简介：AIM:Todelineatethecharacteristicsofthedynamicstereopsistestandanalyzerelatedparametersinintermittentexotropia[X(T)]patients.METHODS:Fifty-sevenX(T)patientsand55normalsubjectswereenrolledinthisstudy.ThenormalandX(T)groupswereusedtotestthereproducibilityandreliabilityofthedynamicstereopsistest,andBangerterfilterswithdensitiesof0.2werethenusedtosimulatesuppressiontotestfortraditionalanddynamicstereopsis.IntheX(T)group,themeasurementsincluded1)dynamicstereopsistestcomprisingthreeparts:motion+disparity,motiononlyanddisparityonly;2)oculardeviationangle;3)Bagolinistriatedlenstest;4)diseasecourse;and5)Titmusstereopsistest.RESULTS:Thetest-retestreliabilityofthedynamicstereopsismethodwas0.901inthenormalandX(T)groups,andnoneoftheX(T)patientswereabletopassthestaticanddynamicstereopsistestsafterusingthe0.2Bangerterfilter.Theaccuracyratewasgreaterthan80%inthenormalgroupand31.81%,36.36%,and45.45%forthemotion+disparity,motion-onlyanddisparityonlycomponentsofthetraditionaltestforX(T)patientsdiagnosedwithstereoblindnessviatraditionaltests,respectively.Patientswithalongdiseasecourse(>1y)hadworsedynamicstereopsisthanthosewithashortdiseasecourse(<1y;P<0.05,Chi-squaretest).Thedeviationanglewasnotcorrelatedwiththemotion+disparity,disparityonly,orthemotion-onlytestcomponents(allP>0.05,Chisquaretest).CONCLUSION:DynamicstereopsisispreservedincertainX(T)patientsdiagnosedwithstereoblindnessviatraditionaltests.AlongdiseasecoursewasshowntobeanegativefactorfordynamicstereopsisinX(T)patientswhichmightbeassociatedwithworseprogression,andprovidegoodreferencesclinically.

简介：Thenumberofpatientswhosufferfromvertigoordizzinessbecomesgreaterduringthesixthandseventhdecadesoflifeandisnowincreasingtototal,whichcouldberelatedtorecentlongerlifeexpectancy.Pertinentmedicalcareshouldbegiventothosepatientstobetter

简介：Arecentreportintroducedthephosphodiesterase-5inhibitionbyvardenafilasanoveltreatmentofportalhypertensioninpatientswithcirrhosis.Inthehereinpresented'lettertotheeditor',theadministrationoftadalafildidnotinfluenceportalhaemodynamicsbutimpairedsystemichaemodynamicsinpatientswithcirrhosis.OurobservationsconcurwiththeresultsofareportinapreviousissueofWorldJournalofGastroenterology(October2008).Moreover,tadalafiladverselyaffectedrenalfunctioninpatientswithdecompensatedliverdisease.

简介：ObjectivesToinvestigatetheclinicalmanifestationsofhypertrophiccardiomyopathy(HCM),andtofindouttheclinicalcluestoavoidmisdiagnosisandprovidereferenceforfutureclinicaldiagnosisandtreatment.MethodsAretrospectiveanalysisof42consecutivepatientswithHCMhospitalizedinourhospitalbetweenJanuary1995andDecember2002wasexplored.BasedonthefamilyhistoryofHCM,clinicalmanifestations,electrocar-diogram,echocardiogram,coronaryangiographyandleftventriculography,theclinicalcharacteristicsbetweenHCMpatientswithleftventricularoutflowtractobstruction(HOCM)andHCMpatientswithoutobstruction(HNOCM)werecompared.Thecausesofmisdiagnosisandlosingdiagnosiswereanalysis.Results13patientswereinHOCMgroupand29patientswereinHNOCMgroup.MorepatientswithsyncopewereinHOCMgroupthaninHNOCMgroup(6/13vs.2/29,P<0.05).PatientswithejectivemurmurwereinHOCMgrouponly(P<0.01).Leftventricularoutflowtractpressuregradient(LVOTPG)onlyobservedinHOCMgroup(P<0.01).Ventriculartachycardiawasseeninbothgroups.28outof42patients(66.67%)hadmisdiagnosis,and4outof42patients(9.53%)hadlosingdiagnosis.Thus,coronaryheartdisease(CHD)hadthehighestrateofmisdiagnosis.Therewere20CHDpatients(71.43%)among28patientswithmisdiagnosis.Hypertensionwasin3,congenitalheartin2,cerebro-embolismin2,andmyocarditisin1.ConclusionsForapatientwithfamilyhistoryorsuddendeathhistoryofHCM,unexplainedsyncopeepisodes,chestpain(angina),especiallyinyoung,anejectionmurmuralongtheleftsternumborder,thepresenceofnarrowanddeepQwaves,orinversionofgiantTwavesinV3-V6,atrialfibrillationand/orcerebra-embolismechocardiogramshouldbegiven.CAGandLVGarenecessaryonlyiftheresultofechoisnegative,andthepatientswithsuspectedHCMorCHD.

简介：Theriskofmyocardialinfarctionincreasesinpatientswithdiabetesmellitus.Theincidenceofmyocardialinfarctionissimilarinpatientswithtype2diabeteswithouthistoryofmyocardialinfarctionandinnon-diabeticpatientswithhistoryofmyocardialinfarction.DiabetesmellituswasconsideredasacoronarydiseaseequivalentbytheNationalCholesterolEducationProgram.Strictglycemiccontrolcanimprovethelong-termoutcomeofbothtype1andtype2diabetesmellitus.Whateverwithdiabeticornon-diabetic,strictglycemiccontrolwithintensiveinsulintherapycanreducethemortalityofcriticallyillpatientsinhospital.Aftermyocardialinfarction,therewouldbeaworseoutcomeforpatientswithpoorglycemiccontrol,whateverindiabeticornon-diabeticpatientswithstresshyperglycemia.Meanwhile,strictglycemiccontrolcanimprovetheoutcome.TheguidelineofAmericanCollegeofCardiology/AmericanHeartAssociationin2004onST-elevatedmyocardialinfarctionrecommendedinsulininfusionmaintainingtheeuglycemiaforpatientswithacutemyocardialinfarctionandcomplicatedconditions,whetherwithdiabetesmellitusornot,anditwasconsideredreasonabletoinfuseinsulinforallpatientswithhyperglycemiaduringtheperiodofacutemyocardialinfarction.Thispaperproposedaneffectiveandsafemethodforintravenousinsulininfusiontherapyfordiabeticpatientswithacutemyocardialinfarction.

简介：BackgroundInmanyEuropeanandAmericanhospitals,representedbytheHouseEarClinic(HEC),theoverlaytympanoplastyisusedwithrareexception,withsimultaneouscanalwallupordownmastoidectomybeingtakenifneeded.InChina,underlaytympanoplastyisusedacrossthecountry,buttheoverlaytech-niqueisusedrarely.Theaimofthecurrentstudywastoreporttheauthors’experiencewithoverlaytympa-noplastyin83Chinesepatientsandstudyitsvalue.MethodsEight-threepatients(86ears)underwentover-laytympanoplastyinaccordancetothestandardoftheHEC.Thepatientswerefollowedupandconditionsoftheexternalauditorycanal,tympanicmembraneandhearingwerereviewedandanalyzed.ResultsAllpatientsgainedstageIincisionhealing.Thesizeofexternalauditorycanalandtympanicmembranemor-phologyweresatisfactory.Hearingeitherremainedunchangedorimproved.Therewerenohearingdeterio-rationorseriouscomplications.ConclusionsOverlaytympanoplastycarriespositivevalueintreatingchron-icotitismediaandcholesteatomawiththemeritsofprocedurestandardization,adequateoperativeexposure,thoroughdiseaseeliminationandextensiveadaptation.

简介：目的：探讨脑电地形图与CT在常见神经系统疾病中的对比应用。方法：509例患者进行了脑电地形图和CT检查。结果：在509例患者中脑电地形图和脑CT显示了不同的改变。结论：脑电地形图和脑CT在常见神经系统疾病的诊断中，各具有其优点和不足。脑电地形图在常见神经系统疾病的临床应用中有重要价值。

简介：[摘要] 目的：探讨心理护理在急性心衰患者中的应用效果。方法：从2020年1月至2021年3月，来我院治疗的130例急性心衰患者。根据入院编号奇偶性分组：奇数编号的65例进入对照组，采用常规护理方案；偶数编号的65例进入试验组，在此基础上进行心理护理干预。比较临床依从性和负面情绪。结果：试验组依从性优良率更高（96.92%vs86.15%），干预后患者的SAS评分和SDS评分较对照组更低，经检验有统计学差异（P＜0.05）。结论：对急性心衰患者实施心理护理干预，能提高临床依从性、缓解负面情绪，具有推广价值。

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简介：AbstractImportance:In cases of epiblepharon with lower eyelid retraction secondary to glaucoma, correcting epiblepharon alone is ineffective. Combined surgery should be performed to obtain satisfactory outcomes.Objective:To investigate outcomes after surgery to correct epiblepharon with lower eyelid retraction secondary to buphthalmos in children.Methods:A retrospective analysis of six eyes in four patients was performed included lower lid retractor recession combined with marginal rotation with tarsal fixation. The margin reflex distance-2, lagophthalmus, resolution of clinical symptoms, and complications were assessed during 6 to 12 months of follow-up.Results:In all cases, epiblepharon and lagophthalmus were corrected, symptoms of photophobia and epiphora were relieved, and the corneal epithelium was repaired. The margin reflex distance-2 decreased and remained normal during the follow-up period, but slightly regressed within 6 months postoperatively.Interpretation:Epiblepharon caused by buphthalmos in children is often associated with lower eyelid retraction. Lower lid retractor recession combined with marginal rotation with tarsal fixation fundamentally solves the problems of high eyelid tension, lower eyelid retraction, and epiblepharon and reduces the recurrence rate.

简介：AbstractIntroduction:Rosai-Dorfman disease (RDD) is an uncommon, benign, and idiopathic histiocytic proliferative disorder. Multiple intracranial RDD is extremely rare and treatment varies.Case presentation:A 9-year-old girl was admitted with 3-month history of blurred vision and facial paralysis, a 2-month history of recurrent giggle, and cognitive impairment. Computed tomography and magnetic resonance imaging scans revealed bilateral ventricular masses based on the dural membrane and the diameters of the masses were 9.1 cm and 9.2 cm, respectively. The lesions were completely removed with staging surgeries. Fifteen months after operation, blurred vision was still present but facial paralysis and giggle and cognitive impairment disappeared. Imaging examinations suggested that there were no new or recurring lesions.Conclusion:For multiple large intracranial masses, surgical treatment is necessary and staged surgery benefits perioperative safety. Active follow-up with magnetic resonance imaging is necessary.

简介：AbstractObjective:Endoscopic approaches for sinus and skull base surgery are increasing in popularity. The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery (EES), highlight preventative measures, and illustrate key management principles.Data Sources:Comprehensive literature review.Methods:Relevant literature was reviewed using PubMed/MEDLINE.Results:Carotid artery injury in EES is rare, with most studies reporting an incidence below 0.1%. Anatomic aberrancies, wide dissection margins, as well as specific provider and hospital factors, may increase the risk of injury. Multidisciplinary teams, comprehensive preoperative imaging, patient risk assessment, and formal training in vascular emergencies may reduce the risk. Management protocols should emphasize proper visualization of the injury site, fluid replacement, rapid packing, angiography, and endovascular techniques to achieve hemostasis.Conclusions:While EES is a relatively safe procedure, carotid artery injury is a devastating complication that warrants full consideration in surgical planning. Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging. Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.

简介：AbstractObjective:Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based pathways designed to reduce complications, promote recovery, and improve outcomes following surgery. These protocols have been successfully applied for the management of head and neck cancer, but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in otolaryngology. Our goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology operations.Methods:A systematic literature review was conducted using MEDLINE, EMBASE, SCOPUS, and gray literature. We identified studies that evaluated ERAS protocols among patients undergoing otologic, laryngeal, nasal/sinus, pediatric, and general otolaryngology operations. We assessed the outcomes and ERAS components across protocols as well as the study design and limitations.Results:A total of eight studies fulfilled the inclusion criteria and were included in the analysis. Types of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy, functional endoscopic sinus surgery, tympanoplasty and mastoidectomy, and septoplasty. A reduction in postoperative length of stay and hospital costs was reported in two and three studies, respectively. Comparative studies between ERAS and control groups showed persistent improvement in pre- and postoperative anxiety and pain levels, without an increase in postoperative complications and readmission rates.Conclusions:A limited number of studies discuss implementation of ERAS protocols for outpatient operations in otolaryngology. These clinical pathways appear promising for these procedures as they may reduce length of stay, decrease costs, and improve pain and anxiety postoperatively.

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简介：AbstractBackground:Minimally invasive pancreatic surgery (MIPS) has developed over the last 3 decades and is nowadays experiencing an increased interest from the surgical community. With increasing awareness of both the public and the surgical community on patient safety, optimization of training has gained importance. For implementation of MIPS we propose 3 training phases. The first phase focuses on developing basic skills and procedure specific skills with the help of simulation, biotissue drills, video libraries, live case observations, and training courses. The second phase consists of index procedures, fellowships, and proctoring programs to ensure patient safety during the first procedures. During the third phase the surgeons aim is to safely implement the procedure into standard practice while minimizing learning curve related excess morbidity and mortality. Case selection, skills assessment, feedback, and mentoring are important methods to optimize this phase. The residual learning curve can reach up to 100 cases depending on the surgeons’ previous experience, selection of cases, and definition of the parameters used to assess the learning curve. Adequate training and high procedural volume are key to implementing MIPS safely.

简介：AIM:Toinvestigatechangesinfundusexcyclotorsionafterinferiorobliquemyectomyormyotomy.METHODS:Therecordsof21patientsundergoingstrabismussurgerybyasinglesurgeonbetween2009and2012wereexamined.Onlypatientswhohadundergoneaninferiorobliquemyectomyormyotomy,withorwithouthorizontalrectusmusclesurgery,wereevaluated.Digitalfundusphotographswereobtained,andtheangleformedbyahorizontallinepassingthroughtheopticdisccenterandareferencelineconnectingthefoveolaandopticdisccenterwasmeasured.Associatedclinicalfactorsexaminedincludeageatthetimeofsurgery,presenceorabsenceofaheadtilt,degreeofpreoperativeverticaldeviation,torsionalangle,inferiorobliquemuscleoveraction/superiorobliquemuscleunderaction,andsurgerylaterality.Whethertheprocedurewasperformedaloneorincombinationwithahorizontalrectusmusclesurgerywasalsoexamined.RESULTS:Meanpreoperativetorsionalanglewas12.0±6.4°,whichdecreasedto6.9±5.7°aftersurgery(P<0.001,pairedt-test).Torsionalanglealsodecreasedfrom15.1±7.0°to6.2±4.3°inthemyectomygroup(P<0.001,pairedt-test)buttherewerenosignificantchangesinthemyotomygroup(P=0.093,Wilcoxonsignedranktest).Multivariablelinearregressionanalysisshowedthatpreoperativetorsionalangle,degreeofinferiorobliqueoveraction,andageatsurgeryindependentlyandsignificantlyaffectedpostoperativetorsionalangle.CONCLUSION:Meantorsionalangledecreasedafterinferiorobliquemyectomy.Degreeofpreoperativetorsionalangle,inferiorobliqueoveraction,andageatsurgeryinfluencepostoperativetorsionalangle.

简介：AbstractPancreatic ductal adenocarcinoma (PDAC) represents one of the most aggressive malignancies, and the majority of patients with PDAC present with metastatic disease, mainly in the liver, at the time of diagnosis. Surgical resection is the only treatment that can offer prolonged survival and possible cure. However, the indications for surgery for patients with PDAC metastases remain extremely limited to highly selected patients with localized disease, and metastatic disease is generally regarded as a contraindication to surgery. Recently, however, the advent of more effective chemotherapy has changed the treatment strategy for metastatic PDAC. In fact, cases in which resection of synchronous or metachronous PDAC liver metastases lead to prolonged survival in highly selected patients have been reported. In this review, we provide current data regarding survival outcomes after surgery, and discuss the role of surgical resection and selection criteria for patients with PDAC liver metastases in the modern era.

简介：BackgroundThoracoscopicminimallyinvasivepectusexcavatumrepair(Nussoperation)featuresitslittletrauma,simple,shortoperationtime,andgoodoutcomecomparedwithtraditionaltreatmentofpectusexcavatumsurgery-sternalelevation(Ravitchoperation)andsternalturnover.Theeffectoftheoperationonpatients’heartandheartfunctionremainsunclear.ThisstudyaimedtounderstandthechangesofelectrocardiogramandcardiacfunctionafterNussprocedure.MethodsFrom2008Januaryto2013July,thoracoscopicNussoperationwasperformedin217patientswithpectusexcavatum.Allthepatientsunderwentthepreoperative,postoperativedetectionofECGandcardiacfunctionin3monthsto1yearafteroperation.ResultsAfter3monthsto1yearfollow-up,arrhythmiaspersistedin46outof135patientswithpreoperativesymptoms(P<0.05);Strokevolumeandcardiacoutputsignificantlyincreased(P<0.05);Andcardiacparametersgreatlyimproved(P<0.05).ConclusionsMinimallyinvasiverepairofpectusexcavatumdeformitycancorrectthechestmalformation,alleviatearrhythmia,andimprovecardiacfunction.

简介：Giventhehighincidenceofcervicallymphnodemetastasisindifferentiatedthyroidcancer(DTC)andtherapidlyincreasedimportanceofneckdissectioninDTC,thejournalofGlandSurgeryislaunchingaspecialissueon'NeckDissectioninDifferentiatedThyroidCarcinoma'inNovemberIssueof2013,

简介：AbstractObjective:To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.Methods:Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.Results:In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery.Conclusion:Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.