BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a we...BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.展开更多
Objective:To explore whether maternal stress exposure during pregnancy impairs cognitive function and white matter ultrastructure in offspring mice.Methods:The parent rats were divided into two groups:pressure exposur...Objective:To explore whether maternal stress exposure during pregnancy impairs cognitive function and white matter ultrastructure in offspring mice.Methods:The parent rats were divided into two groups:pressure exposure group(group PE)and control group(group C),and the positive date of vaginal smear of female SD rats was day 0 of gestation.Female mice in group PE were exposed to binding pressure(3 times/day)on day 14-20 of gestation for 45 min-1 h/time.Behavioral tests(Morris water maze and Y maze)were performed on 1-month-old offspring mice followed by cardiac perfusion of fixed brain specimens and placement in mixed fixative solution.The total volume of white matter,total length and volume of myelinated nerve fibers and total length and volume of myelin sheath were calculated using modern stereoscopic methods,and the inner and outer diameter and inner and outer circumference of the myelin sheath were analyzed.Results:1)Behavioral tests:compared with the group C,the average latency of the 3th and 4th day in the group PE were significantly prolonged,the percentage of the resting time in the quadrant of the platform and the frequency of acrossing the effective area of platform in the fifth day of space exploration experiment were significantly reduced of Morris water maze test,and visiting distance,duration and numbers in novel arm significantly increased of Y-maze test(P<0.05).2)Compared with group C,the total volume of white matter,total length of myelinated nerve fibers,total volume of myelinated nerve fibers and myelin sheath in the group PE were significantly reduced(P<0.05),the inner diameter and outer diameter of myelin sheath decreased significantly(P<0.05),and the inner perimeter,outer perimeter and inner and outer perimeter differences increased significantly(P<0.05).3)There was a correlation between behavioral test results and white matter ultrastructure measurement results.Conclusions:Maternal stress exposure during pregnancy could impair the cognitive function and white matter and its ultrastructure in the offspring,and there was a correlation between decreased cognitive function and white matter damages.展开更多
Context: Endometriosis is a pathology that directly affects the daily lives of women with frequent impairment of their quality of life. In our environment, medical, socio-cultural, financial factors and factors relate...Context: Endometriosis is a pathology that directly affects the daily lives of women with frequent impairment of their quality of life. In our environment, medical, socio-cultural, financial factors and factors related to the organization of the health care system greatly delay its diagnosis. The objectives of the present study were to determine the diagnosis delay and to assess the quality of life before surgery of women with endometriosis using the specific Endometriosis Health Profile 5 (EHP-5) questionnaire. Methods: We carried out a descriptive, observational, retrospective study in 8 medical centers in the City of Kinshasa, from January 2019 to October 2022. A total of 80 women with endometriosis confirmed by laparoscopy (16 diagnostic and 64 operative laparoscopies) and histopathology were interviewed. We used the revised American Society for Reproductive Medicine (rASMR) classification, the Endometriosis Fertility Index (EFI) score was calculated for infertile women and the EHP-5 questionnaire to assess quality of life. Our data was entered and analyzed using Statistical Analysis Software 16.1 (STATA 16.1). Results: Diagnosis delay of endometriosis was on average 12 ± 4.3 years. The overall mean EHP-5 score of all patients showed a severe deterioration in quality of life (604 ± 235). A negative relationship was observed between the age of the patient, the diagnostic delay, and the alteration of the quality of life in patients over 36 years old and those with about 11 years of diagnostic delay presenting the slight alteration. Patients with a high social level had very severe quality impairment. Women on hormonal treatment, those with a history of pregnancy, childbirth, miscarriage and abortion had a slight and significant deterioration in quality of life (p 0.05). Conclusion: Despite some limitations, our preliminary study highlights that in sub-Saharan Africa, the diagnosis of endometriosis is delayed and associated with a severe alteration in quality of life. Moreover, diagnosis of endometriosis seems to be restricted to women with high social levels. Therefore, further efforts are required to develop a health policy to decrease delay for diagnosis with potential benefits on symptoms, quality of life, fertility while limiting stigma and psychological effects of this debilitating pathology.展开更多
BACKGROUND:Ectopic pancreas is defined as pancreatic tissue found outside its usual anatomical position,with no ductal or vascular communication with the native pancreas. We describe a case of ectopic pancreas of the ...BACKGROUND:Ectopic pancreas is defined as pancreatic tissue found outside its usual anatomical position,with no ductal or vascular communication with the native pancreas. We describe a case of ectopic pancreas of the small bowel and mesentery causing recurrent episodes of pancreatitis, initially suspected on computed tomography(CT)and magnetic resonance cholangiopancreatography(MRCP),and confirmed on histological review of the resection. METHODS:A 67-year-old woman presented with clinical symptoms and biochemical evidence of pancreatitis.She had similar episodes over the past 30 years with unrevealing investigations,and was concluded to have idiopathic pancreatitis. She underwent CT and MRCP,with findings suggestive of ectopic pancreas,a diagnosis confirmed on histology of the resection. RESULTS:MRCP identified a mass in the proximal small bowel mesentery isointense to the native pancreas,with a small duct draining into a proximal jejunal loop.The resected specimen consisted of normal parenchyma with lobulated acinar tissue with scattered islets of Langerhans,an occasional ductular structure,and admixed areas of adipose tissue.The patient remained asymptomatic with normal biochemistry six months post-operatively. CONCLUSION:In an individual with abdominal pain,elevated serum amylase/lipase,but imaging findings of a normal native pancreas,ectopic pancreatitis should be considered,and can be evaluated by CT and MRCP.展开更多
A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated,necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy.These masses were later determined to be benign am...A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated,necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy.These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica,which regressed completely with medical therapy.In Western countries,the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm.Not surprisingly,there have been very few cases reported of this clinical entity within the United States.Moreover,we report a patient that had an extremely rare occurrence of two synchronous lesions,one involving the rectum and the other situated in the cecum.We review the current literature on the pathogenesis of invasive E.histolytica infection and ameboma formation,as well as management of this rare disease entity at a western medical center.展开更多
Objctive: To assess the current treatment of AC in a single institution in the series, which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as...Objctive: To assess the current treatment of AC in a single institution in the series, which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as the optimal timing for surgery.Methods: From December 1996 to December 2001, 138 (102 women and 36 men) patients underwent laparoscopic cholecystectomy for acute cholecystitis confirmed by histopathological examination. The patients ranged in age from 21 to 85 years of age ( mean age: 45 3 years). Patients were divided into 2 groups (similar in age and ASA classification): group 1 (98 patients) underwent LC within 3 days after the onset of symptoms of acute cholecystitis and group 2 (40 patients) underwent LC after 3 days. Results: Approximately one half of the cases were uncomplicated, 26% were empyema, 13% had gangrenous changes and 7% had hydrops of the gallbladder. Conversion to open cholecystectomy was required in 21 (15 2%) cases. The principal reason for conversion was anatomic uncertainty (14 cases), uncontrolled bleeding (7 cases). The conversion rates in patients who underwent surgery before and after the onset of symptoms were respectively 6∶15. There was no significant difference in operative time (122 0 min in 1 group versus 124 0 min in 2 group) and postoperative stay ( 5 1 days in group 1 vs 6 8 days in group 2). The hepatorenal space was drained in 78 (56 5 %), and the drain is removed in 3rd postoperative days. Twenty six patients (18 8%) had undergone previous abdominal surgery. Thirty seven patients (26 8%) had spillage of bile and/or stones during the procedure. There were no deaths and major complications. Conclusions: LC for acute cholecystitis should be done immediately after the diagnosis is established because delaying surgery allows inflammation to become more intense, thus increasing the technical difficulty of LC. Intraoperative spillage of bile and stones does not lead to an increase in early complications. LC is safe and effective for acute cholecystitis even when complicated previous surgery, inflammatory adhesions and gangrene. LC has significantly fewer operative complications and provides shorter hospital stay which are medical and economic benefits. LC is safe and effective for acute cholecystitis.展开更多
Recent studies have demonstrated that ferulic acid[3-（4-hydroxy-3-methoxyphenyl）-2-propenoic acid]and sodium ferulate produce protective effects against glutamate-induced neurotoxicity in adult mice.Danshensu（β-3,...Recent studies have demonstrated that ferulic acid[3-（4-hydroxy-3-methoxyphenyl）-2-propenoic acid]and sodium ferulate produce protective effects against glutamate-induced neurotoxicity in adult mice.Danshensu（β-3,4-dihydroxyphenyl-lactic acid）has a similar molecular structure and pharmacological action to caffeic acid.This study aimed to validate the protection conferred by Danshensu against excitotoxic effects of maternal intragastric administration of monosodium glutamate at late stages of pregnancy in the developing mouse fetal brain.Behavioral tests,as well as histopathological and immunohistochemical examination of hippocampi were performed in filial mice.Results revealed that maternal intragastric administration of excessive monosodium glutamate（1.0,2.0,4.0 g/kg body weight）at a late stage of pregnancy resulted in a series of behavioral disorders（hyperactivity,lesions of learning and memory,and disturbance in cooperation of movement ability under high-altitude stress）,histopathological impairment（neuronal edema,degeneration,necrosis,and hyperplasia）and molecular cellular biological changes（upregulated expression of N-methyI-D-aspartate receptor type 1 and neuropeptide Y in the hippocampal region of the brain of the filial mice from mothers treated with monosodium glutamate）.Simultaneous administration of sodium Danshensu partially reversed the effects of monosodium glutamate on the above mentioned phenomena.These findings indicate that sodium Danshensu exhibits obvious protective effects on the excitotoxicity of monosodium glutamate.展开更多
BACKGROUND Colon cancer is one the most common forms of cancer in both sexes.Due to important progress in the field of early detection and effective treatment,colon and rectal cancer survivors currently account for 10...BACKGROUND Colon cancer is one the most common forms of cancer in both sexes.Due to important progress in the field of early detection and effective treatment,colon and rectal cancer survivors currently account for 10%of cancer survivors worldwide.However,the effects of anti-cancer treatments,especially oxaliplatinbased chemotherapy,on the quality of life(QoL)have been less evaluated.Although the incidence of severe chemotherapy-induced neuropathy(CIPN)in clinical studies is below 20%,data from real-world studies is scarce,and CIPN is probably under-reported due to patient selection and the patients’fear that reporting side-effects might lead to treatment cessation.AIM To determine the impact of CIPN on QoL in colorectal cancer patients with a recent history of oxaliplatin-based chemotherapy.METHODS We performed a prospective cross-sectional study in two major Romanian oncology tertiary hospitals—the Regional Institute of Oncology Ia?i(Iasi,Romania)and the Fundeni Clinical Oncology Institute(Bucharest,Romania).All consecutive patients with colon or rectal cancer,undergoing Oxaliplatin-based chemotherapy that consented to enroll in the study,were assessed by means of two questionnaires—the EORTC QQ-CR29(quality of life in colon and rectal cancer patients)and the QLQ-CIPN20(assessment of neuropathy).Several demographical,social,clinical and treatment data were also collected.Statistical analysis was performed by means of SPSS v20.The student t test was used to assess the relationship between the QLQ-CIPN20 and QLQ-CR29 results.Kaplan Meyer-curves were used to report 3-year progression-free survival(PFS)in patients that discontinued chemotherapy vs those that completed the recommended course.RESULTS Of the 267 patients that fulfilled the inclusion criteria in the pre-specified time frame,101(37.8%)agreed to participate in the clinical study.At the time of the enrolment in the study,over 50%of the patients had recently interrupted their oxaliplatin-based chemotherapy,most often due to neuropathy.Almost 85%of the responders reported having tingling or numbness in their fingers or hands,symptoms that were associated with pain in over 20%of the cases.When comparing the scores in the two questionnaires,a statistically significant relationship(P<0.001)was found between the presence of neuropathic symptoms and a decreased quality of life.This correlation was consistent when the patients were stratified by sex,disease stage,comorbidities and the presence of stoma or treatment type,suggesting that neuropathy in itself may be a reason for a decreased quality of life.At the 3 year final assessment,median recurrence-free survival in stageⅢpatients was 26.88 mo.When stratified by completion of chemotherapy,median recurrence freesurvival of stageⅢpatients that completed chemotherapy was 28.27 mo vs 24.33 mo in patients that discontinued chemotherapy due to toxicity,a difference that did not reach statistical significance.CONCLUSION CIPN significantly impacts QoL in colorectal cancer patients.CIPN is also the most frequent reason for treatment discontinuation.Physicians should actively assess for CIPN in order to prevent chronic neuropathy.展开更多
T-cell subsets from peripheral blood and spleen were investigated prospectively by flow cytometry in a murine intrahepatic implanted tumor model. Peripheral blood OX-19+ cells (pan T-cells) and W3/25+ cells (Th cells)...T-cell subsets from peripheral blood and spleen were investigated prospectively by flow cytometry in a murine intrahepatic implanted tumor model. Peripheral blood OX-19+ cells (pan T-cells) and W3/25+ cells (Th cells) decreased with tumor development in tumor-bearing rats, giving significant differences when compared with healthy rats. No significant changes were found in OX-8+ cells (Ts cells). Hence, Th Ts ratio in tumor-bearing rats was lower than that in control group. Meanwhile, on day 17 following tumor implantation, in tumor-bearing rats with intrahepatic or peritoneal metastasis, there were less W3/25+ cells and more OX-8+ cells than those of hepatoma-bearing rats without metastasis (p<0.01). In the spleen, the phenotypes of lymphocyte markers showed less OX-8+ cells and more OX-12+ cells (B cells) tumor-bearing rats. It was suggested that, in tumor-bearing host, not only was T-cell immune function inhibited, but also there was abnormal distribution of T-cell subsets. It seems that there is a close relationship between tumor growth and its spread and a lower Th/Ts ratio.展开更多
Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patien...Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.展开更多
BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours...BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.展开更多
Aim: The expression of the cytokines IL-2, IL-6, IL-10, IFN-γ and TNF-α and the adhesion proteins CD99 and CD106 was studied in the human testis at the protein level. Methods: The expression of the cytokines and the...Aim: The expression of the cytokines IL-2, IL-6, IL-10, IFN-γ and TNF-α and the adhesion proteins CD99 and CD106 was studied in the human testis at the protein level. Methods: The expression of the cytokines and the adhesion proteins was assessed using immunohistochemistry and immunoblotting. Results: None of the cytokines studied was present in the human testis, but CD99 and CD106 (VCAM-1) strongly were expressed in all the testes investigated. CD99 was present in the interstitial tissue of the human testis as well as in the Sertoli cells. The identity of the CD99+ interstitial cells is unclear. CD106 (VCAM-1) was present in Leydig cells as well as the basal parts of the Sertoli cells in the seminiferous tubules. In immunoblotting, CD99 was demonstrated at molecular ratios of 46-57 (kD). This is a novel isoform of the molecule. Conclusion: The human testis produces both CD99 and CD106 and as CD106 mediates cell binding to lymphocytes, it is possible that the human Leydig cells adhere to lymphocytes like the rodent Leydig cells. (Asian J Androl 2002 Dec; 4: 243-248)展开更多
Hepatoblastoma is the most common primary hepatic tumor of children. However, only a very few cases have been reported in adults. Most studies support treatment with chemotherapy followed by surgical resection. We pre...Hepatoblastoma is the most common primary hepatic tumor of children. However, only a very few cases have been reported in adults. Most studies support treatment with chemotherapy followed by surgical resection. We present the first reported case of adult hepatoblastoma in Taiwan. A 52-year-old female suffered from sudden onset of abdominal pain and general weakness for days.Internal bleeding with hemorrhagic shock was suspected and two massive lesions in both lobes of the liver with hemoperitoneum were noted from imaging studies.Surgical resection of the larger left lobe tumor and radio-frequency ablation of the right smaller one were performed. The histopathology diagnosis was of a hepatoblastoma.展开更多
Eosinophilic enteritis,a relatively rare entity,usually involves gastric antrum or proximal small bowel. Our case is rarer in its involvement of the distal small bowel and presents unusually as intussusception. The di...Eosinophilic enteritis,a relatively rare entity,usually involves gastric antrum or proximal small bowel. Our case is rarer in its involvement of the distal small bowel and presents unusually as intussusception. The disease if diagnosed in the initial stages responds well to medical treatment but if associated with complications or misdiagnosed,surgical modality is the treatment of choice. In our case,the patient presented with acute intestinal obstruction due to intussusception and emergency laparotomy with ileoileal anastomosis was done. Histopathology confirmed the diagnosis as eosinophilic enteritis. This case with such a presentation is discussed here.展开更多
AIM: To examine whether muscle training with an oral IQoroR screen(IQS) improves esophageal dysphagia and reflux symptoms.METHODS: A total of 43 adult patients(21 women a n d 2 2 m e n) w e re c o n s e c u t i ve l y...AIM: To examine whether muscle training with an oral IQoroR screen(IQS) improves esophageal dysphagia and reflux symptoms.METHODS: A total of 43 adult patients(21 women a n d 2 2 m e n) w e re c o n s e c u t i ve l y re fe r re d t o a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study(group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients(group B; median age 57 years,range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire(esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale(ability to swallow food: score 0-100), lip force test(≥ 15 N), velopharyngeal closure test(≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients(median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry.RESULTS: Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score(range): 2.5(1-3) vs 0.9(0-2), P < 0.001]. Symptoms of reflux were reported before training in 86% of the patients who showed improvement at follow-up [1.7(0-3) vs 0.5(0-2), P < 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100% showed improvement after IQS training [71(30-100) vs 22(0-50), P < 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N(12-80 N) vs 54 N(27-116), P < 0.001] and velopharyngeal closure test values [28 s(5-74 s) vs 34 s(13-80 s), P < 0.001] were significantly higher after IQS training. The oral IQS traction results showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mm Hg at rest(range: 0-0 mm HG) to 65 mm Hg(range: 20-100 mm Hg). CONCLUSION: Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.展开更多
文摘BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.
基金Shaanxi Province natural science basic research program (No.2023-JC-QN-0961)。
文摘Objective:To explore whether maternal stress exposure during pregnancy impairs cognitive function and white matter ultrastructure in offspring mice.Methods:The parent rats were divided into two groups:pressure exposure group(group PE)and control group(group C),and the positive date of vaginal smear of female SD rats was day 0 of gestation.Female mice in group PE were exposed to binding pressure(3 times/day)on day 14-20 of gestation for 45 min-1 h/time.Behavioral tests(Morris water maze and Y maze)were performed on 1-month-old offspring mice followed by cardiac perfusion of fixed brain specimens and placement in mixed fixative solution.The total volume of white matter,total length and volume of myelinated nerve fibers and total length and volume of myelin sheath were calculated using modern stereoscopic methods,and the inner and outer diameter and inner and outer circumference of the myelin sheath were analyzed.Results:1)Behavioral tests:compared with the group C,the average latency of the 3th and 4th day in the group PE were significantly prolonged,the percentage of the resting time in the quadrant of the platform and the frequency of acrossing the effective area of platform in the fifth day of space exploration experiment were significantly reduced of Morris water maze test,and visiting distance,duration and numbers in novel arm significantly increased of Y-maze test(P<0.05).2)Compared with group C,the total volume of white matter,total length of myelinated nerve fibers,total volume of myelinated nerve fibers and myelin sheath in the group PE were significantly reduced(P<0.05),the inner diameter and outer diameter of myelin sheath decreased significantly(P<0.05),and the inner perimeter,outer perimeter and inner and outer perimeter differences increased significantly(P<0.05).3)There was a correlation between behavioral test results and white matter ultrastructure measurement results.Conclusions:Maternal stress exposure during pregnancy could impair the cognitive function and white matter and its ultrastructure in the offspring,and there was a correlation between decreased cognitive function and white matter damages.
文摘Context: Endometriosis is a pathology that directly affects the daily lives of women with frequent impairment of their quality of life. In our environment, medical, socio-cultural, financial factors and factors related to the organization of the health care system greatly delay its diagnosis. The objectives of the present study were to determine the diagnosis delay and to assess the quality of life before surgery of women with endometriosis using the specific Endometriosis Health Profile 5 (EHP-5) questionnaire. Methods: We carried out a descriptive, observational, retrospective study in 8 medical centers in the City of Kinshasa, from January 2019 to October 2022. A total of 80 women with endometriosis confirmed by laparoscopy (16 diagnostic and 64 operative laparoscopies) and histopathology were interviewed. We used the revised American Society for Reproductive Medicine (rASMR) classification, the Endometriosis Fertility Index (EFI) score was calculated for infertile women and the EHP-5 questionnaire to assess quality of life. Our data was entered and analyzed using Statistical Analysis Software 16.1 (STATA 16.1). Results: Diagnosis delay of endometriosis was on average 12 ± 4.3 years. The overall mean EHP-5 score of all patients showed a severe deterioration in quality of life (604 ± 235). A negative relationship was observed between the age of the patient, the diagnostic delay, and the alteration of the quality of life in patients over 36 years old and those with about 11 years of diagnostic delay presenting the slight alteration. Patients with a high social level had very severe quality impairment. Women on hormonal treatment, those with a history of pregnancy, childbirth, miscarriage and abortion had a slight and significant deterioration in quality of life (p 0.05). Conclusion: Despite some limitations, our preliminary study highlights that in sub-Saharan Africa, the diagnosis of endometriosis is delayed and associated with a severe alteration in quality of life. Moreover, diagnosis of endometriosis seems to be restricted to women with high social levels. Therefore, further efforts are required to develop a health policy to decrease delay for diagnosis with potential benefits on symptoms, quality of life, fertility while limiting stigma and psychological effects of this debilitating pathology.
文摘BACKGROUND:Ectopic pancreas is defined as pancreatic tissue found outside its usual anatomical position,with no ductal or vascular communication with the native pancreas. We describe a case of ectopic pancreas of the small bowel and mesentery causing recurrent episodes of pancreatitis, initially suspected on computed tomography(CT)and magnetic resonance cholangiopancreatography(MRCP),and confirmed on histological review of the resection. METHODS:A 67-year-old woman presented with clinical symptoms and biochemical evidence of pancreatitis.She had similar episodes over the past 30 years with unrevealing investigations,and was concluded to have idiopathic pancreatitis. She underwent CT and MRCP,with findings suggestive of ectopic pancreas,a diagnosis confirmed on histology of the resection. RESULTS:MRCP identified a mass in the proximal small bowel mesentery isointense to the native pancreas,with a small duct draining into a proximal jejunal loop.The resected specimen consisted of normal parenchyma with lobulated acinar tissue with scattered islets of Langerhans,an occasional ductular structure,and admixed areas of adipose tissue.The patient remained asymptomatic with normal biochemistry six months post-operatively. CONCLUSION:In an individual with abdominal pain,elevated serum amylase/lipase,but imaging findings of a normal native pancreas,ectopic pancreatitis should be considered,and can be evaluated by CT and MRCP.
文摘A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated,necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy.These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica,which regressed completely with medical therapy.In Western countries,the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm.Not surprisingly,there have been very few cases reported of this clinical entity within the United States.Moreover,we report a patient that had an extremely rare occurrence of two synchronous lesions,one involving the rectum and the other situated in the cecum.We review the current literature on the pathogenesis of invasive E.histolytica infection and ameboma formation,as well as management of this rare disease entity at a western medical center.
文摘Objctive: To assess the current treatment of AC in a single institution in the series, which the best treatment modality for acute cholecystitis (AC) is still under debate, whereas early cholecystectomy is accepted as the optimal timing for surgery.Methods: From December 1996 to December 2001, 138 (102 women and 36 men) patients underwent laparoscopic cholecystectomy for acute cholecystitis confirmed by histopathological examination. The patients ranged in age from 21 to 85 years of age ( mean age: 45 3 years). Patients were divided into 2 groups (similar in age and ASA classification): group 1 (98 patients) underwent LC within 3 days after the onset of symptoms of acute cholecystitis and group 2 (40 patients) underwent LC after 3 days. Results: Approximately one half of the cases were uncomplicated, 26% were empyema, 13% had gangrenous changes and 7% had hydrops of the gallbladder. Conversion to open cholecystectomy was required in 21 (15 2%) cases. The principal reason for conversion was anatomic uncertainty (14 cases), uncontrolled bleeding (7 cases). The conversion rates in patients who underwent surgery before and after the onset of symptoms were respectively 6∶15. There was no significant difference in operative time (122 0 min in 1 group versus 124 0 min in 2 group) and postoperative stay ( 5 1 days in group 1 vs 6 8 days in group 2). The hepatorenal space was drained in 78 (56 5 %), and the drain is removed in 3rd postoperative days. Twenty six patients (18 8%) had undergone previous abdominal surgery. Thirty seven patients (26 8%) had spillage of bile and/or stones during the procedure. There were no deaths and major complications. Conclusions: LC for acute cholecystitis should be done immediately after the diagnosis is established because delaying surgery allows inflammation to become more intense, thus increasing the technical difficulty of LC. Intraoperative spillage of bile and stones does not lead to an increase in early complications. LC is safe and effective for acute cholecystitis even when complicated previous surgery, inflammatory adhesions and gangrene. LC has significantly fewer operative complications and provides shorter hospital stay which are medical and economic benefits. LC is safe and effective for acute cholecystitis.
文摘Recent studies have demonstrated that ferulic acid[3-（4-hydroxy-3-methoxyphenyl）-2-propenoic acid]and sodium ferulate produce protective effects against glutamate-induced neurotoxicity in adult mice.Danshensu（β-3,4-dihydroxyphenyl-lactic acid）has a similar molecular structure and pharmacological action to caffeic acid.This study aimed to validate the protection conferred by Danshensu against excitotoxic effects of maternal intragastric administration of monosodium glutamate at late stages of pregnancy in the developing mouse fetal brain.Behavioral tests,as well as histopathological and immunohistochemical examination of hippocampi were performed in filial mice.Results revealed that maternal intragastric administration of excessive monosodium glutamate（1.0,2.0,4.0 g/kg body weight）at a late stage of pregnancy resulted in a series of behavioral disorders（hyperactivity,lesions of learning and memory,and disturbance in cooperation of movement ability under high-altitude stress）,histopathological impairment（neuronal edema,degeneration,necrosis,and hyperplasia）and molecular cellular biological changes（upregulated expression of N-methyI-D-aspartate receptor type 1 and neuropeptide Y in the hippocampal region of the brain of the filial mice from mothers treated with monosodium glutamate）.Simultaneous administration of sodium Danshensu partially reversed the effects of monosodium glutamate on the above mentioned phenomena.These findings indicate that sodium Danshensu exhibits obvious protective effects on the excitotoxicity of monosodium glutamate.
文摘BACKGROUND Colon cancer is one the most common forms of cancer in both sexes.Due to important progress in the field of early detection and effective treatment,colon and rectal cancer survivors currently account for 10%of cancer survivors worldwide.However,the effects of anti-cancer treatments,especially oxaliplatinbased chemotherapy,on the quality of life(QoL)have been less evaluated.Although the incidence of severe chemotherapy-induced neuropathy(CIPN)in clinical studies is below 20%,data from real-world studies is scarce,and CIPN is probably under-reported due to patient selection and the patients’fear that reporting side-effects might lead to treatment cessation.AIM To determine the impact of CIPN on QoL in colorectal cancer patients with a recent history of oxaliplatin-based chemotherapy.METHODS We performed a prospective cross-sectional study in two major Romanian oncology tertiary hospitals—the Regional Institute of Oncology Ia?i(Iasi,Romania)and the Fundeni Clinical Oncology Institute(Bucharest,Romania).All consecutive patients with colon or rectal cancer,undergoing Oxaliplatin-based chemotherapy that consented to enroll in the study,were assessed by means of two questionnaires—the EORTC QQ-CR29(quality of life in colon and rectal cancer patients)and the QLQ-CIPN20(assessment of neuropathy).Several demographical,social,clinical and treatment data were also collected.Statistical analysis was performed by means of SPSS v20.The student t test was used to assess the relationship between the QLQ-CIPN20 and QLQ-CR29 results.Kaplan Meyer-curves were used to report 3-year progression-free survival(PFS)in patients that discontinued chemotherapy vs those that completed the recommended course.RESULTS Of the 267 patients that fulfilled the inclusion criteria in the pre-specified time frame,101(37.8%)agreed to participate in the clinical study.At the time of the enrolment in the study,over 50%of the patients had recently interrupted their oxaliplatin-based chemotherapy,most often due to neuropathy.Almost 85%of the responders reported having tingling or numbness in their fingers or hands,symptoms that were associated with pain in over 20%of the cases.When comparing the scores in the two questionnaires,a statistically significant relationship(P<0.001)was found between the presence of neuropathic symptoms and a decreased quality of life.This correlation was consistent when the patients were stratified by sex,disease stage,comorbidities and the presence of stoma or treatment type,suggesting that neuropathy in itself may be a reason for a decreased quality of life.At the 3 year final assessment,median recurrence-free survival in stageⅢpatients was 26.88 mo.When stratified by completion of chemotherapy,median recurrence freesurvival of stageⅢpatients that completed chemotherapy was 28.27 mo vs 24.33 mo in patients that discontinued chemotherapy due to toxicity,a difference that did not reach statistical significance.CONCLUSION CIPN significantly impacts QoL in colorectal cancer patients.CIPN is also the most frequent reason for treatment discontinuation.Physicians should actively assess for CIPN in order to prevent chronic neuropathy.
文摘T-cell subsets from peripheral blood and spleen were investigated prospectively by flow cytometry in a murine intrahepatic implanted tumor model. Peripheral blood OX-19+ cells (pan T-cells) and W3/25+ cells (Th cells) decreased with tumor development in tumor-bearing rats, giving significant differences when compared with healthy rats. No significant changes were found in OX-8+ cells (Ts cells). Hence, Th Ts ratio in tumor-bearing rats was lower than that in control group. Meanwhile, on day 17 following tumor implantation, in tumor-bearing rats with intrahepatic or peritoneal metastasis, there were less W3/25+ cells and more OX-8+ cells than those of hepatoma-bearing rats without metastasis (p<0.01). In the spleen, the phenotypes of lymphocyte markers showed less OX-8+ cells and more OX-12+ cells (B cells) tumor-bearing rats. It was suggested that, in tumor-bearing host, not only was T-cell immune function inhibited, but also there was abnormal distribution of T-cell subsets. It seems that there is a close relationship between tumor growth and its spread and a lower Th/Ts ratio.
基金supported by Improving the Ability of Diagnosis and Treatment of Difficult Diseases (ZLYNXM202009)。
文摘Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.
文摘BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.
基金Correspondence to: Dr. Esko Verijnkorva, University of Turku, Institute of Biomedicine, Department of Anatomy, Kiinamyllynkatu 10, FIN-20520 Turku, Finland.
文摘Aim: The expression of the cytokines IL-2, IL-6, IL-10, IFN-γ and TNF-α and the adhesion proteins CD99 and CD106 was studied in the human testis at the protein level. Methods: The expression of the cytokines and the adhesion proteins was assessed using immunohistochemistry and immunoblotting. Results: None of the cytokines studied was present in the human testis, but CD99 and CD106 (VCAM-1) strongly were expressed in all the testes investigated. CD99 was present in the interstitial tissue of the human testis as well as in the Sertoli cells. The identity of the CD99+ interstitial cells is unclear. CD106 (VCAM-1) was present in Leydig cells as well as the basal parts of the Sertoli cells in the seminiferous tubules. In immunoblotting, CD99 was demonstrated at molecular ratios of 46-57 (kD). This is a novel isoform of the molecule. Conclusion: The human testis produces both CD99 and CD106 and as CD106 mediates cell binding to lymphocytes, it is possible that the human Leydig cells adhere to lymphocytes like the rodent Leydig cells. (Asian J Androl 2002 Dec; 4: 243-248)
文摘Hepatoblastoma is the most common primary hepatic tumor of children. However, only a very few cases have been reported in adults. Most studies support treatment with chemotherapy followed by surgical resection. We present the first reported case of adult hepatoblastoma in Taiwan. A 52-year-old female suffered from sudden onset of abdominal pain and general weakness for days.Internal bleeding with hemorrhagic shock was suspected and two massive lesions in both lobes of the liver with hemoperitoneum were noted from imaging studies.Surgical resection of the larger left lobe tumor and radio-frequency ablation of the right smaller one were performed. The histopathology diagnosis was of a hepatoblastoma.
文摘Eosinophilic enteritis,a relatively rare entity,usually involves gastric antrum or proximal small bowel. Our case is rarer in its involvement of the distal small bowel and presents unusually as intussusception. The disease if diagnosed in the initial stages responds well to medical treatment but if associated with complications or misdiagnosed,surgical modality is the treatment of choice. In our case,the patient presented with acute intestinal obstruction due to intussusception and emergency laparotomy with ileoileal anastomosis was done. Histopathology confirmed the diagnosis as eosinophilic enteritis. This case with such a presentation is discussed here.
基金Supported by Centre for Research and Development,Uppsala University/County Council of Gavleborg,Gavle,Sweden,and the Council for Regional Research in Uppsala and Orebro,Sweden
文摘AIM: To examine whether muscle training with an oral IQoroR screen(IQS) improves esophageal dysphagia and reflux symptoms.METHODS: A total of 43 adult patients(21 women a n d 2 2 m e n) w e re c o n s e c u t i ve l y re fe r re d t o a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study(group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients(group B; median age 57 years,range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire(esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale(ability to swallow food: score 0-100), lip force test(≥ 15 N), velopharyngeal closure test(≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients(median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry.RESULTS: Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score(range): 2.5(1-3) vs 0.9(0-2), P < 0.001]. Symptoms of reflux were reported before training in 86% of the patients who showed improvement at follow-up [1.7(0-3) vs 0.5(0-2), P < 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100% showed improvement after IQS training [71(30-100) vs 22(0-50), P < 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N(12-80 N) vs 54 N(27-116), P < 0.001] and velopharyngeal closure test values [28 s(5-74 s) vs 34 s(13-80 s), P < 0.001] were significantly higher after IQS training. The oral IQS traction results showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mm Hg at rest(range: 0-0 mm HG) to 65 mm Hg(range: 20-100 mm Hg). CONCLUSION: Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.
