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New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients

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World Journal of Diabetes 2019年第2期10卷 78-86页

作者： Ohad Guetta Alex Vakhrushev Oleg Dukhno Amnon Ovnat Gilbert Sebbag department General surgery B Soroka University Medical Center

BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk factor for complications with this type of *** To evaluate the safety of LSG in *** A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May *** was collected through digitized *** deviation from normal postoperative care within the first 60 d was defined as an early complication,and further categorized into mild or *** Nine hundred eighty-four patients underwent LSG,among these 143(14.5%)were diagnosed with *** were 19 complications in the T2DM group(13.3%)compared to 59 cases in the non-T2DM(7.0%).Out of 19 complications in the T2DM group,12 were mild(8.4%)and 7 were severe(4.9%).Compared to the non-T2DM group,patients had a higher risk for mild complications(Odds-ratio 2.316,CI:1.163-4.611,P=0.017),but not for severe ones(P=0.615).An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications(P=0.013,CI:1.074-1.843)but not for mild *** Our data suggest that LSG is relatively safe for patients with *** preoperative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.

关键词： Bariatric surgery Laparoscopic sleeve gastrectomy Type 2 diabetes Complications Morbidity Hemoglobin A1c Fasting plasma glucose Clavien-Dindo classification

Novel indications for autologous fat grafting in reconstruction:scleroderma

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Plastic and Aesthetic Research 2023年第1期10卷 680-688页

作者： Abed Rahman Kawakibi Alexander N.Khouri Paul S.Cederna Amy L.Strong Section of Plastic surgery Department of SurgeryUniversity of MichiganAnn ArborMI 49109USA

Scleroderma is a chronic connective tissue disease characterized by inflammation,vascular injury,and progressive skin fibrosis,resulting in significant aesthetic and functional impairments for *** therapies are limited and insufficiently treat the cutaneous manifestations of *** fat transfer(AFT)is a surgical technique that has been utilized for many decades for facial *** adipose stem cells(ASCs)present in fat grafts have also shown significant promise for their anti-inflammatory and regenerative ***,AFT has been repurposed to treat the skin manifestations of systemic sclerosis and localized *** suggest that AFT in scleroderma patients improves mouth and hand functions,Raynaud’s symptoms,and digital *** is a safe procedure with rare postoperative complications,making it a promising intervention for the treatment of *** studies are required to better characterize the influence of fat grafts on the recipient site and to establish standards for fat transfer in fibrotic skin diseases.

关键词： Scleroderma systemic sclerosis localized scleroderma AFT

Postoperative excessive gain in visceral adipose tissue as well as body mass index are associated with adverse outcomes of an ileal pouch

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Gastroenterology Report 2017年第1期5卷 29-35,I0001,I0002页

作者： Ganglei Liu Xianrui Wu Yi Li Yuanyi Rui Luca Stocchi Feza HRemzi Bo Shen department of Colorectal surgery the Cleveland Clinic FoundationClevelandOHUSA department of Geriatric surgery the Second Xiangya HospitalCentral South UniversityChangshaChina department of Gastroenterology/Hepatology the Cleveland Clinic FoundationClevelandOHUSA

Background:There are no published studies on the impact of visceral adipose tissue(VAT)change on outcomes of restorative proctocolectomy and ileal pouch-anal anastomosis(IPAA).The aim of this historic cohort study was to evaluate the impact of excessive VAT gain on the outcomes of inflammatory bowel disease(IBD)patients with ***:We evaluated all eligible patients with at least two sequential CT scans after pouch construction from our prospectively maintained Pouchitis Registry between 2002 and *** visceral fat area(VFA)was measured on CT *** study group comprised patients with a significant VAT gain(>15%),and the control group was those *** adverse outcomes of the pouch were defined as the new development of chronic pouch inflammation(chronic pouchitis,chronic cuffitis or Crohn’s disease of the pouch),anastomotic sinus and the combination of above(the composite adverse outcome)or pouch failure,after the inception ***:Of 1564 patients in the Registry,59(3.8%)with at least 2 CT scans after pouch surgery were ***-nine patients(49.2%)were in the study group,and 30(50.8%)were in the control *** median duration from the inception to the latest CT was 552(range:31–2598)days for the entire *** compared the frequency of new chronic pouch inflammation(13.8%vs 3.3%,P=0.195),new pouch sinus(10.3%vs 0%,P=0.112),composite adverse pouch outcome(24.1%vs 3.3%,P=0.026)or pouch failure(10.3%vs 6.7%,P=0.671)between the two ***-Meier plot for time-to-pouch failure between the pouch patients with or without excessive body mass index(BMI)gain(>10%)showed statistical difference(P=0.011).Limited stepwise multivariate analysis showed that excessive VAT gain(odds ratio=12.608,95%confidence interval:1.190–133.538,P=0.035)was an independent risk factor for the adverse pouch ***:In this cohort of ileal pouch patients,excessive VAT gain as well as gain in BMI after pouch construction was found to be associated wit

关键词： inflammatory bowel disease ileal pouch pouch failure visceral adipose tissue visceral fat area

Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer

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World Journal of Gastroenterology 2017年第14期23卷 2519-2526页

作者： Kenichi Inaoka Mitsuro Kanda Hiroaki Uda Yuri Tanaka Chie Tanaka Daisuke Kobayashi Hideki Takami Naoki Iwata Masamichi Hayashi Yukiko Niwa Suguru Yamada Tsutomu Fujii Hiroyuki Sugimoto Kenta Murotani Michitaka Fujiwara Yasuhiro Kodera department of Gastroenterological surgery (surgery II) Nagoya University Graduate School of Medicine Division of Biostatistics Clinical Research Center Aichi Medical University Hospital

AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative ***-hundred and twelve patients with previously untreated clinical T2-4 gastric cancer who underwent a D2 standard gastrectomy (distal gastrectomy or total gastrectomy) were included in the analysis. Correlations between 21 parameters that can be determined by preoperative routine blood tests and clinically relevant postoperative complications (grade II or higher according to the Clavien-Dindo classification) were evaluated. The optimal cutoff values and clinical significance of the selected markers were further evaluated by subgroup analyses according to age, body mass index, operative procedure and clinical disease ***-six patients (21.1%) experienced grade II or higher postoperative complications. The platelet-lymphocyte ratio (PLR, total lymphocyte count/platelet count × 100) exhibited the highest area under the curve value (0.639) for predicting postoperative complications among the 21 parameters, and the optimal cutoff value was determined to be 0.71 (sensitivity = 70%, specificity = 56%). In the univariate analysis, the odds ratio of a low PLR for the occurrence of postoperative complications was 2.94 (95%CI: 1.66-5.35, P < 0.001), and a multivariate binomial logistic analysis involving other potential risk factors identified a low PLR as an independent risk factor for postoperative complications (OR = 3.32, 95%CI: 1.82-6.25, P < 0.001). In subgroups classified according to age, body mass index, operative procedure and clinical disease stage, the low PLR group exhibited an increased incidence of postoperative *** preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.

关键词： Gastric cancer Gastrectomy Platelet-lymphocyte ratio Postoperative complication Prediction

Predictive value of serum alpha-fetoprotein for tumor regression after preoperative chemotherapy for rectal cancer

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World Journal of Gastrointestinal Oncology 2022年第2期14卷 525-532页

作者： Da-Kui Zhang Jun Qiao Shao-Xuan Chen Zhi-Yong Hou Jian-Zheng Jie department of General surgery China-Japan Friendship HospitalBeijing 100029China department of General surgery Inner Mongolia International Mongolian HospitalHohhot 010020Inner Mongolia Autonomous RegionChina

BACKGROUND Preoperative therapy is widely used in locally advanced rectal *** can improve local control of rectal ***,there are few indicators that can predict the effect of preoperative chemotherapy *** To investigate whether the increase in serumα-fetoprotein(AFP)can predict better efficacy of preoperative *** This was a retrospective *** analyzed 125 patients admitted between 2017 and 2019 with locally advanced rectal *** patients received six cycles of preoperative chemotherapy(mFOLFOX6 every 2 wk).Serum AFP of 26 patients rose slightly after three or four cycles of chemotherapy,and fell to normal again within 2 *** other 99 patients had a normal level of serum AFP during *** were divided into two groups(AFP risen and AFP normal).According to postoperative pathology,we compared tumor regression and complete response rate between the two *** primary outcome measure was the tumor regression grade(TRG)after *** difference in pathological complete response between the two groups was also *** There were no tumor progression and distant metastasis in both groups during preoperative *** in the AFP risen group achieved better TRG 0/1 than those in the AFP normal group(61.5%vs 39.4%).The increase in AFP was a significant predictor for better tumor regression[χ2=4.144,odds ratio(OR)=2.666,P=0.04].In the AFP risen group,the complete response rate was 30.8%,which was higher than in the AFP normal group(30.8%vs 12.1%,χ2=4.542,OR=3.251,P=0.03).CONCLUSION Patients with a slight increase in serum AFP can achieve better tumor regression during preoperative chemotherapy,and are more likely to achieve pathological complete response.

关键词： Rectal cancer Preoperative chemotherapy Alpha-fetoprotein Predictive value Tumor

An updated scoring system for prediction of survival after resection of colorectal liver metastases: addition of KRAS status as an important risk modifier

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Hepatobiliary surgery and Nutrition 2020年第1期9卷 70-72页

作者： Evan Jost Don Major Elijah Dixon department of Hepatobiliary surgery University of CalgaryCalgaryCanada

Colorectal liver metastases (CRLM) were traditionally associated with a very poor prognosis after resection, with some historical series reporting 5-year survival rates as low as 14% for completely resected multiple metastases (1). However, as modern chemotherapy and surgical techniques have evolved, there has been much progress made in improving survival for this unique group of patients, with 5-year survival approaching 55% with R0 resection (2). However, not all CRLM are the same, with very different biological behaviour and ultimately oncologic outcomes in different patients. There have been many attempts to create a scoring system defining factors which will predict this behaviour, with the system created by Fong et al. in 1999 being the most commonly employed (3). These scoring systems are important because they help the selection of patients who are likely to benefit from surgical treatment of their metastases. Patients who are unlikely to benefit from surgical resection may be better treated by alternative and potentially less morbid therapies, such as the various forms of ablation, or with systemic treatments. It is apparent that the accuracy of this prediction is essential to allow patients to benefit either by having appropriate surgical therapy or by avoiding potentially unnecessary surgical morbidity.

关键词： metastases resection prediction

Isoperistaltic vs antiperistaltic anastomosis after right hemicolectomy:A comprehensive review

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World Journal of Clinical Cases 2023年第8期11卷 1694-1701页

作者： Dimitrios Symeonidis Kostas-Sotirios Karakantas Labrini Kissa Athina A Samara Effrosyni Bompou Konstantinos Tepetes Georgios Tzovaras department of surgery University Hospital of LarissaLarissa 41110Greece

To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been *** include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn *** the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side *** purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant ***-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or ***,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic ***,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the ***,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.

关键词： Isoperistaltic side-to-side anastomosis Antiperistaltic side-to-side anastomosis Ileocolic anastomosis Right hemicolectomy Scenario

Computer-assisted surgery for Scaphoid Fracture

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Current Medical Science 2018年第6期38卷 941-948页

作者： Zi-run XIAO Ge XIONG department of Hand surgery Beijing Jishuitan HospitalBeijing 100035China department of Orthopaedic surgery the 91st Central Hospital of Chinese People's Liberation ArmyHenan 454000China

The computer-assisted surgery (CAS)has significantly improved the accuracy, reliability and outcomes of traumatic,spinal,nerve surgery and many other operations with a less invasive *** application of CAS for scaphoid fractures remains *** related studies are scanty and most of them are cadaver *** intrinsic defects from the registration procedure,scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid)although they are acceptable for spine and other orthopedic *** reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles,scan and registration methods,immobilization of limbs and their *** the basis of the data,we analyzed the limitations of this technique and envisioned its future development.

关键词： computer-assisted surgery wrist scaphoid fracture

T2 relaxation time measurements in the brains of scalded rats

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Science China(Life Sciences) 2017年第1期60卷 5-10页

作者： Tao Jiang Liqi Xie Xin Lou Dawei Li Zhiye Chen Huafeng Xiao Lin Ma department of Radiology PLA General Hospital department of Radiology PLA 401 Hospital department of Burn and Plastic surgery PLA 304 Hospital department of Radiology PLA 302 Hospital

This study aimed to evaluate the T2 relaxation time of the brain in severely scalded rats using a magnetic resonance （MR） T2 mapping sequence, and to investigate the correlation between T2 relaxation time and plasma glucose level. Twenty-eight Wistar rats were randomly divided into the scalded group （n = 21）and control group （n = 7）. Magnetic resonance scans were performed with T1WI, T2WI, and T2-mapping sequences in the scalded group; the scans were performed 1 day prior to scalding and 1, 3, 5, and 7 days post-scalding; in addition, identical MR scans were performed in the control group at the same time points. T2-maps were generated and T2 relaxation times were acquired from the following brain regions： the hippocampus, thalamus, caudate-putamen, and cerebrum. Pathological changes of the hippocampus were observed. The plasma glucose level of each rat was measured before each MR scan, and a correlation analysis was performed between T2 relaxation time and plasma glucose level. We found that conventional T 1WI and T2WI did not reveal any abnormal signals or morphological changes in the hippocampus, thalamus, caudate-putamen,： or cerebrum post-scalding. Both the T2 relaxation times of the selected brain regions and plasma glucose levels increased 1, 3, and 5 days post-scalding, and returned to normal levels 7 days post-scalding. The most marked increase of T2 relaxation time was found in the hippocampus; similar changes were also revealed in the thalamus, caudate-putamen, and cerebrum. No correlation was found between T2 relaxation time and plasma glucose level in scalded rats. Pathological observation of the hippocampus showed edema 1, 3, and 5 days post-scalding, with recovery to normal findings at 7 days post-scalding. Thus, we concluded that T2 mapping is a sensitive method for detecting and monitoring scald injury in the rat brain. As the hippocampus is the main region for modulating a stress reaction, it showed significantly increased water content along with

关键词： burns magnetic resonance imaging T2 relaxation time hippocampus