AIM: To explore the clinical effect of high dacryocystorhinostomy(DCR)combined with RS lacrimal duct recanalization on the treatment of chronic dacryocystitis.METHODS: Retrospective study. From January 2021 to January 2023, 110 patients(110 eyes)with chronic dacryocystitis treated in our hospital were collected and grouped according to the treatment method. The 55 eyes in the control group were treated with high DCR combined with suction cotton, and the 55 eyes in the monitored group were treated with high DCR combined with RS lacrimal duct recanalization. Follow-up for 6 mo, the clinical efficacy, quality of life, and complications were compared.RESULTS:At 6 mo after surgery, the monitored group had higher anatomical success rate than the control group(96.4% vs 83.6%), and had higher total effective rate than the control group(98.2% vs 78.2%; both P<0.05). At 6 mo after surgery, both groups had increased the Shot-Form Health Status Survey-36(SF-36)scores, with the monitored group having higher scores than the control group(all P<0.05); there was no statistical difference in complications between two groups(10.9% vs 20.0%, P>0.05).CONCLUSION:High DCR combined with RS lacrimal duct recanalization is safe and effective in treating patients with chronic dacryocystitis.

Objective To explore the value of dynamic contrast-enhanced(DCE)-MRI quantitative parameters based on differential sub-sampling with Cartesian ordering(DISCO)technology for differentiating high-and low-grade breast cancer.Methods A total of 80 patients with single breast cancer confirmed by biopsy pathology were retrospectively enrolled,including 40 cases of low-grade(L group)and 40 cases of high-grade breast cancer(H group).Then quantitative parameters obtained from DISCO-DCE-MRI before treatment were compared between groups,including extravascular extracellular volume fraction(Ve),rate constant(Kep),contrast enhancement ratio(CER),maximum slope(MaxSlope)and volume transfer constant(Ktrans),and their correlations with histological grade were analyzed.Receiver operating characteristic(ROC)curves of DISCO-DCE-MRI quantitative parameters being significantly different between groups were plotted,and the area under the curves(AUC)were calculated to evaluate their efficacy for differentiating high-and low-grade breast cancer.Results Ve(0.91[0.59,0.99]),CER(2.76±0.54)and MaxSlope(0.02[0.01,0.03])in L group were all higher than those in H group(0.52[0.34,0.73],[2.31±0.74],0.01[0.01,0.02],all P＜0.05),and no significant difference of Kep nor Ktrans was found between groups(both P＞0.05).Ve,CER and MaxSlope of breast cancer were all negatively correlated with histological grade(rs=-0.43,-0.39,-0.35,all P＜0.05),while Kep andKtranshad no significant correlation with histological grade(both P＞0.05).The AUC of Ve,CER and MaxSlope for differentiating high-and low-grade breast cancer was 0.749,0.725 and 0.700,respectively.Conclusion Among DISCO-DCE-MRI quantitative parameters,Ve,CER and MaxSlope could be used for differentiating high-and low-grade breast cancer.

Objective:To compare the clinical efficacy of direct versus double-balloon occlusion in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO).Methods:Clinical data of patients with GOO who underwent EUS-GE at Nanjing Drum Tower Hospital between April 2017 and July 2024 were analyzed in a retrospectively cohort study. The patients were divided into the direct technique group ( n=36) and the double-balloon occlusion technique group ( n=105). The technical success rate, clinical success rate, procedure time, postoperative stay, stent replacement rate, and incidence of adverse events were compared between the two groups. Results:The technical success rates of the two groups were comparable, 97.2% (35/36) and 94.3% (99/105) ( χ2=0.065, P=0.798), so were the clinical success rates, 94.4% (34/36) and 86.7% (91/105) ( χ2=0.932, P=0.334). However, the direct technique group demonstrated significantly shorter procedure time and postoperative stay compared to the double-balloon occlusion group [33.4 (23.2, 42.3) min VS 43.4 (31.7, 63.1) min, Z=-3.057, P=0.002; 4.0 (3.00, 5.75) days VS 6.0 (5.00, 9.00) days, Z=-4.031, P<0.001]. Adverse event rates [11.1% (4/36) VS 11.4% (12/105), χ2<0.001, P=1.000] and stent replacement rates [5.6% (2/36) VS 9.5% (10/105), χ2=0.152, P=0.696] showed no significant differences. Conclusion:Both EUS-GE techniques achieve comparable efficacy and safety for GOO. However, the direct technique showed significant advantages over the double-balloon occlusion technique in terms of shorter procedure time and reduced postoperative hospital stay.

Objective To investigate the risk factors influencing the prolonged length of hospital stay after transjugular intrahepatic portosystemic shunt(TIPS)in patients with ruptured esophagogastric variceal bleeding(EGVB)and to construct a risk prediction model.Methods The clinical data of 215 patients with EGVB,who received TIPS at a certain grade ⅢA hospital in Nanjing of China from January 1,2020 to January 30,2023,were retrospectively analyzed.According to whether the postoperative hospitalization stay was prolonged or not,the patients were divided into prolonged group(n=67)and normal group(n=148).Multivariate logistic regression analysis was sued to analyze the independent risk factors for prolonged postoperative hospitalization stay,and the risk factors were used as predictors for constructing the nomogram model.Results Multivariate logistic regression analysis showed that history of splenectomy,early TIPS performance,NRS 2002 Nutritional Risk Screening Score ≥3 points,and Barthel index score≤40 points were the independent risk factors for prolonged postoperative hospitalization stay in patients with cirrhotic EGVB after receiving TIPS(P＜0.05).The area under receiver operating characteristic(ROC)curve of the model constructed on the basis of independent risk factors was 0.743,which was higher than that of early TIPS performance,history of splenectomy,NRS 2002 score,and Barthel index score.The Hosmer-Lemeshow test obtained P=0.723,indicating that this model had a good fit degree.Conclusion The prediction model established in this study can be used for cirrhotic EGVB patients to predict the risk of prolonged postoperative hospitalization stay,and this model has good discrimination and calibration,besides,it can bring some clinical benefits to patients.

Objective To explore the value of dynamic contrast-enhanced(DCE)-MRI quantitative parameters based on differential sub-sampling with Cartesian ordering(DISCO)technology for differentiating high-and low-grade breast cancer.Methods A total of 80 patients with single breast cancer confirmed by biopsy pathology were retrospectively enrolled,including 40 cases of low-grade(L group)and 40 cases of high-grade breast cancer(H group).Then quantitative parameters obtained from DISCO-DCE-MRI before treatment were compared between groups,including extravascular extracellular volume fraction(Ve),rate constant(Kep),contrast enhancement ratio(CER),maximum slope(MaxSlope)and volume transfer constant(Ktrans),and their correlations with histological grade were analyzed.Receiver operating characteristic(ROC)curves of DISCO-DCE-MRI quantitative parameters being significantly different between groups were plotted,and the area under the curves(AUC)were calculated to evaluate their efficacy for differentiating high-and low-grade breast cancer.Results Ve(0.91[0.59,0.99]),CER(2.76±0.54)and MaxSlope(0.02[0.01,0.03])in L group were all higher than those in H group(0.52[0.34,0.73],[2.31±0.74],0.01[0.01,0.02],all P＜0.05),and no significant difference of Kep nor Ktrans was found between groups(both P＞0.05).Ve,CER and MaxSlope of breast cancer were all negatively correlated with histological grade(rs=-0.43,-0.39,-0.35,all P＜0.05),while Kep andKtranshad no significant correlation with histological grade(both P＞0.05).The AUC of Ve,CER and MaxSlope for differentiating high-and low-grade breast cancer was 0.749,0.725 and 0.700,respectively.Conclusion Among DISCO-DCE-MRI quantitative parameters,Ve,CER and MaxSlope could be used for differentiating high-and low-grade breast cancer.

Objective:To compare the clinical efficacy of direct versus double-balloon occlusion in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO).Methods:Clinical data of patients with GOO who underwent EUS-GE at Nanjing Drum Tower Hospital between April 2017 and July 2024 were analyzed in a retrospectively cohort study. The patients were divided into the direct technique group ( n=36) and the double-balloon occlusion technique group ( n=105). The technical success rate, clinical success rate, procedure time, postoperative stay, stent replacement rate, and incidence of adverse events were compared between the two groups. Results:The technical success rates of the two groups were comparable, 97.2% (35/36) and 94.3% (99/105) ( χ2=0.065, P=0.798), so were the clinical success rates, 94.4% (34/36) and 86.7% (91/105) ( χ2=0.932, P=0.334). However, the direct technique group demonstrated significantly shorter procedure time and postoperative stay compared to the double-balloon occlusion group [33.4 (23.2, 42.3) min VS 43.4 (31.7, 63.1) min, Z=-3.057, P=0.002; 4.0 (3.00, 5.75) days VS 6.0 (5.00, 9.00) days, Z=-4.031, P<0.001]. Adverse event rates [11.1% (4/36) VS 11.4% (12/105), χ2<0.001, P=1.000] and stent replacement rates [5.6% (2/36) VS 9.5% (10/105), χ2=0.152, P=0.696] showed no significant differences. Conclusion:Both EUS-GE techniques achieve comparable efficacy and safety for GOO. However, the direct technique showed significant advantages over the double-balloon occlusion technique in terms of shorter procedure time and reduced postoperative hospital stay.

Objective:To explore the clinical effects of antegrade anterolateral thigh pedicled flaps in repairing wounds in the perineum or inguinal regions.Methods:The study was a retrospective observational study. From January 2022 to May 2024, 7 patients with wounds in the perineum or inguinal regions who met the inclusion criteria were admitted to Fujian Medical University Union Hospital, including 5 males and 2 females, aged 54 to 72 years. The wound area after debridement was 8 cm×6 cm to 16 cm×11 cm. During the operation, antegrade anterolateral thigh pedicled flaps with area of 9 cm×7 cm to 18 cm×13 cm were harvested to repair the wounds. The wounds in the flap donor sites were sutured directly or repaired with split-thickness skin grafts from the thigh. The survival of flaps and the healing of wounds and the survival of skin grafts in flap donor sites were observed after operation. During follow-up, the texture, color, and blood supply of flaps were observed, the muscle strength of the lower extremities on the affected side was evaluated according to Lovett muscle strength grading standard, the muscle tension of the lower extremities on the affected side was evaluated by modified Ashworth scale, and the recovery of lower extremity movement, wound recurrence, and scar formation in the flap donor sites were observed.Results:The flaps all survived successfully after operation. All the wounds in the flap donor sites healed and the skin grafts all survived. During 2 to 29 months of follow-up, the flaps were soft in texture, similar in color to the surrounding normal skin tissue with good blood supply. The muscle strength of the lower extremities on the affected side was evaluated as grade 4 in 2 patients and grade 5 in 5 patients. The muscle tension was grade 0 in all patients with no abnormality in movement. No wound recurred and no obvious scar deformity in the flap donor site was observed.Conclusions:The antegrade anterolateral thigh pedicled flap transplant is one of the effective methods to repair wounds in the perineum and inguinal regions. The procedure is easy to operate, with good postoperative appearances of the donor and recipient sites and good function of affected limbs, which is worthy of clinical promotion.

Objective:To explore the effect of different posture angles on the pain and comfort in patients with early esophageal cancer after endoscopic submucosal dissection (ESD), so as to provide a basis for patients to choose the best position after ESD.Methods:This study was a randomized controlled trial. One hundred and twenty patients with early esophageal cancer who underwent ESD in the Department of Gastroenterology, Nanjing Drum Tower Hospital from March 2021 to March 2022 were selected as the study subjects, and they were randomly divided into 4 groups of 30 patients each according to the randomized numerical method. Group A was the conventional group, which was in the free position after the operation, and groups B, C, and D were the experimental groups, with group B in the head-high-feet-low 30° position, group C in the head-high-feet-low 45° position, and group D in the head-high-feet-low 60° position. The pain scores after returning to the room after the operation, at 8, 16, 24 h after the operation and comfort scores at 24 h after the operation of the patients in the four groups were evaluated by Numeric Rating Scale (NRS) and General Comfort Questionnaire (GCQ).Results:There were 17 males and 13 females in group A; there were 20 males and 10 females in group B; there were 22 males and 8 females in group C; there were 19 males and 11 females in group D. All patients were aged 30-85 years old. The time main effect, grouping main effect, and interaction effect of postoperative pain NRS score among four groups of patients were all statistically significant ( F=618.13, 12.14, 6.75, all P<0.01). There was no significant difference in the NRS scores of patients after returning to the room after the operation among the four groups ( P>0.05). The NRS scores in group D at 8 and 16 h after the operation were (1.93 ± 0.64), (0.60 ± 0.47) points, lower than the (2.87 ± 1.14), (1.97 ± 1.22) points, (2.17 ± 0.83), (1.97 ± 1.61) points, (2.30 ± 0.75), (0.80 ± 0.61) points in groups A, B, and C, the differences were statistically significant ( t values were 0.79-4.72, all P<0.05). The NRS scores in group B at 24 h after the operation was (0.23 ± 0.18) points, lower than the (1.53 ± 1.08), (0.30 ± 0.21), (0.46 ± 0.25) points in groups A, C, and D, the differences were statistically significant ( t= 5.32, 1.34, 1.37, all P<0.05). The GCQ total scores at 24 h after the operation were (96.96 ± 3.05), (99.77 ± 3.21), (93.53 ± 3.76), (92.20 ± 3.69) points in group A, B, C, D, the difference was statistically significant ( F= 29.59, P<0.05). Moreover, the GCQ total scores at 24 h after the operation in group B were higher than those in groups A, C, and D, and the differences were statistically significant ( t=3.15, 7.01, 8.52, all P<0.05). Conclusions:Targeted body position management can effectively reduce postoperative pain and improve patient comfort in early esophageal cancer patients undergoing ESD.

Objective To investigate the risk factors for unplanned readmission within 30 days after discharge in cirrhotic patients with esophagogastric variceal bleeding undergoing transjugular intrahepatic portosystemic shunt(TIPS),and to construct a nomogram predictive model.Methods A total of 241 cirrhotic patients who underwent TIPS due to esophagogastric variceal bleeding in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2020 to June 2023 were enrolled as subjects,and unplanned readmission within 30 days was analyzed.According to the presence or absence of unplanned readmission,they were divided into readmission group with 36 patients and non-readmission group with 198 patients,and related clinical data were collected from all patients.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.A logistic regression analysis was used to identify independent risk factors for unplanned readmission.A nomogram prediction model was constructed,and the receiver operating characteristic(ROC)curve was plotted to assess its discriminatory ability for unplanned readmission;the calibration curve was plotted to evaluate the consistency of the nomogram model in predicting unplanned readmission;the ResourceSelection package of R language was used for the Hosmer-Lemeshow goodness-of-fit test to evaluate the degree of fitting of the mode;the decision curve analysis was used to investigate the practicality of the model.Results Age(odds ratio[OR]=2.664,95%confidence interval[CI]:1.139-6.233,P<0.05),CTP score(OR=1.655,95%CI:1.098-2.495,P<0.05),and blood ammonia(OR=1.032,95%CI:1.016-1.048,P<0.05)were independent risk factors for unplanned readmission within 30 days after discharge in the patients undergoing TIPS.The multivariate analysis showed that for the nomogram predictive model constructed in this study,repeated sampling for 1 000 times using the Bootstrap method was performed for internal validation,and the area under the ROC curve was 0.773,which was significantly higher than that of age(0.582),CTP score(0.675),and blood ammonia(0.641).The calibration curve showed good consistency between the probability of unplanned readmission predicted by the nomogram model and the actual probability,and the Hosmer-Lemeshow goodness-of-fit test showed good degree of fitting(c2=5.647 3,P=0.686 7).Conclusion Age,CTP score,and blood ammonia are independent risk factors for unplanned readmission within 30 days after TIPS,and the nomogram prediction model constructed based on these factors can help to predict the risk of unplanned readmission in TIPS patients and provide an accurate decision-making basis for early prevention.

Purpose To evaluate the fatty infiltration of lower limbs by using iterative decomposition of water and fat with asymmetry and least squares estimation quantitative fat imaging(IDEAL-IQ)technique in idiopathic inflammatory myopathy(IIM)patients,and to analyze the correlation between muscle fat fraction(FF)and clinical assessments.Materials and Methods Thirty-two patients with IIM were diagnosed by muscle biopsy and 32 age-,gender-matched healthy volunteers(control group)were recruited.T1WI,T2WI in axial view and IDEAL-IQ sequence of thighs were scanned on each subject.FF values of the anterior,interior and posterior thigh muscles were measured on the FF image generated in the IDEAL-IQ sequence,and medical research council scale score of the IIM group were collected.The difference of muscle FF value between the IIM group and control group was compared,the correlation between FF value and muscle strength of thigh muscles was also analyzed.Results The mean FF values of anterior,interior and posterior thigh muscles in IIM group were 16.60±3.67,6.77±4.92 and 17.32±4.01,respectively,which were significantly higher than those in control group(2.58±2.57,1.40±0.64 and 1.57±0.19),with statistically significant differences(t=-7.29,-6.91,-4.85;all P<0.05).Spearman test showed that the mean FF value was significantly correlated with course of disease(r=0.587,P<0.001).The mean FF values of anterior,interior and posterior thigh muscles were significantly correlated with muscle strength(r=-0.885,-0.761,-0.594;all P<0.001).Conclusion The IDEAL-IQ technique can quantitatively and objectively analyze the severity of muscle fat infiltration in IIM patients,and its degree is correlated with the muscle strength,which has significant clinical application value.