Visibility of the bleeding point in acute rectal hemorrhagic ulcer using red dichromatic imaging:A case report

BACKGROUND Red dichromatic imaging(RDI)is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point.However,it has not been thoroughly investigated.CASE SUMMARY A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy.An ulcer with pulsatile bleeding was found on the lower rectum.Due to massive bleeding,the exact location of the bleeding point was not easy to detect with white light imaging(WLI).Upon switching to RDI,the bleeding point appeared in deeper yellow compared to the surrounding blood.Thus,RDI enabled us for easier recognition of the bleeding point,and hemostasis was achieved successfully.Furthermore,we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI.In our case,the color difference of RDI was greater than that of WLI(9.75 vs 6.61),and RDI showed a better distinguished bleeding point from the surrounding blood.CONCLUSION RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.

Multimodal image fusion-assisted endoscopic evacuation of spontaneous intracerebral hemorrhage

Purpose:Although traditional craniotomy(TC)surgery has failed to show benefits for the functional outcome of intracerebral hemorrhage(ICH).However,a minimally invasive hematoma removal plan to avoid white matter fiber damage may be a safer and more feasible surgical approach,which may improve the prognosis of ICH.We conducted a historical cohort study on the use of multimodal image fusion-assisted neuroendoscopic surgery(MINS)for the treatment of ICH,and compared its safety and effectiveness with traditional methods.Methods:This is a historical cohort study involving 241 patients with cerebral hemorrhage.Divided into MINS group and TC group based on surgical methods.Multimodal images(CT skull,CT angiography,and white matter fiber of MRI diffusion-tensor imaging)were fused into 3 dimensional images for preoperative planning and intraoperative guidance of endoscopic hematoma removal in the MINS group.Clinical features,operative efficiency,perioperative complications,and prognoses between 2 groups were compared.Normally distributed data were analyzed usingt-test of 2 independent samples,Nonnormally distributed data were compared using the Kruskal-Wallis test.Meanwhile categorical data were analyzed via the Chi-square test or Fisher’s exact test.All statistical tests were two-sided,andp<0.05 was considered statistically significant.Results:A total of 42 patients with ICH were enrolled,who underwent TC surgery or MINS.Patients who underwent MINS had shorter operative time(p<0.001),less blood loss(p<0.001),better hematoma evacuation(p=0.003),and a shorter stay in the intensive care unit(p=0.002)than patients who underwent TC.Based on clinical characteristics and analysis of perioperative complications,there is no significant difference between the 2 surgical methods.Modified Rankin scale scores at 180 days were better in the MINS than in the TC group(p=0.014).Conclusions:Compared with TC for the treatment of ICH,MINS is safer and more efficient in cleaning ICH,which improved the prognosis of the patients.In the future,a larger sample size clinical trial will be needed to evaluate its efficacy.

基于DTI评估内镜经额入路与经颞入路手术治疗基底节脑出血的预后研究

目的 通过磁共振弥散张量成像技术(DTI)评价内镜经额入路和经颞入路治疗基底节区脑出血的优劣性,进一步探讨其临床意义。方法 回顾性分析2020年6月—2021年5月陕西省人民医院神经外科收治的65例基底节区脑出血患者,分为A、B两组。A组(33例)内镜经额入路进入血肿腔,B组(32例)经颞入路进入血肿腔。所有患者在术后2周、术后6个月分别行两次DTI检查,通过重建皮质脊髓束(CST)观察双侧CST的性状,并测量双侧FA值及CST数量。对术后2周患侧FA值及MAS运动功能评分进行相关性分析,并通过ROC曲线预测患侧FA值和CST数量与经颞叶入路手术治疗基底节脑出血的关系。结果 两组术前资料比较,差异无统计学意义。组间比较:术后2周、术后6个月,A组患侧FA值高于B组,差异具有统计学意义(P<0.05);术后2周,A组患侧CST数量高于B组,差异具有统计学意义(P<0.05);组内比较:术后6个月A、B组患侧FA值高于术后2周,差异具有统计学意义(P<0.05)。术后2周患侧FA值与术后6个月MAS运动功能评分之间具有较高正相关性(A组:r^(2)=0.649 3,P<0.000 1;B组:r^(2)=0.934 7,P<0.000 1)。通过ROC曲线对FA值和CST数量进行预测的结果,FA值的AUC=0.696(95%CI=0.569~0.823);CST数量的AUC=0.591(95%CI=0.451~0.731)。结论 DTI可以较好地评价高血压脑出血患者CST损伤程度,FA值与CST数量均可用于预测两种手术入路预后,其中FA值预测效果更好。DTI还可以作为评估基底节脑出血患者远期运动神经功能恢复的可靠指标,且术后2周患侧FA值越高,6个月后运动功能恢复越好。

Asymptomatic pancreatic lesions: New insights and clinical implications

Despite great efforts in experimental and clinical research, the prognosis of pancreatic cancer (PC) has not changed significantly for decades. Detection of pre-invasive lesions or early-stage PC with small resectable cancers in asymptomatic individuals remains one of the most promising approaches to substantially improve the overall outcome of PC. Therefore, screening programs have been proposed to identify curable lesions especially in individuals with a familial or genetic predisposition for PC. In this regard, Canto et al recently contributed an important article comparing computed tomography, magnetic resonance imaging, and endoscopic ultrasound for the screening of 216 asymptomatic high-risk individuals (HRI). Pancreatic lesions were detected in 92 of 216 asymptomatic HRI (42.6%). The high diagnostic yield in this study raises several questions that need to be answered of which two will be discussed in detail in this commentary: First: which imaging test should be performed? Second and most importantly: what are we doing with incidentally detected pancreatic lesions? Which ones can be observed and which ones need to be resected?

术前弥散张量成像在神经内镜血肿清除术治疗脑出血中的应用价值

目的探讨术前弥散张量成像(DTI)在神经内镜血肿清除术治疗脑出血中的应用价值。方法回顾性分析2014年6月至2019年12月郑州大学附属洛阳中心医院神经外科收治的135例脑出血患者的临床资料,其中93例采用神经内镜血肿清除术治疗(神经内镜组),42例采用术前DTI辅以神经内镜血肿清除术治疗(DTI+神经内镜组)。术后3个月对所有患者行门诊随访,采用改良Rankin量表评分(mRS)评估其预后,其中0~3分定义为预后良好,4~6分为预后不良。结果两组患者的性别、年龄、既往病史、吸烟史、饮酒史、入院格拉斯哥昏迷评分(GCS)、平均动脉压、脑出血位置、脑血肿量、脑出血评分、脑出血破入脑室的差异均无统计学意义(均P>0.05)。但是,DTI+神经内镜组术后肺炎发生率低于神经内镜组[分别为16.7%(7/42)、35.5%(33/93),P<0.05],预后良好率高于神经内镜组[分别为73.8%(31/42)、52.7%(49/93),P<0.05]。多因素logistic回归分析结果显示,年龄(每增加10岁)(OR=2.07,95%CI:1.48~3.55,P<0.01)、脑血肿量(每增加10 ml)(OR=1.84,95%CI:1.32~2.34,P<0.01)、脑出血破入脑室(OR=1.92,95%CI:1.46~3.81,P<0.01)、入院GCS评分(每降低1分)(OR=1.15,95%CI:1.08~1.32,P<0.01)是脑出血患者预后的危险因素,而术前应用DTI辅助是脑出血患者预后的保护因素(OR=0.71,95%CI:0.35~0.87,P<0.01)。结论术前DTI辅以神经内镜血肿清除术较单纯神经内镜血肿清除术治疗脑出血患者的术后肺炎发生率低、预后良好率高;且术前应用DTI是脑出血患者预后的保护因素。

消化性溃疡高危险出血内镜征像对内镜治疗的指导价值

目的:分析消化性溃疡经过内镜治疗后的效果,并且对危险出血情况展开分析。方法:本文统计2019年3月~2020年3月入院的消化性溃疡患者91例为研究样本,根据随机抽样的方式进行分组,其中一组为实验组,共计46例患者,展开内镜治疗,另一组为对照组,共计45例患者,展开常规的对症治疗,收集并比较两组患者的治疗效果,并且分析其高危险出血内镜征像。结果:纳入对照组中患者临床总有效率占比为82.22%,再出血率为27.02%。相应的实验组中患者临床总有效率占比为95.65%,再出血率为8.69%。经过研究得知:对照组中患者的临床效果与再出血率显著低于实验组的数据,P<0.05,存在临床可比较的价值。结论:给予胃溃疡出血患者实施Forrest分级,之后展开分层数据分析,可以给患者的内镜治疗提供有效的指导,从而提高止血率,大大降低了再出血率的发生,治疗显著且能够提高患者的预后。