Frequency of Blood Cultures Performed in a Community Hospital

Background: Blood cultures (BCs) are obtained to identify etiologic organisms, demonstrate antibiotic efficacy, determine duration of treatment, and/or suggest further interventions. Published guidelines do not clearly state indications and timing for obtaining BCs. As a result, clinicians may obtain too many BCs, increasing cost and patient discomfort. Objective: To determine frequency of BCs performed at our hospital as part of a quality improvement project. Design: Retrospective review of all BCs submitted during a randomly selected month. Setting: A New York City 535-bed, university-affiliated community hospital. Measurements: Patient demographics and BC data were obtained from medical and laboratory records. Results: During the selected month, 2280 BCs were performed for 379 patients. Negative BCs were seen in 221 patients (58%) with one-half having multiple BCs performed within 48 hours of admission and prior to obtaining results of initial BCs. Repeat BCs frequently did not reveal further pathogens among patients with either negative or positive initial BCs. Conclusions: Two-thirds of BCs were obtained from less than one-half of patients without added clinical utility. Often, BCs were repeated prior to results of initial BCs or repeated in patients receiving antibiotics in spite of known low yield following antibiotic initiation. Clinical assessment and review of initial BCs prior to obtaining further BCs is necessary. Staff education regarding appropriate clinical setting for BCs and indications for repeat BCs is required to maximize utilization of resources, improve diagnostic yield, and limit patient discomfort.

Impact of diabetes mellitus on mortality in pulmonary hypertension:A systematic review and meta-analysis

BACKGROUND Pulmonary hypertension(PH)is a progressive disease characterized by endothelial dysfunction and vascular remodeling and is a leading cause of mortality worldwide.Although it is independently associated with multiple comorbidities,the impact of diabetes mellitus(DM)on mortality in patients with PH remains uncertain.To address this issue,we conducted a systematic review and meta-analysis to investigate the effect of DM on survival in patients with pulmonary hypertension.AIM To investigate the impact of diabetes mellitus on mortality in pulmonary hypertension patients.METHODS We conducted a comprehensive search of four major electronic bibliographic databases like PubMed,Google Scholar,Scopus,and Embase,and identified 106 relevant studies,out of 1561 articles,published since the year 2000 for full-text review.Fourteen retrospective and prospective cohort studies that compared survival between patients with DM and those without DM in the context of PH were deemed eligible for inclusion in our meta-analysis.The study was registered on PROSPERO with the identifier CRD42023390232.RESULTS A total of 116455 patients with PH were included in the meta-analysis,of whom 41228 suffered from DM and 75227 did not.The results of our meta-analysis indicate an elevated mortality rate among PH patients with diabetes mellitus in comparison to those without DM[odds ratio(OR)=1.40,95%CI:1.15–1.70,P=0.0006].The metaregression analysis unveiled a statistically significant negative association between mean age and effect size(coefficient=-0.036,P value=0.018).Conversely,a statistically significant positive association was detected between female proportion and effect size(coefficient=0.000,P value<0.001).CONCLUSION Our meta-analysis,which included approximately 116500 PH patients,revealed that the presence of diabetes mellitus was associated with increased odds of mortality when compared to non-diabetic patients.The metaregression analysis indicates that studies with older participants and lower proportions of females tend to exhibit smaller effect sizes.Clinically,these findings underscore the importance of incorporating diabetes status into the risk stratification of patients with PH with more aggressive monitoring and early intervention to improve prognosis potentially.

中国的男性包皮环切术与艾滋病预防

2008年2月25日，中华医学会男科学分会主任委员朱积川教授带领男科学分会候任主任委员王晓峰教授、副主任委员黄宇烽教授、黄翼然教授、姜辉教授、邓春华教授，《中华男科学杂志》编辑部主任商学军副教授，

应用中国商环包皮环切手术标准化方案对328例成年男性包皮环切的临床报告

目的:成年男性包皮环切手术标准化和培训可显著降低因手术引起的并发症发生率。由于目前国内外尚无可供参考的成年男性包皮环切手术标准化方案和培训制度,使得临床医生开展成年男性包皮环切手术的质量无法保证。为了建立成年男性包皮环切手术标准化和培训制度,便于临床医生和相关医护人员学习和掌握包皮环切器的临床应用技巧,以中国商环(简称"商环,ShangRing")包皮环切技术为例,根据商环的技术特点和临床实践经验,特别制订了商环包皮环切手术标准化方案,并将其标准化操作运用于临床。方法:采用商环包皮环切手术标准化方案对328例受术者(年龄18～58岁,平均27.8岁;已婚134例,未婚194例;包茎25例,包皮过长303例)进行包皮环切手术。对手术时间、疼痛评分(视觉模拟评分法,VAS)、术后并发症、包皮创口愈合时间、术后外观满意情况进行观察和随访。结果:手术时间为(4.70±1.31)min。手术时受术者疼痛(VAS)评分为(0.24±0.59)分,术后24h疼痛评分为(1.59±0.95)分,去环前24h内疼痛评分(1.72±1.11)分,去环时疼痛评分为(2.72±1.37)分。主要并发症发生率为术后感染0.6%(2/328)、出血0.6%(2/328)、伤口裂开0.6%(2/328)和水肿4.89%(16/328)。在发生出血和伤口裂开的受术者中无1例需要缝合。术后包皮创口完全愈合时间为(20.30±6.69)d。受术者对术后外观满意率99.7%(327/328)。结论:商环包皮环切术具有手术方式易于标准化、手术时间短、术中疼痛轻、术后无须特殊护理、容易完整保留系带,并完全暴露冠状沟、术后外观满意度高、受术者易于接受等优点。初步证明了中国商环包皮环切手术标准化方案的可接受性,严格按照此方案实施手术和随访护理,能最大化地实现商环包皮环切技术的诸多临床优势,将并发症发生率控制在可接受的范围内。

童年期伤害对成长及成年身心健康的影响

综述了童年期伤害经历对成长和成年身心健康的影响,提出通过健全社会保障支持系统、强化儿童保健服务机构职能、深化医院爱童理念和对家庭及学校社区的教育等干预,构筑无缝儿童关怀和保护屏障,营造健康、和谐、科学的儿童成长环境,努力提高民族素质,促进社会的文明和进步。

121例腹腔镜Roux-en-Y胃空肠吻合术后随访结果

目的探讨腹腔镜Roux-en-Y胃空肠吻合术（laparoscopic Roux-en-Y gastric bypass，LRYGBP）治疗病态肥胖的术后营养和代谢方面的变化。方法121例LRYGBP，男40例，女81例。分别测定术前1个月及术后6个月的体重指数（body mass index，BMI）。对比分析6个月、12个月，24个月血清铁（Fe）、钙（Ca）、锌（Zn）、硒（Se）及维生素A（VitA）、维生素D（VitD）、维生素B12（VitB12）和甲状旁腺素（parathyroid hormone，PTH）的水平变化。结果术前1个月BMI（47．00±7．15）kg／m^2，术后6个月BMI（33．79±6．06）kg／m^2，BMI下降（13．21±5．47）kg／m^2（t=26．103，P=0．000）。术后血清Fe、Ca、Zn、Se及ViLA、VitD、VitB12均在正常范围，其中术后6个月血清Zn、Se和VitA水平虽然在正常范围内，但分别有19．5％（17／87）、22．7％（20／88）和33．7％（28／83）的患者低于正常水平，但术后2年仅有6．7％（2／30）、11．5％（3／26）和17．2％（5／29）的患者低于正常水平。血清PTH术后6个月11～161pg／ml，（66±34）pg／ml、1年24～154pg／ml，（72±34）pg／ml、2年21～194pg／ml，（75±40）pg／ml（正常值9～44pg／ml）。结论LRYGBP治疗病态肥胖是有效、安全的。术后2年血清Fe、Ca及VitD、VitB12均正常；血清锌、硒及维生素A经术后6个月给予补充剂大多接近正常；血清PTH水平明显高于正常。建议患者术后长期服用复合维生素、矿物质补充剂，定期到医院随访。

胃小囊网片包裹术治疗肥胖症的可行性实验研究

目的 探讨聚四氟乙烯（polytetrafluoroethylene,PTFE）网片包裹胃小囊,预防胃小囊扩张,治疗肥胖症的可行性. 方法 在3例冰鲜（死亡〈72 h）尸体上实施此手术.男2例,女1例,年龄77、86、93岁,体重48、115、167 kg,BMI 19.7、33.4、45.3 kg/m2.做20～30 ml胃小囊,而后行胃空肠吻合术,再分离空肠系膜.PTFE网片穿过空肠系膜,粗面贴胃小囊壁,包裹胃小囊.最后固定网片,缝合空肠系膜. 结果 3例手术顺利,手术时间60、80、85 min, 无手术副损伤. 结论 网片包裹胃小囊,手术操作不十分困难,手术时可以用网片将胃小囊、胃空肠吻合口及空肠残端完全包裹.这样可能会有效地预防胃小囊的扩张.

军队男性包皮环切的历史回顾与展望

成人包皮环切可以预防大多数生殖道感染,显著降低男性获得性HPV、HSV和HIV的感染风险。有关男性包皮环切对军队服役人员健康益处的报道很少。前线的士兵不能保持阴囊与包皮足够的局部卫生条件,容易受到感染,影响执行任务和作战,辅助治疗也会直接给军队增加开支。在服役期间和在派遣之前进行包皮环切可以节省大量时间和成本,对改善官兵生殖健康状况起到长效的益处。这些研究发现正在受到非洲各国军队卫生部门的重视,将成为未来军队卫生和服务的发展方向。在HIV流行可能恶化的亚洲,在军队倡导男性包皮环切术预防生殖道感染和性传播疾病,对提高战斗力和降低医疗成本,增进全社会公众健康状况与国民经济将具有十分显著的战略意义。

中国建立男性包皮环切手术标准化和培训的重要性

尽管HIV在非洲的大流行仍然是一个严重的问题,而在其他地区,如亚洲和南美洲,HIV感染率也正在迅速上升。国际健康组织已经认识到有必要制定有效的策略来检测和控制全球HIV的传播。研究表明,男性包皮环切能显著降低HIV、人乳头状瘤病毒(HPV)、单纯疱疹病毒2型(HSV-2)和其他性传播疾病(STD)的感染率。虽然男性包皮环切技术有许多,但是没有标准化的手术方案和培训计划。研究表明,男性包皮环切技术的标准化与培训计划的实施可以大大降低并发症发生率。并发症发生率高是实施男性包皮环切服务的一个主要障碍。我们建议,在推广男性包皮环切之前应建立手术标准和培训计划。

The Chinese skeleton: insights into microstructure that help to explain the epidemiology of fracture

Osteoporotic fractures are a major public health problem worldwide, but incidence varies greatly across racial groups and geographic regions. Recent work suggests that the incidence of osteoporotic fracture is rising among Asian populations. Studies comparing areal bone mineral density and fracture across races generally indicate lower bone mineral density in Asian individuals including the Chinese, but this does not reflect their relatively low risk of non-vertebral fractures. In contrast, the Chinese have relatively high vertebral fracture rates similar to that of Caucasians. The paradoxically low risk for some types of fractures among the Chinese despite their low areal bone mineral density has been elucidated in part by recent advances in skeletal imaging. New techniques for assessing bone quality non-invasively demonstrate that the Chinese compensate for smaller bone size by differences in hip geometry and microstructural skeletal organization. Studies evaluating factors influencing racial differences in bone remodeling, as well as bone acquisition and loss, may further elucidate racial variation in bone microstructure. Advances in understanding the microstructure of the Chinese skeleton have not only helped to explain the epidemiology of fracture in the Chinese, but may also provide insight into the epidemiology of fracture in other races as well.

Management of hypertension in primary aldosteronism

Hypertension causes significant morbidity and mortal-ity worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldo-steronism(PA) is the most common cause of revers-ible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approxi-mately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic re-section, while bilateral hyperplasia is treated with min-eralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemo-dynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medica-tions in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, asmanifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the im-portance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalec-tomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifac-torial model convenient for use in daily clinical practice.

Histopathological differences utilizing the nonalcoholic fatty liver disease activity score criteria in diabetic(type 2 diabetes mellitus) and non-diabetic patients with nonalcoholic fatty liver disease

AIM: To study clinical and histopathological features of nonalcoholic fatty liver disease(NAFLD) in patients with and without type 2 diabetes mellitus(T2DM) using updated nonalcoholic steatohepatitis clinical research network(NASH-CRN) grading system.METHODS: We retrospectively analyzed data of 235 patients with biopsy proven NAFLD with and without T2 DM.This database was utilized in the previously published study comparing ethnicity outcomes in NAFLD by the same corresponding author.The pathology database from University of Chicago was utilized for enrolling consecutive patients who met the criteria for NAFLD and their detailed clinical and histopathology findings were obtained for comparison.The relevant clinical profile of patients was collected from the Electronic Medical Records around the time of liver biopsy and the histology was read by a single well-trained histopathologist.The updated criteria for type 2 diabetes have been utilized for analysis.Background data of patients with NASH and NAFLD has been included.The mean differences were compared using χ2 and t-test along with regression analysis to evaluate the predictors of NASH and advanced fibrosis.RESULTS: Patients with NAFLD and T2 DM were significantly older(49.9 vs 43.0,P < 0.01),predominantly female(71.4 vs 56.3,P < 0.02),had higher rate of metabolic syndrome(88.7 vs 36.4,P < 0.01),had significantly higher aspartate transaminase(AST)/alanine transaminase(ALT) ratio(0.94 vs 0.78,P < 0.01) and Fib-4 index(1.65 vs 1.06,P < 0.01) as markers of NASH,showed higher mean NAFLD activity score(3.5 vs 3.0,P = 0.03) and higher mean fibrosis score(1.2 vs 0.52,P < 0.01) compared to patients with NAFLD without T2 DM.Furthermore,advanced fibrosis(32.5 vs 12.0,P < 0.01) and ballooning(27.3 vs 13.3,P < 0.01) was significantly higher among patients with NAFLD and T2 DM compared to patients with NAFLD without T2 DM.On multivariate analysis,T2 DM was independently associated with NASH(OR = 3.27,95%CI: 1.43-7.50,P < 0.01) and advanced fibrosis(OR = 3.45,95%CI: 1.53-7.77,P < 0.01) in all patients with NAFLD.There was a higher rate of T2DM(38.1 vs 19.4,P < 0.01) and cirrhosis(8.3 vs 0.0,P = 0.01) along with significantly higher mean Bilirubin(0.71 vs 0.56,P = 0.01) and AST(54.2 vs 38.3,P < 0.01) and ALT(78.7 vs 57.0,P = 0.01) level among patients with NASH when compared to patients with steatosis alone.The mean platelet count(247 vs 283,P < 0.01) and high-density lipoprotein cholesterol level(42.7 vs 48.1,P = 0.01) was lower among patients with NASH compared to patients with steatosis.CONCLUSION: Patients with NAFLD and T2 DM tend to have more advanced stages of NAFLD,particularly advanced fibrosis and higher rate of ballooning than patients with NAFLD without T2 DM.

Acute pain management in symptomatic cholelithiasis

AIM To review the evidence for the use of different nonsteroidal anti-inflammatory drugs(NSAIDs) in the treatment of biliary colic.METHODS The strategies employed included an extensive literature review for articles and studies related to biliary colic from electronic databases including Pub Med,Science Direct,Wiley Inter Science,Medline and Cochrane from last 15 years.Keywords: "Biliary colic","management of biliary colic","non-steroidal anti-inflammatory drugs","cholelithiasis" and "biliary colic management".Six randomized control trials,1 non-randomized trial and 1 meta-analysis were included in this review.The outcomes of these studies and their significance have been reviewed in this paper.RESULTS Current evidence suggests there are no set protocols for biliary colic pain management.NSAIDs are potent in the management of biliary colic,not only in terms of symptom control but in disease progression as well.Apart from the studies on diclofenac and ketorolac,there are studies which have shown that intravenous tenoxicam and injectable flurbiprofen are equally effective in managing biliary colic.The efficacy of NSAIDs is superior in terms of lower number of doses and longer duration of action in comparison to other analgesic agents.CONCLUSION This literature review has found that NSAIDs are safe and effective for pain control in biliary colic,and reduce the likelihood of further complications.

Global research trends in the microbiome related to irritable bowel syndrome: A bibliometric and visualized study

BACKGROUND Irritable bowel syndrome(IBS) is a common functional gastrointestinal disorder. Dysregulation of the gut–brain axis plays a central role in the pathophysiology of IBS. It is increasingly clear that the microbiome plays a key role in the development and normal functioning of the gut–brain axis.AIM To facilitate the identification of specific areas of focus that may be of relevance to future research. This study represents a bibliometric analysis of the literature pertaining to the microbiome in IBS to understand the development of this field.METHODS The data used in our bibliometric analysis were retrieved from the Scopus database. The terms related to IBS and microbiome were searched in titles or abstracts within the period of 2000–2019. VOSviewer software was used for data visualization.RESULTS A total of 13055 documents related to IBS were retrieved at the global level. There were 1872 scientific publications focused on the microbiome in IBS. There was a strong positive correlation between publication productivity related to IBS in all fields and productivity related to the microbiome in IBS(r = 0.951, P < 0.001). The United States was the most prolific country with 449(24%) publications, followed by the United Kingdom(n = 176, 9.4%), China(n = 154, 8.2%), and Italy(n = 151, 8.1%). The h-index for all retrieved publications related to the microbiome in IBS was 138. The hot topics were stratified into four clusters:(1) The gut–brain axis related to IBS;(2) Clinical trials related to IBS and the microbiome;(3) Drugmediated manipulation of the gut microbiome;and(4) The role of the altered composition of intestinal microbiota in IBS prevention.CONCLUSION This is the first study to evaluate and quantify global research productivity pertaining to the microbiome in IBS. The number of publications regarding the gut microbiota in IBS has continuously grown since 2013. This finding suggests that the future outlook for interventions targeting the gut microbiota in IBS remains promising.

Epigenetics of gastroenteropancreatic neuroendocrine tumors:A clinicopathologic perspective

Gastroenteropancreatic neuroendocrine tumors(GEP-NETs) are a heterogeneous group of rare tumors whose site-specific tumor incidence and clinical behavior vary widely. Genetic alterations associated with familial inherited syndromes have been well defined; however, the genetic profile of sporadic tumors is less clear as their tumorigenesis does not appear to be controlled by classic oncogenes such as P53, RB, or KRAS. Even within GEP-NETs, there are no common oncogenic drivers; for example, DAXX/ATRX mutations are strongly implicated in the tumorigenesis of pancreatic but not small bowel NETs. Accordingly, the dysregulation of epigenetic mechanisms has been hypothesized as a potential regulator of GEPNET tumorigenesis and has become a major focus of recent studies. Despite the heterogeneity of tumor cohorts evaluated in these studies, it is obvious that there are methylation patterns, chromatin remodeling alterations, and microR NA and long non-coding RNA(lncR NA) differential expression profiles that are distinctive of GEPNETs, some of which are correlated with significant differences in clinical outcomes. Several translational studies have provided convincing data identifying potential prognostic biomarkers, and some of these have demonstrated preliminary success as serum biomarkers that can be used clinically. Nevertheless, there are many opportunities to further define the mechanisms by which these epigenetic modifications influence tumorigenesis, and this will provide better insight into their prognostic and therapeutic utility. Furthermore, these findings form the foundation for future studies evaluating the clinical efficacy of epigenetic modifications as prognostic biomarkers, as well as potential therapeutic targets.

Management and outcome of recurrent gallstone ileus:A systematic review

AIM: To help the surgeon in decision making whentreating a patient with recurrent gallstone ileus(RGSI). METHODS: A systematic review related to RGSI was performed using the databases CINAHL, EMBASE, MEDLINE via Pub Med from May 1912 to April 2015. All languages were included and the grey literature was also searched. The abstracts were explored for relevance to the topic and full texts obtained as appropriate. A manual search was carried out by scrutinising the reference lists of all the full text articles and further articles were identified and obtained. Total of 903 articles were identified, 656 were excluded after abstract review, 247 full text articles were reviewed and 91 articles selected for final analysis. There were 113 cases of RGSI. RESULTS: There were 113 cases of RGSI reported in 91 articles. The majority of the recurrences, 62.6%, occurred within 6 wk of the index event. The male to female ratio was 1:7. The mean age was 69.6 years(SD 11.2) with a range of 38-95 years. The small bowel was the commonest site of impaction(92.2%). Treatment data was available for 104 patients. The two main operations performed were:(1) Enterolithotomy without repair of biliary fistula in 70.1% of all patients with a procedural mortality rate of 16.4%(12/73) and(2) a single stage surgery approach involving enterolithotomy with cholecystectomy and repair of the biliary enteric fistula in 16.3% with a procedural mortality of 11.7%(2/17). A subset analysis over last 25 years showed mortality from eneterolithotomy was 4.8% while single stage mortality was 22.2%. Enterolithotomy alone was the commonest operation performed for RGSI with four patients(5.4%) having a further recurrence of gallstone ileus. CONCLUSION: Enterolithotomy alone or followed by a delayed two-stage treatment approach is the preferred choice offering low mortality and reduced risk of recurrence.

Secondary causes of inflammatory bowel diseases

Inflammatory bowel diseases(IBD),conventionally consist of Crohn’s disease(CD)and ulcerative colitis.They occur in individuals with high risk genotype for the disease in the setting of appropriate environmental factors.The pathogenesis of IBD involves a dysregulated autoimmune response to gut dysbiosis,which in turn is triggered due to exposure to various inciting environmental factors.But there is no clearly defined etiology of IBD and this type of disease is termed as“idiopathic IBD”,“classic IBD”,or“primary IBD”.We reviewed the current medical literature and found that certain etiological factors may be responsible for the development of IBD or IBD-like conditions,and we consider this form of de novo IBD as“secondary IBD”.Currently known factors that are potentially responsible for giving rise to secondary IBD are medications;bowel altering surgeries and transplantation of organs,stem cells or fecal microbiome.Medications associated with the development of secondary IBD include;immunomodulators,anti-tumor necrosis factor alpha agents,anti-interleukin agents,interferons,immune stimulating agents and checkpoint inhibitors.Colectomy can in some cases give rise to de novo CD,pouchitis of the ileal pouch,or postcolectomy enteritis syndrome.After solid organ transplantation or hematopoietic stem cell transplantation,the recipient may develop de novo IBD or IBD flare.Fecal microbiota transplantation has been widely used to treat patients suffering from recurrent Clostridium difficile infection but can also causes IBD flares.

男性不育的遗传学评估

无精子症或严重少精子症男性(<5×10 6/ml)在接受治疗之前应通过遗传学检测确定其不育的真正原因。正确区分梗阻性无精子症(obstructive azoospermia,OA)与非梗阻性无精子症(non-obstructive azoospermia,NOA)至关重要,因为相比于NOA(睾丸体积小、质地柔软、FSH水平升高),OA(正常的睾丸功能、睾丸体积以及FSH水平)的遗传学检测有所不同。在NOA患者人群中,病史回顾、体格检查和实验室检测对于遗传学检测方法的选择是必须的,尤其针对原发性睾丸衰竭或先天性低促性腺激素型性腺功能低下症的NOA患者。遗传学检测包括由于先天性输精管缺如所致OA的囊性纤维化跨膜传导调节因子的检测,和针对严重少精子症或NOA患者的染色体核型分析、Y染色体微缺失等其他特殊检测方法。这些遗传学检测能够帮助判定哪些患者适合药物和/或手术治疗。最新的遗传学分析技术将有助于男性不育的诊断和掌控。

软骨母细胞瘤:射频消融术在部分病例中替代外科手术切除

目的证明射频（RF）消融可以安全有效地治疗有选择的软骨母细胞瘤（selected cases of chondroblastoma）。方法本研究得到机构伦理委员会批准，并符合HIPPA的要求。由于为回顾性研究，故未签署知情同意书。回顾性分析了1995年7月-2007年7月2个医学中心行射频消融治疗后经活检证实为软骨母细胞瘤的病例。在CT引导下进行单极RF消融，同时获得病变影像学资料。记录术前和术后1d症状。由病历记录获取长期随访情况。结果13例男性和4例女性经RF治疗（平均年龄17-3岁）。

Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy

AIM: To determine the test characteristics of community based video capsule endoscopy (VCE) in patients undergoing sequential VCE and double balloon enteroscopy (DBE). METHODS: Eighty-nine patients (34 females, 55 males, mean age 66) who underwent both VCE and DBE from 2008-2010 were retrospectively reviewed. Lesions detected at VCE were categorized. Capsule directed DBE followed and included 44 antegrade, 11 retrograde and 34 combined antegrade and retrograde procedures. Lesions detected were compared utilizing the McNemar's test. RESULTS: Angioectasia detection with VCE was 25% and with DBE 35% (P < 0.03) with a calculated sensitivity and specificity of 58% and 93% respectively. Polyps were detected by VCE in 22% and in DBE 20%, (P = 0.6), with a sensitivity and specificity for VCE of 61% and 87%. Small bowel diverticula were only seen in 1% of VCE but in 12% of DBE patients (P < 0.002) with a calculated sensitivity and specificity of VCE of 9% and 100%. CONCLUSION: VCE would be moderately sensitiveand specific overall with considerable variation by lesion. Furthermore, VCE cannot be relied upon to diagnose small bowel diverticula.