New anti-mesenteric delta-shaped stapled anastomosis: Technical report with short-term postoperative outcomes in patients with Crohn’s disease

BACKGROUND Medical treatment for Crohn’s disease(CD)has continuously improved,which has led to a decrease in surgical recurrence rates.Despite these advancements,25%of patients will undergo repeat intestinal surgery.Recurrence of CD com-monly occurs on the mesentery side of the anastomosis site.AIM To compare the new anti-mesenteric side-to-side delta-shaped stapled anasto-mosis(DSA)with the conventional stapled functional end-to-end anastomosis(CSA).METHODS This retrospective study included CD patients who underwent ileo-ileal or ileo-colic anastomosis between January 2020 and December 2023.The DSA technique employed a stapler to maintain the concept of anti-mesentery side-to-side ana-stomosis by performing a 90°vertical closure of the open window compared with the CSA technique.At the corner where the open window is closed,the DSA avoids forming a pouch and creates an anastomosis resembling a delta shape within the intestinal lumen.We compared demographics,preoperative condition,operative findings,and operative outcomes for the two techniques.RESULTS The study included 175 patients,including 92 in the DSA group and 83 in the CSA group.The two groups were similar in baseline characteristics,preoperative medical treatment,and operative findings except for the Montreal classification location.The 30-days postoperative complication rate was signi-ficantly lower in the DSA group compared with the CSA group(16.3%vs 32.5%,P=0.009).Ileus incidence was significantly lower in the DSA group than in the CSA group(4.3%vs 14.5%,P=0.033),and the hospital stay was shorter in the DSA group than in the CSA group(5.67±1.53 days vs 7.39±3.68 days,P=0.001).CONCLUSION The DSA technique was feasible and showed comparable postoperative outcomes with lower short-term complic-ations compared with the CSA technique.Further studies on CD recurrence and long-term complications are warranted.

Impact of different anastomosis methods on post-recurrence after intestinal resection for Crohn's disease:A meta-analysis

BACKGROUND Crohn's disease(CD)is a chronic inflammatory disease of the gastrointestinal tract,often requiring intestinal resection as a common treatment.However,recurrence after surgery is common.The anastomotic configuration after bowel resection appears to be associated with the recurrence of CD.Previous studies have suggested that the Kono-S anastomosis may help to reduce the recurrence rate.However,the results remain controversial.Therefore,evidence-based evidence is needed to prove the advantages of Kono-S anastomosis.AIM To measure the influence of anastomosis techniques on the long-term relapse rate of CD by conducting a meta-analysis.METHODS PubMed,Scopus,and Cochrane Library were searched until October 8,2023.Patients who underwent intestinal resection due to CD were included.The intervention measures included Kono-S anastomosis,whereas the control group received traditional anastomosis such as end-to-end,end-to-side,and side-to-side anastomosis.Only randomized clinical trials and observational studies were included.The primary outcome measures were hospital stay post-surgery,overall postoperative complication incidence,the proportion of Clavien-Dindo grade IIIa or higher,overall postoperative recurrence rate,and Rutgeerts score.RESULTS From 2011 to 2023,six articles met the inclusion and exclusion criteria.The results indicated that Kono-S anastomosis can reduce the hospital stay post-surgery of patients with CD[MD=-0.26,95%CI:-0.42 to-0.10,P=0.002]than other traditional anastomosis methods.Compared to other traditional anastomosis methods,Kono-S anastomosis can significantly reduce the total recurrence rate[MD=0.40,95%CI:0.17 to 0.98,P=0.05]and postoperative Rutgeerts score[MD=-0.81,95%CI:-0.96 to-0.66,P<0.001]in patients with CD.However,there is no significant disparity in the overall occurrence of postoperative complications and the proportion of Clavien-Dindo≥IIIa.CONCLUSION Kono-S anastomosis has the potential to expedite the recuperation of CD and diminish relapse hazards;however,additional larger trials are necessary to authenticate its effectiveness.

President Jiang Zemin on China’s Population and Family Planning

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DEVELOPMENT THROUGH OPENING——Mr.Jiang Xingzhen on Shaanxi's Dual Opening Strategy

At the east-west economic and tradeexchange and cooperation conferencesponsored by the China Council forthe Promotion of International Trade, Shaanxi’sVice-Governor Jiang Xingzhen spoke aboutShaanxi’s investment environment and itsdual opening strategy. Firstly Mr. Jiang made a briefintroduction on Shaanxi. Shaanxi, located atthe junction of the middle and western areasof China, is one of the origins of China’ssplendid ancient civilization. Its rich mineralresources include 92 varieties of provenreserves, 28 of which, including molybdenum,rhenium, mercury, coal and natural gas havereserves ranking in the first three and 58ranking in the top ten in the country.

Surgical treatment of inflammatory bowel disease:From the gastroenterologist’s stand-point

Treatment of ulcerative colitis(UC)and Crohn’s disease(CD)represents,in the majority of cases,a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience.During the last two decades,our pharmaceutical arsenal was significantly strengthened,especially after the introduction of the so-called biological agents,drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease.However,colectomy is still necessary for some patients with severe UC although smaller compared to the past,precisely because of the improvements achieved in the available conservative treatment.Nevertheless,surgeries to treat colon dysplasia and cancer are increasing to some extent.At the same time,satisfactory improvements in surgical techniques,the pre-and post-operative care of patients,as well as the selection of the appropriate time for performing the surgery have been noticed.Regarding patients with CD,the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease.On the other hand,the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible.This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view,the results of the emerging new techniques such as transanal surgery and robotics,as well as alternative operations to the classic ileo-anal-pouch anastomosis.The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature.The self-evident is emphasized,that is,to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era;the close cooperation of gastroenterologists with surgeons,pathologists,imaging,and nutritionists is of paramount importance.

结肠S型贮袋在低位直肠癌根治术超低位吻合术中的应用

目的评价老年低位直肠癌前切除结肠S型贮袋—直肠或肛管吻合对改善排便功能的作用。方法将2004年至2007年收治的老年低位直肠癌患者49例随机分为2组,第1组24例,行传统的结肠断端与直肠肛管直接端端吻合(直吻组);第2组25例,将断端结肠制成5cm的S型贮袋并与直肠或肛管行端侧吻合(袋吻组)。分别于术后1、3、6、9、12、18个月对排便功能进行评估,比较2组的手术并发症和排便功能指标。结果直吻组和袋吻组术后并发症无明显差异,术后6、12个月,袋吻组平均排便次数明显少于直吻组;延缓排便控制能力、失禁综合评分、区分排便排气能力等指标也以袋吻组为优。但术后18个月,2组排便功能已无差别。袋吻组的定性排便控制能力和直肠测压指标均优于直吻组。结论直肠癌低位前切除结肠S型贮袋直肠肛管吻合术不增加手术并发症,在术后第1年内有明显改善老年直肠癌患者排便功能的作用。

Recent trends in the surgical management of inflammatory bowel disease

Surgery is required in the vast majority of patients with Crohn’s disease (CD) and in approximately one-third of patients with ulcerative colitis (UC). Similar to medical treatments for IBD, significant advances have occurred in surgery. Advances in CD include an emphasis upon conservatism as exemplified by more limited resections, strictureplasties, and laparoscopic resections. The use of probiotics in selected patients has improved the outcome in patients with pouchitis following restorative proctocolectomy for UC. It is anticipated that ongoing discoveries in the molecular basis of IBD will in turn identify those patients who will best respond to surgery.

Gardner's syndrome:Genetic testing and colonoscopy are indicated in adolescents and young adults with cranial osteomas:A case report

We present a case of a 25-year-old female with diagnosed familial adenomatous polyposis and elevated carcinoembryonic antigen with negative family history. The suspicion of Gardner's syndrome was raised because extirpation of an osteoma of the left temporo-occipital region was made 10 years ago. Restorative procto-colectomy and ileal pouch anal anastomosis was made but histology delineated adenocarcinoma of the rectum (Dukes C stage). We conclude that cranial osteomas often precede gastrointestinal manifestations of familial adenomatous polyposis or Gardner's syndrome and such patients should be evaluated with genetic testing followed by colonoscopy if results are positive to prevent the development of colorectal carcinoma. If the diagnosis is positive all family members should be evaluated for familial adenomatous polyposis.

Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction.Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery.Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting.Primary resection with end colostomy(Hartmann's procedure) is considered the safer option.Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents(SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction.The authors concluded that the technical and clinical success rates for stenting were lower than expected.SEMS was associated with a high incidence of clinical and silent perforation.Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital.The goal of stenting,a decrease of the stoma rate,may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation.Until now,this was not demonstrated in a prospective randomized trial.

Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation(OLT).Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures.We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT,who had successful temporary placement of a prototype removable covered self-expandable metal stent(RCSEMS).These 2 patients(both men,aged 44 and 53 years)were given temporary placement of a prototype RCSEMS (8.5 Fr gauge delivery system,8 mm×40 mm stent dimensions)in the common bile duct across the biliary stricture.There was no morbidity associated with stent placement and removal in these 2 cases.Clinical parameters improved after the RCSEMS placement.Longterm biliary patency was achieved in both the patients. No further biliary intervention was required within 14 and 18 mo follow-up after stent removal.

Role of capsule endoscopy in inflammatory bowel disease

Videocapsule endoscopy (VCE) has revolutionized our ability to visualize the small bowel mucosa. This modality is a valuable tool for the diagnosis of obscure small bowel Crohn&#x02019;s disease (CD), and can also be used for monitoring of disease activity in patients with established small-bowel CD, detection of complications such as obscure bleeding and neoplasms, evaluation of response to anti-inflammatory treatment and postoperative recurrence following small bowel resection. VCE could also be an important tool in the management of patients with unclassified inflammatory bowel disease, potentially resulting in reclassification of these patients as having CD. Reports on postoperative monitoring and evaluation of patients with ileal pouch-anal anastomosis who have developed pouchitis have recenty been published. Monitoring of colonic inflammatory activity in patients with ulcerative colitis using the recently developed colonic capsule has also been reported. Capsule endoscopy is associated with an excellent safety profile. Although retention risk is increased in patients with small bowel CD, this risk can be significanty decreased by a routine utilization of a dissolvable patency capsule preceding the ingestion of the diagnostic capsule. This paper contains an overview of the current and future clinical applications of capsule endoscopy in inflammatory bowel disease.

Perforating and nonperforating indications in repeated surgeries for Crohn's disease

BACKGROUND Despite advances in medical therapy for Crohn’s disease(CD),most patients with CD require repeated resection surgeries.AIM To analyze the perforating and nonperforating indications of repeated CD operations and identify the anastomosis characteristics for postoperative CD.METHODS We retrospectively reviewed 386 patients who underwent at least one resection for CD between 2003 and 2013.Clinical characteristics of each surgery were collected.Univariate and multivariate analyses were performed to determine risk factors for recurrence.RESULTS The indication for reoperation in CD tends to be the same as that for primary operation,i.e.,perforating disease tends to represent as perforating disease and nonperforating as nonperforating.Concordance was found between the first surgery and second surgery in terms of the indication for the operation(P=0.006),and the indication for the third surgery was also correlated with that for the second surgery(P=0.033).Even if the correlation of surgical indications between repeated operations,the rate of perforating indication for the second and third surgeries was significantly higher than that of the first surgery.In addition,the presence of perforating CD was a predictor of recurrence for both the first and second surgeries.Moreover,anastomotic lesions were the most common sites of recurrence after the operation.Based on the importance of anastomosis,anastomosis might be a new type of disease location for the classification of postoperative CD.CONCLUSION CD not only has stable characteristics but also progresses chronically.Perforation is a progressive surgical indication for Crohn’s disease.For CD after surgery,anastomosis may be a new classification of disease location.

Genetic variability of Rhizoctonia solani Kühn and its resistance to fungicides

The aims of this study are to determine the population genetic structure of Rhizoctonia solani,associated with potato,and to assess its resistance degree to pencycuron and thiabendazole fungicides.A total of 57 strains of R.Solani were isolated from different potato crop fields in Mexico,and were classified according to their anastomosis group(AG)using the polymerase chain reaction(PCR)and restriction fragment length polymorphism(RFLP)-based analysis.Then,the amplified fragments were digested with four different endonucleases(Mse I,Ava II,Mun I and Hinc II).The Repetitive Element Sequence-Based PCR(rep-PCR)technique was used to determine the genetic diversity in R.solani populations.Results obtained by PCR-RFLP showed that 81%of the isolates were identified as belonging to AG-3 group,14%to AG1-1B and 5%to AG-11 group.In response to fungicides inhibition,IC_(50)between 0.014-0.039 mg a.i./L for pencycuron,and 0.82 to 2.91 for thiabendazole were determined,This IC_(50)value showed that the resistance factor(RF)values ranged from 1.4 to 3.945 and 0.27 to 0.97,respectively;this tendency suggests that isolates are susceptible to thiabendazole.The AG groups showed a heterogeneous resistance to pencycuron and thiabendazole,being more tolerant to these fungicides AG1-1B and AG-11 groups.The genetic analysis shows a low genetic diversity among(P-value 0.3225)and within(P-value 0.3275)populations;this can indicate a clonal reproduction and little parasexual cycle among the analyzed isolations.

边城之恋:姜夔的合肥情结

南宋的合肥是一座荒凉萧条的边城,姜夔却在此经历了刻骨铭心的恋情,一生中创作了许多与合肥经历有关的词作。作为天涯漂泊的江湖诗人,姜夔在合肥常有低沉凄黯的客怀,但离开后却又对此地抱有魂牵梦萦的归情。而边城之恋的经历,也使他对合肥的感情交织着忧国之思和怀人之情。最后,通过将杜牧的扬州梦典故指向合肥情事,姜夔试图对这段耿耿于怀的经历进行重构和自解,以抒发身世之感。姜夔的合肥情结是客心归情、忧国怀人、身世之感交织的情感空间,并非指向合肥的自然人文环境,而更多是对深刻复杂情感的回忆和铭记。

姜德友从肾论治痛风经验

介绍姜德友教授以肾主水液、主骨生髓理论为依据,用经验方痛风宁治疗痛风的临床经验,以期为痛风的辨证论治提供参考。

192例0～3个月先天性肠无神经节细胞症婴儿临床分析

目的探讨钙视网膜蛋白在3个月内婴儿先天性肠无神经节细胞症（HD）的临床诊断价值;对采用经肛门直肠结肠斜形切除吻合术治疗3个月内婴儿HD进行随访及疗效评价。方法 2008年1月至2014年10月该院确诊并行了经肛门直肠结肠切除斜形吻合术或肠造瘘术治疗3个月内婴儿HD 192例,收集其病案资料,并行根治术中期随访,评价其肛直肠功能及生活质量。结果 192例HD患儿中,139例行经肛门直肠结肠切除斜形吻合术,53例行肠造瘘术。术前诊断依据典型病史、体格检查及辅助检查,包括钡剂灌肠、直肠肛管测压和直肠吸引活检钙视网膜蛋白免疫组织化学染色,阳性率分别为80.1%、92.1%、97.9%。66例（60.5%）获中期随访,小肠结肠炎2例（3.0%）,污粪2例（3.0%）,无便秘复发、大小便失禁、肛门狭窄,男性患儿均有阴茎勃起现象,生长发育与正常婴幼儿相当。门诊随访25例,生化检查均在正常范围,15例钡剂灌肠检查显示肠道形态恢复良好;直肠肛管测压11例,10例（90.9%）肛门松弛反射恢复正常,1例未见松弛反射。结论钙视网膜蛋白免疫组织化学染色检查可作为3月内婴儿HD术前诊断的金标准;经肛门直肠结肠斜形切除吻合术设计符合生理,并发症少,中期疗效满意,适合0~3个月小婴儿根治术。

蒋健运用消食导滞通腑法治疗脾胃病经验

探讨蒋健教授临证运用消食导滞通腑法治疗脾胃病的学术经验,分析其作用机理,提出消食导滞通腑法的临床适用指征。

民族的友人—赛珍珠

赛珍珠一方面与陕北的中央政府没有直接的接触,另一方面又对新中国的某些做法不满,她及她的作品由此一直不被中国人所接受。本文通过对赛珍珠生活史实的查证了解,展示出赛珍珠对中国人民的真实感情。

“心形”吻合法治疗先天性巨结肠31例

目的 探讨“心形”吻合法治疗先天性巨结肠 (HD)的手术方式及治疗效果。方法 术前清洁灌肠 ,对本组 31例在肛门外套叠式拖出并切除病变的巨结肠 ,将正常结肠与直肠下段的吻合口一律吻合成前高后低的鸡心衣领状 ,还纳后逐层关腹。结果 本组 31例患儿均达到最大限度地保留肛门括约肌 ,保留其正常排便功能。未发生 1例吻合口瘘等早期并发症 ,均痊愈出院。远期随访 2 4例均未发生吻合口狭窄和其他晚期并发症 ,均达到良好效果。结论 “心形”吻合法是治疗HD的较好术式之一 。

文字释读规范与清水江文书整理

民间手写文书在用字上很不规范,常常书写俗字、通假字等。此类用字问题也是民间文书整理工作中的棘手问题。文章对《姜元泽家藏契约文书》中有关俗字的误释、漏释问题进行了辨析与补正,并强调指出对民间用字的释读要力求准确和规范,而对于像清水江文书这类弥足丰富而珍贵的民间文书尤应如此。