Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of pr...BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of prognosis.AIM To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.METHODS A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People’s Hospital from January 2021 to June 2024 were retrospectively analyzed.Patients were divided into the abdominal[visceral fat area(VFA)≥100.00 cm^(2),n=80]and non-abdominal(VFA<100.00 cm^(2),n=70)obesity groups according to the VFA measured by preoperative computed tomography.The two groups showed no significant differences in age,sex,tumor location,tumor-node-metastasis stage,and underlying disease(P>0.05).All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management.Complications,nutritional status,changes in biochemical indicators,and tumor recurrence and metastasis were evaluated postoperatively.RESULTS The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group(P<0.05).The pulmonary infection on postoperative day(POD)3(P=0.038),anastomotic leakage on POD 7(P=0.042),and moderate-to-severe complications(Clavien-Dindo class III,P=0.03)were significantly different.With respect to biochemical indicators,the white blood cell count,neutrophil percentage,and C-reactive protein level in the abdominal obesity group continuously increased after surgery(P<0.05);the albumin level on POD 1 was even lower(P=0.024).Regarding tumor markers,carcinoembryonic antigen(P=0.039)and carbohydrate antigen 19-9(P=0.048)levels were significantly higher in the abdominal obesity group at 3 months after surgery,and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery(P<0.05).Abdominal obesity was an independent risk factor for postoperative complications(odds ratio:3.843,P=0.001),overall survival[hazard ratio(HR):1.937,P=0.011],and disease-free survival(HR:1.769,P=0.018).CONCLUSION Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis.Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.展开更多
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
Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30...Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30%-40%.The common complications following esophagectomy are pulmonary infections,cardiac events,anastomotic leakage,bleeding,chylous leak,and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay,increased treatment cost and poor quality of life.A nomographic model comprising preoperative(patient,disease and treatment related)and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity.This will aid in optimizing the modifiable risk factors preoperatively,and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.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 Poor glycaemic control in patients with type 2 diabetes mellitus(T2DM)is often accompanied by multiple complications,including diabetic nephropathy(DN),diabetic retinopathy(DR),diabetic peripheral neuropath...BACKGROUND Poor glycaemic control in patients with type 2 diabetes mellitus(T2DM)is often accompanied by multiple complications,including diabetic nephropathy(DN),diabetic retinopathy(DR),diabetic peripheral neuropathy(DPN),and cardiac structural abnormality left ventricular hypertrophy(LVH).Early identification of high-risk populations for these complications and the implementation of intervention measures are crucial for improving patient outcomes.Serum alpha-1-microglobulin(α1-MG),a multifunctional protein synthesized by the liver and lymphocytes,has been considered a potential biomarker of diabetes-related diseases in recent years.AIM To investigate the associations of serumα1-MG with DN,DR,DPN,and LVH in T2DM patients and its predictive value.METHODS This retrospective study included 5045 T2DM patients.The study participants were stratified into quartiles according to their serumα1-MG levels.Multivariate logistic regression,restricted cubic spline,and explainable machine learning models were employed for risk assessment and feature importance evaluation.RESULTS Increasedα1-MG levels were observed in patients with DN,DR,DPN,and LVH(all P<0.001).Multivariate logistic regression revealed that each standard deviation increase inα1-MG was associated with an 84%increase in DN risk(OR:1.84,95%CI:1.62-2.10,P<0.001),a 17%increase in DR risk(OR:1.17,95%CI:1.07-1.28,P<0.001),a 14%increase in DPN risk(OR:1.14,95%CI:1.03-1.27,P=0.014),and a 28%increase in LVH risk(OR:1.28,95%CI:1.18-1.38,P<0.001).Subgroup analyses and machine learning confirmed the associations of elevatedα1-MG with these complications in T2DM patients.CONCLUSION Elevated serumα1-MG levels were independently associated with increased risks of DN,DR,DPN,and LVH in T2DM patients,suggesting its potential as a predictive biomarker.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
Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and periopera...Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and perioperative risks have not been well established.The objective of this study is to compare the peri-and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.Methods A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database.Statistical analysis involved t test,chi-square test,and logistic regression analysis with the use of the random forest algorithm.The primary outcomes were perioperative and postoperative complications.Results Of the total cohort,45,307(91.6%)underwent laparoscopic salpingectomy,and 4138(8.4%)received laparoscopic tubal ligation.There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics,including age,BMI,minority status,and variations in past medical history.These demographic characteristics were controlled for in the multivariate regression analysis.Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation(OR=1.78,95%CI:1.46-2.20,p<0.001).Salpingectomy was associated with a greater risk of longer operation time(OR=2.03,95%CI:2.02-2.04,p<0.001),longer hospital stay(OR=5.26,95%CI:4.57-6.09,p<0.001),increased readmission(OR=3.15,95%CI:1.92-5.65,p<0.001),and increased unplanned reoperation(OR=2.42,95%CI:1.32-5.12,p=0.010).In addition,the occurrence rates of organ space surgical site infection(OR=2.68,95%CI:1.21-7.59,p=0.032)and sepsis(OR=3.93,95%CI:1.48-16.02,p=0.020)were significantly greater in the salpingectomy group than in the tubal ligation group.Conclusions Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception;however,salpingectomy is more likely to be associated with peri-and postoperative complications.These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.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
BACKGROUND Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure.Few studies focused on intraoperative anastomotic complications in eso...BACKGROUND Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure.Few studies focused on intraoperative anastomotic complications in esophagojejunostomy with circular stapler.AIM To explore whether endoscopic examination could reduce the occurrence of early postoperative anastomotic complications.METHODS Clinical data from 160 patients with gastric cancer who underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler at Nanchong Central Hospital from January 2020 to December 2023 were retrospectively analyzed.Based on whether intraoperative endoscopic examination(IEE)was performed,patients were divided into the IEE group and the non-IEE(NIEE)group.RESULTS All patients successfully underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler.In the IEE group,7(8.8%)patients were found to have anastomotic defects:3(3.8%)air leaks,2(2.5%)bleeding,1(1.3%)stricture and 1(1.3%)full-thickness tearing.Three patients with anastomotic discontinuities were subsequently treated with additional suturing.One anastomotic bleeding was managed with laparoscopic suturing,and another was treated with endoscopic clips.One patient had anastomotic stricture,which was corrected intraoperatively.One patient experienced full-thickness tearing caused by the circular stapler,necessitating a redo anastomosis.These anastomotic defects were repaired intraoperatively,and no postoperative anastomotic complications occurred.6(7.5%)patients with postoperative anastomotic complications were observed in the NIEE group.The NIEE group had a significantly higher incidence of postoperative anastomosis-related complications compared to the IEE group(7.5%vs 0%;P=0.029).CONCLUSION Routine IEE significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects in esophagojejunostomy with circular stapler.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
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
文摘BACKGROUND Elderly patients with colorectal cancer(CRC)can judge the risk of postoperative complications and oncological outcomes due to visceral obesity,which can provide data reference for the early prediction of prognosis.AIM To explore the effect of visceral obesity on postoperative complications and oncological outcomes in elderly patients with CRC.METHODS A total of 150 elderly patients who underwent radical surgery for CRC at Inner Mongolia Medical University and Inner Mongolia Autonomous Region People’s Hospital from January 2021 to June 2024 were retrospectively analyzed.Patients were divided into the abdominal[visceral fat area(VFA)≥100.00 cm^(2),n=80]and non-abdominal(VFA<100.00 cm^(2),n=70)obesity groups according to the VFA measured by preoperative computed tomography.The two groups showed no significant differences in age,sex,tumor location,tumor-node-metastasis stage,and underlying disease(P>0.05).All patients underwent standardized laparoscopic assisted surgery and received unified perioperative management.Complications,nutritional status,changes in biochemical indicators,and tumor recurrence and metastasis were evaluated postoperatively.RESULTS The overall incidence of postoperative complications was significantly higher in the abdominal obesity group than in the non-abdominal obesity group(P<0.05).The pulmonary infection on postoperative day(POD)3(P=0.038),anastomotic leakage on POD 7(P=0.042),and moderate-to-severe complications(Clavien-Dindo class III,P=0.03)were significantly different.With respect to biochemical indicators,the white blood cell count,neutrophil percentage,and C-reactive protein level in the abdominal obesity group continuously increased after surgery(P<0.05);the albumin level on POD 1 was even lower(P=0.024).Regarding tumor markers,carcinoembryonic antigen(P=0.039)and carbohydrate antigen 19-9(P=0.048)levels were significantly higher in the abdominal obesity group at 3 months after surgery,and local recurrence rates were higher than those in the non-abdominal obesity group at 30 days and 3 months after surgery(P<0.05).Abdominal obesity was an independent risk factor for postoperative complications(odds ratio:3.843,P=0.001),overall survival[hazard ratio(HR):1.937,P=0.011],and disease-free survival(HR:1.769,P=0.018).CONCLUSION Visceral obesity significantly increases the risk of postoperative complications in elderly patients with CRC and may adversely affect short-term tumor prognosis.Preoperative risk identification and interventions for abdominal obesity should be strengthened to improve perioperative safety and postoperative rehabilitation quality.
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Perioperative morbidity of esophagectomy significantly affects the surgical outcome,like any major gastrointestinal procedure.Despite introduction of minimally invasive esophagectomy,the morbidity is still close to 30%-40%.The common complications following esophagectomy are pulmonary infections,cardiac events,anastomotic leakage,bleeding,chylous leak,and recurrent laryngeal nerve palsy which in turn lead to longer hospital stay,increased treatment cost and poor quality of life.A nomographic model comprising preoperative(patient,disease and treatment related)and intraoperative factors in combination with Artificial Intelligence may accurately identify the patients at higher risk of morbidity.This will aid in optimizing the modifiable risk factors preoperatively,and closely monitor these patients post operatively for early identification of complications and to initiate early corrective measures to improve the surgical outcome.
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 Poor glycaemic control in patients with type 2 diabetes mellitus(T2DM)is often accompanied by multiple complications,including diabetic nephropathy(DN),diabetic retinopathy(DR),diabetic peripheral neuropathy(DPN),and cardiac structural abnormality left ventricular hypertrophy(LVH).Early identification of high-risk populations for these complications and the implementation of intervention measures are crucial for improving patient outcomes.Serum alpha-1-microglobulin(α1-MG),a multifunctional protein synthesized by the liver and lymphocytes,has been considered a potential biomarker of diabetes-related diseases in recent years.AIM To investigate the associations of serumα1-MG with DN,DR,DPN,and LVH in T2DM patients and its predictive value.METHODS This retrospective study included 5045 T2DM patients.The study participants were stratified into quartiles according to their serumα1-MG levels.Multivariate logistic regression,restricted cubic spline,and explainable machine learning models were employed for risk assessment and feature importance evaluation.RESULTS Increasedα1-MG levels were observed in patients with DN,DR,DPN,and LVH(all P<0.001).Multivariate logistic regression revealed that each standard deviation increase inα1-MG was associated with an 84%increase in DN risk(OR:1.84,95%CI:1.62-2.10,P<0.001),a 17%increase in DR risk(OR:1.17,95%CI:1.07-1.28,P<0.001),a 14%increase in DPN risk(OR:1.14,95%CI:1.03-1.27,P=0.014),and a 28%increase in LVH risk(OR:1.28,95%CI:1.18-1.38,P<0.001).Subgroup analyses and machine learning confirmed the associations of elevatedα1-MG with these complications in T2DM patients.CONCLUSION Elevated serumα1-MG levels were independently associated with increased risks of DN,DR,DPN,and LVH in T2DM patients,suggesting its potential as a predictive biomarker.
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Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and perioperative risks have not been well established.The objective of this study is to compare the peri-and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.Methods A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database.Statistical analysis involved t test,chi-square test,and logistic regression analysis with the use of the random forest algorithm.The primary outcomes were perioperative and postoperative complications.Results Of the total cohort,45,307(91.6%)underwent laparoscopic salpingectomy,and 4138(8.4%)received laparoscopic tubal ligation.There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics,including age,BMI,minority status,and variations in past medical history.These demographic characteristics were controlled for in the multivariate regression analysis.Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation(OR=1.78,95%CI:1.46-2.20,p<0.001).Salpingectomy was associated with a greater risk of longer operation time(OR=2.03,95%CI:2.02-2.04,p<0.001),longer hospital stay(OR=5.26,95%CI:4.57-6.09,p<0.001),increased readmission(OR=3.15,95%CI:1.92-5.65,p<0.001),and increased unplanned reoperation(OR=2.42,95%CI:1.32-5.12,p=0.010).In addition,the occurrence rates of organ space surgical site infection(OR=2.68,95%CI:1.21-7.59,p=0.032)and sepsis(OR=3.93,95%CI:1.48-16.02,p=0.020)were significantly greater in the salpingectomy group than in the tubal ligation group.Conclusions Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception;however,salpingectomy is more likely to be associated with peri-and postoperative complications.These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.
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.
文摘BACKGROUND Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure.Few studies focused on intraoperative anastomotic complications in esophagojejunostomy with circular stapler.AIM To explore whether endoscopic examination could reduce the occurrence of early postoperative anastomotic complications.METHODS Clinical data from 160 patients with gastric cancer who underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler at Nanchong Central Hospital from January 2020 to December 2023 were retrospectively analyzed.Based on whether intraoperative endoscopic examination(IEE)was performed,patients were divided into the IEE group and the non-IEE(NIEE)group.RESULTS All patients successfully underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler.In the IEE group,7(8.8%)patients were found to have anastomotic defects:3(3.8%)air leaks,2(2.5%)bleeding,1(1.3%)stricture and 1(1.3%)full-thickness tearing.Three patients with anastomotic discontinuities were subsequently treated with additional suturing.One anastomotic bleeding was managed with laparoscopic suturing,and another was treated with endoscopic clips.One patient had anastomotic stricture,which was corrected intraoperatively.One patient experienced full-thickness tearing caused by the circular stapler,necessitating a redo anastomosis.These anastomotic defects were repaired intraoperatively,and no postoperative anastomotic complications occurred.6(7.5%)patients with postoperative anastomotic complications were observed in the NIEE group.The NIEE group had a significantly higher incidence of postoperative anastomosis-related complications compared to the IEE group(7.5%vs 0%;P=0.029).CONCLUSION Routine IEE significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects in esophagojejunostomy with circular stapler.
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.
