Adolescent smoking constitutes a critical public health challenge as early initiation increases the risk of premature mortality and smoking-related chronic diseases due to longer exposure and higher cumulative tobacco...Adolescent smoking constitutes a critical public health challenge as early initiation increases the risk of premature mortality and smoking-related chronic diseases due to longer exposure and higher cumulative tobacco use[1].Adolescents are especially prone to developing persistent smoking habits,with many adult smokers having started before the age of 18.In China,16.7%of secondary school students have tried smoking and 4.7%are current smokers,highlighting the critical need for targeted tobacco control interventions among the youth.展开更多
BACKGROUND Mirizzi syndrome(MS)type Vb is an exceptionally rare and advanced form of gallstone disease characterized by the presence of a cholecystoenteric fistula associated with gastrointestinal obstruction.Its pres...BACKGROUND Mirizzi syndrome(MS)type Vb is an exceptionally rare and advanced form of gallstone disease characterized by the presence of a cholecystoenteric fistula associated with gastrointestinal obstruction.Its presentation as gastric outlet obstruction is uncommon and poses significant diagnostic and surgical challenges.CASE SUMMARY We report the case of a 36-year-old woman who presented with progressive vomiting,intolerance to solid food,and significant weight loss.Preoperative investigations revealed gastric outlet obstruction and features of chronic gallstone disease;however,the exact etiology remained unclear.Intraoperatively,a cholecystogastric fistula with migrated gallstones and severe cicatricial deformation of the pyloroduodenal region was identified,consistent with MS type Vb.The patient underwent distal gastrectomy with Billroth II reconstruction,cholecystectomy,exploration of the common bile duct,and intraoperative cholangiography.The postoperative course was uneventful,with complete resolution of symptoms.CONCLUSION MS type Vb should be considered a rare cause of gastric outlet obstruction in patients with long-standing gallstone disease.Definitive diagnosis is often established intraoperatively,and surgical management should be individualized based on the extent of inflammatory and structural changes to achieve favorable outcomes.展开更多
To provide advanced diagnostic techniques for diagnosing the outlet temperature distribution and species concentrations of future advanced combustors,this study focuses on a dual-swirl single-dome rectangular combusto...To provide advanced diagnostic techniques for diagnosing the outlet temperature distribution and species concentrations of future advanced combustors,this study focuses on a dual-swirl single-dome rectangular combustor.Through the integration of multiple diagnostics,simultaneous measurement of outlet temperature distribution and species concentrations was achieved.The study validates the engineering applicability of these simultaneous measurements using tungsten-rhenium(W-Re)thermocouples and Coherent Anti-Stokes Raman Scattering(CARS),CARS and Tunable Diode Laser Absorption Spectroscopy(TDLAS),as well as Gas Analysis(GA)and Mass Spectrometry(MS).The results demonstrate that measurements by thermocouples and CARS exhibit good consistency and repeatability,with a relative deviation of less than 4%,fully meeting the requirements of engineering experiments.The spatial distribution reconstruction results of TDLAS can reflect the temperature distribution characteristics at the combustor outlet.Temperature comparison between TDLAS and CARS at single-point positions shows consistent results,with a relative deviation of less than 11%and 7%under both conditions,respectively.Simultaneous measurements by integrating GA and MS show high engineering applicability for the first time,meeting the requirements for measuring both inorganic species and free radicals at the combustor outlet.Under C1condition,the relative deviations of four key species(Unburned Hydrocarbon(UHC),NO,O2,and CO2)remain within 2%,while that of NO2is slightly higher at approximately 8%.Under C2condition,the overall deviations increase for most species,with only O2and CO2maintaining relatively low deviations.The primary species of UHCs at the combustor outlet under both conditions are small molecular hydrocarbons(C3-C8)and RO2radicals,accounting for over 90%of total UHC.Specifically,RO2species(R is C1-C2alkyl groups)are the predominant species,accounting for 74.3%and 82.1%of total RO2under both conditions,respectively.These integrated diagnostic methods for temperature and species concentrations at the combustor outlet serve as a crucial reference for its engineering applications.展开更多
Background:We evaluated surgical outcomes of biventricular repair for atrioventricular septal defect(AVSD)with tetralogy of Fallot(TOF)or double-outlet right ventricle(DORV).Methods:This retrospective pilot study incl...Background:We evaluated surgical outcomes of biventricular repair for atrioventricular septal defect(AVSD)with tetralogy of Fallot(TOF)or double-outlet right ventricle(DORV).Methods:This retrospective pilot study included 12 patients who underwent biventricular repair of AVSD with TOF(n=6)or DORV(n=6)between 2004 and 2023.Right ventricular outflow tract(RVOT)reconstruction was performed using transannular patch(TAP,n=4)or pulmonary valve preservation(PVP,n=8).Clinical outcomes,including longitudinal pulmonary valve growth,RVOT obstruction,and pulmonary regurgitation,were reviewed descriptively,with particular focus on the feasibility of PVP.Results:The median age and body weight at the time of surgery were 11.7(8.3-18.8)months and 8.6(7.3-10.5)kg,respectively.The median follow-up duration was 67.9(58.7-174.3)months.The two-patch technique(n=10)was most commonly used for AVSD repair.There were no early mortalities and one late mortality.At discharge,significant(≥36 mmHg)RVOT obstruction was observed in two patients who underwent PVP.During follow-up,one patient required reoperation for significant(moderate or greater)atrioventricular valve regurgitation,and two patients in the PVP group underwent transcatheter intervention for significant RVOT obstruction.At the last follow-up,significant RVOT obstruction was present in two patients.Significant(moderate or greater)pulmonary regurgitation occurred in three patients in the TAP group.In patients who underwent PVP,the pulmonary valve annulus z-score remained within acceptable ranges,and the RVOT pressure gradient predominantly decreased to acceptable levels during follow-up.Conclusions:Mid-term outcomes of PVP in the biventricular repair of AVSD with TOF or DORV are acceptable.In selected patients,the PVP strategy may be considered a reasonable and feasible option for RVOT reconstruction.展开更多
Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the ...Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the potential mechanisms of action of XP.The rats underwent bladder outlet obstruction surgery and were administered the corresponding drug concentrations by gavage for 4 weeks.The study observed the body weight,water intake,bladder and kidney indices(to evaluate their general status),urination behavior pattern(to observe frequency and urgency),and urodynamics(to measure bladder parameters).Hematoxylin and eosin and Masson's trichome staining were used to observe changes in the bladder structure.Enzyme-linked immunosorbent assay was used to measure the levels of nerve growth factor,brain-derived neurotrophic factor,and acetylcholine in the urine.The key targets involved in these mechanisms were validated using reverse transcription-quantitative polymerase chain reaction,immunohistochemistry,and western blot in vivo/vitro experiments.Result:Network pharmacological analysis predicted that XP may alleviate OAB by affecting the cholinergic synapse and calcium signaling pathways.XP treatment significantly reduced the bladder index,improved urine behavior and urodynamic parameters,decreased the neurotransmitters in urine,and reduced the thickness of the bladder wall and collagen ratio.These results indicate that XP can alleviate OAB symptoms and improve the bladder structure.In vivo/vitro experiments further demonstrated that XP can inhibit targets,such as muscarinic acetylcholine receptor 2,and participate in cholinergic synapses to further regulate the parasympathetic nervous system.It can also reduce the overexpression of Ca2+ caused by agonists,inhibit targets such as transient receptor potential vanilloid type 1,and participate in calcium signaling pathways to maintain Ca2+ homeostasis.Conclusion:These results suggest that XP inhibited bladder overactivity by maintaining Ca2+ homeostasis and regulating the parasympathetic nervous system.展开更多
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojeju...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojejunostomy(SGJ)and the minimally invasive nature of endoscopic methods.Compared to enteral stenting,EUS-GE shows superior outcomes,including higher long-term patency,lower symptom recurrence,and fewer reinterventions.It also demonstrates comparable or better efficacy than SGJ,with faster oral intake,shorter hospital stays,and reduced complications.However,EUS-GE requires specialized expertise,and long-term outcome data remain limited,so further research is needed to refine protocols and optimize patient selection.展开更多
Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,...Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.展开更多
The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.Wi...The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.With technical success rates close to 96%,stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents.Understanding the correct concept of palliation is the need of the hour in management.Identifying the right patient for palliation,selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care.Also,newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.展开更多
Background:Bladder outlet obstruction(BOO)is a prevalent urinary system disease main caused by benign prostatic hyperplasia(BPH)in males.Traditional Chinese medicine(TCM)Danzhi qing’e decoction(DZQE)has the functions...Background:Bladder outlet obstruction(BOO)is a prevalent urinary system disease main caused by benign prostatic hyperplasia(BPH)in males.Traditional Chinese medicine(TCM)Danzhi qing’e decoction(DZQE)has the functions of strengthening“Yang Qi”(one of the fundamental concept in TCM,representing the active,warming,and energizing force within the body.It governs physiological functions,maintains body temperature,and promotes vitality.Balanced“Yang Qi”supports immunity and metabolism,while deficiency may lead to fatigue,cold intolerance,or weakened resilience),promoting blood circulation,and removing blood stasis,and nourishing yin based on the TCM theory.Previous studies have found that it significantly improved BPH and regulate urinary function in estrogen and androgen-induced rats.However,it is unclear whether DZQE has an inhibitory effect on BOO rats.Methods:Male Wistar rats underwent retropubic partial bladder neck ligation to induce BOO.DZQE extract(2.7/5.4 g/kg)was administered orally for 35 days.Anesthetized rats underwent cystometry to assess BOO and treatment effects on urinary parameters.Bladder histopathology,fibrosis,and PCNA expression were evaluated via HE,Masson’s,and IHC staining.Western blot quantified bladder tissue levels of choline acetyltransferase(ChAT),rho-associated protein kinase 1(ROCK1),myosin light chain kinase(MLCK),myosin light chain 2(MLC-2),extracellular signal-regulated kinase(ERK),proliferating cell nuclear antigen(PCNA),B-cell lymphoma-2(Bcl-2),and Bcl-2 related X protein(Bax).Primary bladder smooth muscle cells were cultured,exposed to hydrostatic pressure(HP,3 h/24 h)using a custom apparatus to mimic BOO,and treated with DZQE components for Western blot analysis of ROCK1,MLCK,ERK,PCNA,and Bax.Results:The bladder hyperplasia,bladder index(BI)increased,and histopathological alteration were easily observed in BOO group,which were significantly inhibited by DZQE administration.DZQE also significantly inhibited the up-regulation of maximum voiding pressure(MVP)and down-regulation of residual urine volume(RV)observed in BOO rats.The expressions of ChAT and MLCK and the activation of ERK were much increased,while the expressions of ROCK1,MLC-2 and Bax were obviously decreased in BOO rats,all of which were then significantly inhibited by DZQE.In rat bladder smooth muscle cells(RBSMC),3 h or 24 h duration of HP successfully simulated the BOO compensation and decompensation respectively in vitro.DZQE or its active components reduced the abnormal gene expressions in HP stimulated RBSMC.Conclusion:DZQE improves the urinary function in BOO rats mainly through the activation of ERK.Bakuchiol,salvianolic acid A,kaempferol,and tanshinoneⅡA are possibly the important active components of its therapeutic effects.展开更多
BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can ca...BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can cause complications ranging from mild symptoms to severe issues like gastric outlet obstruction(GOO).This report discusses a 39-year-old woman who presented with clinical and radiological features of GOO post Silimed IGB placement.CASE SUMMARY A 39-year-old woman presented to our institution with two-week history of abdominal pain,nausea and vomiting post prandially.This was in the context of a Silimed IGB placement two weeks prior to presentation for weight loss in the context of obesity.A computed tomography of the abdomen demonstrated the IGB device in the body and prepyloric region,with proximal dilatation of the body and fundus of the stomach which contained gastric contents.Due to concerns for GOO,the IGB was removed endoscopically with subsequent symptom alleviation.In addition to this,we performed a literature search of cases of IGB related GOO using the PubMed and Web of Science databases from inception date to the August 26,2024.A total of 27 articles were included in the analysis,identifying 29 cases of IGB-related GOO.These patients commonly presented with nausea,vomiting and abdominal pain,with symptom onset varying from 3 days to 18 months post IGB insertion.Abdominal computed tomography was the primary diagnostic tool and endoscopic removal was the standard treatment modality.CONCLUSION This is the first reported case of GOO caused by Silimed IGB.While effective for weight reduction,IGB-related GOO is a rare but serious complication,usually requiring endoscopic retrieval.Future research should aim to identify patient factors linked to this complication to enhance clinical-decision making and outcomes.展开更多
BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic o...BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic or periampullary cancers.In this study,we report a case of GP with the rare symptom of severe gastric outlet obstruction.CASE SUMMARY A 68-year-old man presented to our institution with severe gastric outlet obstruction accompanied by vomiting persisted for 3 days,severe electrolyte imbalance,and altered mental status with cardiac arrest.Differential diagnosis of cancers of the ampulla of Vater or duodenum was difficult due to discordant findings from preoperative imaging and an endoscopic biopsy of the lesion.In addition,the gastric outlet obstruction did not improve with conservative treatment;therefore,pancreatoduodenectomy was performed.Postoperatively,the histological findings revealed multiple cystic lesions in the duodenal wall that were collectively diagnosed as GP.The patient underwent a follow-up 3 years postoperatively and was found to have no postoperative sequelae.CONCLUSION In this case of GP,pancreatoduodenectomy safely treated severe gastric outlet obstruction when a cancer diagnosis could not be excluded.展开更多
To compare the impact of transurethral resection of prostate (TURP) on symptom scores and maximal flow rates (Qmax) in patients with equivocal bladder outlet obstruction (BOO) and definite BOO and to assess the ...To compare the impact of transurethral resection of prostate (TURP) on symptom scores and maximal flow rates (Qmax) in patients with equivocal bladder outlet obstruction (BOO) and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index (BOO1) greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual volume (PVR) check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive (IPSSO) and irritative (IPSSI) subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients' symptoms should be considered in deciding treatment modality.展开更多
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting ...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.展开更多
AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obs...AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.展开更多
The existing research of the deep-well centrifugal pump mainly focuses on reduce the manufacturing cost and improve the pump performance, and how to combine above two aspects together is the most difficult and importa...The existing research of the deep-well centrifugal pump mainly focuses on reduce the manufacturing cost and improve the pump performance, and how to combine above two aspects together is the most difficult and important topic. In this study, the performances of the deep-well centrifugal pump with four different impeller outlet widths are studied by the numerical, theoretical and experimental methods in this paper. Two stages deep-well centrifugal pump equipped with different impellers are simulated employing the commercial CFD software to solve the Navier-Stokes equations for three-dimensional incompressible steady flow. The sensitivity analyses of the grid size and turbulence model have been performed to improve numerical accuracy. The flow field distributions are acquired and compared under the design operating conditions, including the static pressure, turbulence kinetic energy and velocity. The prototype is manufactured and tested to certify the numerical predicted performance. The numerical results of pump performance are higher than the test results, but their change trends have an acceptable agreement with each other. The performance results indicted that the oversize impeller outlet width leads to poor pump performances and increasing shaft power. Changing the performance of deep-well centrifugal pump by alter impeller outlet width is practicable and convenient, which is worth popularizing in the engineering application. The proposed research enhances the theoretical basis of pump design to improve the performance and reduce the manufacturing cost of deep-well centrifugal pump.展开更多
A 46-year-old Chinese woman presented with nausea, recurrent vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor at the prepyloric area on the posterior wall of...A 46-year-old Chinese woman presented with nausea, recurrent vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor at the prepyloric area on the posterior wall of the stomach. A degenerated gastrointestinal stromal tumor was suspected. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas (HPs) was confirmed. The patient had an uneventful postoperative course and was discharged 7 d a^er operation. The patient remains healthy and symptom-free in the follow-up of 6 mo. This is a report of a case of gastric outlet obstruction resulting from pancreatic heterotopia in the gastric antrum in an adult woman.展开更多
AIM: To provide an overview of the clinical outcomes of self-expandable metal stent(SEMS) placement for malignant gastric outlet obstruction(MGOO).METHODS: A systematic literature search was performed in Pub Med of th...AIM: To provide an overview of the clinical outcomes of self-expandable metal stent(SEMS) placement for malignant gastric outlet obstruction(MGOO).METHODS: A systematic literature search was performed in Pub Med of the literature published between January 2009 and March 2015. Only prospective studies that reported on the clinical success of stent placement for MGOO were included. The primary endpoint was clinical success,defined according to the definition used in the original article. Data were pooled and analyzed using descriptive statistics. Subgroup analyses were performed for partially covered SEMSs(PCSEMSs) and uncovered SEMSs(UCSEMSs) using Fisher's exact test.RESULTS: A total of 19 studies,including 1281 patients,were included in the final analysis. Gastric(42%) and pancreatic(37%) cancer were the main causes of MGOO. UCSEMSs were used in 76% of patients and PCSEMSs in 24%. The overall pooled technical success rate was 97.3% and the clinical success rate was 85.7%. Stent dysfunction occurred in 19.6% of patients,mainly caused by re-obstruction(12.6%) and stent migration(4.3%),and was comparable between PCSEMSs and UCSEMSs(21.2% vs 19.1%,respectively,P = 0.412). Re-obstruction was more common with UCSEMSs(14.9% vs 5.1%,P < 0.001) and stent migration was more frequent after PCSEMS placement(10.9% vs 2.2%,P < 0.001). The overall perforation rate was 1.2%. Bleeding was reported in 4.1% of patients,including major bleeding in 0.8%. The median stent patency ranged from 68 to 307 d in five studies. The median overall survival ranged from 49 to 183 d in 13 studies.CONCLUSION: The clinical outcomes in this large population showed that enteral stent placement was feasible,effective and safe. Therefore,stent placement is a valid treatment option for the palliation of MGOO.展开更多
Objective:To avoid perioperative complications caused malnutrition,nutrition therapy is necessary in gastric outlet obstruction(GOO)patients.Compared to parenteral nutrition(PN),enteral nutrition(EN)is associated with...Objective:To avoid perioperative complications caused malnutrition,nutrition therapy is necessary in gastric outlet obstruction(GOO)patients.Compared to parenteral nutrition(PN),enteral nutrition(EN)is associated with many advantages.This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery.Methods:According to the methods of preoperative nutrition therapy,143 patients were divided into EN group(n=42)and PN group(n=101)between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital.Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage.The generalized additive model and twopiecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group.Results:EN shortened the postoperative day of flatus passage in gastric cancer patients with GOO,which is a protective factor,especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy(>3 d)did not accelerate the postoperative recovery of gastrointestinal functions.Conclusions:Preoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery.For patients with absolute obstruction,no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.展开更多
AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review...AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.展开更多
Transport of organic carbon via rivers to estuary is a significant geochemical proc- ess in the global carbon cycle. This paper presents bulk total organic carbon (TOC) from the Dongjiang catchment to the adjacent H...Transport of organic carbon via rivers to estuary is a significant geochemical proc- ess in the global carbon cycle. This paper presents bulk total organic carbon (TOC) from the Dongjiang catchment to the adjacent Humen outlet, and discusses the applicability of 613C and ratio of carbon to nitrogen (C/N) as indicators for sources of organic matter in the surface sediments. Survey results showed that organic carbon concentration in summer were higher than in the winter. An elevated trend of TOC occurred along the river to the Humen outlet in both surveys, and the highest mean values of dissolved and particular organic carbon (DOC-279 μmol L-1 and POC-163μmol L-1) were observed in the urban deltaic region in summer flood flow. Winter samples had a wide range of b'13C and C/N (5-3C -24.6%o to -30.0%o, C/N 4-13), and summer ones varied slightly (8-3C -24.2%o to -27.6%0, C/N 6-18). As results suggest that POC in the three zones of upstream-delta-outlet dominantly came from riverbank soil, phytoplankton and agricultural C3 plants in winter, whereas main sources were from the riverbank and mangrove soil in summer. Moreover, anthropogenic sewage inputs had 11% and 7% contribution to POC in the deltaic and outlet. Transport accompanied with seasonal freshwater variation, phytoplankton production and degradation, and removal be- havior caused variation of organic carbon concentration. The results also discovered that TOC export bulk in Dongjiang was approximately one quarter of Humen flux in the dry flow, and anthropogenic activity significantly impacted the river export contribution.展开更多
基金supported by the World Health Organization Global Youth Tobacco Survey(WPDHP1206671)the Global Health Capacity Building and Tobacco Control Project:Tobacco Epidemic Monitoring and Comprehensive Tobacco Control Intervention。
摘要Adolescent smoking constitutes a critical public health challenge as early initiation increases the risk of premature mortality and smoking-related chronic diseases due to longer exposure and higher cumulative tobacco use[1].Adolescents are especially prone to developing persistent smoking habits,with many adult smokers having started before the age of 18.In China,16.7%of secondary school students have tried smoking and 4.7%are current smokers,highlighting the critical need for targeted tobacco control interventions among the youth.
摘要BACKGROUND Mirizzi syndrome(MS)type Vb is an exceptionally rare and advanced form of gallstone disease characterized by the presence of a cholecystoenteric fistula associated with gastrointestinal obstruction.Its presentation as gastric outlet obstruction is uncommon and poses significant diagnostic and surgical challenges.CASE SUMMARY We report the case of a 36-year-old woman who presented with progressive vomiting,intolerance to solid food,and significant weight loss.Preoperative investigations revealed gastric outlet obstruction and features of chronic gallstone disease;however,the exact etiology remained unclear.Intraoperatively,a cholecystogastric fistula with migrated gallstones and severe cicatricial deformation of the pyloroduodenal region was identified,consistent with MS type Vb.The patient underwent distal gastrectomy with Billroth II reconstruction,cholecystectomy,exploration of the common bile duct,and intraoperative cholangiography.The postoperative course was uneventful,with complete resolution of symptoms.CONCLUSION MS type Vb should be considered a rare cause of gastric outlet obstruction in patients with long-standing gallstone disease.Definitive diagnosis is often established intraoperatively,and surgical management should be individualized based on the extent of inflammatory and structural changes to achieve favorable outcomes.
基金support of the National Major Science and Technology Projects of China(No.J2019-V-0005-0096)the National Key Research and Development Program of China(No.2020YFA0405700).
摘要To provide advanced diagnostic techniques for diagnosing the outlet temperature distribution and species concentrations of future advanced combustors,this study focuses on a dual-swirl single-dome rectangular combustor.Through the integration of multiple diagnostics,simultaneous measurement of outlet temperature distribution and species concentrations was achieved.The study validates the engineering applicability of these simultaneous measurements using tungsten-rhenium(W-Re)thermocouples and Coherent Anti-Stokes Raman Scattering(CARS),CARS and Tunable Diode Laser Absorption Spectroscopy(TDLAS),as well as Gas Analysis(GA)and Mass Spectrometry(MS).The results demonstrate that measurements by thermocouples and CARS exhibit good consistency and repeatability,with a relative deviation of less than 4%,fully meeting the requirements of engineering experiments.The spatial distribution reconstruction results of TDLAS can reflect the temperature distribution characteristics at the combustor outlet.Temperature comparison between TDLAS and CARS at single-point positions shows consistent results,with a relative deviation of less than 11%and 7%under both conditions,respectively.Simultaneous measurements by integrating GA and MS show high engineering applicability for the first time,meeting the requirements for measuring both inorganic species and free radicals at the combustor outlet.Under C1condition,the relative deviations of four key species(Unburned Hydrocarbon(UHC),NO,O2,and CO2)remain within 2%,while that of NO2is slightly higher at approximately 8%.Under C2condition,the overall deviations increase for most species,with only O2and CO2maintaining relatively low deviations.The primary species of UHCs at the combustor outlet under both conditions are small molecular hydrocarbons(C3-C8)and RO2radicals,accounting for over 90%of total UHC.Specifically,RO2species(R is C1-C2alkyl groups)are the predominant species,accounting for 74.3%and 82.1%of total RO2under both conditions,respectively.These integrated diagnostic methods for temperature and species concentrations at the combustor outlet serve as a crucial reference for its engineering applications.
摘要Background:We evaluated surgical outcomes of biventricular repair for atrioventricular septal defect(AVSD)with tetralogy of Fallot(TOF)or double-outlet right ventricle(DORV).Methods:This retrospective pilot study included 12 patients who underwent biventricular repair of AVSD with TOF(n=6)or DORV(n=6)between 2004 and 2023.Right ventricular outflow tract(RVOT)reconstruction was performed using transannular patch(TAP,n=4)or pulmonary valve preservation(PVP,n=8).Clinical outcomes,including longitudinal pulmonary valve growth,RVOT obstruction,and pulmonary regurgitation,were reviewed descriptively,with particular focus on the feasibility of PVP.Results:The median age and body weight at the time of surgery were 11.7(8.3-18.8)months and 8.6(7.3-10.5)kg,respectively.The median follow-up duration was 67.9(58.7-174.3)months.The two-patch technique(n=10)was most commonly used for AVSD repair.There were no early mortalities and one late mortality.At discharge,significant(≥36 mmHg)RVOT obstruction was observed in two patients who underwent PVP.During follow-up,one patient required reoperation for significant(moderate or greater)atrioventricular valve regurgitation,and two patients in the PVP group underwent transcatheter intervention for significant RVOT obstruction.At the last follow-up,significant RVOT obstruction was present in two patients.Significant(moderate or greater)pulmonary regurgitation occurred in three patients in the TAP group.In patients who underwent PVP,the pulmonary valve annulus z-score remained within acceptable ranges,and the RVOT pressure gradient predominantly decreased to acceptable levels during follow-up.Conclusions:Mid-term outcomes of PVP in the biventricular repair of AVSD with TOF or DORV are acceptable.In selected patients,the PVP strategy may be considered a reasonable and feasible option for RVOT reconstruction.
基金supported by the Natural Science Foundation in Xinjiang Uygur Autonomous Region(Urumqi,China,2023D01F38).
摘要Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the potential mechanisms of action of XP.The rats underwent bladder outlet obstruction surgery and were administered the corresponding drug concentrations by gavage for 4 weeks.The study observed the body weight,water intake,bladder and kidney indices(to evaluate their general status),urination behavior pattern(to observe frequency and urgency),and urodynamics(to measure bladder parameters).Hematoxylin and eosin and Masson's trichome staining were used to observe changes in the bladder structure.Enzyme-linked immunosorbent assay was used to measure the levels of nerve growth factor,brain-derived neurotrophic factor,and acetylcholine in the urine.The key targets involved in these mechanisms were validated using reverse transcription-quantitative polymerase chain reaction,immunohistochemistry,and western blot in vivo/vitro experiments.Result:Network pharmacological analysis predicted that XP may alleviate OAB by affecting the cholinergic synapse and calcium signaling pathways.XP treatment significantly reduced the bladder index,improved urine behavior and urodynamic parameters,decreased the neurotransmitters in urine,and reduced the thickness of the bladder wall and collagen ratio.These results indicate that XP can alleviate OAB symptoms and improve the bladder structure.In vivo/vitro experiments further demonstrated that XP can inhibit targets,such as muscarinic acetylcholine receptor 2,and participate in cholinergic synapses to further regulate the parasympathetic nervous system.It can also reduce the overexpression of Ca2+ caused by agonists,inhibit targets such as transient receptor potential vanilloid type 1,and participate in calcium signaling pathways to maintain Ca2+ homeostasis.Conclusion:These results suggest that XP inhibited bladder overactivity by maintaining Ca2+ homeostasis and regulating the parasympathetic nervous system.
摘要Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojejunostomy(SGJ)and the minimally invasive nature of endoscopic methods.Compared to enteral stenting,EUS-GE shows superior outcomes,including higher long-term patency,lower symptom recurrence,and fewer reinterventions.It also demonstrates comparable or better efficacy than SGJ,with faster oral intake,shorter hospital stays,and reduced complications.However,EUS-GE requires specialized expertise,and long-term outcome data remain limited,so further research is needed to refine protocols and optimize patient selection.
摘要Duodenal stenting is a widely used palliative treatment for gastric outlet obstru-ction(GOO)caused by unresectable malignancies.Compared to surgical gastroje-junostomy,duodenal stenting allows for earlier oral intake,shorter hospita-lization,and earlier chemotherapy initiation.However,its long-term efficacy is limited by stent occlusion,which typically occurs 2-4 months post-procedure,due to tumor ingrowth,overgrowth,or food impaction.Covered stents can reduce tumor ingrowth but increase the migration risk,particularly in patients receiving chemotherapy.This review provides a comprehensive comparison of duodenal stenting,surgical gastrojejunostomy,and endoscopic ultrasound-guided gastroen-terostomy,by discussing their clinical outcomes,advantages,and limitations.We further explore stent selection based on stricture characteristics,optimal placement techniques,post-procedural management,and for handling complic-ations including occlusion,migration,bleeding,and perforation.Additionally,we address technical challenges and troubleshooting strategies,including mana-gement of guidewire-induced perforation,incomplete stent expansion,and bile duct obstruction for overlapping biliary and duodenal stricture cases.Despite its widespread clinical use,no prior review has comprehensively covered both the technical and clinical aspects of duodenal stenting so extensively.By providing a clinically oriented,practical guide,this review serves as a valuable resource for endoscopists and gastroenterologists,facilitating optimized decision-making and improved outcomes for patients with GOO in real-world practice.
摘要The scope of management of malignant gastric outlet obstruction is ever-expanding.The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes.With technical success rates close to 96%,stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents.Understanding the correct concept of palliation is the need of the hour in management.Identifying the right patient for palliation,selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care.Also,newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.
基金supported by The National Key Research and Development Project of China(No.2023YFC3504302)the National Natural Science Foundation of China(General Program No.82074105).
摘要Background:Bladder outlet obstruction(BOO)is a prevalent urinary system disease main caused by benign prostatic hyperplasia(BPH)in males.Traditional Chinese medicine(TCM)Danzhi qing’e decoction(DZQE)has the functions of strengthening“Yang Qi”(one of the fundamental concept in TCM,representing the active,warming,and energizing force within the body.It governs physiological functions,maintains body temperature,and promotes vitality.Balanced“Yang Qi”supports immunity and metabolism,while deficiency may lead to fatigue,cold intolerance,or weakened resilience),promoting blood circulation,and removing blood stasis,and nourishing yin based on the TCM theory.Previous studies have found that it significantly improved BPH and regulate urinary function in estrogen and androgen-induced rats.However,it is unclear whether DZQE has an inhibitory effect on BOO rats.Methods:Male Wistar rats underwent retropubic partial bladder neck ligation to induce BOO.DZQE extract(2.7/5.4 g/kg)was administered orally for 35 days.Anesthetized rats underwent cystometry to assess BOO and treatment effects on urinary parameters.Bladder histopathology,fibrosis,and PCNA expression were evaluated via HE,Masson’s,and IHC staining.Western blot quantified bladder tissue levels of choline acetyltransferase(ChAT),rho-associated protein kinase 1(ROCK1),myosin light chain kinase(MLCK),myosin light chain 2(MLC-2),extracellular signal-regulated kinase(ERK),proliferating cell nuclear antigen(PCNA),B-cell lymphoma-2(Bcl-2),and Bcl-2 related X protein(Bax).Primary bladder smooth muscle cells were cultured,exposed to hydrostatic pressure(HP,3 h/24 h)using a custom apparatus to mimic BOO,and treated with DZQE components for Western blot analysis of ROCK1,MLCK,ERK,PCNA,and Bax.Results:The bladder hyperplasia,bladder index(BI)increased,and histopathological alteration were easily observed in BOO group,which were significantly inhibited by DZQE administration.DZQE also significantly inhibited the up-regulation of maximum voiding pressure(MVP)and down-regulation of residual urine volume(RV)observed in BOO rats.The expressions of ChAT and MLCK and the activation of ERK were much increased,while the expressions of ROCK1,MLC-2 and Bax were obviously decreased in BOO rats,all of which were then significantly inhibited by DZQE.In rat bladder smooth muscle cells(RBSMC),3 h or 24 h duration of HP successfully simulated the BOO compensation and decompensation respectively in vitro.DZQE or its active components reduced the abnormal gene expressions in HP stimulated RBSMC.Conclusion:DZQE improves the urinary function in BOO rats mainly through the activation of ERK.Bakuchiol,salvianolic acid A,kaempferol,and tanshinoneⅡA are possibly the important active components of its therapeutic effects.
摘要BACKGROUND Obesity remains a significant global health concern,and intragastric balloons(IGBs)offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions.IGBs can cause complications ranging from mild symptoms to severe issues like gastric outlet obstruction(GOO).This report discusses a 39-year-old woman who presented with clinical and radiological features of GOO post Silimed IGB placement.CASE SUMMARY A 39-year-old woman presented to our institution with two-week history of abdominal pain,nausea and vomiting post prandially.This was in the context of a Silimed IGB placement two weeks prior to presentation for weight loss in the context of obesity.A computed tomography of the abdomen demonstrated the IGB device in the body and prepyloric region,with proximal dilatation of the body and fundus of the stomach which contained gastric contents.Due to concerns for GOO,the IGB was removed endoscopically with subsequent symptom alleviation.In addition to this,we performed a literature search of cases of IGB related GOO using the PubMed and Web of Science databases from inception date to the August 26,2024.A total of 27 articles were included in the analysis,identifying 29 cases of IGB-related GOO.These patients commonly presented with nausea,vomiting and abdominal pain,with symptom onset varying from 3 days to 18 months post IGB insertion.Abdominal computed tomography was the primary diagnostic tool and endoscopic removal was the standard treatment modality.CONCLUSION This is the first reported case of GOO caused by Silimed IGB.While effective for weight reduction,IGB-related GOO is a rare but serious complication,usually requiring endoscopic retrieval.Future research should aim to identify patient factors linked to this complication to enhance clinical-decision making and outcomes.
摘要BACKGROUND Groove pancreatitis(GP)is a rare focal chronic pancreatitis of the pancreaticoduodenal groove that is usually diagnosed in chronic alcoholics.However,it is often difficult to differentiate from pancreatic or periampullary cancers.In this study,we report a case of GP with the rare symptom of severe gastric outlet obstruction.CASE SUMMARY A 68-year-old man presented to our institution with severe gastric outlet obstruction accompanied by vomiting persisted for 3 days,severe electrolyte imbalance,and altered mental status with cardiac arrest.Differential diagnosis of cancers of the ampulla of Vater or duodenum was difficult due to discordant findings from preoperative imaging and an endoscopic biopsy of the lesion.In addition,the gastric outlet obstruction did not improve with conservative treatment;therefore,pancreatoduodenectomy was performed.Postoperatively,the histological findings revealed multiple cystic lesions in the duodenal wall that were collectively diagnosed as GP.The patient underwent a follow-up 3 years postoperatively and was found to have no postoperative sequelae.CONCLUSION In this case of GP,pancreatoduodenectomy safely treated severe gastric outlet obstruction when a cancer diagnosis could not be excluded.
摘要To compare the impact of transurethral resection of prostate (TURP) on symptom scores and maximal flow rates (Qmax) in patients with equivocal bladder outlet obstruction (BOO) and definite BOO and to assess the relationship between the surgical outcomes and degree of preoperative BOO, we prospectively evaluated men with lower urinary tract symptoms and bladder outlet obstruction index (BOO1) greater than 20, who were refractory to conventional medical treatment and underwent TURP. Urodynamic evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual volume (PVR) check and transrectal ultrasound were performed. 20〈B001〈40 was defined as equivocal BOO and BOO1 〉~40 as definite BOO. Changes of IPSS, Qmax, PVR and correlation analysis was performed between the degree of improvement of Qmax, subdomains of I PSS and BOO1. Fifty-four patients showed equivocal BOO and 80 patients showed definite BOO. Preoperatively equivocal BOO group and definite BOO group showed significant differences in maximal bladder capacity and prevalence of detrusor overactivity, whereas no difference was noted in prostate volume. Postoperatively both groups showed improvements in Qmax, obstructive (IPSSO) and irritative (IPSSI) subdomain of IPSS, but the degree of improvement in Qmax and IPSSI subdomain was statistically significantly greater in definite BOO group. The degree of improvement of Qmax and IPSSI showed weak correlation with preoperative BOO1. As a weak correlation was identified between preoperative degree of BOO and outcome of TURP, other factors other than BOO1 such as severity of patients' symptoms should be considered in deciding treatment modality.
摘要Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.
摘要AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.
基金supported by National Natural Science Foundation of China (Grant Nos. 51279069,51109093)Jiangsu Provincial Natural Science Foundation of China (Grant Nos. BK2011503,BK2011505)
摘要The existing research of the deep-well centrifugal pump mainly focuses on reduce the manufacturing cost and improve the pump performance, and how to combine above two aspects together is the most difficult and important topic. In this study, the performances of the deep-well centrifugal pump with four different impeller outlet widths are studied by the numerical, theoretical and experimental methods in this paper. Two stages deep-well centrifugal pump equipped with different impellers are simulated employing the commercial CFD software to solve the Navier-Stokes equations for three-dimensional incompressible steady flow. The sensitivity analyses of the grid size and turbulence model have been performed to improve numerical accuracy. The flow field distributions are acquired and compared under the design operating conditions, including the static pressure, turbulence kinetic energy and velocity. The prototype is manufactured and tested to certify the numerical predicted performance. The numerical results of pump performance are higher than the test results, but their change trends have an acceptable agreement with each other. The performance results indicted that the oversize impeller outlet width leads to poor pump performances and increasing shaft power. Changing the performance of deep-well centrifugal pump by alter impeller outlet width is practicable and convenient, which is worth popularizing in the engineering application. The proposed research enhances the theoretical basis of pump design to improve the performance and reduce the manufacturing cost of deep-well centrifugal pump.
摘要A 46-year-old Chinese woman presented with nausea, recurrent vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor at the prepyloric area on the posterior wall of the stomach. A degenerated gastrointestinal stromal tumor was suspected. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas (HPs) was confirmed. The patient had an uneventful postoperative course and was discharged 7 d a^er operation. The patient remains healthy and symptom-free in the follow-up of 6 mo. This is a report of a case of gastric outlet obstruction resulting from pancreatic heterotopia in the gastric antrum in an adult woman.
摘要AIM: To provide an overview of the clinical outcomes of self-expandable metal stent(SEMS) placement for malignant gastric outlet obstruction(MGOO).METHODS: A systematic literature search was performed in Pub Med of the literature published between January 2009 and March 2015. Only prospective studies that reported on the clinical success of stent placement for MGOO were included. The primary endpoint was clinical success,defined according to the definition used in the original article. Data were pooled and analyzed using descriptive statistics. Subgroup analyses were performed for partially covered SEMSs(PCSEMSs) and uncovered SEMSs(UCSEMSs) using Fisher's exact test.RESULTS: A total of 19 studies,including 1281 patients,were included in the final analysis. Gastric(42%) and pancreatic(37%) cancer were the main causes of MGOO. UCSEMSs were used in 76% of patients and PCSEMSs in 24%. The overall pooled technical success rate was 97.3% and the clinical success rate was 85.7%. Stent dysfunction occurred in 19.6% of patients,mainly caused by re-obstruction(12.6%) and stent migration(4.3%),and was comparable between PCSEMSs and UCSEMSs(21.2% vs 19.1%,respectively,P = 0.412). Re-obstruction was more common with UCSEMSs(14.9% vs 5.1%,P < 0.001) and stent migration was more frequent after PCSEMS placement(10.9% vs 2.2%,P < 0.001). The overall perforation rate was 1.2%. Bleeding was reported in 4.1% of patients,including major bleeding in 0.8%. The median stent patency ranged from 68 to 307 d in five studies. The median overall survival ranged from 49 to 183 d in 13 studies.CONCLUSION: The clinical outcomes in this large population showed that enteral stent placement was feasible,effective and safe. Therefore,stent placement is a valid treatment option for the palliation of MGOO.
基金funded by the Special Funding for Clinical Research of Wu Jieping Medical Foundation(No.320.2710.1848)the Clinical Research Supporting Project of PLA Genenral Hospital(No.109310)the Beijing Municipal Science and Technology Project(No.D171100006517002 and No.D171100006517004)。
摘要Objective:To avoid perioperative complications caused malnutrition,nutrition therapy is necessary in gastric outlet obstruction(GOO)patients.Compared to parenteral nutrition(PN),enteral nutrition(EN)is associated with many advantages.This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery.Methods:According to the methods of preoperative nutrition therapy,143 patients were divided into EN group(n=42)and PN group(n=101)between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital.Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage.The generalized additive model and twopiecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group.Results:EN shortened the postoperative day of flatus passage in gastric cancer patients with GOO,which is a protective factor,especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy(>3 d)did not accelerate the postoperative recovery of gastrointestinal functions.Conclusions:Preoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery.For patients with absolute obstruction,no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.
摘要AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.
基金National Natural Science Foundation of China, No.41101152 No.40901090+5 种基金 No.41172315 The Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry The talents in- troduced into Universities Foundation of Guangdong Province of China The China Scholarship Council (CSC) funding in 2013 The Universities Disciplinary and Special Construction Funds of Guangdong Prov- ince Foundation, No.C 10092 The Scientific Research Foundation of Graduate School of South China Nor- mal University
摘要Transport of organic carbon via rivers to estuary is a significant geochemical proc- ess in the global carbon cycle. This paper presents bulk total organic carbon (TOC) from the Dongjiang catchment to the adjacent Humen outlet, and discusses the applicability of 613C and ratio of carbon to nitrogen (C/N) as indicators for sources of organic matter in the surface sediments. Survey results showed that organic carbon concentration in summer were higher than in the winter. An elevated trend of TOC occurred along the river to the Humen outlet in both surveys, and the highest mean values of dissolved and particular organic carbon (DOC-279 μmol L-1 and POC-163μmol L-1) were observed in the urban deltaic region in summer flood flow. Winter samples had a wide range of b'13C and C/N (5-3C -24.6%o to -30.0%o, C/N 4-13), and summer ones varied slightly (8-3C -24.2%o to -27.6%0, C/N 6-18). As results suggest that POC in the three zones of upstream-delta-outlet dominantly came from riverbank soil, phytoplankton and agricultural C3 plants in winter, whereas main sources were from the riverbank and mangrove soil in summer. Moreover, anthropogenic sewage inputs had 11% and 7% contribution to POC in the deltaic and outlet. Transport accompanied with seasonal freshwater variation, phytoplankton production and degradation, and removal be- havior caused variation of organic carbon concentration. The results also discovered that TOC export bulk in Dongjiang was approximately one quarter of Humen flux in the dry flow, and anthropogenic activity significantly impacted the river export contribution.