Background Colorectal cancer often presents with obstruction needing urgent, potentially life-saving decompression. The comparative efficacy and safety of endoluminal stenting versus emergency surgery as initial treatment for such patients is uncertain. Methods Patients with left-sided colonic obstruction and radiological features of carcinoma were randomized to endoluminal stenting using a combined endoscopic/fluoroscopic technique followed by elective surgery 1–4 weeks later, or surgical decompression with or without tumour resection. Treatment allocation was via a central randomization service using a minimization procedure stratified by curative intent, primary tumour site, and severity score (Acute Physiology And Chronic Health Evaluation). Co-primary outcome measures were duration of hospital stay and 30-day mortality. Secondary outcomes were stoma formation, stenting completion and complication rates, perioperative morbidity, 6-month survival, 3-year recurrence, resource use, adherence to chemotherapy, and quality of life. Analyses were undertaken by intention to treat. Results Between 23 April 2009 and 22 December 2014, 245 patients from 39 hospitals were randomized. Stenting was attempted in 119 of 123 allocated patients (96.7 per cent), achieving relief of obstruction in 98 of 119 (82.4 per cent). For the 89 per cent treated with curative intent, there were no significant differences in 30-day postoperative mortality (3.6 per cent (4 of 110) versus 5.6 per cent (6 of 107); P = 0.48), or duration of hospital stay (median 19 (i.q.r. 11–34) versus 18 (10–28) days; P = 0.94) between stenting followed by delayed elective surgery and emergency surgery. Among patients undergoing potentially curative treatment, stoma formation occurred less frequently in those allocated to stenting than those allocated to immediate surgery (47 of 99 (47.5 per cent) versus 72 of 106 (67.9 per cent); P = 0.003). There were no significant differences in perioperative morbidity, critical care use, quality of life, 3-year recurrence or mortality between treatment groups. Conclusion Stenting as a bridge to surgery reduces stoma formation without detrimental effects. Registration number: ISRCTN13846816 (http://www.controlled-trials.com).
Purpose: A ruptured intracranial aneurysm has a high mortality rate. Moreover, many of its surviving patients have to live with severe disabilities. Therefore, surgical or endovascular treatment is recommended in some patients with a known aneurysm and a high risk of rupture. However, many patients are reluctant to undergo treatment, fearing its complications. This study aimed to evaluate the treatment outcomes and safety in patients with a ruptured and unruptured intracranial aneurysm. Methods: We retrospectively reviewed the records of patients treated for intracranial aneurysms in our hospital between 2017 to 2021. Our primary outcome was discharge functional outcome. We also evaluated cerebral infarction, stay duration, and mortality. We used bivariate and multivariate analysis. Results: 85 patients were included in this study. 69 (77.5%) patients were treated after rupture. Most patients were treated with clipping (78.8%). Patients with a ruptured aneurysm significantly had a higher risk of poor discharge functional outcome (OR 5.708 [1.061 – 30.712]; p 0.042). Six patients with a ruptured aneurysm died. Patients with a ruptured aneurysm also spent more time at the hospital. There was no mortality or complication in patients with an unruptured aneurysm. Conclusion: Patients treated before their aneurysms ruptured had better outcomes with no complications. Therefore, treatment should be considered for high-risk patients.
This study focused on students' learning strategies and extensive reading experience, as well as the varied tactics and disparities between them. In this study, the narrative inquiry method was applied. We polled ten active university students from a variety of disciplines and faculties. While conducting the intensive reading tasks, the researchers asked the respondents a few questions and asked them to discuss their experiences. The students were also interviewed over the phone by the researchers. The researchers chose the responders at random, without considering their major, knowledge, or other factors. Based on the findings, we can deduce that each student has similar challenges and employs a similar learning technique. The majority of them use online dictionaries to look up the definitions of new words.
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