ObjectiveTo summarize the development of surgical treatment of rectal cancer.MethodReviewed the domestic and foreign literatures on surgical methods for rectal cancer.ResultsThe first real surgery for rectal cancer was performed by LisFrance in 1826. Because the early understanding of rectal cancer and its development was not clear, the operation effect was poor, and the postoperative recurrence rate was high. It was not until 1908, when Dr. Miles proposed the classic abdominoperineal resection (APR), that the recurrence of rectal cancer improved significantly. In the 20th century, there also appeared Hartmann, Dixon, Bacon, Parks, and other sphincter-preserving operations, among which Dixon surgery was the most influential. Dixon surgery had changed the focus of rectal cancer treatment from radical APR to more sphincter-preserving surgery. With the emergence of stapler, the introduction of concepts such as total mesorectal excision (TME) and circumferric resection margins (CRM), and the promotion of laparoscopic technology, resection and anastomosis of rectal cancer had a lower location, less surgical trauma, better postoperative quality of life, and higher survival rate. Modern rectal cancer surgery was gradually developing to precision and minimally invasive. Following TME, transanal total mesorectal excision (taTME) and natural orifice specimen extraction surgery (NOSES) had given a new meaning to the operation of rectal cancer.ConclusionsWith the in-depth understanding of the occurrence, development, recurrence, and metastasis of rectal cancer, surgical methods of rectal cancer are constantly developing and improving. The introduction of new concepts and surgical procedures is accompanied by controversy and doubt, which promotes the improvement of the treatment level of rectal cancer.
ObjectiveTo observe and analyze the rate of visual acuity progression and binocular symmetry in patients with choroideremia (CHM). MethodsA single-center retrospective longitudinal cohort study. From April 2009 to August 2022, 38 eyes of 19 patients diagnosed with CHM through clinical and genetic testing at the Department of Ophthalmology, Peking Union Medical College Hospital, were included in this study. All patients underwent at least 2 follow-up visits with a minimum interval of 1 year between visits, and binocular best-corrected visual acuity (BCVA) results were recorded at each follow-up visit. Decimal visual acuity was converted into logarithm of the minimum angle of resolution (logMAR) for analysis. The patient group consisted of 19 males from 16 unrelated families. The age at initial visit was (39.52±13.24) years, with a (2.63±1.61) follow-up visits over a duration of (4.95±2.68) years. A total of 50 binocular BCVA data were included. Annual progression rate of visual acuity was calculated based on longitudinal and cross-sectional data. Spearman correlation coefficient and Bland-Altman method were used to evaluate the binocular symmetry. ResultsThe rate of visual acuity progression was (0.095±0.148) logMAR units/year based on longitudinal data and (0.018±0.009) logMAR units/year based on cross-sectional data. The binocular symmetry for BCVA of the baseline values was strong; however, the binocular symmetry of progression rates for BCVA was moderate. Spearman correlation analysis showed that binocular symmetry in baseline BCVA was high (r=0.881, P＜0.001). The symmetry of binocular vision progression rates based on longitudinal data was moderately symmetric (r=0.528, P=0.020). Bland-Altman analysis showed that 94.7% of binocular baseline BCVA differences were within 95% confidence interval (CI) of 95% limit difference (LOA), indicating good symmetry of binocular baseline BCVA. The number of binocular BCVA progression rate differences within 95%CI of 95%LOA was 89.5%, suggesting moderate symmetry in binocular BCVA progression rate. The results of Spearman correlation coefficient and Bland-Altman analysis of binocular symmetry were basically consistent. ConclusionsThe rate of visual acuity progression of patients with CHM based on longitudinal and cross-sectional data is (0.095±0.148) and (0.018±0.009) logMAR units/year, respectively. Cross-sectional data from patients of different ages should not be used to infer the progression rate of the natural history. Binocular eyes with highly symmetrical baseline visual acuity may differ in the rate of visual acuity progression.
objective To analyze the impact of body mass index (BMI) on medical and surgical complications of colorectal cancer patients served by West China Hospital, based on the current version of Database from Colorectal Cancer (DACCA). Methods The data of DACCA was updated on September 27, 2021. The data included BMI, surgical complications, liver nodules, liver function, renal nodules, renal function, operation history, medical complications, diabetes, hypertension, pneumonia, pulmonary nodules, pulmonary function, heart disease, thrombosis, and cardiac function. Results After scanning, 5 305 data rows were included. BMI was divided by Chinese four classification methods. The analysis results showed that in terms of surgical complications, obese patients were more likely to be complicated with surgical complications of digestive system (χ2= 43.883, P<0.001) and reproductive system (χ2=13.139, P=0.004). Lean patients were more likely to have surgical complications of urinary system (χ2=223.415, P<0.001), and obese patients had liver function (H=61.521, P<0.001) and renal function (H=9.994, P=0.019) might be even worse. In terms of operation history, BMI in colorectal cancer patients had nothing to do with the number of times of operation (H=6.262, P=0.100), and operation history of each system or department (P>0.05). Regarding to medical complications, with the increase of BMI, the risk of colorectal cancer patients with diabetes mellitus (χ2=118.597, P<0.001), or hypertension (χ2= 163.334, P< 0.001) increased. Patients with low BMI were more likely to have pneumonia (H=7.899, P= 0.048) and worse pulmonary function (H=40.673, P<0.001). Conclusions The analysis results of DACCA database show that BMI is not related to the occurrence of any special surgical history included in the research. Because the internal and external complications of patients are closely related to the treatment plan and prognosis, we should pay more attention to the obese patients in the process of clinical treatment, and they are more likely to have multisystemic abnormalities and various abnormal indicators than other patients. For thin patients, we should pay more attention to their lung function and inflammatory lesions, so as to improve the clinical therapeutic effect.
ObjectiveTo investigate the blood pressure level and prevalence of hypertension in middle-aged people with positive family history of hypertension in Chengdu area, compare the differences between middle-aged people with positive family history of hypertension and middle-aged people with negative family history of hypertension, and explore the influencing factors of hypertension in middle-aged people with positive family history of hypertension.MethodsFrom September 2013 to March 2014, the stratified sampling method was used to survey 3 096 middle-aged people aged 40-59 years in Chengdu. Their height, weight, blood pressure, blood glucose, and blood lipids were measured. Questionnaire surveys were conducted using a uniformly designed questionnaire. The blood pressure levels and hypertension prevalences were compared between people with and without positive family history of hypertension. The influencing factors of hypertension in middle-aged people with positive family history of hypertension were analyzed using multiple logistic regression.ResultsThere were significant differences between the middle-aged people with positive family history of hypertension and the ones with negative family history of hypertension in systolic blood pressure [(137.4±22.4) vs. (118.0±11.3) mm Hg (1 mm Hg=0.133 kPa), P<0.001], diastolic blood pressure [(84.1±12.2) vs. (73.9±7.7) mm Hg, P<0.001], and prevalence of hypertension (28.6% vs. 22.2%, P<0.001). Ageing [odds ratio (OR)=1.107, 95% confidence interval (CI) (1.071, 1.144), P<0.001], monthly personal income ≥3 000 yuan [OR=1.566, 95%CI (1.003, 2.445), P=0.048], and abdominal obesity [OR=1.658, 95%CI (1.091, 2.520), P=0.018] were the risk factors for hypertension in middle-aged males with positive family history. Ageing [OR=2.257, 95%CI (1.202, 4.025), P=0.026] and overweight or obesity [OR=2.365, 95%CI (1.653, 3.385), P<0.001] were the risk factors, and physical exercise [OR=0.529, 95%CI (0.304, 0.918), P=0.024] was the protective factor for hypertension in middle-aged females with positive family history.ConclusionsThe prevalence of hypertension is high in middle-aged population with positive family history of hypertension in Chengdu and is significantly higher than that in the ones with negative family history of hypertension. Strengthening health education on hypertension-related knowledge, and reasonably controlling waist circumference and body weight may have positive significance in preventing or delaying the occurrence of hypertension in people with positive family history of hypertension.
ObjectiveTo investigate the relationship between family history of malignant tumor (FHOMT) and clinicopathological features of patients with sporadic papillary thyroid carcinoma (PTC), and to provide basis for individualized diagnosis and treatment.MethodsPatients admitted to the department of breast and thyroid surgery in Renmin Hospital of Wuhan University from January 1, 2017 to September 30, 2019 for thyroid surgery for the first time and pathologically diagnosed as PTC were collected. According to the presence or absence of FHOMT, tumor type and family member type, their clinicopathological features were compared.ResultsIn 2 123 patients, there were 1 932 patients without FHOMT and 191 patients with FHOMT. The most common FHOMT was the family history of lung cancer (1.80%). Compared with PTC patients without FHOMT, PTC patients with FHOMT had a later onset age (P=0.000), a lower proportion of central lymph node metastasis (P=0.004), and a lower ratio of capsule invasion (P=0.021). PTC patients with respiratory-related FHOMT had a later onset age (P=0.000). PTC patients with male first-degree relatives had a later onset age (P=0.000). And PTC patients whose first-degree relatives were female had a lower proportion of central lymph node metastasis (P=0.007).ConclusionThere are differences in onset age, central lymph node metastasis and capsule invasion between PTC patients with and without FHOMT.
With the development of thin section axial computed tomography scan, the detection rate of pulmonary ground-glass nodules (GGN) continues increasing. GGN has a special natural growth history: pure ground-glass nodules (PGGN) smaller than 10 mm can hold steady for a long term, surgery resection is unnecessary, patients need regular follow up. Larger part solid ground-glass nodules (PSN) with a solid component can be malignant early stage lung cancer, which requires early surgery intervention. Establishment of a standard definition of GGN growth, investments in the long term natural growth history of GGN, validation of the clinical, radiology and genetic risk factors would be beneficial for the management of GGN patients.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) was recommended as the gold standard procedure for metabolic and bariatric surgery by the National Institutes of Health in the 1990s and then had been adopted till now, which could effectively control excess weight and treat metabolic diseases relevant to obesity in a long term. The current LRYGB procedure had been performed more than half a century of development and update, and is still constantly evolving. Standardized and precise surgical procedures are of great significance in ensuring treatment effect and reducing the incidence of complications. Thus, the author reviewed the development process of LRYGB, further understanding and emphasizing the importance of standardized and precise surgical procedures.
Spinal robotics has rounded out twenty years in clinical, is mainly used for pedicle screw placement at present, can significantly increase the accuracy of screw placement and reduce radiation exposure to the patient and the surgeon. In the future, haptic feedback, automatic collision avoidance, and other technologies will further expand its application to complete precise operations such as decompression and correction, providing safety guarantee for the implementation of complex spinal surgery.
Blood purification is not only an effective treatment for patients with acute and chronic renal failure, but also plays an important role in the rescue of various critically ill patients. The current blood purification devices is relatively bulky and not suitable for use in daily life and disaster rescue sites. Portable blood purification devices can be divided into portable artificial kidney, wearable artificial kidney, implantable artificial kidneys and mobile continuous renal replacement therapy machine, which have not yet been widely applied in clinical practice. In recent years, with the advancement of materials science and computer science, efficient regeneration of dialysate and intelligent operation of equipment have become possible, and portable blood purification devices is also expected to experience rapid development. This article briefly reviews the development history and future research directions of portable blood purification devices.