Non-anatomical liver resection for hepatocellular carcinoma:the SegSubTe classification to overcome the problem of heterogeneity

Background:The superiority of anatomical resection(AR)vs.non-anatomical resection(NAR)in the surgical management of hepatocellular carcinoma(HCC)is debated.ARs are well-defined procedures,whereas the lack of NAR standardization results in heterogeneous outcomes.This study aimed to introduce the SegSubTe classification for NAR detailing the appropriateness of the level of surgical section of the Glissonean pedicles feeding the tumor.Methods:A single-center retrospective analysis of pre-and postoperative imaging of consecutive patients treated with NAR for single HCC between 2012 and 2020 was conducted.The quality of surgery was assessed classifying the type of vascular supply and the level of surgical section(segmental,subsegmental or terminal next to the tumor)of vascular pedicles feeding the HCCs;then,the population was divided in“SegSubTe-IN”or“SegSubTe-OUT”groups,and the tumor recurrence and survival were analyzed.Results:Ninety-seven patients who underwent NAR were included;76%were SegSubTe-IN and 24%were SegSubTe-OUT.Total disease recurrence,local recurrence and cut-edge recurrence in the SegSubTe-IN vs.SegSubTe-OUT groups were 50%vs.83%(P=0.006),20%vs.52%(P=0.003)and 16%vs.39%(P=0.020),respectively.SegSubTe-OUT odds ratio for local recurrence was 4.1 at univariate regression analysis.One-,three-,and five-year disease-free survival rates in the SegSubTe-IN vs.SegSubTe-OUT groups were 81%,58%and 35%vs.46%,21%and 11%,respectively(P<0.001).Conclusions:The SegSubTe classification is a useful tool to stratify and standardize NAR for HCC,aiming at improving long-term oncological outcomes and reducing the heterogeneity of quality of NAR for HCC.

Education Programs for Invasive Procedures Involving Nurses: A Scoping Review

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

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

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

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

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

The Efficacy and Safety of Dinoprostone Vaginal Insert for Labor Induction Following Optimization of Standard Operating Procedure: A Retrospective Study in China

Background:The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure(SOP)and to discover independent predictors of vaginal delivery.Methods:This study comprised 551 pregnant women who required cervical ripening with dinoprostone before induction of labor.Using univariate and multivariate analyses,independent predictors of vaginal delivery were identified.Results:443 of the 551 women(80.4%)gave birth vaginally.Vaginal delivery was predicted by maternal age(24-30 vs.<24,P<0.001;30-35 vs.<24,P=0.03),gestational age(P=0.005),birth weight(P<0.001),parity(P=0.001),pre-pregnancy BMI(P<0.001),premature rupture of membranes(P=0.001),meconium-stained amniotic fluid(P<0.001),fundal height(P<0.001)and the Bishop score(P<0.001).None of the women exhibited severe postpartum hemorrhage.Conclusions:The maternal age,gestational age,birth weight,parity,body mass index,premature membrane rupture,amniotic fluid contamination,fundal height,and the Bishop score were independent predictors of vaginal delivery.These may guide the clinical use of dinoprostone for induction of labor.

Laparoscopic pancreaticoduodenectomy with portal or superior mesenteric vein resection and reconstruction for pancreatic cancer:A single-center experience

Background: Open pancreaticoduodenectomy(OPD) with portal or superior mesenteric vein resection and reconstruction has been applied in pancreatic cancer patients with tumor infiltration or adherence. However, it is controversial whether laparoscopic pancreaticoduodenectomy(LPD) with major vascular resection and reconstruction is feasible. This study aimed to evaluate the safety and feasibility of LPD with major vascular resection compared with OPD with major vascular resection. Methods: We reviewed data for all pancreatic cancer patients undergoing LPD or OPD with vascular resection at Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, between February 2018 and May 2022. We compared the preoperative, intraoperative, and postoperative clinicopathological data of the two groups to conduct a comprehensive evaluation of LPD with major vascular resection. Results: A total of 63 patients underwent pancreaticoduodenectomy(PD) with portal or superior mesenteric vein resection and reconstruction, including 25 LPDs and 38 OPDs. The LPD group had less intraoperative blood loss(200 vs. 400 m L, P < 0.001), lower proportion of intraoperative blood transfusion(16.0% vs. 39.5%, P = 0.047), longer operation time(390 vs. 334 min, P = 0.004) and shorter postoperative hospital stay(11 vs. 14 days, P = 0.005). There was no perioperative death in all patients. There was no significant difference in the incidence of total postoperative complications, grade B/C postoperative pancreatic fistula, delayed gastric emptying and abdominal infection between the two groups. No postpancreatectomy hemorrhage nor bile leakage occurred during perioperative period. There was no significant difference in R0 resection rate and number of lymph nodes harvested between the two groups. Patency of reconstructed vessels in the two groups were 96.0% and 92.1%, respectively( P = 0.927). Conclusions: LPD with portal or superior mesenteric vein resection and reconstruction was safe, feasible and oncologically acceptable for selected patients with pancreatic cancer, and it can achieve similar or even better perioperative results compared to open approach.

改良Peyton四步教学法联合DOPS在西藏临床技能培训中的应用

目的探讨基于改良Peyton四步教学法的模拟教学联合操作技能直接观察(direct observation of procedural skills,DOPS)评估方法在西藏临床技能培训中的应用效果。方法选取西藏边坝县人民医院2021年5月—2022年5月参加临床技能培训的51名医护人员为研究对象,随机分为试验组与对照组。试验组采用结合改良Peyton四步教学法进行成人男性导尿术教学,并在培训开始前、培训中期及培训结束后,由带教教师采用DOPS评估方法对学员进行测评。对照组采用传统临床技能培训方法进行教学。在培训结束后发放满意度调查问卷,以了解学员对该教学模式的满意度。结果试验组技能考核平均成绩(90.12±5.50)分,对照组技能考核平均成绩(79.36±6.95)分,两组间成绩比较,其差异具有统计学意义(P<0.001);DOPS评估量表显示,试验组学员在培训结束后临床操作各项能力均较前有显著提高,其差异均具有统计学意义(P<0.05);课后满意度调查结果显示,在赞同“增强相关基础知识”等6个方面,试验组与对照组比较,其差异均具有统计学意义(P<0.001)。结论基于改良Peyton四步教学法的模拟教学联合DOPS评估方法的教学模式可提高西藏藏区医护人员的临床技能操作水平,适合在藏区医护人员临床技能培训中推广。

Current diagnostic tools and treatment modalities for rectal prolapse

Rectal prolapse is a circumferential,full-thickness protrusion of the rectum through the anus.It is a rare condition,and only affects 0.5%of the general population.Multiple treatment modalities have been described,which have changed significantly over time.Particularly in the last decade,laparoscopic and robotic surgical approaches with different mobilization techniques,combined with medical therapies,have been widely implemented.Because patients have presented with a wide range of complaints(ranging from abdominal discomfort to incomplete bowel evacuation,mucus discharge,constipation,diarrhea,and fecal incontinence),understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure.It is crucial to assess these additional symptoms and their severities using preoperative scoring systems.Additionally,radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders.However,there is no consensus on or standardization of the optimal extent of dissection,type of procedure,and materials used for rectal fixation;this makes providing maximum benefits to patients with minimal complications difficult.Even recent publications and systematic reviews have not recommended the most appropriate treatment options.This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.

Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.

Fracture Assessment for Electron Beam Welded Damage Tolerant Ti-6Al-4V Alloy by the FITNET Procedure

Fracture assessment of the cracked structures is essential to avoiding fracture failure.A number of fracture assessment procedures have been proposed for various steel structures.However,the studies about the application of available procedures for titanium alloy structures are scarcely reported.Fracture assessment for the electron beam(EB) welded thick-walled damage tolerant Ti-6Al-4V(TC4-DT) alloy is performed by the fitness-for-service(FFS) FITNET procedure.Uniaxial tensile tests and fracture assessment tests of the base metal and weld metal are carried out to obtain the input information of assessment.The standard options and advanced options of FITNET FFS procedure are used to the fracture assessment of the present material.Moreover,the predicted maximum loads of compact tensile specimen using FITNET FFS procedure are verified with the experimental data of fracture assessment tests.As a result,it is shown that the mechanical properties of weld metal are inhomogeneous along the weld depth.The mismatch ratio M is less than 10% at the weld top and middle,whereas more than 10% at the weld bottom.Failure assessment lines of standard options are close to that of advanced option,which means that the standard options are suitable for fracture assessment of the present welds.The accurate estimation of the maximum loads has been obtained by fracture assessment of standard options with error less than 6%.Furthermore,there are no potential advantages of applying higher options or mismatch options.Thus,the present welded joints can be treated as homogeneous material during the fracture assessment,and standard option 1 can be used to achieve accurate enough results.This research provides the engineering treatment methods for the fracture assessment of titanium alloy and its EB welds.

Khubchandani's procedure combined with stapled posterior rectal wall resection for rectocele

BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.

A Comparative Survey of an Approximate Solution Method for Stochastic Delay Differential Equations

This study is focused on the approximate solution for the class of stochastic delay differential equations. The techniques applied involve the use of Caratheodory and Euler Maruyama procedures which approximated to stochastic delay differential equations. Based on the Caratheodory approximate procedure, it was proved that stochastic delay differential equations have unique solution and established that the Caratheodory approximate solution converges to the unique solution of stochastic delay differential equations under the Cauchy sequence and initial condition. This Caratheodory approximate procedure and Euler method both converge at the same rate. This is achieved by replacing the present state with past state. The existence and uniqueness of an approximate solution of the stochastic delay differential equation were shown and the approximate solution to the unique solution was also shown. .

英美刑事诉讼法专业术语之误译及省思——以“indictment”及“information”为视角

“indictment”与“information”属于同义词,适用条件不同,译法有别。美国刑事诉讼法中的“indictment”宜译为“大陪审团起诉书”;“information”宜译为“检察官起诉书”。英国刑事诉讼法中的“indictment”宜译为“普通起诉书”;“information”宜译为“简易起诉书”。由对此二词的翻译可见,我国学界对英美刑事诉讼法专业术语的翻译存在翻译错误、以偏概全、无区分度、有违美感原则及专业性不足等问题。主要缘由在于译者缺乏问题意识及翻译机械、教条式,也同学科壁垒有关。译者应恪守正确翻译观,践行科学精神,提高综合素养。

Robotic surgery for multi-visceral resection in locally advanced colorectal cancer:Techniques,benefits and future directions

Colorectal cancer accounts for 10%of diagnosed cancers globally and often presents as advanced disease,necessitating aggressive treatment.With both younger and healthier elderly patients being diagnosed,as well as potentially the need for salvage therapy post total neoadjuvant treatment,surgical options for cure include pelvic exenteration.Whilst typically performed via an open approach,there has been an increased utilisation of minimally invasive techniques including robotic surgery.Offering smaller in-cisions,reduced postoperative pain,and quicker recovery time than open surgery,robotic techniques have demonstrated lower blood loss,shorter hospital stays,and reduced morbidity.Moreover,the er-gonomic design of robotic systems provides surgeons with comfort during long procedures and increased precision.It also offers an increased opportunity for organ preservation and reconstruction whilst maintaining adequate oncological outcomes.As robotic technology continues to evolve and combines with artificial intelligence,it is poised to play an even more significant role in the management of complex colorectal cancer cases,improving survival and long-term outcomes.

Robot-Assisted Nephrotomy as a Nephron-Sparing Approach for Completely Intraparenchymal Renal Tumors

Introduction: The diagnosis of small renal masses and the endophytic tumor approach have become challenging. This study aims to describe exclusively robot-assisted surgery as an alternative nephron-sparing approach for renal intraparenchymal tumors. Patients and Methods: We retrospectively analyzed all patients with completely endophytic tumors undergoing robot-assisted partial nephrectomy, treated under the Da Vinci System®, aided by intraoperative ultrasound. The patients’ demographic characteristics, perioperative and oncological outcomes were assessed. Results: From a total of 13 partial nephrectomies performed between 06/2010 and 10/2021, all patients underwent nephrotomy. The patients’ mean age was 52 years and the tumor measured mean 2.6 cm. Warm ischemia time was 24 minutes and histopathological analysis revealed that 12 patients had renal cell carcinoma. In a mean 36-month follow-up, no significant renal function alterations were found and no local or systemic recurrences occurred. Conclusion: Robot-assisted access is a safe and effective option for the nephron-sparing technique in completely intraparenchymal renal tumors.

Balloon-occluded retrograde transvenous obliteration for treatment of congenital intrahepatic portosystemic venous shunt:A case report

Congenital intrahepatic portosystemic venous shunt(CPSVS), a rare vascular malformation, has been described in both children and adults and can lead to severe neurophysiological complications. However, a standard therapeutic protocol for CPSVS has not been elucidated. With the advantage of minimally invasive techniques,transcatheter embolization has been used to treat CPSVS. The condition is challenging to manage, especially in patients with large or multiple shunts, through which rapid blood flow can cause ectopic embolism. Here, we describe a case of CPSVS with a large shunt that was successfully treated with balloon-occluded retrograde transvenous obliteration with interlocking detachable coils.

Intraoperative photodynamic therapy for tracheal mass in non-small cell lung cancer:A case report

BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.

The Requirements for Laparoscopy-Assisted Distal Gastrectomy to Become Standard Procedure for Gastric Cancer: Based on Qualitative Study of Surgeons’ Experiences

Laparoscopy-assisted distal gastrectomy (LADG) has become one of the standard surgical procedures for gastric cancer in Japan and Korea. However, LADG is currently listed as being in the clinical research phase under the Gastric Cancer Treatment Guidelines. The aim of this study is to report surgeons’ opinions of what is needed if LADG is to become a standard procedure. We conducted questionnaire survey with open questions in hospitals that either applied or did not apply LADG and compared the answers. We labeled and categorized the collected data using content analysis. The number of hospitals which applied LADG more than doubled from 5 to 12 hospitals over 3 years. Overall, hospitals reported that the necessary elements for LADG to become a standard procedure are: clinical trials of LADG (n = 5, 22.7%), surgeons’ practical experience in performing LADG (n = 4, 18.2%), stability of radical treatment (n = 4, 18.2%), and a shorter operative duration (n = 3, 13.6%) for the procedure. Surgeons’ practical experience was chosen as the most important requirement in the hospitals which applied LADG while clinical trials (n = 2, 40.0%) and stability of radical treatment (n = 2, 40.0%) were the most common answers in the hospitals which did not apply LADG. Hospitals and surgeons’ practical experience, stabilizing radical cure, and the large scale of clinical trials are for LADG to become a standard procedure and to gain equivalent importance as open distal gastrectomy in treating gastric cancer.

Kangaroo Care (Skin-to-Skin) for Clustered Pain Procedures: Case Study

Background: Pain management for term newborns undergoing clustered painful procedures has not been tested. Kangaroo Care (chest-to-chest, skin-to-skin position of infant on mother) effectively reduces pain of single procedures, but its effect on pain from clustered procedures is not known. Aim: The aim was to test Kangaroo Care’s effect on pain in one term infant who received clustered painful procedures while determining feasibility of the Kangaroo Care intervention. Design, Setting, and Participant: A case study design was used with one healthy term newborn who received two heel sticks and one injection in one session in the mother’s postpartum room. Method: Heart rate and oxygen saturation (recorded from Massimo Pulse Oximeter every 30 seconds), crying time (total seconds of crying on videotape) and behavioral state (using Anderson Behavioral State Scoring system every 30 seconds) were measured before (5 minutes), during (10.5 minutes) and after (30 minutes) the three clustered painful procedures in a newborn who was in Kangaroo Care during all observations. One staff nurse administered the clustered procedures. Results: Heart rate increased sequentially with each heelstick, oxygen saturation remained unchanged, sleep predominated, and crying was minimal throughout the procedures. Conclusion: Kangaroo Care appeared to reduce pain from clustered painful procedures and can be further tested.

Rotationplasty type BIIIb as an effective alternative to limb salvage procedure in adults:Two case reports

BACKGROUND Rotationplasty is often performed for malignant tumors,but type BIIIb rotationplasty is rarely reported,and there needs to be more evidence of the procedure and treatment.The purpose of this case study was to report a new direction in the use of type BIIIb rotationplasty in treating patients with limb salvage and longterm non-healing infections.CASE SUMMARY Case 1:A 47-year-old man underwent radiotherapy for hemangioendothelioma in his left thigh,resulting in a femoral fracture.Despite the use of plates,intramedullary nailing,and external fixators,the femoral bone failed to unite due to infectious nonunion.Multiple operations were unable to control the infection,leaving the patient immobile.We performed a modified tibia-pelvic-constrained hip rotationplasty,utilizing a constrained prosthetic hip between the tibia and pelvis following a femur resection.Two years post-surgery,the patient was able to walk with the prosthetic device without any signs of recurring infection.The corresponding functional scores were 72 points for the Musculoskeletal Tumor Society(MSTS),53 for the Functional Mobility Assessment(FMA),93 for the Toronto Extremity Salvage Score(TESS),and 56 for the MOS 36-item short form health survey(SF-36).Case 2:A 59-year-old woman presented with liposarcoma in her left thigh.Magnetic resonance imaging revealed tumors in the medial,anterior,and posterior femur muscles,encircling the femoral vessels and nerves.Fortunately,there were no symptoms of sciatic dysfunction,and the tumor had not invaded the sciatic nucleus.After one year of follow-up,the patient expressed satisfaction with limb preservation post-type BIIIb rotationplasty.The corresponding functional scores were 63 points for the MSTS,47 for the FMA,88 for the TESS,and 52 for the SF-36.CONCLUSION Our study suggests that type BIIIb rotationplasty may be an alternative to amputation in patients with incurable infections.For malignant tumors of the lower extremities without invasion of the sciatic nerve,type BIIIb rotationplasty remains an excellent alternative to amputation.This surgical method may prevent amputation,improve functional outcomes,and facilitate biological reconstruction.