AIM To prospectively investigate the efficacy and safety of clipflap assisted endoscopic submucosal dissection(ESD) for gastric tumors.METHODS From May 2015 to October 2016, we enrolled 104 patients with gastric cance...AIM To prospectively investigate the efficacy and safety of clipflap assisted endoscopic submucosal dissection(ESD) for gastric tumors.METHODS From May 2015 to October 2016, we enrolled 104 patients with gastric cancer or adenoma scheduled for ESD at Shiga University of Medical Science Hospital. We randomized patients into two subgroups using the minimization method based on location of the tumor(upper, middle or lower third of the stomach), tumor size(< 20 mm or > 20 mm) and ulcer status: ESD using an endoclip(the clip-flap group) and ESD without an endoclip(the conventional group). Therapeutic efficacy(procedure time) and safety(complication: Gastrointestinal bleeding and perforation) were assessed. RESULTS En bloc resection was performed in all patients. Four patients had delayed bleeding(3.8%) and two had perforation(1.9%). No significant differences in en bloc resection rate(conventional group: 100%, clip flap group: 100%), curative endoscopic resection rate(conventional group: 90.9%, clip flap group: 89.8%, P = 0.85), procedure time(conventional group: 70.8 ± 46.2 min, clip flap group: 74.7 ± 53.3 min, P = 0.69), area of resected specimen(conventional group: 884.6 ± 792.1 mm^2, clip flap group: 1006.4 ± 1004.8 mm^2, P = 0.49), delayed bleeding rate(conventional group: 5.5%, clip flap group: 2.0%, P = 0.49), or perforation rate(conventional group: 1.8%, clip flap group: 2.0%, P = 0.93) were found between the two groups. Lessexperienced endoscopists did not show any differences in procedure time between the two groups.CONCLUSION For patients with early-stage gastric tumors, the clipflap method has no advantage in efficacy or safety compared with the conventional method.展开更多
AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the...AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients(41 hands) by computer generated(Block of four randomization) into COR and HTFPF group. Nerve conduction study(NCS) included distal sensory latency(DSL), distal motor latency(DML), sensory amplitude (S-amp), motor amplitude(M-amp) and sensory nerve conduction velocity(SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale(VAS)], 2-point discrimination(2-PD), Semmes-Weinstein monofilament test(SWM), Phalen test and Tinel's sign were evaluated in order to compare treatment outcomes.RESULTS The COR group, 19 patients(20 hands) mean age 50.4 years. The HTFPF group, 20 patients(21 hands) mean age 53.3 years. Finally 33 patients(36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk(P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups(P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain(VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel's sign were improved postoperatively in both groups, but there was no significant difference between two groups.CONCLUSION There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.展开更多
BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal c...BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.展开更多
BACKGROUND Microvascular tissue reconstruction is a well-established,commonly used technique for a wide variety of the tissue defects.However,flap failure is associated with an additional hospital stay,medical cost bu...BACKGROUND Microvascular tissue reconstruction is a well-established,commonly used technique for a wide variety of the tissue defects.However,flap failure is associated with an additional hospital stay,medical cost burden,and mental stress.Therefore,understanding of the risk factors associated with this event is of utmost importance.AIM To develop machine learning-based predictive models for flap failure to identify the potential factors and screen out high-risk patients.METHODS Using the data set of 946 consecutive patients,who underwent microvascular tissue reconstruction of free flap reconstruction for head and neck,breast,back,and extremity,we established three machine learning models including random forest classifier,support vector machine,and gradient boosting.Model performances were evaluated by the indicators such as area under the curve of receiver operating characteristic curve,accuracy,precision,recall,and F1 score.A multivariable regression analysis was performed for the most critical variables in the random forest model.RESULTS Post-surgery,the flap failure event occurred in 34 patients(3.6%).The machine learning models based on various preoperative and intraoperative variables were successfully developed.Among them,the random forest classifier reached the best performance in receiver operating characteristic curve,with an area under the curve score of 0.770 in the test set.The top 10 variables in the random forest were age,body mass index,ischemia time,smoking,diabetes,experience,prior chemotherapy,hypertension,insulin,and obesity.Interestingly,only age,body mass index, and ischemic time were statistically associated with the outcomes.CONCLUSIONMachine learning-based algorithms, especially the random forest classifier, were very important incategorizing patients at high risk of flap failure. The occurrence of flap failure was a multifactordrivenevent and was identified with numerous factors that warrant further investigation.Importantly, the successful application of machine learning models may help the clinician indecision-making, understanding the underlying pathologic mechanisms of the disease, andimproving the long-term outcome of patients.展开更多
目的：考察桃红四物汤联合辛伐他汀对大鼠上肢随意皮瓣存活的影响和机制。方法：24只大鼠,体重180~220 g,被随机分为模型对照组、桃红四物汤组、辛伐他汀组和联用组（桃红四物汤＋辛伐他汀）,采用1%异戊巴比妥钠腹腔内注射（7 mg/m L）...目的：考察桃红四物汤联合辛伐他汀对大鼠上肢随意皮瓣存活的影响和机制。方法：24只大鼠,体重180~220 g,被随机分为模型对照组、桃红四物汤组、辛伐他汀组和联用组（桃红四物汤＋辛伐他汀）,采用1%异戊巴比妥钠腹腔内注射（7 mg/m L）麻醉,硫化钠脱毛,温水洗净后,与大鼠背部脊柱两侧设计8cm×2cm随意皮瓣,模型对照组给予生理盐水治疗,桃红四物汤组和辛伐他汀组分别采用桃红四物汤和辛伐他汀单独治疗,联用组采用桃红四物汤＋辛伐他汀治疗,给予药物治疗10 d后,观察各组随意皮瓣外观、MVD、存活率,检测组织中丙二醛（MDA）、超氧化物歧化酶（SOD）、间黏附分子-1（ICAM-1）和一氧化氮合成酶（NOS）的表达水平。结果：联用组坏死面积最少,原味掀起皮瓣出血最多,可见血管数最多;联用组皮瓣存活率最高,与辛伐他汀组、桃红四物汤组比均有统计学差异（72.24±9.25 vs 57.88±10.76,P〈0.05;72.24±9.25 vs 57.88±10.76,P〈0.05）;各组在皮瓣近段MVD均无统计学差异（P〉0.05）,皮瓣中段MVD模型组和辛伐他汀组、桃红四物汤组MVD显著低于联用组（8.23±1.23vs17.24±1.25,P〈0.01;13.55±1.16vs17.24±1.25,P〈0.01;14.88±1.76vs17.24±1.25,P〈0.05）;在MDA指标中,联用组相对于辛伐他汀组、模型对照组具有统计学差异（4.47±0.59 vs5.43±0.76,P〈0.05;4.47±0.59 vs 6.21±0.81,P〈0.01）;在SOD指标中,联用组相对于模型对照组、辛伐他汀组、桃红四物汤组具有统计学差异（312.62±23.99 vs 174.61±23.91,P〈0.01;312.62±23.99 vs 222.24±27.12,P〈0.01;312.62±23.99 vs 275.22±24.78,P〈0.05）;NOS指标中,联用组相较于模型对照组、桃红四物汤组均有显著性统计学差异（9.32±0.24 vs 7.24±0.68,P〈0.01;9.32±0.24 vs 7.52±0.52,P〈0.01）;ICAM-1指标中,联用组相较于桃红四物汤组、模型对照组具有统计学差异（2.97±0.49 vs 3.78±0.62,P〈0.05;2.97±0.49 vs4.15±0.41,P〈0.01）。结论：桃红四物汤联合辛伐他汀可通过增加组织对缺血的耐受能力、减轻炎症反应增加皮瓣的存活率。展开更多
文摘AIM To prospectively investigate the efficacy and safety of clipflap assisted endoscopic submucosal dissection(ESD) for gastric tumors.METHODS From May 2015 to October 2016, we enrolled 104 patients with gastric cancer or adenoma scheduled for ESD at Shiga University of Medical Science Hospital. We randomized patients into two subgroups using the minimization method based on location of the tumor(upper, middle or lower third of the stomach), tumor size(< 20 mm or > 20 mm) and ulcer status: ESD using an endoclip(the clip-flap group) and ESD without an endoclip(the conventional group). Therapeutic efficacy(procedure time) and safety(complication: Gastrointestinal bleeding and perforation) were assessed. RESULTS En bloc resection was performed in all patients. Four patients had delayed bleeding(3.8%) and two had perforation(1.9%). No significant differences in en bloc resection rate(conventional group: 100%, clip flap group: 100%), curative endoscopic resection rate(conventional group: 90.9%, clip flap group: 89.8%, P = 0.85), procedure time(conventional group: 70.8 ± 46.2 min, clip flap group: 74.7 ± 53.3 min, P = 0.69), area of resected specimen(conventional group: 884.6 ± 792.1 mm^2, clip flap group: 1006.4 ± 1004.8 mm^2, P = 0.49), delayed bleeding rate(conventional group: 5.5%, clip flap group: 2.0%, P = 0.49), or perforation rate(conventional group: 1.8%, clip flap group: 2.0%, P = 0.93) were found between the two groups. Lessexperienced endoscopists did not show any differences in procedure time between the two groups.CONCLUSION For patients with early-stage gastric tumors, the clipflap method has no advantage in efficacy or safety compared with the conventional method.
文摘AIM To compared outcomes between the hypothenar fat pad flap(HTFPF) and conventional open carpal tunnel release(COR) in primary carpal tunnel syndrome(CTS). METHODS Forty-five patients(49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients(41 hands) by computer generated(Block of four randomization) into COR and HTFPF group. Nerve conduction study(NCS) included distal sensory latency(DSL), distal motor latency(DML), sensory amplitude (S-amp), motor amplitude(M-amp) and sensory nerve conduction velocity(SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale(VAS)], 2-point discrimination(2-PD), Semmes-Weinstein monofilament test(SWM), Phalen test and Tinel's sign were evaluated in order to compare treatment outcomes.RESULTS The COR group, 19 patients(20 hands) mean age 50.4 years. The HTFPF group, 20 patients(21 hands) mean age 53.3 years. Finally 33 patients(36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk(P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups(P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain(VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel's sign were improved postoperatively in both groups, but there was no significant difference between two groups.CONCLUSION There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.
文摘BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.
文摘BACKGROUND Microvascular tissue reconstruction is a well-established,commonly used technique for a wide variety of the tissue defects.However,flap failure is associated with an additional hospital stay,medical cost burden,and mental stress.Therefore,understanding of the risk factors associated with this event is of utmost importance.AIM To develop machine learning-based predictive models for flap failure to identify the potential factors and screen out high-risk patients.METHODS Using the data set of 946 consecutive patients,who underwent microvascular tissue reconstruction of free flap reconstruction for head and neck,breast,back,and extremity,we established three machine learning models including random forest classifier,support vector machine,and gradient boosting.Model performances were evaluated by the indicators such as area under the curve of receiver operating characteristic curve,accuracy,precision,recall,and F1 score.A multivariable regression analysis was performed for the most critical variables in the random forest model.RESULTS Post-surgery,the flap failure event occurred in 34 patients(3.6%).The machine learning models based on various preoperative and intraoperative variables were successfully developed.Among them,the random forest classifier reached the best performance in receiver operating characteristic curve,with an area under the curve score of 0.770 in the test set.The top 10 variables in the random forest were age,body mass index,ischemia time,smoking,diabetes,experience,prior chemotherapy,hypertension,insulin,and obesity.Interestingly,only age,body mass index, and ischemic time were statistically associated with the outcomes.CONCLUSIONMachine learning-based algorithms, especially the random forest classifier, were very important incategorizing patients at high risk of flap failure. The occurrence of flap failure was a multifactordrivenevent and was identified with numerous factors that warrant further investigation.Importantly, the successful application of machine learning models may help the clinician indecision-making, understanding the underlying pathologic mechanisms of the disease, andimproving the long-term outcome of patients.
文摘目的：考察桃红四物汤联合辛伐他汀对大鼠上肢随意皮瓣存活的影响和机制。方法：24只大鼠,体重180~220 g,被随机分为模型对照组、桃红四物汤组、辛伐他汀组和联用组（桃红四物汤＋辛伐他汀）,采用1%异戊巴比妥钠腹腔内注射（7 mg/m L）麻醉,硫化钠脱毛,温水洗净后,与大鼠背部脊柱两侧设计8cm×2cm随意皮瓣,模型对照组给予生理盐水治疗,桃红四物汤组和辛伐他汀组分别采用桃红四物汤和辛伐他汀单独治疗,联用组采用桃红四物汤＋辛伐他汀治疗,给予药物治疗10 d后,观察各组随意皮瓣外观、MVD、存活率,检测组织中丙二醛（MDA）、超氧化物歧化酶（SOD）、间黏附分子-1（ICAM-1）和一氧化氮合成酶（NOS）的表达水平。结果：联用组坏死面积最少,原味掀起皮瓣出血最多,可见血管数最多;联用组皮瓣存活率最高,与辛伐他汀组、桃红四物汤组比均有统计学差异（72.24±9.25 vs 57.88±10.76,P〈0.05;72.24±9.25 vs 57.88±10.76,P〈0.05）;各组在皮瓣近段MVD均无统计学差异（P〉0.05）,皮瓣中段MVD模型组和辛伐他汀组、桃红四物汤组MVD显著低于联用组（8.23±1.23vs17.24±1.25,P〈0.01;13.55±1.16vs17.24±1.25,P〈0.01;14.88±1.76vs17.24±1.25,P〈0.05）;在MDA指标中,联用组相对于辛伐他汀组、模型对照组具有统计学差异（4.47±0.59 vs5.43±0.76,P〈0.05;4.47±0.59 vs 6.21±0.81,P〈0.01）;在SOD指标中,联用组相对于模型对照组、辛伐他汀组、桃红四物汤组具有统计学差异（312.62±23.99 vs 174.61±23.91,P〈0.01;312.62±23.99 vs 222.24±27.12,P〈0.01;312.62±23.99 vs 275.22±24.78,P〈0.05）;NOS指标中,联用组相较于模型对照组、桃红四物汤组均有显著性统计学差异（9.32±0.24 vs 7.24±0.68,P〈0.01;9.32±0.24 vs 7.52±0.52,P〈0.01）;ICAM-1指标中,联用组相较于桃红四物汤组、模型对照组具有统计学差异（2.97±0.49 vs 3.78±0.62,P〈0.05;2.97±0.49 vs4.15±0.41,P〈0.01）。结论：桃红四物汤联合辛伐他汀可通过增加组织对缺血的耐受能力、减轻炎症反应增加皮瓣的存活率。
