Analysis of palliative care needs and related factors of family caregivers of patients with advanced Alzheimer's disease / 重庆医学

Objective To explore the needs and influencing factors of palliative care among primary car-egivers in families of patients with advanced Alzheimer's disease(AD).Methods The main caregivers of 148 patients with advanced AD who were diagnosed at the Memory Clinic of this hospital from January 2021 to December 2022 were randomly selected as the research subjects.A self-designed questionnaire on palliative care needs was used for investigation and statistical analysis.Results The total score of the main caregivers for palliative medical needs was(91.88±15.19),with a score indicator of 66.57％.The highest score indicator was the demand for professional medical care guidance,and the lowest was the demand for social support.There were statistical differences in the scores of palliative medical care needs of caregivers with different a-ges,education level,relationship with patients,nursing experience,death of relatives and friends,annual family income,medical payment method and physical condition(P＜0.05).The results of linear regression analysis showed that education level,relationship with patients and nursing experience were the influencing factors of family caregivers'easing medical needs(P＜0.05).Conclusion The main caregivers of advanced AD patients have a high demand for palliative care,and there is an urgent need to strengthen palliative care services.

A web-based survey on the telerehabilitation knowledge, attitude, and practice of physical therapists in a developing country during the COVID-19 pandemic: An analytical cross-sectional study

Background and Objective@#Pre-pandemic, various healthcare settings were not used to seeing patients virtually. The unprecedented need to adopt virtual care during the COVID-19 pandemic may have caught physical therapists (PTs) unready for it. This study aimed to determine the telerehabilitation knowledge, attitude, and practice of PTs in the Philippines during the COVID-19 pandemic and determine the association between demographic and study outcome variables.@*Methods@#This is an analytical cross-sectional study among members of the Philippine Physical Therapy Association, Inc. (PPTA) practicing in the Philippines. Purposive sampling (total enumeration) was employed. All PPTA members were invited to the study through e-mail and official social media group chats. A self-administered questionnaire was used to obtain data on telerehabilitation knowledge (through test questions on various theoretical aspects), attitude, and practice.@*Results@#The questionnaire items had a content validity index of >0.80. The study yielded a 40% response rate. Most respondents were practicing clinicians in urban-based, private rehabilitation centers. Approximately half had average telerehabilitation knowledge, while the majority had agreeable telerehabilitation attitudes across different constructs. Among the respondents, 15.9% used telerehabilitation pre-pandemic, while 64.8% used it during the pandemic. Hybrid (synchronous and asynchronous) telerehabilitation sessions usually lasted one hour per patient, mostly using Facebook Messenger. @*Conclusion@#Telerehabilitation was not widely practiced locally pre-pandemic, which may explain their average telerehabilitation knowledge. The positive telerehabilitation attitudes may represent a small group of PTs favoring telerehabilitation, while information from the larger population remains unknown. Early adopters of telerehabilitation may help introduce virtual care to colleagues and guide them in developing relevant knowledge and skills amid and beyond the enduring COVID-19 crisis.

Lived experiences of UAAP Season 84 and NCAA Season 97 student-athletes in their bubble set-up training during the COVID-19 pandemic: A research protocol

Background@#The COVID-19 pandemic has greatly affected the sports industry, postponing events worldwide. To adapt to the situation, athletes have been forced to train at home. Bubble training was introduced to provide a safe and conducive training environment while adhering to government health protocols. However, concerns have emerged regarding the set-up’s implementation.@*Objective@#The study aims to explore the lived experiences of UAAP Season 84 and NCAA Season 97 student-athletes who underwent bubble training.@*Methods@#The study will employ a qualitative phenomenological approach based on Seligman's Well-Being Theory. A purposive sampling technique will be used to recruit at least seven eligible student-athletes. Data will be collected through on-site or online interviews using a semi-structured interview guide to reveal a narrative of the student-athletes' bubble training experiences, common themes, and patterns. Deductive thematic analysis approach will be used with the help of the NVivo software program.@*Expected Results@#This study is expected to develop themes from the daily bubble training routines, habits, coping strategies, and perceived thoughts and feelings of Filipino collegiate student-athletes, regarding their emotions, engagement, relationships, meaning, and achievement in bubble training. This may provide insights to the government, educational institutions, and athletic associations on possible comprehensive guidelines if they plan to implement bubble training when the need arises.

Surveys on Suspected Adverse Effects Related to Coronavirus Disease 2019 Vaccination and the Impact of Early Publication of Results / 医薬品情報学

Objective: The coronavirus disease 2019 (COVID-19) vaccine was a specially approved pharmaceutical in Japan in February 2021. However, several people were concerned about its safety. Therefore, we conducted a survey on our hospital staff with suspected adverse effects related to COVID-19 vaccines and promptly published the results on our website. Methods: The current study included hospital staff who received the COVID-19 vaccine. A questionnaire survey on suspected adverse effects was conducted after each vaccination from the first to the fifth dose. Data on the survey results were promptly posted on the hospital’s website. The number of hits and time spent on the site were also evaluated. Then, we examined. the media (newspapers and television) that reported our findings and the content of their coverage. Results: There were no new findings regarding suspected adverse effects of the COVID-19 vaccines. An article published on our website on June 18, 2021, received more than 9,000 page views with an average time spent of > 3 min. Four media outlets reported on our hospital’s articles from June to July 2021, when public interest in the first and second doses of the vaccine was high. Conclusion: The early release of the survey results has provided a source of information for people who want to obtain safety information regarding the adverse effects of the COVID-19 vaccine.

A Case of Intractable Gastrocutaneous Fistula Successfully Treated with Local Negative Pressure Closure / 日本農村医学会雑誌

A 71-year-old woman underwent gastrostomy due to malnutrition resulting from impaired esophageal peristalsis due to scleroderma. However, the gastrostomy tube was removed due to worsening of difficult-to-treat dermatitis around the gastrostomy. An intractable gastrocutaneous fistula with persistent gastric juice leakage and peri-gastrostomy dermatitis was treated with fistulotomy and local negative pressure closure therapy under local anesthesia. Spontaneous closure of an intractable fistula after gastrostomy removal can be difficult due to underlying malnutrition and exposure to leaking gastric juice, among other factors. The present case suggests that fistulectomy followed by local negative pressure closure therapy for an intractable fistula after gastrostomy removal can enable oral intake in the early postoperative period and also facilitate wound management.

Live Animal Training in Surgical Education for Undergraduate Medical Students / 医学教育

A live animal training program is offered to medical students seeking more advanced surgical education. This program requires active participation in all aspects, from planning to implementation.　The program provides medical students with a valuable opportunity to develop their interest in surgical care and to acquire advanced surgical techniques through a step-by-step approach. Additionally, they have the chance to develop various types of non-technical skills by assuming different roles within a team. Instructors offer support for their learning.　Peer learning allows medical students to learn from and discuss with each other, enabling them to acquire a broad range of knowledge and skills. Simultaneously, students are expected to understand the importance of a team approach by participating in this program from the perspectives of various medical professions. Moreover, the program contributes to the formation of their professional identity.

Clinical characteristics of choledochal cysts with intrahepatic bile duct dilatations: an observational study

Purpose@#Whether a dilated intrahepatic bile duct (IHBD) has any effect on the prognosis of choledochal cyst (CC) remains controversial. We aimed to summarize the clinical characteristics and prognosis of CC with IHBD dilatation. @*Methods@#One hundred ninety-two children diagnosed with CC were identified, including 127 without IHBD dilatation (group A) and 65 with IHBD dilatation (group B). A retrospective analysis was performed to explore the clinical characteristics and prognosis of CC with IHBD dilatation based on clinical indices, symptoms, and complications. @*Results@#Compared with group A, incidences of jaundice and fever were higher in group B (P = 0.010 and P = 0.033). Preoperative total bilirubin, direct bilirubin, and indirect bilirubin were increased in group B compared to group A (P = 0.005, P < 0.001, and P = 0.014), as were preoperative ALT, AST, γ-GT, and total bile acid (P = 0.006, P = 0.025, P < 0.001, and P = 0.024). The risk of liver fibrosis or cirrhosis was significantly increased for group B compared with group A (P = 0.012) and also occurred earlier in group B (P = 0.006). In the dilated IHBDs, 95.4% (62 of 65) recovered to normal, and more than half of dilated IHBDs (37 of 65) recovered to normal in 1 week. @*Conclusion@#Most IHBDs can recover to normal postoperatively in a short time, and proactive treatment is recommended for CC patients with IHBD dilatation for significant abnormal liver functions.

Dynamic Cervical Spinal Canal Stenosis: Identifying Imaging Risk Factors in Extended Positions

Methods@#This study analyzed 143 patients who underwent decompression surgery between 2012 and 2014, who had symptomatic cervical disorders and MRI evidence of spinal cord or nerve compression but had no history of cervical spine surgery. Patient demographics, disease type, Japanese Orthopedic Association score, and follow-up periods were recorded. Spinal surgeons conducted radiological evaluations to determine stenosis levels using computed tomography myelography or MRI in neutral and extended positions. Measurements such as dural tube and spinal cord diameters, cervical alignment, range of motion, and various angles and distances were also analyzed. The residual space available for the spinal cord (SAC) was also calculated. @*Results@#During extension, new stenosis frequently appeared caudal to the stenosis site in a neutral position, particularly at C5/C6 and C6/C7. A low SAC was identified as a significant risk factor for the development of new stenosis in both the upper and lower adjacent disc levels. Each 1-mm decrease in SAC resulted in an 8.9- and 2.7-fold increased risk of new stenosis development in the upper and lower adjacent disc levels, respectively. A practical SAC cutoff of 1.0 mm was established as the threshold for new stenosis development. @*Conclusions@#The study identified SAC narrowing as the primary risk factor for new stenosis, with a clinically relevant cutoff of 1 mm. This study highlights the importance of local factors in stenosis development, advocating for further research to improve outcomes in patient with cervical spine disorders.

Two-Year Outcomes of Daily and Twice-Weekly Teriparatide Treatment in Postmenopausal Women with Severe Osteoporosis: A Randomized Non-Blinded Prospective Study

Background@#The long-term effects of daily teriparatide (D-TPTD) and twice-weekly TPTD (W-TPTD) injections are compared among postmenopausal women with severe osteoporosis. @*Methods@#A total of 102 patients were enrolled and randomly allocated into two groups for the administration of either D-TPTD or W-TPTD. Treatment efficacy was measured as the percentage change in bone mineral density (ΔBMD) from baseline in the lumbar spine, total hip, and femoral neck. The findings were compared between the two groups. @*Results@#At 24 months after treatment, the persistence rates and medication possession ratios in the D-TPTD and W-TPTD groups were 68.6% and 56.9%, and 87.8% and 92.0%, respectively. The ΔBMD in the lumbar spine, total hip, and femoral neck were 15.6%±10.2%, 5.3%± 6.3%, and 5.5%±6.2%, respectively, in the D-TPTD group; and 9.5%±7.9%, 2.3%±6.2%, and 3.1%±7.4%, respectively, in the W-TPTD group following 24 months of treatment. The ΔBMD of the lumbar spine (p=0.008) at 24 months and total hip (p=0.024) at 18 months differed significantly between the two groups. @*Conclusions@#D-TPTD administration resulted in a significantly higher BMD in the lumbar spine and total hip, supporting this therapeutic regimen for postmenopausal women with severe osteoporosis.

Advantages of whole-exome sequencing over immunomapping in 67 Brazilian patients with epidermolysis bullosa

Abstract Background Epidermolysis bullosa (EB) is characterized by skin fragility and blistering. In Brazil, the diagnosis is usually obtained through immunomapping, which involves a skin biopsy. Most recently, whole exome sequencing (WES) has become an important tool for the diagnosis of the subtypes of EB, providing information on prognosis as well as allowing appropriate genetic counseling for the families. Objective To compare the results of immunomapping and molecular analysis and to describe the characteristics of a Brazilian cohort of patients with EB. Methods Patients were submitted to clinical evaluation and WES using peripheral blood samples. WES results were compared to those obtained from immunomapping testing from skin biopsies. Results 67 patients from 60 families were classified: 47 patients with recessive dystrophic EB (DEB), 4 with dominant DEB, 15 with EB simplex (EBS), and 1 with junctional EB (JEB). Novel causative variants were: 10/60 (16%) in COL7A1 associated with recessive DEB and 3 other variants in dominant DEB; one homozygous variant in KRT5 and another homozygous variant in PLEC, both associated with EBS. Immunomapping was available for 59 of the 67 patients and the results were concordant with exome results in 37 (62%), discordant in 13 (22%), and inconclusive in 9 patients (15%). Study limitations Even though EB is a rare disease, for statistical purposes, the number of patients evaluated by this cohort can still be considered limited; other than that, there was a significant difference between the proportion of types of EB (only one case with JEB, against more than 50 with DEB), which unfortunately represents a selection bias. Also, for a small subset of families, segregation (usually through Sanger sequencing) was not an option, usually due to deceased or unknown parent status (mostly the father). Conclusion Although immunomapping has been useful in services where molecular studies are not available, this invasive method may provide a misdiagnosis or an inconclusive result in about 1/3 of the patients. This study shows that WES is an effective method for the diagnosis and genetic counseling of EB patients.

Adaptación y validación argentina de la Cross Cultural Children Trust Beliefs Scale / Argentinean Adaptation and Validation of the Cross-Cultural Children Trust Beliefs Scale

Resumen El estudio de la confianza interpersonal es crucial para el desarrollo psicosocial humano. Se ha observado que, durante la niñez, favorece el comportamiento moral y prosocial, los vínculos de amistad, la competencia social, la experiencia de emociones positivas y el rendimiento académico, entre otros aspectos. El presente trabajo tuvo por objetivo adaptar y validar la Cross Cultural Children Trust Beliefs Scale (CCCTBS), a fin de poder evaluar este constructo en población argentina. La muestra incluyó 348 niños (51.2 % mujeres; 48.8 % varones), de entre 8 y 12 años de edad (m = 10.58; DE = 1.31), quienes completaron la CCCTBS y una escala de apego. Se consiguió una versión conceptual y semánticamente equivalente a la original, con buenas propiedades psicométricas. La escala argentina conserva el mismo número de ítems y replica el modelo operacional de partida, constituido por tres bases principales de la confianza: fiabilidad (α = .76; ω = .80), confianza emocional (α = .72; ω = .78) y honestidad (α = .78; ω = .83). Las puntuaciones de la CCCTBS correlacionaron positiva y significativamente con la medida de apego seguro, lo que aporta evidencias de su validez nomológica.

Abstract The study of interpersonal trust is crucial for human psychological development. It has been observed that it enhances moral and prosocial behavior during childhood, as well as friendship bonds, social competence, experience of positive emotions and academic performance, among others. This research aimed to adapt and validate the Cross-Cultural Children Trust Beliefs Scale (CCCTBS), to assess this construct in the Argentine population. The sample included 348 children (51.2 % female; 48.8 % male) aged 8 to 12 years (m = 10.58; SD = 1.31), who completed the CCCTBS and an attachment scale. A version, conceptually and semantically equivalent to the original was obtained, with good psychometric properties. The Argentine scale retains the same number of items and replicates the starting operational model, consisting of three main bases of trust: reliability (α = .76; ω = .80), emotional trust (α = .72; ω = .78) and honesty (α = .78; ω = .83). The CCCTBS scores correlated positively and significantly with the secure attachment measure, providing evidence of its nomological validity.

Role of A-Kinase Anchoring Protein 12 in the Central Nervous System

A-kinase anchoring protein (AKAP) 12 is a scaffolding protein that anchors various signaling proteins to the plasma membrane. These signaling proteins include protein kinase A, protein kinase C, protein phosphatase 2B, Src-family kinases, cyclins, and calmodulin, which regulate their respective signaling pathways. AKAP12 expression is observed in the neurons, astrocytes, endothelial cells, pericytes, and oligodendrocytes of the central nervous system (CNS).Its physiological roles include promoting the development of the blood–brain barrier, maintaining white-matter homeostasis, and even regulating complex cognitive functions such as long-term memory formation. Under pathological conditions, dysregulation of AKAP12 expression levels may be involved in the pathology of neurological diseases such as ischemic brain injury and Alzheimer’s disease. This minireview aimed to summarize the current literature on the role of AKAP12 in the CNS.

Delay and completion of treatment in head and neck cancer patients employing a multidisciplinary team approach: A single institution experience

Objective@#To explore possible associations of a multidisciplinary team approach compared to a non-multidisciplinary team approach on delay and completion of treatment of head and neck cancer patients.@*Methods@#Design: Historical Cohort Study Setting: Tertiary Private Training Hospital Participants: A total of 240 records of head and neck cancer patients from January 2016 and December 2018 were included in the study; 117 underwent a multidisciplinary team approach and 123 underwent a non- multidisciplinary team approach.@*Results@#Only 24.79% of head and neck cancer patients under the multidisciplinary team approach had treatment delays compared to 37.40% under the non-multidisciplinary team approach. The proportion of treatment delays was significantly higher (χ2 = 4.44, p = .035) with the non-multidisciplinary team approach. Comparative treatment completion of 77.78% and 69.11% under the multidisciplinary and non-multidisciplinary team approaches, respectively, were not significantly different (χ2 = 2.31, p = .129). @*Conclusion@#The multidisciplinary approach might be associated with decreased delay in treatment among patients with head and neck cancer compared to the non-multidisciplinary team approach. A possible trend toward better treatment completion rate was also observed, but it did not reach statistical significance.

The effect of smoking in the development of stroke in young patients 19 to 45 years old: A case-control study

Introduction@#The increasing incidence of stroke in young adults has been a growing concern, which is why research studies were generated to find out the risk factors contributing to the development of this disease. This study investigated the dose-dependent effect of smoking in the development of stroke in the young ages (19-45 years).@*Methods@#A case-control retrospective study was conducted using electronic and printed records of the patients admitted to Amang Rodriguez Memorial Medical Center last 2017-2018. There were 275 patients included in the study. The smoking status and pack-years cigarette smoking of the subjects were recorded and were correlated with the duration of hospitalization and the Modified Rankin Scale (MRS). Results were analyzed using student’s t-test, ANOVA, and Pearson’s Correlation.@*Result@#The prevalence of stroke was higher in men than in women. The ORs (95% CI) of stroke were significant in current cigarette smoking at 2.71 (CI: 1.6398 to 4.4943). Compared with non-smokers and those who smoked 1 to 9 pack years, the OR of stroke was significantly increased for those who smoked 10 to 19, and ≥ 20 cigarettes per day with OR of 14.0765 (4.10 to 48.35), and 31.5854 (1.82 to 548.97), respectively (p= 0.032 for linear trends). There was a weak positive linear correlation between pack years of cigarette smoking (1-9, 10-19, >20 pack years) and days of hospitalization (r= 0.28; p for trend = 0.0168). There was also a strong positive linear correlation between stroke outcome using the Modified Rankin Scale and pack years of cigarette smoking (r = 0.72; P for trend = 0.001). This study shows an increase in the odds of stroke in current cigarette smokers with a dose-dependent relationship in its outcome.@*Conclusion@#Smoking is a significant risk factor for stroke with a dose-dependent effect on its outcome. Furthermore, quitting smoking significantly decreases the risk of developing stroke.

Clinical impact of C-reactive protein to albumin ratio of the 7th postoperative day on prognosis after laparoscopic colorectal cancer surgery

Purpose@#C-reactive protein to albumin ratio (CAR) has been utilized as a prognostic factor in various carcinomas. We investigated the relationship between preoperative, postoperative day (POD) 1, and POD 7 CARs and the prognosis of patients with colorectal cancer (CRC). @*Methods@#Three hundred twenty patients with CRC who underwent laparoscopic radical resection between May 2011 and December 2016 were enrolled. Patients were selected into 2 groups, high CAR and low CAR (n=72/group), based on preoperative, POD 1, and POD 7 CARs. The relapse-free survival (RFS) and overall survival (OS) were compared between groups using propensity score matching. @*Results@#The high CAR group had a significantly worse RFS (P<0.001) and OS (P=0.002) at POD 7 than those in the low CAR group. However, in preoperative and POD 1 analysis, no differences were observed. @*Conclusion@#In patients with CRC, CAR of POD 7 was a significant prognostic factor.

Change in Line of Sight after Corrective Surgery of Adult Spinal Deformity Patients: A 2-Year Follow-up

Methods@#This retrospective study includes 295 corrective surgery patients with ASD. Subjects were divided into two groups after propensity age matching analysis: cranial malalignment (McGS 13) and normal cranial alignment (−8≤ McGS ≤13). Lumbar lordosis (LL), pelvic tilt (PT), TK, cervical lordosis (CL), and sagittal vertical axis (SVA) were evaluated between the two groups. @*Results@#SVA (95–56 mm) and PT (34°–25°) decreased and LL (19°–41°) increased 2 years after surgery (p <0.05), but McGS (−1.1° to −0.5°) and CL (21°–19°) did not change. Conversely, in the group with cranial malalignment, SVA (120–64 mm), PT (35°–26°), and LL (12°–41°) showed similar results to the normal cranial parameter group 2 years after surgery, but in contrast, McGS (−13° to −2°) and CL (24°–18°) improved significantly. @*Conclusions@#Severe ASD adversely affects to maintain horizontal gaze but can be improved by spinal corrective surgery.

Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials

Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.

Influence of Psychotropic Pro Re Nata Drug Use on Outcomes in Hospitalized Patients with Schizophrenia

Objective@#In the treatment of patients with schizophrenia, pro re nata (PRN) drugs are commonly prescribed for medical indications such as agitation, acute psychiatric symptoms, insomnia, and anxiety. However, high-quality evidence supporting the use of PRN medications is lacking, and these drugs are administered on the basis of clinical experience and habits. Therefore, the actual use of psychotropic PRN drugs and its influence on the patients’ outcomes need to be investigated. @*Methods@#This study included 205 patients who underwent inpatient treatment for schizophrenia. We investigated the prescription of psychotropic drugs before admission and at discharge, as well as the dosing frequency of PRN drugs during hospitalization. We also examined the influence of psychotropic PRN drug use on hospitalization days, antipsychotic polypharmacy, and readmission rates. @*Results@#Patients who used psychotropic PRN drugs during hospitalization had significantly longer hospitalization days (p = 7.5 × 10−4 ) and significantly higher rates of antipsychotic polypharmacy (p = 2.4 × 10−4 ) at discharge than those who did not use psychotropic PRN drugs. Moreover, a higher number of psychotropic PRN drugs used per day was associated with higher readmission rates within 3 months of discharge (p = 4.4 × 10−3 ). @*Conclusion@#Psychotropic PRN drug use is associated with prolonged hospitalization, antipsychotic polypharmacy, and increased readmission rates in inpatients with schizophrenia. Therefore, psychiatric symptoms should be stabilized with regularly prescribed medications without the extensive use of psychotropic PRN drugs. Moreover, a system for monitoring and reexamining PRN drug use needs to be established.

Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment

Background/Aims@#Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. @*Methods@#We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. @*Results@#For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. @*Conclusions@#The SLX F2 showed high performance in fragmenting the pancreatic duct stones.In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.

Indications for Dental Floss Clip Traction During Gastric Endoscopic Submucosal Dissection by LessExperienced Endoscopists

Purpose@#Dental floss clip (DFC) traction-assisted endoscopic submucosal dissection (ESD) is widely performed owing to its simplicity. This study aimed to clarify the appropriate indications for the DFC traction method in early gastric cancer when ESD is performed by less-experienced endoscopists. @*Methods@#and Methods: We retrospectively analyzed 1,014 consecutive patients who had undergone gastric ESD performed by less-experienced endoscopists between January 2015 and December 2020. Gastric ESD was performed without DFC in all cases before December 2017 [DFC (−) group, 376 cases], and ESD was performed with DFC in all cases after January 2018 [DFC (+) group, 436 cases]. The procedure time and rates of en bloc resection, complete resection, and adverse events of the groups were compared. @*Results@#The procedure time did not differ significantly between the 2 groups. However, when comparing lesions >20 mm, the procedure time in the DFC (+) group was significantly shorter than that in the DFC (−) group (95±46 vs. 75±31, P20 mm located in the lesser curvature side of the stomach in the DFC (+) group was significantly shorter than that in the DFC (−) group. @*Conclusions@#The indications for DFC during gastric ESD by less-experienced endoscopists include lesions located in the greater curvature of the upper or middle stomach, and lesions >20 mm located in the lesser curvature of the stomach.