Objective To summarize the clinical experiences in treating primary tracheal tumors by surgery, so as to improve the results of surgical treatment. Methods The clinical data concerning 22 surgically treated patients were retrospectively analyzed. Four patients tumor were benign and eighteen cases’s tumor was malignant. Tracheal resections and end to end anastomosis were performed in 14 cases, carinal resection was performed in 4 cases, lateral tracheal wall resection was performed in 1 case, local scrape were performed in 2 cases, tumor was resected transfiberoptic bronchoscopy in 1 case. Tracheal resectable length was from 2.0cm to 5.2cm，and the average resectable length was 3.8cm in operation. Results 17 cases had been misdiagnosised ( 77.3%) in outpatient department. It was easy to be misdiagnosised as asthma. One case died of respiratory failure after operation in 30 days. The complication rate was 31.8%, complications consist of pneumonia in 4 cases, anastomosis leakage in 1 case and chylothorax in 2 cases. Anastomosis stenosis was found in 3 cases, the syndromes were improved after treatment.Twenty cases were followed up from 1 month to 8 years. Four cases with benign tumors were still alive. Among 16 cases with malignant tumors, 6 cases had survived more than 5 years， 3 cases died of brain, liver, bone metastasis of malignant tumors. Conclusion Surgical resection is the most effective treatment of tracheal tumors. Tracheal resection and reconstruction is the main choice of primary tracheal tumors treatment. Benign tumors can be resected conservatively. The reductions of operative complications are the key points of good surgical results. To know the characteristic of primary tracheal tumors well can reduce the misdiagnosis rate.
ObjectiveTo investigate the progress and controversy of membrane anatomy theory in laparoscopic surgery for mid-low rectal cancer. MethodThe literature related to membrane anatomy theory in recent years was reviewed and summarized. ResultsThe membrane anatomy theory not only improved the effect of total mesorectal excision, ensured the integrity of the mesorectum, more standardized the operation and principles of rectal cancer surgery, but also provided the operator with a broad vision and clear anatomical hierarchy. The theory of membrane anatomy had important clinical significance for tumor radical resection, organ resection and functional protection. However, this theory had not been unified, and the establishment of membrane plane and the choice of surgical plane were still needed to be studied and explored. ConclusionAt present, scholars at home still regard the theory of membrane anatomy as the theoretical support and reference basis for the endoscopic treatment of mid-low rectal cancer, which can provide surgeons with new treatment prospects and research direction, and improve the survival expectancy and quality of life of patients with intestinal cancer in the future.
Objective To assess the clinical efficacy of stroke unit (SU) of integrated traditional Chinese medicine and western medicine in the treatment of acute cerebral stroke. Methods Randomized or quasi-randomized controlled trials (RCTs or q-RCTs) were identified from CBM (1978-2009), CNKI (1994-2009), VIP (1989-2009), PubMed (1966-2009), MEDLINE (1978-2009), Scifinder (1998-2009), and The Cochrane Library (Issue 6, 2009), and relevant journals from Liaoning University of Traditional Chinese Medicine were also hand searched. Data were extracted and evaluated by two reviewers independently with a designed extraction form. RevMan5.0.23 software was used for data analyses. Results A total of 12 RCTs and q-RCTs involving 2 316 patients were included. Meta-analyses showed that, stroke unit of integrated traditional Chinese medicine and western medicine was superior to general medicine treatment (Plt;0.05) in case fatality rate one month after stroke (RR= 0.34, 95%CI 0.22 to 0.54), discharge NIHSS score (WMD= –1.01, 95%CI –1.52 to –0.51) and discharge OHS score (WMD= –0.48, 95%CI –0.78 to –0.18); and it was superior to SU of western medicine (Plt;0.05) in NIHSS score one week after stroke (WMD= –2.38, 95%CI –4.08 to –0.68), NIHSS score one month after stroke (WMD= –1.52, 95%CI –2.32 to –0.73) NIHSS score three months after stroke (WMD= –1.77, 95%CI –2.59 to –0.95), difference value of NIHSS score of hospital admission and discharge (WMD= –1.94, 95%CI –2.54 to –1.34), OHS score one month after stroke (WMD= –0.56, 95%CI –0.95 to –0.17) and OHS score three months after stroke (WMD= –1.05, 95%CI –1.44 to –0.66). Conclusion The current limited evidence shows that there is a significant difference between stroke unit of integrated traditional Chinese medicine and western medicine and general medicine treatment. Although there is no significant difference compared with SU of western medicine, it is superior in improving the functional impairment of nerve as well as disability of injury. More large-scale RCTs with high quality are required to verify the effect of stroke unit of integrated traditional Chinese medicine and western medicine in the treatment of acute cerebral stroke.
Glaucoma is one of blind causing diseases. The cup-to-disc ratio is the main basis for glaucoma screening. Therefore, it is of great significance to precisely segment the optic cup and disc. In this article, an optic cup and disc segmentation model based on the linear attention and dual attention is proposed. Firstly, the region of interest is located and cropped according to the characteristics of the optic disc. Secondly, linear attention residual network-34 (ResNet-34) is introduced as a feature extraction network. Finally, channel and spatial dual attention weights are generated by the linear attention output features, which are used to calibrate feature map in the decoder to obtain the optic cup and disc segmentation image. Experimental results show that the intersection over union of the optic disc and cup in Retinal Image Dataset for Optic Nerve Head Segmentation (DRISHTI-GS) dataset are 0.962 3 and 0.856 4, respectively, and the intersection over union of the optic disc and cup in retinal image database for optic nerve evaluation (RIM-ONE-V3) are 0.956 3 and 0.784 4, respectively. The proposed model is better than the comparison algorithm and has certain medical value in the early screening of glaucoma. In addition, this article uses knowledge distillation technology to generate two smaller models, which is beneficial to apply the models to embedded device.
ObjectiveTo summarize clinical features, imaging findings, and pathological characteristics of pancreas intraductal papillary mucinous neoplasm (IPMN) and to improve effect of clinical diagnosis and treatment of pancreas IPMN.MethodThe clinical data of 45 patients with pancreas IPMN who underwent surgical resection from February 2014 to February 2019 in the First Affiliated Hospital of Soochow University were retrospectively analyzed.ResultsOf the 45 patients with pancreas IPMN, 28 patients were male and 17 patients were female, aged from 44 to 81 years old with (65±21) years old. There were 35 patients with age > 60 years old. The most common clinical manifestation was the upper abdominal discomfort (26 patients) and the lesions mainly occurred in the head of pancreas (20 patients). Twenty-four (58.5%, 24/41) patients and 17 (81.0%, 17/21) patients were definitely diagnosed by the CT and MRI, respectively. Twenty-five patients underwent the pancreaticoduodenectomy, 5 patients underwent the partial pancreatectomy, 2 patient underwent the pancreatic tumor resection, 12 patients underwent the pancreatic body and tail resection, 1 patient underwent the total pancreatectomy. The pathological findings showed that 15 cases were mild dysplasia, 5 cases were moderate dysplasia, 3 cases were severe dysplasia. Six cases invaded the pancreas and its surrounding adipose tissue, 5 cases invaded the tissue outside the pancreas. After the discharge, 28/32 patients were followed up for 3 to 24 months. Among all the followed-up patients, the 1-year survival rate was 100% (28/28) and the 2-year survival rate was 96.4% (27/28). The patients underwent the CT examination on the 3rd, 6th, 12th,18th, and 24th month, no lymph node metastasis was found.ConclusionsPancreas IPMN is more common in the elderly, mainly manifests as gastrointestinal symptoms, such as upper abdominal discomfort, etc. Surgery is its main treatment mean. Preoperative diagnosis mainly depends on CT examination and MRI examination, but positive rate of MRI examination is higher. Postoperative pathological section shows different degree of dysplasia.
ObjectiveTo analyze the difference of expression of B7 superfamily member 1 (B7S1) in gastric cancer and adjacent cancer tissues, and to explore the relationship between B7S1 expression and the clinicopathological characteristics and the prognosis of gastric cancer patients.MethodsReverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry were performed to investigate the expression of B7S1 in 78 cases of gastric cancer tissues and adjacent tissues. The correlation of B7S1 expressions with the clinicopathological characteristics and prognosis of the patients was analyzed.ResultsThe results showed that cancer tissues relative expression of B7S1 mRNA was higher than that of adjacent tissues, and the difference was statistically significant (P<0.05). The results showed that positive rate of B7S1 protein expression in gastric cancer tissues was significantly higher than that of adjacent tissues, 74.36% and 11.54%, the difference was statistically significant (P=0.001). Chi-square analysis showed that the expression of B7S1 protein was associated with tumor diameter (P=0.006), pathological-stage (P=0.002), T-stage (P=0.011), and lymph node metastasis (P=0.001). There were no relationship with gender, age, tumor site, and M-stage (P>0.05). B7S1 protein expression was correlated with the overall survival rate for gastric cancer patients. Both univariate and Cox multivariate survival analysis suggested that B7S1 positive expression was a risk factor for poor prognosis in patients with gastric cancer.ConclusionsThe relative expression level of B7S1 mRNA and the positive rate of protein expression in gastric cancer tissues are higher than those in adjacent tissues. The positive expression of B7S1 is correlated with the poor clinicopathological characteristics and prognosis. We speculate that B7S1 may be involved in the malignant progression of gastric cancer.
Objective To evaluate the efficacy and safety of rifaximin in the treatment of irritable bowel syndrome (IBS). Methods The computer system was used to retrieve PubMed, Embase, Web of Science, Cochrane Library, SinoMed, China National Knowledge Infrastructure, Wanfang and Chongqing VIP databases, and the randomized controlled trials of rifaximin for IBS published before November 30, 2022 were retrieved. The data were meta-analysed using RevMan 5.1 and Stata 12.0 softwares. Results Finally, 8 studies including 5176 patients were included. Meta-analysis results showed that the overall effective rate [relative risk (RR)=1.40, 95% confidence interval (CI) (1.21, 1.62), P<0.00001], abdominal pain relief rate [RR=1.21, 95%CI (1.12, 1.32), P<0.00001], abdominal distension relief rate [RR=1.28, 95%CI (1.15, 1.41), P<0.00001], and stool character improvement rate [RR=1.20, 95%CI (1.10, 1.32), P<0.0001] of rifaximin in the treatment of IBS were better than those of the control group. There was no significant difference in the incidence of adverse reactions (P>0.05). Conclusion Rifaximin can effectively improve the abdominal pain, abdominal distension and stool characteristics of IBS patients, and it is safe and reliable.
Objective To systematically evaluate the diagnostic value of artificial intelligence assisted narrow-band imaging endoscopy diagnostic system for colorectal adenomatous polyps. Methods Pubmed, Embase, Web of Science, Cochrane Library, SinoMed, China National Knowledge Infrastructure, Chongqing VIP and Wanfang databases were searched. The diagnostic trials of the artificial intelligence assisted narrow-band imaging endoscopy diagnostic system for colorectal adenomatous polyps were comprehensively searched. The search time limit was from January 1, 2000 to October 31, 2022. The included studies were evaluated according to the Quality Assessment of Diagnostic Accuracy Studies-2, and the data were meta-analysed with RevMan 5.3, Meta-Disc 1.4 and Stata 13.0 statistical softwares. Results Finally, 11 articles were included, including 2178 patients. Meta-analysis results of the artificial intelligence assisted narrow-band imaging endoscopy diagnostic system for colorectal adenomatous polyps showed that the pooled sensitivity was 0.91, the pooled specificity was 0.88, the pooled positive likelihood ratio was 7.41, the pooled negative likelihood ratio was 0.10, the pooled diagnostic odds ratio was 76.45, and the area under the summary receiver operating characteristic curve was 0.957. Among them, 5 articles reported the diagnosis of small adenomatous polyps (diameter <5 mm) by the artificial intelligence assisted narrow-band imaging endoscopy diagnostic system. The results showed that the pooled sensitivity and the pooled specificity were 0.93 and 0.91, respectively, and the area under the summary receiver operating characteristic curve was 0.971. Five articles reported the accuracy of endoscopic diagnosis for adenomatous polyps of those with insufficient experience. The results showed that the pooled sensitivity and the pooled specificity were 0.84 and 0.76, respectively. The area under the summary receiver operating characteristic curve was 0.848. Compared with the artificial intelligence assisted narrow-band imaging endoscopy diagnostic system, the difference was statistically significant (Z=1.979, P=0.048). Conclusion The artificial intelligence assisted narrow-band imaging endoscopy diagnostic system has a high diagnostic accuracy, which can significantly improve the diagnostic accuracy for colorectal adenomatous polyps of those with insufficient endoscopic experience, and can effectively compensate for the adverse impact of their lack of endoscopic experience.
The development and potential application of brain-computer interface (BCI) technology is closely related to the human brain, so that the ethical regulation of BCI has become an important issue attracting the consideration of society. Existing literatures have discussed the ethical norms of BCI technology from the perspectives of non-BCI developers and scientific ethics, while few discussions have been launched from the perspective of BCI developers. Therefore, there is a great need to study and discuss the ethical norms of BCI technology from the perspective of BCI developers. In this paper, we present the user-centered and non-harmful BCI technology ethics, and then discuss and look forward on them. This paper argues that human beings can cope with the ethical issues arising from BCI technology, and as BCI technology develops, its ethical norms will be improved continuously. It is expected that this paper can provide thoughts and references for the formulation of ethical norms related to BCI technology.
Implantable brain-computer interfaces (BCIs) have potentially important clinical applications due to the high spatial resolution and signal-to-noise ratio of electrodes that are closer to or implanted in the cerebral cortex. However, the surgery and electrodes of implantable BCIs carry safety risks of brain tissue damage, and their medical applications face ethical challenges, with little literature to date systematically considering ethical norms for the medical applications of implantable BCIs. In order to promote the clinical translation of this type of BCI, we considered the ethics of practice for the medical application of implantable BCIs, including: reducing the risk of brain tissue damage from implantable BCI surgery and electrodes, providing patients with customized and personalized implantable BCI treatments, ensuring multidisciplinary collaboration in the clinical application of implantable BCIs, and the responsible use of implantable BCIs, among others. It is expected that this article will provide thoughts and references for the research and development of ethics of the medical application of implantable BCI.