1.Randomized Controlled Trail of Ganlu Qingwen Prescription for Treatment of Community-acquired Pneumonia
Xiangpeng LI ; Fengsen LI ; Ling WANG ; Zheng LI ; Dan XU ; Jiangtao LI
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(11):225-236
ObjectiveTo explore the regulatory effect of Ganluqingwen prescription on inflammation and immunity by observing the clinical efficacy of Ganluqingwen prescription in the treatment of community-acquired pneumonia (CAP), so as to provide a clinical basis for the treatment of CAP by traditional Chinese medicine (TCM). MethodsA randomized controlled trial was conducted by selecting patients who were diagnosed with CAP and identified as wind-heat attacking lungs in Xinjiang Uygur Autonomous Region Hospital of TCM from January 2024 to May 2024 and assigning the patients to a control group (treated by western medicine treatment) or an experimental group (treated by Ganluqingwen prescription combined with western medicine). The data of the enrolled patients before treatment, for three-day treatment, for seven-day treatment, and for 14-day treatment were collected, including basic information, medical history, pneumonia severity index (PSI) classification, and distribution and difference of laboratory and imaging information indexes. The peripheral blood specimens were collected from the patients. and the changes of inflammatory factors in peripheral blood were detected by using enzyme-linked immunosorbent assay (ELISA) reagent kits and flow-type multifactor microarrays to evaluate the clinical safety and efficacy of Ganluqingwen prescription in CAP. ResultsCompared with those in the groups before treatment, the total scores of TCM syndromes significantly decreased in both groups (P<0.05). Compared with those in the control group after treatment, the total scores of TCM syndromes decreased more significantly in the experimental group (P<0.05). Compared with the control group after treatment, the experimental group displayed a significantly reduced number of days of fever in patients (P<0.05). Compared with those in the groups before treatment, the leukocyte, neutrophil counts, C-reactive protein (CRP), procalcitonin (PCT), interleukin (IL)-6, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), creatine kinase (CK), and creatine kinase isoenzymes (CK-MB) in both groups decreased (P<0.05) after treatment. Compared with that in the control group after treatment, the decrease of leukocyte, neutrophil counts, CRP, PCT, IL-6, ALT, AST, Cr, CK, and CK-MB was more pronounced in the experimental group (P<0.05). Compared with those in the group before treatment, the partial pressure of carbon dioxide increased in the experimental group for 3 d of treatment (P<0.05), and the standard alkali residual, actual alkali residual, standard bicarbonate concentration, and actual bicarbonate concentration increased in the experimental group for 7 d of treatment (P<0.05). Compared with that in the group before treatment, D-dimer decreased in the control group for 7 d of treatment (P<0.05). D-dimer and activated partial thromboplastin time (APTT) decreased in the experimental group for 3 d of treatment (P<0.05), and D-dimer, fibrinogen (FIB), and APTI significantly decreased in the group for 7 d of treatment (P<0.05). Compared with the group for 3 d of treatment, the experimental group for 7 d of treatment showed decreased FIB (P<0.05). Compared with those in the groups before treatment, the levels of inflammatory factors IL-4, IL-10, and IL-13 were elevated in the peripheral blood of the two groups after treatment, and the levels of B lymphocyte chemoattractant (BLC), interferon gamma-induced protein 10 (IP-10), tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), monocyte chemoattractant protein-1 (MCP-1), CRP, IL-2, IL-6, IL-8, IL-17, IL-22, and IL-23p19 were significantly reduced (P<0.01). Compared with the control group after treatment, the experimental group exhibited more significant improvement in indexes above (P<0.01). ConclusionThe group treated by Ganluqingwen prescription combined with western medicine shows more significant effects on reducing total scores of TCM syndromes, lowering the ability of leukocyte and neutrophil counts, decreasing BLC, IP-10, TNF-α, IFN-γ, MCP-1, CRP, IL-2, IL-6, IL-8, IL-17, IL-22, and IL-23p19 in the peripheral blood of the patients, and elevating levels of IL-4, IL-10, and IL-13 than the group treated by western drugs alone.
2.Randomized Controlled Trail of Ganlu Qingwen Prescription for Treatment of Community-acquired Pneumonia
Xiangpeng LI ; Fengsen LI ; Ling WANG ; Zheng LI ; Dan XU ; Jiangtao LI
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(11):225-236
ObjectiveTo explore the regulatory effect of Ganluqingwen prescription on inflammation and immunity by observing the clinical efficacy of Ganluqingwen prescription in the treatment of community-acquired pneumonia (CAP), so as to provide a clinical basis for the treatment of CAP by traditional Chinese medicine (TCM). MethodsA randomized controlled trial was conducted by selecting patients who were diagnosed with CAP and identified as wind-heat attacking lungs in Xinjiang Uygur Autonomous Region Hospital of TCM from January 2024 to May 2024 and assigning the patients to a control group (treated by western medicine treatment) or an experimental group (treated by Ganluqingwen prescription combined with western medicine). The data of the enrolled patients before treatment, for three-day treatment, for seven-day treatment, and for 14-day treatment were collected, including basic information, medical history, pneumonia severity index (PSI) classification, and distribution and difference of laboratory and imaging information indexes. The peripheral blood specimens were collected from the patients. and the changes of inflammatory factors in peripheral blood were detected by using enzyme-linked immunosorbent assay (ELISA) reagent kits and flow-type multifactor microarrays to evaluate the clinical safety and efficacy of Ganluqingwen prescription in CAP. ResultsCompared with those in the groups before treatment, the total scores of TCM syndromes significantly decreased in both groups (P<0.05). Compared with those in the control group after treatment, the total scores of TCM syndromes decreased more significantly in the experimental group (P<0.05). Compared with the control group after treatment, the experimental group displayed a significantly reduced number of days of fever in patients (P<0.05). Compared with those in the groups before treatment, the leukocyte, neutrophil counts, C-reactive protein (CRP), procalcitonin (PCT), interleukin (IL)-6, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cr), creatine kinase (CK), and creatine kinase isoenzymes (CK-MB) in both groups decreased (P<0.05) after treatment. Compared with that in the control group after treatment, the decrease of leukocyte, neutrophil counts, CRP, PCT, IL-6, ALT, AST, Cr, CK, and CK-MB was more pronounced in the experimental group (P<0.05). Compared with those in the group before treatment, the partial pressure of carbon dioxide increased in the experimental group for 3 d of treatment (P<0.05), and the standard alkali residual, actual alkali residual, standard bicarbonate concentration, and actual bicarbonate concentration increased in the experimental group for 7 d of treatment (P<0.05). Compared with that in the group before treatment, D-dimer decreased in the control group for 7 d of treatment (P<0.05). D-dimer and activated partial thromboplastin time (APTT) decreased in the experimental group for 3 d of treatment (P<0.05), and D-dimer, fibrinogen (FIB), and APTI significantly decreased in the group for 7 d of treatment (P<0.05). Compared with the group for 3 d of treatment, the experimental group for 7 d of treatment showed decreased FIB (P<0.05). Compared with those in the groups before treatment, the levels of inflammatory factors IL-4, IL-10, and IL-13 were elevated in the peripheral blood of the two groups after treatment, and the levels of B lymphocyte chemoattractant (BLC), interferon gamma-induced protein 10 (IP-10), tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), monocyte chemoattractant protein-1 (MCP-1), CRP, IL-2, IL-6, IL-8, IL-17, IL-22, and IL-23p19 were significantly reduced (P<0.01). Compared with the control group after treatment, the experimental group exhibited more significant improvement in indexes above (P<0.01). ConclusionThe group treated by Ganluqingwen prescription combined with western medicine shows more significant effects on reducing total scores of TCM syndromes, lowering the ability of leukocyte and neutrophil counts, decreasing BLC, IP-10, TNF-α, IFN-γ, MCP-1, CRP, IL-2, IL-6, IL-8, IL-17, IL-22, and IL-23p19 in the peripheral blood of the patients, and elevating levels of IL-4, IL-10, and IL-13 than the group treated by western drugs alone.
3.Relationship between metabolic score for insulin resistance and overactive bladder in the US population based on NHANES data from 2005 to 2018
Guoliang XU ; Feiyang GAO ; Xihao WANG ; Jiangtao ZHU ; Wei LIN ; Pengyue LIU ; Yongjun YAN
Journal of Modern Urology 2025;30(5):416-423
Objective: To assess the association between the metabolic score for insulin resistance index (METS-IR) and overactive bladder (OAB) in the US population,so as to explore the potential of METS-IR as a predictive tool for OAB risk and to provide insights for early screening and intervention strategies. Methods: Based on the data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018,a cross-sectional design was employed,and multivariate logistic regression models were used to analyze the association between METS-IR and OAB. METS-IR was analyzed both as a continuous variable and categorized into quartiles. To further validate the association between METS-IR and OAB across diverse populations,subgroup analyses were conducted in participants stratified by clinical characteristics. Smooth curve fitting was employed to test the linearity of the METS-IR-OAB relationship. Results: Elevated METS-IR was associated with an increased risk of OAB (P<0.001),and this positive correlation remained stable when METS-IR was categorized into quartiles (P<0.001). Subgroup analyses revealed that the association between METS-IR and OAB was more pronounced in females,participants younger than 55 years,and non-diabetic individuals (P<0.05). Furthermore,smooth curve fitting confirmed a linear positive correlation between METS-IR and OAB,with this linear relationship observed in both diabetic and non-diabetic groups. Conclusion: This study,based on the NHANES 2005-2018 database,found a linear positive correlation between METS-IR and OAB.
4.Treatment of refractory diffuse large B-cell lymphoma involving the central nervous system with polatuzumab vedotin-based regimen: a case report and literature review
Jiefei BAI ; Ru FENG ; Ting WANG ; Xu LI ; Long QIAN ; Jiangtao LI ; Chunli ZHANG ; Hui LIU
Chinese Journal of Hematology 2024;45(9):864-866
Polatuzumab vedotin (Pola) is a novel antibody-drug conjugate targeting CD79b, which has been shown to be effective in treating newly diagnosed and relapsed/refractory diffuse large B cell lymphoma (DLBCL) during clinical trials. This study aims to conduct a retrospective analysis of the clinical characteristics, diagnosis, and treatment of a patient with refractory secondary central nervous system lymphoma at Beijing Hospital, alongside a review of relevant literature. This study included a 79-year-old female patient who was diagnosed with DLBCL affecting the ilium, sacrum, spinal cord, and nerve roots and had an IPI score of 5 and a high-risk score according to MSKCC. She showed a geriatric comprehensive assessment (IACA) score of 2, which was categorized under the unfit group. Her initial treatment comprised chemo-free therapy and radiotherapy, followed by progression. In the second-line treatment, a Pola-based regimen was applied, and the patient achieved a complete response, suggesting that this regimen may be a therapeutic option for patients with DLBCL involving the central nervous system.
5.Transcranial direct current stimulation at different targets for Parkinson's disease:a network Meta-analysis
Yulin YANG ; Wanpeng CHANG ; Jiangtao DING ; Hongli XU ; Xiao WU ; Boheng XIAO ; Lihong MA
Chinese Journal of Tissue Engineering Research 2024;28(11):1797-1804
OBJECTIVE:To systematically evaluate the efficacy of transcranial direct current stimulation on the motor function of patients with Parkinson's disease,and to compare the efficacy of transcranial direct current stimulation at different targets on the motor function of patients with Parkinson's disease,so as to provide a theoretical basis for the target selection of transcranial direct current stimulation in clinical practice. METHODS:Cochrane Library,PubMed,Web of Science,CNKI,VIP,WanFang Data were retrieved for randomized controlled trials on the improvement of motor function in patients with Parkinson's disease by transcranial direct current stimulation published from the database inception to January 2023.The keywords were"Parkinson,transcranial direct current stimulation"in English and Chinese.The quality of the included studies was evaluated using the Cochrane 5.1.0 risk of bias assessment tool and the PEDro scale.Meta-analysis of outcome indicators was performed using RevMan 5.4 and Stata 17.0 software. RESULTS:Fifteen randomized controlled trials were finally included,and the PEDro scale showed that all were high-quality or very high-quality studies.Meta-analysis showed that transcranial direct current stimulation significantly improved Unified-Parkinson Disease Rating Scale part III score[mean difference(MD)=-2.49,95%confidence interval(CI):-4.42 to-0.55,P<0.05),step frequency score(MD=0.07,95%CI:0.03-0.11,P<0.05)and step speed score(MD=0.02,95%CI:0.00-0.05,P<0.05),but not for Berg Balance Scale scores(MD=2.57,95%CI:-0.74 to 5.87,P>0.05).Network Meta-analysis probability ranking:In terms of Unified-Parkinson Disease Rating Scale part III scores,the probability ranking results of target stimulation efficacy were dorsal lateral prefrontal cortex(52.4%)>primary motor cortex(45.8%)>central point of the brain(1.8%)>conventional rehabilitation(0%);in terms of gait frequency scores,the probability probability ranking results of target stimulation efficacy were cerebellum(50.1%)>central point of the brain(45.8%)>dorsal lateral prefrontal cortex(3.9%)>primary motor cortex(0.2%)>conventional rehabilitation(0%);in terms of gait speed scores,the probability ranking results of target stimulation efficacy were cerebellum(64.8%)>dorsal lateral prefrontal cortex(23.8%)>central point of the brain(9.4%)>primary motor cortex(1.7%)>conventional rehabilitation(0.4%);in terms of Berg Balance Scale scores,the probability ranking results of target stimulation efficacy were cerebellum(77.4%)>dorsal lateral prefrontal cortex(20.7%)>central point of the brain(0.7%)>conventional rehabilitation(0.2%). CONCLUSION:Transcranial direct current stimulation significantly improves motor function of patients with Parkinson's disease,with better motor coordination in the dorsolateral prefrontal cortex and better walking and balance in the cerebellum.
6.Eligibility of C-BIOPRED severe asthma cohort for type-2 biologic therapies.
Zhenan DENG ; Meiling JIN ; Changxing OU ; Wei JIANG ; Jianping ZHAO ; Xiaoxia LIU ; Shenghua SUN ; Huaping TANG ; Bei HE ; Shaoxi CAI ; Ping CHEN ; Penghui WU ; Yujing LIU ; Jian KANG ; Yunhui ZHANG ; Mao HUANG ; Jinfu XU ; Kewu HUANG ; Qiang LI ; Xiangyan ZHANG ; Xiuhua FU ; Changzheng WANG ; Huahao SHEN ; Lei ZHU ; Guochao SHI ; Zhongmin QIU ; Zhongguang WEN ; Xiaoyang WEI ; Wei GU ; Chunhua WEI ; Guangfa WANG ; Ping CHEN ; Lixin XIE ; Jiangtao LIN ; Yuling TANG ; Zhihai HAN ; Kian Fan CHUNG ; Qingling ZHANG ; Nanshan ZHONG
Chinese Medical Journal 2023;136(2):230-232
7.Meta-analysis of Radiomics to predict the efficacy of non-surgical treatment for esophageal cancer
Sumei XU ; Jiangtao JIN ; Qin LI
International Journal of Surgery 2023;50(5):323-328,C2,C3
Objective:To evaluate the value of radiomics in predicting the efficacy of non-operative treatment of esophageal cancer by meta-analysis.Methods:Search terms included "Esophageal Neoplasms", "Esophageal Neoplasms", "Neoplasm, Esophageal", "Esophagus Neoplasm", "Esophagus Neoplasm", "Neoplasm, Esophagus", "Neoplasms, Esophagus", "Neoplasms, Esophageal", "Cancer of Esophagus", "Cancer of the Esophagus", "Esophagus Cancer", "Cancer, Esophagus", "Cancers, Esophagus", "Esophagus Cancers", "Esophageal Cancer", "Cancer, Esophageal", "Cancers, Esophageal", "Esophageal Cancers" and "radiomics", "radiomics features", "radiomic", "texture", "texture analysis", "textural analysis", "histogram", "machine learning", "artificial intelligence", both in English and corresponding Chinese. The Chinese and English literatures related to radiomics prediction of the efficacy of non-surgical treatment of esophageal cancer published in PubMed, Web of Science, Embase, China National Knowledge Internet, Wanfang Medical Online and VIP Chinese Journal Service Platform from the establishment of the database to November 2022 were searched, and screening, quality evaluation and data extraction were carried out. Meta analysis was performed by using Stata 15.1, Meta-disc 1.4 and Review Manager 5.3 software.Results:Seventeen literatures of Chinese and English with 1389 patients with esophageal cancer who received non-surgical treatment were included. There was no significant threshold effect in predicting the effect of non-operative treatment of esophageal cancer by radiomics ( r=0.103, P=0.694), and there was high heterogeneity ( I2>50%). The combined sensitivity of all included literatures was 0.86 (95% CI: 0.81-0.89), specificity was 0.81 (95% CI: 0.76-0.85), positive likelihood ratio was 4.4 (95% CI: 3.5-5.6), and negative likelihood ratio was 0.18 (95% CI: 0.13-0.24). The diagnostic odds ratio was 25 (95% CI: 16-39) and the AUC was 0.90 (95% CI: 0.87-0.92). Conclusions:Radiomics can better predict the efficacy of non-surgical treatment of esophageal cancer, MRI and PET/CT radiomics has higher accuracy in predicting the efficacy of esophageal cancer, and machine learning can also improve the accuracy of prediction. It is helpful to make individualized treatment plan and improve the efficiency of treatment by effectively predicting the curative effect of patients with esophageal cancer before treatment.
8.Experimental study of subcutaneous adipose-derived stem cells inhibiting orthodontic root resorption.
Dan ZHANG ; Chunxian YANG ; Peng XU ; Nana TANG ; Shune XIAO ; Jiangtao ZHANG
Chinese Journal of Reparative and Reconstructive Surgery 2023;37(12):1533-1540
OBJECTIVE:
To investigate the effect of human subcutaneous adipose-derived stem cells (hADSCs) local transplantation on orthodontically induced root resorption (OIRR) and provide theoretical and experimental basis for the clinical application of hADSCs to inhibit OIRR.
METHODS:
Forty 8-week-old male Sprague Dawley rats were randomly divided into experimental group and control group, with 20 rats in each group, to establish the first molar mesial orthodontic tooth movement (OTM) model of rat right maxillary. The rats in the experimental group were injected with 25 μL of cell suspension containing 2.5×10 5 hADSCs on the 1st, 4th, 8th, and 12th day of modeling, while the rats in the control group were injected with 25 μL of PBS. The rat maxillary models were obtained before and after 7 and 14 days of force application, and 10 rats in each group were killed and sampled after 7 and 14 days of force application. The OTM distance was measured by stereomicroscope, the root morphology of the pressure side was observed by scanning electron microscope and the root resorption area ratio was measured. The root resorption and periodontal tissue remodeling of the pressure side were observed by HE staining and the root resorption index was calculated. The number of cementoclast and osteoclast in the periodontal tissue on the pressure side was counted by tartrate resistant acid phosphatase staining.
RESULTS:
The TOM distance of both groups increased with the extension of the force application time, and there was no significant difference ( P<0.05). There was no significant difference in OTM distance between the experimental group and the control group after 7 and 14 days of force application ( P>0.05). Scanning electron microscope observation showed that small and shallow scattered resorption lacunae were observed on the root surface of the experimental group and the control group after 7 days of force application, and there was no significant difference in the root resorption area ratio between the two groups ( P>0.05); after 14 days of application, the root resorption lacunae deepened and became larger in both groups, and the root resorption area ratio in the experimental group was significantly lower than that in the control group ( P<0.05). The range and depth of root absorption in the experimental group were smaller and shallower than those in the control group, and the root absorption index in the experimental group was significantly lower than that in the control group after 14 days of force application ( P<0.05). The number of cementoclast in the experimental group was significantly lower than that in the control group after 7 and 14 days of force application ( P<0.05); the number of osteoclasts in the experimental group was significantly lower than that in the control group after 14 days of force application ( P<0.05).
CONCLUSION
Local transplantation of hADSCs may reduce the area and depth of root resorption by reducing the number of cementoclasts and osteoclasts during OTM in rats, thereby inhibiting orthodontic-derived root resorption.
Rats
;
Male
;
Humans
;
Animals
;
Root Resorption/therapy*
;
Rats, Sprague-Dawley
;
Osteoclasts
;
Tooth Movement Techniques
;
Stem Cells
9.Study on UPLC fingerprint and content determination of mangiferin of Gentiana rhodantha
Chaokun YANG ; Shijuan XU ; Wenfen XU ; Qingwen SUN ; Bo WANG ; Jiangtao GUO ; Yongping ZHANG
China Pharmacy 2023;34(1):34-39
OBJECTIVE To provide reference for quality control of Gentiana rhodantha. METHODS Taking 52 batches of G. rhodantha as subject, ultra-high performance liquid chromatography (UPLC) fingerprint was adopted. The similarity of 52 batches of medicinal materials samples was evaluated by the Similarity Evaluation System for Chromatographic Fingerprints of Traditional Chinese Medicine (2004A edition); the content of mangiferin was determined; chemometric analyses [cluster analysis, principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA)] were performed. RESULTS UPLC fingerprints of 52 batches of G. rhodantha were established, 17 common peaks were identified, and 6 of them were identified, which were loganic acid (peak 1), neomangiferin (peak 3), swertiamarin (peak 5), dangyin (peak 6), mangiferin (peak 7) and isoorientin (peak 9). The similarities of 52 batches of medicinal materials samples were all greater than 0.9; cluster analysis showed that S1-S46, S48-S52 clustered into one class, and S47 alone; PCA results showed that the cumulative variance contribution rate of the first six principal components was 82.928%; OPLS-DA results showed that the corresponding components of swertiamarin, mangiferin and chemical composition represented by peak 4, 14, 15, 16 were the main iconic components affecting the quality differences of G. rhodantha medicinal materials. The contents of mangiferin in 52 batches of medicinal material samples ranged from 18.2 to 101.0 mg/g, mostly in accordance with 2020 edition of Chinese Pharmacopoeia. CONCLUSIONS The established UPLC fingerprint and chemometric analysis methods combined with content determination method of mangiferin can comprehensively evaluate the quality of G. rhodantha.
10.The clinical value of radical resection of retroperitoneal lipo-lymphatic layer for pancreatic head cancer
Shuyou PENG ; Yingbin LIU ; Renyi QIN ; Defei HONG ; Jiangtao LI ; Zhijian TAN ; Yuanquan YU ; Xiaosheng ZHONG ; Min WANG ; Xu′an WANG
Chinese Journal of Surgery 2023;61(11):989-993
Objective:To investigate the clinical value of the novel approach,radical resection of the retroperitoneal lipo-lymphatic layer (RRRLLL),in the surgical treatment of resectable pancreatic head cancer.Methods:Between June 2020 and June 2022,a total of 221 patients with pancreatic head cancer underwent surgical treatment using the RRRLLL approach(RRRLLL group),while 107 patients received traditional surgical treatment(traditional group) in five high-volume pancreatic centers in China. Data from surgical technique and clinical perioperative outcomes,including lymph node harvested,surgical time,and complications,were analyzed. The RRRLLL group consisted of 144 males and 77 females with an age of (67.5±9.0) years(range:41.3 to 81.1 years). The traditional group included 71 males and 36 females,with an age of (66.3±8.1) years(range:45.1 to 79.2 years). Statistical analysis was performed using the K-S test, Z test,or χ 2 test, respectively. Results:Pancreaticoduodenectomy was performed successfully in all patients,achieving R0 resection. RRRLLL group surgery required mobilization of retroperitoneal adipose and lymphatic tissues starting from the right edge of the inferior vena cava and extending to the left side,up to the superior mesenteric artery,down to the inferior mesenteric artery,and left to the left side of the aorta,including the perineural and lymphatic tissues around the superior mesenteric artery and the sheath of the mesenteric artery. However,the traditional group did not include the areas mentioned above in the scope of clearance. There were no statistically significant differences between the RRRLLL group and the traditional group in terms of age,sex,tumor size,T stage,and vascular invasion (all P>0.05). However,the number of lymph nodes harvested in the RRRLLL group was significantly higher at 28.7±9.0 (range: 18 to 39) compared to 18.2±8.0 (range: 12 to 21) in the traditional group ( Z=-10.691, P<0.05). There were no statistically significant differences in the number of positive lymph nodes,N staging,and postoperative complications between the two groups. Conclusion:The RRRLLL approach improved lymph node dissection compared to the traditional approach,potentially leading to reduced recurrence rates.

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