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There is no clear evidence on the indication and surgical approaches on evacuating basal ganglia hemorrhage caused by hypertensive bleeding. Some studies have shown that minimally invasive approaches have therapeutic potentials, but its benefits remain inconclusive. We describe an endoport assisted endoscopic transsylvian approach for basal ganglia hemorrhage evacuation. We evaluate the safety and efficacy of this approach in a cohort study. We included 19 patients (mean age 57 years) who underwent the surgery at a single county-level hospital in Yunan Province, China. The majority had a Glasgow coma scale between 9 and 12 on admission. The midline shift ranged from 16-29 mm (mean 19 mm). Hematoma volume ranged from 46 to 106 ml (mean 67 ml). Six patients (31.6%) presented with intraventricular hemorrhage. All patients achieved greater than 90% decrease in hematoma volume at postoperative computed tomography scan. The average operative time was 115 minutes and average blood loss of 44 ml. The most common postoperative complication was pulmonary infection (63.2%). No rebleeding, seizure, infectious meningitis, or postoperative mortality was observed. A total of 17 patients (89.5%) achieved good functional recovery at follow up within 90 days after surgery (Glasgow outcome scale 4–5) and 2 patients had severe disability (Glasgow outcome scale 3). Endoport assisted endoscopic surgery through transsylvian approach is safe and effective treatment for hypertensive basal ganglia hemorrhage. The majority of patients have good functional recovery and the rate of severe complications is low. [ABSTRACT FROM AUTHOR]

This study aims to investigate the proportion and distribution of female HPB surgeons in China, describe their current status, and analyze the possible barriers and challenges in their careers. Tertiary hospitals with the division of HPB in mainland China in 2021 were enrolled and surgeon demographic information was collected through the review of official websites and/or telephone interviews. The majority of female HPB surgeons (72.92%) were located in the first or second-tier cities in mainland China, with an increasing number of new female HPB surgeons entering the field annually, particularly after 2005 (from 27 to 52 per 5 years). Despite no significant difference in academic backgrounds, female HPB surgeons initiated their careers at an earlier age and took a longer time to obtain chief titles (P < 0.05). Interestingly, female HPB surgeons performed laparoscopic complex HPB cases at a similar rate (95.42%) to their male counterparts and were more likely to specialize in endoscopic surgery (P = 0.021), with a similar ratio of obtaining administrative positions. Minimally invasive surgery may provide females with unprecedented opportunities in the HPB surgery field. However, despite the increasing numbers of female HPB surgeons, the proportion remains low in China. [ABSTRACT FROM AUTHOR]

• RATS harvested an incremental 0.28 QALYs at an additional cost of $3104.82, making for an ICER of $10967.41 per QALY over OT. • Robotic approach was associated with less cost-effective than VATS, making for an ICER of $80324.98 per QALY versus VATS. • The CE probabilities of RATS for 24 of 31 provinces in China were > 0.60 at corresponding WTP thresholds. This study aimed to evaluate the cost-effectiveness of robotic-assisted thoracoscopic surgery (RATS) over open thoracotomy (OT) and video-assisted thoracoscopic surgery (VATS) for operable non-small cell lung cancer (NSCLC) from the perspective of Chinese healthcare payer. The Markov decision model was developed to assess the 5-year costs and quality-adjusted life year (QALY) of RATS versus OT and VATS for operable NSCLC patients. The propensity-matched cohorts were generated from our clinical center to determine the surgical costs and complication rates. An individual patient data meta-analysis was conducted to estimate model probabilities of progression and survival risks. Other model inputs were abstracted from available studies. The primary outcome was incremental cost-effectiveness ratios (ICERs). RATS contributed to an incremental 0.28 QALYs at an additional cost of $3,104.82, making for an ICER of $10,967.41 per QALY versus OT. Robotic approach harvested an incremental 0.05 QALYs at an additional cost of $4006.86, making for an ICER of $80324.98 per QALY over VATS. RATS shown a same cost-effectiveness probability (0.50) versus OT and VATS at a willing-to-pay (WTP) threshold of $12,000 per QALY and $75,800 per QALY, respectively. The probabilities of cost-effectiveness for RATS were 0.64 and 0.21 at a presupposed WTP threshold of $ 30,000 per QALY versus OT and VATS, respectively. RATS was evaluated to be cost-effective versus OT for patients with operable NSCLC from the perspective of Chinese healthcare payer. To the contrary, robotic approach was associated with less cost-effective than VATS. [ABSTRACT FROM AUTHOR]

Background: The role of surgery compared with reirradiation in the primary treatment of patients with resectable, locally recurrent nasopharyngeal carcinoma (NPC) who have previously received radiotherapy is a matter of debate. In this trial, we compared the efficacy and safety outcomes of salvage endoscopic surgery versus intensity-modulated radiotherapy (IMRT) in patients with resectable locally recurrent NPC.Methods: This multicentre, open-label, randomised, controlled, phase 3 trial was done in three hospitals in southern China. We included patients aged 18-70 years with a Karnofsky Performance Status score of at least 70 who were histopathologically diagnosed with undifferentiated or differentiated, non-keratinising, locally recurrent NPC with tumours confined to the nasopharyngeal cavity, the post-naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Eligible patients were randomly assigned (1:1) to receive either endoscopic nasopharyngectomy (ENPG group) or IMRT (IMRT group). Randomisation was done manually using a computer-generated random number code and patients were stratified by treatment centre. Treatment group assignment was not masked. The primary endpoint was overall survival, compared between the groups at 3 years. Efficacy analyses were done by intention to treat. Safety analysis was done in patients who received treatment according to the treatment they actually received. This trial was prospectively registered at the Chinese Clinical Trial Registry, ChiCTR-TRC-11001573, and is currently in follow-up.Findings: Between Sept 30, 2011, and Jan 16, 2017, 200 eligible patients were randomly assigned to receive either ENPG (n=100) or IMRT (n=100). At a median follow-up of 56·0 months (IQR 42·0-69·0), 74 patients had died (29 [29%] of 100 patients in the ENPG group and 45 [45%] of 100 patients in the IMRT group). The 3-year overall survival was 85·8% (95% CI 78·9-92·7) in the ENPG group and 68·0% (58·6-77·4) in the IMRT group (hazard ratio 0·47, 95% CI 0·29-0·76; p=0·0015). The most common grade 3 or worse radiation-related late adverse event was pharyngeal mucositis (in five [5%] of 99 patients who underwent ENPG and 26 [26%] of 101 patients who underwent IMRT). Five [5%] of the 99 patients who underwent ENPG and 20 [20%] of the 101 patients who underwent IMRT died due to late toxic effects specific to radiotherapy; attribution to previous radiotherapy or trial radiotherapy is unclear due to the long-term nature of radiation-related toxicity.Interpretation: Endoscopic surgery significantly improved overall survival compared with IMRT in patients with resectable locally recurrent NPC. These results suggest that ENPG could be considered as the standard treatment option for this patient population, although long-term follow-up is needed to further determine the efficacy and toxicity of this strategy.Funding: Sun Yat-sen University Clinical Research 5010 Program. [ABSTRACT FROM AUTHOR]

There are no data validating the performance of spleen stiffness measurement in ruling out high-risk varices in patients with HBV-related cirrhosis under maintained viral suppression. Thus, we aimed to prospectively validate the performance of spleen stiffness measurement (cut-off 46 kPa) combined with Baveno VI criteria in ruling out high-risk varices in these patients. Patients with cirrhosis were enrolled from April to December 2019 at the hepatology unit of the Nanfang Hospital, China. Liver and spleen transient elastography and esophagogastroduodenoscopy were performed at enrollment. Antiviral regimen(s) and virological responses, evaluated every 3-6 months, were recorded. Overall 341 patients with HBV-related cirrhosis under maintained viral suppression were enrolled, and the prevalence of high-risk varices was 20.5% (70/341). Baveno VI criteria spared 37.0% (126/341) esophagogastroduodenoscopies and no high-risk varices were missed (0/70). Eight cases of high-risk varices (8/70, 11.4%) were misclassified in patients (208/341, 61.0%) within the expanded Baveno VI criteria. The spleen stiffness measurement cut-off (≤46.0 kPa) was shown to safely rule out high-risk varices in these patients (the percentage of missed high-risk varices was 4.3%). Over half (61.6%, 210/341) of patients met the combined model (Baveno VI criteria and spleen stiffness measurement cut-off ≤46 kPa) and 4.3% (3/70) of high-risk varices cases were misclassified. This combined model exhibited a sensitivity of 95.71%, specificity of 76.38%, negative predictive value of 98.57%, and negative likelihood ratio of 0.06 for ruling out high-risk varices. We validated the excellent performance of Baveno VI criteria combined with spleen stiffness measurement (cut-off 46 kPa) for safely ruling out high-risk varices in patients with HBV-related cirrhosis under viral suppression; more than half of esophagogastroduodenoscopy procedures were spared using this combination. NCT04123509 Esophageal varices have important prognostic implications in patients with cirrhosis. Thus, their timely identification is important so that treatment can be initiated early. Herein, we validated the excellent performance of the combination of Baveno VI criteria with spleen stiffness measurement (cut-off 46 kPa) for ruling out high-risk esophageal varices in patients with HBV-related cirrhosis under maintained viral suppression (with antiviral treatment). This combined model was able to safely rule out high-risk varices (missed/total <5%) and over half (61.6%) of esophagogastroduodenoscopy procedures were spared. • Largest prospective study validating the performance of Baveno VI criteria in patients with cirrhosis under HBV suppression. • SSM (≤46 kPa) for ruling out high-risk varices was well validated in patients with cirrhosis under viral suppression. • More unnecessary endoscopies (>50%) can be safely avoided by combining Baveno VI criteria and SSM model. [ABSTRACT FROM AUTHOR]

Recent studies have suggested that insulinoma-associated protein 1 (INSM1) is a useful marker for pathological diagnosis of neuroendocrine tumors. In the present study, we investigated the association between INSM1 expression and prognosis in patients with olfactory neuroblastoma (ONB) and assessed the usefulness of INSM1 as a prognostic biomarker in these patients. Immunohistochemistry was performed on 109 ONB patients who underwent endoscopic surgery at Beijing Tong Ren Hospital (Beijing, China) between June 2006 and November 2021 Patient age at the time of surgery ranged from 10 months to 72 years (mean age, 43.55 ± 13.47 years). In total, 63 (57.8%) and 46 (42.2%) tumors occurred in male and female patients, respectively. The percentages of grade I–IV cases were 13.8% (15/109), 36.7% (40/109), 29.4% (32/109) and 20.2% (22/109), respectively. The expression rate (moderately/strongly positive) of INSM1 was significantly higher in high-grade (Ⅲ/Ⅳ; 83%; 45/54) than low-grade (Ⅰ/Ⅱ; 27%; 15/55) ONB cases. High expression levels of INSM1 were significantly positively associated with high pathological stage (p < 0.001), local recurrence, and death. Kaplan‑Meier analysis revealed that patients with high INSM1 expression had significantly shorter disease‑free survival (DFS) and mean survival (75.01 ± 10.71 vs. 158.56 ± 10.32) times, and shorter overall survival (OS). Multivariate Cox regression analysis revealed that INSM1 was an independent prognostic factor for DFS (HR: 4.963, 95%CI [2.11–10.84] p < 0.001) and OS (HR: 4.791, 95%CI [2.117–10.485], p < 0.001) after adjusting for sex, age, and tumor grade. In addition, INSM1 was an independent prognostic factor for DFS in patients treated with surgery (HR: 3.714, 95%CI [1.267–10.889], p = 0.017) and chemotherapy (HR: 5.574, 95%CI [1.584–19.612], p = 0.007). INSM1 expression had a positive association with the prognosis of patients with ONB and could serve as a prognostic biomarker in these patients. [ABSTRACT FROM AUTHOR]

Pediatric endoscopic skull base surgery is challenging due to the intricate anatomy of the skull base and the presence of tumors with varied pathologies. The use of three-dimensional (3D) printing technologies in skull base surgeries has been found to be highly beneficial. A systematic review of the literature was performed to investigate the published studies that reported the effectiveness of 3D printing in pediatric endoscopic skull base surgery. Pub Med, Embase, Science Direct, The Cochrane Library, and Scopus were searched from January 01, 2000, until June 30, 2022. Original articles of any design reporting on the effectiveness of 3D printing in pediatric endoscopic skull base surgery were included. Information related to study population, conditions, models used, and key findings of study were extracted. Quality of included studies was evaluated using the Joanna Briggs Institute's (JBI) Critical Appraisal Checklist for Studies. To exemplify the use of 3D technology in this scenario, we report a complex clival chordoma case. Six research articles were retrieved and included for qualitative analysis. Four of the six studies were conducted in the United States, followed by two in China. According to these studies, 3D reconstruction and printed models were more beneficial than CT/MRI images when discussing surgery with patients. In clinical training, these models were more helpful than 2D images in understanding the pathology when used in conjunction with image-guiding systems. It has been found that patient-specific 3D modeling, simulations, and rehearsal are the most efficient preoperative planning techniques, particularly in the pediatric population, for the treatment of complicated skull base surgeries. All the studies had a moderate risk of bias. 3D printing technologies assist in printing complex skull base tumors and the structures around them in three dimensions at the point of care and at the time needed, enabling the choice of the appropriate surgical strategy, thus minimizing surgery-related complications. [ABSTRACT FROM AUTHOR]

Background: Although several studies reported that Balloon kyphoplasty (BK) or percutaneous vertebroplasty (PVP) could improve pulmonary functions, there is no study to compare the efficacy and safety of 2 procedures in COPD patients with osteoporotic vertebral compression fractures (OVCFs) and investigate the reason why they could improve pulmonary functions.Method: Two procedures, including BK and PVP were performed in 61 COPD patients with single-level OVCFS. VAS-score, ODI, pulmonary function and radiological parameters (Anterior vertebral body height ratio, posterior vertebral body height ratio and Local kyphotic angle) were evaluated preoperatively and 1 week, 3 months and 12 moths postoperatively, respectively. The operation time and cement leakage rate were also recorded.Result: The operation time was longer in BK than PVP (37.5 ± 7.4 versus 27.6 ± 6.2 min per vertebra). Both groups got an equally significant improvement in pain relief, functional result, pulmonary functions and demonstrated similar cement leakage rate (BK: 6.5%; PVP: 10%). Radiologically, BK is favored than PVP. A significant relationship between VAS and pulmonary functions except FEV1 was observed in first week postoperatively, while the ODI was related to MVV in first 3 months postoperatively.Conclusion: Both BK and PVP provided equally significant back pain relief and improvements of respiratory functions in patients affected by COPD with single level OVCFs. BK was favored in radiography, this improvement was not related to pain relief and improvement of pulmonary functions. Given much higher cost of BK, similar effectiveness and safety of BK and PVP, in COPD patients with OVCFs, PVP may be a better choice. [ABSTRACT FROM AUTHOR]

Several studies, including the multicenter prospective trial JCOG 0508, have reported a higher risk of recurrence in patients with pT1b esophageal carcinoma (EC) with lymphovascular invasion (LVI) after endoscopic resection (ER). The role of adjuvant radiotherapy in this population has not been fully proven. Thus, the aim of this study was to investigate the effectiveness of adjuvant radiotherapy for T1b EC with LVI. This was a multicenter retrospective study including 6 centers in China. From May 2011 to March 2019, patients with T1b EC and LVI who underwent ER with or without radiotherapy were included and analyzed. The overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method, and the log-rank test was used to analyze differences between the groups. Factors between different groups were compared using chi square test. A total of 42 patients were included, including 37 (88.1%) males and 5 (11.9%) females. The median age was 60 (49-80) years old. Forty (95.2%) patients were squamous cell carcinoma, and two (4.8%) were adenosquamous cell carcinoma. The number of patients with tumor of SM1 and SM2 invasion were 10 (23.8%) and 32 (76.2%), respectively. The median lesion length was 3.0 cm. Thirty-six (85.7%) Patients underwent complete ER and six (14.3%) patients were with R1 resection. Sixteen (38.1%) patients received adjuvant radiotherapy, including two received chemoradiotherapy. The factors mentioned above were well balanced between radiotherapy and non-radiotherapy groups. The median survival in the radiotherapy vs. non-radiotherapy groups were not reached vs. 80.4 months, respectively. The 3y- and 5y-OS were 91.7% and 91.7% in the radiotherapy group vs. 80.8% and 58.9% in the non-radiotherapy group, respectively (p=0.045). The median DFS time in the radiotherapy vs. non-radiotherapy groups was not reached vs. 43.8 months, respectively. The 3y- and 5y-DFS were 92.9% and 92.9% in the radiotherapy group vs. 69.2% and 43.5% in the non-radiotherapy group, respectively (p=0.011). Radiotherapy was the only prognostic factor for both OS and DFS. Adjuvant radiotherapy improved the survival of patients with T1b EC with LVI after ER. This combined treatment strategy could cure T1b-LVI EC while preserving the esophagus. [ABSTRACT FROM AUTHOR]

Background: In China, great efforts are dedicated to reducing discomfort and minimizing undesirable complications for patients undergoing upper gastrointestinal (UGI) endoscopy. Methods: This study was conducted to compare the diagnostic accuracy, safety, complications, and patient and examiner satisfaction for different sedation approaches. We carried out a prospective and randomized study on 450 patients undergoing diagnostic UGI endoscopy. During the procedure, patients received NO by inhalation; an intravenous mixture of midazolam, remifentanil, and propofol; or no sedative. The cardiorespiratory functions, procedure duration, recovery time, length of hospital stay, complications, and ratings of patient and examiner satisfaction were recorded. Results: Compared to those deeply sedated, patients inhaling NO had comparable diagnostic accuracy, significantly shorter procedure and recovery times, a lower risk of cardiorespiratory distress, but a higher number of minor complications and post-procedure mental issues. The procedural satisfaction ratings were highest for those receiving deep sedation; fewer patients reported willingness to reconsider NO for a future upper GI endoscopy. The lowest satisfaction rating was given by those who received no sedation. Conclusions: Multiple factors should be considered before selecting NO as the sedative for diagnostic UGI endoscopy, including the patient's economic status, potential risk of cardiorespiratory distress, and sensitivity to potential adverse effects of NO administration. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: With rapid advances in endoscopic neurosurgery, it has become possible to treat some lesions located in the anterior skull base through a transnasal approach. This anatomic study was undertaken to describe the area of surgical exposure of the anterior skull base afforded by transnasal approaches with an endoscope, as well as to provide references for clinical practice. Methods: Thirty bony skull base specimens (all Chinese) were used, and 10 injected adult cadaver heads (all Chinese) were dissected for a simulated endoscopic transnasal approach to the anterior skull base. The distance between the bilateral optic canals was measured in skull base specimens and the distance between the columella and anterior ethmoid artery or posterior ethmoid artery was measured on both sides in adult cadaver heads. Results: The optic canals were 15.13±1.69mm apart. The distance between the columella and posterior ethmoid artery was 71.01±3.99mm on the left side and 72.27±3.97mm on the right side. The distance between the columella and anterior ethmoid artery was 64.811±3.74mm on the left side and 64.18±3.74mm on the right side. The endoscopic transnasal approach to the anterior skull base exposed the optic protuberance, sellar floor, crista galli, anterior ethmoid artery, and posterior ethmoid artery. In addition, bilateral olfactory bulbs, olfactory tracts, and optic nerves beneath the dura mater were also revealed. Conclusions: The anatomic data as well as established anatomic landmarks associated with endoscopic surgery would benefit clinical practice. [Copyright &y& Elsevier]

Intracerebral hematomas (ICH) is a common disease in the developing countries, and minimally invasive transportal resection of ICH is a widely accepted surgical technique. Many port systems are available, but most are disposable and expensive. We present a safe and cost-effective glove-syringe substitute for endoscopic hematoma evacuation, suitable for developing countries such as China. A port substitute of different sizes and lengths was constructed using sterile gloves and syringes, commonly found in a surgical environment. We successfully performed endoscopic hematoma removal in 7 patients including 1 cerebellar hemorrhage case and the remaining 6 supratentorial basal ganglia cases (1 patient taking oral aspirin). Bipolar electrocoagulation was used to control bleeding from the ruptured blood vessels. There were no postsurgical complications. The glove-syringe port is a convenient, safe, and cost-effective tubular port system for endoscopic surgery of ICH. Such ports can be used as substitutes when commercial sleeves are unavailable, especially in rural areas and developing countries. [ABSTRACT FROM AUTHOR]

The video assisted thoracoscopic surgery (VATS) for lobectomy which is newly developed technology represents an important option for lung cancer due to less morbidity and mortality compare with open lobectomy. Although the total hospitalization costs were similar, CNY46,799.70 in VATS lobectomy group vs CNY45,321.98 in open group (P=0.478), the proportion of material cost in VATS was higher (44% vs. 37%, P<0.001). Meanwhile, although the consumable material cost proportion is higher in VATS group, the total hospitalization cost will not increase due to cost-savings in medicine and treatment costs. [Extracted from the article]

Background: Oesophageal cancer is common in China. There is a lack of treatment strategies for metastatic oesophageal cancer (MEC) after radical surgery on the primary tumour. Cryoablation is an attractive option because tumour necrosis can be safely induced in a minimally invasive manner. This study assessed its therapeutic effect in MEC after failure of radical surgery. Methods: One hundred and forty patients met the inclusion criteria between May 2003 and March 2011. Comprehensive cryotherapy of multiple metastases was performed on 105 patients; 35 received chemotherapy. Overall survival (OS) was assessed according to therapeutic protocol, pathological type, treatment timing, and number of procedures. Findings: No severe complications occurred during or after cryoablation. The OS of patients who received comprehensive cryoablation (44±20months) was significantly longer than that of those who underwent chemotherapy (23±24months; p=0.0006). In the cryotherapy group, the OS for squamous cell carcinoma (45 ±19months) was longer than that for adenocarcinoma (33±18months; p=0.0435); the OS for timely cryoablation (46 ±19months) was longer than that for delayed cryoablation (33±20months; p=0.0193); the OS for multiple cryoablation (50±17months) was longer than that for single cryoablation (37±20months; =0.0172); and the OS for cryoimmunotherapy (56±17months) was longer than that for cryoablation alone (39±19months; p=0.0011). Interpretation: Comprehensive cryotherapy could have advantages over chemotherapy in the treatment of MEC and, in patients with squamous cell carcinoma, supplementary immunotherapy and timely and multiple cryoablation could be associated with a better prognosis. [ABSTRACT FROM AUTHOR]