No abstract available.
Transanal Endoscopic Microsurgery*

OBJECTIVE: To investigate the efficacy of transanal endoscopic microsurgery (TEM) combined with imatinib for rectal gastrointestinal stromal tumors(GIST). METHODS: Clinical data of 35 patients with rectal GIST undergoing TEM at Peking Union Medical College Hospital from February 2008 to May 2017 were analyzed retrospectively. Operation details, postoperative recovery condition, and follow-up information were reviewed. The differences in clinicopathological features and perioperative parameters were compared between patients who received neoadjuvant therapy (12 patients, imatinib mesylate, oral, 400 mg daily for 6 months before surgery) and those without neoadjuvant therapy (23 patients). RESULTS: Of 35 patients, 18 were males and 17 were females with the mean age of (49.3±13.3) years. Mean tumor diameter was (1.8±1.1) cm and mean distance from lower tumor margin to anal verge was (4.0±1.8) cm. Mean operative time was (82.4±21.1) minutes and mean blood loss was (11.7±7.5) ml. No conversion to laparotomy occurred. Complete resection with negative margins was achieved in all cases. Complications were classified according to Clavien-Dindo system: 4 cases of grade I, 3 of grade II and 1 of grade IIIb. The tumor size in patients who received neoadjuvant therapy reduced from (3.1±1.2) cm to (2.6±1.2) cm, though it was still larger than the tumor size in patients without neoadjuvant therapy[(1.5±0.8) cm, P<0.01]. No significant difference in operative time was found between patients with and without neoadjuvant therapy [(76.7±24.8) minutes vs. (85.4±18.8) minutes, P>0.05]. Thirty patients (85.7%) were followed up for (50.3±36.6) months, and no local recurrence or metastasis was observed. CONCLUSIONS TEM is safe and effective in the treatment of rectal GIST. Preoperative neoadjuvant therapy is beneficial to TEM in treating larger tumors without increasing operating time. Satisfactory follow-up result is observed.
Adult ; Female ; Gastrointestinal Stromal Tumors ; drug therapy ; surgery ; Humans ; Imatinib Mesylate ; therapeutic use ; Male ; Middle Aged ; Rectal Neoplasms ; drug therapy ; surgery ; Retrospective Studies ; Transanal Endoscopic Microsurgery ; standards ; Treatment Outcome

Molecular identification of human externally visible characteristic （EVC）, which is also called forensic DNA phenotyping （FDP）, can serve as a "molecular witness" when the routine investigations can not determine the identity of a criminal and the DNA database find no match after comparison. FDP could assist in investigation of cases by inferring the externally visible phenotypic characteristics from DNA obtained from the biological materials left at crime scenes, or unknown corpses. In the last few years, studies on the selection of EVC related molecular markers have been reported frequently and some of the EVCs could already be inferred with a certain accuracy, such as hair color and iris color. Further fundamental research on molecular genetics of human external phenotypic characteristics, as well as the continuous innovation on molecular biological technology would promote the rapid development of DNA molecular identification of human phenotypic characteristics.
DNA/genetics* ; Databases, Nucleic Acid ; Eye Color/genetics* ; Forensic Anthropology/trends* ; Forensic Genetics/trends* ; Hair Color/genetics* ; Humans ; Phenotype ; Physical Appearance, Body/genetics* ; Skin Pigmentation/genetics*

Sleepiness, or hypersomnia, is a relatively common complaint and one of the main problems of modern society. Accurate evaluation and diagnosis of sleepiness are important. The methods used for evaluating sleepiness are subjective measures or self-evaluations, performance decrease measures, sleep propensity measures, and arousal decrease measures. A clear and detailed history is important in differential diagnosis of sleepiness because symptoms of sleepiness may be expressed in terms of 'tiredness' or 'fatigue' that do not directly denote sleepiness. Comprehensive diagnostic evaluation is also invaluable because these symptoms may result from a variety of causes ranging from medical disorders to insufficient nocturnal sleep.
Arousal ; Diagnosis* ; Diagnosis, Differential ; Diagnostic Self Evaluation ; Disorders of Excessive Somnolence

BACKGROUND: Medical interviewing skills are now recognized as the most important skill to be acquired for the purpose of accurate diagnosis and treatment. Among the several evaluation methods of interviewing skills, audiovisual method has the merit of allowing the fellow residents to have discussion about the interview and of receiving feedback from the teaching faculty by replaying the real interview. In addition, it allows the resident to evaluate his or her interviewing skills, The purpose of this study is to evaluate the reliability and the validity of family residents' self-interviewing skill evaluation protocol. METHODS: A modified arizona interview rating scale which is an interviewing skill evaluating protocol has been used after Korean version became available. Six interviews with outpatients were recorded and evaluated respectively by 10 residents. The results were compared with that of Golden Standard to assess its validity. Finally, 10 residents were divided into two groups and the results among the groups were compared to evaluate the reliability of the scale. RESULTS: The evaluation of interviewing skills conducted by the residents showed significant rate of correspondence with the Golden Standard(kappa=.22), and in the comparison of 17 evaluation items, there appeared significant correspondence in 7 items. The analysis of the rate of correspondence between the two group of residents revealed significant rate of correspondence (kappa=0.43). Lastly, the comparisons between the items showed significant rate of correspondence in ll items CONCLUSIONS: The residents' self interviewing skill evaluation protocol showed significant validity and reliability from which it may be concluded that the protocol can be used as an effective evaluating method.
Arizona ; Diagnosis ; Diagnostic Self Evaluation ; Humans ; Outpatients ; Reproducibility of Results*

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis.
Colonoscopy ; Colostomy ; Humans ; Microsurgery ; Retropneumoperitoneum* ; Sepsis* ; Transanal Endoscopic Microsurgery

Transanal endoscopic microsurgery(TEM) is a safe and effective procedure for the treatment of local tumors, especially for the rectal villous adenoma (pT0), polyps with severe dysplasia and in situ carcinoma(pTis). It can also be applied as salvage surgery for incidental carcinoma after colonoscopy as well as in cases of giant villous adenoma. With the introduction of screening colonoscopy, more early polyps will be detected. We should be able to customize our treatment accordingly. On one hand, we want to prevent overkill and on the other hand to avoid under-treatment. This article is aimed to review the development of TEM and discuss its various indications.
Carcinoma in Situ ; Colonoscopy ; Humans ; Polyps ; Rectal Neoplasms ; Transanal Endoscopic Microsurgery

Forensic DNA phenotyping （FDP） analysis uses DNA from biological samples left in crime scenes to predict individual phenotypic traits, such as geographical origin of ethnic group, height, weight, skin color, hair color and shape, iris color, male baldness, facial morphology, age, etc., thereby providing clues for case investigations. Among these traits, features of facial morphology are relatively more complicated. This paper makes an overall analysis of the measurement and collection of facial morphology, research on facial morphology related genes, forensic application and establishment of facial morphology depiction model, ethical issues, etc., then summarizes the latest research progress on features of facial morphology.
DNA/genetics* ; Face ; Forensic Genetics/methods* ; Humans ; Male ; Phenotype ; Physical Appearance, Body/genetics*

STUDY DESIGN: Prospective study. PURPOSE: To compare Patients' and parents’ perceptions of physical attributes (PAs) of adolescent idiopathic scoliosis (AIS) patients and to report any correlations between their perceptions and Scoliosis Research Society-22r (SRS-22r) scores. OVERVIEW OF LITERATURE: Few studies have looked into the differences between Patients' and parents’ perceptions of their appearance. METHODS: AIS patient–parent pairs (n=170) were recruited. The Patients' and parents’ perceptions of six PAs were evaluated: waist asymmetry (WA), rib hump (RH), shoulder asymmetry (SA), neck tilt, breast asymmetry (BrA), and chest prominence. These PAs were ranked, and an aggregate PA (Agg-PA) score was derived from a score assigned to the attribute (6 for the most important PA and 1 for the least important). The patients also completed the SRS-22r questionnaire. RESULTS: Ninety-nine patients (58.2%) and 71 patients (41.8%) had thoracic and lumbar major curves, respectively. WA was ranked first by 54 patients (31.8%) and 50 parents (29.4%), whereas RH was ranked first by 50 patients (29.4%) and 38 parents (22.4%). The overall Agg-PA scores were similar for patients and parents (p>0.05). However, for thoracic major curves (TMCs) >40°, a significant difference was noted between the Agg-PA scores of patients and parents for SA (3.5±1.6 vs. 4.2±1.6, p=0.041) and BrA (3.0±1.6 vs. 2.2±1.3, p=0.006). For TMCs <40°, a significant difference was found between the Agg-PA scores of patients and parents for WA (3.7±1.6 vs. 4.4±1.5, p=0.050). BrA was negatively correlated with total SRS-22r score. CONCLUSIONS: There were no significant differences between patients and parents in their ranking of the most important PAs. For TMCs >40°, there were significant differences in the Agg-PA for SA and BrA. Pa¬tients were more concerned about BrA and parents were more concerned about SA. Patients' perception of the six PAs had weak correlation with SRS-22r scores.
Adolescent ; Awards and Prizes ; Body, Physical Appearance ; Breast ; Humans ; Neck ; Parents ; Prospective Studies ; Ribs ; Scoliosis ; Shoulder ; Thorax

The development of transanal endoscopic microsurgery (TEM) during the last 30 years has led to the evolution of the treatment in rectal neoplasms. TEM has revolutionized the technique and outcomes of transanal surgery. To our knowledge, this technique is currently the only one-port system in endoscopic surgery by which a direct endoluminal approach to the target organ by using a natural opening of the body become available. TEM affords the advantage of a less invasive transanal approach with low recurrence rates secondary to a more precise dissection due to enhanced visualization of the surgical field. Currently, TEM represents the standard treatment modality for large rectal adenomas and a surgical option in selected early rectal cancers. Its potential role in the treatment of more invasive cancer in combination with neoadjuvant therapies, and other rectal localized tumors are currently under evaluation. The current trend of TEM is favorable in China. TEM has also been increasingly used in the treatment of rectal neoplasms, but there are many problems in the development of TEM, for example, preoperative assessment is inadequate, patient selection is not precise enough, the surgical procedure is not standardized, etc. These problems require the majority of surgical colleagues to work together to make the standards scientifically and objectively in accordance with the actual situation of our country, so as to promote the healthy development and popularity of TEM in China.
Adenoma ; China ; Humans ; Neoadjuvant Therapy ; Patient Selection ; Rectal Neoplasms ; Transanal Endoscopic Microsurgery