Future directions in managing aniridia-associated keratopathy

Congenital aniridia is a panocular disorder that is typically characterized by iris hypoplasia and aniridia-associated keratopathy (AAK). AAK results in the progressive loss of corneal transparency and thereby loss of vision. Currently, there is no approved therapy to delay or prevent its progression, and clinical management is challenging because of phenotypic variability and high risk of complications after interventions; however, new insights into the molecular pathogenesis of AAK may help improve its management. Here, we review the current understanding about the pathogenesis and management of AAK. We highlight the biological mechanisms involved in AAK development with the aim to develop future treatment options, including surgical, pharmacological, cell therapies, and gene therapies.     

Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center,retrospective and propensity score-matched analysis

BACKGROUND Minimally invasive surgery for gastric cancer(GC) has gained widespread use as a safe curative procedure especially for early GC.AIM To determine risk factors for postoperative complications after minimally invasive gastrectomy for GC.METHODS Between January 2009 and June 2019, 1716 consecutive patients were referred to our division for primary GC. Among them, 1401 patients who were diagnosed with both clinical and pathological Stage Ⅲ or lower GC and underwent robotic gastrectomy(RG) or laparoscopic gastrectomy(LG) were enrolled. Retrospective chart review and multivariate analysis were performed for identifying risk factors for postoperative morbidity.RESULTS Morbidity following minimally invasive gastrectomy was observed in 7.5% of the patients. Multivariate analyses demonstrated that non-robotic minimally invasive surgery, male gender, and an operative time of ≥ 360 min were significant independent risk factors for morbidity. Therefore, morbidity was compared between RG and LG. Accordingly, propensity-matched cohort analysis revealed that the RG group had significantly fewer intra-abdominal infectious complications than the LG group(2.5% vs 5.9%, respectively; P = 0.038), while no significant differences were noted for other local or systemic complications.Multivariate analyses of the propensity-matched cohort revealed that non-robotic minimally invasive surgery [odds ratio = 2.463(1.070–5.682); P = 0.034] was a significant independent risk factor for intra-abdominal infectious complications.CONCLUSION The findings showed that robotic surgery might improve short-term outcomes following minimally invasive radical gastrectomy by reducing intra-abdominal infectious complications.     

Valor de la escala ASPECTS de circulación posterior y del índice puente-mesencéfalo en imágenes de TC sin contraste y angiografía por TC en pacientes con oclusiones de la arteria basilar recanalizados tras trombectomía mecánica

Purpose

Endovascular treatment with mechanical thrombectomy devices demonstrated high recanalization rates but functional outcome did not correlate with high rates of recanalization obtained. Patient selection prior to the endovascular treatment is very important in the final outcome of the patient. The primary aim of our study was to evaluate the prognostic value of posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and Pons-Midbrain Index (PMI) scores in patients with Basilar Artery Occlusion (BAO) treated with successful angiographic recanalization after mechanical thrombectomy.

比较手术夹闭和介入栓塞治疗颅内未破裂动脉瘤安全性和有效性的Meta分析

目的比较手术夹闭和介入栓塞治疗颅内未破裂动脉瘤的安全性和有效性。方法计算机检索1990至2018年颅内未破裂动脉瘤的所有临床对照研究。两名研究员分别纳入研究、提取数据、质量评价并应用Rev Man5. 0软件进行数据处理。结果最终纳入21篇文献,病例数109114例。Meta分析结果提示:手术夹闭组动脉瘤闭塞率为88. 2%,平均住院时间7. 7天,均高于介入栓塞组的65. 3%和4. 1天,P 0. 05。介入组患者的短期死亡率和致残率分别为0. 61%和2. 1%,均低于手术组的1. 27%和4. 7%,P 0. 05。介入组患者的1年期死亡率和致残率(2. 5%、2. 5%)均与手术组(2. 2%、1. 8%)无明显差异,P 0. 05。漏斗图未发现发表偏倚。敏感性分析结果一致。结论介入栓塞相比于手术夹闭可缩短患者的住院时间,降低患者的短期不良预后发生率。但是动脉瘤的闭塞率较低,1年期预后与手术夹闭无明显差异。据此推测手术夹闭患者的长期预后可能要好于介入栓塞,手术夹闭更适合于年轻患者。     

弯刀综合征14例外科治疗结果分析

目的 探讨小儿弯刀综合征的诊断、外科治疗方法及治疗后的近、中期结果。方法 回顾性分析2010年1月到2017年12月手术治疗的14例弯刀综合征的临床资料。其中,男7例,女7例;年龄(18.23±28.55)个月,范围在23 d至9岁。合并其他心血管畸形10例,中位心8例,右肺发育不良7例,有侧支循环8例,合并肺动脉高压10例。用SPSS 16.0软件的寿命表(Life Table)做出本组患儿术后生存曲线,评估其近、中期生存状况。结果 9例异常肺静脉(scimitar vein,SV)从下腔静脉切下,端-侧吻合于左心房;SV分成2支2例,1例采用2支SV连同部分下腔静脉壁切下,另1例2支SV从下腔静脉从根部切下侧-侧吻合形成单根SV,均吻合于左心房;SV离左心房距离过大3例,2例将SV吻合在右心房右侧壁,再重建心房间隔,1例SV与自体心包卷管道连接再吻合于左心房。其他心血管畸形同期手术矫治。8例有侧支循环,3例心导管检查时被封堵,5例手术时切断缝合。本组14例手术死亡2例(14.29%),另有1例于术后1年2个月因肺炎、呼吸衰竭死亡。本组术后1、3、5年累积生存率分别为86%、73%和73%。术后出院时有1例移植的SV开口狭窄,血流速度为1.9 m/s;有3例随访期间发现移植SV狭窄,血流速度超过1.6 m/s。结论 弯刀综合征可合并其他心血管畸形、中位心、右肺发育不良等。一般将SV与左心房吻合;SV离左心房距离大或多条SV时,可采用个性化办法将SV吻合于左心房。侧支循环心导管检查时可封堵,或术中切断缝合。     

可切除肺癌预后预测模型的构建及生存分析

目的 探讨构建的可切除肺癌预后预测模型在患者生存及预后预测中的价值。方法 选择山西省肿瘤医院2007年1月至2018年9月原发性肺癌患者2 267例,患者均行一次肺癌手术治疗,无第二原发肿瘤。选取性别、年龄、职业、肿瘤部位、病理类型、手术路径、手术方式、肿瘤分期、治疗方案为预后影响因素。采用Cox比例风险模型构建预后指数(PI)方程,计算每例患者的PI值。根据PI值的不同范围,划分低、中、高危预后组,对各组生存情况进行评估。结果 性别(RR=0.684,P=0.001)、年龄(RR=0.591,P<0.01)、职业(RR=1.439,P=0.001)、病理类型(RR=3.694,P<0.01)、手术路径(RR=0.734,P=0.001)、肿瘤分期(RR=0.352,P=0.007)为可切除肺癌患者预后独立影响因素。其中,女性、≤65岁、胸腔镜手术、肿瘤分期Ⅰ期为预后保护因素,其预后不良风险分别降低31.6%、40.9%、26.6%、64.8%;农民、腺鳞癌为预后危险因素,其预后不良风险分别增加43.9%、269.4%。PI方程为:∑βixi=-0.380 X1-0.526 X2+0.364 X31+1.307 X55-0.309 X6-1.045 X81(X1代表性别,X2代表年龄,X31代表职业为农民,X55代表病理类型为腺鳞癌,X6代表手术路径,X81代表肿瘤分期Ⅰ期)。PI<-1为低危组,PI≥-1且≤-0.5为中危组,PI>-0.5为高危组。1、3、5年生存率低危组分别为96.8%、87.0%、77.9%,中危组分别为91.8%、82.2%、61.7%,高危组分别为86.5%、61.7%、50.3%,各组间生存率差异具有统计学意义(P<0.05)。结论 可切除肺癌预后预测模型能够预测可切除肺癌患者的预后风险及相应生存率,帮助临床医师评估预后及制订后续治疗方案。     

经自然腔道取标本手术在结直肠外科手术中的应用进展

随着腔镜技术的进一步发展以及微创理念应用于结直肠外科疾病的诊治中,结直肠相关疾病的诊治发生了翻天覆地的变化。由传统的经腹手术到腹腔镜手术、经自然腔道手术,再到经自然腔道取标本手术(NOSES),结直肠疾病的外科诊治在微创领域取得了巨大成果。NOSES技术是目前结直肠外科在微创领域前沿的手术方式之一,它通过经直肠、阴道取标本来避免了腹壁的辅助取标本切口,从而将结直肠外科手术进一步微创化。NOSES技术集传统腹腔镜手术的优势与现代微创外科的理念于一体,它在确保手术效果的基础上集中体现了微创、加速康复外科、功能外科、"无疤"等理念的特点。本文主要就国内外各中心开展NOSES技术在结直肠外科诊治开展中的相关经验、心得和体会进行综述。