Quality assurance of multiport image-guided minimally invasive surgery at the lateral skull base

Contrast Agent and Molecular Imaging Meta-Analysis of the Clinical Effect of Intelligent Image Sensor Combined with Visual Training in the Treatment of Children with Intermittent Exotropia in China

At present, the main treatment for strabismus is still surgical treatment, but there is no unified standard for the evaluation of the timing of surgery. This study mainly explores the clinical effects of using meta-analysis of intelligent image sensors combined with visual training to treat children with intermittent exotropia. Cochrane systematic reviews collect, evaluate, and synthesize an increasing number of original clinical research results to obtain the comprehensive effect of relevant interventions, so as to provide real and reliable evidence for health decision-making and clinical practice. It uses scientific, clear, and reproducible research methods to reduce the influence of biased factors, so it is different from traditional reviews. Cochrane systematic reviews are especially suitable for certain interventions when the pros and cons of interventions are difficult to determine based on the results of a single clinical study or when there are large differences in the clinical application process. Poor quality systematic reviews can mislead policymakers and clinicians. In the meta-analysis, the Cochrane systematic evaluation method of evidence-based medicine was used to comprehensively search the published literature research on the treatment of intermittent exotropia with vision training. Using the Cochrane system evaluation method, computer search of CENTRAL, MEDLINE, Embase, Chinese Biomedical Literature Database, Chinese Journal Full-text Database, manual retrieval of relevant conference documents, and inclusion of all clinical trial documents of visual training in children with intermittent exotropia was conducted. Patients with intermittent exotropia were selected, simultaneous vision, fusion function, and far stereo vision with the same vision machine were measured, and near stereo vision with a stereo vision chart was measured. The number of simultaneous vision, fusion function, and distance and near stereo vision "with" and "without" cases were recorded for all patients, and the relationship with age of onset, type of strabismus, degree of strabismus, and degree of control was counted. Among them, 91 patients who underwent strabismus correction surgery were followed up for at least 6 months with correct eye position. The presence or absence of simultaneous vision, fusion function, far stereo vision, and near stereo vision were recorded and compared with preoperative. The number of recovery and nonrecovery cases was recorded, and the relationship between the age of operation, the type of strabismus, the degree of strabismus, and the degree of control was counted. It was statistically analyzed by SPSS22.0. The results of the meta-analysis showed that in terms of the effective rate of fundus lesions, the visual training group was better than the nontraining group, and the difference between the two groups was statistically significant (RR = 1.32, 95% CI: (1.25, 1.40), P < 0.0001). This study provides guidance for the early rehabilitation of children with intermittent exotropia.

Laparoscopic pancreatoduodenectomy combined with a novel self-assessment system and feedback discussion: a phase 1 surgical trial following the IDEAL guidelines

PURPOSE

Pancreatoduodenectomy (PD) is the standard yet complicated procedure for periampullary tumors. To introduce a laparoscopic approach for PD (Lap-PD), a robust and objective assessment system to evaluate the quality of this approach is needed. We describe a phase 1 surgical trial of Lap-PD (Registration ID: UMIN000015328) as a triad of surgery, novel self-assessment system, and feedback discussion implementing the Idea, Development, Exploration, Assessment, Long-term study (IDEAL) guidelines.

METHODS

This was a surgical phase I trial (corresponding to IDEAL stage 1) approved by the Ethics Committee of our hospital. The resection sequence was divided into 10 parts that were assessed and classified into one of four grades of achievement. Evaluation of each part was then integrated, and the whole Lap-PD was categorized into three grades of achievement. We set discontinuance criteria based on historical surgical outcome of open PD. The previous case was discussed before each new case, and measures to overcome problems were implemented. Five patients underwent Lap-PD.

RESULTS

All Lap-PDs were completed laparoscopically and reconstructed via mini-laparotomy. One patient suffered recurrent ileus requiring re-laparotomy to resolve a severe adhesion. After 1 year, no patient suffered disease recurrence or complication. Based on the self-assessment system, four Lap-PDs were successful, whereas one was rated as feasible owing to bleeding requiring conversion of resection sequence.

CONCLUSIONS

Our triad system for evaluating Lap-PD could be a useful tool for the safe introduction and maintenance of Lap-PD.