OBJECTIVES: With the increase in aging population in China, elderly Crohn's disease (CD) patients need to receive more attention. This study aims to explore the clinical characteristics and disease process of elderly onset CD (EOCD) patients in a single center. METHODS: From January 2002 to January 2022, a total of 221 patients with CD from the Seventh Medical Center of Chinese PLA General Hospital were enrolled. According to the Montreal CD classification standard, the patients were further divided into 4 groups: an EOCD group (≥60 years old, n=25), a middle age onset CD (MOCD) group (40-59 years old, n=46), a young onset CD (YOCD) group (17-40 years old, n=131), and a childhood onset CD (COCD) group (6-16 years old, n=19). We compared the clinical characteristics and long-term prognosis among them. RESULTS: Females were predominant in the EOCD group (15/25, 60%). The number of people without smoking in the EOCD group (80%) was lower than that in COCD group (100%), higher than that in the YOCD group (70.2%) and the MOCD group (69.6%) (all P<0.05). Patients with perianal diseases at diagnosis were rare in the EOCD group (0%), lower than that in the COCD group (21.1%) and the YOVD group (19.8%) (all P<0.05). Stenosis was the most common disease behavior in the EOCD group (63.0%), significantly higher than that in the COCD group (15.8%), the YOCD group (36.6%) and the MOCD group (43.5%) (all P<0.05). The EOCD group was easier to be misdiagnosed as tumor (24%), higher than that in the COCD group (0%), the YOCD group (6.9%) and the MOCD group (19.6%) (all P<0.05). The EOCD group was prone to comorbidities (52%), and 20% of them were complicated with multiple comorbidities (P<0.05). During the follow-up, the all-cause mortality of EOCD was 12%, and the CD-related mortality was 8%, which was significantly higher than the other groups (all P<0.05). The use of immunosuppressants in the EOCD group (4.8%) was lower than that in the COCD group (12.8%), the YOCD group (16.8%) and the MOCD group (16.1%), but there was no statistical significance among the 4 groups (P=0.467). In addition, there was no significant difference in the rate of intestinal resection among the 4 groups (P=0.062). CONCLUSIONS In EOCD patients, females were predominant, smoking was less common, and they were prone to comorbidity. At the initial stage of diagnosis, it is easy to be misdiagnosed as tumor, and the disease behavior mainly showed stricture type, less complicated with perianal diseases. During the follow-up, all-cause mortality and CD-related mortality of EOCD patients were significantly higher than those of the non-elderly onset CD patients.
Female ; Middle Aged ; Humans ; Aged ; Child ; Adult ; Adolescent ; Young Adult ; Crohn Disease/epidemiology* ; Prognosis ; Constriction, Pathologic ; Aging ; Hospitals, General

OBJECTIVE: To delineate the onset and recurrence characteristics of noncardiogenic ischemic stroke patients in China. METHODS: A prospective, multicenter and registry study was carried out in 2,558 patients at 7 representative clinical sub-centers during November 3, 2016 to February 17, 2019. A questionnaire was used to collect information of patients regarding CM syndromes and constitutions and associated risk factors. Additionally, stroke recurrence was defined as a primary outcome indicator. RESULTS: A total of 327 (12.78 %) patients endured recurrence events, 1,681 (65.72%) were men, and the average age was 63.33 ± 9.45 years. Totally 1,741 (68.06%) patients suffered first-ever ischemic stroke, 1,772 (69.27%) patients reported to have hypertension, and 1,640 (64.11%) of them reported dyslipidemia, 1,595 (62.35%) patients exhibited small-artery occlusion by The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Specifically, 1,271 (49.69%) patients were considered as qi-deficient constitution, and 1,227 (47.97%) patients were determined as stagnant blood constitution. There were 1,303 (50.94%) patients diagnosed as blood stasis syndrome, 1,280 (50.04%) patients exhibited phlegm and dampness syndrome and 1,012 (39.56%) patients demonstrated qi deficiency syndrome. And 1,033 (40.38%) patients declared intracranial artery stenosis, and 478 (18.69%) patients reported carotid artery stenosis. The plaque in 1,508 (41.36%) patients were of mixed. Particularly, 41.09% of them demonstrated abnormal levels of glycated hemoglobin levels. CONCLUSIONS Recurrence in minor and small-artery stroke cannot be ignored. Hypertension, dyslipidemia, abnormal HbA1c, intracranial artery stenosis and carotid plaque were more common in stroke patients. Particularly, phlegm-dampness and blood stasis syndromes, as well as qi deficiency and blood stasis constitutions, were still the main manifestations of stroke. (Trial registration at ClinicalTrials.gov No. NCT03174535).
Aged ; Constriction, Pathologic ; Female ; Hospitals ; Humans ; Hypertension ; Ischemic Stroke ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Prospective Studies ; Stroke/epidemiology* ; Syndrome

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases. However, patients with cirrhosis, particularly those with decompensated cirrhosis, are believed to be at increased risk for complications associated with ERCP. There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis. This study aimed to investigate the outcomes of ERCP for cirrhosis patients, especially adverse events, and evaluated its safety and efficacy. METHODS: We performed a multicenter, retrospective study of all patients at Beijing Friendship Hospital affiliated to Capital Medical University, Xijing Hospital affiliated to Air Force Military Medical University, Beijing Youan Hospital affiliated to Capital Medical University, and the Fifth Medical Center of the People's Liberation Army General Hospital from June 2003 to August 2019. The adverse events of inpatient ERCP for patients with ( n  = 182) and without liver cirrhosis (controls; n  = 385) were compared. RESULTS: A total of 567 patients underwent ERCP between January 2003 and December 2019 were enrolled in this study. Compared to patients without cirrhosis, patients with cirrhosis were at higher risk for postoperative complications (odds ratio [OR], 4.172; 95% confidence interval [CI], 1.232-7.031; P  < 0.001) such as postoperative pancreatitis (OR, 2.026; 95% CI, 1.002-4.378; P  = 0.001) and cholangitis (OR, 3.903; 95% CI, 1.001-10.038; P  = 0.036). The main indications for ERCP for patients with cirrhosis in this study included choledocholithiasis (101 cases; 55.5%), benign bile duct strictures (46 cases; 25.3%), and malignant bile duct strictures (28 cases; 15.4%). Among them, 23 patients (12.6%) underwent balloon dilation and 79 patients (43.4%) underwent sphincterotomy. Of the patients with cirrhosis, delayed bleeding occurred in ten patients (5.5%), postoperative pancreatitis occurred in 80 patients (44.0%), and postoperative cholangitis occurred in 25 patients (13.7%). An additional multivariate analysis showed that the total bilirubin (TBIL) level (OR, 4.58; 95% CI, 2.37-6.70) and Child-Pugh score of C (OR, 3.11; 95% CI, 1.04-5.37) were risk factors for postoperative complications in patients with cirrhosis. CONCLUSIONS Compared with the general population of patients undergoing ERCP, patients with cirrhosis were more prone to postoperative pancreatitis and cholangitis. TBIL levels and Child-Pugh scores were risk factors for postoperative complications in patients with cirrhosis.
Humans ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects* ; Retrospective Studies ; Constriction, Pathologic ; Risk Factors ; Liver Cirrhosis/complications* ; Pancreatitis/etiology* ; Postoperative Complications/epidemiology* ; Cholangitis

Objective: To explore the advantages and safety of a modified mattress inversion suturing using double barbed sutures compared with the traditional overlap method in totally laparoscopic esophagojejunostomy overlap anastomosis. Methods: A retrospective cohort study was conducted. The inclusion criteria were as follows: (1) patients were aged 18 - 80 years old; (2) adenocarcinoma was preoperatively confirmed by pathological analysis; (3) patients had undergone a complete laparoscopic radical total gastrectomy; (4) patients had undergone esophagojejunostomy using the overlap method; (5) patients received a grade of I-III on the American Society of Anesthesiologists physical status classification system; (6) patients' complete follow-up data had been collected. Patients with a history of other malignant tumors, multi-origin tumors, emergency surgery, non-R0 radical resection or distant metastasis were excluded. The clinical data of 89 gastric cancer patients who underwent total laparoscopic radical total gastrectomy in the Department of Gastrointestinal Surgery in the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2020 were collected. These patients were grouped according to the esophagojejunostomy method used. Of 89 patients, 32 received modified mattress inversion suturing with double barbed sutures to close the common opening of esophagojejunostomy (the modified anastomosis group), while 57 received traditional overlap anastomosis in which the common opening was closed by barbed suture (the traditional anastomosis group). The operation conditions (incision length, conversion to laparotomy, duration of esophagojejunostomy) and postoperative recovery (time to commencement of a liquid diet, duration of postoperative hospital stay, anastomotic leakage, anastomotic stenosis, and anastomotic bleeding) were compared between the two groups. Results: There was no significant difference in the baseline data of the two groups for any parameter (all P>0.05). All patients received complete laparoscopic radical gastrectomy without conversion to laparotomy. There were no significant differences in the length of the median incision, the proportion of food intake on the first day after surgery, or in the incidence of anastomotic complications such as anastomotic leakage, anastomotic stenosis, and anastomotic bleeding between the two groups (P>0.05). Compared with the traditional anastomosis group, patients in the modified anastomosis group had shorter anastomosis time [26 (19-62) minutes vs. 36 (20-50) minutes, Z=-2.546, P=0.011] and postoperative hospital stay [7 (6-12) days vs. 9 (7-42) days, Z=-4.202, P<0.001]. The differences were statistically significant (all P<0.05). In a subgroup analysis of tumor TNM stage III, Siewert type II and neoadjuvant chemotherapy patients, there was no significant difference in the incidence of anastomotic complications between the modified group and the traditional group. However, the postoperative hospital stay duration in the modified anastomosis group was less than in the traditional anastomosis group. The duration of anastomosis in Siewert type II patients was also shorter in the modified anastomosis group than in the traditional anastomosis group [26 (19-62) minutes vs. 38 (21-50) minutes, Z=-2.105, P=0.035], and the difference was statistically significant (all P<0.05). Conclusion: Complete laparoscopic esophagojejunostomy using modified mattress inversion suturing with double barbed sutures is a safe and feasible anastomosis method to close the common opening of esophagojejunostomy, with shorter operation time, faster postoperative recovery and shorter hospital stay than the traditional method.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods* ; Anastomotic Leak/epidemiology* ; Constriction, Pathologic ; Gastrectomy/methods* ; Humans ; Laparoscopy/methods* ; Middle Aged ; Retrospective Studies ; Sutures ; Young Adult

Objective To analyze the correlation between tortuosity and stenosis in patients with myocardial bridge(MB)on the left anterior descending artery(LAD). Methods Data of patients with MB on the LAD,which was discovered by coronary computed tomography angiography(CCTA),in the Affiliated Hospital of North China University of Science and Technology from October 2015 to December 2018 were retrospectively analyzed.Among them 278 patients with tortuosity on LAD and 278 patients without tortuosity were selected.The clinical charateristics(age,gender,hypertension,hyperlipidemia,diabetes,smoking history,and family history)as well as the incidence and severity of stenosis of LAD were recorded and compared. Results The incidence of coronary artery stenosis in the non-tortuosity group(57.6%)was significantly lower than that in the tortuosity group(71.9%)($\bar{χ}$=12.608,
China ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis/epidemiology* ; Coronary Vessels/diagnostic imaging* ; Humans ; Myocardial Bridging/pathology* ; Retrospective Studies

Angiography ; Bias (Epidemiology) ; Constriction, Pathologic ; Coronary Angiography ; Fractional Flow Reserve, Myocardial ; Humans ; Ischemia ; Patient-Specific Modeling ; Sensitivity and Specificity

BACKGROUND: Cervical foraminal stenosis (CFS) is one of the degenerative changes of the cervical spine; however, correlations between the severity of stenosis and that of symptoms are not consistent in the literature. Studies to date on the prevalence of stenosis are based on images obtained from the departments treating cervical lesions, and thus patient selection bias may have occurred. The purpose of this study was to investigate the prevalence of CFS according to the site, extent, and morphology of stenosis using cervical computed tomography (CT) images obtained from patients who were visiting not because of symptoms related to the cervical spine, cervical pain, or upper limb pain. METHODS: Among patients who underwent CT from January 2016 to March 2016 for reasons other than cervical spine symptoms, a total of 438 subjects were enrolled, and 2,628 cervical disc images (C4–5, C5–6, and C6–7; left and right sides) were examined. Three orthopedic surgeons performed two measurements each at 4-week intervals. Values were used for analysis if matched by more than two surgeons; if no match was found, the median values were used for analysis. The left and right sides on the same axial image were independently classified. RESULTS: Left C5–6 stenosis was most common (24.66%) among patients. At the left C6–7, there were 20 focal types and 33 diffuse types. At bilateral C4–5 and right C6–7, the focal type was more common, whereas at bilateral C5–6 and left C6–7, the diffuse type was more common. Age and the severity of stenosis showed statistically significant correlation at all cervical levels. CONCLUSIONS: The prevalence of CFS was highest at the C5–6 level (19.06%). Compared to other levels, focal stenosis was more frequent at C4–5 and diffuse stenosis was more common at C5–6. At C6–7, the incidence of focal stenosis was higher on the right side and that of diffuse stenosis was higher on the left side.
Bias (Epidemiology) ; Cervical Vertebrae ; Constriction, Pathologic* ; Female ; Humans ; Incidence ; Neck Pain ; Orthopedics ; Patient Selection ; Prevalence* ; Spinal Stenosis ; Spine ; Surgeons ; Upper Extremity

OBJECTIVETo evaluate the feasibility and safety of the delta-shaped anastomosis in laparoscopic distal gastrectomy and digestive tract reconstruction.

METHODSClinical data of 34 gastric cancer patients undergoing laparoscopic distal gastrectomy with the delta-shaped anastomosis for digestive tract reconstruction (delta-shaped group) and 83 gastric cancer patients undergoing laparoscopic distal gastrectomy with Billroth I( for digestive tract reconstruction (Billroth group) by same surgeon team from July 2013 to July 2015 at the Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University were retrospectively analyzed. Data of two groups were compared.

RESULTAge, gender, tumor stage were not significantly different between the two groups(all P>0.05). Operation time of the first 15 cases in delta-shaped group was longer than that in Billroth group [(254.7±35.4) min vs. (177.8±33.0) min, t=11.190, P=0.000], while after above 15 cases, the operation time of delta-shaped group was significantly shorter than that of Billroth group [(142.1±14.6) min vs. (177.8±33.0) min, t=-4.109, P=0.001]. Delta-shaped group had less blood loss during operation [(87.1±36.7) ml vs. (194.0±55.1) ml, t=-10.268, P=0.000], and shorter length of incision [(4.1±0.4) cm vs. (6.1±1.0) cm, t=-10.331, P=0.000] than Billroth group. Compared with Billroth group, delta-shaped group presented faster postoperative bowel function return [(2.8±0.6) d vs. (3.3±0.5) d, t=-3.755, P=0.000], earlier liquid food intake [(7.4±1.5) d vs. (8.1±1.7) d, t=-4.135, P=0.000], earlier ambulation [(4.0±1.6) d vs. (6.8±1.4) d, t=-7.197, P=0.000] and shorter postoperative hospital stay [(12.6±1.9) d vs.(13.6±2.0) d, t=-20.149, P=0.000]. Morbidity of postoperative complication was 5.9%(2/34) in delta-shaped group, including anastomotic fistula in 1 case and incision infection in 1 case, and 6.0%(5/83) in Billroth group, including anastomotic fistula, incision infection, anastomotic stricture and dumping syndrome, without significant difference(P>0.05). Difference value of total protein and albumin between pre-operation and post-operation, and average decreased value of total protein, albumin, body weight between pre-operation and postoperative 6-month were not significantly different between two groups(all P>0.05). As for patients with BMI > 25 kg/m, compared to Billroth group, delta-shaped group presented less blood loss during operation [(94.1±36.7) ml vs. (203.0±55.1) ml, t=-10.268, P=0.000], lower injective dosage of postoperative analgesics [(1.9±1.1) ampule vs.(3.3±2.0) ampule, t=-2.188, P=0.032], faster intestinal recovery [(2.9±0.7) d vs. (3.2±0.9) d, t=-3.755, P=0.009], shorter hospital stay [(10.5±1.2) d vs. (11.7±1.5) d, t=-2.026, P=0.004], and lower morbidity of postoperative complication [7.1%(1/14) vs. 13.6%(3/22), χ=4.066, P=0.031].

CONCLUSIONIn laparoscopic distal gastrectomy and digestive tract reconstruction, the delta-shaped anastomosis is safe and feasible, especially suitable for obese patients.

Anastomosis, Surgical ; adverse effects ; methods ; Blood Loss, Surgical ; statistics & numerical data ; Comparative Effectiveness Research ; Constriction, Pathologic ; epidemiology ; etiology ; Defecation ; Digestive System Fistula ; epidemiology ; etiology ; Drinking ; Dumping Syndrome ; epidemiology ; etiology ; Female ; Gastrectomy ; adverse effects ; methods ; Gastroenterostomy ; adverse effects ; methods ; Humans ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; Male ; Operative Time ; Postoperative Complications ; epidemiology ; Postoperative Period ; Recovery of Function ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Surgical Wound ; Surgical Wound Infection ; epidemiology ; Treatment Outcome

OBJECTIVETo explore the clinical efficacy and safety of gastroepiploic tunnel esophagogastrostomy applied in minimally invasive esophagectomy and gastroesophageal cervical anastomosis.

METHODSClinical data of 137 esophageal cancer patients who received minimally invasive esophagectomy from December 2013 to June 2015 in Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University were analyzed retrospectively, including 84 patients receiving anastomosis with tubular anastomat (circular staple group), and 53 patients receiving gastroepiploic tunnel anastomosis(tunnel group, position of tunnel anastomosis located in the side of gastrocolic omentum, about 2-3 cm apart from fundus). Incidence of postoperative anastomotic leakage and stricture was compared between two groups.

RESULTSAll the 137 patients completed minimally invasive esophageal surgeries successfully without conversion to open thoracic or abdominal operation. The time for anastomosis was(20.2±3.1) minutes in circular stapler group and (38.9±2.9) minutes in tunnel group respectively, and the difference was statistically significant (t=75.22, P=0.000 0). The incidence of postoperative anastomotic leakage was 21.4%(18/84) in circular stapler group and 0(0/53) in tunnel group respectively, and the difference was statistically significant (P=0.000 3). All the patients were followed up for more than 6 months. During follow-up period, the incidence of postoperative anastomotic stricture was 14.3%(12/84) in circular stapler group and 3.8%(2/53) in tunnel group respectively, and the difference was statistically significant(P=0.047 9).

CONCLUSIONThe gastroepiploic cervical tunnel anastomosis is safe and effective and can reduce the incidence of postoperative anastomotic leakage as well as anastomotic stricture.

Anastomosis, Surgical ; adverse effects ; methods ; Anastomotic Leak ; epidemiology ; prevention & control ; Comparative Effectiveness Research ; Constriction, Pathologic ; epidemiology ; prevention & control ; Esophageal Neoplasms ; complications ; surgery ; Esophagectomy ; adverse effects ; methods ; Esophagoplasty ; adverse effects ; methods ; Humans ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Neck ; surgery ; Omentum ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Surgical Stapling ; adverse effects ; methods

Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. Although its etiology remains unknown, recent genetic studies identified RNF213 in the 17q25-ter region as an important susceptibility gene of MMD among East Asian populations. Possibly because of genetic differences, MMD is relatively common in people living in East Asian countries such as Korea and Japan, compared to those in the Western Hemisphere. The prevalence of MMD appears to be slightly lower among Chinese, compared to Koreans or Japanese. There are two peaks of incidence with different clinical presentations, at around 10 years and 30-40 years. The peak appears to occur later in women than men. In children, ischemic symptoms, especially transient ischemic attacks, are predominant. Intellectual decline, seizures, and involuntary movements are also more common in this age group. In contrast, adult patients present with intracranial hemorrhage more often than pediatric patients. In patients with MMD, intracerebral hemorrhage is more often accompanied by intraventricular hemorrhage than in patients with hypertensive intracerebral hemorrhage. These different age peaks and different clinical presentations in each age group are also observed in MMD patients in the USA. Catheter angiography is the diagnostic method of choice. Magnetic resonance (MR) angiography and computed tomographic angiography are noninvasive diagnostic methods. High-resolution vessel wall MR imaging also helps diagnose MMD by revealing concentric vessel wall narrowing with basal collaterals.
Adult ; Angiography ; Asian Continental Ancestry Group ; Brain ; Carotid Artery, Internal ; Catheters ; Cerebral Hemorrhage ; Child ; Constriction, Pathologic ; Diagnosis* ; Dyskinesias ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Japan ; Korea ; Magnetic Resonance Imaging ; Male ; Moyamoya Disease* ; Prevalence ; Seizures