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 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
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
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
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
BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopi...BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.展开更多
Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim w...Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim was to determine the prevalence and preoperative factors associated with early POC at University Clinics of Kisangani (CUKIS). Methods: This was a cross-sectional study conducted in the CUKIS, Department of Surgery from 1 January 2014 to 31 December 2023. The target population consisted of all patients who had undergone full post-operative follow-up. A logistic regression model using RStudio version 4.4.0 software was used to determine the factors predicting early postoperative complications. Results: The prevalence of early POC was estimated at 35%, with surgical site infection the most frequent POC at 45.3%. After multivariate analysis using logistic regression, the social category of widow(er)s, transfer, previous laparotomy, acute generalised peritonitis, preoperative length of stay of more than 10 days and ASA score 2 and 5 were significant risk factors associated with the occurrence of POC in the preoperative period. Conclusion: Certain factors can predict the occurrence of POC. Knowledge of these factors can help practitioners to take useful measures before each surgical operation on a patient with these factors, with a view to preventing or managing POC.展开更多
Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, an...Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, and QoL of diabetic patients during COVID-19. Methods: A cross-sectional study was conducted on 385 diabetic patients (aged 18-80) from tertiary hospitals in Dhaka and Mymensingh between May and October 2022. Data were collected via a semi-structured questionnaire on sociodemographics, complications, treatment patterns, and QoL (SF-12 scale). Chi-square tests, ANOVA, and linear regression were used for inferential analysis. Results: The sample predominantly included middle-aged males (41 - 55 years) with type 2 diabetes. Diabetic retinopathy (34.5%), polyneuropathy (32.2%), and hypertension (52.3%) were the most common complications. Oral medications were used by 59.7% of patients, with 29.1% on insulin. Chi-square analysis showed a significant association between treatment adherence and complications (p β = 0.45, p Conclusion: Complications in diabetic patients significantly affect QoL in Bangladesh. Treatment adherence, especially with oral medications, positively impacts QoL. There is a need for improved access to diabetes care to manage complications and enhance the overall well-being of diabetic patients.展开更多
Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cr...Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cross-sectional study was conducted at the outpatient department of a county referral hospital in Kenya, from 1st August 2022 to 30th October 2022. Patients with known type II diabetes of age ≥ 20 years visiting the hospital for routine follow-up visits were included. A 7-tem Summary of Diabetes Self-care Activities (SDSAC) Questionnaire was used to assess Diabetes self-care activities. For data entry and statistical analysis, SPSS for Windows version 27.0 was used. There were 96 (39.2%) males and 149 (60.8%) females. Most of the participants were more than 61 years, 148 (60.4%). Significant association was found between the sum scale scores of dietary activities, blood glucose testing, physical activity, foot care, and neuropathy at 95% CI and (p Conclusions: Diabetes self-management activities have an impact on microvascular complications in patients with diabetes.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 Stoma creation is a common procedure in colorectal cancer surgery,however,stoma-related complications remain a significant concern.AIM To investigate the incidence,types,and risk factors of stoma-related co...BACKGROUND Stoma creation is a common procedure in colorectal cancer surgery,however,stoma-related complications remain a significant concern.AIM To investigate the incidence,types,and risk factors of stoma-related complications in colorectal cancer patients who underwent stoma creation.METHODS Patients with stoma was prospectively recorded in the established stoma system.Data was collected from this stoma management system from November 2021 through May 2024.The rates of stoma-related complications were assessed,and potential risk factors were analyzed using univariate and multivariate logistic regression models.RESULTS A total of 734 patients were included in the analysis.The results showed that 12.3%of patients experienced stoma-related complications,with mucocutaneous separation,edema,and skin excoriation being the most common complications.The majority(90%)of complications were classified as grade 2 according to the Clavien-Dindo classification.Surgical factors,such as blood loss volume greater than 500 mL and open surgery,were significantly associated with stoma complications.Additionally,stoma features like location,shape,color,height,and edema were important factors in the association with complications.Body mass index over 30 kg/m²was also found to be a significant risk factor.CONCLUSION These findings highlight the need for a holistic approach to preventing and managing stoma complications,considering both patient-related and surgical factors.展开更多
Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to c...Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.Methods:We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey.The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%,and defined as high robotic proportion cohort and low robotic proportion cohort.We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching(PSM).To account for potential clustering effects within hospitals,we employed Generalized Estimating Equations with hospital as the clustering variable.Results:This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer.In low robotic proportion cohort,RG had a longer operation time(P<0.001)but similar blood loss(P=0.792)compared to LG.In the high robotic proportion cohort,RG showed longer operation time(P<0.001),less blood loss(P<0.001),and shorter hospital stays(P<0.001)compared to LG.Additionally,RG in the high robotic proportion cohort had shorter operative time(P<0.001)and less blood loss(P=0.024)compared with that in the low robotic proportion cohort.Conclusions:RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis.However,RG offers limited benefits over LG at institutions with lower frequencies of RG use.展开更多
BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in ...BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in a large population remain unclear.AIM To investigate the complications and risk factors associated with diagnostic SBE.METHODS This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024.Data on baseline characteristics,procedural parameters,indications,findings,and major complications were collected and analyzed.RESULTS A total of 2865 SBE procedures were performed in 1840 patients.The mean age was 51±18 years,and 64.5%were male.The most common indication was obscure gastrointestinal bleeding(57.1%),followed by abdominal pain(30.5%).The major complication rate was 0.4%(7/1840),all of which involved acute intestinal perforation identified during the procedure.Among the perforation cases,6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding.The perforation sites included the ileum(6/7)and duodenum(1/7).All cases were successfully managed surgically.Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation(P value<0.001 for both).In subgroup analysis,perforation rates were 2.1%(6/288)in patients with prior abdominal surgery and 1.6%(7/428)with abdominal compression.CONCLUSION Acute intestinal perforation is a rare but serious complication.Prior abdominal surgery and abdominal compression are important risk factors,and careful patient selection is recommended to minimize complications.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
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
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 Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene...BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.展开更多
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
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 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.
基金Supported by the National Natural Science Foundation of China,No.81302124.
文摘BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.
文摘Background and Objectives: Post-operative complications (POC) are new pathological phenomena occurring in the post-operative period and worsening the previous situation through their morbidity and mortality. Our aim was to determine the prevalence and preoperative factors associated with early POC at University Clinics of Kisangani (CUKIS). Methods: This was a cross-sectional study conducted in the CUKIS, Department of Surgery from 1 January 2014 to 31 December 2023. The target population consisted of all patients who had undergone full post-operative follow-up. A logistic regression model using RStudio version 4.4.0 software was used to determine the factors predicting early postoperative complications. Results: The prevalence of early POC was estimated at 35%, with surgical site infection the most frequent POC at 45.3%. After multivariate analysis using logistic regression, the social category of widow(er)s, transfer, previous laparotomy, acute generalised peritonitis, preoperative length of stay of more than 10 days and ASA score 2 and 5 were significant risk factors associated with the occurrence of POC in the preoperative period. Conclusion: Certain factors can predict the occurrence of POC. Knowledge of these factors can help practitioners to take useful measures before each surgical operation on a patient with these factors, with a view to preventing or managing POC.
文摘Background: Diabetes Mellitus (DM) is a growing health issue in Bangladesh, with significant complications affecting the quality of life (QoL). This study aims to assess long-term complications, treatment patterns, and QoL of diabetic patients during COVID-19. Methods: A cross-sectional study was conducted on 385 diabetic patients (aged 18-80) from tertiary hospitals in Dhaka and Mymensingh between May and October 2022. Data were collected via a semi-structured questionnaire on sociodemographics, complications, treatment patterns, and QoL (SF-12 scale). Chi-square tests, ANOVA, and linear regression were used for inferential analysis. Results: The sample predominantly included middle-aged males (41 - 55 years) with type 2 diabetes. Diabetic retinopathy (34.5%), polyneuropathy (32.2%), and hypertension (52.3%) were the most common complications. Oral medications were used by 59.7% of patients, with 29.1% on insulin. Chi-square analysis showed a significant association between treatment adherence and complications (p β = 0.45, p Conclusion: Complications in diabetic patients significantly affect QoL in Bangladesh. Treatment adherence, especially with oral medications, positively impacts QoL. There is a need for improved access to diabetes care to manage complications and enhance the overall well-being of diabetic patients.
文摘Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cross-sectional study was conducted at the outpatient department of a county referral hospital in Kenya, from 1st August 2022 to 30th October 2022. Patients with known type II diabetes of age ≥ 20 years visiting the hospital for routine follow-up visits were included. A 7-tem Summary of Diabetes Self-care Activities (SDSAC) Questionnaire was used to assess Diabetes self-care activities. For data entry and statistical analysis, SPSS for Windows version 27.0 was used. There were 96 (39.2%) males and 149 (60.8%) females. Most of the participants were more than 61 years, 148 (60.4%). Significant association was found between the sum scale scores of dietary activities, blood glucose testing, physical activity, foot care, and neuropathy at 95% CI and (p Conclusions: Diabetes self-management activities have an impact on microvascular complications in patients with diabetes.
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.
基金Beijing Municipal Administration of Hospitals Incubating Program,No.PZ20200272018 Beijing Talent Incubating Funding,No.2018-4+3 种基金National Natural Science Foundation of China,No.81773214Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support,No.ZYLX202116the National Key R&D Program of China,No.2021YFF1201104Science Foundation of Peking University Cancer Hospital-2023,No.JC202310.
文摘BACKGROUND Stoma creation is a common procedure in colorectal cancer surgery,however,stoma-related complications remain a significant concern.AIM To investigate the incidence,types,and risk factors of stoma-related complications in colorectal cancer patients who underwent stoma creation.METHODS Patients with stoma was prospectively recorded in the established stoma system.Data was collected from this stoma management system from November 2021 through May 2024.The rates of stoma-related complications were assessed,and potential risk factors were analyzed using univariate and multivariate logistic regression models.RESULTS A total of 734 patients were included in the analysis.The results showed that 12.3%of patients experienced stoma-related complications,with mucocutaneous separation,edema,and skin excoriation being the most common complications.The majority(90%)of complications were classified as grade 2 according to the Clavien-Dindo classification.Surgical factors,such as blood loss volume greater than 500 mL and open surgery,were significantly associated with stoma complications.Additionally,stoma features like location,shape,color,height,and edema were important factors in the association with complications.Body mass index over 30 kg/m²was also found to be a significant risk factor.CONCLUSION These findings highlight the need for a holistic approach to preventing and managing stoma complications,considering both patient-related and surgical factors.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI),funded by the Ministry of Health&Welfare,Republic of Korea(No.RS-2023-KH140183)the new faculty research fund of Ajou University School of Medicine(No.M-2024C0460-00064)。
文摘Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.Methods:We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey.The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%,and defined as high robotic proportion cohort and low robotic proportion cohort.We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching(PSM).To account for potential clustering effects within hospitals,we employed Generalized Estimating Equations with hospital as the clustering variable.Results:This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer.In low robotic proportion cohort,RG had a longer operation time(P<0.001)but similar blood loss(P=0.792)compared to LG.In the high robotic proportion cohort,RG showed longer operation time(P<0.001),less blood loss(P<0.001),and shorter hospital stays(P<0.001)compared to LG.Additionally,RG in the high robotic proportion cohort had shorter operative time(P<0.001)and less blood loss(P=0.024)compared with that in the low robotic proportion cohort.Conclusions:RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis.However,RG offers limited benefits over LG at institutions with lower frequencies of RG use.
文摘BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in a large population remain unclear.AIM To investigate the complications and risk factors associated with diagnostic SBE.METHODS This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024.Data on baseline characteristics,procedural parameters,indications,findings,and major complications were collected and analyzed.RESULTS A total of 2865 SBE procedures were performed in 1840 patients.The mean age was 51±18 years,and 64.5%were male.The most common indication was obscure gastrointestinal bleeding(57.1%),followed by abdominal pain(30.5%).The major complication rate was 0.4%(7/1840),all of which involved acute intestinal perforation identified during the procedure.Among the perforation cases,6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding.The perforation sites included the ileum(6/7)and duodenum(1/7).All cases were successfully managed surgically.Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation(P value<0.001 for both).In subgroup analysis,perforation rates were 2.1%(6/288)in patients with prior abdominal surgery and 1.6%(7/428)with abdominal compression.CONCLUSION Acute intestinal perforation is a rare but serious complication.Prior abdominal surgery and abdominal compression are important risk factors,and careful patient selection is recommended to minimize complications.
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This study aimed to explore the application effect of the medical and nursing integration working mode in children with inguinal hernia undergoing laparoscopic surgery and to provide a basis for its clinical promotion.A total of 70 children with inguinal hernia admitted to our hospital from July 2023 to June 2024 and treated with laparoscopic surgery were selected as study subjects and randomly divided into an observation group and a control group,with 35 cases in each.Both groups received routine nursing care,while the observation group additionally adopted the integrated medical and nursing working mode,including systematic health education,psychological interventions,and postoperative follow-up from admission to discharge.The anxiety and depression scores of the two groups before and after surgery,medical compliance index,and incidence of complications during hospitalization were compared.Results showed that the preoperative anxiety scores of the observation and control groups were(14.01±1.07)and(14.62±2.31),respectively,with no statistically significant difference(P>0.05);however,postoperative anxiety scores were significantly lower in the observation group(4.01±0.77)compared to the control group(6.62±0.31)(P<0.05).Similarly,preoperative depression scores were(15.11±1.22)in the observation group and(15.41±2.01)in the control group(P>0.05),but postoperative depression scores were significantly reduced in the observation group(4.24±0.61)compared to the control group(7.12±0.54)(P<0.05).After intervention,the medical compliance behavior index in the observation group was(83.31±5.92),significantly higher than(75.34±6.73)in the control group(P<0.05).Regarding postoperative complications,only 1 case(2.86%)occurred in the observation group,while 8 cases(22.86%)were reported in the control group,showing a statistically significant difference(P<0.05).In conclusion,the medical and nursing integration working mode effectively improves the perioperative psychological state of children,enhances medical compliance,reduces postoperative complications,and is worthy of widespread clinical application.
基金supported by the 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 Jiaxing Science and Technology Projects,No.2023AD31041。
文摘BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.
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 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.
