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Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?

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Stroke & Vascular Neurology 2024年第3期9卷 279-288,I0247页

作者： Adam Ingleton Marko Raseta Rui-En Chung Kevin Jun Hui Kow Jake Weddell Sanjeev Nayak Changez Jadun Zafar Hashim Noman Qayyum Phillip Ferdinand Indira Natarajan Christine Roffe Neurosciences University Hospitals of North Midlands NHS TrustStoke-on TrentUK Statistics and Mathematical Modelling Department of Molecular GeneticsErasmus Medical CenterRotterdamZuid-HollandThe Netherlands Radiology University Hospitals of North Midlands NHS TrustStoke-on TrentUK School of Medicine Keele UniversityKeeleUK Interventional Radiology University Hospitals of North Midlands NHS TrustStoke-on TrentUK Stroke Research Keele UniversityKeeleUK

Background Intraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy(MT).Most patients undergoing MT are also given *** agents are contraindicated within 24 hours of *** evaluated outcomes and complications of patients stented with and without intravenous aspirin during *** All patients who underwent emergent extracranial stenting during MT at the Royal Stoke university hospital,UK between 2010 and 2020,were *** were thrombolysed before MT,unless *** 500 mg intravenously was given intraoperatively at the discretion of the *** intracranial haemorrhage(sICH)and the National Institutes for Health Stroke Scale score(NIHSS)were recorded at 7 days,and mortality and functional recovery(modified Rankin Scale:mRS≤2)at 90 *** Out of 565 patients treated by MT 102 patients(median age 67 IQR 57–72 years,baseline median NIHSS 18 IQR 13–23,76(75%)thrombolysed)had a stent *** these 49(48%)were given aspirin and 53(52%)were *** treated with aspirin had greater NIHSS improvement(median 8 IQR 1–16 vs median 3 IQR-9–8 points,p=0.003),but there were no significant differences in sICH(2/49(4%)vs 9/53(17%)),mRS≤2(25/49(51%)vs 19/53(36%))and mortality(10/49(20%)vs 12/53(23%))with and without *** improvement(median 12 IQR 4–18 vs median 7 IQR-7–10,p=0.01)was greater,and mortality was lower(4/33(12%)vs 6/15(40%),p=0.05)when aspirin was combined with thrombolysis,than for aspirin alone,with no increase in *** Our findings based on registry data derived from routine clinical care suggest that intraprocedural intravenous aspirin in patients undergoing emergent stenting during MT does not increase sICH and is associated with good clinical outcomes,even when combined with intravenous thrombolysis.

关键词： patients aspirin intravenous

Using clinical cases to guide healthcare

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World Journal of Clinical Cases 2024年第9期12卷 1555-1559页

作者： Michael Colwill Samantha Baillie Richard Pollok Andrew Poullis Department of Gastroenterology St George's University Hospital NHS Foundation TrustLondon SW170QTUnited Kingdom

Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their *** well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support ***-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare *** series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming *** are also vital in generating and disseminating early signals and encouraging further *** these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

关键词： Evidence based medicine Hierarchy of evidence Case reports Case series

Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

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World Journal of Gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis Translational Gastroenterology and Liver Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic *** disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary *** the last century,owing to migration,its global incidence has *** main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic *** classifications have aimed at providing useful insight of clinically relevant aspects and guidance for *** management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious *** comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant Paediatric

Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer

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World Journal of Gastroenterology 2024年第32期30卷 3739-3742页

作者： Gaetano Piccolo Matteo Barabino Guglielmo NiccolòPiozzi Paolo Pietro Bianchi Department of Health Sciences(DISS) University of MilanSan Paolo HospitalMilan 20142LombardyItaly Department of Colorectal Surgery Portsmouth Hospitals University NHS TrustPortsmouthUnited Kingdom

Gallbladder cancer(GBC)is a rare disease with a poor *** cholecystectomy may be an adequate treatment only for very early disease(Tis,T1a),whereas reoperation is recommended for more advanced disease(T1b and T2).Radical cholecystectomy should have two fundamental objectives:To radically resect the liver parenchyma and to achieve adequate clearance of the lymph ***,recent studies have shown that compared with lymph node dissection alone,liver resection does not improve survival *** oncological roles of lymphadenectomy and liver resection is ***,for patients with incidental GBC without liver invasion,hepatic resection is not always mandatory.

关键词： Incidental gallbladder cancer Reoperation Radical cholecystectomy Early stage Liver resection

Endoscopic treatment of scarred polyps with a non-thermal device(Endorotor):A review of the literature

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World Journal of Gastroenterology 2024年第12期30卷 1706-1713页

作者： Mariam Zaghloul Hameed Rehman Stefano Sansone Konstantinos Argyriou Adolfo Parra-Blanco Department of Hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversitKafr-Elshikh 33516Egypt Department of Gastroenterology Service Nottingham City Hospital CampusNottingham University Hospitals NHS TrustNottingham NG51PBUnited Kingdom Department of Gastroenterology University Hospital of LarissaLarissa 41334Greece NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and University of NottinghamNottingham NG72UHUnited Kingdom

Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic *** procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness *** resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these *** EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such *** EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA *** review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.

关键词： EndoRotor Scarred polyps Recurrent polyps Colorectal cancer Colorectal polyps

Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

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World Journal of Diabetes 2024年第4期15卷 598-605页

作者： Vasileios K Mavroeidis Jennifer Knapton Francesca Saffioti Daniel L Morganstein Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal Surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal Unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic *** centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved *** this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic *** 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and *** preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative *** incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe *** involvement of a specialist diabetes team is essential to ensure a holistic *** the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve *** various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required *** need for perioperative support of diabetic

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

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Asian Journal of Urology 2024年第1期11卷 1-9页

作者： Panagiotis Kallidonis Angelis Peteinaris Gernot Ortner Kostantinos Pagonis Costantinos Adamou Athanasios Vagionis Evangelos Liatsikos Bhaskar Somani Theodoros Tokas Department of Urology University Hospital of RionPatrasGreece Department of Urology and Andrology General Hospital Hall I.T.Hall in TirolAustria Medical university of Vienna ViennaAustria Department of Urology University Hospital Southampton NHS Foundation TrustSouthamptonUK

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological *** kind of surgery demands a set of skills that need training and *** this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching ***:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic *** out of 932 studies met our inclusion criteria and are presented in the current ***:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the *** inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical *** construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was *** simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate *** test objective competency model based on SIMBLA simulator could be used for evaluating *** porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried *** Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the *** 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the ***:Simulators and courses or curricula based on a simulator training could be a valuable learning tool fo

关键词： Simulator Train Curriculum Transurethral resection Vaporesection Laser Bladder

Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

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World Journal of Stem Cells 2024年第4期16卷 324-333页

作者： Ilias E Epanomeritakis Wasim S Khan Division of Trauma and Orthopaedic Surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom Division of Trauma and Orthopaedic Surgery Department of SurgeryUniversity of CambridgeCambridge CB20QQUnited Kingdom

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying *** treatment ultimately requires joint *** capable of regenerating cartilage could significantly reduce financial and clinical *** regenerative potential of mesenchymal stromal cells(MSCs)has been extensively studied in the context of knee *** has yielded promising results in human studies,and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to ***-derived MSCs(ASCs)are becoming increasingly popular owing to their relative ease of isolation and high proliferative *** vascular fraction(SVF)and micro-fragmented adipose tissue(MFAT)are produced by the enzymatic and mechanical disruption of adipose tissue,*** avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations,including immune cells,may potentiate the reparative function of *** this editorial,we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee *** discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative *** underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs,SVF,and MFAT.

关键词： Knee osteoarthritis Mesenchymal stromal cells Adipose tissue Stromal vascular fraction Micro-fragmented adipose tissue Regeneration

Safety of tranexamic acid in surgically treated isolated spine trauma

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World Journal of Orthopedics 2024年第4期15卷 346-354页

作者： Wajiha Zahra Sandeep Krishan Nayar Ashwin Bhadresha Vinay Jasani Syed Aftab Trauma and Orthopedics Department University Hospital of North Midlands NHS TrustStoke-on-Trent ST46QGUnited Kingdom Trauma and Orthopedics Department Royal London HospitalBarts Health InstituteLondon E11BBUnited Kingdom Craniospinal Services University Hospital of North Midlands NHS TrustStokeon-Trent ST46QGUnited Kingdom Spine Department Royal London HospitalBarts Health InstituteLondon E11BBUnited Kingdom

BACKGROUND Tranexamic acid(TXA),a synthetic antifibrinolytic drug,effectively reduces blood loss by inhibiting plasmin-induced fibrin *** is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine *** To assess the safety of TXA in isolated spine *** primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion,*** This prospective observational study included patients aged≥17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United *** We identified 67 patients:26(39%)and 41(61%)received and did not receive TXA,*** groups were matched in terms of age,gender,American Society of Anesthesiologists grade,and mechanism of injury.A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score>4(74%vs 56%).All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min,compared with 24 patients(58%)in the non TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 *** patients who received TXA,blood loss was<150 and 150–300 mL in 8(31%)and 15(58%)patients,*** were no cases of thromboembolic events in any patient who received *** Our study demonstrated that TXA is safe for isolated spine *** is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel ***,larger studies are necessary to explore the rate,dosage,and mode of administration of TXA.

关键词： Tranexamic acid Infection Trauma Thromboembolic disease Minimally invasive Percutaneous