complication

摘要： Background and Aim: Lumbar posterior open microdiscectomy is a procedure that is widely used to treat lumbar disc diseases. These operations have a low risk of complications. It is unusual for the tool to break and remain in the intervertebral space during surgery. In this situation, we wanted to provide a set of suggestions based on our research of the literature on pituitary forceps blade fractures and the procedure for removing the fractured portion from the disc space during lumbar posterior open microdiscectomy surgery. Case Presentation: 10 days ago, a 37-year-old female patient presented to our clinic complaining of low back pain, left leg pain, and left foot weakness. A diagnosis of lumbar disc herniation necessitating surgery was obtained following neurological and radiographic examinations. The patient was advised to have surgery. The patient had standard lumbar microdiscectomy surgery. However, the tip of the pituitary forceps was broken during disc removal and remained in the L5-S1 disc space. The scope confirmed that the alien object was in space. After the evaluation, it was decided to remove the piece of instrument that was broken and remained in the disc space. The broken surgical handpiece was removed and documented under fluoroscopy. Additionally, it was forwarded to the technical unit for examination. Conclusion: A few case reports in the literature describe a surgical tool piece fracture that remained in the disc distance of the lumbar microdiscectomy. Complication management may be time-consuming and risky. Such a complication should be addressed and resolved appropriately because this situation might have detrimental terms on surgical risks and the legal procedure.

摘要： Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.

摘要： BACKGROUND Acute pancreatitis is an uncommon complication of gastrointestinal endoscopy,especially if the patient has none of the common risk factors associated with pancreatitis;such as alcoholism,gallstones,hypertriglyceridemia,hypercalcemia or the use of certain drugs.CASE SUMMARY A 56-year-old female patient developed abdominal pain immediately after the completion of an upper gastrointestinal endoscopy.The pain was predominantly in the upper and middle abdomen and was persistent and severe.The patient was diagnosed with acute pancreatitis.Treatment included complete fasting,octreotide injection prepared in a prefilled syringe to inhibit pancreatic enzymes secretion,ulinastatin injection to inhibit pancreatic enzymes activity,esomeprazole for gastric acid suppression,fluid replacement and nutritional support.Over the next 3 d,the patient's symptoms improved.The patient remained hemodynamically stable throughout hospitalization and was discharged home in a clinically stable state.CONCLUSION Pancreatitis should be considered in the differential diagnosis of abdominal pain after upper and lower gastrointestinal endoscopy.

摘要： BACKGROUND As the aging population grows worldwide,the rates of endoscopic retrograde cholangiopancreatography(ERCP)for common bile duct stones(CBDS)in older patients with a poor performance status(PS)have been increasing.However,the data on the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4 are lacking,with only a few studies having investigated this issue among patients with poor PS.AIM To examine the safety and efficacy of ERCP for CBDS in patients with a PS score of 3 or 4.METHODS This study utilized a retrospective multi-centered design of three institutions in Japan for 8 years to identify a total of 1343 patients with CBDS having native papillae who underwent therapeutic ERCP.As a result,1113 patients with a PS 0-2 and 230 patients with a PS 3-4 were included.One-to-one propensity-score matching was performed to compare the safety and efficacy of ERCP for CBDS between patients with a PS 0-2 and those with a PS 3-4.RESULTS The overall ERCP-related complication rates in all patients and propensity score-matched patients with a PS 0-2 and 3-4 were 9.0%(100/1113)and 7.0%(16/230;P=0.37),and 4.6%(9/196)and 6.6%(13/196;P=0.51),respectively.In the propensity score-matched patients,complications were significantly more severe in the group with a PS 3-4 than in the group with a PS 0-2 group(P=0.042).Risk factors for complications were indications of ERCP and absence of antibiotics in the multivariate analysis.Therapeutic success rates,including complete CBDS removal and permanent biliary stent placement,in propensity score-matched patients with a PS 0-2 and 3-4 were 97.4%(191/196)and 97.4%(191/196),respectively(P=1.0).CONCLUSION ERCP for CBDS can be effectively performed in patients with a PS 3 or 4.Nevertheless,the indication for ERCP in such patients should be carefully considered with prophylactic antibiotics.

摘要： BACKGROUND Type 1 diabetes(T1D),a chronic metabolic and autoimmune disease,seriously endangers human health.In recent years,mesenchymal stem cell(MSC)transplantation has become an effective treatment for diabetes.Menstrual bloodderived endometrial stem cells(MenSC),a novel MSC type derived from the decidual endometrium during menstruation,are expected to become promising seeding cells for diabetes treatment because of their noninvasive collection procedure,high proliferation rate and high immunomodulation capacity.AIM To comprehensively compare the effects of MenSC and umbilical cord-derived MSC(UcMSC)transplantation on T1D treatment,to further explore the potential mechanism of MSC-based therapies in T1D,and to provide support for the clinical application of MSC in diabetes treatment.METHODS A conventional streptozotocin-induced T1D mouse model was established,and the effects of MenSC and UcMSC transplantation on their blood glucose and serum insulin levels were detected.The morphological and functional changes in the pancreas,liver,kidney,and spleen were analyzed by routine histological and immunohistochemical examinations.Changes in the serum cytokine levels in the model mice were assessed by protein arrays.The expression of target proteins related to pancreatic regeneration and apoptosis was examined by western blot.RESULTS MenSC and UcMSC transplantation significantly improved the blood glucose and serum insulin levels in T1D model mice.Immunofluorescence analysis revealed that the numbers of insulin+and CD31+cells in the pancreas were significantly increased in MSC-treated mice compared with control mice.Subsequent western blot analysis also showed that vascular endothelial growth factor(VEGF),Bcl2,Bcl-xL and Proliferating cell nuclear antigen in pancreatic tissue was significantly upregulated in MSC-treated mice compared with control mice.Additionally,protein arrays indicated that MenSC and UcMSC transplantation significantly downregulated the serum levels of interferonγand tumor necrosis factorαand upregulated the serum levels of interleukin-6 and VEGF in the model mice.Additionally,histological and immunohistochemical analyses revealed that MSC transplantation systematically improved the morphologies and functions of the liver,kidney,and spleen in T1D model mice.CONCLUSION MenSC transplantation significantly improves the symptoms in T1D model mice and exerts protective effects on their main organs.Moreover,MSC-mediated angiogenesis,antiapoptotic effects and immunomodulation likely contribute to the above improvements.Thus,MenSC are expected to become promising seeding cells for clinical diabetes treatment due to their advantages mentioned above.

摘要： BACKGROUND After cardiac and non-cardiac surgeries,elderly patients have a high probability of developing cardiac complications and postoperative delirium.Although several clinical trials have investigated whether perioperative intravenous dexmedetomidine can protect the heart and reduce postoperative complications such as delirium in elderly patients,the obtained results have been inconsistent.We conducted a meta-analysis to investigate the effects of dexmedetomidine on cardioprotection and other postoperative complications in elderly patients undergoing cardiac or non-cardiac surgery.AIM To investigate the effects of dexmedetomidine on cardiac complications and delirium in elderly patients undergoing cardiac or non-cardiac surgery.METHODS The PubMed,Cochrane Library,web of science,and other sources were comprehensively searched for all randomized controlled trials published before May 2021 that investigated the efficacy of dexmedetomidine in the prevention of cardiac and postoperative delirium(POD).RESULTS In total,18 studies involving 1025 patients were included in the meta-analysis.Intravenous dexmedetomidine significantly reduced cardiac troponin I(cTnI)and the inflammatory factor tumor necrosis factor-α(TNF-α)was comparable to the control group.Dexmedetomidine also reduced the POD and mortality rates.However,patients in the dexmedetomidine group were more likely to have a decreased heart rate(within the normal range)and hypotension during dexmedetomidine administration than those in the control group.There was no difference in the occurrence of myocardial infarction,bradycardia,or stroke between the two groups.Dexmedetomidine significantly shortened the time to extubate;however,it did not shorten the length of stay in the intensive care unit.CONCLUSION The administration of dexmedetomidine during cardiac and non-cardiac surgeries can provide myocardial protection by inhibiting inflammation and cTnI,which may be beneficial for the rapid recovery of patients.Meanwhile,the administration of dexmedetomidine reduced the incidence of POD and decreased mortality(in-hospital).

摘要： Objective To investigate the risk factors for cervical lymph node metastasis of clinically lymph node-negative(cN0)papillary thyroid carcinoma(PTC).Methods Patients and Methods:The clinicopathologic data of patients with cN0 PTC who underwent at least one lobectomy plus central lymph node dissection at Xuzhou Central Hospital from January 2018 to December 2020 were retrospectively collected and the risk factors of lymph node metastasis analyzed.Univariate and multivariate analyses were performed to detect the risk factors for cervical lymph node metastasis.Results A total of 312 patients with cN0 PTC were enrolled in this study.The postoperative pathology results showed that 134 patients(42.9%)had central lymph node metastasis,of whom 24(17.9%)had lateral lymph node metastasis(LLNM).The univariate analysis results showed that male gender,age<45 years,tumor diameter≥10 mm,bilateral cancer,capsule invasion,and multiple foci were associated with cervical lymph node metastasis of cN0 PTC(P<0.05).Further logistic regression analysis results showed that these factors,except age,were independent risk factors for cervical lymph node metastasis of cN0 PTC(P<0.05).The results also showed that the risk of LLNM increased with an increase in the number of positive central lymph nodes in patients with cN0 PTC(P<0.05).Conclusion Cervical lymph node metastasis of cN0 PTC is related to many factors,and a high number of positive central lymph nodes indicates a high risk of LLNM.Patients with risk factors should undergo preventive central lymph node dissection at the first surgery,and in patients with a high number of positive central lymph nodes,lateral lymph node dissection should be discreetly performed.

摘要： BACKGROUND The life-threatening complications following pancreatoduodenectomy(PD),intraabdominal hemorrhage,and postoperative infection,are associated with leaks from the anastomosis of pancreaticoduodenectomy.Although several methods have attempted to reduce the postoperative pancreatic fistula(POPF)rate after PD,few have been considered effective.The safety and short-term clinical benefits of omental interposition remain controversial.AIM To investigate the safety and feasibility of omental interposition to reduce the POPF rate and related complications in pancreaticoduodenectomy.METHODS In total,196 consecutive patients underwent PD performed by the same surgical team.The patients were divided into two groups:An omental interposition group(127,64.8%)and a non-omental interposition group(69,35.2%).Propensity scorematched(PSM)analyses were performed to compare the severe complication rates and mortality between the two groups.RESULTS Following PSM,the clinically relevant POPF(CR-POPF,10.1%vs 24.6%;P=0.025)and delayed postpancreatectomy hemorrhage(1.4%vs 11.6%;P=0.016)rates were significantly lower in the omental interposition group.The omental interposition technique was associated with a shorter time to resume food intake(7 d vs 8 d;P=0.048)and shorter hospitalization period(16 d vs 21 d;P=0.031).Multivariate analyses showed that a high body mass index,nonapplication of omental interposition,and a main pancreatic duct diameter<3 mm were independent risk factors for CR-POPF.CONCLUSION The application of omental interposition is an effective and safe approach to reduce the CR-POPF rate and related complications after PD.

摘要： BACKGROUND Non-steroidal anti-inflammatory drugs(NSAIDs)are among the most commonly prescribed medications in the United States.Although they are safe and effective means of analgesia for children with broken bones,there is considerable variation in their clinical use due to persistent concerns about their potentially adverse effect on fracture healing.AIM To assess whether NSAID exposure is a risk factor for fracture nonunion in children.METHODS We systematically reviewed the literature reporting the effect of NSAIDs on bone healing.We included all clinical studies that reported on adverse bone healing complications in children with respect to NSAID exposure.The outcomes of interest were delayed union or nonunion.Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies.A final table was constructed summarizing the available evidence.RESULTS A total of 120 articles were identified and screened,of which 6 articles were included for final review.Nonunion in children is extremely rare;among the studies included,there were 2011 nonunions among 238822 fractures(0.84%).None of the included studies documented an increased risk of nonunion or delayed bone healing in those children who are treated with NSAIDs in the immediate post-injury or peri-operative time period.Additionally,children are likely to take these medications for only a few days after injury or surgery,further decreasing their risk of adverse side-effects.CONCLUSION This systematic review suggests that NSAIDS can be safely prescribed to pediatric orthopaedic patients absent other contraindications without concern for increased risk of fracture non-union or delayed bone healing.Additional prospective studies are needed focusing on higher risk fractures and elective orthopaedic procedures such as osteotomies and spinal fusion.

摘要： BACKGROUND Endoscopic ultrasonography(EUS)has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure.EUS is now used as an alternative technique to percutaneous and surgical drainage.Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage,there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible.CASE SUMMARY We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma(SHH)of the left lobe following percutaneous biliary drainage.After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn’t withstand surgery,we conducted a EUS drainage and debridement of the SHH.Using a lumen apposing metal stent(LAMS)by a transgastric approach,we were able to gain endoscopic access to the SHH.With our experience in the debridement of walled off pancreatic necrosis using this technique,we were confident it was the right approach.After four debridement sessions,the computed tomography scan showed a clear regression of the SHH.CONCLUSION To our knowledge,this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.