Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treat...Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treatment with intravenous antibiotics and close in-hospital monitoring. In this study, we aimed to identify the main risk factors associated with the development of complications in children aged 2 - 17 years with ABRS. Methods: We conducted a retrospective cohort study of patients with ABRS complications in a primary hospital. Participants were divided into two groups: the control group comprising patients without complications (Group 1, n = 82) and the study group comprising patients with complications requiring hospitalization (Group 2, n = 41). We assessed the sociodemographic, clinical, and imaging data of both groups. Using multivariate logistic regression, we assessed risk factors of ABRS complications. Results: No socio-demographic characteristics were associated with ABRS complications (p ≥ 0.05). Factors associated with complications were delay in consultation (t = 5.282;p Conclusions: Intracranial and extracranial complications of ABRS in children have become rare in our setting. These complications can be serious and potentially fatal. Risk factors of these complications are delays in consultation, the presence of ophthalmological signs, and more than one affected sinus. Controlling modifiable factors would improve the treatment success of ABRS complications in children.展开更多
Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researcher...Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researchers for their established role in inflammatory conditions.In this respect,T2DM and its mi-crovascular complications are characterized by high inflammatory burden.Hence,recent studies in the literature have reported an association between T2DM and hemogram-derived markers.Emerging evidence highlights the utility of hemo-gram-derived markers,including the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,red cell distribution width,and mean platelet volume,as potential predictors of T2DM onset and progression.These markers,readily available from routine hemogram tests,offer valuable insights into the systemic inflammation and vascular changes associated with T2DM and its complications,such as cardiovascular disease,nephropathy,and retinopathy.This review syn-thesizes current research on the association between hemogram-derived markers and T2DM,emphasizing their prognostic value in predicting disease severity and complications.We also explore the underlying pathophysiological mechanisms linking these markers to inflammation and metabolic dysfunction.The findings suggest that hemogram-derived markers could serve as cost-effective,non-invasive tools for risk stratification and early intervention in T2DM management.Future research should focus on standardizing reference ranges and validating these markers in diverse populations to enhance their clinical utility.展开更多
BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently estab...BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.展开更多
AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hos...AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hospital in Saudi Arabia.METHODS:The medical records of 813 eyes with different refractive errors corrected with ICL implantation were identified and included in this single-arm retrospective cohort study.The following data were collected:demographic characteristics,primary diagnosis,preoperative refraction,anterior chamber depth(ACD),white-to-white(WTW)measurement,endothelial cell density(ECD),and axial length.Patients’satisfaction and complaints,and their postoperative refraction,vault depth,and axis alignment with the preoperative target,were reviewed during the postoperative period.Collectively,these data were correlated with symptomatic axis rotation and the need for repositioning,explantation,or exchange due to high or low ICL vaults.RESULTS:Of 813 eyes,27(3.32%),13(1.59%),and 11(1.35%)required ICL repositioning,ICL explantation only without exchange,and ICL explantation with the placement of a new ICL,respectively.The mean follow-up period was 37.5mo.The main cause of explanation or exchange was incorrect WTW measurement in seven(29.17%)eyes,followed by high vault in four(16.56%)eyes.ICL repositioning was required in 27(3.32%)eyes with considerable rotation.Only 2(0.24%)eyes developed cataracts that required ICL removal,and retinal complications were reported in 7(0.86%)eyes.Long-term glaucoma and corneal decompensation were not observed in this cohort.CONCLUSION:With a high safety profile and reversibility,ICL implantation is a good alternative to corneal-based refractive surgery in eyes unsuitable for laser vision correction.The rate of secondary procedures in our study was 6.26%.Old age is a risk factor for secondary surgical interventions in the repositioning group,whereas abnormal vault and toric ICL rotation in the explantation group necessitated subsequent surgical procedures.Overall,ICL implantation demonstrates a good efficacy index and safety profile in patients with diverse refractive errors.展开更多
Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the pre...Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty,particularly infections,across procedures such as total knee,hip,shoulder,and ankle replacements.Several studies have indicated that increased STT is associated with a higher risk of complications,including infection and wound healing issues.The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instru-mental in guiding preoperative planning to optimize outcomes in arthroplasty procedures.Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthro-plasty surgery.展开更多
BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological pro...BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological profile and endoscopic methods for treating FB impacted in the esophagus of children,as it can help in the development of more effective,safe and personalized preventive and therapeutic strategies.AIM To define the profile of children seeking emergency care due to FB impaction in the esophagus,analyze factors associated with complications,and evaluate the effectiveness of rigid(RE)and flexible endoscopes(FE).METHODS A retrospective cohort study of 166 children with impacted FB in the esophagus who underwent an endoscopy(FE=84 vs RE=82)at the Dr.JoséFrota Institute was performed.The primary outcomes were to assess the efficacy of the endoscopic technique and factors associated with complications.The secondary outcomes were age group,gender,symptoms,length of hospital stay,and location of the FB.RESULTS Boys(66.9%),preschoolers(43.4%),FB>24 hours(62.7%),cervical esophagus(60.8%),coin ingestion(57.2%)and complaints of dysphagia(24.9%)and sialorrhea(23.1%)were the predominant findings.Endoscopy was successful(90.4%)with sedation(89.1%).A total of 97%of patients were discharged from the hospital,while 3%died.The average hospital stay length was 2.6 days.Most patients did not experience complications predominated(64.5%).Esophageal perforations were more frequent after RE(11%vs 4.8%),while FE was more effective(95.2%vs 85.4%).Theχ2 test or Fisher's exact test was used to compare categorical variables.For continuous variables,the Kruskal-Wallis test or analysis of variance was used.Statistical analyses were performed in R®software(version 1.3.1093).CONCLUSION Coins were the most frequent FBs and were mainly lodged in the upper esophagus of preschool boys.Risk factors for complications due to esophageal FB include battery ingestion,delayed removal(>48 hours)and lodging in the thoracic esophagus.FE was generally more effective than RE for removing FBs;both procedures are safe.展开更多
BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early...BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early postoperative stoma complications in colorectal cancer patients and to construct a nomogram prediction model for predicting the probability of these complications.METHODS A retrospective study of 462 patients who underwent postoperative ostomy for colorectal cancer in the Gastrointestinal Department of the Anhui Provincial Cancer Hospital.The patients’basic information,surgical details,pathological results,and preoperative inflammatory and nutritional indicators were reviewed.We used univariate and multivariate logistic regression to analyze the risk factors for early postoperative stoma complications in colorectal cancer patients and constructed a nomogram prediction model to predict the probability of these complications.RESULTS Binary logistic regression analysis revealed that diabetes[odds ratio(OR)=3.088,95%confidence interval(CI):1.419-6.719],preoperative radiotherapy and chemotherapy(OR=6.822,95%CI:2.171-21.433),stoma type(OR=2.118,95%CI:1.151-3.898),Nutritional risk screening 2002 score(OR=2.034,95%CI:1.082-3.822)and prognostic nutritional index(OR=0.486,95%CI:0.254-0.927)were risk factors for early stoma complications after colorectal cancer surgery(P<0.05).On the basis of these results,a prediction model was constructed and the area under the re-ceiver operating characteristic curve was 0.740(95%CI:0.669-0.811).After internal validation,the area under the receiver operating characteristic curve of the validation group was 0.725(95%CI:0.631-0.820).The calibration curves for the modeling group and validation group are displayed.The predicted results have a good degree of overlap with the actual results.CONCLUSION A previous history of diabetes,preoperative radiotherapy and chemotherapy,stoma type,Nutritional risk screening 2002 score and prognostic nutritional index are risk factors for early stoma complications after colorectal cancer surgery.The nomogram prediction model constructed on the basis of the results of logistic regression analysis in this study can effectively predict the probability of early stomal complications after colorectal cancer surgery.展开更多
This study evaluates the findings of Gu et al,who investigated the role of neutrophil gelatinase-associated lipocalin(NGAL)as a biomarker for predicting neuropsychiatric complications in acute ischemic stroke(AIS)pati...This study evaluates the findings of Gu et al,who investigated the role of neutrophil gelatinase-associated lipocalin(NGAL)as a biomarker for predicting neuropsychiatric complications in acute ischemic stroke(AIS)patients.The results revealed that elevated serum NGAL levels at admission are associated with a higher risk of cognitive impairment,anxiety,and depressive symptoms at discharge.The study analyzed 150 AIS patients(mean age 65.4 years,58%male)using the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale to assess neuropsychiatric outcomes.Multivariate analysis demonstrated that higher NGAL levels were independent predictors of cognitive impairment[odds ratio(OR)=1.42],anxiety(OR=1.28),and depression(OR=1.39).Notably,NGAL exhibited strong predictive power for cognitive impairment,with an area under the curve of 0.78.Despite these promising findings,NGAL’s clinical utility is limited by its non-specificity across various conditions.Nevertheless,NGAL levels could help identify AIS patients at risk for neuropsychiatric complications,enabling timely intervention and comprehensive neuropsychiatric evaluation.The study emphasizes the need for further research to validate NGAL’s predictive accuracy and specificity in diverse AIS populations and advocates for its integration with other diagnostic modalities to enhance clinical decision-making.展开更多
Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplica...Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplications can delay the initiation of adjuvant therapies,increase healthcare costs,and negatively affectpatients’quality of life.This study evaluated the use of a latex-based tissue adhesive(LTA)as an intraoperativestrategy to prevent seroma formation and prolonged lymphorrhea following axillary dissection.Methods:In this prospective study,65 female patients diagnosed with stage Ⅱb-Ⅲ breast cancer and clinicallyconfirmed axillary lymph node involvement were enrolled.Participants were divided into two groups.The studygroup(n=33)received an intraoperative application of LTA without drainage,while the control group(n=32)underwent standard ALND with placement of a silicone vacuum drain.Postoperative outcomes assessed includedlymphatic drainage volume,number of aspirations,duration of lymphorrhea,length of hospital stay,and incidence of complications.Results:Use of the LTA significantly reduced both the volume and duration of postoperative lymphorrhea.Bypostoperative day 10,the average wound exudate volume in the LTA group was 8.2±3.3 mL,compared to54.1±3.9 mL in the control group—an 84.8%reduction.The LTA group also experienced shorter hospital staysand fewer cases of postoperative seroma requiring intervention.Conclusion:LTA appears to be a safe,effective,and practical intraoperative technique for preventing lymphaticcomplications after ALND.Its use may reduce dependence on drainage systems,shorten hospitalization,andsupport earlier initiation of adjuvant therapies,ultimately improving surgical outcomes and patient recovery.展开更多
Irisin is a chief myokine released during physical activity and has garnered attention for its potential therapeutic effects on different metabolic and cardiovascular disorders.This review explores the intricate conne...Irisin is a chief myokine released during physical activity and has garnered attention for its potential therapeutic effects on different metabolic and cardiovascular disorders.This review explores the intricate connections between irisin,physical activity,sarcopenia,type 2 diabetes mellitus(T2DM),and cardiovascular complications.Experimental data suggests that through irisin release,physical activity positively influences muscle health,metabolic regulation,and cardiovascular function.In individuals with sarcopenia,characterized by progressive muscle mass and function loss,irisin plays a pivotal role in maintaining muscle integrity and function.Additionally,irisin’s beneficial effects on insulin sensitivity and glucose metabolism suggest its involvement in the pathophysiology of T2DM.The review will examine how irisin may modulate the development of cardiovascular complications,particularly in the context of diabetes and aging.Additionally,it will explore its potential as a therapeutic target for managing sarcopenia,T2DM,and cardiovascular complications,underscoring the importance of physical activity in mitigating these interconnected health challenges.Further research is needed to elucidate the precise mechanisms by which irisin mediates these effects and assess its clinical applicability in preventing and treating metabolic and cardiovascular disorders.展开更多
This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion...This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion.A total of 70 children with inguinal hernia admitted to our hospital from July 2023 to June 2024 and treated with laparoscopic surgery were selected as study subjects and randomly divided into an observation group and a control group,with 35 cases in each.Both groups received routine nursing care,while the observation group additionally adopted the integrated medical and nursing working mode,including systematic health education,psychological interventions,and postoperative follow-up from admission to discharge.The anxiety and depression scores of the two groups before and after surgery,medical compliance index,and incidence of complications during hospitalization were compared.Results showed that the preoperative anxiety scores of the observation and control groups were(14.01±1.07)and(14.62±2.31),respectively,with no statistically significant difference(P>0.05);however,postoperative anxiety scores were significantly lower in the observation group(4.01±0.77)compared to the control group(6.62±0.31)(P<0.05).Similarly,preoperative depression scores were(15.11±1.22)in the observation group and(15.41±2.01)in the control group(P>0.05),but postoperative depression scores were significantly reduced in the observation group(4.24±0.61)compared to the control group(7.12±0.54)(P<0.05).After intervention,the medical compliance behavior index in the observation group was(83.31±5.92),significantly higher than(75.34±6.73)in the control group(P<0.05).Regarding postoperative complications,only 1 case(2.86%)occurred in the observation group,while 8 cases(22.86%)were reported in the control group,showing a statistically significant difference(P<0.05).In conclusion,the medical and nursing integration working mode effectively improves the perioperative psychological state of children,enhances medical compliance,reduces postoperative complications,and is worthy of widespread clinical application.展开更多
Objective:This study aimed to develop and validate a predictive model for postoperative complications in gastrointestinal cancer patients using a large multicenter database,based on machine learning algorithms.Methods...Objective:This study aimed to develop and validate a predictive model for postoperative complications in gastrointestinal cancer patients using a large multicenter database,based on machine learning algorithms.Methods:We analyzed the clinicopathological data of 3,926 gastrointestinal cancer patients from the Prevalence of Abdominal Complications After GastroEnterological surgery(PACAGE)database,covering 20 medical centers from December 2018 to December 2020.The predictive performance was evaluated using receiver operating characteristic(ROC)curves and Brier Score.Results:The patients were divided into gastric(2,271 cases)and colorectal cancer(1,655 cases)groups and further divided into training and external validation sets.The overall postoperative complication rates for gastric and colorectal cancer groups were 18.1%and 14.8%,respectively.The most common complication was the intraabdominal infection in both gastric and colorectal cancer groups.In the training set,the Random Forest(RF)model predicted the highest mean area under the curve(AUC)values for overall complications and different types of complications,in both the gastric cancer group and the colorectal cancer group,with similar results obtained in the external validation set.ROC curve analysis showed good predictive performance of the RF model for overall and infectious complications.An application-based clinical tool was developed for easy application in clinical practice.Conclusions:This model demonstrated good predictive performance for overall and infectious complications based on the multi-center database,supporting clinical decision-making and personalized treatment strategies.展开更多
Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an ar...Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an artificial airway mucus(ARM)coating is straightforwardly constructed by combining carboxymethyl chitosan with methyl cellulose.The ARM coating exhibited excellent lubricity(coefficient of friction(Co F)=0.05)and hydrophilicity(water contact angle(WCA)=21.3°),and was capable of coating both the internal and external surfaces of the endotracheal tube(ETT).In vitro experiments demonstrated that the ARM coating not only showed good broad-spectrum antibacterial activity,but also significantly reduced nonspecific protein adhesion.Through an in vivo intubation cynomolgus monkey model,ARM-coated ETT potently mitigated airway injury and inflammation,and was highly potential to prevent bacterial infection and catheter blockage.This work offers a promising avenue for the development of airway-friendly invasive devices.展开更多
BACKGROUND Heart rate variability(HRV)represents efferent vagus nerve activity,which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers.Therefor...BACKGROUND Heart rate variability(HRV)represents efferent vagus nerve activity,which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers.Therefore,this study hypothesized that HRV monitoring could predict perioperative complication(PC)in colorectal cancer(CRC)patients.AIM To investigate the prognostic value of HRV in hospitalized CRC patients.METHODS The observational studies included 87 patients who underwent CRC surgical procedures under enhanced recovery after surgery programs in a first-class hospital.The HRV parameters were compared between the PC group and the non PC(NPC)group from preoperative day 1 to postoperative day(Pod)3.In addition,inflammatory biomarkers and nutritional indicators were also analyzed.RESULTS The complication rate was 14.9%.HRV was markedly abnormal after surgery,especially in the PC group.The frequency-domain parameters(including pNN50)and time-domain parameters[including high-frequency(HF)]of HRV were significantly different between the two groups postoperatively.The pNN50 was significantly greater at Pod1 in the PC group than that in the NPC group and returned to baseline at Pod2,suggesting that patients with complications exhibited autonomic nerve dysfunction in the early postoperative period.In the PC group,HFs were also enhanced from Pod1 and were significantly higher than in the NPC group;inflammatory biomarkers were significantly elevated at Pod2 and Pod3;the levels of nutritional indicators were significantly lower at Pod1 and Pod2;and the white blood cell count was slightly elevated at Pod3.CONCLUSION HRV is independently associated with postoperative complications in patients with CRC.Abnormal HRV could predicted an increased risk of postoperative complications in CRC patients.Continuous HRV could be used to monitor complications in patients with CRC during the perioperative period.展开更多
BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene...BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.展开更多
Chronic otitis media(COM)is a long-standing inflammatory condition affecting the middle ear and mastoid cavity,often resulting in progressive structural damage and functional deficits.Radiological imaging is fundament...Chronic otitis media(COM)is a long-standing inflammatory condition affecting the middle ear and mastoid cavity,often resulting in progressive structural damage and functional deficits.Radiological imaging is fundamental in diagnosing the disease,assessing its severity,and identifying possible complications.The literature indicates that the prevalence rates of extracranial and intracranial complications range from 0.69% to 5%,while the mortality rate for intracranial complications is 26%.While magnetic resonance imaging is particularly useful in distinguishing soft tissue abnormalities and detecting intracranial extensions like meningitis,brain abscess,and sigmoid sinus thrombosis,highresolution computed tomography remains the preferred modality for evaluating bony erosion,cholesteatoma,and mastoid involvement.Key complications such as ossicular chain destruction,facial nerve damage,and labyrinthine fistulae can be precisely identified using advanced imaging modalities,allowing for timely and effective surgical intervention.This minireview underscores the essential role of radiology in both diagnosing and managing COM,highlighting critical imaging findings that facilitate early detection and inform treatment decisions.A collaborative approach among radiologists,otolaryngologists,and infectious disease specialists is crucial for improving clinical outcomes in affected patients.展开更多
Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary su...Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.展开更多
BACKGROUND The annual incidence of gastric cancer in elderly patients is increasing.Despite the continuous progress in treatment methods,the prognosis of elderly patients remains poor,and postoperative complications a...BACKGROUND The annual incidence of gastric cancer in elderly patients is increasing.Despite the continuous progress in treatment methods,the prognosis of elderly patients remains poor,and postoperative complications are frequent.Obesity is believed to be associated with the risk of gastric cancer and postoperative prognosis;however,the effect of visceral fat distribution on postoperative complications of gastric cancer in elderly patients remains unclear.AIM To explore the effect of visceral fat distribution on postoperative complications of gastric cancer in elderly patients.METHODS A total of 163 elderly patients treated at the Affiliated Longyan First Hospital of Fujian Medical University after radical gastrectomy between January 2021 and January 2024 were enrolled.The patients'visceral and subcutaneous fat distributions were measured and divided into a high visceral fat area(VFA-H)group and a low visceral fat area(VFA-L)group,with a critical value of 100 cm^(2).The ttest andχ^(2) test were used to calculate and analyze the relationship between visceral fat area(VFA)and complications.Independent risk factors for postoperative complications were analyzed using binary logistic regression analysis.RESULTS Compared with the VFA-L group,the incidence of postoperative complications was higher in the VFA-H group(27.8%vs 6.4%,P<0.001),and the operation time was longer(268.55±63.41 vs 224.31±51.89,P<0.001).The amount of blood loss was more(163.77±105.27 mL vs 127.93±98.26 mL,P<0.001).Logistic regression analysis showed that VFA[odds ratio(OR):2.597,95%CI:1.479-4.853,P=0.004],total fat area(OR:1.655,95%CI:1.076-4.040,P=0.013),and the visceral subcutaneous fat area ratio(OR:2.046,95%CI:1.196-5.640,P=0.008)were independent risk factors for postoperative complications.CONCLUSION This study showed that postoperative complications are closely related to fat distribution in elderly patients with gastric cancer undergoing gastrectomy.A high VFA is associated by a high incidence of postoperative complications.展开更多
Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included pati...Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital.Patients were divided into CKD and non-GKD groups based on the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73m2)]or not.Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications,30-day readmission,and in-hospital death.Logistic regression analysis was used to calculate the odds ratio(OR)of CKD on these outcomes.Results A total of 498 patients were included,165 in the CKD group and 333 in the non-CKD group.Eighty-seven(52.7%)CKD patients experienced 140 episodes of postoperative complications.In comparison,114(34.2%)non-CKD patients had 158 episodes of postoperative complications.CKD patients were more likely to have postoperative complications than non-CKD patients(OR=2.143,95%CI:1.465-3.134,P<0.001).CKD increased the risk of cardiovascular complications(OR=2.044,95%CI:1.245-3.356,P=0.004),acute kidney injury(OR=3.401,95%CI:1.905-6.072,P<0.001),delirium(OR=2.276,95%CI:1.140-4.543,P=0.024),and gastrointestinal bleeding(OR=4.151,95%CI:1.025-16.812,P=0.031).The transfusion rate(OR=2.457,95%CI:1.668-3.618,P<0.001)and incidence of 30-day readmission(OR=2.426,95%CI:1.203-4.892,P=0.011)in CKD patients were significantly higher than those in patients without CKD.Conclusion CKD is associated with poor postoperative outcomes in geriatric hip fracture patients.Special attention should be paid to patients with CKD.展开更多
BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Iden...BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022.Postoperative complications were classified using the Clavien-Dindo system.RESULTS The overall complication rate was 28.4%(142/500),with 15.2%(76/500)experiencing major complications(Clavien-Dindo grade≥III).Pulmonary complications were the most frequent(10.8%),followed by surgical site infections(8.6%),and anastomotic leakage(4.2%).Age 70 years or more,body mass index of 25 kg/m²or more,advanced tumor stage,total gastrectomy,and operative time 240 min or more emerged as independent risk factors.CONCLUSION Focused preoperative risk assessment,targeted interventions,and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.展开更多
文摘Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treatment with intravenous antibiotics and close in-hospital monitoring. In this study, we aimed to identify the main risk factors associated with the development of complications in children aged 2 - 17 years with ABRS. Methods: We conducted a retrospective cohort study of patients with ABRS complications in a primary hospital. Participants were divided into two groups: the control group comprising patients without complications (Group 1, n = 82) and the study group comprising patients with complications requiring hospitalization (Group 2, n = 41). We assessed the sociodemographic, clinical, and imaging data of both groups. Using multivariate logistic regression, we assessed risk factors of ABRS complications. Results: No socio-demographic characteristics were associated with ABRS complications (p ≥ 0.05). Factors associated with complications were delay in consultation (t = 5.282;p Conclusions: Intracranial and extracranial complications of ABRS in children have become rare in our setting. These complications can be serious and potentially fatal. Risk factors of these complications are delays in consultation, the presence of ophthalmological signs, and more than one affected sinus. Controlling modifiable factors would improve the treatment success of ABRS complications in children.
文摘Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder characterized by hyperglycemia and insulin resistance,often leading to severe complications.Hemogram markers have attracted great attention from researchers for their established role in inflammatory conditions.In this respect,T2DM and its mi-crovascular complications are characterized by high inflammatory burden.Hence,recent studies in the literature have reported an association between T2DM and hemogram-derived markers.Emerging evidence highlights the utility of hemo-gram-derived markers,including the neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,red cell distribution width,and mean platelet volume,as potential predictors of T2DM onset and progression.These markers,readily available from routine hemogram tests,offer valuable insights into the systemic inflammation and vascular changes associated with T2DM and its complications,such as cardiovascular disease,nephropathy,and retinopathy.This review syn-thesizes current research on the association between hemogram-derived markers and T2DM,emphasizing their prognostic value in predicting disease severity and complications.We also explore the underlying pathophysiological mechanisms linking these markers to inflammation and metabolic dysfunction.The findings suggest that hemogram-derived markers could serve as cost-effective,non-invasive tools for risk stratification and early intervention in T2DM management.Future research should focus on standardizing reference ranges and validating these markers in diverse populations to enhance their clinical utility.
文摘BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.
文摘AIM:To evaluate the visual outcomes of implantable collamer lenses(ICLs)and identify the possible risk factors for ICL axis misalignment,and consequently,repositioning,explanting,or exchanging at a specialized eye hospital in Saudi Arabia.METHODS:The medical records of 813 eyes with different refractive errors corrected with ICL implantation were identified and included in this single-arm retrospective cohort study.The following data were collected:demographic characteristics,primary diagnosis,preoperative refraction,anterior chamber depth(ACD),white-to-white(WTW)measurement,endothelial cell density(ECD),and axial length.Patients’satisfaction and complaints,and their postoperative refraction,vault depth,and axis alignment with the preoperative target,were reviewed during the postoperative period.Collectively,these data were correlated with symptomatic axis rotation and the need for repositioning,explantation,or exchange due to high or low ICL vaults.RESULTS:Of 813 eyes,27(3.32%),13(1.59%),and 11(1.35%)required ICL repositioning,ICL explantation only without exchange,and ICL explantation with the placement of a new ICL,respectively.The mean follow-up period was 37.5mo.The main cause of explanation or exchange was incorrect WTW measurement in seven(29.17%)eyes,followed by high vault in four(16.56%)eyes.ICL repositioning was required in 27(3.32%)eyes with considerable rotation.Only 2(0.24%)eyes developed cataracts that required ICL removal,and retinal complications were reported in 7(0.86%)eyes.Long-term glaucoma and corneal decompensation were not observed in this cohort.CONCLUSION:With a high safety profile and reversibility,ICL implantation is a good alternative to corneal-based refractive surgery in eyes unsuitable for laser vision correction.The rate of secondary procedures in our study was 6.26%.Old age is a risk factor for secondary surgical interventions in the repositioning group,whereas abnormal vault and toric ICL rotation in the explantation group necessitated subsequent surgical procedures.Overall,ICL implantation demonstrates a good efficacy index and safety profile in patients with diverse refractive errors.
文摘Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty,particularly infections,across procedures such as total knee,hip,shoulder,and ankle replacements.Several studies have indicated that increased STT is associated with a higher risk of complications,including infection and wound healing issues.The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instru-mental in guiding preoperative planning to optimize outcomes in arthroplasty procedures.Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthro-plasty surgery.
基金the Institutional Research Ethics Board(number 6.886.384)Brazil platform system(Approval with CAAE number 79007324.1.0000.5047).
文摘BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological profile and endoscopic methods for treating FB impacted in the esophagus of children,as it can help in the development of more effective,safe and personalized preventive and therapeutic strategies.AIM To define the profile of children seeking emergency care due to FB impaction in the esophagus,analyze factors associated with complications,and evaluate the effectiveness of rigid(RE)and flexible endoscopes(FE).METHODS A retrospective cohort study of 166 children with impacted FB in the esophagus who underwent an endoscopy(FE=84 vs RE=82)at the Dr.JoséFrota Institute was performed.The primary outcomes were to assess the efficacy of the endoscopic technique and factors associated with complications.The secondary outcomes were age group,gender,symptoms,length of hospital stay,and location of the FB.RESULTS Boys(66.9%),preschoolers(43.4%),FB>24 hours(62.7%),cervical esophagus(60.8%),coin ingestion(57.2%)and complaints of dysphagia(24.9%)and sialorrhea(23.1%)were the predominant findings.Endoscopy was successful(90.4%)with sedation(89.1%).A total of 97%of patients were discharged from the hospital,while 3%died.The average hospital stay length was 2.6 days.Most patients did not experience complications predominated(64.5%).Esophageal perforations were more frequent after RE(11%vs 4.8%),while FE was more effective(95.2%vs 85.4%).Theχ2 test or Fisher's exact test was used to compare categorical variables.For continuous variables,the Kruskal-Wallis test or analysis of variance was used.Statistical analyses were performed in R®software(version 1.3.1093).CONCLUSION Coins were the most frequent FBs and were mainly lodged in the upper esophagus of preschool boys.Risk factors for complications due to esophageal FB include battery ingestion,delayed removal(>48 hours)and lodging in the thoracic esophagus.FE was generally more effective than RE for removing FBs;both procedures are safe.
文摘BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early postoperative stoma complications in colorectal cancer patients and to construct a nomogram prediction model for predicting the probability of these complications.METHODS A retrospective study of 462 patients who underwent postoperative ostomy for colorectal cancer in the Gastrointestinal Department of the Anhui Provincial Cancer Hospital.The patients’basic information,surgical details,pathological results,and preoperative inflammatory and nutritional indicators were reviewed.We used univariate and multivariate logistic regression to analyze the risk factors for early postoperative stoma complications in colorectal cancer patients and constructed a nomogram prediction model to predict the probability of these complications.RESULTS Binary logistic regression analysis revealed that diabetes[odds ratio(OR)=3.088,95%confidence interval(CI):1.419-6.719],preoperative radiotherapy and chemotherapy(OR=6.822,95%CI:2.171-21.433),stoma type(OR=2.118,95%CI:1.151-3.898),Nutritional risk screening 2002 score(OR=2.034,95%CI:1.082-3.822)and prognostic nutritional index(OR=0.486,95%CI:0.254-0.927)were risk factors for early stoma complications after colorectal cancer surgery(P<0.05).On the basis of these results,a prediction model was constructed and the area under the re-ceiver operating characteristic curve was 0.740(95%CI:0.669-0.811).After internal validation,the area under the receiver operating characteristic curve of the validation group was 0.725(95%CI:0.631-0.820).The calibration curves for the modeling group and validation group are displayed.The predicted results have a good degree of overlap with the actual results.CONCLUSION A previous history of diabetes,preoperative radiotherapy and chemotherapy,stoma type,Nutritional risk screening 2002 score and prognostic nutritional index are risk factors for early stoma complications after colorectal cancer surgery.The nomogram prediction model constructed on the basis of the results of logistic regression analysis in this study can effectively predict the probability of early stomal complications after colorectal cancer surgery.
基金Supported by the Basic Science Research Program through the National Research Foundation of Korea Funded by the Ministry of Education,No.RS-2023-00237287Regional Innovation Strategy Through the National Research Foundation of Korea Funded by the Ministry of Education,No.2021RIS-003.
文摘This study evaluates the findings of Gu et al,who investigated the role of neutrophil gelatinase-associated lipocalin(NGAL)as a biomarker for predicting neuropsychiatric complications in acute ischemic stroke(AIS)patients.The results revealed that elevated serum NGAL levels at admission are associated with a higher risk of cognitive impairment,anxiety,and depressive symptoms at discharge.The study analyzed 150 AIS patients(mean age 65.4 years,58%male)using the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale to assess neuropsychiatric outcomes.Multivariate analysis demonstrated that higher NGAL levels were independent predictors of cognitive impairment[odds ratio(OR)=1.42],anxiety(OR=1.28),and depression(OR=1.39).Notably,NGAL exhibited strong predictive power for cognitive impairment,with an area under the curve of 0.78.Despite these promising findings,NGAL’s clinical utility is limited by its non-specificity across various conditions.Nevertheless,NGAL levels could help identify AIS patients at risk for neuropsychiatric complications,enabling timely intervention and comprehensive neuropsychiatric evaluation.The study emphasizes the need for further research to validate NGAL’s predictive accuracy and specificity in diverse AIS populations and advocates for its integration with other diagnostic modalities to enhance clinical decision-making.
文摘Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplications can delay the initiation of adjuvant therapies,increase healthcare costs,and negatively affectpatients’quality of life.This study evaluated the use of a latex-based tissue adhesive(LTA)as an intraoperativestrategy to prevent seroma formation and prolonged lymphorrhea following axillary dissection.Methods:In this prospective study,65 female patients diagnosed with stage Ⅱb-Ⅲ breast cancer and clinicallyconfirmed axillary lymph node involvement were enrolled.Participants were divided into two groups.The studygroup(n=33)received an intraoperative application of LTA without drainage,while the control group(n=32)underwent standard ALND with placement of a silicone vacuum drain.Postoperative outcomes assessed includedlymphatic drainage volume,number of aspirations,duration of lymphorrhea,length of hospital stay,and incidence of complications.Results:Use of the LTA significantly reduced both the volume and duration of postoperative lymphorrhea.Bypostoperative day 10,the average wound exudate volume in the LTA group was 8.2±3.3 mL,compared to54.1±3.9 mL in the control group—an 84.8%reduction.The LTA group also experienced shorter hospital staysand fewer cases of postoperative seroma requiring intervention.Conclusion:LTA appears to be a safe,effective,and practical intraoperative technique for preventing lymphaticcomplications after ALND.Its use may reduce dependence on drainage systems,shorten hospitalization,andsupport earlier initiation of adjuvant therapies,ultimately improving surgical outcomes and patient recovery.
文摘Irisin is a chief myokine released during physical activity and has garnered attention for its potential therapeutic effects on different metabolic and cardiovascular disorders.This review explores the intricate connections between irisin,physical activity,sarcopenia,type 2 diabetes mellitus(T2DM),and cardiovascular complications.Experimental data suggests that through irisin release,physical activity positively influences muscle health,metabolic regulation,and cardiovascular function.In individuals with sarcopenia,characterized by progressive muscle mass and function loss,irisin plays a pivotal role in maintaining muscle integrity and function.Additionally,irisin’s beneficial effects on insulin sensitivity and glucose metabolism suggest its involvement in the pathophysiology of T2DM.The review will examine how irisin may modulate the development of cardiovascular complications,particularly in the context of diabetes and aging.Additionally,it will explore its potential as a therapeutic target for managing sarcopenia,T2DM,and cardiovascular complications,underscoring the importance of physical activity in mitigating these interconnected health challenges.Further research is needed to elucidate the precise mechanisms by which irisin mediates these effects and assess its clinical applicability in preventing and treating metabolic and cardiovascular disorders.
文摘This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion.A total of 70 children with inguinal hernia admitted to our hospital from July 2023 to June 2024 and treated with laparoscopic surgery were selected as study subjects and randomly divided into an observation group and a control group,with 35 cases in each.Both groups received routine nursing care,while the observation group additionally adopted the integrated medical and nursing working mode,including systematic health education,psychological interventions,and postoperative follow-up from admission to discharge.The anxiety and depression scores of the two groups before and after surgery,medical compliance index,and incidence of complications during hospitalization were compared.Results showed that the preoperative anxiety scores of the observation and control groups were(14.01±1.07)and(14.62±2.31),respectively,with no statistically significant difference(P>0.05);however,postoperative anxiety scores were significantly lower in the observation group(4.01±0.77)compared to the control group(6.62±0.31)(P<0.05).Similarly,preoperative depression scores were(15.11±1.22)in the observation group and(15.41±2.01)in the control group(P>0.05),but postoperative depression scores were significantly reduced in the observation group(4.24±0.61)compared to the control group(7.12±0.54)(P<0.05).After intervention,the medical compliance behavior index in the observation group was(83.31±5.92),significantly higher than(75.34±6.73)in the control group(P<0.05).Regarding postoperative complications,only 1 case(2.86%)occurred in the observation group,while 8 cases(22.86%)were reported in the control group,showing a statistically significant difference(P<0.05).In conclusion,the medical and nursing integration working mode effectively improves the perioperative psychological state of children,enhances medical compliance,reduces postoperative complications,and is worthy of widespread clinical application.
基金supported by the Natural Science Foundation of Fujian Province(No.2022J01755)。
文摘Objective:This study aimed to develop and validate a predictive model for postoperative complications in gastrointestinal cancer patients using a large multicenter database,based on machine learning algorithms.Methods:We analyzed the clinicopathological data of 3,926 gastrointestinal cancer patients from the Prevalence of Abdominal Complications After GastroEnterological surgery(PACAGE)database,covering 20 medical centers from December 2018 to December 2020.The predictive performance was evaluated using receiver operating characteristic(ROC)curves and Brier Score.Results:The patients were divided into gastric(2,271 cases)and colorectal cancer(1,655 cases)groups and further divided into training and external validation sets.The overall postoperative complication rates for gastric and colorectal cancer groups were 18.1%and 14.8%,respectively.The most common complication was the intraabdominal infection in both gastric and colorectal cancer groups.In the training set,the Random Forest(RF)model predicted the highest mean area under the curve(AUC)values for overall complications and different types of complications,in both the gastric cancer group and the colorectal cancer group,with similar results obtained in the external validation set.ROC curve analysis showed good predictive performance of the RF model for overall and infectious complications.An application-based clinical tool was developed for easy application in clinical practice.Conclusions:This model demonstrated good predictive performance for overall and infectious complications based on the multi-center database,supporting clinical decision-making and personalized treatment strategies.
基金supported by the National Natural Science Foundation of China(Nos.52203046 and 82171219)Sichuan Science and Technology Program(No.2023NSFSC1944)+3 种基金West China Nursing Discipline Development Special Fund ProjectSichuan University(No.HXHL21007)the China Postdoctoral Science Foundation(No.2023M742483)the National Natural Science Foundation of Guangdong(No.2024A1515012881)。
文摘Endotracheal intubation-related complications are common in clinical,and there are currently no effective strategies to address these matters.Inspired by the biological characteristics of human airway mucus(HAM),an artificial airway mucus(ARM)coating is straightforwardly constructed by combining carboxymethyl chitosan with methyl cellulose.The ARM coating exhibited excellent lubricity(coefficient of friction(Co F)=0.05)and hydrophilicity(water contact angle(WCA)=21.3°),and was capable of coating both the internal and external surfaces of the endotracheal tube(ETT).In vitro experiments demonstrated that the ARM coating not only showed good broad-spectrum antibacterial activity,but also significantly reduced nonspecific protein adhesion.Through an in vivo intubation cynomolgus monkey model,ARM-coated ETT potently mitigated airway injury and inflammation,and was highly potential to prevent bacterial infection and catheter blockage.This work offers a promising avenue for the development of airway-friendly invasive devices.
基金Supported by The Natural Science Foundation of Nanjing University of Chinese Medicine,No.XZR2021019The Outstanding Young Doctor Program of Jiangsu Province of Chinese Medicine,No.2023QB0140+1 种基金Project of National Clinical Research Base of Traditional Chinese Medicine in Jiangsu Province,No.JD2022SZ18The Natural Science Foundation of Nanjing University of Chinese Medicine,No.KYCX21_1710.
文摘BACKGROUND Heart rate variability(HRV)represents efferent vagus nerve activity,which is suggested to be related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various cancers.Therefore,this study hypothesized that HRV monitoring could predict perioperative complication(PC)in colorectal cancer(CRC)patients.AIM To investigate the prognostic value of HRV in hospitalized CRC patients.METHODS The observational studies included 87 patients who underwent CRC surgical procedures under enhanced recovery after surgery programs in a first-class hospital.The HRV parameters were compared between the PC group and the non PC(NPC)group from preoperative day 1 to postoperative day(Pod)3.In addition,inflammatory biomarkers and nutritional indicators were also analyzed.RESULTS The complication rate was 14.9%.HRV was markedly abnormal after surgery,especially in the PC group.The frequency-domain parameters(including pNN50)and time-domain parameters[including high-frequency(HF)]of HRV were significantly different between the two groups postoperatively.The pNN50 was significantly greater at Pod1 in the PC group than that in the NPC group and returned to baseline at Pod2,suggesting that patients with complications exhibited autonomic nerve dysfunction in the early postoperative period.In the PC group,HFs were also enhanced from Pod1 and were significantly higher than in the NPC group;inflammatory biomarkers were significantly elevated at Pod2 and Pod3;the levels of nutritional indicators were significantly lower at Pod1 and Pod2;and the white blood cell count was slightly elevated at Pod3.CONCLUSION HRV is independently associated with postoperative complications in patients with CRC.Abnormal HRV could predicted an increased risk of postoperative complications in CRC patients.Continuous HRV could be used to monitor complications in patients with CRC during the perioperative period.
基金Supported by Jiaxing Science and Technology Projects,No.2023AD31041。
文摘BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.
文摘Chronic otitis media(COM)is a long-standing inflammatory condition affecting the middle ear and mastoid cavity,often resulting in progressive structural damage and functional deficits.Radiological imaging is fundamental in diagnosing the disease,assessing its severity,and identifying possible complications.The literature indicates that the prevalence rates of extracranial and intracranial complications range from 0.69% to 5%,while the mortality rate for intracranial complications is 26%.While magnetic resonance imaging is particularly useful in distinguishing soft tissue abnormalities and detecting intracranial extensions like meningitis,brain abscess,and sigmoid sinus thrombosis,highresolution computed tomography remains the preferred modality for evaluating bony erosion,cholesteatoma,and mastoid involvement.Key complications such as ossicular chain destruction,facial nerve damage,and labyrinthine fistulae can be precisely identified using advanced imaging modalities,allowing for timely and effective surgical intervention.This minireview underscores the essential role of radiology in both diagnosing and managing COM,highlighting critical imaging findings that facilitate early detection and inform treatment decisions.A collaborative approach among radiologists,otolaryngologists,and infectious disease specialists is crucial for improving clinical outcomes in affected patients.
基金supported by grants from the Science Fund for Creative Research Groups of the National Natural Science Founda-tion of China(81521091 and 82073031)the National Natural Sci-ence Foundation of China(92269204)Clinical Research Plan of SHDC(SHDC2020CR5007 and SHDC22020213)。
文摘Background:Currently,there is a deficiency in a strong risk prediction framework for precisely evaluating the likelihood of severe postoperative complications in patients undergoing elective hepato-pancreatobiliary surgery subsequent to experiencing breakthrough infection of coronavirus disease 2019(COVID-19).This study aimed to find factors predicting postoperative complications and construct an innovative nomogram to pinpoint patients who were susceptible to developing severe complications following breakthrough infection of COVID-19 after undergoing elective hepato-pancreato-biliary surgery.Methods:This multicenter retrospective cohort study included consecutive patients who underwent elective hepato-pancreato-biliary surgeries between January 3 and April 1,2023 from four hospitals in China.All of these patients had experienced breakthrough infection of COVID-19 prior to their surgeries.Additionally,two groups of patients without preoperative COVID-19 infection were included as comparative controls.Surgical complications were meticulously documented and evaluated using the comprehensive complication index(CCI),which ranged from 0(uneventful course)to 100(death).A CCI value of 20.9 was identified as the threshold for defining severe complications.Results:Among 2636 patients who were included in this study,873 were included in the reference group I,941 in the reference group II,389 in the internal cohort,and 433 in the external validation cohort.Multivariate logistic regression analysis revealed that completing a full course of COVID-19 vaccination>6 months before surgery,undergoing surgery within 4 weeks of diagnosis of COVID-19 breakthrough infection,operation duration of 4 h or longer,cancer-related surgery,and major surgical procedures were significantly linked to a CCI>20.9.A nomogram model was constructed utilizing CCI>20.9 in the training cohort[area under the curve(AUC):0.919,95%confidence interval(CI):0.881–0.957],the internal validation cohort(AUC:0.910,95%CI:0.847–0.973),and the external validation cohort(AUC:0.841,95%CI:0.799–0.883).The calibration curve for the probability of CCI>20.9 demonstrated good agreement between the predictions made by the nomogram and the actual observations.Conclusions:The developed model holds significant potential in aiding clinicians with clinical decisionmaking and risk stratification for patients who have experienced breakthrough infection of COVID-19 prior to undergoing elective hepato-pancreato-biliary surgery.
文摘BACKGROUND The annual incidence of gastric cancer in elderly patients is increasing.Despite the continuous progress in treatment methods,the prognosis of elderly patients remains poor,and postoperative complications are frequent.Obesity is believed to be associated with the risk of gastric cancer and postoperative prognosis;however,the effect of visceral fat distribution on postoperative complications of gastric cancer in elderly patients remains unclear.AIM To explore the effect of visceral fat distribution on postoperative complications of gastric cancer in elderly patients.METHODS A total of 163 elderly patients treated at the Affiliated Longyan First Hospital of Fujian Medical University after radical gastrectomy between January 2021 and January 2024 were enrolled.The patients'visceral and subcutaneous fat distributions were measured and divided into a high visceral fat area(VFA-H)group and a low visceral fat area(VFA-L)group,with a critical value of 100 cm^(2).The ttest andχ^(2) test were used to calculate and analyze the relationship between visceral fat area(VFA)and complications.Independent risk factors for postoperative complications were analyzed using binary logistic regression analysis.RESULTS Compared with the VFA-L group,the incidence of postoperative complications was higher in the VFA-H group(27.8%vs 6.4%,P<0.001),and the operation time was longer(268.55±63.41 vs 224.31±51.89,P<0.001).The amount of blood loss was more(163.77±105.27 mL vs 127.93±98.26 mL,P<0.001).Logistic regression analysis showed that VFA[odds ratio(OR):2.597,95%CI:1.479-4.853,P=0.004],total fat area(OR:1.655,95%CI:1.076-4.040,P=0.013),and the visceral subcutaneous fat area ratio(OR:2.046,95%CI:1.196-5.640,P=0.008)were independent risk factors for postoperative complications.CONCLUSION This study showed that postoperative complications are closely related to fat distribution in elderly patients with gastric cancer undergoing gastrectomy.A high VFA is associated by a high incidence of postoperative complications.
文摘Objective This study aimed to explore the impact of chronic kidney disease(CKD)on prognosis of patients older than 80 years after hip fracture.Methods This retrospective,observational,single-center study included patients older than 80 years who underwent hip fracture operations between Feburary 2013 to June 2021 at our hospital.Patients were divided into CKD and non-GKD groups based on the estimated glomerular filtration rate(eGFR)<60 mL/(min·1.73m2)]or not.Outcomes were the incidence of in-hospital postoperative infectious and non-infectious complications,30-day readmission,and in-hospital death.Logistic regression analysis was used to calculate the odds ratio(OR)of CKD on these outcomes.Results A total of 498 patients were included,165 in the CKD group and 333 in the non-CKD group.Eighty-seven(52.7%)CKD patients experienced 140 episodes of postoperative complications.In comparison,114(34.2%)non-CKD patients had 158 episodes of postoperative complications.CKD patients were more likely to have postoperative complications than non-CKD patients(OR=2.143,95%CI:1.465-3.134,P<0.001).CKD increased the risk of cardiovascular complications(OR=2.044,95%CI:1.245-3.356,P=0.004),acute kidney injury(OR=3.401,95%CI:1.905-6.072,P<0.001),delirium(OR=2.276,95%CI:1.140-4.543,P=0.024),and gastrointestinal bleeding(OR=4.151,95%CI:1.025-16.812,P=0.031).The transfusion rate(OR=2.457,95%CI:1.668-3.618,P<0.001)and incidence of 30-day readmission(OR=2.426,95%CI:1.203-4.892,P=0.011)in CKD patients were significantly higher than those in patients without CKD.Conclusion CKD is associated with poor postoperative outcomes in geriatric hip fracture patients.Special attention should be paid to patients with CKD.
基金Supported by the Chongqing Natural Science Foundation,No.cstc2020jcyj-msxmX0288the Chongqing Medical University Program for Youth Innovation in Future Medicine,No.W0190.
文摘BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022.Postoperative complications were classified using the Clavien-Dindo system.RESULTS The overall complication rate was 28.4%(142/500),with 15.2%(76/500)experiencing major complications(Clavien-Dindo grade≥III).Pulmonary complications were the most frequent(10.8%),followed by surgical site infections(8.6%),and anastomotic leakage(4.2%).Age 70 years or more,body mass index of 25 kg/m²or more,advanced tumor stage,total gastrectomy,and operative time 240 min or more emerged as independent risk factors.CONCLUSION Focused preoperative risk assessment,targeted interventions,and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.
