简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：Cardiaccatheterizationandpercutaneouscoronaryinterventionplayanimportantroleinthemanagementofcoronaryarterydisease.Althoughthetransfemoralapproachhasbeenthetraditionallydominantmethod,therehasbeenanincreasedutilizationofthetransradialapproach.Multipleobservationalstudiesandrandomizedclinicaltrialshaveshownfewerbleedingcomplications,reducedmorbidityandmortality,improvedqualityoflife,andbettereconomicoutcomeswhenthetransradialapproachisutilizedwhencomparedtothetransfemoralapproach.Despiteitsmanybenefits,utilizationofthisapproachincertaincountriesincludingtheUnitedStateshasbeenlessthanoptimalduetoaloweradoptionratesmostlydrivenbylackoftrainingopportunitiesanddecreasedawarenessofclinicalbenefitsofthetransradialapproach.Inthisreview,thehistory,observationaltrends,efficacy,andtechnicalaspectsoftransradialcardiaccatheterizationandpercutaneouscoronaryinterventionarediscussed.

简介：AIMTounderstandtheinfluenceoffrailtyonpostoperativeoutcomesforlaparoscopicandopencolectomy.METHODSDatawereobtainedfromtheNationalSurgicalQualityImprovementProgram(2005-2012)forpatientsundergoingcolonresection[opencolectomy(OC)andlaparoscopiccolectomy(LC)].Patientswereclassifiedasnon-frail(0points),lowfrailty(1point),moderatefrailty(2points),andseverefrailty(≥3)usingtheModifiedFrailtyIndex.30-dmortalityandcomplicationswereusedastheprimaryendpointandanalyzedfortheoverallpopulation.Complicationsweregroupedintomajorandminor.Subsetanalysiswasperformedforpatientsundergoingcolectomy(totalcolectomy,partialcolectomyandsigmoidcolectomy)andseparatelyforpatientsundergoingrectalsurgery(abdominoperinealresection,lowanteriorresection,andproctocolectomy).WeanalyzedthedatausingSASPlatformJMPProversion10.0.0(SASInstituteInc.,Cary,NC,UnitedStates).RESULTSAtotalof94811patientswereidentified;themajorityunderwentOC(58.7%),werewhite(76.9%),andnon-frail(44.8%).Themedianagewas61.3years.Prolongedlengthofstay(LOS)occurredin4.7%,and30-dmortalitywas2.28%.PatientsundergoingOCwereolder(61.89±15.31vs60.55±14.93)andhadahigherASAscore(48.3%ASA3vs57.7%ASA2intheLCgroup)(P<0.0001).Mostpatientswerenon-frail(42.5%OCvs48%LC,P<0.0001).Complications,prolongedLOS,andmortalityweresignificantlymorecommoninpatientsundergoingOC(P<0.0001).OChadahigherriskofdeathandcomplicationscomparedtoLCforallfrailtyscores(non-frail:OR=4.7,andOR=4.67;mildlyfrail:OR=2.51,andOR=2.47;moderatelyfrail:OR=2.94,andOR=2.02,severelyfrail:OR=2.37,andOR=2.34,P<0.05)andanincreaseinabsolutemortalitywithincreasingfrailty(non-frail0.68%OC,mildlyfrail1.39%,moderatelyfrail3.44%,andseverelyfrail5.83%,P<0.0001).CONCLUSIONLCisassociatedwithimprovedoutcomes.Althoughtheoddsofmortalityarehigherin