Objective To explore the application value of microwave ablation under ultrasound-magnetic resonance imaging(US-MRI)in the treatment of small liver cancer.Methods A total of 94 patients with small liver cancer were selected and randomly divided into observation group and control group using a random number table method,with 47 patients in each group.The observation group underwent microwave ablation under US-MRI,while the control group received surgical resection.The tumor control rate,periopera-tive indicators,liver function indicators[total bilirubin(TBIL),albumin(ALB),aspartate aminotransferase(AST),and alanine amin-otransferase(ALT)],postoperative complications,and 6-month follow-up status were compared between the two groups.Results There was no significant difference in tumor control rate between the two groups(P>0.05).In the observation group,the proportion of patients with smaller intraoperative blood loss,shorter operative time and postoperative performance status(PS)score of 0-1 was higher than those in the control group(P<0.05).After treatment,the levels of TBIL,AST and ALT were lower and the level of ALB was higher,and the incidence of complications was lower in the observation group(P<0.05).There were no significant differences between the two groups in residual lesion and recurrence(P>0.05).Conclusion The short-term efficacy of microwave ablation under US-MRI in the treatment of small liver cancer is similar to that of surgical treatment,and the microwave ablation under US-MRI can also reduce liver function injury,reduce intraoperative blood loss and shorten operation time.

Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

Objective To investigate the safety and feasibility of the domestic SA-1000 single-port single-arm robot-assisted laparoscopic system in total hysterectomy.Methods Data from 16 patients who underwent total hysterectomy using the SA-1000 system at the Department of Obstetrics and Gynecology,The Second Affiliated Hospital of Naval Medical University,between Mar.2023 and Jan.2024 were retrospectively collected.Surgical parameters were analyzed.Postoperative pain was assessed using the visual analogue scale(VAS)at 24 h after surgery and before discharge.Incision cosmesis was evaluated 3-5 weeks postoperatively using the body image questionnaire(BIQ,score range 3-24).Results All 16 procedures were successfully completed using the SA-1000 system without conversion to open surgery,achieving a 100.0%procedural success rate.The mean whole surgery time was(234.40±56.24)min.The median robotic arm setup time was 8.0(4.0,13.5)min,and the median console operating time was 128.0(100.0,151.0)min.The median intraoperative blood loss was 100.0(100.0,200.0)mL.No perioperative complications,such as hemorrhage,infection,injury to adjacent organs(ureters,bladder,bowel),poor wound healing,or incisional hernia,were observed.The mean wound pain score at 24 h postoperatively was 3.81±1.64,decreasing to a median of 3.0(2.0,4.0)before discharge.The BIQ score assessed at 3-5 weeks postoperatively was 21.88±1.15.Conclusion The application of the domestic SA-1000 single-port single-arm robot-assisted laparoscopic system for total hysterectomy is safe and feasible,demonstrating favorable surgical outcomes.It holds promise for broader implementation and promotion in domestic medical centers.

Objective To discuss the risk of complications occurring after CT-guided percutaneous puncture pulmonary nodule biopsy and to establish its prediction model.Methods The clinical data and imaging materials of 180 patients with small pulmonary nodules,who received CT-guided percutaneous puncture pulmonary nodule biopsy at the Affiliated Hongqi Hospital of Mudanjiang Medical University of China from September 2018 to September 2023,were collected.Logistic regression analysis was used to screen out the independent risk factors for the occurrence of complications after CT-guided percutaneous puncture pulmonary nodule biopsy.Based on the results of logistic regression analysis,a risk prediction model was constructed.Results Of the 180 patients with small pulmonary nodules,42(23.33％)developed postoperative complications(complication group),including pneumothorax(n=18,10.00％),hemorrhage(n=20,11.11％),pleural reaction(n=2,1.11％),and fever(n=2,1.11％).No complication occurred in the remaining 138 patients(76.67％,non-complication group).The differences in the coexisting chronic obstructive pulmonary disease(COPD),nodule diameter,number of needle-passing across the pleura,residence time of puncture needle,and distance between lesion and chest wall between the two groups were statistically significant(all P＜0.05).Multivariate logistic regression analysis showed that coexisting COPD(OR=6.558,95％CI:1.225-9.228,P=0.028),nodule diameter＜8 mm(OR=5.387,95％CI:1.773-16.367,P=0.003),number of puncture needle-passing across the pleura ≥3(OR=2.044,95％CI:1.275-3.278,P=0.003),residence time of puncture needle＞10 min(OR=12.620,95％CI:2.687-18.557,P=0.001)and distance between lesion and chest wall ≥30 mm(OR=1.992,95％CI:1.049-2.217,P=0.035)were the independent risk factors for the occurrence of complications after CT-guided percutaneous puncture pulmonary nodule biopsy.The above determined risk factors were used as the predictors to construct a prediction model.Receiver operating characteristic(ROC)curve analysis indicated that the critical value of this model to predict the occurrence of complications after CT-guided percutaneous puncture pulmonary nodule biopsy was 35.736,the area under ROC curve(AUC)was 0.831(95％CI:0.788-0.913),the sensitivity was 73.7％(95％CI:0.705-0.882),and the specificity was 90.6％(95％CI:0.811-0.985).Conclusion The predictive risk model,which is established based on the indicators of coexisting COPD,nodule diameter＜8 mm,number of puncture needle-passing across the pleura ≥3,residence time of puncture needle＞10 min and distance between lesion and chest wall ≥30 mm,can well predict the occurrence of complications after CT-guided percutaneous puncture pulmonary nodule biopsy,and this model carries high clinical application value.

Objective To explore the application value of microwave ablation under ultrasound-magnetic resonance imaging(US-MRI)in the treatment of small liver cancer.Methods A total of 94 patients with small liver cancer were selected and randomly divided into observation group and control group using a random number table method,with 47 patients in each group.The observation group underwent microwave ablation under US-MRI,while the control group received surgical resection.The tumor control rate,periopera-tive indicators,liver function indicators[total bilirubin(TBIL),albumin(ALB),aspartate aminotransferase(AST),and alanine amin-otransferase(ALT)],postoperative complications,and 6-month follow-up status were compared between the two groups.Results There was no significant difference in tumor control rate between the two groups(P>0.05).In the observation group,the proportion of patients with smaller intraoperative blood loss,shorter operative time and postoperative performance status(PS)score of 0-1 was higher than those in the control group(P<0.05).After treatment,the levels of TBIL,AST and ALT were lower and the level of ALB was higher,and the incidence of complications was lower in the observation group(P<0.05).There were no significant differences between the two groups in residual lesion and recurrence(P>0.05).Conclusion The short-term efficacy of microwave ablation under US-MRI in the treatment of small liver cancer is similar to that of surgical treatment,and the microwave ablation under US-MRI can also reduce liver function injury,reduce intraoperative blood loss and shorten operation time.

Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

IgA nephropathy (IgAN) is one common type of glomerulonephritis caused by a deposition of immune complexes in mesangium and partial capillary loops. It is also an important risk factor for end-stage renal disease (ESRD). Kidney transplantation (KT) has been an ultimate treatment for IgAN patients progressing into ESRD. However, there is still a high risk of recurrence after transplantation. Currently no effective treatment is available for recurrent IgAN. This review summarized the latest researches of managing IgAN recurrence after KT, such as optimal treatment, immunosuppression, complement therapy and surgery.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

Objective:To classified the fluid location of of grade B and C postoperative pancreatic fistula (POPF) and propose processing flow.Methods:Data from 232 patients who underwent pancreatic surgery from January 2018 to December 2022 at Department of General Surgery & Hepato-billo-pancreatic,Beijing Hospital were collected retrospectively. Forty-six patients who suffered from grade B and C POPF underwent ultrasound-guided drainage. There were 32 males and 14 females, with an age of (60.2±13.7)years (range:18 to 85 years). The imaging data of postoperative CT were collected and the the fluid location was classified. Then analyzed the drainage status when patents were diagnosed as POPF. Machine learning was performed and a random forest model was applied to construct the relationship between intervention time and mortality. The optimal intervention time was calculated. The patients were then divided into early and late intervention groups and clinical data and outcomes were compared using the t test,Mann-Whitney U test, χ2 test or Fisher′s exact test between the two groups. Results:Based on the results of the random forest model, the optimal puncture time was within 5.38 days after the diagnosis of POPF. Based on the optimal time, 21 patients were subsumed into early intervention group and 25 patients were subsumed into late intervention group. The location of fluid collection was classified into four types: peripancreatic (32.7%,15/46), extra-pancreatic and epigastric (41.3%,19/46), extra-pancreatic and hypogastic (13.0%,6/46) and diffused (13.0%,6/46). The status of the drainage included normal in 10 patients (21.8%), displaced drain in 18 patients (39.1%) and drain removed or blocked in 18 patients (39.1%). The perioperative mortality rate was 19.0% (4/21) in the early intervention group and 8.0%(2/25) in the late. The late intervention group had significantly higher rates of positive drainage fluid cultures (88.0%(22/25) vs. 42.9%(10/21), χ2=10.584, P=0.001), secondary surgery (24.0%(6/25) vs. 0(0/21), P=0.025), and readmission within 90 days(32.0%(8/25) vs. 4.8%(1/21), χ2=5.381, P=0.020) than the early group, and a significantly longer postoperative hospital stay( M(IQR))(24(20)days vs. 39(53)days, Z=3.023, P=0.003). Conclusions:The location of the POPF fluid collection is classified into four types. Early radiological evaluation can detect abdominal effusion promptly,and early puncture and drainage will be beneficial in improving outcomes in these patents.

BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome