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

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

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

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

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。

The “No-touch” technique improves the survival of patients with advanced hepatocellular carcinomas treated by liver transplantation: A single-center prospective randomized controlled trial

Background:Liver transplantation(LT)is the best treatment for patients with hepatocellular carcinoma(HCC).However,the surgical technique needs to be improved.The present study aimed to evaluate the“no-touch”technique in LT.Methods:From January 2018 to December 2019,we performed a prospective randomized controlled trial on HCC patients who underwent LT.The patients were randomized into two groups:a no-touch technique LT group(NT group,n=38)and a conventional LT technique group(CT group,n=46).Operative outcomes and survival in the two groups were analyzed.Results:The perioperative parameters were comparable between the two groups(P>0.05).There was no significant difference between the two groups in disease-free survival(DFS)(P=0.732)or overall survival(OS)(P=0.891).Of 36 patients who were beyond the Hangzhou criteria for LT,the DFS of the patients in the NT group was significantly longer than that in the CT group(median 402 vs.126 days,P=0.025).In 31 patients who had portal vein tumor thrombosis(PVTT),DFS and OS in the NT group were significantly better than those in the CT group(median DFS 420 vs.167 days,P=0.022;2-year OS rate 93.8%vs.66.7%,P=0.043).In 14 patients who had diffuse-type HCCs,DFS and OS were significantly better in the NT group than those in the CT group(median DFS 141 vs.56 days,P=0.008;2-year OS rate 75.0%vs.33.3%,P=0.034).Multivariate analysis showed that for patients with PVTT and diffusetype HCCs,the no-touch technique was an independent favorable factor for OS(PVTT:HR=0.018,95%CI:0.001-0.408,P=0.012;diffuse-type HCCs:HR=0.034,95%CI:0.002-0.634,P=0.024).Conclusions:The no-touch technique improved the survival of patients with advanced HCC compared with the conventional technique.The no-touch technique may provide a new and effective LT technique for advanced HCCs.

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.

进行CTOD试验的焊接工艺评定试板制备要点分析

文中对双面焊的大厚试板焊接工艺评定试板的制备过程制定了指导说明。针对大厚试板的制备过程的各个环节提出了合理做法,并结合作业特点,设定了合理的作业顺序,提高试板制备效率。针对热影响区CTOD试样容易出现无效试样的情况,明确了在试板焊接时应关注的操作要点,提高获取热影响区CTOD试样的有效率。

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.

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.

Minimally invasive pelvic exenteration for primary or recurrent locally advanced rectal cancer:A glimpse into the future

Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer(LARC)for many years.Their main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative complications.Currently,pelvic exenteration(PE)with or without neoadjuvant treatment is a curative treatment when negative resection margins are achieved.The traditional open approach has been favored by many surgeons.However,the technological advancements in minimally invasive surgery have radically changed the surgical options.Recent studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE.A recent retrospective study entitled“Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review”was published in the World Journal of Gastrointestinal Surgery.As we read this article with great interest,we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for LARC.Currently,the small number of suitable patients,limited surgeon experience,and steep learning curve are hindering the establishment of minimally invasive PE.

Pilot study to determine improvements in subjective penile morphology and personal relationships following a Nesbit plication procedure for men with congenital penile curvature

Aim： To determine whether the surgical straightening of congenital penile curvature can improve intromission comfort, penile features, personal relationships and psychogenic erectile dysfunction （ED）. Methods： Fifty-four patients （mean age 24 years, range 20-31 years） whose congenital penile deviation due to physiological curvature was ≥ 25 degrees, as measured on a graph, and who were experiencing penetration discomfort were assessed specifically for the present study. Of these, 14 patients suffered from psychogenic ED. The assessment included a case history, an objective examination, a pharmacologically-induced erection with prostaglandin E1 10-20 g, a graph taken during erection, a basal and dynamic Duplex ultrasonograph, penile length measurement, nocturnal penile tumescence recording, hormonal profiles and a psychological interview to evaluate the quality of their personal relationships according to Hinde＇s parameters （contents, number, features, frequency, ability to perceive limits of mutuality, subjective perception of the other person[s], and reliability）. All patients underwent the Nesbit procedure. The initial assessment was repeated at 3 and 12 months after surgery. Data analyses were carried out using the z test. Results： Subjective judgement of cosmetic penile features and vaginal intromission comfort improved significantly after surgery whereas the quality of personal relationships and ED did not. Conclusion： The surgical straightening of congenital penile curvature improved intromission comfort and penile features, but it failed to improve interpersonal relationships or psychogenic ED.

Multi-Objective Optimization of the Ultrasonic Scalpel Rod and Tip with Improved Performance:Vibration Frequency,Amplitude,and Service Life

Ultrasonic scalpel design for minimally invasive surgical procedures is mainly focused on optimizing cutting performance.However,an important issue is the low fatigue life of traditional ultrasonic scalpels,which affects their long-term reliability and effectiveness and creates hidden dangers for surgery.In this study,a multi-objective optimal design for the cutting performance and fatigue life of ultrasonic scalpels was proposed using finite element analysis and fatigue simulation.The optimal design parameters of resonance frequency and amplitude were determined.By setting the transition fillet and keeping the gain structure away from the node position to enable the scalpel to have a high service life with excellent cutting performance.The frequency modulation method of setting the vibration node bosses at the node position and setting the vibration antinode grooves at the antinode position was compared.Then,the mechanism of the influence of various design elements,such as tip,shank,node position,and antinode position,on the resonance frequency,amplitude,and fatigue life of the ultrasonic scalpel was analyzed,and the optimal design principles of the ultrasonic scalpel were obtained.The proposed ultrasonic scalpel design was confirmed by simulations,impedance measurements,and liver tissue cutting experiments,demonstrating its feasibility and enhanced performance.This research introduces innovative design strategies to improve the fatigue life and performance of ultrasonic scalpels to address an important issue in minimally invasive surgery.

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.

Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants: Lessons learned from single-balloon enteroscopy-assisted ERCP

Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.

Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique:Two case reports

BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;however,it often results in defects requiring complex reconstructions.CASE SUMMARY We report two cases in which the keystone flap(KF)was used for CNF defect coverage:Case 1,an 85-year-old patient with CNF in the anterior neck,and Case 2,a 54-year-old patient with CNF in the posterior neck.Both patients received empirical intravenous antibiotic therapy and underwent serial debridement,enabling adequate wound preparation and stabilization.The final defect size measured 5.5 cm×12 cm in Case 1 and 6 cm×11 cm in Case 2.For defect coverage,we employed an 8 cm×19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm×18 cm type II KF based on perforators from the transverse cervical artery in Case 2.Both flaps showed complete survival.No postoperative complications occurred in both cases,and favorable outcomes were observed at 7-and 6-month follow-ups in case 1 and 2,respectively.CONCLUSION We effectively treated CNF-associated defects using the KF technique;KF is viable for covering CNF defects in carefully selected cases.

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.

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

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

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.

Coordinated Mining Procedures of Open Pit Mines Based on River Management

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

Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study

BACKGROUND Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide,necessitating surgical resection as the sole treatment option.Over the years,there has been a growing adoption of minimally invasive surgical techni-ques such as robotic and laparoscopic approaches.Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques.While previous studies have reported favo-rable perioperative outcomes for robot-assisted radical resection in rectal cancer patients,further evidence regarding its oncological safety is still warranted.AIM To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection(LALAR)procedures.METHODS The clinical data of 125 patients who underwent robot-assisted low anterior resection(RALAR)and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed.After performing a 1:1 propensity score matching,the patients were divided into two groups:The RALAR group and the LALAR group(111 cases in each group).Subsequently,a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups.RESULTS Compared to the LALAR group,the RALAR group exhibited a significantly earlier time to first flatus[2(2-2)d vs 3(3-3)d,P=0.000],as well as a shorter time to first fluid diet[4(3-4)d vs 5(4-6)d,P=0.001].Additionally,the RALAR group demonstrated reduced postoperative indwelling catheter time[2(1-3)d vs 4(3-5)d,P=0.000]and decreased length of hospital stay after surgery[5(5-7)d vs 7(6-8)d,P=0.009].Moreover,there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group[10777(10780-11850)dollars vs 10550(8766-11715)dollars,P=0.012].No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups.Furthermore,no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups.CONCLUSION Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection,while maintaining similar perioperative and 3-year oncological outcomes.

Optimization of Open-cast Mining Procedure Based on RSR Method

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