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Facilitators and obstacles for the provision regarding your body inpatient attention: The interpretive phenomenological examination.
Compared with Milligan-Morgan hemorrhoidectomy, suture-fixation mucopexy is as effective in the treatment of prolapsed hemorrhoid, but it has more advantages in reducing postoperative pain and protecting the anal function.
Transanal endoscopic microsurgery (TEM) is a safe procedure and the rates of intra- and postoperative complications are low. The information in the literature on the management of these complications is limited, and so their importance may be either under- or overestimated (which may in turn lead to under- or overtreatment). The present article reviews the most relevant series of TEM procedures and their complications and describes various approaches to their management.

A systematic review of the literature, including TEM series of more than 150 cases each. We analyzed the population characteristics, surgical variables and intraoperative and postoperative complications.

A total of 1043 records were found. After review, 1031 were excluded. The review therefore includes 12 independent cohorts of TEM procedures with a total of 4395 patients. The rate of perforation into the peritoneal cavity was 5.1%, and conversion to abdominal approach was required in 0.8% of cases. The most frequent complications were acute urinary retention (AUR, 4.9%) and rectal bleeding (2.2%). Less common complications included abscesses (0.99%) and rectovaginal fistula (0.62%). Mortality rates were low, with a mean value of 0.29%.

Awareness and knowledge of TEM complications and their management can play an important role in their treatment and patient safety. Here, we present a review of the most important TEM series and their complication rates and describe various approaches to their management.
Awareness and knowledge of TEM complications and their management can play an important role in their treatment and patient safety. Here, we present a review of the most important TEM series and their complication rates and describe various approaches to their management.Patients with acute leukemia frequently develop thrombocytopenia and hemostatic complications caused by coagulopathy. Coagulopathy complicates the management of these patients and can lead to significant morbidity and mortality. This guidance document aims to review and provide guidance on the management of hemostatic complications in adult patients with acute leukemia, addressing four main issues, including platelet transfusion, disseminated intravascular coagulation, L-asparaginase-related hypofibrinogenemia, and the use of antifibrinolytic agents.
Congenital thrombotic thrombocytopenic purpura (cTTP), otherwise known as Upshaw-Schulman syndrome, is an extremely rare hereditary disease. Pregnancy is identified as a trigger for TTP episodes in patients with cTTP.

To investigate the ideal management of pregnant patients with cTTP.

We identified 21 patients with a reproductive history (38 pregnancies) in a Japanese cTTP registry. Fetal outcomes were compared between two groups group 1 (n=12), pregnancy after diagnosis of confirmed cTTP by ADAMTS13 gene analysis; and group 2 (n=26), pregnancy before diagnosis of confirmed cTTP.

In group 1, ADAMTS13 activity was closely monitored until delivery in most cases. Among 10 pregnancies in group 1, prophylactic fresh frozen plasma (FFP) infusions during pregnancy were performed to replenish ADAMTS13. In group 2, prophylactic FFP infusions were not administrated in 23 pregnancies and FFP test infusions were performed in only three pregnancies. The live birth rate of group 1 was significantly higher than that of group 2 (91.7% vs 50.0%, respectively, P=.027). The fetal survival rates of women without FFP infusions were dramatically decreased after 20weeks of gestation. Navitoclax concentration The FFP infusion dosage in group 1 was generally higher than 5mL/kg/wk by 20weeks of gestation.

Our results indicate that FFP infusions of more than 5mL/kg/wk should be initiated as soon as patients become pregnant. However, even with these infusions, patients with repeated TTP episodes before pregnancy might have difficulty giving birth successfully. Recombinant ADAMTS13 products might be new treatment options for pregnant patients with cTTP.
Our results indicate that FFP infusions of more than 5 mL/kg/wk should be initiated as soon as patients become pregnant. However, even with these infusions, patients with repeated TTP episodes before pregnancy might have difficulty giving birth successfully. Recombinant ADAMTS13 products might be new treatment options for pregnant patients with cTTP.
In passive scattering proton beam therapy, scattered protons from the snout and aperture increase the superficial dose, however, treatment planning systems (TPSs) based on analytic algorithms (such as proton convolution superposition) are often inaccurate in this aspect. This additional dose can cause permanent alopecia or severe radiation dermatitis. This study aimed to evaluate the effect of bolus on the superficial radiation dose in passive scattering proton beam therapy.

We drew a clinical target volume (CTV) and a scalp-p (phantom), and created plans using a TPS for a solid water phantom with and without bolus. We calculated the dose distribution in the established plans independently with Monte Carlo (MC) simulation and measured the actual dose distribution with an array of ion chambers and radiochromic films. To assess the clinical impact of bolus on scalp dose, we conducted independent dose verification using MC simulation in a clinical case.

In the solid water phantom without bolus, the calculated scalp-p volume receiving 190cGy was 20% with TPS but 80% with MC simulation when the CTV received 200cGy. With 2cm bolus, this decreased from 80% to 10% in MC simulation. With the measurements, average superficial dose to the scalp-p was reduced by 5.2% when 2cm bolus was applied. In the clinical case, the scalp-c (clinical) volume receiving 3000cGy decreased from 74% to 63% when 2cm bolus was applied.

This study revealed that bolus can reduce radiation dose at the superficial body area and alleviate toxicity in passive scattering proton beam therapy.
This study revealed that bolus can reduce radiation dose at the superficial body area and alleviate toxicity in passive scattering proton beam therapy.
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