BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical sign...BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.展开更多
BACKGROUND We report a case of eye-penetrating injury in which a massive silicone oil migration into the patient’s subconjunctival space and orbit occurred after vitrectomy.CASE SUMMARY A 30-year-old male patient sou...BACKGROUND We report a case of eye-penetrating injury in which a massive silicone oil migration into the patient’s subconjunctival space and orbit occurred after vitrectomy.CASE SUMMARY A 30-year-old male patient sought medical attention at Ganzhou People’s Hospital after experiencing pain and vision loss in his left eye due to a nail wound on December 9,2023.Diagnosis of penetrating injury caused by magnetic foreign body retention in the left eye and hospitalization for treatment.On December 9,2023,pars plana vitrectomy was performed on the left eye for intraocular foreign body removal,abnormal crystal extraction,retinal photocoagulation.Owing to the discovery of retinal detachment at the posterior pole during surgery,silicone oil was injected to fill the vitreous body,following which upper conjunctival bubble-like swelling was observed.Postoperative orbital computed tomography(CT)review indicated migration of silicone oil to the subconjunctival space and orbit through a self-permeable outlet.On December 18,2023,the patient sought treatment at the First Affiliated Hospital of Nanchang University,China.The patient presented with a pronounced foreign body sensation following left eye surgery.On December 20,2023,the foreign body was removed from the left eye frame and an intraocular examination was conducted.The posterior scleral tear had closed,leading to termination of the surgical procedure following supplementary laser treatment around the tear.The patient reported a significant reduction in ocular surface symptoms just one day after surgery.Furthermore,a notable decrease in the migration of silicone oil was observed in orbital CT scans.CONCLUSION The timing of silicone oil injection for an eye-penetrating injury should be carefully evaluated to avoid the possibility of silicone oil migration.展开更多
Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedu...Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.展开更多
AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected...AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.展开更多
Objective This study aimed to evaluate the clinical efficacy and safety of foldable capsular vitreous body(FCVB)implant surgery in silicone oil-dependent eyes.Methods A total of 22 participants with silicone oil-depen...Objective This study aimed to evaluate the clinical efficacy and safety of foldable capsular vitreous body(FCVB)implant surgery in silicone oil-dependent eyes.Methods A total of 22 participants with silicone oil-dependent eyes who received treatment with FCVB implant surgery between January 2019 and June 2020 were included in this retrospective study.The intraocular pressure(IOP),best-corrected visual acuity(BCVA),demographic data,and any recorded complications were evaluated.Results The postoperative IOP(12.73±4.20 mmHg)was significantly improved(P=0.03)compared to the preoperative IOP(10.23±3.69 mmHg)(the main endpoint).There was no significant difference(P=0.33)in the final BCVA preoperation and 3rd month postoperation(the secondary endpoint).The most common postoperative complication was hyphema.Other common postoperative complications included corneal opacity,a shallow anterior chamber,and a low IOP.Conclusion FCVB implant surgery is a safe and effective method for treating silicone oil-dependent eyes;however,attention should be paid to the prevention and timely treatment of complications.展开更多
AIM:To investigate the influence of ophthalmic viscoelastic devices(OVDs)and different surgical approaches on the intraocular pressure(IOP)before and after creation of the curvilinear circular capsulorhexis(CCC)as a m...AIM:To investigate the influence of ophthalmic viscoelastic devices(OVDs)and different surgical approaches on the intraocular pressure(IOP)before and after creation of the curvilinear circular capsulorhexis(CCC)as a measure for anterior chamber stability during this maneuver.METHODS:Prospective experimental WetLab study carried out on enucleated porcine eyes.IOP was measured before and after CCC with the iCare Rebound tonometer(iCare ic200;iCare Finland Oy,Vantaa,Finland).The OVDs used were a cohesive one[Z-Hyalin,Carl Zeiss Meditec AG,Germany;hyaluronic acid(HA)]and a dispersive[Z-Celcoat,Carl Zeiss Meditec AG,Germany;hydroxy propylmethylcellulosis(HPMC)].The CCC was created using Utrata forceps or 23 g microforceps in different combinations with the OVDs.RESULTS:Using the Utrata forceps the IOP dropped from 63.65±6.44 to 11.25±3.63 mm Hg during the CCC.The use of different OVDs made no difference.Using the 23 g microforceps the IOP dropped from 65.35±8.15 to 36.55±6.09 mm Hg.The difference between IOP drop using either Utrata forceps or 23 g microforceps was highly significant regardless of the OVD used.CONCLUSION:Using the sideport for the creation of the capsulorhexis leads to a lesser drop in IOP during this maneuver compared to the main incision in enucleated porcine eyes.The use of different OVD has no significant influence on IOP drop.展开更多
BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medi...BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.展开更多
The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm...The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.展开更多
In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyan...In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.展开更多
AIM:To compare high or low concentration of hyaluronic acid eye drops(HY)for dry eye syndromes(DES).METHODS:Randomized controlled trials(RCTs)comparing various concentrations of HY were searched in PubMed,Embase,Web o...AIM:To compare high or low concentration of hyaluronic acid eye drops(HY)for dry eye syndromes(DES).METHODS:Randomized controlled trials(RCTs)comparing various concentrations of HY were searched in PubMed,Embase,Web of Science,Cochrane,SinoMed,CNKI,Wanfang Database,CQVIP,and Chinese journals databases between inception and July 2023.Pooled standardized mean differences(SMD)or weighted mean difference(WMD)with 95%confidence intervals(CI)from RCTs evaluating Schirmer’s I test(SIT),corneal fluorescein staining score(CFS),tear breakup time(TBUT),DES score(DESS),and Ocular Surface Disease Index(OSDI)were calculated.Sensitivity analysis,Egger’s test and Meta-regression analysis were performed for all indicators.RESULTS:We conducted a Meta-analysis of 10 RCTs that met the inclusion criteria,involving 1796 cases.High-concentrations group significantly improved the outcome of CFS according to random effects modelling(SMD,-3.37;95%CI,-5.25 to-1.48;P=0.0005).The rest of the results were not statistically significant,including indicators such as SIT,TBUT,DESS and OSDI.CONCLUSION:For dry eyes with positive corneal staining,a high concentration of HY is recommended,whereas in other cases,a high concentration of HY does not offer a more pronounced advantage over a low concentration of HY in the treatment of dry eyes.展开更多
BACKGROUND There is still some room for optimizing ambulatory pediatric surgical procedures,and the preoperative and postoperative management quality for pediatric patients needs to be improved.AIM To discuss the safe...BACKGROUND There is still some room for optimizing ambulatory pediatric surgical procedures,and the preoperative and postoperative management quality for pediatric patients needs to be improved.AIM To discuss the safety and feasibility of the enhanced recovery after surgery(ERAS)-based management model for ambulatory pediatric surgical procedures.METHODS We selected 320 pediatric patients undergoing ambulatory surgery from June 2023 to January 2024 at The First People’s Hospital of Liangshan Yi Autonomous Prefecture.Of these,220 received ERAS-based management(research group)and 100 received routine management(control group).General information,postoperative ambulation activities,surgical outcomes(operation time,postoperative gastro-intestinal ventilation time,and hospital stay),postoperative pain visual analogue scale,postoperative complications(incision infection,abdominal distension,fever,nausea,and vomiting),and family satisfaction were compared.RESULTS The general information of the research group(sex,age,disease type,single parent,family history,etc.)was comparable to that of the control group(P>0.05),but the rate of postoperative(2 h,4 h,and 6 h after surgery)ambulation activities was statistically higher(P<0.01),and operation time,postoperative gastrointestinal ventilation time,and hospital stay were markedly shorter(P<0.05).The research group had lower visual analogue scale scores(P<0.01)at 12 h and 24 h after surgery and a lower incidence of total postoperative complications than the control group(P=0.001).The research group had higher family satisfaction than the control group(P=0.007).CONCLUSION The ERAS-based management model was safe and feasible in ambulatory pediatric surgical procedures and worthy of clinical promotion.展开更多
BACKGROUND Dry eye is a common eye disease.Artificial tears supplements are widely used for the treatment of dry eyes.However,multiple adverse effects have been observed in patients receiving long-term treatment with ...BACKGROUND Dry eye is a common eye disease.Artificial tears supplements are widely used for the treatment of dry eyes.However,multiple adverse effects have been observed in patients receiving long-term treatment with artificial tears,which may affect the therapeutic effect.AIM To analyze the characteristics of interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α)levels in patients with dry eye and the therapeutic effect of artificial tears combined with cyclosporine A.METHODS A total of 124 dry eye patients treated at The First People’s Hospital of Xining from April 2020 to April 2022 were selected as the observation group,while 20 healthy individuals served as the control group during the same period.Levels of inflammatory markers,including IL-1β,IL-6,and TNF-α,were analyzed.The observation group was further divided into a study group and a control group,each consisting of 62 patients.The control group received artificial tears,whereas the study group received a combination of artificial tears and cyclosporine A.Inflammatory markers,Schirmer’s test(SIT),tear break-up time(TBUT),corneal fluorescein staining(CFS),National Eye Institute Visual Function Questionnaire-25(NEI-VFQ-25)scores,and adverse events(AEs)were compared between the two groups.RESULTS The observation group exhibited significantly elevated serum levels of IL-1β,IL-6,and TNF-αin comparison to the healthy group.Following treatment,the study group demonstrated substantial reductions in IL-1β,IL-6,and TNF-αlevels relative to the control group.Moreover,after treatment,the study group experienced a marked decrease in CFS scores and significant increases in both SIT and BUT levels when compared to the control group.Additionally,significant improvements were observed in the primary symptom of dry eye and secondary symptoms such as photophobia,foreign body sensation,fatigue,red eye,and burning sensation within the study group.Furthermore,post-treatment NEI-VFQ-25 scores across all dimensions exhibited significant enhancements in the study group compared to the control group(P<0.05).It is noteworthy that significant AEs were reported in both groups throughout the treatment period.CONCLUSION Cyclosporine A combined with artificial tears is effective in treating dry eye,yielding enhanced outcomes by improving SIT and TBUT levels,reducing CFS scores,and ameliorating vision-related quality of life.展开更多
In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,acc...In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.展开更多
Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce...Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.展开更多
To the Editor: As we all know, even with the current advancements regarding novel chemotherapy regimens, patients affected by pancreatic cancer(PC) have an extremely dismal prognosis(5-year survival rate 12% for all s...To the Editor: As we all know, even with the current advancements regarding novel chemotherapy regimens, patients affected by pancreatic cancer(PC) have an extremely dismal prognosis(5-year survival rate 12% for all stages in the National Cancer Institute SEER database). Among the patients undergoing surgical treatment, the prognosis is mostly affected by recurrence. PC after surgery has mainly four patterns of recurrence, isolated or variously associated with each other: local, lymph nodal, peritoneal or distant(liver, lung, other sites).展开更多
AIM:To evaluate the effectiveness and safety of intravitreal ranibizumab(IVR)for diabetic macular edema(DME)in vitrectomized versus non-vitrectomized eyes.METHODS:The PubMed,EMBASE,Web of Science,Cochrane,EBSCO were c...AIM:To evaluate the effectiveness and safety of intravitreal ranibizumab(IVR)for diabetic macular edema(DME)in vitrectomized versus non-vitrectomized eyes.METHODS:The PubMed,EMBASE,Web of Science,Cochrane,EBSCO were comprehensively searched for studies comparing vitrectomized and non-vitrectomized eyes with DME.Clinical outcomes of best-corrected visual acuity(BCVA),central macular thickness(CMT),the mean number of intravitreal injection and adverse events were extracted and analyzed.RESULTS:Six studies involving 641 eyes were included.Final visual gain significantly improved and CMT significantly reduced in vitrectomized eyes at 6mo and 12mo visits(P<0.05).Although the mean reduction in CMT among non-vitrectomized eyes was significantly greater than in vitrectomized eyes at the 6mo[mean difference(MD)=53.57,95%confidence interval(CI):28.03 to 78.72,P<0.0001]and 12mo(MD=49.65,95%CI:19.58 to 79.72,P=0.01),no significant difference was detected in improvement in BCVA at either 6mo(MD=0.05,95%CI:-0.02 to 0.13,P=0.14)or 12mo(MD=0.03,95%CI:-0.04 to 0.09,P=0.43).Injection number of ranibizumab in non-vitrectomized eyes was significantly less than that in vitrectomized eyes during 6-month period(MD=0.60,95%CI:0.16 to 1.04,P=0.008),while there was no statistically significant difference between the two groups during 12mo of follow-up.CONCLUSION:Evidence from current study suggests that IVR was useful for both vitrectomized group and nonvitrectomized group with DME.Although less reduction in macular thickness is found in vitrectomized group,visual improvement between two groups is similar.展开更多
Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed...Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed in oncological patients(liver metastasis,hepatocellular carcinoma,cholangiocarcinoma,etc.),but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined.Theoretical advantages of ERAS programs are:ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes;a better and faster posto-perative recovery should let oncologic teams begin chemotherapeutic regimens on time;prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy.So,ERAS could be another way to improve our oncological results.We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.展开更多
Objective:Prostate cancer(PCa)patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia(BPH).Some of them might be treated for their lower urinary tract symptoms inste...Objective:Prostate cancer(PCa)patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia(BPH).Some of them might be treated for their lower urinary tract symptoms instead of PCa.We aimed to test the effect of PCa versus BPH on surgical outcomes after transurethral prostate surgery,namely complication and mortality rates.Methods:Within the American College of Surgeons National Surgical Quality Improvement Program database(2011-2016),we identified patients who underwent transurethral resection of the prostate,photoselective vaporization,or laser enucleation.Patients were stratified according to postoperative diagnosis(PCa vs.BPH).Univariable and multivariable logistic regression models evaluated the predictors of perioperative morbidity and mortality.A formal test of interaction between diagnosis and surgical technique used was performed.Results:Overall,34542 patients were included.Of all,2008(5.8%)had a diagnosis of PCa.The multivariable logistic regression model failed to show statistically significant higher rates of postoperative complications in PCa patients(odds ratio:0.9,95%confidence interval:0.7-1.1;p=0.252).Moreover,similar rates of perioperative mortality(p=0.255),major acute cardiovascular events(p=0.581),transfusions(p=0.933),and length of stay of more than or equal to 30 days(p=0.174)were found.Additionally,all tests failed to show an interaction between post-operative diagnosis and surgical technique used.Conclusion:Patients diagnosed with PCa do not experience higher perioperative morbidity or mortality after transurethral prostate surgery when compared to their BPH counterparts.Moreover,the diagnosis seems to not influence surgical technique outcomes.展开更多
AIM:To investigate the types of bacteria in patients with eye infections in Suzhou and their drug resistance to commonly used antibacterial drugs.METHODS:The clinical data of 155 patients were retrospectively collecte...AIM:To investigate the types of bacteria in patients with eye infections in Suzhou and their drug resistance to commonly used antibacterial drugs.METHODS:The clinical data of 155 patients were retrospectively collected in this study,and the pathogenic bacteria species and drug resistance of each pathogenic bacteria were analyzed.RESULTS:Among the 155 patients(age from 12 to 87 years old,with an average age of 57,99 males and 56 females)with eye infections(160 eyes:74 in the left eye,76 in the right eye and 5 in both eyes,all of which were exogenous),71(45.81%)strains were gram-positive bacteria,23(14.84%)strains were gram-negative bacteria and 61(39.35%)strains were fungi.Gram-positive bacteria were highly resistant to penicillin and erythromycin(78.87%and 46.48%respectively),but least resistant to vancomycin at 0.Gram-negative bacteria were highly resistant to cefoxitin and compound sulfamethoxazole(100%and 95.65%respectively),but least resistant to meropenem at 0.Comparison of the resistance of gram-positive and gram-negative bacteria to some drugs revealed statistically significant differences(P<0.05)in the resistance of both to cefoxitin,cotrimoxazole,levofloxacin,cefuroxime,ceftriaxone and ceftazidime,and both had higher rates of resistance to gram-negative bacteria than to gram-positive bacteria.The distribution of bacterial infection strains showed that Staphylococcus epidermidis was the most common strain in the conjunctiva,cornea,aqueous humor or vitreous body and other eye parts.Besides,Fusarium and Pseudomonas aeruginosa were also among the most common strains of conjunctival and corneal infections.CONCLUSION:Gram-positive bacteria are the dominant bacteria in eye infections,followed by gram-negative bacteria and fungi.Considering the resistance of gramnegative bacteria to multiple drugs,monitoring of bacteria should be strengthened in eye bacterial infections for effective prevention and control to reduce complications caused by eye infections.展开更多
This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular ris...This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.展开更多
基金Supported by Tianjin Health Research Project,No.TJWJ2023MS062。
文摘BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.
基金National Natural Science Foundation of China,No.82160207Technology Plan of Jiangxi Provincial Health and Health Commission,No.202130156+1 种基金Young Scholar Project of the First Affiliated Hospital of Nanchang University,No.YFYPY202219Science and Key Projects of Jiangxi Youth Science Fund,No.20202ACBL216008.
文摘BACKGROUND We report a case of eye-penetrating injury in which a massive silicone oil migration into the patient’s subconjunctival space and orbit occurred after vitrectomy.CASE SUMMARY A 30-year-old male patient sought medical attention at Ganzhou People’s Hospital after experiencing pain and vision loss in his left eye due to a nail wound on December 9,2023.Diagnosis of penetrating injury caused by magnetic foreign body retention in the left eye and hospitalization for treatment.On December 9,2023,pars plana vitrectomy was performed on the left eye for intraocular foreign body removal,abnormal crystal extraction,retinal photocoagulation.Owing to the discovery of retinal detachment at the posterior pole during surgery,silicone oil was injected to fill the vitreous body,following which upper conjunctival bubble-like swelling was observed.Postoperative orbital computed tomography(CT)review indicated migration of silicone oil to the subconjunctival space and orbit through a self-permeable outlet.On December 18,2023,the patient sought treatment at the First Affiliated Hospital of Nanchang University,China.The patient presented with a pronounced foreign body sensation following left eye surgery.On December 20,2023,the foreign body was removed from the left eye frame and an intraocular examination was conducted.The posterior scleral tear had closed,leading to termination of the surgical procedure following supplementary laser treatment around the tear.The patient reported a significant reduction in ocular surface symptoms just one day after surgery.Furthermore,a notable decrease in the migration of silicone oil was observed in orbital CT scans.CONCLUSION The timing of silicone oil injection for an eye-penetrating injury should be carefully evaluated to avoid the possibility of silicone oil migration.
基金Supported by the National Natural Science Foundation of China (No.82171038No.81974129)Jiangsu Provincial Medical Key Discipline (No.JSDW202245).
文摘Cataract is the main cause of visual impairment and blindness worldwide while the only effective cure for cataract is still surgery.Consecutive phacoemulsification under topical anesthesia has been the routine procedure for cataract surgery.However,patients often grumbled that they felt more painful during the second-eye surgery compared to the first-eye surgery.The intraoperative pain experience has negative influence on satisfaction and willingness for second-eye cataract surgery of patients with bilateral cataracts.Intraoperative ocular pain is a complicated process induced by the nociceptors activation in the peripheral nervous system.Immunological,neuropsychological,and pharmacological factors work together in the enhancement of intraoperative pain.Accumulating published literatures have focused on the pain enhancement during the secondeye phacoemulsification surgeries.In this review,we searched PubMed database for articles associated with pain perception differences between consecutive cataract surgeries published up to Feb.1,2024.We summarized the recent research progress in mechanisms and interventions for pain perception enhancement in consecutive secondeye phacoemulsification cataract surgeries.This review aimed to provide novel insights into strategies for improving patients’intraoperative experience in second-eye cataract surgeries.
文摘AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.
文摘Objective This study aimed to evaluate the clinical efficacy and safety of foldable capsular vitreous body(FCVB)implant surgery in silicone oil-dependent eyes.Methods A total of 22 participants with silicone oil-dependent eyes who received treatment with FCVB implant surgery between January 2019 and June 2020 were included in this retrospective study.The intraocular pressure(IOP),best-corrected visual acuity(BCVA),demographic data,and any recorded complications were evaluated.Results The postoperative IOP(12.73±4.20 mmHg)was significantly improved(P=0.03)compared to the preoperative IOP(10.23±3.69 mmHg)(the main endpoint).There was no significant difference(P=0.33)in the final BCVA preoperation and 3rd month postoperation(the secondary endpoint).The most common postoperative complication was hyphema.Other common postoperative complications included corneal opacity,a shallow anterior chamber,and a low IOP.Conclusion FCVB implant surgery is a safe and effective method for treating silicone oil-dependent eyes;however,attention should be paid to the prevention and timely treatment of complications.
文摘AIM:To investigate the influence of ophthalmic viscoelastic devices(OVDs)and different surgical approaches on the intraocular pressure(IOP)before and after creation of the curvilinear circular capsulorhexis(CCC)as a measure for anterior chamber stability during this maneuver.METHODS:Prospective experimental WetLab study carried out on enucleated porcine eyes.IOP was measured before and after CCC with the iCare Rebound tonometer(iCare ic200;iCare Finland Oy,Vantaa,Finland).The OVDs used were a cohesive one[Z-Hyalin,Carl Zeiss Meditec AG,Germany;hyaluronic acid(HA)]and a dispersive[Z-Celcoat,Carl Zeiss Meditec AG,Germany;hydroxy propylmethylcellulosis(HPMC)].The CCC was created using Utrata forceps or 23 g microforceps in different combinations with the OVDs.RESULTS:Using the Utrata forceps the IOP dropped from 63.65±6.44 to 11.25±3.63 mm Hg during the CCC.The use of different OVDs made no difference.Using the 23 g microforceps the IOP dropped from 65.35±8.15 to 36.55±6.09 mm Hg.The difference between IOP drop using either Utrata forceps or 23 g microforceps was highly significant regardless of the OVD used.CONCLUSION:Using the sideport for the creation of the capsulorhexis leads to a lesser drop in IOP during this maneuver compared to the main incision in enucleated porcine eyes.The use of different OVD has no significant influence on IOP drop.
基金Supported by Natural Science Foundation of Sichuan Province of China,No.2022NSFSC1400Youth Innovation Project of Sichuan Medical Association,No.Q15045。
文摘BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.
基金Supported by National Key R&D Programs of China,No.2022YFC2503600.
文摘The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.
文摘In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.
文摘AIM:To compare high or low concentration of hyaluronic acid eye drops(HY)for dry eye syndromes(DES).METHODS:Randomized controlled trials(RCTs)comparing various concentrations of HY were searched in PubMed,Embase,Web of Science,Cochrane,SinoMed,CNKI,Wanfang Database,CQVIP,and Chinese journals databases between inception and July 2023.Pooled standardized mean differences(SMD)or weighted mean difference(WMD)with 95%confidence intervals(CI)from RCTs evaluating Schirmer’s I test(SIT),corneal fluorescein staining score(CFS),tear breakup time(TBUT),DES score(DESS),and Ocular Surface Disease Index(OSDI)were calculated.Sensitivity analysis,Egger’s test and Meta-regression analysis were performed for all indicators.RESULTS:We conducted a Meta-analysis of 10 RCTs that met the inclusion criteria,involving 1796 cases.High-concentrations group significantly improved the outcome of CFS according to random effects modelling(SMD,-3.37;95%CI,-5.25 to-1.48;P=0.0005).The rest of the results were not statistically significant,including indicators such as SIT,TBUT,DESS and OSDI.CONCLUSION:For dry eyes with positive corneal staining,a high concentration of HY is recommended,whereas in other cases,a high concentration of HY does not offer a more pronounced advantage over a low concentration of HY in the treatment of dry eyes.
基金Supported by Liangshan Prefecture Science Research,Development,Promotion and Application Project Application Form,No.17yyjs0011.
文摘BACKGROUND There is still some room for optimizing ambulatory pediatric surgical procedures,and the preoperative and postoperative management quality for pediatric patients needs to be improved.AIM To discuss the safety and feasibility of the enhanced recovery after surgery(ERAS)-based management model for ambulatory pediatric surgical procedures.METHODS We selected 320 pediatric patients undergoing ambulatory surgery from June 2023 to January 2024 at The First People’s Hospital of Liangshan Yi Autonomous Prefecture.Of these,220 received ERAS-based management(research group)and 100 received routine management(control group).General information,postoperative ambulation activities,surgical outcomes(operation time,postoperative gastro-intestinal ventilation time,and hospital stay),postoperative pain visual analogue scale,postoperative complications(incision infection,abdominal distension,fever,nausea,and vomiting),and family satisfaction were compared.RESULTS The general information of the research group(sex,age,disease type,single parent,family history,etc.)was comparable to that of the control group(P>0.05),but the rate of postoperative(2 h,4 h,and 6 h after surgery)ambulation activities was statistically higher(P<0.01),and operation time,postoperative gastrointestinal ventilation time,and hospital stay were markedly shorter(P<0.05).The research group had lower visual analogue scale scores(P<0.01)at 12 h and 24 h after surgery and a lower incidence of total postoperative complications than the control group(P=0.001).The research group had higher family satisfaction than the control group(P=0.007).CONCLUSION The ERAS-based management model was safe and feasible in ambulatory pediatric surgical procedures and worthy of clinical promotion.
文摘BACKGROUND Dry eye is a common eye disease.Artificial tears supplements are widely used for the treatment of dry eyes.However,multiple adverse effects have been observed in patients receiving long-term treatment with artificial tears,which may affect the therapeutic effect.AIM To analyze the characteristics of interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α)levels in patients with dry eye and the therapeutic effect of artificial tears combined with cyclosporine A.METHODS A total of 124 dry eye patients treated at The First People’s Hospital of Xining from April 2020 to April 2022 were selected as the observation group,while 20 healthy individuals served as the control group during the same period.Levels of inflammatory markers,including IL-1β,IL-6,and TNF-α,were analyzed.The observation group was further divided into a study group and a control group,each consisting of 62 patients.The control group received artificial tears,whereas the study group received a combination of artificial tears and cyclosporine A.Inflammatory markers,Schirmer’s test(SIT),tear break-up time(TBUT),corneal fluorescein staining(CFS),National Eye Institute Visual Function Questionnaire-25(NEI-VFQ-25)scores,and adverse events(AEs)were compared between the two groups.RESULTS The observation group exhibited significantly elevated serum levels of IL-1β,IL-6,and TNF-αin comparison to the healthy group.Following treatment,the study group demonstrated substantial reductions in IL-1β,IL-6,and TNF-αlevels relative to the control group.Moreover,after treatment,the study group experienced a marked decrease in CFS scores and significant increases in both SIT and BUT levels when compared to the control group.Additionally,significant improvements were observed in the primary symptom of dry eye and secondary symptoms such as photophobia,foreign body sensation,fatigue,red eye,and burning sensation within the study group.Furthermore,post-treatment NEI-VFQ-25 scores across all dimensions exhibited significant enhancements in the study group compared to the control group(P<0.05).It is noteworthy that significant AEs were reported in both groups throughout the treatment period.CONCLUSION Cyclosporine A combined with artificial tears is effective in treating dry eye,yielding enhanced outcomes by improving SIT and TBUT levels,reducing CFS scores,and ameliorating vision-related quality of life.
文摘In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.
文摘Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.
基金supported by a grant from the National Natural Science Foundation of China (No. 81972671)。
文摘To the Editor: As we all know, even with the current advancements regarding novel chemotherapy regimens, patients affected by pancreatic cancer(PC) have an extremely dismal prognosis(5-year survival rate 12% for all stages in the National Cancer Institute SEER database). Among the patients undergoing surgical treatment, the prognosis is mostly affected by recurrence. PC after surgery has mainly four patterns of recurrence, isolated or variously associated with each other: local, lymph nodal, peritoneal or distant(liver, lung, other sites).
文摘AIM:To evaluate the effectiveness and safety of intravitreal ranibizumab(IVR)for diabetic macular edema(DME)in vitrectomized versus non-vitrectomized eyes.METHODS:The PubMed,EMBASE,Web of Science,Cochrane,EBSCO were comprehensively searched for studies comparing vitrectomized and non-vitrectomized eyes with DME.Clinical outcomes of best-corrected visual acuity(BCVA),central macular thickness(CMT),the mean number of intravitreal injection and adverse events were extracted and analyzed.RESULTS:Six studies involving 641 eyes were included.Final visual gain significantly improved and CMT significantly reduced in vitrectomized eyes at 6mo and 12mo visits(P<0.05).Although the mean reduction in CMT among non-vitrectomized eyes was significantly greater than in vitrectomized eyes at the 6mo[mean difference(MD)=53.57,95%confidence interval(CI):28.03 to 78.72,P<0.0001]and 12mo(MD=49.65,95%CI:19.58 to 79.72,P=0.01),no significant difference was detected in improvement in BCVA at either 6mo(MD=0.05,95%CI:-0.02 to 0.13,P=0.14)or 12mo(MD=0.03,95%CI:-0.04 to 0.09,P=0.43).Injection number of ranibizumab in non-vitrectomized eyes was significantly less than that in vitrectomized eyes during 6-month period(MD=0.60,95%CI:0.16 to 1.04,P=0.008),while there was no statistically significant difference between the two groups during 12mo of follow-up.CONCLUSION:Evidence from current study suggests that IVR was useful for both vitrectomized group and nonvitrectomized group with DME.Although less reduction in macular thickness is found in vitrectomized group,visual improvement between two groups is similar.
文摘Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed in oncological patients(liver metastasis,hepatocellular carcinoma,cholangiocarcinoma,etc.),but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined.Theoretical advantages of ERAS programs are:ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes;a better and faster posto-perative recovery should let oncologic teams begin chemotherapeutic regimens on time;prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy.So,ERAS could be another way to improve our oncological results.We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.
文摘Objective:Prostate cancer(PCa)patients might experience lower urinary tract symptoms as those diagnosed with benign prostatic hyperplasia(BPH).Some of them might be treated for their lower urinary tract symptoms instead of PCa.We aimed to test the effect of PCa versus BPH on surgical outcomes after transurethral prostate surgery,namely complication and mortality rates.Methods:Within the American College of Surgeons National Surgical Quality Improvement Program database(2011-2016),we identified patients who underwent transurethral resection of the prostate,photoselective vaporization,or laser enucleation.Patients were stratified according to postoperative diagnosis(PCa vs.BPH).Univariable and multivariable logistic regression models evaluated the predictors of perioperative morbidity and mortality.A formal test of interaction between diagnosis and surgical technique used was performed.Results:Overall,34542 patients were included.Of all,2008(5.8%)had a diagnosis of PCa.The multivariable logistic regression model failed to show statistically significant higher rates of postoperative complications in PCa patients(odds ratio:0.9,95%confidence interval:0.7-1.1;p=0.252).Moreover,similar rates of perioperative mortality(p=0.255),major acute cardiovascular events(p=0.581),transfusions(p=0.933),and length of stay of more than or equal to 30 days(p=0.174)were found.Additionally,all tests failed to show an interaction between post-operative diagnosis and surgical technique used.Conclusion:Patients diagnosed with PCa do not experience higher perioperative morbidity or mortality after transurethral prostate surgery when compared to their BPH counterparts.Moreover,the diagnosis seems to not influence surgical technique outcomes.
文摘AIM:To investigate the types of bacteria in patients with eye infections in Suzhou and their drug resistance to commonly used antibacterial drugs.METHODS:The clinical data of 155 patients were retrospectively collected in this study,and the pathogenic bacteria species and drug resistance of each pathogenic bacteria were analyzed.RESULTS:Among the 155 patients(age from 12 to 87 years old,with an average age of 57,99 males and 56 females)with eye infections(160 eyes:74 in the left eye,76 in the right eye and 5 in both eyes,all of which were exogenous),71(45.81%)strains were gram-positive bacteria,23(14.84%)strains were gram-negative bacteria and 61(39.35%)strains were fungi.Gram-positive bacteria were highly resistant to penicillin and erythromycin(78.87%and 46.48%respectively),but least resistant to vancomycin at 0.Gram-negative bacteria were highly resistant to cefoxitin and compound sulfamethoxazole(100%and 95.65%respectively),but least resistant to meropenem at 0.Comparison of the resistance of gram-positive and gram-negative bacteria to some drugs revealed statistically significant differences(P<0.05)in the resistance of both to cefoxitin,cotrimoxazole,levofloxacin,cefuroxime,ceftriaxone and ceftazidime,and both had higher rates of resistance to gram-negative bacteria than to gram-positive bacteria.The distribution of bacterial infection strains showed that Staphylococcus epidermidis was the most common strain in the conjunctiva,cornea,aqueous humor or vitreous body and other eye parts.Besides,Fusarium and Pseudomonas aeruginosa were also among the most common strains of conjunctival and corneal infections.CONCLUSION:Gram-positive bacteria are the dominant bacteria in eye infections,followed by gram-negative bacteria and fungi.Considering the resistance of gramnegative bacteria to multiple drugs,monitoring of bacteria should be strengthened in eye bacterial infections for effective prevention and control to reduce complications caused by eye infections.
文摘This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.