BACKGROUND & AIMS: CONTEXT:Estrogen treatment of men with prostate cancer is associated with increased cardiovascular morbidity and mortality; however, the role of endogenous estrogen levels for atherosclerotic disease in men is unknown. OBJECTIVE:The objective of the study was to determine whether endogenous serum estradiol (E2) levels predict the progression of carotid artery intima-media thickness in men. DESIGN, SETTING AND PARTICIPANTS:This was a population-based, prospective cohort study (the Atherosclerosis and Insulin Resistance study) conducted in Göteborg, Sweden, among 313 Caucasian men without cardiovascular or other clinically overt diseases. Carotid artery intima-media thickness, an index of preclinical atherosclerosis, was measured by ultrasound at baseline (58 yr of age) and after 3 yr of follow-up. Serum sex hormone levels and cardiovascular risk factors (body mass index, waist to hip ratio, systolic blood pressure, serum triglycerides, plasma c-peptide, and smoking status) were assessed at study entry. INTERVENTION:There was no intervention. MAIN OUTCOME MEASURES:Association between baseline total and free E2 levels and progression of carotid intima-media thickness over 3 yr with adjustments for cardiovascular risk factors was measured. RESULTS:In univariate analyses, both total and free E2 levels at baseline were positively associated with the annual change in intima-media thickness. In linear regression models including E2 and cardiovascular risk factors, low-density lipoprotein and high-density lipoprotein cholesterol and E2 were identified as independent predictors of progression of carotid artery intima-media thickness (total E2 beta = 0.187, P = 0.001; and free E2 beta = 0.183, P = 0.003). CONCLUSIONS:Circulating E2 is a predictor of progression of carotid artery intima-media thickness in middle-aged men. Further studies are needed to investigate the role of endogenous E2 for incident cardiovascular disease events.

背景与目标：

BACKGROUND & AIMS: :The aquaporin-4 (AQP4) pool in the perivascular astrocyte membranes has been shown to be critically involved in the formation and dissolution of brain edema. Cerebral edema is a major cause of morbidity and mortality in stroke. It is therefore essential to know whether the perivascular pool of AQP4 is up- or down-regulated after an ischemic insult, because such changes would determine the time course of edema formation. Here we demonstrate by quantitative immunogold cytochemistry that the ischemic striatum and neocortex show distinct patterns of AQP4 expression in the reperfusion phase after 90 min of middle cerebral artery occlusion. The striatal core displays a loss of perivascular AQP4 at 24 hr of reperfusion with no sign of subsequent recovery. The most affected part of the cortex also exhibits loss of perivascular AQP4. This loss is of magnitude similar to that of the striatal core, but it shows a partial recovery toward 72 hr of reperfusion. By freeze fracture we show that the loss of perivascular AQP4 is associated with the disappearance of the square lattices of particles that normally are distinct features of the perivascular astrocyte membrane. The cortical border zone differs from the central part of the ischemic lesion by showing no loss of perivascular AQP4 at 24 hr of reperfusion but rather a slight increase. These data indicate that the size of the AQP4 pool that controls the exchange of fluid between brain and blood during edema formation and dissolution is subject to large and region-specific changes in the reperfusion phase.

背景与目标： : 血管周围星形胶质细胞膜中的aquaporin-4 (AQP4) 池已被证明与脑水肿的形成和溶解密切相关。脑水肿是中风发病和死亡的主要原因。因此，必须了解缺血性损伤后AQP4的血管周围池是上调还是下调，因为这种变化将决定水肿形成的时间过程。在这里，我们通过定量免疫金细胞化学证明，在大脑中动脉闭塞90分钟后，缺血纹状体和新皮层在再灌注阶段显示出不同的AQP4表达模式。再灌注24小时时，纹状体核心显示血管周围AQP4丢失，没有随后恢复的迹象。皮质中受影响最大的部分也表现出血管周围aqp4的损失。这种损失的幅度与纹状体核心的损失相似，但在再灌注72小时后显示部分恢复。通过冷冻断裂，我们表明血管周围AQP4的丢失与颗粒的正方形晶格的消失有关，这些正方形晶格通常是血管周围星形胶质细胞膜的独特特征。皮质边界区与缺血性病变的中央部分不同，在再灌注24小时时未显示血管周围AQP4的丢失，但略有增加。这些数据表明，在水肿形成和溶解过程中控制大脑和血液之间流体交换的AQP4池的大小在再灌注阶段会发生较大且区域特定的变化。

BACKGROUND & AIMS: BACKGROUND:In some centers, palliative resection (PR; partial pancreaticoduodenectomy) is, in selected cases, promoted in preference to double loop bypass (DLB) surgery for advanced pancreatic cancer. This prospective study compares PR with DLB, placing particular focus on patients' quality of life (QoL). METHODS:From 01/1993 to 09/2004, 167 patients were analyzed in a prospective single center study of palliative surgical treatment of advanced ductal adenocarcinoma of the pancreatic head. Thirty-eight underwent PR and 129 underwent palliative DLB. Patients undergoing DLB were divided into: (1) locally advanced disease (LAD-subgroup; n = 61; 47%) and (2) metastasized disease (MD-subgroup; n = 68; 53%). QoL was assessed using the EORTC QLQ-C30 questionnaire supplemented by a pancreatic cancer specific module. QoL data were collected pre-operatively and for up to 12 months after surgery. RESULTS:Median survival was 7.0 months (95% CI 4.09; 9.91) in PR patients and 6.0 months (95% CI 5.39; 6.61) in patients who received DLB. Mortality and morbidity were, respectively, 7.8 and 58% for PR, and 2.6 and 42% for DLB. QoL decreased more after PR than after DLB. The DLB-group recovered quicker, reaching pre-operative QoL levels after 3 months, and were less impaired when discharged. The LAD-subgroup and the MD-subgroup presented with equal levels of QoL. CONCLUSIONS:QoL analysis revealed favorable QoL data after DLB. Additionally, the survival rates of the two groups did not differ significantly, but morbidity and mortality rates in the PR group were elevated. Therefore, the use of PR for advanced pancreatic cancer needs to be carefully evaluated.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Tissue factor (TF) has been implicated in coronary artery disease (CAD). High levels of circulating TF are found in patients with acute atherothrombotic events. Whether high serum TF levels predict risk of future CAD independent of known risk factors remains unknown. METHODS:We conducted a prospective case-control study nested in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population study. Cases (n=1037) were apparently healthy men and women, aged 45-79 years, who developed fatal or non-fatal CAD during follow-up. Controls (n=2005) were matched by age, sex, and enrolment time. Serum TF levels were measured using high-affinity antibodies. RESULTS:In men, median TF levels were not significant higher in cases than in controls (59.0 pg mL-1, range: 16.7-370.4 vs. 54.9 pg mL-1, range: 16.2-452.4). In women, median TF levels were not significant higher in controls than in cases (73.4 pg mL-1, range: 16.7-492.3 vs. 50.5 pg mL-1, range: 16.5-376.7). The incidence of smoking was about double in the lowest compared with the highest TF quartile. Correcting for sex, age, body mass index, smoking, diabetes, systolic blood pressure, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol and C-reactive protein levels, the risk of future CAD was 1.05 (95% CI: 0.81-1.36) for people in the highest TF quartile, compared with those in the lowest (P-value for linearity=0.8). CONCLUSION:High levels of serum TF were not independently associated with an increased risk of future CAD in apparently healthy individuals.

背景与目标：

BACKGROUND & AIMS: STUDY OBJECTIVE:To assess the prognostic performance of general severity systems (APACHE II [acute physiology and chronic health evaluation], simplified acute physiology score [SAPS II], and mortality probability models [MPM II]) in coronary patients and to derive new customized indexes for coronary patients using a reduced number of variables.

DESIGN:Inception cohort.

SETTING:Adult medical and surgical ICUs in 17 hospitals in Catalonia and the Balearic Islands.

PATIENTS:Four hundred fifty-six patients with acute myocardial infarction.

MEASUREMENTS AND RESULTS:The APACHE II, SAPS II, and MPM II variables and survival status at hospital discharge have been collected. Performance of the severity systems was assessed by evaluating calibration and discrimination. Logistic regression was used to customize the MPM II(24) and SAPS II indexes. Discrimination was high enough for all of the models. However, calibration of the MPM II(24) was not as satisfactory as for the other models. The MPM II(24) and SAPS II were both reduced to five variables (MPM II(24 cor:) age, PaO2, continuous vasoactive drugs, urinary output, and mechanical ventilation; SAPS II(cor:) age, PaO2/FI(O2) ratio, systolic BP, Glasgow coma score, and urinary output). Both models showed better calibration and discrimination than the original ones.

CONCLUSIONS:Prognostic indexes developed for multidisciplinary patients show good performance when applied to patients with acute myocardial infarction, but customization can reduce the number of variables necessary to compute them without a loss of, and a possible improvement in, prognostic accuracy.

背景与目标： 研究目标 : 评估一般严重程度系统 (APACHE II [急性生理学和慢性健康评估]，简化的急性生理学评分 [SAPS II]，和冠心病患者的死亡率概率模型 [MPM II])，并使用减少的变量数量为冠心病患者推导新的定制指标。
设计 : 初始队列。
设置 : 加泰罗尼亚和巴利阿里群岛17家医院的成人医疗和外科重症监护医师。
患者 : 456例急性心肌梗死患者。
测量和结果 : 已收集APACHE II，SAPS II和MPM II变量以及出院时的生存状态。通过评估校准和判别来评估严重性系统的性能。Logistic回归用于定制MPM II(24) 和SAPS II指数。歧视对于所有模型来说都足够高。但是，MPM II(24) 的校准不如其他模型令人满意。MPM II(24) 和SAPS II均降低为五个变量 (MPM II(24 cor :) 年龄，PaO2，持续血管活性药物，尿量和机械通气; SAPS II(cor :) 年龄，PaO2/FI(O2) 比，收缩压，格拉斯哥昏迷评分，和尿量)。两种模型均显示出比原始模型更好的校准和区分度。
结论 : 为多学科患者开发的预后指标在应用于急性心肌梗死患者时显示出良好的表现，但是，自定义可以减少计算它们所需的变量数量，而不会损失预后准确性，并可能提高预后准确性。

BACKGROUND & AIMS: CONTEXT:In animal models, estrogen inhibits atherogenesis by inhibiting many of the early steps of atherosclerotic plaque formation. However, the lack of cardioprotective effect by postmenopausal hormone replacement therapy and possible increase in cardiovascular events observed during the first year after the initiation of hormone replacement therapy may suggest that once the plaque is formed, estrogen may have additional effects that may counteract its beneficial outcomes. Indeed, the effect of estrogen on plaque stability has not been identified. OBJECTIVE:We hypothesized that 17beta-estradiol (E2) may cause increased apoptosis in human coronary artery endothelial cells (HCAECs). This effect would explain an adverse effect on plaque stability in vivo. INTERVENTION(S) AND MAIN OUTCOME MEASURE(S):The effect of E2 on apoptosis, cell proliferation, and expression of proapoptotic molecules Fas and Fas ligand (FasL) in cultured HCAECs was evaluated. RESULTS:HCAECs in culture treated with E2 showed an increase in DNA strand breaks and nuclear fragmentation indicative of apoptosis. E2 treatment also induced a significant concentration-dependent increase in Fas mRNA and protein expressions in HCAECs. Moreover, the expression of FasL mRNA and secretion of FasL protein by HCAECs were enhanced in response to E2 treatments. CONCLUSIONS:E2 increases the apoptosis in cultured HCAECs. Enhanced Fas and FasL expressions in response to E2 suggest that activation of the Fas/FasL pathway may be a mediator of the proapoptotic effects of E2 in these cells.

背景与目标：

BACKGROUND & AIMS: Focal and segmental sclerosed lesions in the glomeruli are found in several pathological entities and more often are found in the corticomedullary junction where renal blood flow and filtration pressure is maximal. Experimental data suggest that hyperfiltration injury results in focal and segmental glomerulosclerosis (FSGS). In keeping with this concept, malignant hypertension is a known cause of nephrotic-range proteinuria and nephrotic syndrome pathalobically represented by FSGS. We report a case of unilateral renal artery stenosis associated with nephrotic syndrome and FSGS in the contralateral kidney only. The kidney with the stenosed renal artery showed normal glomeruli with juxtaglomerular hyperplasia, suggesting that protection from hyperfiltration injury was provided by the presence of high-grade stenosis. Serum creatinine concentration, blood pressure, and proteinuria normalized after aorto-renal bypass surgery. This case shows the importance of hemodynamic factors on the pathogenesis of secondary FSGS and the progression of renal disease.

背景与目标： 肾小球的局灶性和节段性硬化性病变在几种病理实体中发现，而在肾血流量和过滤压力最大的皮质管交界处更常见。实验数据表明，超滤损伤会导致局灶性和节段性肾小球硬化 (FSGS)。与这个概念保持一致，恶性高血压是由FSGS病理代表的肾病范围蛋白尿和肾病综合征的已知原因。我们报告了仅在对侧肾脏中与肾病综合征和FSGS相关的单侧肾动脉狭窄病例。肾动脉狭窄的肾脏显示正常的肾小球并伴有近肾小球增生，这表明高级别狭窄的存在可保护高滤过损伤。主动脉-肾搭桥手术后血清肌酐浓度，血压和蛋白尿正常化。该病例显示了血流动力学因素对继发性FSGS发病机理和肾脏疾病进展的重要性。

BACKGROUND & AIMS: :This study aimed to clarify the effectiveness of post-operative oral care, including tooth brushing, denture cleaning and tongue cleaning, after digestive tract surgery. Subjects included 30 elderly patients aged 60-98 years (74.9 +/- 7.8 years) who underwent digestive tract surgery. Subjects were randomly divided into an intervention group and a control group. In the intervention group, the following oral care was provided daily over a 5-min period in the morning starting at baseline (day of surgery) and continued for 5 days: gargling with povidone iodine, tooth brushing, denture cleaning using a special brush and tongue cleaning using a tongue brush. In the control group, the subjects only gargled with povidone iodine. We compared the following variables between the two groups at baseline and 5 days later: the sensation of dry mouth, intra-oral gas concentration, pulmonary sounds, body temperature and bacterial flora. The number of patients with abnormal pulmonary sounds (dry or moist rales) increased from 1 to 2 in the intervention group and from 0 to 4 in the control group (P < 0.05). The average number of bacterial species per subject for the control group was 3.64 +/- 1.34 pre-operatively and 3.50 +/- 1.74 post-operatively, whereas that for the intervention group was 3.08 +/- 0.95 pre-operatively and 2.62 +/- 0.65 post-operatively. In the intervention group, there was a significant decrease in the number of bacterial species (P < 0.05). These findings indicate that post-operative oral care in elderly patients undergoing digestive tract surgery lowers the number of bacterial species found in the oral cavity. This effect, in turn, might improve respiratory function.

背景与目标： : 本研究旨在阐明消化道手术后口腔护理的有效性，包括刷牙，义齿清洁和舌头清洁。受试者包括30名60-98岁 (74.9 +/- 7.8岁) 接受消化道手术的老年患者。受试者随机分为干预组和对照组。在干预组中，从基线 (手术当天) 开始，在早晨的5分钟内每天提供以下口腔护理，并持续5天: 用聚维酮碘漱口，刷牙，使用特殊刷子清洁义齿和使用舌头刷子清洁舌头。在对照组中，受试者仅用聚维酮碘漱液。我们在基线和5天后比较了两组之间的以下变量: 口干感，口内气体浓度，肺音，体温和细菌菌群。肺音异常 (干或湿啰音) 的患者数量在干预组从1增加到2，在对照组从0增加到4 (P <0.05)。对照组每个受试者的平均细菌种类数术前为3.64 +/- 1.34，术后为3.50 +/- 1.74，而干预组的平均细菌种类数术前为3.08 +/- 0.95，术后为2.62 +/- 0.65。干预组细菌种类显著减少 (P <0.05)。这些发现表明，接受消化道手术的老年患者的术后口腔护理降低了口腔中发现的细菌种类的数量。反过来，这种作用可能会改善呼吸功能。

BACKGROUND & AIMS: Rupture of atheromatous plaques leading to acute coronary syndromes usually occur in lipid-reach and well-developed coronary lesions. We describe 2 unusual patients with acute coronary syndromes in whom there was angiographic and intravascular ultrasound evidence of an intraluminal thrombus overlying a small, nonocclusive plaque in an enlarged coronary artery.

背景与目标： 导致急性冠状动脉综合征的动脉粥样硬化斑块破裂通常发生在脂质到达和发达的冠状动脉病变中。我们描述了2例不寻常的急性冠状动脉综合征患者，其中有血管造影和血管内超声证据表明腔内血栓覆盖了扩大的冠状动脉中的一个小的非闭塞斑块。

BACKGROUND & AIMS: BACKGROUND:Although the benefit of thrombolytic therapy in reducing mortality in acute myocardial infarction is well established, the types of bleeding and risk factors for bleeding are less well described in large trials.

METHODS AND RESULTS:We analyzed the baseline characteristics, outcomes, and incidence of bleeding by location, severity, and treatment assignment among 41,021 patients in the GUSTO-I trial of thrombolysis for acute myocardial infarction. Of the 40,903 patients for whom there were complete data, 1.2% suffered severe bleeding and 11.4% experienced moderate hemorrhage at a variety of sites. The most common sources of bleeding were procedure related. The thrombolytic regimen was strongly related to the incidence of bleeding; comparatively more bleeding was seen with the therapies of streptokinase plus intravenous heparin and the streptokinase and tissue plasminogen activator plus intravenous heparin combination. In multivariate analysis, the four most powerful independent predictors of hemorrhage were older age, lighter body weight, female sex, and African ancestry; they remained the most important predictors of bleeding when multivariate analysis was performed on patients who did not undergo invasive procedures. The presence of serious hemorrhage was associated with other undesirable outcomes (recurrent events, left ventricular dysfunction, arrhythmia, or stroke).

CONCLUSIONS:Important predictors of bleeding in this population are increased age, lighter weight, female sex, African ancestry, and experiencing invasive procedures. Other nonhemorrhagic adverse clinical outcomes were associated with moderate and severe bleeding, which was in turn associated with increased length of hospital stay and mortality at 30 days.

背景与目标： 背景 : 尽管溶栓治疗在降低急性心肌梗死死亡率方面的益处已得到充分证实，但在大型试验中，出血类型和出血危险因素的描述较少。
方法和结果 : 在GUSTO-I急性心肌梗死溶栓试验中，我们分析了41,021名患者的基线特征，结局和出血发生率，按位置，严重程度和治疗分配。在40,903例有完整数据的患者中，1.2% 例严重出血，11.4% 例在不同部位出现中度出血。最常见的出血来源与手术有关。溶栓方案与出血发生率密切相关; 链激酶加静脉肝素以及链激酶和组织型纤溶酶原激活剂加静脉肝素联合治疗的出血相对较多。在多变量分析中，出血的四个最有效的独立预测因子是年龄较大，体重较轻，女性和非洲血统; 当对未接受侵入性操作的患者进行多变量分析时，它们仍然是出血的最重要预测因子。严重出血的存在与其他不良结果 (复发事件，左心室功能障碍，心律失常或中风) 相关。
结论 : 该人群出血的重要预测因素是年龄增加，体重减轻，女性，非洲血统，经历侵入性手术。其他非出血性不良临床结局与中度和重度出血相关，而中度和重度出血又与30天时的住院时间和死亡率增加相关。

BACKGROUND & AIMS: BACKGROUND:In early-stage lung cancer, evidence is accumulating for the benefits of lobectomy by video-assisted thoracic surgery (VATS) over open lobectomy. Few thoracic training programs offer sufficient experience in this technically demanding procedure. This article describes the evolution of a new graduate's practice from open thoracotomy to VATS lobectomy. STUDY DESIGN:Our model involves a transition in technique from posterolateral thoracotomy to muscle-sparing thoracotomy and, ultimately, to VATS lobectomy. This approach was evaluated by examining outcomes of open thoracotomy patients before VATS lobectomy and outcomes of the initial 30 VATS patients. Data were collected prospectively. RESULTS:Before undertaking VATS lobectomy, 94 major pulmonary resections were performed by thoracotomy. Mortality was 1.2% for lobectomy and 0% for pneumonectomy. Use of the muscle-sparing thoracotomy increased from 17% of patients in the first half to 70% in the latter half of this group. For the first 30 VATS lobectomy patients, the mean operative time was 168 minutes. Median blood loss was 200 mL. Conversion rate to open thoracotomy was 13.3%. Mortality was 3.3% and morbidity was 26.7%. After short-term followup (mean followup 16 months), overall survival for stage I lung cancer was 96%. CONCLUSIONS:With our approach, new graduates of thoracic surgery programs can safely transition to VATS lobectomy. Gaining experience with the lateral muscle-sparing thoracotomy is an important step in the transition, as it offers similar operative exposure. Longterm disease-free and overall survival data are needed to evaluate our oncologic efficacy with this approach.

背景与目标：

BACKGROUND & AIMS: Visual optics is taking on new clinical significance. Given that current refractive procedures can and do induce large amounts of higher order ocular aberration that often affects the patient's daily visual function and quality of life, we can no longer relegate the considerations of ocular aberrations to academic discussions. Instead, we need to move toward minimizing (not increasing) the eye's aberrations at the same time we are correcting the eye's spherical and cylindrical refractive error. These are exciting times in refractive surgery, which need to be tempered by the fact that after all the research, clinical, and marketing dust settles, the level to which we improve the quality of the retinal image will be guided by the trade-off between cost and the improvement in the quality of life that refractive surgery offers.

背景与目标： 视觉光学具有新的临床意义。鉴于当前的屈光手术可以并且确实会引起大量的高阶眼像差，这些像差通常会影响患者的日常视觉功能和生活质量，因此我们不能再将眼像差的考虑因素置于学术讨论中。相反，我们需要在校正眼睛的球形和圆柱形屈光不正的同时，朝着最小化 (不增加) 眼睛的像差的方向发展。在屈光手术中，这是激动人心的时刻，需要通过以下事实来缓解: 在所有研究，临床和营销尘埃落定之后，我们提高视网膜图像质量的水平将取决于成本与屈光手术提供的生活质量之间的权衡。

BACKGROUND & AIMS: OBJECTIVE:To assess the prevalence of night eating syndrome (NES) and binge eating disorder (BED) and their related behavioral and psychological correlates in persons who sought bariatric surgery. RESEARCH METHODS AND PROCEDURES:A consecutive series of 215 persons with extreme obesity (82% women, 70% European American) completed the Weight and Lifestyle Inventory and a semistructured interview as part of a pre-surgery behavioral/psychological assessment. Diagnoses for NES and BED were based on graded diagnostic criteria. RESULTS:Percentages of participants who met diagnostic criteria for NES by interview were 1.9% for the strictest definition and 8.9% across all definitions of NES. After interview, full DSM-TR criteria for BED were met by 4.2%; an additional 1.4% reported binge eating at least once per week. Self-reported prevalence of NES and BED were higher. Those with NES or BED had significantly more symptoms of depression and a greater history of psychological complications than the remaining sample. DISCUSSION:The prevalence rates of NES and BED among this population of bariatric surgery candidates were lower than expected based on previous reports. Findings and hypotheses regarding lowered prevalence rates are discussed.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The literature reports that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75-100 cases. This aim of the present study was to evaluate the safety and feasibility of shortening the learning curve for performing LRYGBP by an experienced laparoscopic surgeon. METHODS:This study analyzed retrospectively the first 100 consecutive LRYGBP cases performed by an experienced laparoscopic surgeon between April 2003 and September 2003. The surgeon performed these cases after first assisting in 30 cases, and the first 4 cases were proctored by an experienced laparoscopic bariatric surgeon. Two cases done after previous gastric stapling and Nissen fundoplication were excluded from the study. Outcome variables included operative time, complications, conversion, and mortality. RESULTS:For the first 100 LRYGBP patients, the mean age was 42.6 years (range, 22-62 years) and mean body mass index (BMI) was 47.6 kg/m2 (range, 36-71.8). The complications included 1 case of intestinal leak, 1 case of small bowel obstruction, 6 cases of gastrojejunal stenosis, 8 cases of wound infection, 1 case of wound seroma, and 2 cases of pulmonary embolism, resulting in 1 mortality. One case was converted to an open technique. Over the second 50 cases, there was a significant reduction in mean operative time, to 73 minutes (range, 39-145 minutes) from 113 minutes (range, 54-238 minutes) (P < .0001). However, despite the reduction in complication frequency (no gastrointestinal leak or obstruction, 2 cases of gastrojejunal stenosis, 2 cases of wound infection, no pulmonary embolism/deep venous thrombosis, and no mortality), there was no significant correlation between the mortality, conversion, and complication rates and the surgeon's experience. CONCLUSION:A bariatric surgical practice incorporating LRYGBP can be safely done by an experienced laparoscopic surgeon. With appropriate advanced laparoscopic skills, preparatory steps, proctorship, and adequate volume of cases, the learning curve for performing LRYGBP can be reduced to 50 cases. Further experience is associated with a significant reduction in operative time with acceptable mortality, complication, and conversion rates.

背景与目标：

BACKGROUND & AIMS: :Fine needle aspiration cytology (FNAC) is an important tool in the investigation of thyroid nodules and has few reported complications. We present the first report of recurrent laryngeal nerve palsy arising as a complication of thyroid nodule FNAC. This complication led to inaccurate diagnosis and unnecessarily radical surgery, with consequent increased morbidity.

背景与目标： : 细针穿刺细胞学检查 (FNAC) 是检查甲状腺结节的重要工具，几乎没有并发症的报道。我们提出了作为甲状腺结节FNAC并发症引起的喉返神经麻痹的第一份报告。这种并发症导致不准确的诊断和不必要的根治性手术，从而增加了发病率。