, this device based on MXT8051 single-chip is developed. The device can use Pulse Width Modulation （PWM） signal to drive the motor of negative pressure pump and it can adjust the motor＇s speed through the Proportional In- tegral Derivative （PID） algorithm to realize the setting negative pressure rapidly, aoctarately and stably. The control requiroemnt is accomplishedthrough the nmn-machine interface. This device has the advantage of simple operation, low cost and good practicability.

Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases:A systematic review and meta-analysis

BACKGROUND In hepatology,the clinical use of endoscopic ultrasound(EUS)has experienced a notable increase in recent times.These applications range from the diagnosis to the treatment of various liver diseases.Therefore,this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases.AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy.METHODS PubMed,Medline,Cochrane Library,Web of Science,and Google Scholar databases were extensively searched until October 2023.The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool.In addition,statistical analyses were performed using the Comprehensive Meta-Analysis software.RESULTS Overall,45 articles on EUS were included(28 on diagnostic role and 17 on therapeutic role).Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4%for focal liver lesions(FLL)and 96.6%for parenchymal liver diseases.EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases(3.1%and 8.7%,respectively).Analysis of data from four studies showed that EUS-guided liver abscess had high clinical(90.7%)and technical success(90.7%)without significant complications.Similarly,EUS-guided interventions for the treatment of gastric varices(GV)have high technical success(98%)and GV obliteration rate(84%)with few complications(15%)and rebleeding events(17%).CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

Contrast-enhanced guided endoscopic ultrasound procedures

Contrast-enhanced endoscopic ultrasound(CH-EUS)can overcome the limi-tations of endoscopic ultrasound-guided acquisition by identifying microvessels inside inhomogeneous tumours and improving the characterization of these tumours.Despite the initial enthusiasm that oriented needle sampling under CH-EUS guidance could provide better diagnostic yield in pancreatic solid lesions,further studies did not confirm the supplementary values in cases of tissue acquisition guided by CH-EUS.This review details the knowledge based on the available data on contrast-guided procedures.The indications for CH-EUS tissue acquisition include isoechoic EUS lesions with poor visible delineation where CH-EUS can differentiate the lesion vascularisation from the surrounding parenchyma and also the mural nodules within biliopancreatic cystic lesions,which occur in select cases.Additionally,the roles of CH-EUS-guided therapy in patients whose pancreatic fluid collections or bile ducts that have an echogenic content have indications for drainage,and patients who have nonvisualized vessels that need to be highlighted via Doppler EUS are presented.Another indication is represented if there is a need for an immediate assessment of the post-radiofrequency ablation of pancreatic neuroendocrine tumours,in which case CH-EUS can be used to reveal the incomplete tumour destruction.

Is endoscopic ultrasound a promising technique in the diagnosis and treatment of liver diseases?

Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases.In some countries,its use is restricted to radiologists,limiting access for other clinicians,such as gastroenterologists.Endoscopic ultrasound,as a novel technique,plays a crucial role in diagnosis and treatment of digestive diseases.However,its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists,leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.

Fine-needle aspiration technique under endoscopic ultrasound guidance:A technical approach for RNA profiling of pancreatic neoplasms

BACKGROUND Early diagnosis of pancreatic ductal adenocarcinoma(PDAC)has been a longstanding challenge.The prognosis of patients with PDAC depends on the stage at diagnosis.It is necessary to identify biomarkers for the detection and differentiation of pancreatic tumors and optimize PDAC sample preparation procedures for DNA and RNA analysis.Most molecular studies are done using paraffin-embedded blocks;however,the integrity of DNA and RNA is often compromised in this format.Moreover,RNA isolated from human pancreatic tissue samples is generally of low quality,in part,because of the high concentration of endogenous pancreatic RNAse activity present.AIM To assess the potential of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)to obtain specimens from pancreatic neoplasms for subsequent RNA molecular profiling,including next-generation sequencing(NGS).METHODS Thirty-four EUS-FNA samples were included in this study:PDAC(n=15),chronic pancreatitis(n=5),pancreatic cysts(n=14),mucinous cysts(mucinous cystic neoplasia/intraductal papillary mucinous neoplasia)n=7,serous cystic neoplasms n=5,and pseudocysts n=2.Cyst material consisted of cyst fluid and cyst wall samples obtained by through-the-needle biopsy(TTNB).Samples were stored at -80℃ until analysis.RNA purity(A260/230,A260/280 ratios),concentration,and integrity(RIN)were assessed.Real-time polymerase chain reaction was conducted on all samples,and small RNA libraries were prepared from solid mass samples.RESULTS RNA was successfully extracted from 29/34(85%)EUS-FNA samples:100% pancreatic adenocarcinoma samples,100% chronic pancreatitis samples,70% pancreatic fluid cyst samples,and 50%TTNB samples.The relative expression of GAPDH and HPRT were obtained for all successfully extracted RNA samples(n=29)including lowquality RNA specimens.Low concentration and nonoptimal RIN values(no less than 3)of RNA extracted from EUS-FNA samples did not prevent NGS library preparation.The suitability of cyst fluid samples for RNA profiling varied.The quality of RNA extracted from mucinous cyst fluid had a median RIN of 7.7(5.0-8.2),which was compatible with that from solid neoplasms[6.2(0-7.8)],whereas the quality of the RNA extracted from all fluids of serous cystic neoplasms and TTNB samples had a RIN of 0.CONCLUSION The results demonstrate the high potential of EUS-FNA material for RNA profiling of various pancreatic lesions,including low-quality RNA specimens.

Parathyroid carcinoma located in the thyroid gland:A case report

BACKGROUND Parathyroid carcinoma(PC)is a difficult-to-diagnose rare disease with low incidence.Relatively accurate preoperative diagnosis is very important in choosing surgical methods and patient prognosis.CASE SUMMARY This study reported the clinical diagnosis and treatment of a rare patient with PC located in the thyroid gland and provided a case reference for the diagnosis and treatment of PC.A case of a 64-year-old male patient who presented to our hospital with systemic muscle and joint pain and palpitations is outlined.Subsequently,the patient was admitted to the Department of Nephrology for the treatment of“multiple myeloma nephropathy pending investigation”.The patient was diagnosed with“primary hyperparathyroidism and hypercalcemic crisis”using thyroid color ultrasound.CONCLUSION The intraoperative frozen section report considered the parathyroid tumor.Surgical tumor resection was promptly performed,and the diagnosis of PC was confirmed.

Young patient with a giant gastric bronchogenic cyst:A case report and review of literature

BACKGROUND Gastric bronchogenic cysts(BCs)are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period.Gastric bronchial cysts are rare lesions that were first reported in 1956;as of 2023,only 33 cases are available in the PubMed online database.BCs usually have no clinical symptoms in the early stage,and imaging findings also lack specificity.Therefore,they are difficult to diagnose before histopathological examination.CASE SUMMARY A 34-year-old woman with respiratory distress presented at our hospital.Endoscopic ultrasound revealed an anechoic mass between the spleen,left kidney and gastric fundus,with hyperechogenic and soft elastography textures and with a size of approximately 6.5 cm×4.0 cm.Furthermore,a computed tomography scan demonstrated high density between the posterior stomach and the spleen and the left kidney,with uniform internal density and a small amount of calcification.The maximum cross section was approximately 10.1 cm×6.1 cm,and the possibility of a cyst was high.Because the imaging findings did not suggest a malignancy and because the patient required complete resection,she underwent laparotomy surgery.Intraoperatively,this cystic lesion was found to be located in the posterior wall of the large curvature of the fundus and was approximately 8 cm×6 cm in size.Finally,the pathologists verified that the cyst in the fundus was a gastric BC.The patient recovered well,her symptoms of chest tightness disappeared,and the abdominal drain was removed on postoperative day 6,after which she was discharged on day 7 for 6 months of follow-up.She had no tumor recurrence or postoperative complications during the follow-up.CONCLUSION This is a valuable report as it describes an extremely rare case of gastric BC.Moreover,this was a very young patient with a large BC in the stomach.

Pleural effusion,ascites,colon ulcers and hematochezia:What we can learn from the diagnostic process of a patient with plasma cell myeloma:A case report

BACKGROUND Plasma cell myeloma(PCM)is characterized by hypercalcemia,renal impairment,anemia,and bone destruction.While pleural effusion,ascites,abdominal pain,and bloody stool are common manifestations of lung disease or gastrointestinal disorders,they are rarely observed in patients with PCM.CASE SUMMARY A 66-year-old woman presented with complaints of recurrent chest tightness,wheezing,and abdominal bloating accompanied by bloody stools.Computed tomography revealed pleural effusion and ascites.Pleural effusion tests showed inflammation,but the T-cell spot test and carcinoembryonic antigen were negative.Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis.Echocardiography revealed enlarged atria and reduced left ventricular systolic function.The diagnosis remained unclear.Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels.Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type.Smear cytology of the bone marrow showed a high proportion of plasma cells,accounting for about 4.5%.Histopathological examination of the bone marrow suggested PCM.Flow cytometry showed abnormal plasma cells with strong expression of CD38,CD138,cLambda,CD28,CD200,and CD117.Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification,but cytogenetic testing showed no clonal abnormalities.Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining.The patient was finally diagnosed with PCM.CONCLUSION A diagnosis of PCM should be considered in older patients with pleural effusion,ascites,and multi-organ injury.

Prediction model establishment and validation for enteral nutrition aspiration during hospitalization in patients with acute pancreatitis

BACKGROUND Acute pancreatitis(AP)is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs.Enteral nutrition plays a vital role in the treatment of AP because it can meet the nutritional needs of patients,promote the recovery of intestinal function,and maintain the barrier and immune functions of the intestine.However,the risk of aspiration during enteral nutrition is high;once aspiration occurs,it may cause serious complications,such as aspiration pneumonia,and suffocation,posing a threat to the patient’s life.This study aims to establish and validate a prediction model for enteral nutrition aspiration during hospitalization in patients with AP.AIM To establish and validate a predictive model for enteral nutrition aspiration during hospitalization in patients with AP.METHODS A retrospective review was conducted on 200 patients with AP admitted to Chengdu Shangjin Nanfu Hospital,West China Hospital of Sichuan University from January 2020 to February 2024.Clinical data were collected from the electronic medical record system.Patients were randomly divided into a validation group(n=40)and a modeling group(n=160)in a 1:4 ratio,matched with 200 patients from the same time period.The modeling group was further categorized into an aspiration group(n=25)and a non-aspiration group(n=175)based on the occurrence of enteral nutrition aspiration during hospitalization.Univariate and multivariate logistic regression analyses were performed to identify factors influencing enteral nutrition aspiration in patients with AP during hospitalization.A prediction model for enteral nutrition aspiration during hospitalization was constructed,and calibration curves were used for validation.Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of the model.RESULTS There was no statistically significant difference in general data between the validation and modeling groups(P>0.05).The comparison of age,gender,body mass index,smoking history,hypertension history,and diabetes history showed no statistically significant difference between the two groups(P>0.05).However,patient position,consciousness status,nutritional risk,Acute Physiology and Chronic Health Evaluation(APACHE-II)score,and length of nasogastric tube placement showed statistically significant differences(P<0.05)between the two groups.Multivariate logistic regression analysis showed that patient position,consciousness status,nutritional risk,APACHE-II score,and length of nasogastric tube placement were independent factors influencing enteral nutrition aspiration in patients with AP during hospitalization(P<0.05).These factors were incorporated into the prediction model,which showed good consistency between the predicted and actual risks,as indicated by calibration curves with slopes close to 1 in the training and validation sets.Receiver operating characteristic analysis revealed an area under the curve(AUC)of 0.926(95%CI:0.8889-0.9675)in the training set.The optimal cutoff value is 0.73,with a sensitivity of 88.4 and specificity of 85.2.In the validation set,the AUC of the model for predicting enteral nutrition aspiration in patients with AP patients during hospitalization was 0.902,with a standard error of 0.040(95%CI:0.8284-0.9858),and the best cutoff value was 0.73,with a sensitivity of 91.9 and specificity of 81.8.CONCLUSION A prediction model for enteral nutrition aspiration during hospitalization in patients with AP was established and demonstrated high predictive value.Further clinical application of the model is warranted.

Does progress in microfracture techniques necessarily translate into clinical effectiveness?

BACKGROUND Multitudinous advancements have been made to the traditional microfracture(MFx)technique,which have involved delivery of various acellular 2nd generation MFx and cellular MFx-III components to the area of cartilage defect.The relative benefits and pitfalls of these diverse modifications of MFx technique are still not widely understood.AIM To comparatively analyze the functional,radiological,and histological outcomes,and complications of various generations of MFx available for the treatment of cartilage defects.METHODS A systematic review was performed using PubMed,EMBASE,Web of Science,Cochrane,and Scopus.Patients of any age and sex with cartilage defects undergoing any form of MFx were considered for analysis.We included only randomized controlled trials(RCTs)reporting functional,radiological,histological outcomes or complications of various generations of MFx for the management of cartilage defects.Network meta-analysis(NMA)was conducted in Stata and Cochrane’s Confidence in NMA approach was utilized for appraisal of evidence.RESULTS Forty-four RCTs were included in the analysis with patients of mean age of 39.40(±9.46)years.Upon comparing the results of the other generations with MFX-I as a constant comparator,we noted a trend towards better pain control and functional outcome(KOOS,IKDC,and Cincinnati scores)at the end of 1-,2-,and 5-year time points with MFx-III,although the differences were not statistically significant(P>0.05).We also noted statistically significant Magnetic resonance observation of cartilage repair tissue score in the higher generations of microfracture(weighted mean difference:17.44,95%confidence interval:0.72,34.16,P=0.025;without significant heterogeneity)at 1 year.However,the difference was not maintained at 2 years.There was a trend towards better defect filling on MRI with the second and third generation MFx,although the difference was not statistically significant(P>0.05).CONCLUSION The higher generations of traditional MFx technique utilizing acellular and cellular components to augment its potential in the management of cartilage defects has shown only marginal improvement in the clinical and radiological outcomes.

Early endoscopic management of an infected acute necrotic collection misdiagnosed as a pancreatic pseudocyst: A case report

BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.

Impact of glucagon-like peptide receptor agonists on endoscopy and its preoperative management: Guidelines, challenges, and future directions

Glucagon-like peptide receptor agonists(GLP-1RA)are used to treat type 2 diabetes mellitus and,more recently,have garnered attention for their effect-iveness in promoting weight loss.They have been associated with several gastrointestinal adverse effects,including nausea and vomiting.These side effects are presumed to be due to increased residual gastric contents.Given the potential risk of aspiration and based on limited data,the American Society of Anesthesi-ologists updated the guidelines concerning the preoperative management of patients on GLP-1RA in 2023.They included the duration of mandated cessation of GLP-1RA before sedation and usage of“full stomach”precautions if these medications were not appropriately held before the procedure.This has led to additional challenges,such as extended waiting time,higher costs,and increased risk for patients.In this editorial,we review the current societal guidelines,clinical practice,and future directions regarding the usage of GLP-1RA in patients undergoing an endoscopic procedure.

Clinical application of reserved gastric tube in neuroendoscopic endonasal surgery for pituitary tumor

BACKGROUND The neuroendoscopic approach has the advantages of a clear operative field,convenient tumor removal,and less damage,and is the development direction of modern neurosurgery.At present,transnasal surgery for sphenoidal pituitary tumor is widely used.But it has been found in clinical practice that some patients with this type of surgery may experience post-operative nausea and vomiting and other discomforts.AIM To explore the effect of reserved gastric tube application in the neuroendoscopic endonasal resection of pituitary tumors.METHODS A total of 60 patients who underwent pituitary adenoma resection via the endoscopic endonasal approach were selected and randomly divided into the experimental and control groups,with 30 in each group.Experimental group:After anesthesia,a gastric tube was placed through the mouth under direct vision using a visual laryngoscope,and the fluid accumulated in the oropharynx was suctioned intermittently with low negative pressure throughout the whole process after nasal disinfection,during the operation,and when the patient recovered from anesthesia.Control group:Given the routine intraoperative care,no gastric tube was left.The number of cases of nausea/vomiting/aspiration within 24 h post-operation was counted and compared between the two groups;the scores of pharyngalgia after waking up,6 h post-operation,and 24 h postoperation.The frequency of postoperative cerebrospinal fluid leakage and intracranial infection were compared.The hospitalization days of the two groups were statistically compared.RESULTS The times of postoperative nausea and vomiting in the experimental group were lower than that in the control group,and the difference in the incidence of nausea was statistically significant(P<0.05).After the patient woke up,the scores of sore throat 6 h after the operation and 24 h after operation were lower than those in the control group,and the difference was statistically significant(P<0.05).The number of cases of postoperative cerebrospinal fluid leakage and intracranial infection was higher than that of the control group,but there was no statistically significant difference from the control group(P>0.05).The hospitalization days of the experimental group was lower than that of the control group,and the difference was statistically significant(P<0.05).CONCLUSION Reserving a gastric tube in the endoscopic endonasal resection of pituitary tumors,combined with intraoperative and postoperative gastrointestinal decompression,can effectively reduce the incidence of nausea,reduce the number of vomiting and aspiration in patients,and reduce the complications of sore throat The incidence rate shortened the hospitalization days of the patients.

Role of macroscopic on-site evaluation of endoscopic ultrasoundguided fine-needle aspiration/biopsy:Results of a multicentric prospective study

BACKGROUND The concept of macroscopic on-site evaluation(MOSE)was introduced in 2015 when the endoscopist observed better diagnostic yield when the macroscopically visible core on MOSE was superior to 4 mm.Recent studies suggest that MOSE by the endoscopist may be an excellent alternative to rapid on-site evaluation,and some classi-fications have been published.Few studies have assessed the adequacy of histologic cores in MOSE during endoscopic ultrasound-guided fine-needle aspiration/biopsy(EUS-FNA/FNB).AIM To evaluate the performance of MOSE during EUS-FNA/FNB.METHODS This multicentric prospective study was conducted in 16 centers in 3 countries(Egypt,Iraq,and Morocco)and included 1108 patients with pancreatic,biliary,or gastrointestinal pathology who were referred for EUS examination.We prospectively analyzed the MOSE in 1008 patients with available histopathological reports according to 2 classifications to determine the adequacy of the histological core samples.Data management and analysis were performed using a Statistical Package for Social Sciences(SPSS)version 27.RESULTS A total of 1074 solid lesions were biopsied in 1008 patients with available cytopathological reports.Mean age was 59 years,and 509 patients(50.5%)were male.The mean lesion size was 38 mm.The most frequently utilized needles were FNB-Franseen(74.5%)and 22 G(93.4%),with a median of 2 passes.According to 2 classifications,618 non-bloody cores(61.3%)and 964 good samples(95.6%)were adequate for histological evaluation.The overall diagnostic yield of cytopathology was 95.5%.The cytological examination confirmed the diagnosis of malignancy in 861 patients(85.4%),while 45 samples(4.5%)were inconclusive.Post-procedural adverse events occurred in 33 patients(3.3%).Statistical analysis showed a difference between needle types(P=0.035)with a high sensitivity of FNB(97%).The analysis of the relationship between the MOSE-score and the final diagnosis showed a significant difference between the different scores of the MOSE(P<0.001).CONCLUSION MOSE is a simple method that allows endoscopists to increase needle passes to improve sample quality.There is significantly higher FNB sensitivity and cytopathology diagnostic yield with good MOSE cores.

Core needle biopsy for thyroid nodules assessment-a new horizon?

Ultrasound-guided fine-needle aspiration is the standard for evaluating thyroid nodules with a high safety profile and a relatively low number of non-diagnostic cytological findings.Nevertheless,this diagnostic method traditionally has its weak points.Several diagnostic categories such as BethesdaⅠ,ⅢandⅣare not reliable for thyroid carcinoma risk assessment.Recent advancements in a core needle biopsy made it possible to use this tool as a new method for thyroid nodules evaluation.The main feature of this method is the use of thin needles(18-21G)and guns with an automatic trigger mechanism.The histological material collected with the use of a core needle biopsy is usually superior to cytological.Therefore,the core needle biopsy can be used as a complementary technique to a standard fine needle aspiration in difficult and dubious cases of thyroid neoplasia with uncertain malignant potential.

Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion

In patients with liver tumors,the histopathology examination can assist in diagnosis,staging,prognosis,and therapeutic management strategy.Endoscopic ultrasound(EUS)-guided tissue acquisition using fine needle aspiration(FNA)or more newly fine needle biopsy(FNB)is a well-developed technique in order to evaluate and differentiate the liver masses.The goal of the EUS-FNA or EUS-FNB is to provide an accurate sample for a histopathology examination.Therefore,malignant tumors such as hepatocarcinoma,cholangiocarcinoma and liver metastasis or benign tumors such as liver adenoma,focal hyperplastic nodular tumors and cystic lesions can be accurately diagnosed using EUS-guided tissue acquisition.EUS-FNB using 19 or 22 Ga needle provide longer samples and a higher diagnostic accuracy in patients with liver masses when compared with EUS-FNA.Few data are available on the diagnostic accuracy of EUS-FNB when compared with percutaneously,ultrasound,computer tomography or transjugulary-guided liver biopsies.This review will discuss the EUS-guided tissue acquisition options in patients with liver tumors and its efficacy and safety in providing accurate samples.The results of the last studies comparing EUS-guided liver biopsy with other conventional techniques are presented.The EUS-guided tissue acquisition using FNB can be a suitable technique in suspected liver lesions in order to provide an accurate histopathology diagnosis,especially for those who require endoscopy.

Dosage Formula in Anesthesia for Manual Intrauterine Aspiration Post-Abortion in Resource-Limited Settings

Setting: Provincial General Reference Hospital of Bukavu, General Reference Hospital of Panzi, General Reference Hospital of Ciriri, General Reference Hospital of Nyatende and Biopharm Hospital Center. Objective: Contribute to the improvement of the anesthetic ECP of patients benefiting from MVA for incomplete abortion, Describe the methodology used for adoption of the dosage formula in Anesthesia for MVA, present the mathematical demonstration leading to the dosage formula in anesthesia for MVA. Materials and Methods: Our study was descriptive by mathematical demonstration of obtaining the equilibrium constant of the dosage formula of bipuvacaine 0.1% and Fentanyl 50 µg% adapted to the weight and specific size of patients treated anesthetically in MVA cases for incomplete abortion. We also carried out an operational research by first determining the interval where our equilibrium constant is included and secondly by means of the ends of the intervals found correlated to the ends of intervals of possible weights and sizes in the being normal human female of childbearing age to arrive at the real numerical value of the equilibrium constant of the BUKAVU Dosage Formula in the case of anesthesia for MVA during the management of incomplete abortions. Results: TWO-STAGE OPERATIONAL RESEARCH: • Determination of the interval where the equilibrium constant x = −0.95 x x by crossing the means between the extremes of volumes of anesthetic drugs giving a satisfactory sensory block without hemodynamic disturbance and the extremes of normal weight and height for women of childbearing age. We ended up with X = 0.37. Conclusion: At the end of our study which had the general objectives of contributing to the improvement of the anesthetic PEC of patients receiving MVA for incomplete abortion and specific objectives of describing the methodology used for adoption of the dosage formula in Anesthesia for MVA and present the mathematical demonstration which resulted in the dosage formula in nesthesia for MVA, it appears that the dosage formula of Bukavu, in case of intrathecal spinal analgesia of MVA for incomplete abortion provides precision on the specificity of the doses of bipuvacaine hypobarre 0.1% and Fentanyl 50 µg% reported to each patient according to her weight and height. Its application could therefore reduce morbidity and mortality and improve patient-practitioner comfort in the event of MVA for incomplete abortion following the dosage precision it provides.

Refuting the Misconception:Li Bai as an Impolite Person

This essay endeavors to dispel the lingering misconception that Li Bai,the celebrated Tang Dynasty poet,was a man devoid of propriety.Through a meticulous examination of historical records,literary works,and contemporary interpretations,this study presents a nuanced portrait of Li Bai as a poet who,despite his eccentricities and wanderlust,possessed a profound sense of etiquette and respect for societal norms.This essay argues that his unique personality in life and free expression in poetry are all driven by the need for artistic creation,rather than challenging for ancient propriety.

Flexible bronchoscopy for foreign body aspiration in children:A single-centre experience

BACKGROUND The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes.Currently,there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration.AIM To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview.METHODS This was a single-centre retrospective study.Twenty-four patients were enrolled between January 2017 and January 2023.Medical records of patients aged below 18 years who were admitted to authors’affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital’s database to Microsoft Excel 2019.Data were analysed using MedCalc Statistical Software.RESULTS Patient ages varied from 9 months to 11 years.The median age was 23.5 months,95%confidence interval(CI)19.49-44.77.We observed age clustering in children with foreign body aspiration at our institution with three age subgroups:(1)0-25 months;(2)40-60 months;and(3)120-140 months.We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together(odds ratio=10.0,95%CI:1.44-29.26,P=0.0197).Successful foreign body extraction was performed in all cases.Conversion to a rigid bronchoscope was not required in any of the cases.No major complications(massive bleeding,tracheobronchial tree perforation,or asphyxia)were observed.CONCLUSION Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.