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Practice,training and safety of laparoscopic surgery in low and middle-income countries

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World Journal of Gastrointestinal Surgery 2017年第1期9卷 13-18页

作者： Maryam Alfa-Wali Samuel Osaghae Epsom and St Helier University hospitals University of Benin Teaching Hospital

Surgical management of diseases is recognised as a major unmet need in low and middle-income countries(LMICs). Laparoscopic surgery has been present since the 1980 s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with highincome countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.

关键词： Laparoscopic surgery Global surgery Low and middle-income countries Laparoscopic training Patient safety Laparoscopy Minimally invasive surgery

Employment and Patient Satisfaction after Liver Transplantation

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Journal of Clinical and Translational Hepatology 2020年第3期8卷 299-303页

作者： Christopher Cao Dina Halegoua-DeMarzio Shady Guirguis Crystal Chen Jonathan M.Fenkel Steven Herrine Department of Gastroenterology and Hepatology Thomas Jefferson University HospitalsPhiladelphiaPAUSA

Background and Aims:This study serves to revisit the effects of liver transplantation(LT)on employment in an era of improving survival outcomes post-transplant,and to identify areas of improvement in the transplant process to better optimize post-LT employment and patient ***:Prospectively,patients who had undergone LT at a single tertiary LT center were surveyed in person and by *** outcomes included employment rate pre-and post-LT,annual salary,weekly hours worked,barriers to re-employment,and patient ***:Responses were collected and analyzed from 121 patients who underwent ***-LT,68(56.1%)reported full-time employment,13(10.7%)part-time employment,and 40(33.1%)***-LT,26(21.4%)reported continued full-time employment,18(14.9%)part-time employment,and 77(63.6%)*** weekly work hours decreased post-LT(16.1 h/week vs.39.9 h/week).Mean annual salaries decreased post-LT(17 earning salary≥$40,000 vs.56 earning salary≥$40,000).These outcomes differed from patient pre-LT expectations,with 81.0%of previously employed patients believing they would return to employment,resulting in decreased patient *** working physically demanding jobs pre-LT were less likely to return to *** cited for lack of return to full employment included early fatigue and difficulty regaining physical ***:Re-employment rates remain low post-LT,which is particularly true for patients working physically active *** is a significant barrier to re-employment and increased physical rehabilitation post-LT may prove to be *** should be given realistic expectations about return to employment prior to their LT.

关键词： Liver Transplant Liver transplant Employment Patient satisfaction

Transanal total mesorectal excision: Myths and reality

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World Journal of Clinical Oncology 2016年第5期7卷 337-339页

作者： Nicolas C Buchs Marta Penna Alexander L Bloemendaal Roel Hompes Division of Visceral Surgery Department of Surgery University Hospitals of Geneva Department of Colorectal Surgery Churchill Hospital Oxford University Hospitals

Transanal total mesorectal excision(TaTME) is a new and promising approach for the treatment of rectal cancer. Whilst the experience is still limited, there are growing evidences that this approach might overcome the limits of standard low anterior resection. TaTME might help to decrease the conversion rate especially in difficult patients, and to improve the pathological results, while preserving the urogenital function. Evaluation of data from large registries and randomized studies should help to draw firmer conclusions. Beyond these technical considerations, the next challenge seems to be clearly the safe introduction of this approach, motivating the development of dedicated courses.

关键词： Transanal total mesorectal excision Bottom up TAMIS Laparoscopy Robotic Outcomes Rectal cancer

Anticonvulsant and hypnotic effects of amiodarone

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2009年第4期10卷 317-322页

作者： Gunnur OZBAKIS-DENGIZ Aysegul BAKIRCI Department of Pharmacology Medical Faculty Karaelmas University Department of Infectious Diseases and Clinical Microbiology Public Hospitals

Amiodarone hydrochloride is a potent anti-arrhythmic agent, known as a multiple ion-channel blocker in the heart. Although it has been detected in the rat brain, there are no data related to its central nervous system （CNS） effects. In this study, we evaluated anticonvulsant and hypnotic effects of amiodarone. Convulsions were induced by phentylenetetrazole （PTZ）（100 mg/kg） or caffeine （300 mg/kg） in mice. In both models, amiodarone prolonged both latency period and time to death, and acted as an anticonvulsant drug. It was found to be more effective in the PTZ model than in the caffeine model; none of the animals treated with 150 mg/kg dose amiodarone had died in the PTZ model. For hypnotic effect, sleeping was induced with pentobarbital （35 mg/kg） in rats. Amiodarone dose-dependently increased the sleeping time （677.7%-725.9%）. In the sleeping test, all rats in 200 mg/kg amiodarone group died. In conclusion, anticonvulsant and hypnotic effects of amiodarone have shown the depressant effects on CNS. These effects may be dependent on its pharmacological properties.

关键词： Amiodarone Phentylenetetrazole (PTZ) Caffeine Convulsion Sleeping

Impact of direct-acting antivirals on the recurrence of hepatocellular carcinoma in chronic hepatitis C

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Hepatoma Research 2022年第1期8卷 327-339页

作者： Nikoletta M.Tagkou Nicolas Goossens Francesco Negro Division of Gastroenterology and Hepatology Geneva University HospitalsGeneva 1211Switzerland Division of Clinical Pathology Geneva University HospitalsGeneva 1211Switzerland

Chronic hepatitis C virus(HCV)infection is estimated to affect 56.8 million individuals globally and is a major and independent risk factor for the development of hepatocellular carcinoma(HCC).After the introduction of safe and potent direct-acting antivirals(DAAs),capable of curing HCV infection also in patients with advanced liver disease at high risk of HCC,the beneficial effect on a de novo HCC development after viral clearance has been ***,studies addressing the relationship between DAA-induced eradication and risk of HCC recurrence(i.e.,reappearance of HCC treated before starting antivirals)have produced contradictory data,suggesting either an increase or a decrease of HCC recurrence rate,while some report no effect of these ***,there seems to be an unclear benefit of viral clearance in patients with a history of HCC curative treatment,where the recurrence rate remains worryingly *** short review aims to summarize current evidence on the impact of DAAs on HCC recurrence rates,the pathogenic mechanisms and characteristics of HCC recurrence after DAA treatment,the predictors of tumor recurrence,and the impact of DAAs on overall survival.

关键词： Hepatitis C virus hepatocellular carcinoma liver oncogenesis direct-acting antivirals tumor recurrence

Safe surgical zone during TORS radical tonsillectomy:An anatomical and radiological study

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Laparoscopic, Endoscopic and Robotic Surgery 2020年第2期3卷 34-38页

作者： J.G.Aishwarya Ashish S.Shah Satish Nair Savith Kumar Swetha Kumar K.V.R.Brijith Namrata Srivastava Ameena Ibrahim Department of ENT-HNS Apollo HospitalsBangaloreKarnatakaIndia Department of Neuroradiology and Neurointervention Apollo HospitalsBangaloreKarnatakaIndia

Objective:Parapharyngeal space contains intricate vascular anatomy(external and internal carotid arteries)that might be inadvertently injured during the dissection in this *** of the bony landmarks can be used during the transoral robotic surgery(TORS)radical tonsillectomy as these landmarks lie lateral to the internal carotid artery(ICA)and external carotid artery(ECA)in transoral *** study aims to identify the safe surgical limits during the dissection of parapharyneal space in TORS radical tonsillectomy and to correlate the same with radiological *** and methods:Fifteen cadavers(30 head and neck regions)and 50 CT-Angiogram of neck(100 head and neck regions)were included in the anatomical and radiological study *** vertical midpoint of anterior tonsillar pillar(palatoglossus muscle)was taken as the reference point and all the measurements were done at the level of reference point both for anatomical and radiological *** between tonsillar fossa and ECA,distance between tonsillar fossa and ICA,relation between ECA and styloglossus and relation between ICA and stylopharyngeus at reference level were ***:The mean distance of ECA from the tonsillar fossa at the reference point was 18.2 mm in the anatomical study and 16.2 mm in the radiological *** mean distance of ICA from the tonsillar fossa was 23.4 mm and 23.3 mm in the anatomical study and radiological *** was no significant difference between the anatomical and radiological findings for both the mean distance between ECA and ICA to the tonsillar fossa(p value was 0.45 and 0.30 respectively).ECA was located posterolateral to styloglossus in 24 cases(80.0%)and 79 cases(79.0%)in the anatomical and radiological study *** was found posterolateral to stylopharyngeus in 21 cases(70.0%)and 69 cases(69.0%)in the anatomical and radiological study ***:The muscular plane between styloglossus and stylopharyngeus can be

关键词： Radical tonsillectomy Transoral robotic surgery Parapharyngeal space Styloglossus Stylopharyngeus

Penile metastasis in prostate cancer patients:Two case reports,surgical excision technique,and literature review

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Current Urology 2023年第3期17卷 165-172页

作者： Lucas Landen Gaëtan Devos Steven Joniau Maarten Albersen Department of Urology University Hospitals LeuvenLeuvenBelgium

Two cases of penile metastasis from primary prostate cancer in a single center are presented,along with a literature review and description of the excision *** its rich vascularization,penile metastasis is rare,with 72 new cases from September 2006 to March *** is a wide variety of diagnoses,treatments,and prognoses for penile metastatic ***-68 prostatespecific membrane antigen positron emission tomography/computed tomography is the most sensitive imaging tool for detecting metastasis from primary prostate *** resonance imaging of the penis is the most reliable technique for differentiating penile *** diagnosis is mostly performed using fine-needle biopsy ***-directed treatment is not considered to contribute to prolonged *** treatment is feasible and can be offered to symptomatic *** to a heterogeneous group,defining overall survival is *** until 46months after detecting penile metastases is described.

关键词： Metastasis-directed therapy Oligometastasis Penile metastasis Prostatic neoplasms

Cellular therapy:A promising tool in the future of colorectal surgery

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World Journal of Gastroenterology 2019年第13期25卷 1560-1565页

作者： Mohammed Mohammed El-Said Sameh Hany Emile Colorectal Surgery Unit General Surgery Department Mansoura University Hospitals Mansoura University

Cellular therapy may be the solution of challenging problems in colorectal surgery such as impaired healing leading to anastomotic leakage and metastatic colorectal cancer(CRC). This review aimed to illustrate the role of cellular therapy in promotion of wound healing and management of metastatic CRC. An organized literature search for the role of cellular therapy in promotion of wound healing and management of metastatic CRC was conducted. Electronic databases including PubMed/Medline, Scopus, and Embase were queried for the search process. Two types of cellular therapy have been recognized, the mesenchymal stem cells(MSCs) and bone marrow-mononuclear cells(BM-MNCs) *** cells have been shown to accelerate and promote healing of various tissue injuries in animal and human studies. In addition, experimental studies have reported that MSCs may help suppress the progression of colon cancer in rat models. This article reviews the possible mechanisms of action and clinical utility of MSCs and BM-MNCs in promotion of healing and suppression of tumor growth in light of the published literature. Cellular therapy has a potentially important role in colorectal surgery, particularly in the promotion of wound healing and management of metastatic CRC. Future directions of cellular therapy in colorectal surgery were explored which may help stimulate futures studies on the role of cellular therapy in colorectal surgery.

关键词： Cellular therapy Future Colorectal surgery Stem cells

Liver transplantation for non-resectable colorectal liver metastases

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Hepatobiliary Surgery and Nutrition 2023年第4期12卷 595-597页

作者： Hassan Aziz Saima Sharif Irena Gribovskaja-Rupp Alan W.Hemming University of Iowa hospitals and Clinics Iowa CityIAUSA

At present,there are no absolute practice guidelines for liver transplants in colorectal liver metastases(CRLM),and treatment protocols for unresectable CRLM are institution-specific(1).One of the first prospective studies evaluating the safety of liver transplants for CRLM was the SECA-I trial(1,2).A 5-year overall survival rate of 60% was observed in this trial,which far outperformed survival with chemotherapy alone(3).In the SECA-Ⅱ trial,enrollment was increased,and patients with better prognostic factors,including at least a 10% response to chemotherapy before the transplant,were selected.

关键词： Colorectal liver metastases(CRLM) liver transplant International Hepato-Pancreato-Biliary Association transplant oncology