Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding

There is the East-West paradox in prevalence and phenotype of colonic diverticula, but colonic diverticular bleeding (CDB) is the most common cause of acute lower gastrointestinal bleeding worldwide. Death from CDB can occur in elderly patients with multiple comorbidities, thus the management of CDB is clinically pivotal amid the aging populations in the East and West. Colonoscopy is the key modality for managing the condition appropriately; however, conventional endoscopic hemostasis by thermal coagulation and clipping cannot achieve the expected results of preventing early rebleeding and conversion to intensive intervention by surgery or transcatheter arterial embolization. Ligation therapy by endoscopic band ligation or endoscopic detachable snare ligation has emerged recently to enable more effective hemostasis for CDB, with an early rebleeding rate of approximately 10% and very rare conversion to intensive intervention. Ligation therapy might in turn reduce long-term rebleeding rates by eliminating the target diverticulum itself. Adverse events have been reported with ligation therapy including diverticulitis of the ascending colon in less than 1% of cases and perforation of the sigmoid colon in a few cases, thus more data are necessary to verify the safety of ligation therapy. Endoscopic hemostasis is indicated only for diverticulum with stigmata of recent hemorrhage (SRH), but the detection rates of SRH are relatively low. Therefore, efforts to increase detection are also key for improving CDB management. Urgent colonoscopy and triage by early contrast-enhanced computed tomography may be candidates to increase detection but further data are necessary in order to make a conclusion.     

Emergency endoscopic variceal band ligation in a COVID-19 patient presented with hematemesis while on mechanical ventilation

COVID-19, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), is now a global pandemic with serious health consequences. Currently, many strict control measures are applied in health care settings, including endoscopy units, in order to limit virus spread. Several recommendations called to limit endoscopic procedures to emergent endoscopies; however, several uncertainties still exist concerning patient safety, protective measures, and infection control methods in emergency endoscopic settings. In this case report, we present a case of successful endoscopic band ligation for bleeding esophageal varices in man with COVID-19 disease who presented with an acute attack of hematemesis while on mechanical ventilation (MV). Esophago-gastroduodenoscopy was performed in the ICU room after preparing the setting, and revealed large, risky esophageal varices. Endoscopic band ligation was done with successful control of bleeding. Third-level measures of medical protection were applied for the participating medical personnel, and patient monitoring was maintained all through the procedure. After the procedure, the bleeding stopped, and the patient was vitally stable and conscious. We conclude that emergency endoscopic interventions could be performed safely with appropriate arrangements in patients with confirmed COVID-19 on MV.     

限制韧带切除矫正轻度上睑下垂在重睑成形术中的应用体会

目的 介绍一种切开重睑术同时进行轻度上睑下垂治疗的新术式——限制韧带切除术.方法 轻度上睑下垂患者存在着独特的解剖学结构,即在上睑提肌腱膜的浅面存在着数条横向走行的白色、质韧的索带样结构——限制韧带,其限制了上睑提肌的上提功能.在术中将其切除掉,使受到束缚的上睑提肌腱膜得到松解.结果 本组共21例患者,18例单纯采取限制韧带切除术,3例采取限制韧带切除术加上睑提肌腱膜缩短术.随访1～18个月,19例取得满意效果,1例重睑线在术后1个月时消失,1例上睑上提效果欠佳.无并发症发生.结论 在重睑成形术中行限制韧带切除术,对轻度上睑下垂有良好的治疗效果,建议在临床中推广应用.     

Floating thumb with double dislocation of carpometacarpal and metacarpo-phalangeal joints

INTRODUCTION

Double dislocations of carpometacarpal and metacarpo-phanlageal joints are rare. We report an unusual case of simultaneous dislocation of both CMC and MCP joints in the thumb.

PRESENTATION OF CASE

A 31 year old male was admitted following a road traffic accident. He was complaining of pain and deformity of right thumb. The X-ray examination revealed simultaneous dislocation of both CMC and MCP joints. He underwent closed manipulative reduction and percutaneous K wire fixation. The wires were removed after six weeks. After a course of physiotherapy he regained full range of pain free movements.

DISCUSSION

The incidence of simultaneous dislocation of both CMC and MCP joints in thumb are associated with high energy injuries. The options of treatment are conservative with cast immobilisation and serial X-rays or operative including closed manipulative reduction and K wire fixation or open reduction and internal fixation.

CONCLUSION

The option of treating this rare injury with closed manipulative reduction and percutaneous K wiring gives excellent and predictable results.     

The safety,efficacy and acceptability of task sharing tubal sterilization to midlevel providers: a systematic review

Background

Task sharing is an important strategy for increasing access to modern, effective contraception for women and reducing unmet need for family planning.

Objective

The objective was to identify evidence for the safety, efficacy or acceptability of task sharing tubal sterilization to midlevel providers.

Search strategy

We searched PubMed, Cochrane and Popline for articles in all languages using the following key words: task sharing, tubal sterilization, midlevel providers, task shifting.

Selection criteria

All studies reporting on any measure of safety, efficacy or acceptability of tubal sterilization performed by any cadre of midlevel providers.

Data collection and analysis

Data were independently abstracted by two authors and graded using the United States Preventive Services Task Force rating for evidence quality. Heterogeneity of outcome measures precluded a meta-analysis.

Main results

Nine studies of fair to poor quality reported on safety and acceptability outcomes. Generalizability of findings is limited by inadequate sample size and lack of statistical comparisons. No study reported on long-term efficacy outcomes.

Conclusions

Well-designed clinical trials, of adequate sample size, are urgently needed to establish the safety, efficacy and acceptability of task sharing tubal sterilization to midlevel providers.     

内镜下橡皮圈套扎术与经典外科手术吻合器痔上黏膜环切钉合术治疗痔疮的临床疗效

目的 对比研究内镜下橡皮圈套扎术(ERBL)与经典外科手术吻合器痔上黏膜环切钉合术(PPH)治疗痔疮的临床疗效。方法 选取2018年1月-2020年1月在淮安市第二人民医院消化内科及胃肠外科住院,分别行ERBL及PPH的Ⅱ度和Ⅲ度痔疮患者各40例。观察组为ERBL手术患者,对照组为PPH手术患者,比较两组患者的手术时间、术中出血量、术后住院天数、术后早期和晚期并发症以及治疗效果。同时比较ERBL组套扎环数量与套扎早期和晚期并发症的相关性。结果 ERBL组手术时间及术后住院时间明显短于PPH组,术中出血量明显少于PPH组,差异有统计学意义(均P=0.000);ERBL组术后早期并发症中疼痛及里急后重的发生率明显低于PPH组(P=0.004和P=0.044);两组患者治疗总有效率比较,差异无统计学意义(χ²=0.26,P=0.608)。不同套扎环数量与ERBL术后早期及晚期并发症的发生无明显相关性(P> 0.05)。结论 ERBL及PPH治疗痔疮的总有效率相仿,但EBRL组手术时间及术后住院天数明显短于PPH组,术中出血量明显少于PPH组,且不同套扎环数量对ER...     

外痔切除内痔注射消痔灵与外剥内扎术治疗混合痔的疗效比较

为观察比较混合痔外痔使用高频电容场痔疮治疗仪电钳切除、内痔注射消痔灵与外剥内扎术两种术式的疗效,将以Ⅱ～Ⅳ期内痔为主的混合痔患者120例随机分为两组,每组60例,治疗组采用高频电容场痔疮治疗仪电钳切除外痔,内痔行消痔灵注射治疗;对照组采用外剥内扎术治疗。分别观察其手术时间、疗效及术后并发症情况。结果显示,两组疗效无明显统计学差异（P〉O．05）;但在手术时间、术后并发症方面治疗组优于对照组（P〈O．01或P〈O．05）。结果表明,两种术式疗效接近,但治疗组操作较简便,术后并发症少。     

新型胶圈套扎器治疗混合痔100例临床疗效分析

为探讨新型胶圈套扎器治疗混合痔的临床疗效,将200例混合痔患者随机分为两组,各100例,治疗组采用新型胶圈套扎术治疗,对照组采用传统外剥内扎术治疗。观察两组手术时间,创口愈合时间,术后疼痛、出血、水肿等情况。结果显示,两组患者治愈率均达90％以上,无显著性差异,但在手术时间、术后疼痛、水肿、创口愈合时间等方面,治疗组优于对照组。结果表明,新型胶圈套扎术与外剥内扎术相比,操作简单,手术时间短,术后疼痛、水肿轻微,恢复较快,并发症少。     

腹腔镜治疗交通性鞘膜积液的疗效观察(附25例报告)

目的:探讨腹腔镜下鞘状突高位结扎术治疗交通性鞘膜积液的效果。方法:回顾我院2010年8月~2013年12月间腹腔镜下鞘状突高位结扎术治疗交通性鞘膜积液的患儿共25例,平均年龄5岁,左侧8例,右侧17例,术中发现对侧隐性鞘状突未闭2例。结果:手术均获成功,单侧手术时间15~20min,术中无精索血管和输精管损伤,随访无复发、睾丸萎缩、切口瘢痕等。结论:腹腔镜鞘状突高位结扎术治疗交通性鞘膜积液,操作简单、创伤小、并发症少、复发率低,可同时处理对侧隐匿性未闭鞘状突。     

Site‐Specific Labeling of Proteins and Peptides with Trans‐cyclooctene Containing Handles Capable of Tetrazine Ligation

There is a growing library of functionalized non‐natural substrates for the enzyme protein farnesyltransferase (PFTase). PFTase covalently attaches these functionalized non‐natural substrates to proteins ending in the sequence CAAX, where C is a cysteine that becomes alkylated, A represents an aliphatic amino acid, and X is Ser, Met, Ala, or Gln. Reported substrates include a variety of functionalities that allow modified proteins to undergo subsequent bioconjugation reactions. To date the most common strategy used in this approach has been copper catalyzed azide‐alkyne cycloaddition (CuAAC). While being fast and bioorthogonal CuAAC has limited use in live cell experiments due to copper's toxicity.¹ Here, we report the synthesis of trans‐cyclooctene geranyl diphosphate. This substrate can be synthesized from geraniol in six steps and be enzymatically transferred to peptides and proteins that end in a CAAX sequence. Proteins and peptides site‐specially modified with trans‐cyclooctene geranyl diphosphate were subsequently targeted for further modification via tetrazine ligation. As tetrazine ligation is bioorthogonal, fast, and is contingent on ring strain rather than the addition of a copper catalyst, this labeling strategy should prove useful for labeling proteins where the presence of copper may hinder solubility or biological reactivity.