简介：Endoscopicsubmucosaldissection(ESD)inventedinJapan,playsanimportantroleinthetreatmentofearlygastrointestinalcancer(EGC)anddysplasia.Endoscopicproceduresarenowwidelyspreadingaroundtheworld.ESDhastheadvantagethatenblocresectionaswellaspathologicalviewcanbeachievedwhencomparedwithconventionalendoscopicmucosalresection(1).Thankstothe

简介：Anticoagulationisimperativetoreducetheincidenceofthromboticcomplicationsinpatientsundergoingpercutaneousinterventionalcardiovascularprocedures;however,thisisattheexpenseofincreasedriskofbleeding.Theoptimalanticoagulationstrategyfortheseproceduresremainsunclear.Unfractionatedheparinisthemostcommonlyusedanticoagulantduringinterventionalprocedures,buthasseverallimitations,suchasrelativelyhighincidenceofbleedingevents,occurrenceofheparin-inducedthrombocytopenia,andaparadoxicalthromboticeffect.Contemporarystudieshavedemonstratedthatbivalirudindecreasestheoccurrenceofbleedingcomplications,butpotentiallyincreasestheriskofacutestentthrombosis.Thisreviewdiscussesthepharmacologyofbivalirudinanditscurrentclinicalapplicationinpatientsundergoingpercutaneouscoronaryinterventionandtranscatheteraorticvalvereplacementprocedures.

简介：ObjectivesToevaluatethesafetyandefficacyoftransradialcoronaryprocedures(TRCP).MethodsThedataof83caseswhoacceptedtransradialcoronaryangiography(CAG)andtransradialpercutaneouscoronaryintervention(PCI)inourdepartmentweresummarized.Thesuccessrates,proximalcoronarycomplications,peripheralvascularcomplications,severevagalreflex,meanoperationtime(MOT),meanrecumbenttime(MRT),meanhospital-stayingtime(MHT)wereanalyzed.Thedatawerecomparedwiththatof420casesoftransfemoralcoronaryprocedures(TFCP)inthesameperiod.ResultsSuccessratesandproximalcoronarycomplicationsweresimilarinbothgroups.SeverevagalreflexeswerelessinTRCPgroupthaninTFCPgroup.MOTwaslongerinTRCPgroup.MRTandMHTwereshorterinTRCPgroup.12(14.5%)radialarteryspasm,3(3.6%)radialarteryobstruction,1suddenrespiratoryarrestcausedbyjugularhematomawereobservedinTRCPgroup.ConclusionsTheefficacyandsafetyofTRCParedefinite.TRCPismoreeconomical.ForthepurposeofproperlyevaluatetheperipheralvascularcomplicationsofTRCP,itisnecessarytopayspecialattentiontoradialarteryocclusion,radialarterystenosis,andjugularhematoma.

简介：Objective:Toexplorechemicalcomponentchangesofdogboneatdifferentlengtheningtimeandindifferentboneregionsofinterest,andtoevaluatethemineralizationduringIiizarovlengtheningprocess.Methods:Theashweight,theconcentrationsofcalcium,phosphorusandthecalcium/phosphorusratioweremeasuredatdifferentintervals(2,4,6,8,12weeks)sincelengtheningandthelengthenedpartwascomparedwithacontrolareaateachinterval.Results:Theashweight,theconcentrationsofcalciumandphosphorusinthelengthenedareadifferedatalldevelopmenttime.Thecalcium/phosphorus(Ca/P)ratiointhelengthenedregionremainedsignificantlylowerthanthatinthecontrolregionupto12weeksafterthelengthening.Conclusions:Theseresultssuggestthatalsootherinorganicionsplayanimportantroleinthemineralizationprocessandthattheybecomerelativelymoreimportantsince8weeksafterthelengthening.

简介：ThepulmonarymicrocirculationoftheFontananimalmodelestablishedbytwodifferentprocedures,wasobservedbyusinglaserDopplerthermometer.Tenmongrelcaninesweredividedintotwogroupswith5ineachaccordingtodifferentsurgicalprocedures.ThemicrocirculationflowofthemiddleupperlobeofthepulmonarywasmeasuredbeforeandafterFontancirculationwasestablishedwhiletheleftsignofthecaninewasinstablecondition.Frictioninspirednooxygen

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简介：AbstractSimulation plays a pivotal role in neurosurgical training by allowing trainees to develop the requisite expertise to enhance patient safety. Several models have been used for simulation purposes. Non-living animal models offer a range of benefits, including affordability, availability, biological texture, and a comparable similarity to human anatomy. In this paper, we review the available literature on the use of non-living animals in neurosurgical simulation training. We aim to answer the following questions: (1) what animals have been used so far, (2) what neurosurgical approaches have been simulated, (3) what were the trainee tasks, and (4) what was the experience of the authors with these models. A search of the PubMed Medline database was performed to identify studies that examined the use of non-living animals in cranial neurosurgical simulation between 1990 and 2020. Our initial search yielded a total of 70 results. After careful screening, we included 22 articles for qualitative analysis. We compared the reports in terms of the (1) animal used, (2) type of surgery, and (3) trainee tasks. All articles were published between 2003 and 2019. These simulations were performed on three types of animals, namely sheep, cow, and swine. All authors designed specific, task-oriented approaches and concluded that the models used were adequate for replicating the surgical approaches. Simulation on non-living animal heads has recently gained popularity in the field of neurosurgical training. Non-living animal models are an increasingly attractive option for cranial neurosurgical simulation training. These models enable the acquisition and refinement of surgical skills, with the added benefits of accessibility and cost-effectiveness. To date, 16 different microneurosurgical cranial approaches have been replicated on three non-living animal models, including sheep, cows, and swine. This review summarizes the experience reported with the use of non-living animal models as alternative laboratory tools for cranial neurosurgical training, with particular attention to the set of tasks that could be performed on them.

简介：AbstractBackground:The rise in the use of prescription opioids for postoperative analgesia within surgery has mirrored an increased trend of opioid-related morbidity within Canada and the United States. This study prospectively studied daily pain levels and medication requirements postoperatively in patients undergoing elective Otolaryngology—Head and Neck surgery procedures.Methods:Patients were asked to prospectively document their pain level and medication use daily for 7 days postoperatively. A final survey was used to quantify unused medication left at home and clarify each patient's disposal plan. We included patients undergoing elective outpatient or short stay surgeries from three tertiary care centers in Toronto, Ontario from September 2016 to September 2017. Previous opioids users or patients suffering from chronic pain were excluded.Results:A final cohort of 56 eligible adult patients were included in the study. The most common procedures were thyroidectomy (n = 19), endoscopic sinus surgery (n= 10), tympanoplasty/ossiculoplasty (n= 7), and cochlear implant (n = 5). Most patients received a prescription for acetaminophen/codeine (n = 29, 51.8%) or acetaminophen/oxycodone (n = 22, 39.3%) and used on average 29% of their initial prescription. Patients most commonly opted to keep their unused narcotics at home (n = 23, 41%). A total of 710 tablets of narcotics were overprescribed in our study population, 351 of which were kept in patients' home for future use.Conclusion:There is a clear tendency to overestimate postoperative pain resulting in significant overprescription of opioids among Otolaryngologists.

简介：当保守处理失败时，可膨胀的阴茎修复术(IPP)的培植是可勃起的机能障碍的一个生长得很好的权威的解决方案。阴茎植入可以弄短阴茎。AMS700LGXIPP在普通使用，但是在它的机械可靠性，中期的postsurgical病人满足，和吝啬的阴茎长度上报导保藏正在缺乏。我们在AMS700LGX的培植以后在6和12个月调查吝啬的阴茎长度，机械可靠性，和耐心的满足。这未来的研究连续地注册了经历初次的IPP的人从2009年2月植入外科到2012年4月。拉长的松驰的阴茎长度，在50%点的阴茎长度和僵硬(P50和P100)和可勃起的功能(IIEF)和可勃起的机能障碍的国际索引的100%治疗盘点满足(编辑)分数，在6和12月postsurgery被测量。经历了AMS700LGX培植的45个病人(中部的年龄61年)并且完成了6月的后续，(80%)36完成了学习。在拉长的松驰的阴茎长度的重要差别在6和12个月之间被看见(P=0.033)。P100显著地也在6和12个月被增加，与到12个月的从基线的10%增加的一个平均数(1.30.4厘米)。在在6和12个月的吝啬的IIEF分数的差别为需要的领域是重要的(P=0.0001)并且为全面满足(P=0.002)；然而，平均数在6和12个月编辑分数显著地没被改进。AMS700LGX是为在经历阴茎修复术培植的人保存阴茎长度的一个强大的工具。

简介：AbstractBackground:It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.Methods:A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided).Results:The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107).Conclusions:The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.Trial registration number:NCT03620565, https://register.clinicaltrials.gov.

简介：Radiationexposureisahazardforpatientsandphysiciansduringfluoroscopically-guidedprocedures.Invasivecardiologistsareexposedtohighlevelsofscatterradiationandbothincreasingproceduralcomplexityandhigheroperatorvolumescontributetoexposureaboverecommendedthresholds.Standardshieldingdoesnotoffersufficientprotectiontotheheadandneckregionandthepotentialfornegativebiological,subclinical,andclinicaleffectsexists.Largepopulationstudiessuggestthatcranialexposuretolowdoseradiationincreasestherisksoftumordevelopment.Inaddition,modestdosesoftherapeuticcranialradiationhavebeenlinkedwiththedevelopmentofbraincancer.Althoughacausalassociationbetweenscatterradiationinthecathlabandbraincancerdoesnotcurrentlyexist,giventheknowndetrimentaleffectsofradiationexposuretotheheadandneckregionsupportafocusonpotentialmethodsofprotectionforboththepatientandtheoperator.