Liver transplantation as an alternative for the treatment of non-resectable liver colorectal cancer: Advancing the therapeutic algorithm

Colorectal cancer is a leading cause of cancerrelated mortality,with nearly half of the affected patients developing liver metastases.For three decades,liver resection(LR)has been the primary curative strategy,yet its applicability is limited to about 20%of cases.Liver transplantation(LT)for unresectable metastases was attempted unsuccessfully in the 1990s,with high rates of perioperative death and recurrence.There is now more interest in this strategy due to improvements in systemic therapies and surgical techniques.A significant study conducted by the Oslo group showed that patients receiving liver transplants had a 60%chance of survival after five years.Significantly better results have been achieved by using advanced imaging for risk stratification and further refining selection criteria,especially in the Norvegian SECA trials.This review carefully charts the development and history of LT as a treatment option for colorectal cancer liver metastases.The revolutionary path from the early days of exploratory surgery to the current situation of cautious optimism is traced,highlighting the critical clinical developments and improved patient selection standards that have made LT a potentially curative treatment for such challenging very well selected cases.

Artificial intelligence analysis of videos to augment clinical assessment:an overview

Observation is a fundamental part of the practice of clinical medicine.Observation of movement is particularly important for the neurologist.Conditions such as Parkinson’s disease,multiple sclerosis,stroke,epilepsy,and many others affect a person’s movement in characteristic ways.In some conditions,changes in the patient’s voice can be included in this-changes in sound caused by changes in the movements of speech.The clinician’s detection of a characteristic abnormality,and their judgment of its severity,plays a central role in both diagnosis and the assessment of prognosis or response to treatment.However,that practice depends upon a limited resource of experienced experts.In addition,these experts are limited by human visual judgment,which cannot reliably or precisely detect and measure small or subtle changes in movement(Williams et al.,2023).

COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women: A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia

Introduction: The coronavirus disease 2019 (COVID-19) is an infectious disease of the respiratory tract caused by SARS-CoV-2. Since its emergence, there have been increased rates of transmission and spread, morbidity and mortality which led to the development of COVID-19 vaccines to address the pandemic. This study assessed acceptance, knowledge, attitude, and perceived risks regarding COVID-19 vaccines among pregnant women attending antenatal care at two First-Level Hospitals in Lusaka, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 241 pregnant women using a questionnaire from August 2023 to October 2023 in two First-Level Hospitals in Lusaka district, Zambia. The collected data were analyzed using IBM Statistical Package for Social Sciences (SPSS) version 22.0. Statistical analysis was performed using a Chi-square test. The statistical significance was set at a 95% confidence level. Results: Of the 241 participants, 107 (42.7%) were aged between 24 and 34 years. Overall, 64.3% accepted the COVID-19 vaccines, of which 122 (50.6%) were already vaccinated. Further, 203 (84.6%) of the pregnant women had good knowledge, and 199 (82.6%) had positive attitudes towards COVID-19 vaccines. However, 58.5% thought COVID-19 vaccines were not safe and could cause infertility. Alongside this, 70.1% thought that COVID-19 vaccines were harmful during pregnancy. Having good knowledge of COVID-19 vaccines was associated with age (p = 0.049), education status (p = 0.001), and employment status (p = 0.001). Having a positive attitude towards COVID-19 vaccines was associated with education status (p = 0.001) and employment status (p = 0.001). Conclusion: This study found that most pregnant women had good knowledge, and positive attitudes, and the majority accepted the COVID-19 vaccine. Encouragingly, most of the pregnant women who accepted the COVID-19 vaccines were already vaccinated. Most pregnant women thought that COVID-19 vaccines had side effects, were not safe, and could be harmful during pregnancy. Consequently, this could have contributed to the hesitancy to receive a vaccine among some participants. The findings of this study demonstrate the need to provide pregnant women with continuous educational programs on the benefits of vaccinations for themselves and their children.

A matched-pair analysis of laparoscopic versus open pancreaticoduodenectomy: oncological outcomes using Leeds Pathology Protocol

BACKGROUND： Laparoscopic pancreaticoduodenectomy（LPD）is a safe procedure. Oncological safety of LPD is still a matter for debate. This study aimed to compare the oncological outcomes,in terms of adequacy of resection and recurrence rate following LPD and open pancreaticoduodenectomy（OPD）.METHODS： Between November 2005 and April 2009, 12LPDs（9 ampullary and 3 distal common bile duct tumors）were performed. A cohort of 12 OPDs were matched for age,gender, body mass index（BMI） and American Society of Anesthesiologists（ASA） score and tumor site.RESULTS： Mean tumor size LPD vs OPD（19.8 vs 19.2 mm,P=0.870）. R0 resection was achieved in 9 LPD vs 8 OPD（P=1.000）. The mean number of metastatic lymph nodes and total number resected for LPD vs OPD were 1.1 vs 2.1（P=0.140）and 20.7 vs 18.5（P=0.534） respectively. Clavien complications grade I/II（5 vs 8）, III/IV（2 vs 6） and pancreatic leak（2 vs 1）were statistically not significant（LPD vs OPD）. The mean high dependency unit（HDU） stay was longer in OPD（3.7 vs 1.4 days,P〈0.001）. There were 2 recurrences each in LPD and OPD（logrank,P=0.983）. Overall mortality for LPD vs OPD was 3 vs 6（log-rank, P=0.283） and recurrence-related mortality was 2 vs 1.There was one death within 30 days in the OPD group secondary to severe sepsis and none in the LPD group.CONCLUSIONS： Compared to open procedure, LPD achieved a similar rate of R0 resection, lymph node harvest and longterm recurrence for tumors less than 2 cm. Though technically challenging, LPD is safe and does not compromise oncological outcome.

Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease:A retrospective observational study

BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.

Global Strategies to Combat Antimicrobial Resistance: A One Health Perspective

Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevalent among humans, animals, and the environment. Successfully addressing AMR calls for a collaborative, multifaceted One Health approach. Despite this, some gaps remain effectively implementing strategies currently recommended to combat AMR. As a result, it is essential to reinforce the strategies that are deployed to counter AMR across the human, animal, and environmental sectors.

Accuracy between clinical and radiological diagnoses compared to surgical orbital biopsies

AIM:To assess the concordance between diagnosing orbital lesions by clinical examination,orbital imaging,and histological evaluation,in order to help guide future research and clinical practice.METHODS:A retrospective analysis was undertaken at a large regional tertiary referral centre of all surgical orbital biopsies performed over a 5-year period,from 1st January 2015 until 31st December 2019.Accuracy and concordance between clinical,radiological and histological diagnoses are reported as percentage sensitivity and positive predictive value.RESULTS:A total of 128 operations involving 111 patients were identified.Overall,sensitivities of 47.7%for clinical and 37.3%for radiological diagnoses were found when compared to the histological gold standard.Vascular lesions that have characteristic clinical and radiological features had the highest sensitivity at 71.4%and 57.1%,respectively.Inflammatory conditions showed the lowest sensitivity in both clinical(30.3%)and radiological(18.2%)diagnoses.The PPV for inflammatory conditions were 47.6%for clinical and 30.0%for radiological diagnoses.CONCLUSION:Accurate diagnoses are difficult to reach by relying on clinical examination and imaging alone.Surgical orbital biopsy with histological diagnosis should remain the gold standard approach for definitively identifying orbital lesions.Although larger scale prospective studies would help further refine concordance and guide future research avenues.

Surgical and long-term functional outcomes of patients with Duchenne muscular dystrophy following spinal deformity correction

BACKGROUND Life expectancy in patients with Duchenne muscular dystrophy(DMD)has improved due to advances in medical care.DMD patients develop progressive spinal deformity after loss of ambulatory function and onset of wheelchair dependence for mobility.There is limited published data on the effect of spinal deformity correction on long-term functional outcomes,quality of life(QoL),and satisfaction in DMD patients.AIM To investigate the long-term functional outcomes following spinal deformity correction in DMD patients.METHODS This was a retrospective cohort study from 2000-2022.Data was collected from hospital records and radiographs.At follow-up,patients completed the muscular dystrophy spine questionnaire(MDSQ).Statistical analysis was performed by linear regression analysis and ANOVA to analyse clinical and radiographic factors significantly associated with MDSQ scores.RESULTS Forty-three patients were included with mean age 14.4 years at surgery.Spinopelvic fusion was performed in 41.9%of patients.Mean surgical time was 352.1 min and mean blood loss was 36%of estimated total blood volume.Mean hospital stay was 14.1 d.Postoperative complications occurred in 25.6%of patients.Mean preoperative scoliosis was 58°,pelvic obliquity 16.4°,thoracic kyphosis 55.8°,lumbar lordosis 11.1°,coronal balance 3.8 cm,and sagittal balance+6.1 cm.Mean surgical correction of scoliosis was 79.2%and of pelvic obliquity was 80.8%.Mean follow-up was 10.9 years(range:2-22.5).Twenty-four patients had died at follow-up.Sixteen patients completed the MDSQ at mean age 25.4 years(range 15.2-37.3).Two patients were bed-ridden and 7 were on ventilatory support.Mean MDSQ total score was 38.1.All 16 patients were satisfied with the results of spinal surgery and would choose surgery again if offered.Most patients(87.5%)reported no severe back pain at follow-up.Factors significantly associated with functional outcomes(MDSQ total score)included greater duration of post-operative follow-up,age,scoliosis postoperatively,correction of scoliosis,increased lumbar lordosis postoperatively,and greater age at loss of independent ambulation.CONCLUSION Spinal deformity correction in DMD patients leads to positive long-term effects on QoL and high patient satisfaction.These results support spinal deformity correction to improve long-term QoL in DMD patients.

糖尿病相关的足溃疡分类指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

本文是对国际糖尿病足工作组(IWGDF)2019年指南的更新,针对在日常临床工作中使用的糖尿病伴足溃疡的分类提出了新指南。本指南基于对现有文献的系统综述,确定了149篇文献中涉及的28种分类,随后使用推荐、评估、发展和评价分级(GRADE)方法获取了专家意见。首先,我们通过对诊断试验的判断总结,制定了一份可能适合在临床实践中使用的分类系统的清单,重点关注每个系统在预测溃疡相关并发症的可用性、准确性和可靠性以及资源可及性。其次,经过小组讨论和共识研讨,我们确定了哪些分类系统应该用于特定的临床场景。总之,对于糖尿病合并足溃疡患者,我们推荐:①医务人员之间的沟通:使用部位、缺血、神经病变、细菌感染、溃疡面积、溃疡深度(SINBAD)分类(第一选择)或考虑使用创面、缺血、足感染(WIfI)分类系统(替代选择,当具备所需的设备和专业水平,并且具有可行性时),针对每例患者,应具体描述组成分类系统的每个变量而不是仅仅报告总分;②不推荐任何现有分类系统用以预测特定个体的具体的溃疡结局;③对于描述有感染的溃疡患者的特征:使用美国感染性疾病学会(IDSA)/IWGDF(第一选择)分类或考虑使用WIfI系统(替代选择,当具备所需的设备和专业水平,并且具有可行性时);④对于描述周围动脉病变患者的特征:考虑使用WIfI系统作为对愈合可能性和截肢风险进行分层的手段;⑤对于人群结果的稽查:使用SINBAD评分。基于GRADE分级,本文提出的所有推荐,证据的可信度是低的。然而,基于对当前数据的合理应用,本文的推荐具有临床应用价值。

Pregnancy and inflammatory bowel disease: Do we provide enough patient education? A British study of 1324 women

AIM To examine patient knowledge and factors influencing knowledge about pregnancy in British women with inflammatory bowel disease(IBD).METHODS This is a post hoc analysis of a study of female members of Crohn's and Colitis United Kingdom, aged 18-45 years who were sent an online questionnaire recording patient demographics, education, employment, marital status, and disease characteristics. Disease related pregnancy knowledge was recorded using Crohn's and colitis pregnancy knowledge score(CCPKnow).RESULTS Of 1324 responders, 776(59%) suffered from Crohn's disease, 496(38%) from ulcerative colitis and 52(4%) from IBD-uncategorised. CCPKnow scores were poor(0-7) in 50.8%, adequate(8-10) in 23.6%, good(11-13) in 17.7% and very good(≥ 14) in 7.8%. Multiple linear regression analysis revealed that higher CCPKnow scores were independently associated with higher educational achievement(P < 0.001), younger age at diagnosis(P = 0.003) and having consulted a health care professional about pregnancy and IBD(P = 0.001). CONCLUSION Knowledge was poor in 50%. Speaking with healthcare professionals was a modifiable factor associated with better knowledge. This illustrates the importance of disease related pregnancy

The 7th lung cancer TNM classification and staging system:Review of the changes and implications

Lung cancer is the most common cause of death from cancer in males,accounting for more than 1.4 million deaths in 2008.It is a growing concern in China,Asia and Africa as well.Accurate staging of the disease is an important part of the management as it provides estimation of patient’s prognosis and identifies treatment sterategies.It also helps to build a database for future staging projects.A major revision of lung cancer staging has been announced with effect from January 2010.The new classification is based on a larger surgical and non-surgical cohort of patients,and thus more accurate in terms of outcome prediction compared to the previous classification.There are several original papers regarding this new classification which give comprehensive description of the methodology,the changes in the staging and the statistical analysis.This overview is a simplified description of the changes in the new classification and their potential impact on patients’ treatment and prognosis.

Clinical relevance of endoscopic assessment of inflammation in ulcerative colitis: Can endoscopic evaluation predict outcomes?

Ulcerative colitis(UC) is a chronic inflammatory bowel condition characterised by a relapsing and remitting course. Symptom control has been the traditional mainstay of medical treatment. It is well known that histological inflammatory activity persists despite adequate symptom control and absence of endoscopic inflammation. Current evidence suggests that presence of histological inflammation poses a greater risk of disease relapse and subsequent colorectal cancer risk. New endoscopic technologies hold promise for developing endoscopic markers of mucosal inflammation. Achieving endoscopic and histological remission appears be the future aim of medical treatments for UC. This review article aims to evaluate the use of endoscopy as a tool in assessment of mucosal inflammation UC and its correlation with disease outcomes.

Colonic lesion characterization in inflammatory bowel disease:A systematic review and meta-analysis

AIM To perform a systematic review and meta-analysis for the diagnostic accuracy of in vivo lesion characterization in colonic inflammatory bowel disease(IBD), using optical imaging techniques, including virtual chromoendoscopy(VCE), dye-based chromoendoscopy(DBC), magnification endoscopy and confocal laser endomicroscopy(CLE). METHODS We searched Medline, Embase and the Cochrane library. We performed a bivariate meta-analysis to calculate the pooled estimate sensitivities, specificities, positive and negative likelihood ratios(+LHR,-LHR), diagnostic odds ratios(DOR), and area under the SROC curve(AUSROC) for each technology group. A subgroup analysis was performed to investigate differences in real-time nonmagnified Kudo pit patterns(with VCE and DBC) and real-time CLE.RESULTS We included 22 studies [1491 patients; 4674 polyps, of which 539(11.5%) were neoplastic]. Real-time CLE had a pooled sensitivity of 91%(95%CI: 66%-98%), specificity of 97%(95%CI: 94%-98%), and an AUSROC of 0.98(95%CI: 0.97-0.99). Magnification endoscopy had a pooled sensitivity of 90%(95%CI: 77%-96%)and specificity of 87%(95%CI: 81%-91%). VCE had a pooled sensitivity of 86%(95%CI: 62%-95%) and specificity of 87%(95%CI: 72%-95%). DBC had a pooled sensitivity of 67%(95%CI: 44%-84%) and specificity of 86%(95%CI: 72%-94%). CONCLUSION Real-time CLE is a highly accurate technology for differentiating neoplastic from non-neoplastic lesions in patients with colonic IBD. However, most CLE studies were performed by single expert users within tertiary centres, potentially confounding these results.

Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

国际糖尿病足工作组:糖尿病足溃疡分类指南——《国际糖尿病足工作组:糖尿病足防治国际指南(2019)》的一部分

国际糖尿病足工作组(IWGDF)自1999年以来一直以循证为基础发布糖尿病足病的预防和管理指南。本文中针对日常临床工作中糖尿病足溃疡的分类提出了新指南,并对既有的分类进行了综述。新指南只对现患糖尿病足溃疡进行分类,不包括用于定义未来溃疡风险的分类系统。本指南的制定是基于对现有文献的综述以及专家对最大程度影响临床结局的8个关键因素的鉴定。分类级别是根据关键因素的数量、内部和外部有效性验证以及使用意向而制定的。判定分类评分的关键因素有3种:患者相关的因素(终末期肾衰竭)、肢体相关的因素(周围动脉病变和保护性感觉丧失)和溃疡相关的因素(面积、深度、部位、单发或多发以及感染)。特殊分类系统要考虑以下5种临床情况:①卫生专业人员之间交流;②预测单个溃疡预后;③对个案临床决策的辅助;④伤口评估,有感染或无感染及周围动脉病变(评估灌注及血管重建的潜在益处);⑤用于地方、区域或国家人群结局的稽查。指南推荐:①医务人员之间交流使用SINBAD系统。②无适用于预测个体溃疡预后的分类。③感染的评估采用美国传染病学会/国际糖尿病足工作组(IDSA/IWGDF)分类系统。④评估灌注及血管重建的潜在获益使用创面、缺血、足感染(WIfI)系统。⑤人群结局的稽查使用SINBAD系统。

Tenascin C upregulates interleukin-6 expression in human cardiac myofibroblasts via toll-like receptor 4

AIM:To investigate the effect of Tenascin C(TNC)on the expression of pro-inflammatory cytokines and matrixmetalloproteinases in human cardiac myofibroblasts(CMF).METHODS:CMF were isolated and cultured from patients undergoing coronary artery bypass grafting.Cultured cells were treated with either TNC(0.1μmol/L,24 h)or a recombinant protein corresponding to different domains of the TNC protein;fibrinogen-like globe(FBG)and fibronectin typeⅢ-like repeats(TNⅢ5-7)(both 1μmol/L,24 h).The expression of the proinflammatory cytokines;interleukin(IL)-6,IL-1β,TNFαand the matrix metalloproteinases;MMPs(MMP1,2,3,9,10,MT1-MMP)was assessed using real time RT-PCR and western blot analysis.RESULTS:TNC increased both IL-6 and MMP3(P<0.01)mR NA levels in cultured human CMF but had no significant effect on the other markers studied.The increase in IL-6 mR NA expression was mirrored by an increase in protein secretion as assessed by enzymelinked immunosorbant assay(P<0.01).Treating CMF with the recombinant protein FBG increased IL-6mR NA and protein(P<0.01)whereas the recombinant protein TNⅢ5-7 had no effect.Neither FBG nor TNⅢ5-7 had any significant effect on MMP3 expression.The expression of toll-like receptor 4(TLR4)in human CMF was confirmed by real time RT-PCR,western blot and immunohistochemistry.Pre-incubation of cells with TLR4neutralising antisera attenuated the effect of both TNC and FBG on IL-6 mR NA and protein expression.CONCLUSION:TNC up-regulates IL-6 expression in human CMF,an effect mediated through the FBG domain of TNC and via the TLR4 receptor.

Conduit necrosis following esophagectomy: An up-to-date literature review

Esophageal conduit ischaemia and necrosis is an uncommon but devastating complication of esophagectomy and remains one of the most challenging issues in surgical practice. The incidence, time interval to develop symptoms, and clinical presentation are highly variable with no predictable pattern. Evidence comes from case reports and case series rather than randomized controlled trials.We describe the issues surrounding conduit necrosis affecting the stomach,jejunum and colon as an esophageal replacement and the advantages,disadvantages and challenges of each type of reconstruction. Diagnosis is challenging for the most experienced surgeon. Upper gastrointestinal endoscopy and computed tomography thorax with both oral and intravenous contrast is the gold standard. Management, either conservative or interventional is also a difficult decision. Management options include conservative treatment and more aggressive treatments such as stent insertion, surgical debridement and repair of the esophagus using jejunum, colon or a musculocutaneous flap. In spite of recent advances in surgical techniques, there is no reliable strategy to manage esophageal conduit necrosis. Our review covers the pathophysiology and clinical significance of esophageal necrosis while highlighting current techniques of prevention, diagnosis and treatment of this life-threatening condition.

剪切波弹性成像与传统超声及MRI对骨肌系统软组织良恶性肿瘤鉴别诊断能力的比较

目的探讨剪切波弹性成像(SWE)与单一超声检查或超声联合MRI检查相比,能否提高软组织肿块良恶性诊断的准确性。材料与方法2015年12月—2017年3月间连续招募预行软组织肿块活检的206例成年病人(年龄18~91岁,平均57.7岁),其中男89例(年龄21~91岁,平均56.0岁),女117例(年龄18~88岁,平均59.1岁),活检前病人接受了B超、MRI和SWE检查。

Current practice and clinicians' perception of medication non-adherence in patients with inflammatory bowel disease:A survey of 98 clinicians

AIMThe survey ascertains perceptions and describes current practice of clinicians regarding medication non-adherence in patients with Inflammatory Bowel Disease. METHODSGastroenterologists, trainees and inflammatory bowel disease (IBD) specialist nurses from the United Kingdom were invited to a web based survey collecting data on clinician demographics, patient volume and level of interest in IBD. Respondents were asked to estimate non-adherence levels and report use of screening tools and interventions to improve adherence. RESULTSNon-adherence was seen as an infrequent problem by 57% of 98 respondents. Levels of non-adherence were estimated lower than evidence suggests by 29% for mesalazine (5ASA), 26% for immunomodulators (IMM) and 21% for biologics (BIOL). Respondents reporting non-adherence as a frequent problem were more likely to report adherence levels in line with evidence (5ASA P P = 0.012; BIOL P = 0.015). While 80% regarded screening as important only 25% screen regularly (40% of these with validated assessment tools). Respondents stated forgetfulness, beliefs about necessity of medication and not immediately apparent benefits as the main reasons for non-adherence. Patient counselling on benefits and risks of medication was a commonly used intervention. CONCLUSIONClinicians treating IBD patients frequently underestimate non-adherence and use of validated screening tools is infrequent. Most respondents identified the main factors associated with non-adherence in line with evidence and often counselled patients accordingly. Professional education should focus more on non-adherence practice to avoid adverse treatment outcomes associated with non-adherence.

Clinical results of linezolid in arthroplasty and trauma related infections

AIM: To analyse the management of patients treated with linezolid for orthopaedic infections.METHODS: Twenty-two patients with orthopaedic related infections receiving a course of linezolid were reviewed retrospectively. Patients were classified into either post trauma, post arthroplasty and non trauma related infections. A diagnosis of infection was based on clinical findings, positive microbiological specimens, and positive signs of infection on radiological imaging and raised inflammatory markers. Pathogens isolated, inflammatory markers both at presentation and at final follow up, length of linezolid treatment, adverse drug reactions, concomitant anti-microbial therapy, length of hospital stay and any surgical interventions were recorded.RESULTS: Infections were classified as post arthroplasty(n = 10), post trauma surgery(n = 8) or nontrauma related infections(n = 4). Twenty patients(91%) underwent surgical intervention as part of their treatment. The number of required surgical procedures ranged from 1 to 6(mean = 2.56). Mean total length of stay per admission was 28.5 d(range 1-160 d). Furthermore, the mean duration of treatment with linezolid of patients who had resolution of symptoms was 31 d(range 10-84 d). All patients within this group were discharged on oral linezolid. Pathogens isolated included methicillin resistant Staphylococcus aureus, coagulase negative staphylococci, coliforms, enterococcus, Staphylococcus epidermidis, streptococcus viridans, Escherichia coli, group B streptococcus and pseudomonas. An overall 77% of patients demonstrated resolution of infections at follow-up, with mean C-reactive protein reducing from 123 mg/L to 13.2 mg/L.CONCLUSION: This study demonstrates that the use of linezolid offers excellent efficacy in orthopaedic related infections when used alongside appropriate surgical management.