DSA-guided pyloric balloon dilation versus conservative medical treatment for postsurgical gastroparesis syndrome / 介入放射学杂志

Objective To compare the clinical efficacy of DSA-guided pyloric balloon dilation with that of conservative medical treatment for postsurgical gastroparesis syndrome(PGS).Methods The clinical data of 41 patients with PGS,who were admitted to the Department of Interventional Radiology,Affiliated Third Hospital of Suzhou University of China to receive DSA-guided pyloric balloon dilation(study group,n=21)or conservative medical treatment(control group,n=20)between January 2012 and February 2021,were retrospectively analyzed.The median follow-up period in the control group and the study group was 626 days and 588 days respectively.The average length of stay(ALOS)was compared between the two groups.Results In the study group,all the 21 patients returned to normal food intake within 2 days after successful DSA-guided pyloric balloon dilation treatment,and they were all discharged within one week after treatment.The ALOS in the study group was(10.2±1.3)days,which was strikingly shorter than(34.5±14.2)days in the control group,the difference between the two groups was statistically significant(P＜0.001).Conclusion For the treatment of PGS,DSA-guided pyloric balloon dilation carries better clinical efficacy when compared with conservative medical treatment,therefore,it can be used as the preferred treatment for patients with PGS.Further studies are need to be conducted before its therapeutic mechanism can be clarified.

Mid-to-long term fate of neo-aortic root after arterial switch operation for Taussig-Bing anomaly: A retrospective study in a single center / 中国胸心血管外科临床杂志

@#Objective To explore growth pattern of neo-aortic root as well as development of neo-aortic regurgitation after arterial switch operation (ASO) for Taussig-Bing anomaly. Methods From 2002 to 2017, the patients who received ASO, and were discharged alive from Shanghai Children’s Medical Center and followed up for more than 3 years were retrospectively involved in this study. Results A total of 127 patients were enrolled. There were 98 (77.2%) males, the median age at ASO was 73.0 d and the average weight was 4.7 kg. Forty-five (35.4%) children were complicated with mild or mild-to-moderate pulmonary insufficiency (PI) before ASO. The average follow-up time was 7.0 years. During the follow-up, 14 (11.0%) children presented moderate or greater neo-aortic regurgitation (neo-AR). The diameter of neo-aortic annulus and sinus of Valsalva was beyond normal range during the entire follow-up. The average diameter of neo-aortic annulus was 18.0 mm at 5 years and 20.5 mm at 10 years. The average diameter of sinus of Valsalva was 25.9 mm at 5 years and 31.1 mm at 10 years. Neo-AR continued to develop over time. The diameter of children who developed moderate or greater neo-AR was constantly larger than that of children who did not (χ2=18.3, P<0.001). Preoperative mild or mild-to-moderate PI was an independent risk factor for the development of moderate or greater neo-AR during mid-to-long term follow-up (c-HR=3.46, P=0.03). Conclusion The diameters of neo-aortic annulus and sinus of Valsalva of Taussig-Bing children who receive ASO repair continue to expand without normalization. The dilation of annulus correlates with the development of neo-AR. PI before ASO repair increases the risk of neo-AR development.

Cojoined twins: safe termination of pregnancy through dilation and evacuation at later gestation: a case series

BACKGROUND: Currently, there is limited evidence on termination of pregnancy for cojoined twin documented with only 33 cases reports to-date. This study aimed to describe the clinical and procedure characteristics of second trimester dilation and evacuation(D&E) for cojoined twins at later gestation. METHODS: This retrospective case series was conducted at a tertiary-level hospital in Ethiopia from February 2023- July 2023. Women who had a cojoined twin pregnancy in later gestation (≥20 weeks) and underwent second trimester D&E were retrospectively studied through chart review. Clinical presentation, D&E procedural description, and procedure outcomes of the cases were analyzed. RESULTS: Three women who had a cojoined twin in later gestation (≥20 weeks) and underwent second trimester D&E were identified. In two of the cases, a two- day cervical preparation with laminaria was used to prepare the cervix while overnight Foley catheter (1-day preparation) was used for similar purpose in the third case. A cervical dilation of 3 cm was achieved in all cases and was deemed adequate to proceed with the procedure by the managing physicians. Intra-operative ultrasound guidance was utilized in all the cases and there were no complications encountered. CONCLUSION: Our case series underscores the importance of achieving adequate cervical preparation, utilization of intra-operative ultrasound guidance, and handling the procedure by the most experienced provider, in increasing the safety and effectiveness of D&E procedures for conjoined twin at later gestation.

Persistent right aortic arch and aberrant left subclavian artery in a dog / Persistência de arco aórtico direito e artéria subclávia esquerda aberrante em um cão

A 1.5-year-old male German Shepherd dog was referred to a Teaching Veterinary Hospital with a chronic history of regurgitation and a previous presumptive diagnosis of megaesophagus. An esophagogram showed partial esophageal dilation, suggesting one vascular ring anomaly. Computed tomography identified a persistent right aortic arch (PRAA) and an aberrant left subclavian artery (ALSA). The patient underwent thoracotomy, ligamentum arteriosum ligation, and debridement of the periesophageal region. The ligation of the ALSA was not carried out because the esophagus was observed to be released entirely during the surgical intervention. Therefore, intervention on the subclavian artery was not necessary. Clinical follow-up occurred on seven, 14, and 30 postoperative days. The dog improved, showing only sporadic regurgitations. Clinical history and complementary exams were essential to establish a diagnosis. The liberation of the esophageal transit during surgery contributed to the decision not to perform the ALSA ligation.(AU)

Um cão pastor alemão, macho, de 1,5 anos de idade, foi atendido em um Hospital Veterinário Universitário com história crônica de regurgitação e diagnóstico presuntivo prévio de megaesôfago. Um esofagograma mostrou dilatação parcial do esôfago sugerindo uma anomalia de anel vascular. A tomografia computadorizada identificou persistência do arco aórtico direito (PAAD) e artéria subclávia esquerda aberrante (ALSA). O paciente foi submetido à toracotomia, ligadura do ligamento arterioso e desbridamento da região periesofágica. A ligadura da ALSA não foi realizada, pois, durante a intervenção cirúrgica, observou-se que o esôfago estava completamente liberado, não sendo necessária intervenção na artéria subclávia. O acompanhamento clínico ocorreu aos sete, 14 e 30 dias de pós-operatório. O cão evidenciou boa recuperação, apresentando apenas regurgitações esporádicas. A história clínica associada aos exames complementares foi essencial para o diagnóstico. A liberação do trânsito esofágico durante a cirurgia contribuiu para a decisão de não realizar a ligadura da ALSA.(AU)

Acalasia o hipertrofia del músculo Cricofaríngeo: opciones de tratamiento

La disfagia alta es un síntoma frecuente de consulta al otorrinolaringólogo o gastroenteròlogo. Los diagnósticos diferenciales son trastornos de la deglución por daño neurològico, anillos esofágicos superiores, globus faríngeo, neoplasia, disfagia lusoria y trastornos motores inespecífico y otras más raras aún. Hay escasa literatura actualizada en pacientes adultos. El diagnóstico se basa en el estudio radiológico baritado, endoscopia y complementariamente con manometría. Las opciones de tratamiento son motivo de discusión, dada la poca evidencia disponible. En este artículo se presentan los resultados observados en una cohorte de 10 pacientes con diagnóstico confirmado de acalasia del cricofaríngeo sometidos a dilatación endoscópica (7 pacientes) o miotomía quirúrgica por cervicotomía (3 pacientes). Se evaluó evolución de la disfagia, complicaciones post procedimiento y resultados a largo plazo. No hubo complicaciones mayores, la disfagia mejoro en ambos grupos, en el grupo de dilatación se complementó el tratamiento con dilataciones periódicas en 2 pacientes. No hubo diferencias significativas en los 2 grupos estudiados. Conclusión: ambas opciones terapéuticas presentan buenos resultados en el tratamiento de estos pacientes.

Dysphagia at cervical level is a frequent symptom causing visit to otolaryngologist or gastroenterologist. The differential diagnoses are swallowing disorders due to neurological damage, upper esophageal rings, pharyngeal globus, neoplasia, non-specific motor disorders and other even rarer ones. There is little updated literature in adult patients. The diagnosis is based on the barium radiological study, endoscopy and complementary manometry. Treatment options are a matter of discussion, given the little evidence available. This paper presents the results observed in a cohort of 10 patients with a confirmed diagnosis of cricopharyngeal achalasia who underwent endoscopic dilation (7 patients) or surgical myotomy by cervicotomy (3 patients). The evolution of dysphagia, post-procedure complications and long-term results were evaluated. There were no major complications, dysphagia improved in both groups, in the dilation group the treatment was supplemented with periodic dilations in 2 patients. There were no significant differences in the 2 groups studied. Conclusion: both therapeutic options present good results in the treatment of these patients.

Drotaverine to improve progression of labour among parturient women- a case control study

Background: Prolonged labour contributes to increased perinatal and maternal morbidity. Pharmacological interventions can hasten cervical dilation and help obstetrician to accomplish the delivery in the shortest possible time without compromising maternal and fetal safety. Aims and objectives were to evaluate the acceleration effect of drotaverine on the dilatation of the cervix in both primigravidae and multigravida and compare it with control group.Methods: A total of 70 patients were studied (35 in drotaverine group and 35 in control group). The inclusion criteria were pregnancy with at least 37 weeks completed, cervical dilatation 3-4 cm, regular uterine contractions and cephalic presentation. The study group received 40 mg drotaverine hydrochloride i.m. in active phase of labour, control group received standard delivery care. Parameters such as duration of first and second stage of labour, mode of delivery, neonatal outcome and side effects to drug was recorded.Results: 6 subjects from the study group and 4 from the control group developed complications in first stage of labour and were taken up for operative delivery and hence they were excluded from calculation of various labour parameters. The mean rate of cervical dilatation with drotaverine was 2.26 cm/hour, while it was 1.67 cm/hour without any intervention (p value <0.05). Mean duration of active phase of first stage of labor was 3.09 hours in drotaverine group against 4.98 hours in study group (p value <0.05). There were no significant untoward effects noted in either of the groups.Conclusions: Drotaverine was found to be an effective and safe drug in shortening the duration of the first stage of labor without any significant detrimental effects on the mother and newborn. Drotaverine did not interfere with uterine contractility and there was no increased incidence of operative deliveries.

Drotaverine to improve progression of labour among parturient women- a case control study

Background: Prolonged labour contributes to increased perinatal and maternal morbidity. Pharmacological interventions can hasten cervical dilation and help obstetrician to accomplish the delivery in the shortest possible time without compromising maternal and fetal safety. Aims and objectives were to evaluate the acceleration effect of drotaverine on the dilatation of the cervix in both primigravidae and multigravida and compare it with control group.Methods: A total of 70 patients were studied (35 in drotaverine group and 35 in control group). The inclusion criteria were pregnancy with at least 37 weeks completed, cervical dilatation 3-4 cm, regular uterine contractions and cephalic presentation. The study group received 40 mg drotaverine hydrochloride i.m. in active phase of labour, control group received standard delivery care. Parameters such as duration of first and second stage of labour, mode of delivery, neonatal outcome and side effects to drug was recorded.Results: 6 subjects from the study group and 4 from the control group developed complications in first stage of labour and were taken up for operative delivery and hence they were excluded from calculation of various labour parameters. The mean rate of cervical dilatation with drotaverine was 2.26 cm/hour, while it was 1.67 cm/hour without any intervention (p value <0.05). Mean duration of active phase of first stage of labor was 3.09 hours in drotaverine group against 4.98 hours in study group (p value <0.05). There were no significant untoward effects noted in either of the groups.Conclusions: Drotaverine was found to be an effective and safe drug in shortening the duration of the first stage of labor without any significant detrimental effects on the mother and newborn. Drotaverine did not interfere with uterine contractility and there was no increased incidence of operative deliveries.

Effect of pupil dilation on biometric iris recognition systems for personal authentication

Purpose: To study the effect of pupil dilation on a biometric iris recognition (BIR) system for personal authentication and identification. Methods: A prospective, non?randomized, single?center cohort study was conducted on patients who reported for a routine eye check?up from November 2017 to November 2019 (2 years). An iris scanning device “IRITECH?MK2120U” was used to initially enroll the undilated eyes. Baseline scans were taken after matching with the enrolled database. All eyes were topically dilated and matched again with the enrolled database. The Hamming distance (a measure of disagreement between two iris codes) and recognition status were recorded from the device output, and eyes were evaluated by slit?lamp ophthalmoscopy with special emphasis on pupil shape, size, and texture. Results: All 321 enrolled eyes matched after topical dilation. The pupil size had a significant effect on Hamming distance with a P value <0.05. There were no false matches. A correct recognition rate of 100% was obtained after dilation. No loss of iris texture or pupil shape was observed after dilation. Conclusion: A BIR system is a reliable method for identification and personal authentication after pupil dilation. Topically dilated pupils are not a cause for non?recognition of iris scans.

Comparison of the efficacy of transurethral columnar balloon dilation of prostate and transurethral bipolar plasmakinetic resection of prostate in the treatment of small volume (≤30 mL) benign prostatic hyperplasia / 现代泌尿外科杂志

【Objective】 To explore the efficacy of transurethral columnar balloon dilation of prostate (TUCBDP) and transurethral bipolar plasmakinetic resection of prostate (TUPKP) for patients with small volume (≤30 mL) benign prostatic hyperplasia (BPH) and the effects on urinary control and sexual function. 【Methods】 Clinical data of BPH patients who underwent surgical treatment during Jun.2021 and Jan.2022 were reviewed. A total of 95 patients with prostate volume ≤30 mL and regular sexual life were selected as subjects, including 45 patients who received TUCBDP as the TUCBDP group and 50 patients who received TUPKP as the TUPKP group. The patients were followed up for 12 months, and the perioperative data and follow-up results were analyzed. 【Results】 The TUCBDP group had shorter operation time, less intraoperative blood loss, less postoperative hemoglobin loss and sodium concentration loss, shorter bladder irrigation time, lower pain score, shorter urinary tube indwelling time and shorter hospital stay than the TUPKP group (P0.05). The TUPKP group had worse ejaculation function score and ejaculation disturbance score after surgery (P0.05), and the two indexes were superior in the TUCBDP group than in the TUPKP group. The TUCBDP group had significantly lower complication rate than the TUPKP group (P<0.05). 【Conclusion】 TUCBDP is safe and effective in the treatment of small volume (≤30 mL) BPH, less trauma, less biochemical interference, less pain, fewer complications, and shorter course of disease. It has little effect on the ejaculation function and erectile function, and is more suitable for patients requiring retention of sexual function. It has a good application prospect in the treatment of small volume BPH.

Endoscopic dilation guided by two guidewires: a novel method in establishing channels in percutaneous nephrolithotomy / 现代泌尿外科杂志

【Objective】 To explore the safety and efficacy of a novel endoscopic two-wire guided dilation in the creation of channels in percutaneous nephrolithotomy (PCNL). 【Methods】 Clinical records of 180 patients undergoing PCNL during Oct.2020 and Oct.2022 were retrospectively analyzed. The patients were divided into three groups, 60 in AMD group (fascial amplatz dilation), 60 in OSD group (one shot dilation) and 60 in END group (endoscopic dilation). Time to establish channels, operating time, failure of access, stone clearance rate, drop in hemoglobin, embolization rate, fever rate, blood transfusion rate and postoperative hospitalization were compared among the three groups. 【Results】 There were no significant differences in the general data among the three groups (P>0.05). Compared with AMD and OSD groups, END group needed significantly reduced time to establish the first channel [(5.6±0.8) min vs. (4.9±1.4) min vs. (4.2±0.5) min, (P<0.05)] . Compared with OSD group, END and AMD groups had significantly more hemoglobin drop [(14.0±17.6) g/L vs. (19.4±12.6) g/L vs. (10.2±6.8) g/L, (P<0.05)] . There were no significant differences in terms of failure of establishing channels, operating time, stone clearance rate, embolization rate, fever rate, blood transfusion rate and postoperative hospitality. Four patients needed selective renal artery embolization (1 case in AMD group and 3 in OSD group). No serious complications such as organ injuries, septic shock or death occurred. 【Conclusion】 Endoscopic two-wire guided dilation is simple, with few complications and good application value.

Transurethral columnar balloon dilation of the prostate for small volume prostatic hyperplasia:a single-center,open,randomized controlled clinical trial / 现代泌尿外科杂志

【Objective】 To compare the efficacy of transurethral columnar balloon dilation of the prostate (TUCBDP) and transurethral resection of prostate (TURP) in the treatment of small volume prostatic hyperplasia. 【Methods】 A total of 96 patients with small volume prostatic hyperplasia diagnosed in our hospital during Jan.2019 and Jan.2021 were enrolled and divided into the observation group and control group,with 48 patients in either group. The observation group received TUCBDP while the control group TURP. The International Prostate Symptom score (IPSS),Quality of Life Score (QOL), international index of erectile function-erectile function (IIEF-EF),maximum urinary flow rate (Qmax),postvoid residual urine (PVR) and maximum detrusor pressure (MDP) of the two groups were compared before surgery and 24 months after surgery. The surgery-related complications and occurrence of new or aggravated sexual dysfunction were observed. 【Results】 Both groups successfully completed the treatment. The operation time and indwelling catheterization time were shorter in the observation group than in the control group (P<0.05). The scores of QOL,IPSS and IIEF-EF,the levels of Qmax,PVR and MDP of both groups 24 months after surgery were significantly improved compared with those before surgery (P<0.05). The IPSS score of the observation group was lower than that of the control group 24 months after surgery (P<0.05),while the IIEF-EF score and Qmax of the observation group were higher than those of the control group (P<0.05). The incidences of surgery-related complications and new or aggravated sexual dysfunction were significantly lower in the observation group than in the control group (P<0.05). 【Conclusion】 TUCBDP is significantly effective in the treatment of small volume prostatic hyperplasia,showing greater advantages than TURP in improving postoperative IPSS,IIEF-EF score and Qmax,with higher safety.

Progress in Diagnosis and Treatment of Gastric Outlet Obstruction / 胃肠病学

Gastric outlet obstruction,also known as pyloric obstruction or stenosis,refers to pyloric stenosis caused by mechanical compression or obstruction of the duodenum,distal stomach,pyloric duct,and anterior pyloric region.Patients will have the phenomenon that gastric contents cannot pass,accompanied by nausea,vomiting,abdominal pain,and loss of appetite and other related symptoms,which greatly reduces the quality of life of patients,has a wide range of individual impact,and has a high degree of harm.Scientific treatment of this disease has extremely important social significance.Based on the pathogenesis,clinical diagnosis and treatment strategies of gastric outlet obstruction,this article will make a certain summary for the diagnosis and treatment of gastric outlet obstruction for reference.

Characteristics and endoscopic diagnosis and treatment experience for ureteropelvic urothelial encrusted inflammatory diseases / 中华泌尿外科杂志

Objective:To retrospectively summarize disease characteristics and the clinical experience of minimally invasive endoscopy in the treatment of upper urinary tract obstruction caused by ureteropelvic encrusted inflammatory disease.Methods:Three patients with bilateral ureteropelvic encrusted inflammatory disease admitted to our hospital from March 2018 to July 2021 were involved. Case 1, male, 45 years old, admitted due to bilateral hydronephrosis for 5 months. The preoperative diagnosis were bilateral ureteropelvic stones (encrustation), right ureteral atresia, left ureteral stenosis, and systemic vasculitis. Left double J tube insertion and right nephrostomy were performed in another hospital. We conducted antegrade percutaneous nephroscopy combined with retrograde ureteroscopy surgery and assisted balloon dilation to treat bilateral lesions stage by stage. Case 2, Male, 12 years old, admitted due to bilateral abdominal pain for 6 weeks. The preoperative diagnosis were bilateral ureteral stones, bilateral hydronephrosis, and dermatomyositis. After the failure of double J tube insertion in another hospital, double nephrostomy was performed instead. We performed left percutaneous nephroscopy and right percutaneous nephroscopy combined with ureteroscopy for the treatment of bilateral lesions. Case 3, female, 32 years old, was admitted because of pain in the left lower back and abdomen for over 6 months. The preoperative diagnosis were bilateral ureteral stones, bilateral ureteral stenosis, and dermatomyositis. She underwent three times of ESWL and once URS before. We performed ureteroscopic surgery for bilateral lesions. During the surgery, various degrees of crusting in the renal pelvis or ureter were observed in all 3 cases, and the lesions were removed using pneumatic lithotripsy combined with forceps or baskets. After surgery, oral antibiotics were continuously used for 1-3 months. The efficacy and prognosis were evaluated based on the follow-up of urine, imaging, and endoscopic examinations at 3, 6, and 12 months after surgery.Results:All 3 surgeries were successfully completed. At 3, 6, and 12 months after surgery, follow-up CT showed no crusting in the left ureter, and endoscopy showed good mucosal wound healing and unobstructed lumen in case 1. There were still some crusting lesions and lumen stenosis in the right renal pelvis, and the right ureter reconstruction surgery was ultimately performed. There were no crusting on both sides and the urinary tract was unobstructed after 3, 6, and 12 months of follow-up in case 2 and case 3. Postoperative pathological examination showed chronic inflammation of urothelial mucosal tissue, small pieces of proliferative fibrous tissue with peripheral calcification. Calcification layer composition analysis showed magnesium ammonium phosphate and carbonate apatite. No related complications occurred in case 2 and case 3.Conclusions:Urothelial crusted inflammatory disease is rare clinically, and the diagnosis and treatment strategies are rarely reported domestically and internationally. Preoperative imaging examination, intraoperative findings and postoperative pathology or calcification composition analysis are of instruction for the diagnosis and treatment of this disease. Minimally invasive endoscopy treatment for upper urinary tract obstruction caused by ureteropelvic encrusted inflammatory disease has a good effect. Long-term efficacy and other adjuvant treatment need long-term follow-up and clinical practice.

Multi-point drug injection combined with hydraulic dilation of the shoulder joint cavity in the treatment of frozen shoulder / 中华物理医学与康复杂志

Objective:To observe any effect of combining ultrasound-guided drug injection into the subacromial bursa, coracoid bursa and shoulder joint cavity with hydraulic dilation of the glenohumeral joint in the treatment of frozen shoulder (FS).Methods:A total of 116 persons diagnosed with FS were randomly divided into an injection treatment group and a combined treatment group, each of 58. On the first day, both groups received ultrasound-guided steroid injections into the subacromial bursa, coracoid bursa and shoulder joint cavity. The combined treatment group was also injected with 30ml of normal saline into the glenohumeral joint for hydraulic dilation. All then followed a family-based program of shoulder function training for 15 days. Shoulder pain assessment (VAS) and shoulder function assessment (PROM) were performed for both groups before the treatment, after the injections and after the shoulder function training.Results:The average VAS and PROM scores of both groups were significantly different after the treatment, with those of the combined treatment group significantly better than the injection group′s averages at each time point.Conclusion:Combining ultrasound-guided drug injection with hydraulic dilation of the subacromial bursa, the coracoid bursa and the shoulder joint cavity can significantly relieve pain of FS and improve shoulder mobility. It is more effective than drug injection alone.

Effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture / 中国综合临床

Objective:To investigate the effect of different pressure balloon dilation combined with prying reduction and bone graft fixation in the treatment of thoracolumbar fractures and the risk factors of postoperative re-fracture.Methods:One hundred cases of thoracolumbar fracture patients admitted to Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province from March 2019 to June 2021 were selected. Prospective randomized controlled study method was used and random number table method was used to divide them into three groups: incomplete expansion group (33 cases), moderate expansion group (33 cases) and complete expansion group (34 cases). All the 3 groups were treated with balloon dilation combined with prying reduction and bone graft fixation. The pressure of balloon dilation in incomplete dilation group, moderate dilation group and complete dilation group was 100 psi, 150 psi and no more than 200 psi respectively, and the volume of balloon dilation was 0.5∶1, 1∶1 and 1.5∶1 respectively. The operation time, intraoperative bleeding volume, postoperative drainage volume, vertebral anterior margin recovery rate and hospital stay, as well as local Cobb angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores before and after operation were compared among the three groups. According to the follow-up of whether there is re-fracture after surgery, the clinical data of the re-fracture group and the non re-fracture group were compared, and the risk factors of the re-fracture after surgery were analyzed. The measurement data with normal distribution was expressed as: independent sample t-test was used for comparison between two groups, one-way ANOVA or repeated measurement ANOVA was used for comparison between three groups, and SNK-q test was used for comparison between two groups. Counting data were expressed in cases or cases (%), and compared between groups by χ 2 Inspection. Logistic regression was used to analyze the risk factors of refracture after thoracolumbar fracture. Results:There was no significant difference in operation time, intraoperative blood loss and postoperative drainage volume among the three groups ( P=0.096, 0.328 and 0.344, respectively). The recovery rate of vertebral anterior edge height in moderate expansion group was higher than that in incomplete expansion group and complete expansion group ((84.15±4.21)% vs (70.18±7.44)%, (75.94±6.56)%), and the hospitalization time was shorter than that in incomplete expansion group and complete expansion group ((10.38±2.35) d vs (15.18±3.44), (14.59±2.48) d) (all P<0.001). Before treatment, there was no significant difference in Cobb angle, VAS and ODI scores among the three groups (all P>0.05). After treatment, the Cobb angle, VAS and ODI scores of patients in the three groups were lower than those before treatment, and the moderate expansion group were lower than those in the incomplete expansion group and the complete expansion group ((14.08±2.15) ° vs (16.48±4.85) °, (15.06±3.45) °, (1.81±0.53)% vs (2.25±0.41), (2.31±0.42), (18.16±2.18)% vs (20.48±4.85), (20.01±4.45) points) (all P<0.001). 100 patients were followed up until the fracture was healed. They were divided into re-fracture group (15 cases) and non re-fracture group (85 cases) according to whether there was re-fracture after operation. The results of multifactor logistic regression analysis showed that body mass index and bone mineral density were protective factors for patients with thoracolumbar fracture after operation (odds ratio was 0.66 and 0.15 respectively, 95% confidence interval: 0.51~0.86, 0.05~0.42, P values were 0.006 and <0.001 respectively), The old wedge-shaped change of the vertebral body and the abnormal structure of the lumbar spine are the risk factors for postoperative re-fracture (odds ratio 4.22 and 6.36, 95% confidence interval 1.14-15.56 and 1.43-28.21, respectively, P values were 0.027 and 0.015). Conclusions:In the treatment of thoracolumbar fracture with prying reduction and bone grafting fixation, the effect of balloon expansion pressure of 150 psi is better. Body mass index (BMI) and bone mineral density (BMD) were protective factors for postoperative re-fracture of patients with thoracolumbar fracture. Old wedge-shaped change of vertebral body and abnormal lumbar structure are risk factors for postoperative re-fracture.

Efficacy and safety of balloon dilation technique during ureteroscopic lithotripsy with "difficult ureter" / 中华泌尿外科杂志

Objective:To summarize the preliminary clinical experience of utilizing ureteral balloon dilation catheter in the treatment of "difficult ureter" during ureteroscopic lithotripsy, and to discuss the efficacy and safety of the technique.Methods:Clinical data of 28 patients (30 sides) with upper urinary tract calculi admitted to Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University from April 2021 to July 2022 were retrospectively analyzed. There were 23 males (82.1%) and 5 females (17.9%), with age of (51.5±13.6) years. Among the 30 sides, 20 (66.7%) on the left and 10(33.3%) were on the right. Calculi were either located in the renal pelvis or calyxes in 7 sides (23.3%), upper ureter in 17 sides (56.7%), and lower ureter in 6 sides (20.0%). The maximum diameter of the stones was (9.4±4.2)mm, and 23 sides (76.7%) were combined with hydronephrosis before surgery. When "difficult ureter" was encountered during the procedure, that is, it was difficult to insert ureteroscope or ureteral access sheath (UAS) due to small ureteral lumen, balloon catheter was used for dilation in the first stage, in which the balloon diameter was 4 mm on 22 sides and 5mm on 8 sides. The instrument was retrogradely inserted through the working channel of F8 semi-rigid ureteroscope, and the small site of the ureteral lumen was dilated under direct endoscopic view. After a single dilation, the balloon catheter was withdrawn, and the effect of dilation was evaluated by semi-rigid ureteroscopy to determine whether to proceed with the following procedures. The intraoperative data were recorded, including surgical method, stage of "difficult ureter" occurred, site of the small part of the ureter, related data of utilizing ureteral dilatation balloon catheter, grade of ureteral injury after dilatation (according to the 0-4 grading classification of endoscopic ureteral injuries), total operation time, balloon catheter-related adverse events, stone-free rate, and time of removing ureteral stents.Results:Among the 30 sides, 29 (96.7%) had difficulty in the stage of ureteroscope insertion, and 1(3.3%) had difficulty in the stage of UAS insertion. A total of 37 small sites of ureter were involved, including 18 in the intramural segment, 10 in the lower part, 2 in the middle part, and 7 in the upper part. Each site was dilated once with a median time of 3 (0.5, 5.0) minutes and a median maximum balloon pressure of 1 215.9(1 215.9, 1 443.9)kPa[12.0(12.0, 14.3)atm]. There were 28 sites of grade Ⅰ injury, 8 sites of grade Ⅱinjury, and 1 site of grade Ⅲinjury. The total duration of unilateral procedure was (73.4±30.3) min. Ureteroscope or UAS insertion was successful in 28 sides(93.3%) after balloon dilation, and failed in 2 sides(6.7%), both of which were in the stage of inserting ureteroscope and ureteral stent was indwelled for the second-stage procedures. On the first day after surgery, the hemoglobin level was (134.1±12.9)g/L, which was significantly different from the preoperative parameters ( P<0.01), and serum creatinine level was (86.7±23.2)μmol/L, which showed no significant difference from the preoperative one ( P=0.263). The primary stone-free rate was 92.9% (26/28), and the total postoperative complication rate was 13.3% (4/30), including 3 of grade Ⅰ (lateral lower abdominal pain requiring additional analgesic drugs) and 1 of grade Ⅱ (postoperative hematuria requiring intravenous hemostatic drugs). Follow-up was conducted for 3 months. All of the 28 successful sides had their ureteral stents removed before the last follow-up, and the time of removal was (36.9±11.5) days. No hydronephrosis was found in the ipsilateral kidney by ultrasound 3 months after operation. Conclusions:Balloon dilation technique showed good efficacy and safety in the treatment of "difficult ureter" during ureteroscopic lithotripsy.

Risk factors of restenosis after dilation of anastomotic stenosis in patients with esophageal cancer surgery / 中华全科医师杂志

Objective:To investigate the risk factors of restenosis after dilation of anastomotic stenosis in patients with esophageal cancer surgery.Methods:Clinical data of 997 patients who underwent endoscopic dilation due to anastomotic stenosis after esophageal cancer radical surgery in the Affiliated Huai′an First Hospital of Nanjing Medical University from June 2015 to July 2021, were retrospectively analyzed. There were 486 cases receiving single dilation (single dilation group) and 511 cases receiving more than two dilations (multiple dilation group). The risk factors of restenosis were explored using univariate and multivariate logistic regression analysis.Results:There were 682 males and 315 females with a median age of 65 years, the median distance between the stenosis and incisor was 20 (20, 22) cm, the median stenosis diameter was 4 (3, 5) mm, and the median stenosis diameter after dilation was 11 (11, 13) mm. Univariate analysis showed that there were significant differences in the distance of the stenosis and incisor ( Z=-2.303, P<0.05), stenosis diameter ( Z=-4.637, P<0.05) and stenosis diameter after dilation ( Z=-5.773, P<0.05) between single and multiple dilation groups. Stratified multivariate logistic regression showed that for male patients, risk of multiple dilations dropped by approximately 3% for every 1-mm increase in the distance between the stenosis and incisor ( OR=0.97, 95% CI:0.93-1.00, P=0.047); the risk of multiple dilations decreased by about 15%, for every 1-mm increase in stenosis diameter ( OR=0.85, 95% CI:0.76-0.94, P=0.004); the risk of multiple dilations decreased by about 13% for every 1-mm increase in stenosis diameter after dilation ( OR=0.87, 95% CI:0.78-0.96, P=0.007). For females patients under 60 years old, the risk of multiple dilations decreased by about 31%, for every 1-mm increase in stenosis diameter after dilation ( OR=0.69, 95% CI:0.47-0.98, P=0.049); for female patients≥60 years old, the risk decreased by about 5%, for every 1-year increase in age ( OR=0.95, 95% CI:0.91-1.00, P=0.037), risk of multiple dilations dropped by 17%( OR=0.83, 95% CI:0.70-0.99, P=0.039) for every 1 mm increase in stenosis diameter after dilation. Stratified smooth curve fitting indicated that the distance between the stenosis and incisor≤23 mm, stenosis diameter≤4.5 mm, stenosis diameter after dilation≤12 mm were risk factors for multiple dilations. Conclusions:The study indicates that patients with the distance between the stenosis and incisor≤23 mm, stenosis diameter≤4.5 mm, stenosis diameter after dilation≤12 mm may need multiple dilations; and the first dilation should expand the stenosis diameter to 12 mm or above as far as possible to reduce the risk of restenosis in patients receiving esophageal cancer radical surgery.

Clinical analysis of endoscopic esophageal dilation for the treatment of corrosive esophageal strictures in children / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children.@*METHODS@#A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed.@*RESULTS@#A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure.@*CONCLUSIONS@#Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.

Three-dimensional Printer Molds for Vaginal Agenesis: An Individualized Approach as Conservative Treatment / Moldes de impressão tridimensionais para agenesia vaginal: Uma abordagem individualizada como tratamento conservador

Abstract Objective The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA). Methods A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient. Results There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27-3.84) and the effect size (95% CI) was 4.58 (2.88-6.28). Conclusion The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.

Resumo Objetivo O objetivo deste estudo foi avaliar o uso de moldes dilatadores vaginais, confeccionados com impressão tridimensional (3D), para tratamento conservador através da dilatação vaginal em pacientes com agenesia vaginal (AV). Métodos Foram selecionadas 16 pacientes com diagnóstico de AV (síndrome de Mayer-Rokitansky-Küster-Hauser, síndrome de insensibilidade androgênica total e agenesia cervicovaginal), da Universidade Federal de São Paulo. A produção dos dispositivos foi realizada em uma impressora 3D e, como matéria-prima, foi utilizado o filamento polimérico do poliácido lático (PLA). Um tratamento personalizado foi proposto e desenvolvido para cada paciente. Resultados Quatorze pacientes atingiram um comprimento vaginal final (CVF) de 6 cm ou mais. A média inicial do CVF (DP) foi de 1,81 (1,05) e a média final do CVF (DP) 6,37 (0,94); a diferença (IC 95%) foi de 4,56 (5,27-3,84) e o tamanho do efeito (IC 95%) foi de 4,58 (2,88-6,28). Conclusão Os moldes de impressão 3D para dilatação vaginal obtiveram sucesso em 87,5% das pacientes. Como impacto secundário, não apresentaram efeitos adversos importantes e ofereceram uma estratégia econômica, acessível e reprodutível para o tratamento da AV.

Do static and dynamic pupillary parameters differ according to childhood, adulthood, and old age? A quantitative study in healthy volunteers

Purpose: We aimed to evaluate the normative pupillometry values and mean pupil dilatation speed in healthy individuals in different age groups in our study. Methods: The study group included 180 eyes of 90 healthy volunteers in different age groups. Group 1 consisted of 30 participants between the ages of 6 and 18, group 2 consisted of 30 participants aged 19–40, and group 3 consisted of 30 participants aged 41–75. Scotopic, mesopic, photopic, and dynamic measurements were taken with automatic pupillometry of Sirius Topographer (CSO, Firenze, Italy). The mean pupil dilation speed at the 18th second was calculated according to dynamic measurements. Results: Group 1 had a significantly larger pupil diameter than groups 2 and 3 in all static and dynamic parameters, and the mean pupil dilation speed was the highest among the groups (P < 0.001 for all static and dynamic parameters). In addition, group 2 had a significantly larger pupil diameter than group 3 (P < 0.001 for all static and dynamic parameters) and the mean pupil dilation speed was faster than group 3 (P = 0.027). Conclusion: We have presented the static and dynamic parameters and the mean speed of pupil dilatation at the 18th second with automatic pupillometry in healthy individuals in childhood, adulthood, and old age. More studies with higher participants and younger age children are needed.