BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recur...BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula.AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures.METHODS In this retrospective study,525 patients with anorectal abscesses treated by incision and drainage alone,at a tertiary general hospital from August 2012 to July 2022,were included.A new classification for anorectal abscesses based on their propensity to develop into fistulas,considering 18 other potential risk factors,was established.These factors,from electronic medical records,were screened for significance using theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses.RESULTSOne year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,respectively.Univariateχ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(P<0.05).Fistula-prone abscess,≥7 days between symptomonset and surgery,chronic diarrhea,preoperative antibiotic use,and local anesthesia were risk factors for recurrence,while diabetes mellitus was protective(P<0.05).Moreover,fistula-prone abscess[odds ratio(OR)=7.651,95%CI:4.049–14.458,P<0.001],≥7 days from symptom onset to surgery(OR=2.137,95%CI:1.090–4.190,P=0.027),chronic diarrhea(OR=2.508,95%CI:1.216–5.173,P=0.013),and local anesthesia(OR=2.308,95%CI:1.313–4.059,P=0.004)were independent risk factors for postoperative anorectal abscess recurrence using multivariatelogistic regression.Body mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone abscess.CONCLUSIONThe choice of surgical procedure for treating anorectal abscesses should follow this new classification.Prompt andthorough incision and drainage can significantly reduce postoperative recurrence.展开更多
AIM To test the reliability of the Sawai’s classification for dental cervical abrasions.METHODSIntraoral photographs of 70 teeth from 23 patients with tooth abrasions were taken by the first examiner MS.The teeth wer...AIM To test the reliability of the Sawai’s classification for dental cervical abrasions.METHODSIntraoral photographs of 70 teeth from 23 patients with tooth abrasions were taken by the first examiner MS.The teeth were marked and the photos were maintained in a soft copy sequentially.Two other examiners FA and SC were trained in the use of the classification and any clarifications needed were provided at the beginning of the study.Each examiner was then given the soft copy of the complied photographs and was asked to classify the dental cervical abrasion according to their understanding of the Sawai’s classification.They were given sheets to write their responses for every marked tooth.All the examiners were blinded to each other’s observations which were then tested for inter-rater agreement among the three examiners.RESULTSThe 70 teeth with tooth abrasions from 23 patients were examined by 3 investigators(MS,FA and SC)to test the reliability of the Sawai’s classification system for tooth abrasion.Each examiner marked their responses in separate sheets which were blinded to each other.The kappa statistics were performed for inter-rater agreement among the three examiners.The level of agreement was evaluated according to the six-level nomenclature given by Landis and Koch.ICC and 95%CI between two examiners,i.e.,the inter-rater agreement among 1^(st) examiner(MS) and 2^(nd) examiner(FA) was 0.89.The inter-rater agreement among 1^(st) examiner(MS) and 3^(rd) examiner(SC) was 0.89.And the inter-rater agreement among 2^(nd) examiner(FA) and 3^(rd) examiner(SC) was 0.83.All the three comparisons show an almost perfect agreement between them.CONCLUSIONThere is an almost perfect agreement between multiple observers for classifying dental cervical abrasions using Sawai’s classification.Hence,this classification is reliable.展开更多
Objective: To analyze Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and inves-tigate the relationship between the major risk factors and Clavien-Dindo classification of c...Objective: To analyze Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and inves-tigate the relationship between the major risk factors and Clavien-Dindo classification of complications. Methods: The retrospective case-control study was adopted. The clinical data of 200 patients who underwent pancreatico-duodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected. The patients underwent Whipple procedure or pylorus-preserving pancreaticoduodenectomy according to the tumor site. Observation indicators included: (1) postoperative complications using Clavien-Dindo classification;(2) univariate and multivariate analyses: patients' basic information, surgery-related factors, pancreas-related factors;(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy. The chi-square test was applied to univariate analysis and categorical data. The comparison between groups was done by using independent samples nonparametric test (Kolmogorov-Smirnov Z), and multivariate analysis was done by using Logistic regression model. Results: (1) Postoperative complications: Of 200 patients, 122 underwent Whipple procedure and 78 underwent pylorus-preserving pancreaticoduodenectomy, including 6 cases combined with vascular reconstructions and 1 case with RFA of liver tumors. Ninety-eight patients had postoperative complications, including 41 patients with no less than 2 types of complications. After surgery, pancreatic fistula was detected in 80 patients, including 42 cases with grade A, 28 cases with grade B and 10 cases with grade C;incisional infection in 29 patients;gastric retention in 24 patients;intra-abdominal infection in 16 patients;intra-abdominal hemorrhage in 10 patients, including 8 patients receiving interventional treatment;biliary leakage in 7 patients and unplanned reoperation in 2 patients. Three patients were dead during hospitalization. The incidences of complications in grade Ⅰ, Ⅱ, Ⅲ (Ⅲ a and Ⅲ b), Ⅳ and Ⅴ of Clavien-Dindo classification were 28.00% (56/200), 13.00% (26/200), 5.00% (10/200), 1.50% (3/200) and 1.50% (3/200). (2) Univariate and multivariate analyses: The results of univariate analysis showed that body mass index (BMI) and pancreas texture were risk factors affecting complications after pancreaticoduodenectomy (χ2 = 6.483, Z = -3.189, p < .05). The results of multivariate analysis showed that BMI > 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR = 2.044, 1.649, 95% confidence interval: 1.212-3.447, 1.194-2.275). (3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed. There were statistically significant differences between BMI or pancreas texture and Clavien-Dindo classification of complications after pancreaticoduodenectomy (χ2 = 13.897, 27.077, p < .05). Conclusions: Clavien-Dindo classification of complications after pancreaticoduodenectomy contributes to comprehensive com-parison and evaluation, and this type of classification in this study mainly refers to grade I and II. Reducing BMI and good management of pancreatic stump may improve Clavien-Dindo classification of complications after pancreaticoduodenectomy.展开更多
正当我们仍在对2004年WHO肺癌病理分类津津乐道的时候，今年年初国际肺癌研究协会（International Association for the Study of Lung Cancer，IASLC）、美国胸科学会（American Thoracic Society，ATS）及欧洲呼吸学会（European Resp...正当我们仍在对2004年WHO肺癌病理分类津津乐道的时候，今年年初国际肺癌研究协会（International Association for the Study of Lung Cancer，IASLC）、美国胸科学会（American Thoracic Society，ATS）及欧洲呼吸学会（European Respiratory Society，ERS）又联手推出了新版的肺腺癌分类。展开更多
基金Supported by The Zhenjiang City Key Research and Development Plan Social Development,China,No.SH2023047.
文摘BACKGROUND Current surgical procedures for anorectal abscesses,including incision and drainage alone or combined concurrent fistulotomy,remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula.AIM To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures.METHODS In this retrospective study,525 patients with anorectal abscesses treated by incision and drainage alone,at a tertiary general hospital from August 2012 to July 2022,were included.A new classification for anorectal abscesses based on their propensity to develop into fistulas,considering 18 other potential risk factors,was established.These factors,from electronic medical records,were screened for significance using theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses.RESULTSOne year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,respectively.Univariateχ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(P<0.05).Fistula-prone abscess,≥7 days between symptomonset and surgery,chronic diarrhea,preoperative antibiotic use,and local anesthesia were risk factors for recurrence,while diabetes mellitus was protective(P<0.05).Moreover,fistula-prone abscess[odds ratio(OR)=7.651,95%CI:4.049–14.458,P<0.001],≥7 days from symptom onset to surgery(OR=2.137,95%CI:1.090–4.190,P=0.027),chronic diarrhea(OR=2.508,95%CI:1.216–5.173,P=0.013),and local anesthesia(OR=2.308,95%CI:1.313–4.059,P=0.004)were independent risk factors for postoperative anorectal abscess recurrence using multivariatelogistic regression.Body mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone abscess.CONCLUSIONThe choice of surgical procedure for treating anorectal abscesses should follow this new classification.Prompt andthorough incision and drainage can significantly reduce postoperative recurrence.
文摘AIM To test the reliability of the Sawai’s classification for dental cervical abrasions.METHODSIntraoral photographs of 70 teeth from 23 patients with tooth abrasions were taken by the first examiner MS.The teeth were marked and the photos were maintained in a soft copy sequentially.Two other examiners FA and SC were trained in the use of the classification and any clarifications needed were provided at the beginning of the study.Each examiner was then given the soft copy of the complied photographs and was asked to classify the dental cervical abrasion according to their understanding of the Sawai’s classification.They were given sheets to write their responses for every marked tooth.All the examiners were blinded to each other’s observations which were then tested for inter-rater agreement among the three examiners.RESULTSThe 70 teeth with tooth abrasions from 23 patients were examined by 3 investigators(MS,FA and SC)to test the reliability of the Sawai’s classification system for tooth abrasion.Each examiner marked their responses in separate sheets which were blinded to each other.The kappa statistics were performed for inter-rater agreement among the three examiners.The level of agreement was evaluated according to the six-level nomenclature given by Landis and Koch.ICC and 95%CI between two examiners,i.e.,the inter-rater agreement among 1^(st) examiner(MS) and 2^(nd) examiner(FA) was 0.89.The inter-rater agreement among 1^(st) examiner(MS) and 3^(rd) examiner(SC) was 0.89.And the inter-rater agreement among 2^(nd) examiner(FA) and 3^(rd) examiner(SC) was 0.83.All the three comparisons show an almost perfect agreement between them.CONCLUSIONThere is an almost perfect agreement between multiple observers for classifying dental cervical abrasions using Sawai’s classification.Hence,this classification is reliable.
文摘Objective: To analyze Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and inves-tigate the relationship between the major risk factors and Clavien-Dindo classification of complications. Methods: The retrospective case-control study was adopted. The clinical data of 200 patients who underwent pancreatico-duodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected. The patients underwent Whipple procedure or pylorus-preserving pancreaticoduodenectomy according to the tumor site. Observation indicators included: (1) postoperative complications using Clavien-Dindo classification;(2) univariate and multivariate analyses: patients' basic information, surgery-related factors, pancreas-related factors;(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy. The chi-square test was applied to univariate analysis and categorical data. The comparison between groups was done by using independent samples nonparametric test (Kolmogorov-Smirnov Z), and multivariate analysis was done by using Logistic regression model. Results: (1) Postoperative complications: Of 200 patients, 122 underwent Whipple procedure and 78 underwent pylorus-preserving pancreaticoduodenectomy, including 6 cases combined with vascular reconstructions and 1 case with RFA of liver tumors. Ninety-eight patients had postoperative complications, including 41 patients with no less than 2 types of complications. After surgery, pancreatic fistula was detected in 80 patients, including 42 cases with grade A, 28 cases with grade B and 10 cases with grade C;incisional infection in 29 patients;gastric retention in 24 patients;intra-abdominal infection in 16 patients;intra-abdominal hemorrhage in 10 patients, including 8 patients receiving interventional treatment;biliary leakage in 7 patients and unplanned reoperation in 2 patients. Three patients were dead during hospitalization. The incidences of complications in grade Ⅰ, Ⅱ, Ⅲ (Ⅲ a and Ⅲ b), Ⅳ and Ⅴ of Clavien-Dindo classification were 28.00% (56/200), 13.00% (26/200), 5.00% (10/200), 1.50% (3/200) and 1.50% (3/200). (2) Univariate and multivariate analyses: The results of univariate analysis showed that body mass index (BMI) and pancreas texture were risk factors affecting complications after pancreaticoduodenectomy (χ2 = 6.483, Z = -3.189, p < .05). The results of multivariate analysis showed that BMI > 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR = 2.044, 1.649, 95% confidence interval: 1.212-3.447, 1.194-2.275). (3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed. There were statistically significant differences between BMI or pancreas texture and Clavien-Dindo classification of complications after pancreaticoduodenectomy (χ2 = 13.897, 27.077, p < .05). Conclusions: Clavien-Dindo classification of complications after pancreaticoduodenectomy contributes to comprehensive com-parison and evaluation, and this type of classification in this study mainly refers to grade I and II. Reducing BMI and good management of pancreatic stump may improve Clavien-Dindo classification of complications after pancreaticoduodenectomy.
文摘正当我们仍在对2004年WHO肺癌病理分类津津乐道的时候，今年年初国际肺癌研究协会（International Association for the Study of Lung Cancer，IASLC）、美国胸科学会（American Thoracic Society，ATS）及欧洲呼吸学会（European Respiratory Society，ERS）又联手推出了新版的肺腺癌分类。
