Reconstruction and analysis of K-Clip surgery process based on finite element method / 中国胸心血管外科临床杂志

@#Objective     To investigate the effects of different types of tricuspid regurgitation, implantation positions, and device models on the treatment outcomes of K-Clip for tricuspid regurgitation using numerical simulations. Methods     Three-dimensional reconstruction of the heart model was performed based on CT images. Two different regurgitation orifices were obtained by modifying the standard parameterized tricuspid valve leaflets and chordae tendineae. The effects of different K-Clip models at different implantation positions (posterior leaflet midpoint, anterior-posterior commissure, anterior leaflet midpoint, posterior septal commissure) were simulated using commercial explicit dynamics software Ls-Dyna. Conclusion     For the two types of regurgitation in this study, clipping at the posterior leaflet midpoint resulted in a better reduction of the regurgitation orifice (up to 75% reduction in area). Higher clamping forces were required for implantation at the anterior leaflet midpoint and posterior septal commissure, which was unfavorable for the smooth closure of the clipping components. There was no statistical difference in the treatment outcomes between the 18T and 16T K-Clip components, and the 16T component required less clamping force. Therefore, the use of the 16T K-Clip component is recommended.

Factors affecting the geometry variations of surgical clips in radiotherapy after breast-conserving surgery / 中华放射医学与防护杂志

Objective:To investigate the variations and related influencing factors of the volumes, positions, and morphologies of geometries formed by surgical clips in intensity-modulated radiation therapy (IMRT) for whole breasts after breast-conserving surgery.Methods:A retrospective analysis was conducted on 18 patients treated with IMRT from October 2021 to September 2022 after breast-conserving surgery. Set-up errors were obtained by reading the coordinate information of tumor bed surgical clips according to the cone beam CT (CBCT) images at 0, 10, 20, 30, 40, and 50 Gy sequentially. Geometries were constructed using the convex hull program, and the volumes ( Vct and V0-5) of geometries were then calculated based on the localization CT images and the six CBCT images, respectively. The centroid displacements ( D0-5) and degrees of inclusion ( DI0-5) of these geometries were compared. The t-test or rank-sum test was used to analyze the effects of radiation doses on V0-5, D0-5, and DI0-5. The Pearson correlation analysis was conducted to analyze the correlations between D0-5 and corresponding set-up errors in three-dimensional directions, and the correlations of average V0-5 variation ( AV), average D0-5 ( AD), and average DI0-5 ( ADI) with the body mass index (BMI), the volume of a breast ( VB), the breast axial height ( H), and the time interval from surgery to radiotherapy ( T) each. The influences of quadrants ( Q) where geometries are located and states ( S) of geometries adhering to or away from the chest walls on AV, AD, and ADI were analyzed through one-way ANOVA. Results:The differences between D5 and D0, between D5 and D1, and between D5 and D2 were statistically significant ( t = -3.27, -4.52, -3.38, P < 0.05), respectively. The differences between DI5 and DI0, between DI5 and DI1, between DI5 and DI2 were statistically significant ( t = 2.53, 2.70, 2.64, P < 0.05), respectively. D1 and D4 correlated with the set-up errors in the superior-inferior dimension, and D3 correlated with the set-up errors in the left-right dimension ( r = 0.50, 0.56, 0.53, P < 0.05). The AD was related to BMI, VB, and H ( r = 0.54, 0.48, 0.50, P < 0.05). There were statistically significant differences in AV and ADI of geometries away from ( S3) and near ( S2) chest walls ( F = 2.66, 3.83, P < 0.05). The AD differences of geometries between S3 and the state adhering to chest walls ( S1) and between S3 and S2 were statistically significant ( F = 7.46, P < 0.05), respectively. Conclusions:The geometries are relatively constant volumes during whole-breast radiotherapy. However, their positions and morphologies vary greatly in the late course. The volume variation ratios, centroid displacements, and degrees of inclusion of geometries are all affected by the states of their attachments to the chest walls. The centroid displacements correlate with breast morphologies and BMI. The radiotherapy plan modification can be individualized.

Adjustable "paper clip" techniques suturing the dorsal vein complex in radical prostatectomy / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of the adjustable "paper clip" techniques in the suture of dorsal vein complex (DVC) and retention of urethral function in robot-assisted laparoscopic radical prostatectomy (RALRP). 【Methods】 A total of 30 cases of prostate cancer treated with RALRP were enrolled, all of which used the adjustable "paper clip" techniques. During operation, the DVC was sewed with barbed suture, and then a reverse suture was made through two sides of the prostatic ligaments. A Hem-o-lock was used to fasten the suture, which would be flexible to control the degree of tightness for the ligature. Perioperative and follow-up data of urinary continence and symptoms were collected and analyzed. 【Results】 All operations were successful. The estimated blood loss was (123.3±80.7) mL, 53.6% patients recovered continence in 1 month, and the continence rate increased to 92.9% and 96.3% at month 3 and 6. 92.9 of patients had no risk of incontinence 3 months after surgery. 【Conclusion】 The adjustable "paper clip" techniques have advantages in reducing blood loss, maintaining clear surgical field, preserving urethral function, and improving urinary continence.

A case report of an intracranial giant aneurysm in a 10-year-old female

@#Pediatric intracranial aneurysms are rare and differ from aneurysms in adults in terms of location, etiology, natural history and management. This is a case report of giant aneurysm in a 10-year old patient presenting with symptoms of headache and vomiting. Cerebral catheter angiogram revealed a large aneurysm in the left middle cerebral artery, M1 segment. The patient underwent left pterional craniotomy, clip reconstruction of the patent artery, and aneurysmectomy. Post operatively the patient had an unremarkable course and was discharged improved after 1 week. Cerebral catheter angiogram was performed after 2 months and revealed no residual aneurysm.

Preclinical evaluation of analgesic activity of hydroalcoholic extract of Costus pictus leaves in Wistar albino rats

Background: Pain is the most common symptom in various pathological conditions requiring appropriate treatment with analgesics. Use of analgesics is limited by various adverse drug effects. The present study was aimed to evaluate the analgesic activity of hydroalcoholic extract of Costus pictus leaves in Wistar albino rats. Aim and Objective: The objective of this study is to evaluate the analgesic activity of hydroalcoholic extract of C. pictus leaves in Wistar albino rats. Materials and Methods: The study was conducted on 30 Wistar albino rats and was divided into five groups each of six rats. Group-I (Sterile water-equivalent volume/po), Group-II Morphine (5 mg/kg/ip), Group-III CPHAE (200 mg/kg/po), Group-IV CPHAE (400 mg/kg/po), and Group-V Diclofenac (12.5 mg/kg/po). All the rats were administered respective drugs before starting of 30 min of experiment. Central analgesic (Tail clip and hot plate) and peripheral analgesic (Writhing test) methods were used to evaluate the analgesic activity. The data were recorded and analyzed with SPSS software. Results: Group-II, III, IV and V showed significant analgesic activity compared to Group-I in both central and peripheral animal models. Group-II showed significant effect compared to Group-III and IV in the central analgesic activity. Group-V showed significant effect compared to Group-III and IV in peripheral analgesic activity. Group-IV showed significant effect compared to Group-III. Conclusion: High dose of (400 mg/kg) C. pictus plant extract showed significant analgesic activity in the central and peripheral animal models compared to low dose.

Evaluation of analgesic properties of petroleum ether extract of Zingiber officinale

Background: Herbal remedies and alternative therapies have been employed in the treatment of pain from time immemorial. Ginger is a widely used spice with a lot of medicinal properties, and it is especially soothing to the gastro-intestinal system. Most of the analgesics used in modern medicine have side effects to either gastro-intestinal tract or nervous system. Ginger has neither. Scientific evaluation of the analgesic properties of Zingiber officinale is needed. Aim and Objective: The aim of the study was to evaluate the analgesic effect of three doses of orally administered petroleum ether extract of Z. officinale and to compare with morphine. When tested for analgesic activity, to find out the difference in reaction time at various time intervals for each dose of the extract, and their significance. Materials and Methods: Petroleum ether extract of Z. officinale rhizomes was used. Wistar strain albino rats (150-200 g) and Swiss albino mice (20-25 g) housed under standard laboratory conditions were used. The central analgesic activities of the extract were evaluated by the tail clip method and hot plate method. Statistical analysis was done by one-way analysis of variance to compare the means in the experimental groups. Results: In tail clip method, pain was mechanically induced pain and the pain threshold was measured in terms of mice’ reaction time in seconds. All doses of the extract of Z. officinale were capable of increasing the reaction time in mice during the various time periods. Maximum analgesic activity was shown by 800 mg/kg of the extract at 90 minutes. In hot plate test, maximum analgesic activity was shown by 800 mg/kg of the extract at 180 min. At 30 and 60 min, 800 mg/kg of the extract was as effective as the standard drug, morphine. Conclusions: The study revealed that Z. officinale has significant analgesic properties especially in higher doses.

Recurrent hepatogastric fistula during lenvatinib therapy for advanced hepatocellular carcinoma managed by over-the-scope clip closure: a case report / Journal of Rural Medicine

Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.

Prophylactic effect of clipping after endoscopic mucosal resection of small colorectal polyps on delayed bleeding / 中华消化内镜杂志

Objective:To explore the prophylactic effect of clipping after endoscopic mucosal resection(EMR) of sessile colorectal polyps of diameter below 10 mm on delayed post-polypectomy bleeding (DPPB).Methods:Patients with sessile colorectal polyps of below 10 mm undergoing EMR from January 2017 to December 2019 in Digestive Disease Hospital, Heilongjiang Provincial Hospital were randomly divided into the clipping group (group A) and the non-clipping group (group B) by random number table, and DPPB rates of both groups were compared.Results:A total of 1 838 patients were included, 912 patients in group A and 926 patients in group B. The incidences of DPPB were 1.00% (9/912) and 1.10% (10/926) respectively, with no significant difference ( χ2=0.039, P>0.05). The proportion of bleeding polyps were 0.44%(9/2 029)and 0.49%(10/2 025) respectively, with no significant difference ( χ2=0.055, P>0.05). Polyp of 6-9 mm ( OR=11.032, 95% CI: 2.545-47.821, P<0.05) was the independent risk factor for delayed bleeding in small sessile colorectal polyps after EMR. Conclusion:Prophylactic clipping for sessile colorectal polyps below 10 mm after EMR may not significantly reduce the risk of DPPB.

A preclinical animal study on a novel detachable endoscopic anastomosis clip for stomach perforation (with video) / 中华消化内镜杂志

Objective:To evaluate the safety and efficacy of a novel endoscopic anastomosis clip for the stomach perforation via an animal trial.Methods:Six pigs were used as experimental animals, and two perforation models (10-20 mm in diameter) were created by an endoscopic needle-knife in the stomach of each pig. The perforations were then closed by the novel detachable endoscopic anastomosis clip. The animal survival and healing of the lesions were recorded. All the clips were taken out 30 days after operation through endoscopy. Half of the animals were immediately after clip extraction and the other half of the animals survived for another 30 days owing to observation.Results:All clips were implanted successfully and all lesions healed during 30 days after the operation. All animals survived. The clip natural shedding rate was 33.3%(4/12), and the rest of clips were successfully disassembled and removed. All animals were alive 30 days after clip removal with lesions healed.Conclusion:The novel anastomosis clip is safe and effective in animal experiments with easy to operate. It could be recommended for further clinical research with good clinical prospect.

Current status and research advances on the use of assisted traction technique in endoscopic full-thickness resection / 中华胃肠外科杂志

Endoscopic full-thickness resection (EFTR) allows completely resecting deep submucosal tumors (SMTs) in the gastrointestinal wall, which has a broad application prospect in clinic. However, its application and promotion are limited by complex surgical procedures and high surgical risk. Various auxiliary traction techniques are expected to reduce the operation difficulty and risk of EFTR and improve its operative success rate. To provide a reference for clinicians, we summarize various auxiliary traction techniques in EFTR in this article. The clip-with-line method is simple to operate and widely used, whereas its traction is limited and there is a risk of clip falling off. The snare traction method and the clip-snare traction method has advantage of large traction force, but its thrust is affected by the hardness of snare. The traction point of the grasping forceps traction method is flexible and easy to adjust. Nevertheless, it requires the use of a dual-channel upper endoscope, which is difficult to operate. The transparent cap traction method and the full-thickness resection device traction method takes a short time and is easy to promote, whereas the resectable lesion is limited, and the size of the lesion may affect the success rate. In contrast, the suture loop needle-T-tag tissue anchors assisted method has a large resection range, but the operation is complicated and the feasibility has not been verified. The robot-assisted method has flexible operation and excellent visualization, whereas it is expensive and difficult to operate. There is no report of the application of magnetic anchor technology in EFTR, but it may have good application prospects in the auxiliary traction of EFTR.

Is there neural and functional recovery after clip removal in cervical experimental sympathectomy? / Existe recuperação neural e funcional após a retirada de clipe quando da indução de simpatectomia cervical experimental?

ABSTRACT Background: The surgical treatment of hyperhidrosis by thoracic sympathectomy has brought, in addition to symptomatic relief for many, its main adverse effect: compensatory or reflex sweating. The clipping technique in place of the sympathetic nerve section gave rise to the hope of reversibility, but the positive results showed to be quite divergent, evidencing the academic deficiency regarding the study of this phenomenon. Aim: To observe micro and macroscopic damage caused by the polymer clip on sympathetic nerve of rabbits seven days after their clipping and the findings after three weeks of clip removal. Method: In this experimental study, 20 rabbits were divided into two groups of 10, group 1 (clipping) and group 2 (de-clipping). The right cervical sympathetic nerve of all animals was clamped with polymeric clip, and in group 2 the nerve was unclipped seven days later. Group 1 rabbits were induced to death on the 7th postoperative day, and group 2 on the 21st after removal of the polymer clip. Macroscopic variables were: clip appearance, presence of discontinuity lesion, infection and adhesions around the nerve. H&E was used in the evaluation of the phases and degree of the inflammatory process and presence of necrosis, and picrosirius red F3BA for quantification of collagen. Results: The cervical sympathetic nerve was intact, without necrosis or infection in all animals of the experiment; there were adhesions in both groups, being minimal in eight animals of each group and moderate or intense in two; the clip was completely closed in all animals at the 7th postoperative day; the inflammatory process shown was chronic, with monomorphonuclear predominance. There was no significant difference between groups regarding the intensity the inflammatory process, but the amount of collagen type I and type III was significantly higher in group 2. Conclusions: The injury caused by the polymer clip on the sympathetic nerve may be reversible, allowing functional return in the areas involved in the simulated cervical sympathectomy. Clipping of the cervical sympathetic nerve using a polymer clip does not cause discontinuity injury.

RESUMO Racional: O tratamento cirúrgico da hiperidrose pela simpatectomia torácica trouxe além do alívio sintomático para muitos, também seu principal efeito adverso: o suor compensatório ou reflexo. A técnica de clipagem do nervo simpático no lugar de sua secção deu margem à esperança de reversão do procedimento; porém, os resultados mostram-se bastante divergentes e pouco conclusivos Objetivo: Observar a lesão provocada pelo clipe de polímero em nervo simpático de coelhos sete dias após sua clipagem, comparando-a com os achados após três semanas da retirada do clipe. Método: Estudo experimental, com amostra formada por 20 coelhos, divididos em dois grupos de 10, sendo o grupo 1 chamado clipagem e o 2, desclipagem. Todos foram submetidos à clipagem do nervo simpático cervical direito com clipe polimérico, e no grupo 2 realizou-se a desclipagem sete dias após. Os coelhos do grupo 1 foram submetidos à eutanásia no 7º dia de pós-operatório, e os do grupo 2 no 21º dia após a remoção do clipe. Observou-se na macroscopia o aspecto do clipe, a presença de lesão de descontinuidade, infecção e aderências ao redor do nervo. Para estudo microscópico utilizou-se a coloração H&E na avaliação das fases, grau do processo inflamatório e presença de necrose, e a de picrosirius red F3BA para quantificação de colágeno. Resultados: O nervo simpático cervical foi identificado íntegro, sem necrose ou infecção em todos os animais do experimento; havia aderências em ambos os grupos, sendo mínimas em oito de cada grupo e moderadas ou intensas em dois; em toda a amostra o clipe encontrava-se completamente fechado no 7º dia de pós-operatório; o processo inflamatório presente foi do tipo crônico, com predomínio monomorfonuclear, não se observando diferença significativa em relação ao grau do processo inflamatório entre os grupos; porém, a quantidade de colágeno tanto do tipo I quanto do tipo III foi significativamente maior no grupo 2. Conclusões: A lesão provocada pelo clipe de polímero em nervo simpático pode ser reversível possibilitando o retorno funcional nas áreas envolvidas na simpatectomia cervical simulada. A clipagem do nervo simpático cervical com uso de clipe de polímero não causa lesão de descontinuidade.

Clip Occlusion Versus Extracorporeal Suture Ligation (Roeder Knot) of the Cystic Duct in Laparoscopic Cholecystectomy – A Comparative Study

Introduction: Laparoscopic cholecystectomy today hasbeen rapidly embraced worldwide as the procedure of choicefor cholecystectomy. Conventionally, titanium clips areused to ligate the cystic duct. Recently, various methods ofsuture ligation of the cystic duct both intra corporeal andextra corporeal have been described during laparoscopiccholecystectomy. Only limited number of studies have beencarried out prospectively to compare the various methods. Thepresent study was thus designed to compare clip occlusionversus extra corporeal suture ligation (Roeder knot) of thecystic duct in laparoscopic cholecystectomy.Material and methods: This study was a single blindedrandomized controlled trial conducted on 150 adult patientsundergoing laparoscopic cholecystectomy. They wererandomized into two groups of 75 each to compare theprocedures of clip occlusion versus extracorporeal sutureligation (Roeder knot) of the cystic duct with respect to theoperative time, complications, associated morbidity, operativecost and hospital stay.Results: There was no significant (p>0.05) differencein duration of surgery between the groups (Clipligation=40.44±4.63 minutes, suture ligation=43.32±4.44minutes). Bile leakage due to slippage of ligature was presentin 2 (2.7%) patients with clip ligation as compared to 0% insuture ligation. This difference was found to be statisticallysignificant (p=0.03). Obstructive jaundice due to accidentalligation of CBD was present in 2 (2.7%) patients with clipligation as compared to 0% in suture ligation. This differencewas also found to be statistically significant. (p=0.03). Thecost of Clip ligation (Rs.369.07±8.08) was higher than sutureligation (Rs.300.00±0.00).Conclusion: The results of this study indicate thatextracorporeal (Roeder’s knot) is a safe, cost effectivealternative with a low complication rate as compared totitanium clip ligation of the cystic duct in laparoscopiccholecystectomy

Antinociceptive effect of methanolic extract of Murraya koenigii leaves in swiss albino mice

Background: The objective of the study was to evaluate anti-nociceptive effect of methanolic extract of Murraya koenigii leaves on thermal and mechanical pain in swiss albino mice.Methods: Thirty adult male swiss albino mice weighing 25-30 grams were selected and allocated in to five groups. Each group consists of six animals. The control group received vehicle (10 ml/kg), standard group received morphine (10 mg/kg) and test groups received dried methanolic extract of Murraya koenigii leaves (100 mg/kg, 200 mg/kg, 400 mg/kg per oral respectively) 1 hour before placing the animal over the hot plate at temperature of 55?C . A cut off period of 10 sec was observed to avoid damage of the paw. The response in the form of withdrawal of paws or licking of the paws. The delay in the reaction time denotes analgesic activity. The latency was recorded before and after 15, 30, 60, 120 minutes administration of drug. After washout period of 1 month the same group of animals were utilized to evaluate the analgesic effect by tail clip method for better comparison.Results: All the doses of Murraya koenigii leaves significantly delayed reaction time in hot plate method and tail clip method. The results were comparable to that produced by standard drug morphine.Conclusions: Murraya koenigii leaves has analgesic activity which was comparable to morphine.

Accuracy of ultrasound-guided core-needle biopsy confronted with pathological findings and comparison of its costs with vacuum-assisted biopsy's costs

Introduction: Breast cancer screening has enhanced early­stage diagnosis by detection of impalpable tumors which require histopathological evaluation. Main percutaneous biopsy types are core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). CNB is less invasive and related to less bleeding and pain. VAB allows larger tissue samples and permits metal clip placement in biopsy bed for posterior localization in case of surgery. Access to VAB is restricted in Brazil due to its high costs. Objectives: To evaluate the agreement between pathological results of ultrasound (US) guided CNB with metal clip placement and surgery and settle false negative rates (FNR), sensibility, specificity, and accuracy of this method, for breast lesions < 20 mm. Methods: 388 US-guided CNB were retrospectively reviewed. Results: Surgical excision was performed in 317 patients. Overall FNR was 9.8%, (5.2% for lesions 10­20 mm), sensibility 90.2% (94.8% for lesions 10­20 mm), specificity 94.9% (94.1% for lesions 10­20 mm), and accuracy 91.1% (94.7% for lesions 10­20 mm). Cost of VAB varies from 2.2 to 12.5 times US-guided CNB. With metal clip placement, VAB costs 1.95 to 5.2 times US-guided CNB. Conclusions: For lesions that can be identified in US, CNB with metal clip placement has high sensitivity, specificity, and accuracy, as well as low FNR.

Accuracy of ultrasound-guided core-needle biopsy confronted with pathological findings and comparison of its costs with vacuum-assisted biopsy's costs

Introduction: Breast cancer screening has enhanced early­stage diagnosis by detection of impalpable tumors which require histopathological evaluation. Main percutaneous biopsy types are core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). CNB is less invasive and related to less bleeding and pain. VAB allows larger tissue samples and permits metal clip placement in biopsy bed for posterior localization in case of surgery. Access to VAB is restricted in Brazil due to its high costs. Objectives: To evaluate the agreement between pathological results of ultrasound (US) guided CNB with metal clip placement and surgery and settle false negative rates (FNR), sensibility, specificity, and accuracy of this method, for breast lesions < 20 mm. Methods: 388 US-guided CNB were retrospectively reviewed. Results: Surgical excision was performed in 317 patients. Overall FNR was 9.8%, (5.2% for lesions 10­20 mm), sensibility 90.2% (94.8% for lesions 10­20 mm), specificity 94.9% (94.1% for lesions 10­20 mm), and accuracy 91.1% (94.7% for lesions 10­20 mm). Cost of VAB varies from 2.2 to 12.5 times US-guided CNB. With metal clip placement, VAB costs 1.95 to 5.2 times US-guided CNB. Conclusions: For lesions that can be identified in US, CNB with metal clip placement has high sensitivity, specificity, and accuracy, as well as low FNR.

Clinical research in the endoscopic management of digestive fistula / 中华消化内镜杂志

Objective To evaluate the therapeutic value of endoscopic jejunal tube placement, endoscopic clipping, and over the scope clip ( OTSC) for digestive fistula. Methods Data of 38 patients with digestive fistulas at the First Affiliated Hospital of Soochow University admitted from July 2015 to July 2017 were retrospectively analyzed. Treatments were chosen according to the size and the site of the fistulas. Thirteen patients underwent jejunal tube placement ( the jejunal tube group ) , 20 underwent endoscopic clipping( the endoscopic clipping group) , and 5 underwent OTSC( the OTSC group) . The technical success rate, clinical cure rate and postoperative hospital stay were analyzed. Results All patients received the endoscopic operation successfully with no significant complications. In the jejunal tube group, 4 patients′fistulas fully healed, lesion was smaller after treatment in 3 patients, lesion didn′t change in 5 patients, and 1 patient died. The complete cure rate was 30. 8％ (4/13), and the postoperative hospital stay was 47. 4± 14. 1 days. For the endoscopic clipping group, 16 patients′ fistulas fully healed, lesion was no smaller compared with that before treatment in 3 cases, and 1 patient died. The complete cure rate was 80. 0％ ( 16/20) , and the postoperative hospital stay was 17. 9 ± 8. 9 days. Total patients in the OTSC group were completely cured, with 100. 0％( 5/5) of complete cure rate. One patient with refractory esophageal fistula underwent OTSC repeatedly with endoscopic clipping, and the healing time of fistula was 102 days. The postoperative hospital stay of 4 others was 5. 3±1. 7 days. The cure rate of fistula was higher (P=0. 03, P<0. 001) and the postoperative hospital stay was shorter ( P=0. 04, P<0. 001) in the OTSC group compared with the clipping group and the jejunal tube group. Conclusion Endoscopic management is safe and effective for digestive fistulas with less trauma, easy performance and short time of healing.

Comparison of breast tissue markers for tumor localization in breast cancer patients undergoing neoadjuvant chemotherapy

PURPOSE: The purpose of this study was to compare the visibility of breast tissue markers in cases of breast cancer on ultrasonography (US) after neoadjuvant chemotherapy (NAC) and to analyze whether the type of marker affected the choice of localization method after NAC. METHODS: We included 153 tissue markers inserted within breast cancers that showed pathologically complete response (pCR) after NAC from January 2012 to April 2017. One of three types of markers (a surgical clip, Cormark, or UltraClip) was inserted. Medical records and imaging findings were retrospectively reviewed. We compared the visibility of the different types of tissue markers on US after NAC, and also compared the imaging modalities used in the preoperative localization. The chi-square test, Fisher exact test, and multiple logistic regression were used for analysis. RESULTS: Of the 153 tissue markers, 56 were surgical clips, 61 Cormark, and 36 UltraClip. After NAC, residual lesions were not seen on US in 42 cases (27.5%). In multivariate analysis, the visibility of the surgical clips and Cormark markers was better than that of the UltraClip markers (odds ratio [OR], 5.467; 95% confidence interal [CI], 1.717 to 17.410; P=0.004 and OR, 3.045; 95% CI, 1.074 to 8.628; P=0.036, respectively). Among the 131 cases where localization targeting the marker was required, the proportion of US-guided localizations was significantly higher when a surgical clip was used than when an UltraClip marker was used (OR, 5.566; 95% CI, 1.610 to 19.246; P=0.007) in the multivariate analysis. CONCLUSION: The type of breast tissue marker affected its visibility on US in cases with pCR after NAC, which in turn affected the localization methodology.

Endoscopic Management with a Novel Over-The-Scope Padlock Clip System

BACKGROUND/AIMS: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate technique and has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to present our clinical experience using this novel Padlock clip system.METHODS: Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by an experienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding, as well as for endoscopic full-thickness resection in the remaining 3 patients.RESULTS: All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up of a minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events was noted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly after the application of the Padlock clip, with no GI bleeding observed.CONCLUSIONS: The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy may be reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.

Development of Educational Contents for Therapeutic Communication based on Video Clip / 의료커뮤니케이션

BACKGROUND: This study was conducted to develop therapeutic communication skills for nursing students by using video clip.METHODS: The development of therapeutic communication contents were carried out in three steps: The first step is to extract the methods of therapeutic communication described in the case report prepared by a nursing student during mental clinical practice which is highly frequently used and prone to confusion. The second step is to extract cases and create scenarios that reflect the techniques extracted. The third step is to film the developed scenarios with expert advice and then edit it to reflect the content utilization to enhance the efficiency of teaching.RESULTS: Eight video content reflecting therapeutic communication techniques and eight video contents that improperly reflected therapeutic communication, a total of 16 video contents were finally developed.CONCLUSION: The developed video clip based on real error cases in this study can be utilized as an educational contents for nursing students to apply therapeutic communication skills.

Comparison of over-the-scope-clip and metal clips combined with nylon rope as endoscopic suture methods for full-thickness defect of gastric wall(with video) / 中华消化内镜杂志

Objective To evaluate the clinical efficacy and safety of different stitching methods,over-the-scope-clip (OTSC) and metal clips combined with nylon rope (King closure),for full-layer gastric wall defect.Methods Data of 75 cases,who underwent endoscopic full-thickness resection (EFTR) of gastric SMTs from May 2015 to May 2018 in our endoscopy center were retrospectively analyzed.According to the closure method,the patients were divided into the OTSC group (20 cases) and the King closure group (55 cases).Comparison was made in gender,age,the largest diameter of tumor,the location of tumor,defect surface diameter,total operating time,defect closure time,closure success rate,the length of hospital stays,cost and postoperative complications between the two groups,Results The baseline data were comparable,and there were no significant differences in age,gender,tumor location,tumor diameter,and defect surface diameter between the two groups(all P＞0.05).The success rate of closure was 100％ in both groups.In terms of length of hospital stay,there was no significant difference between the two groups (t =1.13,P=0.268).The total operating time was 63.24±43.22 min in the King closure group versus 47.60± 18.13 min in the OTSC group (t =2.20,P =0.030).The closure time of the defect surface was 20.85 ± 16.35 min in the King closure group versus 10.95±5.20 min in the OTSC group (t =2.65,P=O.010).Hospitalization costs were 24 200±800 yuan in the King closure group versus 36 200±2 350 yuan in the OTSC group (t=6.21,P＜0.001).Postoperative abdominal elevation radiographs in both groups indicated a small amount of subphrenic free gas,and no intervention was given due to the small amount of gas and no obvious symptoms.No late bleeding,recurrent perforation,infection or other complications occurred after operation,and all patients were discharged successfully.Six months after surgery,15 patients (27％) in the King closure group developed metal clips or nylon rope residue,which were successfully removed by endoscopy.The anastomosis clamp of nighteen patients (95％) in the OTSC group were in the original position.None of the patient received open surgery.Conclusion OTSC and King closure are both safe and effective in the treatment of full-thickness defect of gastric wall.OTSC has the advantages of short total operation time and short closure time,but with high cost.