Pulmonary embolism after shoulder surgery:Is it a real threat?

Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.

Controversy of hand-assisted laparoscopic colorectal surgery

Laparoscopically assisted colorectal procedures are time-consuming and technically demanding and hence have a long steep learning curve. In the technical demand, surgeons need to handle a long mobile organ, the colon, and have to operate on multiple abdominal quadrants, most of the time with the need to secure multiple mesenteric vessels. Therefore, a new surgical innovation called hand-assisted laparoscopic surgery (HALS) was introduced in the mid 1990s as a useful alternative to totally laparoscopic procedures. This hybrid operation allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum. A hand in the abdomen can restore the tactile sensation which is usually lacking in laparoscopic procedures. It also improves the eye-to-hand coordination, allows the hand to be used for blunt dissection or retraction and also permits rapid control of unexpected bleeding. All of those factors can contribute tremendously to reducing the operative time. Moreover, this procedure is also considered as a hybrid procedure that combines the advantages of both minimally invasive and conventional open surgery. Nevertheless, the exact role of HALS in colorectal surgery has not been well defined during the advanced totally laparoscopic procedures. This article reviews the current status of hand-assisted laparoscopic colorectal surgery as a minimally invasive procedure in the era of laparoscopic surgery.

Clinical application of ultrasound-guided selective proximal and distal brachial plexus block in rapid rehabilitation surgery for hand trauma

BACKGROUND Anesthesia plays an essential role in the successful surgical procedures for hand trauma.Compared with general anesthesia,brachial plexus block shows lots of benefits for the upper extremity.Specifically,ultrasound-guided selective proximal and distal brachial plexus block may overcome the issues of incomplete block and failure of anesthesia in such circumstances.The present study assessed the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in clinical practice.AIM To explore the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in rapid recovery surgery for hand trauma.METHODS A total of 68 patients with traumatic hand injuries treated at our hospital from January 2018 to June 2019 were selected.They were divided into an observation group and a control group with 34 patients in each group.The observation group underwent selective brachial plexus block guided by ultrasound and the control group underwent conventional brachial plexus block.The analgesic efficacy,intraoperative complications,wound healing time,and length of hospital stay were compared between the two groups under different anesthesia.RESULTS The percentage of cases with analgesia graded as“excellent or very good”was higher in the observation group than in the control group(P<0.05).Moreover,the incidence of intraoperative complications was lower and the wound healing time and length of hospital stay were shorter in the observation group than in the control group(P<0.05).CONCLUSION Ultrasound-guided selective proximal and distal brachial plexus block has remarkable analgesic efficacy in patients with traumatic hand injuries.It can reduce the incidence of intraoperative complications,promote wound healing,and shorten the length of hospital stay.

Hand-assisted laparoscopic surgery for complex gallstone disease: A report of five cases

AIM:To describe the use of hand-assisted laparoscopic surg-ery(HALS) as an alternative to open conversion for complex gall-stone diseases, including Mirizzi syndrome (MS) and mimic MS. METHODS: Five patients with MS and mimic MS of 232 consecutive patients undergoing laparoscopic cholecyst-ectomies were analyzed. HALS without a hand-port device was performed as an alternative to open conversion if the anatomy was still unclear after the neck of the gallbladder was reached. RESULTS: HALS was performed on three patients with MS type I and 2 with mimic MS owing to an unclear or abnormal anatomy, or an unusual circumstance in which an impacted stone was squeezed out from the infundibulum or the aberrant cystic duct impossible with laparoscopic approach. The median operative time was 165 min (range, 115-190 min). The median hand-assisted time was 75 min (range, 65-100 min). The median postoperative stay was 4 d (range, 3-5 d). The postoperative course was uneventful, except for 1 patient complicated with a minor incision infection. CONCLUSION: HALS for MS type I and mimic MS is safe and feasible. It simplifies laparoscopic procedure, and can be used as an alternative to open conversion for complex gallstone diseases.

基于HAND的流域洪水淹没快速分析技术

快速分析计算流域洪水淹没,对于防洪具有重要作用,而基于水动力学模型的经典淹没算法在时效性方面存在不足,制约防洪“四预”功能实现和数字孪生流域建设。针对此,本文建立了基于HAND(Height Above Nearest Drainage)的形态淹没模型,用于快速分析流域洪水淹没情况,在乐安河流域上游进行了应用验证。结果表明,模型可在5秒内完成洪水淹没计算,对四场历史洪水和三场设计洪水淹没范围的总体模拟精度平均为0.95,达到水动力学模型的模拟精度;对淹没水深的模拟存在较大误差,平均误差为0.79 m。基于HAND的形态淹没模型可快速绘制全流域洪水淹没范围图,大幅提升影响预报和防洪预演的时效性水平。

Hand-assisted laparoscopic surgery of abdominal large visceral organs

AIM： To design a hand-assisted laparoscopic approach in an attempt to provide an option for laparoscopic resection of abdominal large viscera. METHODS： A 5-6 cm incision （for HandPort） and 2 trocars were employed. The main vessel of the target organ was taken as a ＂core＂, and all tissues around the core were taken as peripheral structures. The peripheral structures were dissected first, and the core vessels were treated last. Twenty-six patients underwent laparoscopic deroofing of the hepatic huge cysts, resection of the segments lying at the outer edge of the liver （segments 2 to 6）, splenectomy, hemicolectomy, ileocecectomy and subtotal gastrectomy with HandPort device, harmonic scalpel, or Ligasure. RESULTS： The duration of the procedure was within 2 hours. Blood loss amounted to 8-120 mL. The conversion rate was 3.8% （1/26）. All patients had uneventful postoperative courses with less pain, earlier oral intake, and faster recovery, compared with conventional surgery. CONCLUSION： This method combines the advantages of both open and laparoscopic techniques, achieving better hemostasis effect, shortening the operative time, and is beneficial to the patients.

Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

AIM:To compare perioperative parameters of one-handed rotational phacoemulsification technique(one-handed phaco-roll)with each of other two techniques,“Divide et Conquer”and femtosecond laser-assisted cataract surgery(FLACS)METHODS:In this retrospective and comparative cohort study,eyes with uncomplicated cataract(nuclear density grade 2 to 3)treated routinely with one-handed phacoroll(n=23;Group 1)or“Divide et Conquer”(n=23;Group 2)or FLACS(n=23;Group 3)were enrolled.Intraoperative parameters including effective phaco-time(EPt),ultrasound time(USt),aspiration time,surgical time,phacoemulsification(phaco)-power,balanced salt solution(BSS)use,cumulative dissipated energy(CDE)were recorded and compared.Clinical outcomes including best corrected visual acuity(BCVA),corneal endothelial cell density(ECD),endothelial cell loss(ECL),central corneal thickness(CCT)and central macular thickness(CMT),were assessed and compared pre-operatively and at 1mo after surgery.RESULTS:Aspiration and surgical time,and BSS used were lower in Group 1(P<0.01)than other groups.EPt,phaco-power and CDE were lower in Group 1(P<0.05)than Group 2 but not significantly different from Group 3.In Group 1,USt was lower(P<0.05)than Group 2 but higher(P<0.05)than Group 3.BCVA improved in all groups without significant difference between Group 1 and the other ones.No significant differences regarding all post-operative morphologic outcomes(ECD,ECL,CCT,CMT)were reported.No clinical complications occurred.CONCLUSION:One-handed phaco-roll seems to be less time-consuming than“Divide et Conquer”and FLACS and less energy-consuming than“Divide et Conquer”.Furthermore,one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.

Robotic4all project:Results of a hands-on robotic surgery training program

Objective Although robotic surgery adoption and its indications are growing worldwide,for multiple factors,including costs,there is a lack of training and experience.Our aim was to study the impact of a robotic introduction training program on gesture performance,such as suturing,in robot-naive individuals.Methods Using the DaVinci robot,a 2-hour program was based on virtual reality and anatomical model exercises.All participants performed 3 repetitions of virtual reality exercises on the virtual simulator,and then performed and were assessed on 2 tests,ie robot and laparoscopic training box.After the course,the participants were surveyed for this training program.Results Twenty-seven residents and surgeons were enrolled in the training program.With only 2 hours of training,all of the participants were able to complete the training program,thus learning generic and specific skills in robotic surgery.In virtual reality exercise,the scores of the 3 exercises increased significantly with every repetition(p<0.001)and the size of the increase was large.The completion time on the robot platform was 2.6 times faster(169.33±28.28 s vs.447.96±156.55 s,p<0.001)than that in the laparoscopic box,and the difference between both types of tests was large(pη2=0.797).The centralization and passage of the needle were significantly better on the robot platform(5 vs.3,p<0.001,r=0.47;5 vs.4,p<0.001,r=0.59)than in the laparoscopic box.For the intracorporeal stitch+knot test,every participant was able to perform the exercise on the robot but only 85.2%(23/27)in the laparoscopic box.Twenty-one participants answered the survey,and 13(61.9%)of them considered robotic performance independent of laparoscopic experience.Conclusions Surgeons are interested and seek training in robotic surgery.We implemented the first hands-on robotic surgery training program in Portugal and participants considered it was important and adequate for its purpose.All participants,even without robotic experience,learned quicker,performed better,faster and more precisely on the robot over laparoscopy.

New direction for surgery:Super minimally invasive surgery

The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.

The Relevant Roles of Plastic and Orthopedic Surgery in Hand Salvage

Over the recent past few years, there is a huge innovation in plastic surgery and orthopedic surgery through implantation of new techniques, which enabled a great level of success in hand salvage. Conditions such as trauma, tumor, sepsis, or vascular disease, may necessitate hand salvage. The most frequent argument among surgeon from different subspecialties (orthopedics, plastics, trauma, and vascular surgery) are characterized by in what way each one can do his own part of the salvage operation, be it bony fixation, revascularization, or soft-tissue coverage, but none of them is sure whether it should be endeavored. What is necessary in such clinical situations is an interdisciplinary team attitude led by individual or groups of clinicians who are conversant not only with their identifiable subspecialized skills but also with those of their coworkers and the consequences accompanying the joined efforts at hand salvage. The perception of orthoplastic surgery is based on such an indication, where the integrated skills and techniques of the orthopedic surgeon and reconstructive microsurgeon are performed in recital to direct efforts concerning hand salvage or choose against it when it is not designated. The current article reviews the roles of orthopedic and plastic surgery and how this team can deal with the existing techniques to improve outcomes in hand salvage surgery.

Bariatric surgery and diabetes:Current challenges and perspectives

Diabetes mellitus(DM)and obesity have become public issues of global concern.Bariatric surgery for the treatment of obesity combined with type 2 DM has been shown to be a safe and effective approach;however,there are limited studies that have systematically addressed the challenges of surgical treatment of obesity combined with DM.In this review,we summarize and answer the most pressing questions in the field of surgical treatment of obesity-associated DM.I believe that our insights will be of great help to clinicians in their daily practice.

Hand-Held Surgical Instrument with the Function of Self-Locking for Minimally Invasive Surgery

In order to improve the flexibility of the surgical instruments, a wire-driven wrist-like structure is proposed in this paper. The instrument has three degrees of freedom (DOFs) of rotation, yaw, opening and closing. Furthermore, we also acknowledge no coupling motion for each DOF. Moreover, the self-locking motion contributes to sustaining joint posture under external force. A static analysis for the end effector was conducted using the ANSYS software. At the end of this paper, a series of experiments for the prototype was performed. The results revealed that for the same surgical task, the proposed instrument had higher flexibility and the completion time of the operation tasks was obviously less than that of the traditional instrument. The results of the self-locking and operating force test showed that the surgical instruments perform well in maintaining joint posture under the force of 8.2N. The proposed surgical instrument meets the requirements of minimally invasive surgery (MIS).

子痫前期病人长链非编码RNA H19和长链非编码RNA HAND2-AS1表达水平与胰岛素抵抗的相关性研究

目的检测子痫前期病人胎盘组织、血清长链非编码RNA H19(LncRNA H19)与长链非编码RNAHAND2-AS1(Ln⁃cRNA HAND2-AS1)表达水平,并分析其与病人胰岛素抵抗(IR)的相关性。方法将2021年1—12月在唐山市妇幼保健院建卡的子痫前期孕妇105例作为子痫前期组,根据子痫前期孕妇严重程度分为轻度子痫前期组与重度子痫前期组,另选取同期孕周、年龄相符的健康孕妇97例作为对照组,收集所有孕妇身体质量指数(BMI)、孕周、收缩压、舒张压、空腹胰岛素(FINS)、空腹血糖(FBG)等一般资料,并计算稳态模型的IR指数(HOMA-IR);实时荧光定量PCR(qRT-PCR)法测定孕妇血清、胎盘组织中LncRNA H19,LncRNA HAND2-AS1水平;比较对照组与子痫前期组、轻度子痫前期组与重度子痫前期组间血清、胎盘组织LncRNA H19、LncRNA HAND2-AS1水平;Pearson法分析子痫前期孕妇血清、胎盘组织LncRNA H19、LncRNA HAND2-AS1与HOMA-IR的相关性。结果子痫前期组病人收缩压、舒张压高于对照组(P<0.05),且重度子痫前期病人收缩压、舒张压高于轻度子痫前期病人,孕周低于轻度子痫前期病人(P<0.05);与对照组相比,子痫前期组孕妇24 h尿蛋白、FBG[(5.84±0.97)mmol/L比(4.22±0.70)mmol/L]、FINS[(13.37±2.23)mU/L比(7.52±1.25)mU/L]、HOMI-IR水平(3.47±0.57比1.41±0.23)升高(P<0.05),且重度子痫前期孕妇24 h尿蛋白、FBG[(6.90±1.15)mmol/L比(5.24±0.85)mmol/L]、FINS[(13.97±2.32)mU/L比(13.05±2.17)mU/L]、HOMI-IR水平(4.27±0.71比3.03±0.50)高于轻度子痫前期孕妇(P<0.05);与对照组相比,子痫前期组孕妇血清、胎盘组织Ln⁃cRNA H19(2.52±1.42比1.01±0.15,3.75±0.62比1.02±0.17)与LncRNA HAND2-AS1水平(1.98±0.33比1.01±0.15,2.87±0.47比1.02±0.17)升高(P<0.05),且重度子痫前期孕妇血清、胎盘组织LncRNA H19(2.84±0.47比2.34±0.39,4.28±0.71比3.45±0.57)与LncRNA HAND2-AS1水平(2.59±0.43比1.63±0.27,3.56±0.59比2.49±0.41)高于轻度子痫前期孕妇(P<0.05);子痫前期病人血清与胎盘组织间LncRNA H19水平呈正相关(r=0.55,P<0.05),血清与胎盘组织间LncRNA HAND2-AS1水平呈正相关性(r=0.65,P<0.05)。子痫前期孕妇血清、胎盘组织LncRNA H19水平分别与HOMI-IR呈正相关(r=0.53、0.59,P<0.05);血清、胎盘组织LncRNA HAND2-AS1水平分别与HOMI-IR呈正相关(r=0.60、0.61,P<0.05)。结论子痫前期病人血清、胎盘组织LncRNA H19、LncRNA HAND2-AS1高表达,二者与IR密切相关,可能通过影响IR参与子痫前期发生发展。

Artificial Intelligence and Computer Vision during Surgery: Discussing Laparoscopic Images with ChatGPT4—Preliminary Results

Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.

Fully automatic AI segmentation of oral surgery-related tissues based on cone beam computed tomography images

Accurate segmentation of oral surgery-related tissues from cone beam computed tomography(CBCT)images can significantly accelerate treatment planning and improve surgical accuracy.In this paper,we propose a fully automated tissue segmentation system for dental implant surgery.Specifically,we propose an image preprocessing method based on data distribution histograms,which can adaptively process CBCT images with different parameters.Based on this,we use the bone segmentation network to obtain the segmentation results of alveolar bone,teeth,and maxillary sinus.We use the tooth and mandibular regions as the ROI regions of tooth segmentation and mandibular nerve tube segmentation to achieve the corresponding tasks.The tooth segmentation results can obtain the order information of the dentition.The corresponding experimental results show that our method can achieve higher segmentation accuracy and efficiency compared to existing methods.Its average Dice scores on the tooth,alveolar bone,maxillary sinus,and mandibular canal segmentation tasks were 96.5%,95.4%,93.6%,and 94.8%,respectively.These results demonstrate that it can accelerate the development of digital dentistry.

Evaluation of Clinical Efficacy of Combination of Surgery and Rehabilitation for Treatment of Scar Contracture after Hand Burn

Objective:To evaluate the clinical efficacy of combination of surgery and rehabilitation for patients with scar contracture after hand burn.Methods:Subjects of data calculation in this study were 66 patients with scar contracture after hand burn who were admitted from May 2018 to May 2019.The subjects were divided into regular group and combined group according to random number table method.The regular group(n=33)received surgical treatment alone.The combined group(n=33)patients were given surgery combined with rehabilitation.Recovery of hand function,efficacy of clinical treatment,hand function recovery and ADL score were calculated and compared between the two groups of patients with scare contracture after hand burn.Results:Efficacy,recovery of hand function(finger,finger flexion and extension,palm and finger adduction or abduction,daily activity,wrist rotation,wrist flexion and extension,appearance and sensory function)and ADL score were more superior in combined group when compared with regular group patients with scar contracture after hand burn.P<0.05,the indicator data showed statistical significance.Conclusion:Surgery combined with rehabilitation therapy shown significant value for patients with scar contracture after hand burn.

Dynamic Hand Gesture-Based Person Identification Using Leap Motion and Machine Learning Approaches

Person identification is one of the most vital tasks for network security. People are more concerned about theirsecurity due to traditional passwords becoming weaker or leaking in various attacks. In recent decades, fingerprintsand faces have been widely used for person identification, which has the risk of information leakage as a resultof reproducing fingers or faces by taking a snapshot. Recently, people have focused on creating an identifiablepattern, which will not be reproducible falsely by capturing psychological and behavioral information of a personusing vision and sensor-based techniques. In existing studies, most of the researchers used very complex patternsin this direction, which need special training and attention to remember the patterns and failed to capturethe psychological and behavioral information of a person properly. To overcome these problems, this researchdevised a novel dynamic hand gesture-based person identification system using a Leap Motion sensor. Thisstudy developed two hand gesture-based pattern datasets for performing the experiments, which contained morethan 500 samples, collected from 25 subjects. Various static and dynamic features were extracted from the handgeometry. Randomforest was used to measure feature importance using the Gini Index. Finally, the support vectormachinewas implemented for person identification and evaluate its performance using identification accuracy. Theexperimental results showed that the proposed system produced an identification accuracy of 99.8% for arbitraryhand gesture-based patterns and 99.6% for the same dynamic hand gesture-based patterns. This result indicatedthat the proposed system can be used for person identification in the field of security.

Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients?

BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.

Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.

Uterine artery pseudoaneurysm caused by hysteroscopic surgery: A case report

BACKGROUND We report a case of uterine artery pseudoaneurysm(UAP)occurrence during hysteroscopic endometrial polypectomy and its treatment via uterine artery embolization(UAE).CASE SUMMARY A 48-year-old primigravid,primiparous patient was incidentally found to have an endometrial polyp during a health checkup,and underwent a hysteroscopic polypectomy at another hospital.Her cervix was dilated with a Laminken-R®device.After the Laminken-R®was withdrawn,a large amount of genital bleeding was observed.This bleeding persisted after the hysteroscopic polypectomy,and,as hemostasis became impossible,the patient was transferred to our hospital by ambulance.On arrival,transvaginal ultrasonography revealed a 3-cm hypoechoic mass with a swirling internal pulse on the right side of the uterus,and color Doppler ultrasonography showed feeder vessels penetrating the mass.Pelvic contrast-enhanced computed tomography(CT)confirmed the presence of a mass at this site,and vascular proliferation was observed within the uterine cavity.Consequently,UAP was diagnosed,and UAE was performed.The patient’s postoperative course was uneventful,and 6 mo post-UAE,no recurrence of blood flow to the UAP was observed.CONCLUSION When abnormal genital bleeding occurs during hysteroscopic surgery,ultrasonography and contrast-enhanced CT can assist in the detection of early UAPs.