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Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions

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World Journal of Gastrointestinal surgery 2024年第2期16卷 270-275页

作者： Davina Perini Jacopo Martellucci Department of emergency Emergency and Minimally Invasive Surgery UnitCareggi University HospitalFirenze 50041Italy

Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency *** trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective *** is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been *** present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal ***,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute *** the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute *** then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two *** emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality *** need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.

关键词： Indocyanine green Fluorescence Navigation surgery Angiography emergency surgery Decision-making

Artificial Intelligence and Computer Vision during surgery: Discussing Laparoscopic Images with ChatGPT4—Preliminary Results

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Surgical Science 2024年第3期15卷 169-181页

作者： Savvas Hirides Petros Hirides Kouloufakou Kalliopi Constantinos Hirides Department of surgery Medical School University of Nicosia Nicosia Cyprus Department of Laparoscopic & robotic surgery Athens Medical Center Athens Greece Department of Laparoscopic & robotic surgery IASO Maternity & Gynecology Clinic Athens Greece

Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.

关键词： Artificial Intelligence surgery Image Recognition Autonomous surgery

Evaluation of hand infections in the emergency department using point-of-care ultrasound

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World Journal of emergency Medicine 2024年第4期15卷 283-288页

作者： David Ahmad Haidar David Mintz Brandon M Wubben Omar Rizvi Srikar Adhikari Department of emergency Medicine Michigan MedicineAnn Arbor 48109-1382USA University of Arizona College of Medicine Tucson 85724USA Department of emergency Medicine University of IowaIowa City 52242-1009USA Department of surgery University of Arizona College of MedicineTucson 85724USA Department of emergency Medicine University of Arizona College of MedicineTucson 85724USA

BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient ***:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December *** trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the *** then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final ***:We included a total of 50 cases(28 male,22 female)in the final *** most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 ***:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.

关键词： Ultrasound Point-of-care ultrasound Cellulitis Abscess Flexor tenosynovitis

Multilocular thymic cysts can be easily misdiagnosed as malignant tumor on computer tomography:A case report

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World Journal of Clinical Cases 2024年第8期12卷 1474-1480页

作者： Jun Sun Qing-Ning Yang Yi Guo Ping Zeng Long-Yan Ma Ling-Wen Kong Bo-Ying Zhao Chuan-Ming Li Department of Radiology Chongqing University Central HospitalChongqing Emergency Medical CenterChongqing 400014China Department of Pathology Chongqing University Central HospitalChongqing Emergency Medical CenterChongqing 400014China Department of Cardiothoracic surgery Chongqing University Central HospitalChongqing Emergency Medical CenterChongqing 400014China

BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired *** is usually characterized by well-defined cystic density and is filled with transparent *** SUMMARY We report on a 39-year-old male with a cystic-solid mass in the anterior *** tomography(CT)imaging showed that the mass was irregular with unclear *** injection of contrast agent,there was a slight enhancement of stripes and *** to CT findings,it was diagnosed as thymic *** After surgery,MTC accompanied by bleeding and infection was confirmed by pathological *** main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT *** is necessary in clinical work to avoid misdiagnosis.

关键词： Multilocular thymic cyst Computer tomography Misdiagnosis Hemorrhage Infection Case report

KLF4 Inhibits the Activation of Human Hepatic Stellate Cell In Vitro

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Current Medical Science 2024年第3期44卷 512-518页

作者： Xing-yu YANG Zhe CHEN Jun TAN Yin-kai XUE Hai ZHENG Department of emergency surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Department of Thoracic surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an710061China Department of Thoracic surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China

Objective Hepatic stellate cells(HSCs)play a crucial role in liver ***-stage liver fibrosis is reversible and intimately associated with the state of ***-like factor 4(KLF4)plays a pivotal role in a wide array of physiological and pathological *** study aimed to investigate the effect of KLF4 on the proliferation,apoptosis and phenotype of quiescent HSCs Methods We designed a KLF4 lentiviral vector and a KLF4 siRNA lentiviral vector,to upregulate and silence KLF4 expression in human HSC LX-2 cells via *** proliferation was assessed using the CCK-8 *** cytometry was used to detect the cell cycle distribution and apoptosis *** blotting was used to determine the levels of some quiescence and activation markers of HSCs Results Overexpression of KLF4 significantly increased the levels of E-cadherin and ZO-1,which are quiescent HSC markers,while significantly decreased the levels of N-cadherin and a-SMA,known activated HSC *** contrast,cell proliferation and apoptosis rates were elevated in LX-2 cells in which KLF4 expression was silenced Conclusion KLF4 inhibits the proliferation and activation of human LX-2 *** might be a key regulatory protein in the maintenance of HSC quiescence and may serve as a target for the inhibition of hepatic fibrosis.

关键词： Kruppel-like factor 4 hepatic stellate cells LX-2 cells liver fibrosis

Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy:A singlecenter retrospective study

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World Journal of Gastrointestinal surgery 2024年第7期16卷 2211-2220页

作者： Xi-Ning Zhao Jing Lu Hong-Yong He Sheng-Jin Ge Department of Anesthesiology Zhongshan HospitalFudan UniversityShanghai 200032China Department of Nursing Zhongshan HospitalFudan UniversityShanghai 200032China Department of General surgery/emergency surgery Zhongshan HospitalFudan UniversityShanghai 200032China

BACKGROUND The population of elderly patients with gastric cancer is increasing,which is a major public health issue in *** is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric *** To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical *** A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May *** The overall rate of malnutrition was 31.8%.The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group(P<0.001).Nutritional characteristics in the malnourished group,including body mass index,prognostic nutritional index(PNI),albumin,prealbumin,and hemoglobin,were all significantly lower than those in the well-nourished *** percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the wellnourished group(22.1%vs 33.5%,P=0.001).Age≥70 years(HR=1.216,95%CI:1.048-1.411),PNI<44.5(HR=1.792,95%CI:1.058-3.032),operation time≥160 minutes(HR=1.431,95%CI:1.237-1.656),and postoperative complications grade III or higher(HR=2.191,95%CI:1.604-2.991)were all recognized as independent risk factors associated with delayed *** Malnutrition is relatively common in elderly patients undergoing *** PNI is an independent risk factor associated with delay *** strategies are needed to improve the clinical outcome of these patients.

关键词： Gastric cancer Preoperative nutritional status Malnutrition Elderly Radical gastrectomy

How to identify early complications in patients undergoing distal gastrectomy?

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World Journal of Gastrointestinal surgery 2024年第4期16卷 974-981页

作者： Giuseppe Tropeano Maria Michela Chiarello Valeria Fico Giuseppe Brisinda emergency surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Department of Medical and Surgical Sciences UniversitàCattolica del Sacro CuoreRome 00168Italy

In this editorial we comment on the article by Zhang et al published in a recent issue of the World Journal of Gastrointestinal *** with appropriate lymph node dissection is still standard curative treatment in locally advanced gastric *** studies point out that gastric cancer surgery is a complex procedure that leads to a high risk of morbidity and *** factors can contribute to the onset of complications with consequent effects on prognosis and increased *** complications can be divided in complications related to anastomosis,to motility and to surgical site *** study presented by Zhang B et al represent an interesting analysis on the possibility to prevent postoperative *** study was performed on 131 patients with distal gastric cancer who underwent gastrectomy with D2 lymph node *** these patients,16%developed early postoperative *** univariate analysis showed that prealbumin level,hypertension,diabetes,history of abdominal surgery,R0 resection,and blood transfusion were factors influencing early postoperative complications after distal ***,the inclusion of the above significant variables in the logistic regression analysis revealed that hypertension,diabetes,a history of abdominal surgery,and blood transfusion were independent predictors of postoperative *** conclusion,preoperative and intraoperative factors can be used to establish an early postoperative nomogram *** results of the study presented by Zhang et al suggest that the prediction model can be used to guide the detection of postoperative complications and has clinical reference value.

关键词： Gastric cancer Gastrectomy Lymph node dissection Morbidity Mortality Surgical site infections

Loculated pericardial hematoma diagnosed with point-of-care ultrasound

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World Journal of emergency Medicine 2024年第3期15卷 241-242页

作者： Joaquín Valle Alonso Esther Montoro Leandro Noblia emergency Department Royal Bournemouth HospitalBournemouth 14450UK emergency Department Hospital Santa LuciaCartagena 30202Spain

Pericardial hematoma is a rare but potentially lifethreatening consequence following cardiac surgery that requires prompt recognition and *** can present with symptoms such as chest pain,dyspnea,tachycardia,and hypotension,which may mimic other post-operative *** pericardial hematoma compressing the atria might be difficult to *** and hematoma are more common in patients receiving early anticoagulant therapy.A focused cardiac ultrasound (Fo CUS) plays a pivotal role in the diagnosis,revealing the presence of pericardial effusion and signs of cardiac *** aim of this report was to provide a prompt diagnosis of loculated pericardial hematoma via Fo CUS in the emergency department (ED).

关键词： hematoma diagnosis cardiac

Recovering from prolonged cardiac arrest induced by electric shock:A case report

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World Journal of Clinical Cases 2024年第13期12卷 2248-2253页

作者： Jian Zhang Yan-Ru Qiao Ya-Dong Yang Guo-Zheng Pan Chong-Qing Lv Department of General surgery Shengli Oilfield Central HospitalDongying 257000Shandong ProvinceChina Department of emergency Medicine Shengli Oilfield Central HospitalDongying 257000Shandong ProvinceChina

BACKGROUND Cardiac arrest(CA)induced by electric shock is a rare occurrence,particularly in cases of prolonged ***,there is limited literature on similar incidents,and we present a relevant case *** SUMMARY A 27-year-old Asian male man,experiencing respiratory CA due to electric shock,was successfully restored to sinus rhythm after 50 min of cardiopulmonary resuscitation and 8 electrical defibrillation *** the subsequent stages,the patient received multiple organ function protection measures,leading to a successful recovery and eventual discharge from the *** Prolonging resuscitation time can enhance the chances of survival for patients,this study provide valuable insights into the management of electric shock-induced CA.

关键词： Electric shock Cardiac arrest Prolonged cardiopulmonary resuscitation Cerebral resuscitation Case report