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Management of obstructed colorectal carcinoma in an emergency setting:An update

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 598-613页

作者： Efstathios T Pavlidis ioannis n Galanis Theodoros E Pavlidis 2nd Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Colorectal carcinoma is common,particularly on the left side.In 20%of patients,obstruction and ileus may be the first clinical manifestations of a carcinoma that has advanced(stage II,III or even IV).Diagnosis is based on clinical presentation,plain abdominal radiogram,computed tomography(CT),CT colonography and positron emission tomography/CT.The best management strategy in terms of short-term operative or interventional and long-term oncological outcomes re-mains unknown.For the most common left-sided obstruction,the first choice should be either emergency surgery or endoscopic decompression by self-expen-dable metal stents or tubes.The operative plan should be either one-stage or two-stage resection.One-stage resection with on-table bowel decompression and irrigation can be accompanied or not accompanied by proximal defunctioning stoma(colostomy or ileostomy).Primary anastomosis is more convenient but has increased risks of anastomotic leakage and morbidity.Two-stage resection(Hart-mann’s procedure)is safer and the most widely used despite temporally affecting quality of life.Damage control surgery in high-risk frail patients is less frequently performed since it can be successfully substituted with endoscopic stenting or tubing.For the less common right-sided obstruction,one-stage surgical resection is more beneficial than endoscopic decompression.The role of minimally invasive surgery(laparoscopic or robotic)is a subject of debate.Emergency laparoscopic-assisted management is advantageous to some extent but requires much expertise due to inherent difficulties in dissecting the distended colon and the risk of rup-ture and subsequent septic complications.The decompressing stent as a bridge to elective surgery more substantially decreases the risks of morbidity and mortality than emergency surgery for decompression and has equivalent medium-term overall survival and disease-free survival rates.Its combination with neoadjuvant chemotherapy or radiation may have a positive effect on long-term oncological outcomes

关键词： Acute abdomen Obstructive ileus Colorectal carcinoma Emergency surgery Colectomy Intraluminal metal stents

new trends in diagnosis and management of gallbladder carcinoma

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World Journal of Gastrointestinal Oncology 2024年第1期16卷 13-29页

作者： Efstathios T Pavlidis ioannis n Galanis Theodoros E Pavlidis ^(nd)Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Gallbladder(GB)carcinoma,although relatively rare,is the most common biliary tree cholangiocarcinoma with aggressiveness and poor prognosis.It is closely associated with cholelithiasis and long-standing large(>3 cm)gallstones in up to 90%of cases.The other main predisposing factors for GB carcinoma include molecular factors such as mutated genes,GB wall calcification(porcelain)or mainly mucosal microcalcifications,and GB polyps≥1 cm in size.Diagnosis is made by ultrasound,computed tomography(CT),and,more precisely,magnetic resonance imaging(MRI).Preoperative staging is of great importance in decisionmaking regarding therapeutic management.Preoperative staging is based on MRI findings,the leading technique for liver metastasis imaging,enhanced three-phase CT angiography,or magnetic resonance angiography for major vessel assessment.It is also necessary to use positron emission tomography(PET)-CT or ^(18)F-FDG PET-MRI to more accurately detect metastases and any other occult deposits with active metabolic uptake.Staging laparoscopy may detect dissemination not otherwise found in 20%-28.6%of cases.Multimodality treatment is needed,including surgical resection,targeted therapy by biological agents according to molecular testing gene mapping,chemotherapy,radiation therapy,and immunotherapy.It is of great importance to understand the updated guidelines and current treatment options.The extent of surgical intervention depends on the disease stage,ranging from simple cholecystectomy(T1a)to extended resections and including extended cholecystectomy(T1b),with wide lymph node resection in every case or IV-V segmentectomy(T2),hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y,and adjacent organ resection if necessary(T3).Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery,but much attention must be paid to avoiding injuries.In addition to surgery,novel targeted treatment along with immunotherapy and recen

关键词： Biliary tract neoplasms Extrahepatic cholangiocarcinoma Gallbladder carcinoma Gallbladder diseases Biliary tree diseases Gastrointestinal malignancies

Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct

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World Journal of Gastroenterology 2024年第10期30卷 1461-1465页

作者： Efstathios T Pavlidis ioannis n Galanis Theodoros E Pavlidis 2^(nd) Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Pancreatobiliary intraductal papillary neoplasms(IPns)represent precursors of pancreatic cancer or bile duct cholangiocarcinoma that can be detected and treated.Despite advances in diagnostic methods,identifying these premalignant lesions is still challenging for treatment providers.Modern imaging,biomarkers and molecular tests for genomic alterations can be used for diagnosis and follow-up.Surgical intervention in combination with new chemotherapeutic agents is considered the optimal treatment for malignant cases.The balance between the risk of malignancy and any risk of resection guides management policy;therefore,treatment should be individualized based on a meticulous preoperative assessment of high-risk stigmata.IPn of the bile duct is more aggressive;thus,early diagnosis and surgery are crucial.The conservative management of low-risk pancreatic branch-duct lesions is safe and effective.

关键词： Biliary tree diseases Pancreatic cystic neoplasms Biliary tract neoplasms Extrahepatic cholangiocarcinoma Pancreatic adenocarcinoma

Critical considerations for the management of acute abdomen in transplant patients

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World Journal of Transplantation 2024年第2期14卷 8-12页

作者： Efstathios T Pavlidis Georgios Katsanos Athanasios Kofinas Georgios Tsoulfas ioannis n Galanis Theodoros E Pavlidis The 2^(nd)Department of Propaedeutic Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Surgery Center for Research and Innovation in Solid Organ TransplantationAristotle University of ThessalonikiSchool of MedicineThessaloniki 54642Greece

The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic su

关键词： Acute abdomen Abdominal emergency surgery Transplantation Immunocompromised patients Immuno-suppression Posttransplantation surgery

The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation:A randomized,physiological,crossover study

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Journal of Intensive Medicine 2024年第2期4卷 202-208页

作者： Elena Lytra Stelios Kokkoris ioannis Poularas Dimitrios Filippiadis Demosthenes Cokkinos Dimitrios Exarhos Spyros Zakynthinos Christina Routsi 1st Department of Intensive Care Medical SchoolNational and Kapodistrian University of AthensEvangelismos HospitalAthensGreece Radiology Department Evangelismos HospitalAthensGreece 2nd Radiology Department Medical SchoolNational and Kapodistrian University of AthensAttikon HospitalAthensGreece

Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical benefits.Limited data exist on whether such effects are also present in HFOT through tracheostomy.Hence,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.Methods A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical ventilation.The patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner.At the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle effort.Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied once.Patients were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,Pnd from[12.4±4.3]L/min to[13.1±4.2]L/min,Pnot change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),Pnot change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(min∙L));partial pressure of arterial oxygen incre

关键词： Diaphragm Diaphragm ultrasonography High-flow 0Xygen Prolonged mechanical ventilation Tracheostomy

5-Bromo-2'-deoxyuridine labeling:historical perspectives,factors infiuencing the detection,toxicity,and its implications in the neurogenesis

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neural Regeneration Research 2024年第2期19卷 302-308页

作者： Joaquín Martí-Clúa Unidad de Citología e Histología.Departament de Biologia Cel·lular de Fisiologia i d’Immunologia.Facultad de Biociencias.Institut de Neurociències.Universidad Autónoma de Barcelona08193 BellaterraBarcelonaSpain

The halopyrimidine 5-bromo-2′-deoxyuridine(BrdU)is an exogenous marker of DnA synthesis.Since the introduction of monoclonal antibodies against BrdU,an increasing number of methodologies have been used for the immunodetection of this synthesized bromine-tagged base analogue into replicating DnA.BrdU labeling is widely used for identifying neuron precursors and following their fate during the embryonic,perinatal,and adult neurogenesis in a variety of vertebrate species including birds,reptiles,and mammals.Due to BrdU toxicity,its incorporation into replicating DnA presents adverse consequences on the generation,survival,and settled patterns of cells.This may lead to false results and misinterpretation in the identification of proliferative neuroblasts.In this review,I will indicate the detrimental effects of this nucleoside during the development of the central nervous system,as well as the reliability of BrdU labeling to detect proliferating neuroblasts.Moreover,it will show factors influencing BrdU immunodetection and the contribution of this nucleoside to the study of prenatal,perinatal,and adult neurogenesis.Human adult neurogenesis will also be discussed.It is my hope that this review serves as a reference for those researchers who focused on detecting cells that are in the synthetic phase of the cell cycle.

关键词： 5-bromo-2′-deoxyuridine adult neurogenesis human adult neurogenesis labeling pitfalls prenatal neurogenesis proliferation S-phase suturing S-phase toxicity

Physical and Mechanical Properties of Eco-Friendly Composites Made from Wood Dust and Recycled Polystyrene

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Journal of Renewable Materials 2022年第1期10卷 75-88页

作者： Dafni Foti Eleni E.Voulgaridou Sotirios Karastergiou Hamid R.Taghiyari Antonios n.papadopoulos Department of Forestry and natural Environment International Hellenic UniversityDramaGreece Department of Forestry Wood Sciences and DesignUniversity of ThessalyKarditsaGreece Wood Science and Technology Department Faculty of Materials Engineering&New TechnologiesShahid Rajaee Teacher Training UniversityTehranIran

The development of alternative wood composites based on the use of waste or recycled materials can be beneficial due to over exploitation of natural resources.Under this frame,an option for the successful utilization of waste polystyrene which avoids environmental problems that formaldehyde adhesives cause and also reduces waste dis-posal,is its potential application as a binder for the production of value-added environmentally friendly and low cost wood composites.Two types of panel were successfully made,consisting of wood dust and two recycled poly-styrene contents,namely,15%and 30%.Both physical properties,water absorption and thickness swelling,and mechanical properties,modulus of rupture,shear strength parallel in the plane of the board and glue line shear strength,were significantly improved as the recycled polystyrene content increased from 15%to 30%.Water absorption and thickness swelling after 24 h immersion in water were improved by 165%and 750%as the recycled polystyrene content increased from 15%to 30%.The magnitude of the improvement in mechanical properties however,was less pronounced than of the physical properties since modulus of rupture,shear strength parallel in the plane of the board and glue line shear strength were increased by 43.6%,50%and 61.5%,respec-tively.The low viscosity of the recycled polystyrene caused more mobility inside the panel matrix and therefore,an improved penetration took place into adequate depth of the compressed dust particles.It is concluded that boards can be successfully produced using these waste raw materials,wood dust and recycled polystyrene in organic solvent as a binder,and therefore it can reduce waste disposal and provide cleaner production for the development of wood-based boards.

关键词： Cold pressing composites recycled polystyrene wood dust

An Interview with Peter Deadman—Acupuncture Pioneer and Founder of The Journal of Chinese Medicine

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Chinese Medicine and Culture 2024年第1期7卷 19-28页

作者： ioannis Solos Charles Buck Peter Deadman Saint George Clinic and Research Institute Scottsdale 85251the United States of America northern College of Acupuncture Micklegate YO16LJthe United Kingdom British Acupuncture Council London W129HQthe United Kingdom The Register of Chinese Herbal Medicine London WC1N 3GSthe United Kingdom

This interview was conducted on August 21st, 2022 by Charles Buck and ioannis Solos. Peter Deadman has worked in the field of health promotion for 50 years. He co-founded Infinity Foods(an organic and natural foods workers co-op) in 1971, followed by the Brighton natural Health Centre-a charity dedicated to teaching ways to improve personal, community and planetary health and wellbeing. He qualified as an acupuncturist in 1978 and in Chinese herbal medicine in 1990. He founded The Journal of Chinese Medicine(UK) in 1979(Fig. 1), and co-authored A Manual of Acupuncture(published in 1998). He is the author of Live Well Live Long: Teachings from the Chinese nourishment of Life Tradition. He has taught Chinese medicine and health promotion internationally for decades and is a dedicated practitioner and teacher of Qi Gong(气功).

关键词： Acupuncture Medicine herbal

Chebyshev polynomial-based Ritz method for thermal buckling and free vibration behaviors of metal foam beams

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Applied Mathematics and Mechanics(English Edition) 2024年第5期45卷 891-910页

作者： n.D.nGUYEn T.n.nGUYEn Faculty of Civil Engineering Ho Chi Minh City University of Technology and EducationHo Chi Minh City 71309Viet Nam Faculty of Engineering and Technology Kien Giang UniversityChau Thanh 92000Viet Nam

This study presents the Chebyshev polynomials-based Ritz method to examine the thermal buckling and free vibration characteristics of metal foam beams.The analyses include three models for porosity distribution and two scenarios for thermal distribution.The material properties are assessed under two conditions,i.e.,temperature dependence and temperature independence.The theoretical framework for the beams is based on the higher-order shear deformation theory,which incorporates shear deformations with higher-order polynomials.The governing equations are established from the Lagrange equations,and the beam displacement fields are approximated by the Chebyshev polynomials.numerical simulations are performed to evaluate the effects of thermal load,slenderness,boundary condition(BC),and porosity distribution on the buckling and vibration behaviors of metal foam beams.The findings highlight the significant influence of temperature-dependent(TD)material properties on metal foam beams'buckling and vibration responses.

关键词： Ritz method Chebyshev function buckling vibration metal foam beam higher-order beam theory(HOBT)