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| 1 | Endoscopic management of postoperative bile leaks显示文摘BACKGROUND: Significant bile leak as an uncommon complication after biliary tract surgery may constitute a serious and difficult management problem. Surgical management of biliary fistulae is associated with high morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice for management of biliary Gstulae. METHODS: Ninety patients presented with bile leaks after cholecystectomy ( open cholecystectomy in 45 patients, cholecystectomy with common bile duct exploration in 20 and laparoscopic cholecystectomy in 25). The presence of bile leaks was confirmed by ERCP and the appearance of bile in percutaneous drainage of abdominal collections. Of the 90 patients with postoperative bile leaks, 18 patients had complete transaction of the common bile duct by ERCP and were subjected to bilioenteric anastomosis. In the remaining patients after cholangiography and localization of the site of bile leaks. therapeutic procedures like sphinctero-tomy, biliary stenting and nasobiliary drainage ( NBD ) were performed. If residual stones were seen in the common bile duct, sphincterotomy was followed by stone extraction using dormia basket. Nasobiliary drain or stents of 7F size were placed according to the standard techniques. The NBD was removed when bile leak stopped and closure of the fistula confirmed cholangiographically. The stents were removed after an interval of 6-8 weeks. RESULTS: Bile leaks in 72 patients occurred in the cystic duct (38 patients), the common bile duct (30 ), and the right hepatic duct (4). Of the 72 patients with post-operative bile leak, 24 had associated retained common bile duct stones and 1 had ascaris in common bile duct. All the 72 patients were subjected to therapeutic procedures including sphincterotomy with stone extraction followed by biliary stenting (24 patients), removal of ascaris and biliary stenting (1), sphincterotomy with biliary stenting (18), sphincterotomy with NBD (12), biliary stenting alone (12), and NBD alone (5). Bile leaks stopped in all patients at a median interval of 3 days (range 3-16 days) after endoscopic in- terventions. No difference was observed in efficacy and in time for the treatment of bile leak by sphincterotomy with endoprosthesis or endoprosthesis alone in patients with bile leak after surgery. CONCLUSIONS: Post-cholecystectomy bile leaks occur most commonly in the cystic duct and associated common bile duct stones are found in one-third of cases. Endoscopic therapy is safe and effective in the management of bile leaks and fistulae after surgery. Sphincterotomy with endoprosthesis or endoprosthesis alone is equally effective in the management of postoperative bile leak. | Naresh Agarwal Barjesh Chander Sharma Sanjay Garg Rakesh Kumar Shiv K Sarin | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，2： | 33 |
| 2 | Epithelial-mesenchymal transition- activating transcription factors- multifunctional regulators in cancer显示文摘The process of epithelial to mesenchymal transition(EMT), first noted during embryogenesis, has also been reported in tumor formation and leads to the development of metastatic growth. It is a naturally occurring process that drives the transformation of adhesive,non-mobile epithelial like cells into mobile cells with a mesenchymal phenotype that have ability to migrate to distant anatomical sites. Activating complex network of embryonic signaling pathways, including Wnt, Notch,hedgehog and transforming growth factor-β pathways,lead to the upregulation of EMT activating transcription factors, crucial for normal tissue development and maintenance. However, deregulation of tightly regulated pathways affecting the process of EMT has been recently investigated in various human cancers. Given the critical role of EMT in metastatic tumor formation,better understanding of the mechanistic regulation provides new opportunities for the development of potential therapeutic targets of clinical importance. | Minal Garg | 2013 | World Journal of Stem Cells2013，5，4： | 26 |
| 3 | PCSK9 inhibitors: A new era of lipid lowering therapy显示文摘Hyperlipidemia is a well-established risk factor for developing cardiovascular disease(CVD). The recent American College of Cardiology and American Heart Association guidelines on lipid management emphasize treatment of individuals at increased risk for developing CVD events with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors(statins) at doses proven to reduce CVD events. However, there are limited options for patients who are either intolerant to statin therapy, develop CVD despite being on maximally tolerated statin therapy, or have severe hypercholesterolemia. Recently the Food and Drug Administration approved two novel medications for low-density lipoprotein(LDL)-cholesterol reduction: Evolocumab and Alirocumab. These agents target and inactivate proprotein convertase subtilsinkexin type 9(PCSK9), a hepatic protease that attaches and internalizes LDL receptors into lysosomes hence promoting their destruction. By preventing LDL receptor destruction, LDL-C levels can be lowered 50%-60% above that achieved by statin therapy alone. This review explores PCSK-9 biology and the mechanisms available to alter it; clinical trials targeting PCSK9 activity, and the current state of clinically available inhibitors of PCSK9. | Rahul Chaudhary Jalaj Garg Neeraj Shah Andrew Sumner | 2017 | World Journal of Cardiology2017，9，2： | 23 |
| 4 | Total hip replacement for arthritis following tuberculosis of hip显示文摘AIM: To present the results of total hip arthroplasty(THA) for post tubercular arthritis of the hip joint.METHODS: Sixty-five patients(45 male, 20 female) with previously treated tuberculosis of the hip joint underwent cementless THA for post tubercular arthritis. The average age at the time of THA was 48 years(range 29 to 65 years). Erythrocyte sedimentation rate, C reactive protein, chest X-ray and contrast enhanced magnetic resonance imaging were done preoperatively to confirm resolution of the disease and to rule out any residual disease. Intra-operative samples were taken for microbiological examination, polymerase chain reaction(PCR) and histological examination. Patients were started on anti-tubercular drugs one week before the operation and continued for 6 mo post operatively. The patients were followed up clinically using the Harris hip score as well as radiologically for any loosening of the implants, osteolysis and any recurrence of tuberculosis. Any complications especially the recurrence of the infection was also recorded.RESULTS: The mean interval from completion of antitubercular therapy for tuberculosis to surgery was 4.2 years(range, 2-6 years). Preoperatively, 17 patients had ankylosis whereas 48 patients had functional but painful range of motion. The mean surgical time was 97 min(range, 65-125) whereas the mean blood loss was 600 m L(range, 400-900 m L). The average follow up was 8.3 years(range 6-11 years). The average Harris Hip score improved from 27 preoperatively to 91 at the final follow up. Seventeen patients had acetabularprotrusion which was managed with impaction grafting and cementless acetabular cup. The bone graft had consolidated in all these 17 patients at the follow up. Two patients developed discharging sinuses at 9 and 11 mo postoperatively respectively. The discharge tested positive for tuberculosis on the PCR. Both these patients were put on antitubercular therapy for another year. Both of them recovered and had no evidence of any loosening or osteolysis on X-rays. There were no other complications recorded.CONCLUSION: Total hip replacement restores good function to patients suffering from post tubercular arthritis of the hip. | Vijay Kumar Bhavuk Garg Rajesh Malhotra | 2015 | World Journal of Orthopedics2015，6，8： | 19 |
| 5 | 在过敏 bronchopulmonary 麴菌病的胸 X 光线照相术、计算的 tomographic 表明显示文摘 AIM:To investigate the chest radiographic and high resolution computed tomography(HRCT)chest manifestations in glucocorticoid-naive allergic bronchopulmonary aspergillosis(ABPA)patients.METHODS:This is a prospective observational study and includes 60 consecutive glucocorticoid-naive patients with ABPA who underwent chest radiography and HRCT of the chest(1.25 mm every 10 mm)in the routine diagnostic workup for ABPA.RESULTS:Chest radiographs were normal in 50%of cases.Of the remainder,most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis.Consolidation was detected in 17 cases but in the majority,the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities.Chest HRCT was normal in 22 patients,while central bronchiectasis(CB)was demonstrated in the remaining 38 patients.Bronchiectasis extended to the periphery in 33%-43%depending on the criteria used for defining CB.The other findings observed on HRCT were mucoid impaction,centrilobular nodules and high-attenuation mucus in decreasing order of frequency.CONCLUSION:Patients with ABPA can present with normal HRCT chest scans.Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed.Consolidation is an uncommon finding in ABPA. | Ritesh Agarwal Ajmal Khan Mandeep Garg Ashutosh N Aggarwal Dheeraj Gupta | 2012 | World Journal of Radiology2012，4，4： | 14 |
| 6 | Targeted therapy of gastrointestinal stromal tumours显示文摘Gastrointestinal stromal tumours(GISTs) are mesen-chymal neoplasms originating in the gastrointestinal tract, usually in the stomach or the small intestine, and rarely elsewhere in the abdomen. The malignant potential of GISTs is variable ranging from small lesions with a benign behaviour to fatal sarcomas. The majo-rity of the tumours stain positively for the CD-117(KIT) and discovered on GIST-1(DOG-1 or anoctamin 1) expression, and they are characterized by the presence of a driver kinase-activating mutation in either KIT or platelet-derived growth factor receptor α. Although surgery is the primary modality of treatment, almost half of the patients have disease recurrence following surgery, which highlights the need for an effective adjuvant therapy. Traditionally, GISTs are considered chemotherapy and radiotherapy resistant. With the advent of targeted therapy(tyrosine kinase inhibitors), there has been a paradigm shift in the management of GISTs in the last decade. We present a comprehensive review of targeted therapy in the management of GISTs. | Ashish Jakhetiya Pankaj Kumar Garg Gaurav Prakash Jyoti Sharma Rambha Pandey Durgatosh Pandey | 2016 | World Journal of Gastrointestinal Surgery2016，8，5： | 14 |
| 7 | CFD-DEM study of effect of bed thickness for bubbling fluidized beds显示文摘The effect of bed thickness in rectangular fluidized beds is investigated through the CFD-DEM simula- tions of small-scale systems. Numerical results are compared for bubbling fluidized beds of various bed thicknesses with respect to particle packing, bed expansion, bubble behavior, solids velocities, and particle kinetic energy. Good two-dimensional (2D) flow behavior is observed in the bed having a thickness of up to 20 particle diameters. However, a strong three-dimensional (3D) flow behavior is observed in beds with a thickness of 40 particle diameters, indicating the transition from 2D flow to 3D flow within the range of 20-40 particle diameters. Comparison of velocity profiles near the walls and at the center of the bed shows significant impact of the front and back walls on the flow hydrodynamics of pseudo-2D fluidized beds. Hence, for quantitative comparison with experiments in pseudo-2D columns, the effect of walls has to be accounted for in numerical simulations. | Tingwen Li Pradeep Gopalakrishnan Rahul Garg Mehrdad Shahnam | 2012 | Particuology2012，10，5： | 14 |
| 8 | Bilirubin in coronary artery disease:Cytotoxic or protective?显示文摘Bilirubin has traditionally been considered a cytotoxic waste product.However,recent studies have shown bilirubin to have anti-oxidant,anti-inflammatory,vasodilatory,anti-apoptotic and anti-proliferative functions.These properties potentially confer bilirubin a new role of protection especially in coronary artery disease(CAD),which is a low grade inflammatory process exacerbated by oxidative stress.In fact,recent literature reports an inverse relationship between serum concentration of bilirubin and the presence of CAD.In this article,we review the current literature exploring the association between levels of bilirubin and risk of CAD.We conclude that current evidence is inconclusive regarding the protective effect of bilirubin on CAD.A causal relationship between low serum bilirubin level and increased risk of CAD is not currently established. | Nancy Gupta Tavankit Singh Rahul Chaudhary Sushil K Garg Gurprataap Singh Sandhu Varun Mittal Rahul Gupta Roxana Bodin Sachin Sule | 2016 | World Journal of Gastrointestinal Pharmacology and Therapeutics2016，7，4： | 14 |
| 9 | Preoperative therapy in locally advanced esophageal cancer显示文摘Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer(T2 or greater or node positive); however, a high rate of disease recurrence(systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment(preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy(radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer. | Pankaj Kumar Garg Jyoti Sharma Ashish Jakhetiya Aakanksha Goel Manish Kumar Gaur | 2016 | World Journal of Gastroenterology2016，22，39： | 13 |
| 10 | WNT/β-catenin signaling in urothelial carcinoma of bladder显示文摘Urothelial carcinoma of bladder is the second most prevalent genitourinary disease.It is a highly heterogeneous disease as it represents a spectrum of neoplasms,including non-muscle invasive bladder cancer(NMIBC),muscle invasive bladder cancer(MIBC)and metastatic lesions.Genome-wide approaches and candidate gene analysis suggest that malignant transformation of the bladder is multifactorial and a multitude of genes are involved in the development of MIBC or NMIBC phenotypes.Wnt signaling is being examined to control and maintain balance between stemness and differentiation in adult stem cell niches.Owing to its participation in urothelial development and maintenance of adult urothelial tissue homeostasis,the components of Wnt signaling are reported as an important diagnostic and prognostic markers as well as novel therapeutic targets.Mutations/epigenetic alterations in the key molecules of Wnt/β-catenin canonical pathway have been linked with tumorigenesis,development of drug resistance and enhanced survival.Present review extends our understanding on the functions of key regulatory molecules of canonical Wnt/β-catenin pathway in urothelial tumorigenesis by inducing cancer stem cell phenotype(UCSCs).UCSCs may be responsible for tumor heterogeneity,high recurrence rates and complex biological behavior of bladder cancer.Therefore,understanding the role of UCSCs and the regulatory mechanisms that are responsible for high relapse rates and metastasis could help to develop pathway inhibitors and augment current therapies.Potential implications in the treatment of urothelial carcinoma of bladder by targeting this pathway primarily in UCSCs as well as in bulk tumor population that are responsible for high relapse rates and metastasis may facilitate potential therapeutic avenues and better prognosis. | Minal Garg Niharika Maurya | 2019 | World Journal of Nephrology2019，8，5： | 11 |
| 11 | Discriminating mild from critical COVID-19 by innate and adaptive immune single-cell profiling of bronchoalveolar lavages显示文摘How the innate and adaptive host immune system miscommunicate to worsen COVID-19 immunopathology has not been fully elucidated.Here,we perform single-cell deep-immune profiling of bronchoalveolar lavage(BAL)samples from 5 patients with mild and 26 with critical COVID-19 in comparison to BALs from non-COVID-19 pneumonia and normal lung.We use pseudotime inference to build T-cell and monocyte-to-macrophage trajectories and model gene expression changes along them.In mild COVID-19,CD8^(+)resident-memory(TRM)and CD4^(+)T-helper-17(T_(H17))cells undergo active(presumably antigen-driven)expansion towards the end of the trajectory,and are characterized by good effector functions,while in critical COVID-19 they remain more naïve.Vice versa,CD4^(+)T-cells with T-helper-1 characteristics(TH1-like)and CD8^(+)T-cells expressing exhaustion markers(T_(EX)-like)are enriched halfway their trajectories in mild COVID-19,where they also exhibit good effector functions,while in critical COVID-19 they show evidence of inflammation-associated stress at the end of their trajectories.Monocyte-to-macrophage trajectories show that chronic hyperinflammatory monocytes are enriched in critical COVID-19,while alveolar macrophages,otherwise characterized by anti-inflammatory and antigen-presenting characteristics,are depleted.In critical COVID-19,monocytes contribute to an ATP-purinergic signaling-inflammasome footprint that could enable COVID-19 associated fibrosis and worsen disease-severity.Finally,viral RNA-tracking reveals infected lung epithelial cells,and a significant proportion of neutrophils and macrophages that are involved in viral clearance. | Els Wauters Pierre Van Mol Abhishek Dinkarnath Garg Sander Jansen Yannick Van Herck Lore Vanderbeke Ayse Bassez Bram Boeckx Bert Malengier-Devlies Anna Timmerman Thomas Van Brussel Tina Van Buyten Rogier Schepers Elisabeth Heylen Dieter Dauwe Christophe Dooms Jan Gunst Greet Hermans Philippe Meersseman Dries Testelmans Jonas Yserbyt Sabine Tejpar Walter De Wever Patrick Matthys CONTAGIOUS collaborators Johan Neyts Joost Wauters Junbin Qian Diether Lambrechts | 2021 | Cell Research2021，31，3： | 11 |
| 12 | An update on the role of medical treatment including antioxidant therapy in varicocele显示文摘联系精索静脉曲张的男不孕古典主义地用外科被管理了或帮助了繁殖技术。与在联系精索静脉曲张的不孕作为一个 pathophysiological 因素增加氧化应力的证据,医药治疗特别抗氧化剂可能与更低的风险成为一种治疗选择。我们在归因于精索静脉曲张的男不孕的管理在各种各样的医药代理人的角色上考察了存在文学。医药治疗典型地与外科对药治疗作为辅助治疗与安慰剂,药对手术的(b) 比较,和药的(c) 比较处于象二药或一药的(a) 比较那样的三种不同状况被评估独自一个。由于数据的异质和进行得好的研究的缺乏,有不够的数据与联系精索静脉曲张的不孕为人推荐医药治疗的平淡的使用,外科仍然是选择的处理。怀孕和实时出生率通常没在精子参数在大多数研究和仅仅的改进被报导或抗氧化剂能力是不够的支持它的平淡的使用。抗氧化剂治疗由于它的理论利益,从现出症状之前的潜的研究的数据,和主要副作用的缺乏是一种潜在的选择。有在精索静脉曲张的外科的修理以后的抗氧化剂的辅助治疗可以改进结果并且是为进一步的研究的一个潜在的区域。 | Harshit Garg Rajeev Kumar | 2016 | Asian Journal of Andrology2016，18，2： | 10 |
| 13 | Surgical considerations for ‘intrinsic' brainstem gliomas: proposal of a modification in classification显示文摘 | Mehta VS Chandra PS Singh PK Garg A Rath GK | 2009 | 中国神经肿瘤杂志2009，7，3： | 9 |
| 14 | Comparative prospective study between medial and lateral distal tibial locking compression plates for distal third tibial fractures显示文摘 | Sandeep Garg Vikram Khanna Mahaveer Prashad Goyal Narendra Joshi Amrut Borade Ishan Ghuse | 2017 | Chinese Journal of Traumatology2017，20，3： | 8 |
| 15 | Lessons learned from an audit of 1250 anal fistula patients operated at a single center:A retrospective review显示文摘BACKGROUND A complex anal fistula is a challenging disease to manage.AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.METHODS Anal fistulas operated on by a single surgeon over 14 years were analyzed.Preoperative magnetic resonance imaging was done in all patients.Four procedures were performed:fistulotomy;two novel sphincter-saving procedures,proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts(PERFACT)and transanal opening of intersphincteric space(TROPIS),and anal fistula plug.PERFACT was initiated before TROPIS.As per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex fistulas.Fistulas with associated abscesses were treated by definitive surgery.Incontinence was evaluated objectively by Vaizey incontinence scores.RESULTS A total of 1351 anal fistula operations were performed in 1250 patients.The overall fistula healing rate was 19.4%in anal fistula plug(n=56),50.3%in PERFACT(n=175),86%in TROPIS(n=408),and 98.6%in fistulotomy(n=611)patients.Continence did not change significantly after surgery in any group.As per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS procedure.The overall success rate was 93.5%in those patients.In a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,respectively.The 90.6%healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess(94.5%,P=0.057,not significant).CONCLUSION Fistulotomy had a high 98.6%healing rate in simple fistulas without deterioration of continence if the patient selection was done judiciously.The sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex fistulas.This is the largest anal fistula series to date. | Pankaj Garg Baljit Kaur Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon | 2021 | World Journal of Gastrointestinal Surgery2021，13，4： | 8 |
| 16 | Treatment of Neuropathic Pain with Plant Medicines显示文摘神经病的疼痛是影响公民的普通、很流行的混乱发展并且发展中的国家。为神经病的疼痛的同意并且准许的药被报导联系了副作用。传统的植物处理为神经病的疼痛的处理在全世界被使用了。在许多药和另外的其他的药之中,几植物为痊愈所知并且没有副作用控制神经病的疼痛。现在的论文神经病的疼痛并且相关有益的效果从当前的兴趣的世界的不同部分发源地讨论植物。 | Garima Garg James D.Adams | 2012 | Chinese Journal of Integrative Medicine2012，18，8： | 8 |
| 17 | One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable显示文摘AIM:To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease(PUD),erosive gastritis(EG)or duodenitis(ED).METHODS:Retrospective cohort study using ICD-10codes to identify all patients with upper gastrointestinal hemorrhage secondary to endoscopically proven PUD,EG or ED during the period from March 2007 to October 2010 in three major metropolitan hospitals in Melbourne,Australia.Patients were divided into'high risk'(those who would benefit from gastroprotection)and'not high risk'groups as defined by established guidelines.Mean Rockall score,transfusion requirement,length of stay,rebleeding rates,need for surgery and in-hospital mortality was compared between'high risk'and'not high risk'groups.Within the'high risk'group,those on gastroprotection and those with no gastroprotection were also compared.RESULTS:Five hundred and seven patients were included for analysis of which 174 were classified as high risk.Median values of complete Rockall Score(5vs 4,P=0.002)and length of stay(5 d vs 4 d,P=0.04)were higher in the high risk group but in-hospital mortality was lower(0.6%vs 3.9%,P=0.03).130out of the 174 patients in the high risk group were not taking recommended gastroprotective therapy prior to hospitalization.Past history of PUD(OR=3.7,P=0.006)and clopidogrel use(OR=3.2,P=0.007)significantly predicted prescription of gastroprotective therapy.Using proton pump inhibitor protection rates of 50%-85%from published studies,an estimation of13%to 22%of the total number of the hospitalizations due to PUD or EG/ED related bleeding may have been preventable.CONCLUSION:Up to one fifth of all hospitalizations for bleeding secondary to PUD or EG/ED are potentially preventable. | Ray Boyapati Sim Ye Ong Bei Ye Anuk Kruavit Nora Lee Rhys Vaughan Sanjay Nurkar Peter Gibson Mayur Garg | 2014 | World Journal of Gastroenterology2014，20，30： | 8 |
| 18 | Outcome of surgical treatment of type IV capitellum frac- tures in adults显示文摘 | Ajay Pal Singh Ish Kumar Dhammi Vipul Garg Arun Pal Singh | 2012 | Chinese Journal of Traumatology2012，15，4： | 7 |
| 19 | Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study显示文摘AIM To compare the impact of laparoscopic Roux-en-Y gastric bypass(LRYGB) and laparoscopic sleeve gastrectomy(LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design.METHODS Forty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus(T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2 DM, hypertension(HTN), obstructive sleep apnea syndrome(OSAS), hypothyroidism and gastroesophageal reflux disease(GERD).RESULTS Percentage excess weight loss(EWL%) was similar in LRYGB and LSG groups at one year follow-up(70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group(76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar(10% vs 7.5%,P = 0.99). The median duration of T2 DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group(7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2 DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG.CONCLUSION LRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2 DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG. | Harshit Garg Pratyusha Priyadarshini Sandeep Aggarwal Samagra Agarwal Rachna Chaudhary | 2017 | World Journal of Gastrointestinal Endoscopy2017，9，4： | 7 |
| 20 | PERFACT procedure:A new concept to treat highly complex anal fistula显示文摘AIM: To check the efficacy of the PERFACT procedure in highly complex fistula-in-ano.METHODS: The PERFACT procedure(proximal superficial cauterization, emptying regularly fistula tracts and curettage of tracts) entails two steps: superficial cauterization of mucosa at and around the internal opening and keeping all the tracts clean. The principle is to permanently close the internal opening by granulation tissue. This is achieved by superficial electrocauterization at and around the internal opening and subsequently allowing the wound to heal by secondary intention. Along with this, all the tracts are curetted and it is ensured that they remain empty and clean in the postoperative period until they heal completely. The latter step also facilitates the closure of the internal opening by preventing collected fluid in the tracts from entering the internal opening and thus not letting it close. Objective incontinence scoring was done preoperatively and 3 mo after the operation.RESULTS: Fifty-one patients with complex fistula-inano were prospectively enrolled. The median followup was 9 mo(5-14 mo). The mean age was 42.7 ± 11.3 years. Male:female ratio was 43:8. Fistula was recurrent in 76.5%(39/51), horseshoe in 50.1%(26/51), had multiple tracts in 52.9%(27/51), had an associated abscess in 41.2%(21/51), was anterior in 33.3%(17/51), the internal opening was not found in 15.7%(8/51) and 9.8%(5/51) of fistulas had a supralevator extension. Seven patients were excluded(5 lost to follow up, 2 with tuberculosis leading to/associated with fistula-in-ano). The success rate was 79.5%(35/44) and the recurrence rate was 20.5%(9/44). Out of these recurrences, three underwent reoperation(2 PERFACT procedure, 1 fistulotomy) and all three were successful. Thus, the overall success rate was 86.4%. The only complication was a non-healing tract in 9.1%(4/44) of patients. There was no significant change in objective incontinence scores three months after the operation. The pain was minimal, with all patients resuming their normal activities within 72 h of the operation.CONCLUSION: The PERFACT procedure is a new effective method for complex fistula-in-ano, effective even in fistula associated with abscess, supralevator fistula-in-ano and where the internal opening is nonlocalizable. | Pankaj Garg Mahak Garg | 2015 | World Journal of Gastroenterology2015，21，13： | 7 |
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