Objectives: Hypoglycemia is a recognized danger in pediatric patients. Extended period of preoperative fasting in this subset of patients is not well tolerated with metabolic derangements. The oral carbohydrate loadin...Objectives: Hypoglycemia is a recognized danger in pediatric patients. Extended period of preoperative fasting in this subset of patients is not well tolerated with metabolic derangements. The oral carbohydrate loading preoperatively can ameliorate many adverse effects. The aim of this study was to compare the glycemic profile in pediatric cardiac surgical patients kept fasting preoperatively with those fed oral clear solutions of carbohydrate half hour prior to induction of anaesthesia. Also we tried to establish a correlation with other factors contributing to preoperative hypoglycemia. Methodology: We planned a randomized controlled study. Group A included patients who were kept fasting according to the ASA guidelines preoperatively and Group B included patients who received 2 ml per kg of body weight of 10% Dextrose water as oral feeds half hour before the expected time of start of anaesthesia. Results: The mean (SD) preoperative BG concentrations were higher in group B (102.5 ±16.97) as compared to group A (64.08 ± 25.37) (p value -0.86 and -0.67) (pvalue Conclusion: Preoperative oral carbohydrate preloading can develop as the easiest and cheapest path to better perioperative blood glucose concentration management in congenital cardiac disease children.展开更多
Aim: Wilms tumor (WT) is the most frequent type of pediatric renal tumors. Her/2 is an oncoprotein, its over-expression revealed to play a very vital role in the progress and improvement of certain tumors. This study ...Aim: Wilms tumor (WT) is the most frequent type of pediatric renal tumors. Her/2 is an oncoprotein, its over-expression revealed to play a very vital role in the progress and improvement of certain tumors. This study evaluates the possible role of Her/2 as a prognostic indicator in formerly treated WT. Method: Immunohistochemical expression of Her/2 was studied in paraffin material of 40 WT patients followed SIOP 9 protocol. Patients’ medical records reviewed for clinical, pathological and outcome data and correlated with HER2 expression. Additional 15 samples of normal surrounding kidney tissue specimens were included. Results: Her/2 was often expressed in normal kidney tissue (renal tubules but not glomeruli) and at variable levels in the three elements of WT. At a median of 84 months, 70% of patients are living and under follow-up, surgical stage and pathologic subtypes were the only two factors significantly affect the outcome of our patients (p = 0.000, p = 0.007 & p = 0.004, p = 0.005 for OS (Overall survival) and DFS (Disease Free survival) respectively). Her/2 expression was associated with epithelial differentiation (p < 0.001). There was non-significant effect of Her/2 expression on OS or DFS of studied group. Conclusion: while the major progress in studying biology of WT, stage and pathological subtype continues the only predictive factors of significant value affecting the outcome of patients with WT. There was important association between Her/2 expression and histological differentiation in formerly treated Wilms tumor. Non-conclusive results regarding influence of Her/2 expression on the result of WT patients were found.展开更多
We have experienced three inverted Meckel’s diverticula with ileus that are diagnosed before surgery and treated with laparoscopic surgery. The patients were 22, 26, and 29 years of age. The history of ileus for each...We have experienced three inverted Meckel’s diverticula with ileus that are diagnosed before surgery and treated with laparoscopic surgery. The patients were 22, 26, and 29 years of age. The history of ileus for each patient differed, being the first experience for one patient, the second for another, and the third experience for the remaining patient. None of these patients had a history of abdominal surgery. Conservative therapy eventually improved the existing symptoms, but the cause of past ileus remained unclear. Elective surgery was performed 12 days from the onset of symptoms on two of the patients after improving the ileus by inserting a long tube into the bowel. Emergency surgery was performed on the same day of admission on the remaining case that involved moderate expansion of intestine. In these patients, the first trocar was inserted into the umbilicus region. Laparoscopic surgery was then performed with three trocars. The patients were discharged upon favorable outcome after surgery. No recurrence of ileus was noted post-surgery. Laparoscopy was useful both to diagnose and treat ileus of a Meckel’s diverticulum.展开更多
Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to mak...Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to make the loops preoperatively and rebuild the elongated/ruptured chordae intraoperatively. Materials and method From June 2011 to February 2012, 19 consecutive cases with mitral anterior leaflet prolapse underwent valve repair procedures. Echocardiography was used to determine the length of normal chordae that the prolapsed leaflets should have for normal coaptation. The artificial chordae was fabricated in loops according to echo-determined length. Results All patients survived the operations. 2.8 preoperatively prepared loops were used per patient to restore the anterior leaflets, as well as posterior leaflets. Artificial mitral valve rings were applied to 18 patients for mitral annuloplasty. 16 patients were underwent different concomitant operations. Echocardiographic results at discharge showed that grade of mitral regurgitation, left ventricular end-diastolic, end-systolic dimension de-creased definitely,respectively from 3.26 ± 1.10, 53.79 ± 15.03 mm, 33.00 ± 12.05 mm preoperatively to 0.47 ± 0.61 （P 〈 0.01）, 44.74±10.28 mm （P 〈 0.01）, 30.16 ± 10.58 mm （P 〈 0.05） postoperatively. All patients improved clinically and NYHA functional class Conclusion Reconstruction of prolapsed anterior decreased significantly from 2.17 ± 0.81 to 1.12 ± 0.33. leaflet chordae with artificial loops in preoperatively echo-de-termined length is safe and effective, and initial clinical outcome is satisfactory.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
Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in in...Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in infants.However,the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant.This review explores historical developments,various approaches to measuring the required functional liver mass,and techniques to prevent complications associated with large-for-size grafts in infants.展开更多
BACKGROUND Primary splenic lesions are rare and often detected incidentally through imaging,biopsy,or autopsy,typically without distinct clinical symptoms.Although imaging can help differentiate benign from malignant ...BACKGROUND Primary splenic lesions are rare and often detected incidentally through imaging,biopsy,or autopsy,typically without distinct clinical symptoms.Although imaging can help differentiate benign from malignant lesions,splenic hamartomas,and angiosarcomas may exhibit overlapping features,making diagnosis challenging.This report presents a case of splenic hamartoma suspected to be an angiosarcoma based on preoperative imaging.Splenic hamartomas that mimic angiosarcomas are exceedingly rare.CASE SUMMARY A 33-year-old male presented to the Department of Emergency with frank red blood hematemesis and a 1-week history of epigastric pain.On arrival,he was alert and hemodynamically stable.Contrast-enhanced abdominal computed tomography revealed splenomegaly with significant engorgement of the portal and splenic veins,along with a diffuse nodular splenic lesion measuring 8.2 cm×6.2 cm.Following esophageal varix ligation,abdominal magnetic resonance imaging demonstrated iso-to high-signal intensity within the splenic mass and multiple hypervascular lesions in the right hepatic lobe,raising suspicion for splenic an-giosarcoma with hepatic metastases.18F-fluorodeoxyglucose positron emission tomography-computed tomography showed diffusely mild increased metabolic activity in the spleen.The patient subsequently underwent splenectomy and liver biopsy.Histopathological examination revealed chronic inflammation in the liver,and the splenic lesion was confirmed to be a splenic hamartoma.The patient successfully returned to work and remains in good health.CONCLUSION This rare case of splenic hamartoma mimicking angiosarcoma highlights the importance of differential diagnosis in managing splenic tumors.展开更多
Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted betw...Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted between February 2023 and May 2023 in a public hospital in northern Turkey with 123 nurses who agreed to participate in the study.Results:The results showed that 64.2%of the nurses thought that preoperative hair removal should be done by shaving with a razor,74%thought that hair removal should be performed the night before the operation,and 70.7%thought that the patient/patient’s relative should perform preoperative hair removal.Conclusions:This study found that nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of SSI were not at the desired level.Following current resources and improving their levels of knowledge and practices are considered to be important for nurses.展开更多
Objective:The day surgery mode has significantly reduced preoperative waiting time for patients.However,this mode also led to brief and sometimes abrupt interactions between patients with vision loss and nursing staff...Objective:The day surgery mode has significantly reduced preoperative waiting time for patients.However,this mode also led to brief and sometimes abrupt interactions between patients with vision loss and nursing staff during the preoperative visits.Additionally,patients may experience negative emotions.The aim of this study was to describe the preoperative experiences and identify related stressful factors among patients waiting vitreo-retinal day surgery.Methods:This study was guided by an interpretive approach.Semi-structured,face-to-face,in-depth interviews were conducted with patients from August 2021 to October 2024.Inductive content analysis and research software were used to analyze the data.Results:Twenty-seven patients agreed to participate the interviews.Their ages ranged from 19 to 70 years old.The waiting time before hospitalization varied from 7 to 90 days.Three main categories emerged from patients’complaints:day surgery procedures,concerns about eye conditions and supports.Conclusions:The findings underscore the importance of preoperative care services.It is suggested that providing accurate preoperative information and effective support can significantly enhance the quality of preoperative care service.展开更多
Objective: This study evaluates the impact of handshake and information support on patients’ outcomes during laparoscopic cholecystectomy. It examines the effects on their physiological and psychological responses an...Objective: This study evaluates the impact of handshake and information support on patients’ outcomes during laparoscopic cholecystectomy. It examines the effects on their physiological and psychological responses and overall satisfaction with nursing care. Methods: A total of 84 patients scheduled for laparoscopic cholecystectomy were selected through convenient sampling and randomly assigned to either the control group or the intervention group using a random number table. Each group consisted of 42 patients. The control group received standard surgical nursing care. In addition to standard care, the intervention group received handshake and information support from the circulating nurse before anesthesia induction. Vital signs were recorded before surgery and before anesthesia induction. Anxiety levels were measured using the State-Trait Anxiety Inventory (STAI) and the State-Anxiety Inventory (S-AI), while nursing satisfaction was assessed using a numerical rating scale. Results: No significant differences were found between the two groups in systolic and diastolic blood pressures before surgery and anesthesia induction (P > 0.05). However, there was a significant difference in heart rate before anesthesia induction (P Conclusion: Providing handshake and information support before anesthesia induction effectively reduces stress, alleviates anxiety, and enhances comfort and satisfaction among patients undergoing laparoscopic cholecystectomy.展开更多
BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is c...BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation.AIM To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery.METHODS A retrospective analysis of the demographics,preoperative and intraoperative data,and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted.These clinical data were compared between two groups:Patients with sphincter preservation and those without,categorised as the sphincter-preserved and sphincter-unpreserved groups,respectively.RESULTS Of the 179 patients analysed,150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group.Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group.Conversely,elevated levels of carcinoembryonic antigen,carbohydrate antigen 19-9,and plasma D-dimer were significantly higher in the sphincter-unpreserved group.Significant differences were also observed between the two groups in terms of place of residence,presence of colonic polyps,neoadjuvant chemotherapy,preoperative radiotherapy,mucinous adenocarcinoma,nerve invasion,and tumour height.No significant differences were observed for other parameters.Logistic regression analysis identified colonic polyps,mucinous adenocarcinoma,nerve invasion,and tumour height as independent risk factors for sphincter preser-vation.CONCLUSION Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified.These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations.展开更多
Currently,preoperative visits have problems such as monotonous forms and insufficient humanistic care,which affect patients’psychological states and surgical cooperation.This article analyzes the current situation of...Currently,preoperative visits have problems such as monotonous forms and insufficient humanistic care,which affect patients’psychological states and surgical cooperation.This article analyzes the current situation of preoperative visits and the mechanisms influencing patients’psychology,proposes optimization strategies and safeguard measures,and explores the mechanisms of information transmission,emotional support,trust establishment,and environmental familiarity on patients’psychology.It designs optimization plans from the aspects of personalized content,standardized processes,professional techniques,and diversified forms,supplemented by nurse training,system improvement,and quality evaluation to ensure implementation.Practice shows that the optimized preoperative visit can improve the psychological state of patients,enhance surgical cooperation,and optimize the nurse-patient relationship.The conclusion indicates that scientific and standardized preoperative visits can improve the quality of surgical care through multiple psychological effects and are an important link in perioperative care.展开更多
Granular composite(GC)hydrogels have attracted considerable interest in biomedical applications due to their versatile printability and exceptional mechanical properties.However,the lack of comprehensive design guidel...Granular composite(GC)hydrogels have attracted considerable interest in biomedical applications due to their versatile printability and exceptional mechanical properties.However,the lack of comprehensive design guidelines has limited their optimal engineering,as the factors influencing their mechanical performance and printability remain largely unexamined.In this study,we developed GC hydrogels by integrating microgels with interstitial matrices of photocrosslinkable gelatin methacrylate(GelMA).We utilized confocal microscopy and nanoindentation analyses to investigate the spatial distribution and mechanical behavior of these hydrogels.Our findings indicate that the mechanical and rheological properties of GC hydrogels can be precisely tailored by adjusting the volume fraction and size of the microgels.Furthermore,hydrogen bonds were identified as significant contributors to compressive performance,although they had minimal effect on cyclic mechanical behavior.Compared to bulk GelMA hydrogels,GC hydrogels demonstrated enhanced printability and remarkable superelasticity.As a proof of concept,we illustrated their dual printability in embedded printing to create prosthetic liver models for preoperative planning.This study provides valuable insights into the design and optimization of GC hydrogels for advanced biomedical applications.展开更多
This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based r...This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based risk scoring system origi-nally developed in South Korea.The scoring system incorporated five parame-ters:(1)Tumor size;(2)Portal venous phase density;(3)Necrosis;(4)Peripan-creatic infiltration;and(5)Suspected metastatic lymph nodes.While demonstra-ting satisfactory recurrence prediction capability without requiring complex tech-nologies,thereby supporting clinical utility in Chinese populations,the study exhibited notable limitations.Most analyzed patients lacked neoadjuvant chemo-therapy exposure,resulting in underrepresentation of low-risk subgroups.Addi-tionally,the short follow-up duration potentially compromised long-term progno-stic assessment.Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management.However,clinical implementation continues to confront challenges including variability in imaging parameters,incomplete understanding of molecular underpinnings,and confounding treatment effects.Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic,molecular,and clinical data.Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation,ultimately advancing personalized therapeutic strategies for PDAC.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retro...Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retrospectively analyzed 190 patients who underwent ERCP and found that gastrointestinal obstruction,jaundice,opioid use,female sex,and primary diseases were in-dependent predictors and risk factors of preoperative gastric retention.Based on these findings and comprehensive analysis,a proposed predictive model offers clinicians valuable tools to tailor preoperative strategies,improving the proce-dural safety and efficacy of ERCP.Despite having several limitations,like single-center design and limited generalizability,the study marks a significant advan-cement in optimizing ERCP outcomes through predictive analytics.Further research with larger populations and prospective designs is warranted to establish these findings.展开更多
Objective: To assess the impact of preoperative psychological interventions on the care of patients undergoing elective surgery. Methods: Ninety-two patients scheduled for elective surgery in the surgical department b...Objective: To assess the impact of preoperative psychological interventions on the care of patients undergoing elective surgery. Methods: Ninety-two patients scheduled for elective surgery in the surgical department between August 2021 and August 2023 were selected and divided into groups using a random number table. The observation group received preoperative psychological interventions, while the reference group received standard preoperative care. Anxiety and depression scores, fear grading, vital signs, and self-efficacy levels were compared. Results: After the intervention, the anxiety and depression scores in the observation group were lower than those in the reference group, and the proportion of fear graded as Level I was higher. During the waiting period and 15 minutes before entering the operating room, vital sign levels in the observation group were lower than those in the reference group. Additionally, the self-efficacy scores of the observation group were significantly higher than those of the reference group (P < 0.05). Conclusion: Preoperative psychological interventions can alleviate negative emotions, stabilize preoperative vital signs, and significantly improve self-efficacy in patients undergoing elective surgery, demonstrating high feasibility for implementation.展开更多
Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical expe...Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical experience and recovery.This mini review aims to evaluate the impact of preoperative anxiety in children,identify contributing factors,and explore effective strategies to manage this anxiety during day surgery.Methods:A literature review was conducted,focusing on studies that assess anxiety levels in pediatric patients before day surgery and the interventions designed to alleviate this anxiety.The review included both psychological and procedural strategies.Results:Preoperative anxiety in children can be influenced by a variety of factors,including age,previous medical experiences,parental anxiety,and the hospital environment.Untreated anxiety may lead to increased postoperative pain,behavioral changes,and extended recovery times.Several strategies,including psychological preparation,family centered approaches,and the involvement of child life specialists,have been shown to effectively reduce anxiety.Conclusions:Managing anxiety in pediatric day surgery is vital to improving both surgical outcomes and the overall experience for children and their families.Healthcare professionals can play a key role in reducing anxiety through targeted interventions and supportive care.展开更多
BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonanc...BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.展开更多
This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians...This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians in determining surgical indications,assessing patient conditions,and offering valuable assistance in formulating surgical strategies and predicting outcomes.Developed by a collaborative team of experts from the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,in conjunction with the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,these guidelines have been formulated through extensive research and evaluation,incorporating the latest technological advancements and studies on a global and domestic scale in vitreoretinal surgery.After extensive deliberations and incorporation of up-to-date clinical data,these guidelines have been developed to assist in standardizing preoperative examinations for vitreoretinal surgery.The overarching goals include improving medical quality,maximizing resource allocation,offering decision-making assistance,and safeguarding patient rights.This document provides a comprehensive analysis of preoperative assessments for vitreoretinal procedures,covering principles,methodologies,and precautions related to a range of diagnostic techniques including ultra-wide-angle fundus imaging,fluorescein angiography,indocyanine green angiography,ophthalmic B-ultrasound examinations,ultrasound biomicroscopy,optical coherence tomography,optical coherence tomography angiography,orbital CT scan,orbital MRI,and ophthalmic electrophysiology tests such as electroretinograms,visually evoked potentials,and visual field testing.展开更多
BACKGROUND Although obesity is a well-established contributor to surgical risks,evidence regarding the specific outcomes of laparoscopic cholecystectomy(LC)in obese patients remains scarce.AIM To assess clinicopatholo...BACKGROUND Although obesity is a well-established contributor to surgical risks,evidence regarding the specific outcomes of laparoscopic cholecystectomy(LC)in obese patients remains scarce.AIM To assess clinicopathologic differences and 1-year outcomes following elective LC in patients with obesity and gallstone disease.METHODS This retrospective study analyzed data from 65 patients who underwent elective LC for gallstone disease between January 2020 and May 2022,with outcomes assessed at the 1-year follow-up.Patients were categorized as obese(body mass index≥25 kg/m^(2))or non-obese(body mass index<25 kg/m^(2)),and comparisons were made across preoperative laboratory values,intraoperative parameters,and patient-reported outcomes.RESULTS The obese group had significantly higher American Society of Anesthesiologists scores,higher glycated hemoglobin levels,and lower vitamin D levels than the non-obese group.Elevated triglycerides were more frequent in the obese group,whereas higher high-density lipoprotein levels were more common in the nonobese group.Intraoperative and postoperative outcomes did not differ between the groups.At the 1-year follow-up,24.6%of patients reported post-cholecystectomy symptoms,with no group differences.CONCLUSION Obese patients had higher American Society of Anesthesiologists scores,lower vitamin D,and elevated triglycerides preoperatively,but these differences did not significantly affect intraoperative findings or 1-year postoperative outcomes compared to non-obese patients.展开更多
文摘Objectives: Hypoglycemia is a recognized danger in pediatric patients. Extended period of preoperative fasting in this subset of patients is not well tolerated with metabolic derangements. The oral carbohydrate loading preoperatively can ameliorate many adverse effects. The aim of this study was to compare the glycemic profile in pediatric cardiac surgical patients kept fasting preoperatively with those fed oral clear solutions of carbohydrate half hour prior to induction of anaesthesia. Also we tried to establish a correlation with other factors contributing to preoperative hypoglycemia. Methodology: We planned a randomized controlled study. Group A included patients who were kept fasting according to the ASA guidelines preoperatively and Group B included patients who received 2 ml per kg of body weight of 10% Dextrose water as oral feeds half hour before the expected time of start of anaesthesia. Results: The mean (SD) preoperative BG concentrations were higher in group B (102.5 ±16.97) as compared to group A (64.08 ± 25.37) (p value -0.86 and -0.67) (pvalue Conclusion: Preoperative oral carbohydrate preloading can develop as the easiest and cheapest path to better perioperative blood glucose concentration management in congenital cardiac disease children.
文摘Aim: Wilms tumor (WT) is the most frequent type of pediatric renal tumors. Her/2 is an oncoprotein, its over-expression revealed to play a very vital role in the progress and improvement of certain tumors. This study evaluates the possible role of Her/2 as a prognostic indicator in formerly treated WT. Method: Immunohistochemical expression of Her/2 was studied in paraffin material of 40 WT patients followed SIOP 9 protocol. Patients’ medical records reviewed for clinical, pathological and outcome data and correlated with HER2 expression. Additional 15 samples of normal surrounding kidney tissue specimens were included. Results: Her/2 was often expressed in normal kidney tissue (renal tubules but not glomeruli) and at variable levels in the three elements of WT. At a median of 84 months, 70% of patients are living and under follow-up, surgical stage and pathologic subtypes were the only two factors significantly affect the outcome of our patients (p = 0.000, p = 0.007 & p = 0.004, p = 0.005 for OS (Overall survival) and DFS (Disease Free survival) respectively). Her/2 expression was associated with epithelial differentiation (p < 0.001). There was non-significant effect of Her/2 expression on OS or DFS of studied group. Conclusion: while the major progress in studying biology of WT, stage and pathological subtype continues the only predictive factors of significant value affecting the outcome of patients with WT. There was important association between Her/2 expression and histological differentiation in formerly treated Wilms tumor. Non-conclusive results regarding influence of Her/2 expression on the result of WT patients were found.
文摘We have experienced three inverted Meckel’s diverticula with ileus that are diagnosed before surgery and treated with laparoscopic surgery. The patients were 22, 26, and 29 years of age. The history of ileus for each patient differed, being the first experience for one patient, the second for another, and the third experience for the remaining patient. None of these patients had a history of abdominal surgery. Conservative therapy eventually improved the existing symptoms, but the cause of past ileus remained unclear. Elective surgery was performed 12 days from the onset of symptoms on two of the patients after improving the ileus by inserting a long tube into the bowel. Emergency surgery was performed on the same day of admission on the remaining case that involved moderate expansion of intestine. In these patients, the first trocar was inserted into the umbilicus region. Laparoscopic surgery was then performed with three trocars. The patients were discharged upon favorable outcome after surgery. No recurrence of ileus was noted post-surgery. Laparoscopy was useful both to diagnose and treat ileus of a Meckel’s diverticulum.
基金supported by the Natural Science Foundation of Guangdong Province, China (Grant No.S2011010005828)
文摘Background Chordae reconstruction is one of the key points in repair of mitral valve prolapse, especially for anterior leaflets. Here we introduce our experiences of using echo-determined normal chordael length to make the loops preoperatively and rebuild the elongated/ruptured chordae intraoperatively. Materials and method From June 2011 to February 2012, 19 consecutive cases with mitral anterior leaflet prolapse underwent valve repair procedures. Echocardiography was used to determine the length of normal chordae that the prolapsed leaflets should have for normal coaptation. The artificial chordae was fabricated in loops according to echo-determined length. Results All patients survived the operations. 2.8 preoperatively prepared loops were used per patient to restore the anterior leaflets, as well as posterior leaflets. Artificial mitral valve rings were applied to 18 patients for mitral annuloplasty. 16 patients were underwent different concomitant operations. Echocardiographic results at discharge showed that grade of mitral regurgitation, left ventricular end-diastolic, end-systolic dimension de-creased definitely,respectively from 3.26 ± 1.10, 53.79 ± 15.03 mm, 33.00 ± 12.05 mm preoperatively to 0.47 ± 0.61 （P 〈 0.01）, 44.74±10.28 mm （P 〈 0.01）, 30.16 ± 10.58 mm （P 〈 0.05） postoperatively. All patients improved clinically and NYHA functional class Conclusion Reconstruction of prolapsed anterior decreased significantly from 2.17 ± 0.81 to 1.12 ± 0.33. leaflet chordae with artificial loops in preoperatively echo-de-termined length is safe and effective, and initial clinical outcome is satisfactory.
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.
文摘Transplantation of the left lateral section(LLS)of the liver is now an established practice for treating advanced diffuse and unresectable focal liver diseases in children,with variants of the LLS primarily used in infants.However,the surgical challenge of matching the size of an adult donor's graft to the volume of a child's abdomen remains significant.This review explores historical developments,various approaches to measuring the required functional liver mass,and techniques to prevent complications associated with large-for-size grafts in infants.
基金Supported by Clinical Research Grant from Pusan National University Hospital in 2024.
文摘BACKGROUND Primary splenic lesions are rare and often detected incidentally through imaging,biopsy,or autopsy,typically without distinct clinical symptoms.Although imaging can help differentiate benign from malignant lesions,splenic hamartomas,and angiosarcomas may exhibit overlapping features,making diagnosis challenging.This report presents a case of splenic hamartoma suspected to be an angiosarcoma based on preoperative imaging.Splenic hamartomas that mimic angiosarcomas are exceedingly rare.CASE SUMMARY A 33-year-old male presented to the Department of Emergency with frank red blood hematemesis and a 1-week history of epigastric pain.On arrival,he was alert and hemodynamically stable.Contrast-enhanced abdominal computed tomography revealed splenomegaly with significant engorgement of the portal and splenic veins,along with a diffuse nodular splenic lesion measuring 8.2 cm×6.2 cm.Following esophageal varix ligation,abdominal magnetic resonance imaging demonstrated iso-to high-signal intensity within the splenic mass and multiple hypervascular lesions in the right hepatic lobe,raising suspicion for splenic an-giosarcoma with hepatic metastases.18F-fluorodeoxyglucose positron emission tomography-computed tomography showed diffusely mild increased metabolic activity in the spleen.The patient subsequently underwent splenectomy and liver biopsy.Histopathological examination revealed chronic inflammation in the liver,and the splenic lesion was confirmed to be a splenic hamartoma.The patient successfully returned to work and remains in good health.CONCLUSION This rare case of splenic hamartoma mimicking angiosarcoma highlights the importance of differential diagnosis in managing splenic tumors.
文摘Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted between February 2023 and May 2023 in a public hospital in northern Turkey with 123 nurses who agreed to participate in the study.Results:The results showed that 64.2%of the nurses thought that preoperative hair removal should be done by shaving with a razor,74%thought that hair removal should be performed the night before the operation,and 70.7%thought that the patient/patient’s relative should perform preoperative hair removal.Conclusions:This study found that nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of SSI were not at the desired level.Following current resources and improving their levels of knowledge and practices are considered to be important for nurses.
基金supported by the Nursing Innovation and Development Research Project of the Lingnan Nightingale Nursing Research Institute and Nursing Association,Guangdong Province(GDHLYJYB202403,GDHLYJYM202417)Research Project on Party Building Theory and Practice at Zhongshan Ophthalmic Center in 2024,Research Project on Standardized Management of Day Medical Services by the Institute of Hospital Management,National Health Commission(DSQ20251016)Medical Science and Technology Foundation of Guangdong Province(A2021088).
文摘Objective:The day surgery mode has significantly reduced preoperative waiting time for patients.However,this mode also led to brief and sometimes abrupt interactions between patients with vision loss and nursing staff during the preoperative visits.Additionally,patients may experience negative emotions.The aim of this study was to describe the preoperative experiences and identify related stressful factors among patients waiting vitreo-retinal day surgery.Methods:This study was guided by an interpretive approach.Semi-structured,face-to-face,in-depth interviews were conducted with patients from August 2021 to October 2024.Inductive content analysis and research software were used to analyze the data.Results:Twenty-seven patients agreed to participate the interviews.Their ages ranged from 19 to 70 years old.The waiting time before hospitalization varied from 7 to 90 days.Three main categories emerged from patients’complaints:day surgery procedures,concerns about eye conditions and supports.Conclusions:The findings underscore the importance of preoperative care services.It is suggested that providing accurate preoperative information and effective support can significantly enhance the quality of preoperative care service.
文摘Objective: This study evaluates the impact of handshake and information support on patients’ outcomes during laparoscopic cholecystectomy. It examines the effects on their physiological and psychological responses and overall satisfaction with nursing care. Methods: A total of 84 patients scheduled for laparoscopic cholecystectomy were selected through convenient sampling and randomly assigned to either the control group or the intervention group using a random number table. Each group consisted of 42 patients. The control group received standard surgical nursing care. In addition to standard care, the intervention group received handshake and information support from the circulating nurse before anesthesia induction. Vital signs were recorded before surgery and before anesthesia induction. Anxiety levels were measured using the State-Trait Anxiety Inventory (STAI) and the State-Anxiety Inventory (S-AI), while nursing satisfaction was assessed using a numerical rating scale. Results: No significant differences were found between the two groups in systolic and diastolic blood pressures before surgery and anesthesia induction (P > 0.05). However, there was a significant difference in heart rate before anesthesia induction (P Conclusion: Providing handshake and information support before anesthesia induction effectively reduces stress, alleviates anxiety, and enhances comfort and satisfaction among patients undergoing laparoscopic cholecystectomy.
基金Supported by The National Natural Science Foundation of China,No.82460107Science and Technology Talent Support Program of Shaanxi Provincial People's Hospital,No.2021 LJ-05.
文摘BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation.AIM To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery.METHODS A retrospective analysis of the demographics,preoperative and intraoperative data,and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted.These clinical data were compared between two groups:Patients with sphincter preservation and those without,categorised as the sphincter-preserved and sphincter-unpreserved groups,respectively.RESULTS Of the 179 patients analysed,150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group.Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group.Conversely,elevated levels of carcinoembryonic antigen,carbohydrate antigen 19-9,and plasma D-dimer were significantly higher in the sphincter-unpreserved group.Significant differences were also observed between the two groups in terms of place of residence,presence of colonic polyps,neoadjuvant chemotherapy,preoperative radiotherapy,mucinous adenocarcinoma,nerve invasion,and tumour height.No significant differences were observed for other parameters.Logistic regression analysis identified colonic polyps,mucinous adenocarcinoma,nerve invasion,and tumour height as independent risk factors for sphincter preser-vation.CONCLUSION Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified.These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations.
文摘Currently,preoperative visits have problems such as monotonous forms and insufficient humanistic care,which affect patients’psychological states and surgical cooperation.This article analyzes the current situation of preoperative visits and the mechanisms influencing patients’psychology,proposes optimization strategies and safeguard measures,and explores the mechanisms of information transmission,emotional support,trust establishment,and environmental familiarity on patients’psychology.It designs optimization plans from the aspects of personalized content,standardized processes,professional techniques,and diversified forms,supplemented by nurse training,system improvement,and quality evaluation to ensure implementation.Practice shows that the optimized preoperative visit can improve the psychological state of patients,enhance surgical cooperation,and optimize the nurse-patient relationship.The conclusion indicates that scientific and standardized preoperative visits can improve the quality of surgical care through multiple psychological effects and are an important link in perioperative care.
基金support from the National Natural Science Foundation of China(Nos.U21A20394 and 52305314)the Beijing Natural Science Foundation(Nos.7252285 and L246001)the National Key Research and Development Program of China(No.2023YFB4605800)。
文摘Granular composite(GC)hydrogels have attracted considerable interest in biomedical applications due to their versatile printability and exceptional mechanical properties.However,the lack of comprehensive design guidelines has limited their optimal engineering,as the factors influencing their mechanical performance and printability remain largely unexamined.In this study,we developed GC hydrogels by integrating microgels with interstitial matrices of photocrosslinkable gelatin methacrylate(GelMA).We utilized confocal microscopy and nanoindentation analyses to investigate the spatial distribution and mechanical behavior of these hydrogels.Our findings indicate that the mechanical and rheological properties of GC hydrogels can be precisely tailored by adjusting the volume fraction and size of the microgels.Furthermore,hydrogen bonds were identified as significant contributors to compressive performance,although they had minimal effect on cyclic mechanical behavior.Compared to bulk GelMA hydrogels,GC hydrogels demonstrated enhanced printability and remarkable superelasticity.As a proof of concept,we illustrated their dual printability in embedded printing to create prosthetic liver models for preoperative planning.This study provides valuable insights into the design and optimization of GC hydrogels for advanced biomedical applications.
文摘This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based risk scoring system origi-nally developed in South Korea.The scoring system incorporated five parame-ters:(1)Tumor size;(2)Portal venous phase density;(3)Necrosis;(4)Peripan-creatic infiltration;and(5)Suspected metastatic lymph nodes.While demonstra-ting satisfactory recurrence prediction capability without requiring complex tech-nologies,thereby supporting clinical utility in Chinese populations,the study exhibited notable limitations.Most analyzed patients lacked neoadjuvant chemo-therapy exposure,resulting in underrepresentation of low-risk subgroups.Addi-tionally,the short follow-up duration potentially compromised long-term progno-stic assessment.Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management.However,clinical implementation continues to confront challenges including variability in imaging parameters,incomplete understanding of molecular underpinnings,and confounding treatment effects.Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic,molecular,and clinical data.Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation,ultimately advancing personalized therapeutic strategies for PDAC.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is a vital tool for diagnosing and treating biliary and pancreatic disorders,but its safety and efficacy are marred by preoperative gastric retention.Jia et al retrospectively analyzed 190 patients who underwent ERCP and found that gastrointestinal obstruction,jaundice,opioid use,female sex,and primary diseases were in-dependent predictors and risk factors of preoperative gastric retention.Based on these findings and comprehensive analysis,a proposed predictive model offers clinicians valuable tools to tailor preoperative strategies,improving the proce-dural safety and efficacy of ERCP.Despite having several limitations,like single-center design and limited generalizability,the study marks a significant advan-cement in optimizing ERCP outcomes through predictive analytics.Further research with larger populations and prospective designs is warranted to establish these findings.
文摘Objective: To assess the impact of preoperative psychological interventions on the care of patients undergoing elective surgery. Methods: Ninety-two patients scheduled for elective surgery in the surgical department between August 2021 and August 2023 were selected and divided into groups using a random number table. The observation group received preoperative psychological interventions, while the reference group received standard preoperative care. Anxiety and depression scores, fear grading, vital signs, and self-efficacy levels were compared. Results: After the intervention, the anxiety and depression scores in the observation group were lower than those in the reference group, and the proportion of fear graded as Level I was higher. During the waiting period and 15 minutes before entering the operating room, vital sign levels in the observation group were lower than those in the reference group. Additionally, the self-efficacy scores of the observation group were significantly higher than those of the reference group (P < 0.05). Conclusion: Preoperative psychological interventions can alleviate negative emotions, stabilize preoperative vital signs, and significantly improve self-efficacy in patients undergoing elective surgery, demonstrating high feasibility for implementation.
文摘Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical experience and recovery.This mini review aims to evaluate the impact of preoperative anxiety in children,identify contributing factors,and explore effective strategies to manage this anxiety during day surgery.Methods:A literature review was conducted,focusing on studies that assess anxiety levels in pediatric patients before day surgery and the interventions designed to alleviate this anxiety.The review included both psychological and procedural strategies.Results:Preoperative anxiety in children can be influenced by a variety of factors,including age,previous medical experiences,parental anxiety,and the hospital environment.Untreated anxiety may lead to increased postoperative pain,behavioral changes,and extended recovery times.Several strategies,including psychological preparation,family centered approaches,and the involvement of child life specialists,have been shown to effectively reduce anxiety.Conclusions:Managing anxiety in pediatric day surgery is vital to improving both surgical outcomes and the overall experience for children and their families.Healthcare professionals can play a key role in reducing anxiety through targeted interventions and supportive care.
文摘BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.
基金Supported by National Natural Science Foundation of China(No.82160195No.82460203)Key Scientific and Technological Research Projects of China Medical Education Association(No.2024KTZ038).
文摘This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians in determining surgical indications,assessing patient conditions,and offering valuable assistance in formulating surgical strategies and predicting outcomes.Developed by a collaborative team of experts from the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,in conjunction with the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,these guidelines have been formulated through extensive research and evaluation,incorporating the latest technological advancements and studies on a global and domestic scale in vitreoretinal surgery.After extensive deliberations and incorporation of up-to-date clinical data,these guidelines have been developed to assist in standardizing preoperative examinations for vitreoretinal surgery.The overarching goals include improving medical quality,maximizing resource allocation,offering decision-making assistance,and safeguarding patient rights.This document provides a comprehensive analysis of preoperative assessments for vitreoretinal procedures,covering principles,methodologies,and precautions related to a range of diagnostic techniques including ultra-wide-angle fundus imaging,fluorescein angiography,indocyanine green angiography,ophthalmic B-ultrasound examinations,ultrasound biomicroscopy,optical coherence tomography,optical coherence tomography angiography,orbital CT scan,orbital MRI,and ophthalmic electrophysiology tests such as electroretinograms,visually evoked potentials,and visual field testing.
基金Supported by Biomedical Research Institute Grant from Pusan National University Hospital,No.202500360001.
文摘BACKGROUND Although obesity is a well-established contributor to surgical risks,evidence regarding the specific outcomes of laparoscopic cholecystectomy(LC)in obese patients remains scarce.AIM To assess clinicopathologic differences and 1-year outcomes following elective LC in patients with obesity and gallstone disease.METHODS This retrospective study analyzed data from 65 patients who underwent elective LC for gallstone disease between January 2020 and May 2022,with outcomes assessed at the 1-year follow-up.Patients were categorized as obese(body mass index≥25 kg/m^(2))or non-obese(body mass index<25 kg/m^(2)),and comparisons were made across preoperative laboratory values,intraoperative parameters,and patient-reported outcomes.RESULTS The obese group had significantly higher American Society of Anesthesiologists scores,higher glycated hemoglobin levels,and lower vitamin D levels than the non-obese group.Elevated triglycerides were more frequent in the obese group,whereas higher high-density lipoprotein levels were more common in the nonobese group.Intraoperative and postoperative outcomes did not differ between the groups.At the 1-year follow-up,24.6%of patients reported post-cholecystectomy symptoms,with no group differences.CONCLUSION Obese patients had higher American Society of Anesthesiologists scores,lower vitamin D,and elevated triglycerides preoperatively,but these differences did not significantly affect intraoperative findings or 1-year postoperative outcomes compared to non-obese patients.
