BACKGROUND: Inflammation plays a critical role in severe cerebral venous thrombosis (CVT) pathogenesis, but the benefits of anti-inflammatory therapies remain unclear. This study aimed to investigate the association between steroid therapy combined with anticoagulation and the prognosis of acute/subacute severe CVT patients. METHODS: A prospective cohort study enrolled patients with acute/subacute severe CVT at Xuanwu Hospital (July 2020-January 2024). Patients were allocated into steroid and non-steroid groups based on the treatment they received. Functional outcomes (modified Rankin scale [mRS]) were evaluated at admission, discharge, and 6 months after discharge. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), cerebrospinal fluid (CSF) IL-6, and intracranial pressure were measured at admission and discharge in the steroid group. Fundoscopic Frisén grades were assessed at admission and 6 months after discharge. Univariate and multivariate logistic regression were used to evaluat associations between steroid use and favorable outcomes (mRS ≤2) at the 6-month follow-up. Paired tests assessed changes in hs-CRP and other variables before and after treatment, and Spearman's correlations were used to analyze relationships between these changes and functional improvements. RESULTS: A total of 107 and 58 patients in the steroid and non-steroid groups, respectively, were included in the analysis. Compared with the non-steroid group, the steroid group had a higher likelihood of achieving an mRS score of 0-2 (93.5% vs . 82.5%, odds ratio [OR] = 2.98, P  = 0.037) at the 6-month follow-up. After adjusting for confounding factors, the result remained consistent. Pulsed steroid therapy did not increase mortality during hospitalization or follow-up, nor did it lead to severe steroid-related complications (all P  >0.05). Patients in the steroid group showed a significant reduction in serum hs-CRP, IL-6, CSF IL-6, and intracranial pressure at discharge compared to at admission, as well as a significant reduction in the fundoscopic Frisén grade at the 6-month follow-up compare to at admission (all P  <0.001). A reduction in serum inflammatory marker levels during hospitalization positively correlated with improvements in functional outcomes ( P  <0.05). CONCLUSION: Short-term steroid use may be an effective and safe adjuvant therapy for acute/subacute severe CVT when used alongside standard anticoagulant treatments, which are likely due to suppression of the inflammatory response. However, these findings require further validation in randomized controlled trials. TRAIL REGISTRATION ClinicalTrials.gov , NCT05990894.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Anticoagulants/therapeutic use* ; C-Reactive Protein/metabolism* ; Interleukin-6/metabolism* ; Intracranial Thrombosis/drug therapy* ; Prospective Studies ; Steroids/therapeutic use* ; Venous Thrombosis/drug therapy*

Background: and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. Methods: This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. Results: Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Objective To evaluate the early outcomes of breast reconstruction with immediate deep inferior epigastric perfora -tor ( DIEP) flaps after resection of breast cancer with DIEP reconstruction after modified radical mastectomy with papilla and mammary areola reserving .Methods A retrospective analysis of 14 breast cancer patients who were hospitalized and received breast reconstruc -tion from January 2011 to January 2015 was made, so as to investigate the features of the surgery and its clinical indications .Then, e-valuations were performed on the cosmetic effects and postsurgical complications .A 1-24-month medical follow-up was made after sur-gery.Results Breast reconstruction surgery was successful in all the 16 patients, all the flaps completely survived postoperatively , with 2 cases of distal skin flap necrosis and 1 case of hematoma in the surgical site .No complications such as abdominal hernia or bulge in donor sites were found and the reconstructed breast was well-shaped.Conclusion The immediate DIEP reconstruction is safe and relia-ble, at the same time, it has the advantages of hidden incision , rich blood supply of the affected area , abundant tissue volume, minimal donor site damage , less complications , which met the requirements of oncotherapy and aesthetics as well .

OBJECTIVETo investigate the safety and efficacy of postoperative intraperitoneal hyperthermic perfusion chemotherapy(IHPEC) following laparoscopic palliative resection for advanced gastric cancer patients with peritoneal metastasis.

METHODSBetween March 2010 and October 2013, 37 patients with advanced gastric cancer were treated by IHPEC(cisplatin 100 mg, 5-fluorouracil 1000 mg and saline 2000 mL) following laparoscopic palliative resection in our department between March 2010 and October 2013 were analyzed retrospectively. Short-term efficacy and adverse reactions were observed.

RESULTSComplete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD) were found in 18, 4, 8 and 7 cases respectively, and the total progression-free rate was 59.5%(22/37). The significant improved, improved, stable and progressive cases of Karnofsky performance status were 6, 13, 10 and 8 respectively, and the rate of improved and stable cases was 78.4% (29/37). Serious adverse reactions (class III ( or IIII) were noted in 3 cases (8.1%), including 2 cases of abdominal pain (class III), 1 case of nausea and vomiting.

CONCLUSIONSThe modality of IHPEC adopting cisplatin plus 5-fluorouracil regimen following laparoscopic palliative resection for advanced gastric cancer patients with peritoneal metastasis is technically feasible and safe, which has certain effect on postponing the progression of gastric cancer.

Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cisplatin ; Fluorouracil ; Humans ; Laparoscopy ; Palliative Care ; Peritoneal Neoplasms ; drug therapy ; secondary ; surgery ; Remission Induction ; Retrospective Studies ; Stomach Neoplasms ; drug therapy ; surgery

OBJECTIVETo evaluate the application value of three risk-stratification criteria in domestic GIST risk assessment.

METHODSThe clinical data of 144 patients with GIST who were admitted to our hospital from January 2008 to December 2010 were analyzed retrospectively. 144 cases of GISTs were evaluated for their biologic potential by the risk-stratification criteria of Fletcher, NIH2008, and among those, 119 cases of GISTs were evaluated by the risk-stratification criteria of Miettinen. Fletcher and Miettinen criteria were compared by Kaplan-Meier survival analysis. The Logistic regression model was established to analyze the comparison of Miettinen and NIH2008 criteria.

RESULTS(1) According to Fletcher criteria in the intermediate risk GISTs, the recurrence-free survival (RFS) of non gastric(small intestinal, rectal and so on) GISTs and gastric GISTs were statistically different (P=0.001). According to Miettinen criteria, in the risk subgroup of GISTs, the recurrence-free survival of different location of GISTs had no statistical difference(P>0.05); (2)Logistic regression model judgment rate: Miettinen criteria (89.4)>NIH2008 criteria (85.2).

CONCLUSIONFletcher criteria is simple and easy to use, but may misjudge the prognosis of the GIST in different part; Miettinen criteria may be a potential supplementary way of NIH2008 criteria in domestic GIST risk assessment.

Adult ; Aged ; Aged, 80 and over ; China ; Female ; Gastrointestinal Stromal Tumors ; mortality ; pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate ; Young Adult

OBJECTIVETo compare the long-term oncological outcomes of laparoscopic and open resection of rectal cancers.

METHODSBetween January, 2003 and December, 2008, 514 patients with rectal cancer were admitted in our hospital, among whom 186 underwent laparoscopic tumor resection and 238 received open radical resection of the tumors. The long-term survival of the patients and the recurrence pattern were compared between the two groups.

RESULTSThe median follow-up of the patients was 48.54∓28.76 months. No significant differences were found between the two groups in the local recurrence rate (3.9% vs 5.5%, P=0.284), 5-year overall survival (69.4% vs 61.3%, P=0.067), or the 5-year disease-free survival rates (67.7% vs 60.7%, P=0.110). Both the 5-year overall survival and progression-free survival of the patients in stage IV were better in the laparoscopic group than in the open surgery group (P<0.05).

CONCLUSIONLaparoscopic resection of rectal cancer can achieve long-term oncological outcomes comparable to those of conventional open surgery.

Aged ; Female ; Humans ; Laparoscopy ; Laparotomy ; Male ; Middle Aged ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection is still difficult to accomplish,which restrains its application in total gastrectomy for advanced proximal gastric cancer.Based on our anatomical understanding of pre- and retropancreatic spaces,features of splenic vessels and distribution of perigastric lymph nodes,we combined the characteristics of laparoscopic surgery and developed a novel technique for laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection through retropancreatic space.The key lies in mobilization of the splenic pedicle through retropancreatic space,dissection of peri-vascular lymph nodes in sequence of trunk-to-branch,in-sheath vascularization of the splenic vessels.From August 2009 to December 2010,this technique was performed on 6 patients in Nanfang hospital.The initial results suggested that this technique could be safe and feasible for skillful surgeons.Further studies on the application of this technique in total gastrectomy for advanced proximal gastric cancer would be needed.

ObjectiveTo evaluate the safety and feasibility of esophagojejunostomy using transorally inserted anvil ( OrVilTM ) after laparoscopic total gastrectomy for gastric cancer.MethodsThe clinical data of 8 patients with advanced gastric cancer who were admitted to the Nanfang Hospital of Southern Medical University from January 2011 to Febuary 2012 were retrospectively analyzed.Laparoscopic total gastrectomy + D2 lymph node dissection was first performed,and then esophagojejunostomy was completed using OrVilTM. Perioperative condition and prognosis of the patients were analyzed.ResultsAll the procedures were completed successfully,with no complications occurred.There was no extension of the incisiou during operatiou.The mean operation time,anvil inserting time and volume of operative blood loss were (203 + 38 ) minutes,( 10 -+ 4) minutes and ( 106 ± 18 )ml,respectively.Tumor-free proximal margins were confirmed by pathological examination in all the patients.The mean time to first flatus,time to liquid and semi-liquid diet and duration of hospital stay were (3.5 ± 1.3 )days,(5.5 ± 2.9 ) days,( 7.5 ± 3.2) days and ( 11.5 ± 3.5 ) days.The mean time of follow-up was 10 months ( rauge,1-14 months),no anatomosis-related complications were observed.Conclusion Esophagojejunostomy using OrVilTM after laparoscopic total gastrectomy for gastric cancer is safe and feasible.