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| 1 | Treatment of hemorrhoids: A coloproctologist's view显示文摘Hemorrhoids is recognized as one of the most common medical conditions in general population. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Generally,hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid. External hemorrhoid usually requires no specific treatment unless it becomes acutely thrombosed or causes patients discomfort. Meanwhile,low-graded internal hemorrhoids can be effectively treated with medication and nonoperative measures(such as rubber band ligation and injection sclerotherapy). Surgery is indicated for highgraded internal hemorrhoids,or when non-operative approaches have failed,or complications have occurred. Although excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids,several minimally invasive operations(including Ligasure hemorrhoidectomy,doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain. This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist- which includes the management of hemorrhoids in complicated situations such as hemorrhoids in pregnancy,hemorrhoids in immunocompromised patients,hemorrhoids in patients with cirrhosis or portal hypertension,hemorrhoids in patients having antithrombotic agents,and acutely thrombosed or strangulated hemorrhoids. Future perspectives in the treatment of hemorrhoids are also discussed. | Varut Lohsiriwat | 2015 | World Journal of Gastroenterology2015，21，31： | 54 |
| 2 | Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou,China显示文摘Ethnicity and socioeconomic factors can influence disease susceptibility,clinical presentation,and outcome.We investigated the clinical characteristics(age,sex,seasonal variation,lesion site,symptoms,complications,prognosis,and sequelae) and risk factors for intracerebral hemorrhage(ICH) in 266 cases treated at our hospital in Hangzhou City,China,from January 2011 to December 2011.Risk of ICH increased dramatically with age;only 4.3% of cases were <30 years old,while 44.4% were >60 years of age.Men outnumbered women by 2:1(67.3% vs.32.7%).Single hemorrhage was most often located in the cerebral lobes(37.2% of cases),basal ganglia(34.2%),thalamus(8.3%),cerebellum(6.8%),ventricle(1.5%),and brainstem(1.1%),while 10.9% of cases exhibited hemorrhages at multiple sites.Hypertension was also a major risk factor for ICH,as 47% of all patients were hypertensive and the percentage increased with age.In hypertensive patients,the most common hemorrhage site was the basal ganglia and ICH was often associated with thrombopenia.In patients with leukemia(all forms),most hemorrhages were lobar.Warfarinand encephalic operation-associated ICHs were all lobar.Headache was the major symptom of occipital,temporal,and frontal lobe hemorrhage.Dizziness,nausea,and vomiting were the major symptoms of cerebellum hemorrhage.Limb dysfunction was the major symptom of thalamic and basal ganglia hemorrhage.Disturbed level of consciousness was the major symptom in multisite,ventricular,parietal lobe,and brainstem hemorrhage.Hyperspasmia occurred most often in lobar hemorrhage and blurred vision in occipital lobe hemorrhage.Hospital mortality was 24.4%(n=65) with a mean delay from presentation to death of(10.5±18.5) d.The majority of fatalities were cerebral hernia cases(58.5%) and these patients also had the shortest time to death [(2.9±3.5) d].Mortality was 100% in brainstem ICH and hemorrhagic conversion of cerebral infarct.Thrombopenia-associated ICH also had a high mortality rate(81.0%),while patients with cerebrovascular malformations and cerebral aneurysms demonstrated a much better prognosis(46.2% recovery). | Yun-zhen HU Jian-wen WANG Ben-yan LUO | 2013 | Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)2013，14，6： | 43 |
| 3 | Clinical importance of aspirin and clopidogrel resistance显示文摘Aspirin and clopidogrel are important components of medical therapy for patients with acute coronary syndromes, for those who received coronary artery stents and in the secondary prevention of ischaemic stroke. Despite their use, a significant number of patients experience recurrent adverse ischaemic events. Interindividual variability of platelet aggregation in response to these antiplatelet agents may be an explanation for some of these recurrent events, and small trials have linked 'aspirin and/or clopidogrel resistance', as measured by platelet function tests, to adverse events. We systematically reviewed all available evidence on the prevalence of aspirin/clopidogrel resistance, their possible risk factors and their association with clinical outcomes. We also identified articles showing possible treatments. After analyzing the data on different laboratory methods, we found that aspirin/clopidogrel resistance seems to be associated with poor clinical outcomes and there is currently no standardized or widely accepted definition of clopidogrel resistance. Therefore, we conclude that specific treatment recommendations are not established for patients who exhibit high platelet reactivity during aspirin/clopidogrel therapy or who have poor platelet inhibition by clopidogrel. | Gergely Feher Andrea Feher Gabriella Pusch Katalin Koltai Antal Tibold Beata Gasztonyi Elod Papp Laszlo Szapary Gabor Kesmarky Kalman Toth | 2010 | World Journal of Cardiology2010，2，7： | 36 |
| 4 | 影响小儿重症病毒性脑炎预后的相关危险因素分析显示文摘目的观察小儿重症病毒性脑炎的临床特点,探讨影响其预后的危险因素,为临床早期识别重症病毒性脑炎,指导临床治疗及预防提供理论依据。方法选取2012-09—2015-09在我院儿科及重症监护病房住院并首次确诊为重症病毒性脑炎的151例患儿为研究对象。对所有入组患儿进行定期随访,回顾分析入组患者的临床及辅助检查资料。并应用Lo-gistic回归模型分析影响重症病毒性脑炎患儿预后的危险因素。结果重症病毒性脑炎患儿预后良好率为56.2%,预后不良率为43.8%。预后良好组与预后不良组性别、年龄、住院时间、有无发热、意识障碍、合并低钠血症、低钾血症、CSF白细胞数、CSF蛋白量组间比较差异均无统计学意义(P>0.05);预后良好组发热时间、惊厥及惊厥时间、意识障碍时间显著短于预后不良组,意识障碍程度Glasgow评分显著低于预后不良组,其组间比较差异均具有统计学意义(P<0.05);预后良好组脑电图异常、头颅MRI异常情况所占比例低于预后不良组,差异均具有统计学意义(P<0.05)。Logistic回归分析显示发热时间、惊厥时间、意识障碍及意识障碍时间、意识障碍程度、脑电图异常、头颅MRI异常可增加重症病毒性脑炎患儿预后不良的发生风险,是影响重症病毒性脑炎患儿预后的危险因素。其风险比分别为2.59、5.62、2.68、4.59、4.97、11.59、9.74。结论发热时间、惊厥时间、意识障碍及意识障碍时间、意识障碍程度、脑电图异常、头颅MRI异常可增加重症病毒性脑炎患儿预后不良的发生风险,是影响重症病毒性脑炎患儿预后的危险因素。 | 杨志晓 陈国洪 王媛 | 2016 | 中国实用神经疾病杂志2016，19，4： | 39 |
| 5 | Prognostic factors and long-term outcomes of hilar cholangiocarcinoma:A single-institution experience in China显示文摘AIM: To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution.METHODS: Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival(OS) and disease-free survival(DFS) were evaluated by univariate and multivariate analyses.RESULTS: Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio(HR) = 1.482, 95%CI: 1.127-1.949; P = 0.005], positive nodal disease(HR = 1.701, 95%CI: 1.346-2.149; P < 0.001), poor differentiation(HR = 2.535, 95%CI: 1.839-3.493; P < 0.001), vascular invasion(HR = 1.542, 95%CI: 1.082-2.197; P = 0.017), and positive margins(HR = 1.798, 95%CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease(HR = 3.383, 95%CI: 2.633-4.348; P < 0.001), poor differentiation(HR = 2.774, 95%CI: 2.012-3.823; P < 0.001), vascular invasion(HR = 2.136, 95%CI: 1.658-3.236; P < 0.001), and positive margins(HR = 1.835, 95%CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio(OR) = 9.771, 95%CI: 4.672-20.433; P < 0.001], tumor diameter(OR = 3.772, 95%CI: 1.914-7.434; P < 0.001), surgical procedures(OR = 10.236, 95%CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage(OR = 2.010, 95%CI: 1.043-3.870; P = 0.037), and vascular invasion(OR = 2.278, 95%CI: 0.997-5.207; P = 0.051) were independently associated with tumorfree margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin. CONCLUSION: Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent factors for OS and DFS. Surgical procedures can indirectly affect survival outcome by influencing the tumor resection margin. | Hai-Jie Hu Hui Mao Anuj Shrestha Yong-Qiong Tan Wen-Jie Ma Qin Yang Jun-Ke Wang Nan-Sheng Cheng Fu-Yu Li | 2016 | World Journal of Gastroenterology2016，22，8： | 40 |
| 6 | Endoscopic submucosal dissection for superficial esophageal neoplasms显示文摘Endoscopic submucosal dissection(ESD) is currently accepted as the major treatment modality for superficial neoplasms in the gastrointestinal tract including the esophagus.An important advantage of ESD is its effectiveness in resecting lesions regardless of their size and severity of fibrosis.Based on excellent outcomes for esophageal neoplasms with a small likelihood of lymph node metastasis,the number of ESD candidates has increased.On the other hand,ESD still requires highly skilled endoscopists due to technical difficulties.To avoid unnecessary complications including perforation and postoperative stricture,the indications for ESD require careful consideration and a full understanding of this modality.This article,in the highlight topic series,provides detailed information on the indication,procedure,outcome,complications and their prevention in ESD of superficial esophageal neoplasms. | Satoshi Ono Mitsuhiro Fujishiro Kazuhiko Koike | 2012 | World Journal of Gastrointestinal Endoscopy2012，4，5： | 32 |
| 7 | Preoperative biliary drainage in patients with hilar cholangiocarcinoma undergoing major hepatectomy显示文摘AIM:To investigate the effect of preoperative biliary drainage(PBD)in jaundiced patients with hilar cholangiocarcinoma(HCCA)undergoing major liver resections.METHODS:An observational study was carried out by reviewing a prospectively maintained database of HCCA patients who underwent major liver resection for curative therapy from January 2002 to December 2012.Patients were divided into two groups based on whether PBD was performed:a drained group and an undrained group.Patient baseline characteristics,preoperative factors,perioperative and short-term postoperative outcomes were compared between the two groups.Risk factors for postoperative complications were also analyzed by logistic regression test with calculating OR and 95%CI.RESULTS:In total,78 jaundiced patients with HCCA underwent major liver resection:32 had PBD prior to operation while 46 did not have PBD.The two groups were comparable with respect to age,sex,body mass index and co-morbidities.Furthermore,there was no significant difference in the total bilirubin(TBIL)levels between the drained group and the undrained group at admission(294.2±135.7 vs 254.0±63.5,P=0.126).PBD significantly improved liver function,reducing not only the bilirubin levels but also other liver enzymes.The preoperative TBIL level was significantly lower in the drained group as compared to the undrained group(108.1±60.6 vs 265.7±69.1,P=0.000).The rate of overall postoperative complications(53.1%vs 58.7%,P=0.626),reoperation rate(6.3%vs 6.5%,P=1.000),postoperative hospital stay(16.5 vs 15.0,P=0.221)and mortality(9.4%vs 4.3%,P=0.673)were similar between the two groups.In addition,there was no significant difference in infectious complications(40.6%vs 23.9%,P=0.116)and noninfectious complications(31.3%vs 47.8%,P=0.143)between the two groups.Univariate and multivariate analyses revealed that preoperative TBIL>170μmol/L(OR=13.690,95%CI:1.275-147.028,P=0.031),Bismuth-Corlette classification(OR=0.013,95%CI:0.001-0.166,P=0.001)and extended liver resection(OR=14.010,95%CI:1.130-173.646,P=0.040)were independent risk factors for postoperative complications.CONCLUSION:Overall postoperative morbidity and mortality rates after major liver resection are not improved by PBD in HCCA patients with jaundice.Preoperative TBIL>170μmol/L,Bismuth-Corlette classification and extended liver resection are independent risk factors linked to postoperative complications. | Jun-Jie Xiong Quentin M Nunes Wei Huang Samir Pathak Ai-Lin Wei Chun-Lu Tan Xu-Bao Liu | 2013 | World Journal of Gastroenterology2013，19，46： | 33 |
| 8 | Impact of mechanical bowel preparation in elective colorectal surgery:A meta-analysis显示文摘AIM To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery.METHODS Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery. RESULTS A total of 36 studies(23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates(OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection(OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intraabdominal collection(OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality(OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation(OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay(overall mean difference 0.11 d, 95%CI:-0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlledtrials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures. CONCLUSION In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery. | Katie E Rollins Hannah Javanmard-Emamghissi Dileep N Lobo | 2018 | World Journal of Gastroenterology2018，24，4： | 33 |
| 9 | Current status, problems, and perspectives of non-alcoholic fatty liver disease research显示文摘Non-alcoholic fatty liver disease(NAFLD) is a major chronic liver disease that can lead to liver cirrhosis, liver cancer, and ultimately death. NAFLD is pathologically classified as non-alcoholic fatty liver(NAFL) or non-alcoholic steatohepatitis(NASH) based on the existence of ballooned hepatocytes,although the states have been known to transform into each other. Moreover,since the detection of ballooned hepatocytes may be difficult with limited biopsied specimens, its clinical significance needs reconsideration. Repeated liver biopsy to assess histological NAFLD activity for therapeutic response is also impractical, creating the need for body fluid biomarkers and less invasive imaging modalities. Recent longitudinal observational studies have emphasized the importance of advanced fibrosis as a determinant of NAFLD outcome. Thus,identifying predictors of fibrosis progression and developing better screening methods will enable clinicians to isolate high-risk NAFLD patients requiring early intensive intervention. Despite the considerable heterogeneity of NAFLD with regard to underlying disease, patient age, and fibrosis stage, several clinical trials are underway to develop a first-in-class drug. In this review, we summarize the present status and future direction of NAFLD/NASH research towards solving unmet medical needs. | Naoki Tanaka Takefumi Kimura Naoyuki Fujimori Tadanobu Nagaya Michiharu Komatsu Eiji Tanaka | 2019 | World Journal of Gastroenterology2019，25，2： | 29 |
| 10 | Comparison of extracorporeal and conventional cardiopulmonary resuscitation:A meta-analysis of 2 260 patients with cardiac arrest显示文摘BACKGROUND: This meta-analysis aimed to determine whether extracorporeal cardiopulmonary resuscitation(ECPR), compared with conventional cardiopulmonary resuscitation(CCPR), improves outcomes in adult patients with cardiac arrest(CA).DATA RESOURCES: Pub Med, EMBASE, Web of Science, and China Biological Medicine Database were searched for relevant articles. The baseline information and outcome data(survival, good neurological outcome at discharge, at 3–6 months, and at 1 year after CA) were collected and extracted by two authors. Pooled risk ratios(RRs) and 95% confidence intervals(CIs) were calculated using Review Manager 5.3.RESULTS: In six studies 2 260 patients were enrolled to study the survival rate to discharge and longterm neurological outcome published since 2000. A signi? cant effect of ECPR was observed on survival rate to discharge compared to CCPR in CA patients(RR 2.37, 95%CI 1.63–3.45, P<0.001), and patients who underwent ECPR had a better long-term neurological outcome than those who received CCPR(RR 2.79, 95%CI 1.96–3.97, P<0.001). In subgroup analysis, there was a significant difference in survival to discharge favoring ECPR over CCPR group in OHCA patients(RR 2.69, 95%CI 1.48–4.91, P=0.001). However, no signi? cant difference was found in IHCA patients(RR 1.84, 95%CI 0.91–3.73, P=0.09).CONCLUSION: ECPR showed a bene? cial effect on survival rate to discharge and long-term neurological outcome over CCPR in adult patients with CA. | Gan-nan Wang Xu-feng Chen Li Qiao Yong Mei Jin-ru Lv Xi-hua Huang Bin Shen Jin-song Zhang | 2017 | World Journal of Emergency Medicine2017，8，1： | 25 |
| 11 | How antibiotic resistances could change Helicobacter pylori treatment:A matter of geography?显示文摘Therapeutic management of Helicobacter pylori(H.pylori)remains an unsolved issue.Indeed,no therapeutic regimen is able to cure the infection in all treated patients,and in many the infection persists despite the administration of several consecutive standard therapies.Although antibiotic resistance reports describe alarming results,the outcome of therapeutic regimens does not seem to parallel this scenario in most cases,since a successful performance is often reached in more than 80%of cases.However,the phenomenon of increasing antibiotic resistance is being closely studied,and the results show controversial aspects even in the same geographic area.For the continents of Europe,America,Asia,Africa,and Oceania,minimal and maximal values of resistance to the main antibiotics(clarithromycin,amoxicillin,metronidazole,and levofloxacin)feature wide ranges in different countries.The real enigma is therefore linked to the several different therapeutic regimens,which show results that often do not parallel the in vitro findings even in the same areas.A first aspect to be emphasized is that some regimens are limited by their use in very small geographic districts.Moreover,not all therapeutic trials have considered bacterial and host factors affecting the therapeutic outcome.The additional use of probiotics may help to reduce adverse events,but their therapeutic impact is doubtful.In conclusion,the'ideal therapy',paradoxically,appears to be a'utopia',despite the unprecedented volume of studies in the field and the real breakthrough in medical practice made by the discovery and treatment of H.pylori.The ample discrepancies observed in the different areas do not encourage the development of therapeutic guidelines that could be valid worldwide.On these bases,one of the main challenges for the future might be identifying a successful solution to overcome antibiotic resistances.In this context,geography must be considered a relevant matter. | Enzo Ierardi Floriana Giorgio Giuseppe Losurdo Alfredo Di Leo Mariabeatrice Principi | 2013 | World Journal of Gastroenterology2013，19，45： | 23 |
| 12 | Outcomes of robotic vs laparoscopic hepatectomy:A systematic review and meta-analysis显示文摘AIM: To perform a systematic review and metaanalysis on robotic-assisted vs laparoscopic liver resections.METHODS: A systematic literature search was performed using Pub Med, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria:(1) studies comparing robotic and laparoscopic liver resection;(2) studies reporting at least one perioperative outcome; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy rates.RESULTS: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time(MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital stay.CONCLUSION: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay. | Roberto Montalti Giammauro Berardi Alberto Patriti Marco Vivarelli Roberto Ivan Troisi | 2015 | World Journal of Gastroenterology2015，21，27： | 22 |
| 13 | Colonoscopic perforation:Incidence,risk factors,management and outcome显示文摘This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are discussed.Overall outcomes of patients with CP are also addressed. | Varut Lohsiriwat | 2010 | World Journal of Gastroenterology2010，16，4： | 20 |
| 14 | Perioperative pain control after total knee arthroplasty: An evidence based review of the role of peripheral nerve blocks显示文摘Over the last decades,the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically.This very successful intervention,however,is associated with significant postoperative pain,and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery.The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal.Many different approaches and techniques for peripheral nerve blockades,either landmark or,more recently,ultrasound guided have been described over the last decades.This includes but is not restricted to techniques discussed in this review.The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block.Moreover,ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block.In contrast to patient controlled analgesia using opioids,patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction;this is important as hospital rank-ings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure.This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications,considerations and outcomes. | Thomas Danninger Mathias Opperer Stavros G Memtsoudis | 2014 | World Journal of Orthopedics2014，5，3： | 20 |
| 15 | Volar locking distal radius plates show better short-term results than other treatment options: A prospective randomised controlled trial显示文摘AIM To compare the outcomes of displaced distal radius fractures treated with volar locking plates and with immediate postoperative mobilisation with the outcomes of these fractures treated with modalities that necessitate 6 wk wrist immobilisation.METHODS A prospective, randomised controlled single-centre trial was conducted with 56 patients who had a displaced radius fracture were randomised to treatment either with a volar locking plate(n = 29), or another treatment modality(n = 27; cast immobilisation with or without wires or external fixator). Outcomes were measured at 12 wk. Functional outcome scores measured were the Patient-Rated Wrist Evaluation(PRWE) Score; Disabilities of the Arm, Shoulder and Hand and activities of daily living(ADLs). Clinical outcomes were wrist range of motion and grip strength. Radiographic parameters were volar inclination and ulnar variance.RESULTS Patients in the volar locking plate group had significantly better PRWE scores, ADL scores, grip strength and range of extension at three months compared with the control group. All radiological parameters were significantly better in the volar locking plate group at 3 mo. CONCLUSION The present study suggests that volar locking plates produced significantly better functional and clinical outcomes at 3 mo compared with other treatment modalities. Anatomical reduction was significantly more likely to be preserved in the plating group. Level of evidence: Ⅱ. | Herwig Drobetz Lidia Koval Patrick Weninger Ruth Luscombe Paula Jeffries Stefan Ehrendorfer Clare Heal | 2016 | World Journal of Orthopedics2016，7，10： | 18 |
| 16 | Outcome of surgical resection in Klatskin tumors显示文摘Cholangiocarcinomas are the second most frequent primary hepatic malignancy,and make up from 5% to 30% of malignant hepatic tumours.Hilar cholangiocarcinoma(HCC) is the most common type,and accounts for approximately 60% to 67% of all cholangiocarcinoma cases.There is not a staging system that permits us to compare all series and extract some conclusions to increase the long-survival rate in this dismal disease.Neither the extension of resection,according to the sort of HCC,is a closed topic.Some authors defend limited resection(mesohepatectomy with S1,S1 plus S4b-S5,local excision for papillary tumours,etc.) while others insist in the compulsoriness of an extended hepatic resection with portal vein bifurcation removed to reach cure.As there is not an ideal adjuvant therapy,R1 resection can be justified to prolong the survival rate.Morbidity and mortality rates changed along the last decade,but variability is the rule,with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%,respectively.Conclusion:Surgical resection continues to be the main treatment of HCC.Negative resection margins achieved with major hepatic resections are associated with improved outcome.Preresectional management with biliary drainage,portal vein embolization and staging laparoscopy should be considered in selected patients.Additional evidence is needed to fully define the role of orthotopic liver transplant.Portal and lymph node involvement worsen the prognosis and long-term survival,and surgery is the only option that can lengthen it.Improvements in adjuvant therapy are essential for improving long-term outcome.Furthermore,the lack of effective chemotherapy drugs and radiotherapy approaches leads us to can consider R1 resection as an option,because operated patients have a longer survival rate than those who not undergo surgery. | Alejandro Serrablo Luis Tejedor | 2013 | World Journal of Gastrointestinal Oncology2013，5，7： | 18 |
| 17 | Clinical outcomes and risk factors for perforation in gastric endoscopic submucosal dissection: A prospective pilot study显示文摘AIM: To evaluate clinical outcomes and risk factors for endoscopic perforation during endoscopic submucosal dissection (ESD) in a prospective study. METHODS: We investigated the clinical outcomes and risk factors for the development of perforation in 98 consecutive gastric neoplasms undergoing ESD regarding. Demographic and clinical parameters including patient-, tumor-, and treatment-related factors, clinical parameters, and duration of hospital stay were analyzed for risk factors for perforation. In subgroup analysis, we also compared the clinical outcomes between perforation and 'silent' free air without endoscopically visible perforation detected only by computed tomography.RESULTS: Perforation was identified in 8.2% of patients. All patients were managed conservatively by the administration of antibiotics. The mean procedure time was significantly longer in patients with endoscopic perforation than in those without. According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for perforation was 115 min (87.5% sensitivity, 56.7% specificity). Prolonged procedure time (≥ 115 min) was associated with an increased risk of perforation (odds ratio 9.15; 95%CI: 1.08-77.54; P = 0.04). Following ESD, body temperature and C-reactive protein level were significantly higher in patients with perforation than in those without (P = 0.02), whereas there was no difference between these patient groups on the starting day of oral intake or of hospitalization. In subgroup analysis, the post-ESD clinical course was not different between endoscopic perforation and silent free air. CONCLUSION: Only prolonged procedure time (≥ 115 min) was significantly associated with perforation. The clinical outcomes of perforation are favorable and are comparable to those of patients with or without silent free air. | Jiro Watari Toshihiko Tomita Fumihiko Toyoshima Jun Sakurai Takashi Kondo Haruki Asano Takahisa Yamasaki Takuya Okugawa Hisatomo Ikehara Tadayuki Oshima Hirokazu Fukui Hiroto Miwa | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，6： | 17 |
| 18 | Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review显示文摘Over the last decades the demand for hip surgery,be it elective or in a traumatic setting,has greatly increased and is projected to expand even further.Concurrent with demographic changes the affected population is burdened by an increase in average comorbidity and serious complications.It has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a whole.Therefore different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery patients.Recent studies on comparative effectiveness utilizing population based data have given us a novel insight on anesthetic practice and outcome,showing favorable results in the usage of regional vs general anesthesia.In this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative outcome.While there still remains a scarcity of data investigating perioperative outcomes and anesthesia,most studies concur on a positive outcome in overall mortality,thromboembolic events,blood loss and transfusion requirements when comparing regional to gener-al anesthesia.Much of the currently available evidence suggests that a comprehensive medical approach with emphasis on regional anesthesia can prove beneficial to patients and the health care system. | Mathias Opperer Thomas Danninger Ottokar Stundner Stavros G Memtsoudis | 2014 | World Journal of Orthopedics2014，5，3： | 17 |
| 19 | Outcomes of endoscopic sphincterotomy vs open choledochotomy for common bile duct stones显示文摘BACKGROUND Endoscopic sphincterotomy(EST) for the management of common bile duct stones(CBDS) is used increasingly widely because it is a minimally invasive procedure. However, some clinical practitioners argued that EST may be complicated by post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP) and accompanied by a higher recurrence of CBDS than open choledochotomy(OCT). Whether any differences in outcomes exist between these two approaches for treating CBDS has not been thoroughly elucidated to date.AIM To compare the outcomes of EST vs OCT for the management of CBDS and to clarify the risk factors associated with stone recurrence.METHODS Patients who underwent EST or OCT for CBDS between January 2010 and December 2012 were enrolled in this retrospective study. Follow-up data were obtained through telephone or by searching the medical records. Statistical analysis was carried out for 302 patients who had a follow-up period of at least 5 years or had a recurrence. Propensity score matching(1:1) was performed to adjust for clinical differences. A logistic regression model was used to identify potential risk factors for recurrence, and a receiver operating characteristic(ROC)curve was generated for qualifying independent risk factors.RESULTS In total, 302 patients undergoing successful EST(n = 168) or OCT(n = 134) were enrolled in the study and were followed for a median of 6.3 years. After propensity score matching, 176 patients remained, and all covariates were balanced. EST was associated with significantly shorter time to relieving biliary obstruction, anesthetic duration, procedure time, and hospital stay than OCT(P <0.001). The number of complete stone clearance sessions increased significantly in the EST group(P = 0.009). The overall incidence of complications and mortality did not differ significantly between the two groups. Recurrent CBDS occurred in18.8%(33/176) of the patients overall, but no difference was found between the EST(20.5%, 18/88) and OCT(17.0%, 15/88) groups. Factors associated with CBDS recurrence included common bile duct(CBD) diameter > 15 mm(OR =2.72; 95%CI: 1.26-5.87; P = 0.011), multiple CBDS(OR = 5.09; 95%CI: 2.58-10.07; P< 0.001), and distal CBD angle ≤ 145°(OR = 2.92; 95%CI: 1.54-5.55; P = 0.001). The prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.81(95%CI: 0.76-0.87).CONCLUSION EST is superior to OCT with regard to time to biliary obstruction relief, anesthetic duration, procedure time, and hospital stay and is not associated with an increased recurrence rate or mortality compared with OCT in the management of CBDS. | Xiao-Dong Zhou Qiao-Feng Chen Yuan-Yuan Zhang Ming-Ju Yu Chang Zhong Zhi-Jian Liu Guo-Hua Li Xiao-Jiang Zhou Jun-Bo Hong You-Xiang Chen | 2019 | World Journal of Gastroenterology2019，25，4： | 17 |
| 20 | Comparison of endoscopic submucosal dissection with surgical gastrectomy for early gastric cancer: An updated meta-analysis显示文摘BACKGROUND There are several surgical options for treating early gastric cancers(EGCs), such as endoscopic resection, laparoscopic or open gastrectomy with D1 or D2 lymphadenectomy. Endoscopic resection for EGC with low risk of lymph node metastasis has been widely accepted as a therapeutic alternative. The role of endoscopic submucosal dissection(ESD) in treating EGC is not well established,especially when compared with resection surgery cases in a long-term follow-up scope.AIM To compare the safety and efficacy of the short-and long-term outcomes between ESD and resection surgery.METHODS We searched the databases of PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1990 to June 2018, enrolling studies reporting short-or long-term outcomes of ESD in comparison with resection surgery for EGC. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Stata software(version 12.0) was used for the analysis. Pooling analysis was conducted using either fixed-or random-effects models depending on heterogeneity across studies.RESULTS Fourteen studies comprising 5112 patients were eligible for analysis(2402 for EGC and 2710 for radical surgery). Our meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time [weighted mean difference(WMD):-140.02 min, 95%CI:-254.23 to-34.82 min, P = 0.009], shorter hospital stay(WMD:-5.41 d, 95% CI:-5.93 to-4.89 d, P < 0.001), and lowerpostoperative complication rate [Odds ratio(OR) = 0.39, 95%CI: 0.28-0.55, P <0.001). Meanwhile, EGC patients who underwent ESD had higher recurrence rate(OR = 9.24, 95%CI: 5.94-14.36, P < 0.001) than resection surgery patients.However, the long-term survival including overall survival [Hazard ratio(HR) =0.51, 95%CI: 0.26-1.00, P = 0.05] and event-free survival(HR = 1.59, 95%CI: 0.66-9.81, P = 0.300) showed no significant differences between these two groups.CONCLUSION In the treatment of EGC, ESD was safe and feasible in comparison with resection surgery, with advantages in several surgical and post-operative recovery parameters. Although the recurrence rate was higher in ESD group, the longterm survival was still comparable in these two groups, suggesting ESD could be recommended as standard treatment for EGC with indications. | Hua Li Li-Qian Feng Yao-Yao Bian Li-Li Yang Deng-Xiang Liu Zhi-Bin Huo Li Zeng | 2019 | World Journal of Gastrointestinal Oncology2019，11，2： | 17 |
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