BACKGROUND Acupuncture promotes the recovery of gastrointestinal function and provides analgesia after major abdominal surgery.The effects of transcutaneous electrical acupoint stimulation(TEAS)remain unclear.AIM To e...BACKGROUND Acupuncture promotes the recovery of gastrointestinal function and provides analgesia after major abdominal surgery.The effects of transcutaneous electrical acupoint stimulation(TEAS)remain unclear.AIM To explore the potential effects of TEAS on the recovery of gastrointestinal function after gastrectomy and colorectal resection.METHODS Patients scheduled for gastrectomy or colorectal resection were randomized at a 2:3:3:2 ratio to receive:(1)TEAS at maximum tolerable current for 30 min immediately prior to anesthesia induction and for the entire duration of surgery,plus two 30-min daily sessions for 3 consecutive days after surgery(perioperative TEAS group);(2)Preoperative and intraoperative TEAS only;(3)Preoperative and postoperative TEAS only;or(4)Sham stimulation.The primary outcome was the time from the end of surgery to the first bowel sound.RESULTS In total,441 patients were randomized;405 patients(58.4±10.2 years of age;247 males)received the planned surgery.The time to the first bowel sounds did not differ among the four groups(P=0.90;log-rank test).On postoperative day 1,the rest pain scores differed significantly among the four groups(P=0.04;Kruskal–Wallis test).Post hoc comparison using the Bonferroni test showed lower pain scores in the perioperative TEAS group(1.4±1.2)than in the sham sti-mulation group(1.7±1.1;P=0.04).Surgical complications did not differ among the four groups.CONCLUSION TEAS provided analgesic effects in adult patients undergoing major abdominal surgery,and it can be added to clinical practice as a means of accelerating postoperative rehabilitation of these patients.展开更多
AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation pro...AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P < 0.01).The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P < 0.05).Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P < 0.05).The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care(5 d vs 7 d,P < 0.01).No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.展开更多
AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients wit...AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients with CRC admitted from August 2022 to August 2024.Participants undergoing open radical resection of CRC were categorized as the control group(50 patients),whereas those receiving LRRCC were classified as the research group(54 patients).Subsequently,comparative analyses involved data on efficacy,postoperative complications(ileus,incision infection,anastomotic fistula,and pulmonary infection),surgery-related parameters(operation duration and intraoperative bleeding volume),postoperative recoveryrelated indicators(time to first postoperative passage of flatus and defecation and length of hospital stay),and inflammatory factors(tumor necrosis factor-α,highsensitivity C-reactive protein,and interleukin-6).RESULTS Data revealed markedly superior therapeutic efficacy and a lower overall postoperative complication rate in the research group compared to the control group.The research group demonstrated substantially less intraoperative bleeding,less time to first postoperative passage of flatus and defecation,and a shorter length of hospital stay despite a notably longer operation duration compared to the control group.Further,tumor necrosis factor-α,high-sensitivity C-reactive protein,and interleukin-6 levels in the research group were significantly reduced 3 days postoperatively compared to both the preoperative and control group values.CONCLUSION LRRCC for older patients with CRC exhibited superior therapeutic efficacy compared to open radical resection and significantly suppressed postoperative stress-related inflammatory responses,which merits clinical application and promotion.展开更多
BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.Intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcome...BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.Intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcomes of patients with CRC and hinders their rehabilitation process.However,the factors influencing abdominal infection after CRC surgery remain unclear;further,prediction models are rarely used to analyze preoperative laboratory indicators and postoperative complications.AIM To explore the predictive value of preoperative blood markers for IAI after radical resection of CRC.METHODS The data of 80 patients who underwent radical resection of CRC in the Anorectal Surgery Department of Suzhou Hospital affiliated with Anhui Medical University were analyzed.These patients were categorized into IAI(n=15)and non-IAI groups(n=65)based on whether IAI occurred.Influencing factors were compared;general data and laboratory indices of both groups were identified.The relationship between the indicators was assessed.Further,a nomogram prediction model was developed and evaluated;its utility and clinical applic-ability were assessed.RESULTS The risk factors for IAI after radical resection of CRC were neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and carcinoembryonic antigen(CEA)levels.NLR was correlated with PLR and SII(r=0.604,0.925,and 0.305,respectively),while PLR was correlated with SII(r=0.787).The nomogram prediction model demonstrated an area under the curve of 0.968[95%confidence interval(CI):0.948-0.988]in the training set(n=60)and 0.926(95%CI:0.906-0.980)in the validation set(n=20).The average absolute errors of the calibration curves for the training and validation sets were 0.032 and 0.048,respectively,indicating a good model fit.The decision curve analysis curves demonstrated high net income above the 5%threshold,indicating the clinical practicality of the model.CONCLUSION The nomogram model constructed using NLR,PLR,SII,and CEA levels had good accuracy and reliability in predicting IAI after radical resection of CRC,potentially aiding clinical treatment decision-making.展开更多
Colorectal cancer is the third most common cancer in the world.Surgery is man-datory to treat patients with colorectal cancer.Can colorectal cancer be treated in laparoscopy?Scientific literature has validated the onc...Colorectal cancer is the third most common cancer in the world.Surgery is man-datory to treat patients with colorectal cancer.Can colorectal cancer be treated in laparoscopy?Scientific literature has validated the oncological quality of laparo-scopic approach for the treatment of patients with colorectal cancer.Randomized non-inferiority trials with good remote control have answered positively to this long-debated question.Early as 1994,first publications demonstrated technical feasibility and compliance with oncological imperatives and,as far as short-term outcomes are concerned,there is no difference in terms of mortality and post-operative morbidity between open and minimally invasive surgical approaches,but only longer operating times at the beginning of the experience.Subsequently,from 2007 onwards,long-term results were published that demonstrated the ab-sence of a significant difference regarding overall survival,disease-free survival,quality of life,local and distant recurrence rates between open and minimally in-vasive surgery.In this editorial,we aim to summarize the clinical and technical aspects which,even today,make the use of open surgery relevant and necessary in the treatment of patients with colorectal cancer.展开更多
BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hy...BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.AIM To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.METHODS This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects.An ARM was repeated every 30 min during intraoperative mechanical ventilation.The primary endpoint was ARM-related hypotension,defined as a mean arterial pressure(MAP)<60 mmHg during an ARM or within 5 min after an ARM.The risk factors for hypotension were identified.The peri-ARM changes in blood pressure were analyzed for the first three ARMs(ARM_(1,2,3))and the last ARM(ARMl_(ast)).RESULTS Thirty-four subjects(24.3%)developed ARM-related hypotension.Of all 1027 ARMs,37(3.61%)induced hypotension.More ARMs under nonpneumoperitoneum(33/349,9.46%)than under pneumoperitoneum conditions(4/678,0.59%)induced hypotension(P<0.01).The incidence of hypotension was higher at ARM_(1)points than at non-ARM_(1)points(18/135,13.3%vs 19/892,2.1%;P<0.01).The median percentage decrease in the MAP at ARM1 was 14%.Age≥74 years,blood loss≥150 mL and peak inspiratory pressure under pneumoperitoneum<24 cm H_(2)O were risk factors for ARM-related hypotension.CONCLUSION When the ARM was repeated intraoperatively,a quarter of subjects developed ARM-related hypotension,but only 3.61%of ARMs induced hypotension.ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state,and in elderly subjects.Fortunately,ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure.展开更多
Objective: to evaluate the application of high quality nursing measures in surgery. Methods: a double-blind randomized trial was used and 80 patients were divided into two groups. The control group received routine nu...Objective: to evaluate the application of high quality nursing measures in surgery. Methods: a double-blind randomized trial was used and 80 patients were divided into two groups. The control group received routine nursing care while the experimental group received high-quality nursing care. The levels of anxiety SAS, SDS and satisfaction before and after nursing were compared. Results: the scores of anxiety SAS and depression SDS in the experimental group were lower than those in the control group, and the degree of satisfaction was higher than that in the control group (P < 0.05). Conclusion: the application of high quality surgical nursing intervention in laparoscopic radical resection of colorectal cancer has very obvious effect.展开更多
Objective: to explore the effect of operating room nursing on postoperative rehabilitation of patients undergoing laparoscopic colorectal tumor resection. Methods: the study was conducted from January 2019 to December...Objective: to explore the effect of operating room nursing on postoperative rehabilitation of patients undergoing laparoscopic colorectal tumor resection. Methods: the study was conducted from January 2019 to December 2020. The subjects were patients who underwent laparoscopic colorectal tumor resection (n = 80). According to different treatment models, the patients were divided into the control group (n = 40) and the observation group (n = 40) for treatment in the operating room. The incidence of postoperative complications in the two groups was compared. Results: the incidence of postoperative complications was 10.00% in the observation group and 27.50% in the control group, the former was significantly lower than the latter. Conclusion: operating room nursing for patients undergoing laparoscopic colorectal tumor resection can produce better results, reduce the possibility of postoperative complications, and accelerate postoperative rehabilitation of patients. It is worthy of application.展开更多
BACKGROUND Cold-inducible RNA-binding protein(CIRP)is related to a family of stressinduced RNA-binding proteins.It is primarily found in the nucleus,where it regulates transcription.Under stress,CIRP translocates to t...BACKGROUND Cold-inducible RNA-binding protein(CIRP)is related to a family of stressinduced RNA-binding proteins.It is primarily found in the nucleus,where it regulates transcription.Under stress,CIRP translocates to the cytoplasm where it modulates translation;a subset is secreted as extracellular CIRP(eCIRP)which is a damage-associated molecular pattern(DAMP)molecule that stimulates the production of inflammatory mediators.Elevated blood eCIRP levels may foster immune tolerance and facilitate tumor growth.Increased CIRP levels have been noted in various malignancies including colorectal cancer(CRC).This study’s objective was to determine plasma eCIRP levels before and after minimally invasive colorectal resection(MICR)for CRC.AIM To assess plasma eCIRP levels prior to and following minimally invasive colorectal resection in the context of cancer pathology.METHODS MICR patients from an IRB-approved data/tissue bank for whom plasma samples were available were eligible.Plasma specimens were obtained preoperatively(preop)and at least 3 time’s postop[between postoperative day(POD)1-41];late samples were grouped into 7-day blocks and were considered separate time points.eCIRP levels were assessed via enzyme-linked immunosorbent assay(pg/mL)and results presented as mean±SD,analysis with Wilcoxon paired t-test.RESULTS A total of 83 CRC patients who underwent MICR[colon 66%,rectal 34%;laparoscopic-assisted(LA),70%;handassisted laparoscopic(HAL),30%]were studied.The mean preop eCIRP level was 896.8±757.0 pg/mL.Elevations in mean plasma levels(P=<0.001)were noted on POD1(2549±2632 pg/mL,n=83),POD3(1871±1362 pg/mL,n=77),POD7-13(1788±1403 pg/mL,n=57),POD14-20(1473±738.8 pg/mL,n=30),and POD21-27(1681±1375 pg/mL,n=21).No significant differences were noted at POD 28-41.Higher values were noted in the HAL’s(vs LA)group,however,there were more rectal cancers in the former.CONCLUSION Elevated plasma eCIRP levels persist for a month post MICR for CRC(change from baseline,77%-184%);highest values seen on POD1.The initial surge may be due to the acute inflammatory response while later elevations may be related to wound healing and remodeling.The higher levels noted in the HAL’s group(with greater IL and more rectal cases)suggest the extent of surgical trauma impacts eCIRP levels.Further investigations are needed.展开更多
BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outc...BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outcomes.AIM To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.METHODS One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled.The patients were assigned to control(n=60,receiving standard nursing care)and observation groups(n=60,receiving music therapy,anesthesia recovery care,and standard nursing care).We comparatively analyzed the time to regain consciousness,extubation time,and length of stay in the postanesthesia care unit;heart rate,systolic blood pressure,and diastolic blood pressure before anesthesia and during recovery;cortisol,aldosterone,norepinephrine,and adrenaline levels before anesthesia and 24 hours postoperatively;Postoperative Quality of Recovery Scale scores;and complication rates between the groups.RESULTS The observation group exhibited a significantly shorter time to regain consciousness,extubation time,and postanesthesia care unit stay than the control group(P<0.05).During the recovery period,heart rate,systolic blood pressure,and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels,with the levels in the observation group being significantly lower than those in the control group(P<0.05).At 24 hours postoperatively,cortisol,aldosterone,norepinephrine,and adrenaline levels were elevated in both groups compared with preanesthesia levels,with levels in the observation group being significantly lower than those in the control group(P<0.05).The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group(P<0.05).Moreover,the complication rate in the observation group was significantly lower than that in the control group(10.00%vs 40.00%,P<0.05).CONCLUSION Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection,mitigated fluctuations in vital signs and stress responses,improved postoperative recovery quality,and reduced complication rates,demonstrating substantial clinical value.展开更多
Objective: to analyze the clinical effect of fast recovery nursing combined with nutritional support in patients with colorectal cancer radical operation. Methods: 78 patients with colorectal cancer in our hospital we...Objective: to analyze the clinical effect of fast recovery nursing combined with nutritional support in patients with colorectal cancer radical operation. Methods: 78 patients with colorectal cancer in our hospital were selected from October 2017 to October 2019. All patients were divided into conventional group (39 cases) and intervention group (39 cases) by drawing lots. The clinical effects and nutritional indexes of the two groups after intervention were compared. Results: compared with the conventional group, the recovery of bowel sounds, the first exhaust and the time to get out of bed in the intervention group were significantly shorter than those in the conventional group (P < 0.05);compared with the conventional group, the levels of MAMC, TSH and ALB in the intervention group were significantly higher (P < 0.05). Conclusion: the application of rapid rehabilitation nursing combined with nutritional support in patients with colorectal cancer can significantly improve their nutritional status and shorten the recovery time.展开更多
BACKGROUND MMP-2 also known as gelatinase A and MMP-7(matrilysin)are members of the zinc-dependent family of MMPs(Matrix metalloproteinase).MMP-2 and MMP-7 are remodeling enzymes that digest extracellular matrix;MMP-2...BACKGROUND MMP-2 also known as gelatinase A and MMP-7(matrilysin)are members of the zinc-dependent family of MMPs(Matrix metalloproteinase).MMP-2 and MMP-7 are remodeling enzymes that digest extracellular matrix;MMP-2 is extensively expressed during development and is upregulated at sites of tissue damage,inflammation,and in stromal cells of metastatic tumors.MMP-7 is expressed in the epithelial cells and in a variety of cancers including colon tumors.Plasma MMP-2 and MMP-7 levels were assessed before and after minimally invasive colorectal resection for cancer pathology.AIM To determine plasma MMP-2 and MMP-7 levels before and after minimally invasive colorectal resection for cancer pathology.METHODS Patients enrolled in a plasma bank for whom plasma was available were eligible.Plasma obtained from preoperative(Preop)and postoperative blood samples was used.Only colorectal cancer(CRC)patients who underwent elective minimally invasive cancer resection with preop,post-operative day(POD)1,3 and at least 1 late postop sample(POD 7-34)were included.Late samples were bundled into 7 d blocks(POD 7-13,14-20,etc.)and treated as single time points.Plasma MMP-2 and MMP-7 levels were determined via enzyme-linked immunosorbent assay in duplicate.RESULTS Total 88 minimally invasive CRC resection CRC patients were studied(right colectomy,37%;sigmoid,24%;and LAR/AR 18%).Cancer stages were:1,31%;2,30%;3,34%;and 4,5%.Mean Preop MMP-2 plasma level(ng/mL)was 179.3±40.9(n=88).Elevated mean levels were noted on POD1(214.3±51.2,n=87,P<0.001),POD3(258.0±63.9,n=80,P<0.001),POD7-13(229.9±62.3,n=65,P<0.001),POD 14-20(234.9±47.5,n=25,P<0.001),POD 21-27(237.0±63.5,n=17,P<0.001,)and POD 28-34(255.4±59.7,n=15,P<0.001).Mean Preop MMP-7 level was 3.9±1.9(n=88).No significant differences were noted on POD 1 or 3,however,significantly elevated levels were noted on POD 7-13(5.7±2.5,n=65,P<0.001),POD 14-20(5.9±2.5,n=25,P<0.001),POD 21-27(6.1±3.6,n=17,P=0.002)and on POD 28-34(6.8±3.3,n=15 P<0.001,)vs preop levels.CONCLUSION MMP-2 levels are elevated for 5 wk and MMP-7 levels elevated for weeks 2-6.The etiology of these changes in unclear,trauma and wound healing likely play a role.These changes may promote residual tumor growth and metastasis.展开更多
Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum ...Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum is involved. Herein, we report on one of 4 cases. The procedures, using a bipolar needle knife (B-Knife) to reduce the perforation risk and carbon dioxide instead of conventional air insufflation for patient comfort, achieved curative resections without any complications.展开更多
基金National Basic Research Program of China(Project 973)from The Ministry of Science and Technology of the People's Republic of China,No.2013CB531900。
文摘BACKGROUND Acupuncture promotes the recovery of gastrointestinal function and provides analgesia after major abdominal surgery.The effects of transcutaneous electrical acupoint stimulation(TEAS)remain unclear.AIM To explore the potential effects of TEAS on the recovery of gastrointestinal function after gastrectomy and colorectal resection.METHODS Patients scheduled for gastrectomy or colorectal resection were randomized at a 2:3:3:2 ratio to receive:(1)TEAS at maximum tolerable current for 30 min immediately prior to anesthesia induction and for the entire duration of surgery,plus two 30-min daily sessions for 3 consecutive days after surgery(perioperative TEAS group);(2)Preoperative and intraoperative TEAS only;(3)Preoperative and postoperative TEAS only;or(4)Sham stimulation.The primary outcome was the time from the end of surgery to the first bowel sound.RESULTS In total,441 patients were randomized;405 patients(58.4±10.2 years of age;247 males)received the planned surgery.The time to the first bowel sounds did not differ among the four groups(P=0.90;log-rank test).On postoperative day 1,the rest pain scores differed significantly among the four groups(P=0.04;Kruskal–Wallis test).Post hoc comparison using the Bonferroni test showed lower pain scores in the perioperative TEAS group(1.4±1.2)than in the sham sti-mulation group(1.7±1.1;P=0.04).Surgical complications did not differ among the four groups.CONCLUSION TEAS provided analgesic effects in adult patients undergoing major abdominal surgery,and it can be added to clinical practice as a means of accelerating postoperative rehabilitation of these patients.
基金Supported by Social Development Fund of Jiangsu Province,No. BS2007054
文摘AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P < 0.01).The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P < 0.05).Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P < 0.05).The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care(5 d vs 7 d,P < 0.01).No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.
基金Supported by the Medical Research Project of Jiangsu Health Commission,No.Z2021010.
文摘AIM To analyze the efficacy of laparoscopic radical resection of CRC(LRRCC)in treating older patients with CRC and the effect of this procedure on inflammatory factors.METHODS The study included 104 older patients with CRC admitted from August 2022 to August 2024.Participants undergoing open radical resection of CRC were categorized as the control group(50 patients),whereas those receiving LRRCC were classified as the research group(54 patients).Subsequently,comparative analyses involved data on efficacy,postoperative complications(ileus,incision infection,anastomotic fistula,and pulmonary infection),surgery-related parameters(operation duration and intraoperative bleeding volume),postoperative recoveryrelated indicators(time to first postoperative passage of flatus and defecation and length of hospital stay),and inflammatory factors(tumor necrosis factor-α,highsensitivity C-reactive protein,and interleukin-6).RESULTS Data revealed markedly superior therapeutic efficacy and a lower overall postoperative complication rate in the research group compared to the control group.The research group demonstrated substantially less intraoperative bleeding,less time to first postoperative passage of flatus and defecation,and a shorter length of hospital stay despite a notably longer operation duration compared to the control group.Further,tumor necrosis factor-α,high-sensitivity C-reactive protein,and interleukin-6 levels in the research group were significantly reduced 3 days postoperatively compared to both the preoperative and control group values.CONCLUSION LRRCC for older patients with CRC exhibited superior therapeutic efficacy compared to open radical resection and significantly suppressed postoperative stress-related inflammatory responses,which merits clinical application and promotion.
基金Supported by Suzhou Health Scientific Research Project,No.SZWJ2022a001.
文摘BACKGROUND Colorectal cancer(CRC)has one of the highest morbidity and mortality rates among digestive tract tumors.Intra-abdominal infection(IAI)is a common postoperative complication that affects the clinical outcomes of patients with CRC and hinders their rehabilitation process.However,the factors influencing abdominal infection after CRC surgery remain unclear;further,prediction models are rarely used to analyze preoperative laboratory indicators and postoperative complications.AIM To explore the predictive value of preoperative blood markers for IAI after radical resection of CRC.METHODS The data of 80 patients who underwent radical resection of CRC in the Anorectal Surgery Department of Suzhou Hospital affiliated with Anhui Medical University were analyzed.These patients were categorized into IAI(n=15)and non-IAI groups(n=65)based on whether IAI occurred.Influencing factors were compared;general data and laboratory indices of both groups were identified.The relationship between the indicators was assessed.Further,a nomogram prediction model was developed and evaluated;its utility and clinical applic-ability were assessed.RESULTS The risk factors for IAI after radical resection of CRC were neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and carcinoembryonic antigen(CEA)levels.NLR was correlated with PLR and SII(r=0.604,0.925,and 0.305,respectively),while PLR was correlated with SII(r=0.787).The nomogram prediction model demonstrated an area under the curve of 0.968[95%confidence interval(CI):0.948-0.988]in the training set(n=60)and 0.926(95%CI:0.906-0.980)in the validation set(n=20).The average absolute errors of the calibration curves for the training and validation sets were 0.032 and 0.048,respectively,indicating a good model fit.The decision curve analysis curves demonstrated high net income above the 5%threshold,indicating the clinical practicality of the model.CONCLUSION The nomogram model constructed using NLR,PLR,SII,and CEA levels had good accuracy and reliability in predicting IAI after radical resection of CRC,potentially aiding clinical treatment decision-making.
文摘Colorectal cancer is the third most common cancer in the world.Surgery is man-datory to treat patients with colorectal cancer.Can colorectal cancer be treated in laparoscopy?Scientific literature has validated the oncological quality of laparo-scopic approach for the treatment of patients with colorectal cancer.Randomized non-inferiority trials with good remote control have answered positively to this long-debated question.Early as 1994,first publications demonstrated technical feasibility and compliance with oncological imperatives and,as far as short-term outcomes are concerned,there is no difference in terms of mortality and post-operative morbidity between open and minimally invasive surgical approaches,but only longer operating times at the beginning of the experience.Subsequently,from 2007 onwards,long-term results were published that demonstrated the ab-sence of a significant difference regarding overall survival,disease-free survival,quality of life,local and distant recurrence rates between open and minimally in-vasive surgery.In this editorial,we aim to summarize the clinical and technical aspects which,even today,make the use of open surgery relevant and necessary in the treatment of patients with colorectal cancer.
基金the Medical Scientific Research Foundation of Guangdong Province,No.A2017045。
文摘BACKGROUND Alveolar recruitment maneuvers(ARMs)may lead to transient hypotension,but the clinical characteristics of this induced hypotension are poorly understood.We investigated the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.AIM To investigate the characteristics of ARM-related hypotension in patients who underwent laparoscopic colorectal cancer resection.METHODS This was a secondary analysis of the PROtective Ventilation using Open Lung approach Or Not trial and included 140 subjects.An ARM was repeated every 30 min during intraoperative mechanical ventilation.The primary endpoint was ARM-related hypotension,defined as a mean arterial pressure(MAP)<60 mmHg during an ARM or within 5 min after an ARM.The risk factors for hypotension were identified.The peri-ARM changes in blood pressure were analyzed for the first three ARMs(ARM_(1,2,3))and the last ARM(ARMl_(ast)).RESULTS Thirty-four subjects(24.3%)developed ARM-related hypotension.Of all 1027 ARMs,37(3.61%)induced hypotension.More ARMs under nonpneumoperitoneum(33/349,9.46%)than under pneumoperitoneum conditions(4/678,0.59%)induced hypotension(P<0.01).The incidence of hypotension was higher at ARM_(1)points than at non-ARM_(1)points(18/135,13.3%vs 19/892,2.1%;P<0.01).The median percentage decrease in the MAP at ARM1 was 14%.Age≥74 years,blood loss≥150 mL and peak inspiratory pressure under pneumoperitoneum<24 cm H_(2)O were risk factors for ARM-related hypotension.CONCLUSION When the ARM was repeated intraoperatively,a quarter of subjects developed ARM-related hypotension,but only 3.61%of ARMs induced hypotension.ARM-related hypotension most occurred in a hemodynamically unstable state or a hypovolemic state,and in elderly subjects.Fortunately,ARMs that were performed under pneumoperitoneum conditions had less impact on blood pressure.
文摘Objective: to evaluate the application of high quality nursing measures in surgery. Methods: a double-blind randomized trial was used and 80 patients were divided into two groups. The control group received routine nursing care while the experimental group received high-quality nursing care. The levels of anxiety SAS, SDS and satisfaction before and after nursing were compared. Results: the scores of anxiety SAS and depression SDS in the experimental group were lower than those in the control group, and the degree of satisfaction was higher than that in the control group (P < 0.05). Conclusion: the application of high quality surgical nursing intervention in laparoscopic radical resection of colorectal cancer has very obvious effect.
文摘Objective: to explore the effect of operating room nursing on postoperative rehabilitation of patients undergoing laparoscopic colorectal tumor resection. Methods: the study was conducted from January 2019 to December 2020. The subjects were patients who underwent laparoscopic colorectal tumor resection (n = 80). According to different treatment models, the patients were divided into the control group (n = 40) and the observation group (n = 40) for treatment in the operating room. The incidence of postoperative complications in the two groups was compared. Results: the incidence of postoperative complications was 10.00% in the observation group and 27.50% in the control group, the former was significantly lower than the latter. Conclusion: operating room nursing for patients undergoing laparoscopic colorectal tumor resection can produce better results, reduce the possibility of postoperative complications, and accelerate postoperative rehabilitation of patients. It is worthy of application.
文摘BACKGROUND Cold-inducible RNA-binding protein(CIRP)is related to a family of stressinduced RNA-binding proteins.It is primarily found in the nucleus,where it regulates transcription.Under stress,CIRP translocates to the cytoplasm where it modulates translation;a subset is secreted as extracellular CIRP(eCIRP)which is a damage-associated molecular pattern(DAMP)molecule that stimulates the production of inflammatory mediators.Elevated blood eCIRP levels may foster immune tolerance and facilitate tumor growth.Increased CIRP levels have been noted in various malignancies including colorectal cancer(CRC).This study’s objective was to determine plasma eCIRP levels before and after minimally invasive colorectal resection(MICR)for CRC.AIM To assess plasma eCIRP levels prior to and following minimally invasive colorectal resection in the context of cancer pathology.METHODS MICR patients from an IRB-approved data/tissue bank for whom plasma samples were available were eligible.Plasma specimens were obtained preoperatively(preop)and at least 3 time’s postop[between postoperative day(POD)1-41];late samples were grouped into 7-day blocks and were considered separate time points.eCIRP levels were assessed via enzyme-linked immunosorbent assay(pg/mL)and results presented as mean±SD,analysis with Wilcoxon paired t-test.RESULTS A total of 83 CRC patients who underwent MICR[colon 66%,rectal 34%;laparoscopic-assisted(LA),70%;handassisted laparoscopic(HAL),30%]were studied.The mean preop eCIRP level was 896.8±757.0 pg/mL.Elevations in mean plasma levels(P=<0.001)were noted on POD1(2549±2632 pg/mL,n=83),POD3(1871±1362 pg/mL,n=77),POD7-13(1788±1403 pg/mL,n=57),POD14-20(1473±738.8 pg/mL,n=30),and POD21-27(1681±1375 pg/mL,n=21).No significant differences were noted at POD 28-41.Higher values were noted in the HAL’s(vs LA)group,however,there were more rectal cancers in the former.CONCLUSION Elevated plasma eCIRP levels persist for a month post MICR for CRC(change from baseline,77%-184%);highest values seen on POD1.The initial surge may be due to the acute inflammatory response while later elevations may be related to wound healing and remodeling.The higher levels noted in the HAL’s group(with greater IL and more rectal cases)suggest the extent of surgical trauma impacts eCIRP levels.Further investigations are needed.
文摘BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outcomes.AIM To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.METHODS One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled.The patients were assigned to control(n=60,receiving standard nursing care)and observation groups(n=60,receiving music therapy,anesthesia recovery care,and standard nursing care).We comparatively analyzed the time to regain consciousness,extubation time,and length of stay in the postanesthesia care unit;heart rate,systolic blood pressure,and diastolic blood pressure before anesthesia and during recovery;cortisol,aldosterone,norepinephrine,and adrenaline levels before anesthesia and 24 hours postoperatively;Postoperative Quality of Recovery Scale scores;and complication rates between the groups.RESULTS The observation group exhibited a significantly shorter time to regain consciousness,extubation time,and postanesthesia care unit stay than the control group(P<0.05).During the recovery period,heart rate,systolic blood pressure,and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels,with the levels in the observation group being significantly lower than those in the control group(P<0.05).At 24 hours postoperatively,cortisol,aldosterone,norepinephrine,and adrenaline levels were elevated in both groups compared with preanesthesia levels,with levels in the observation group being significantly lower than those in the control group(P<0.05).The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group(P<0.05).Moreover,the complication rate in the observation group was significantly lower than that in the control group(10.00%vs 40.00%,P<0.05).CONCLUSION Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection,mitigated fluctuations in vital signs and stress responses,improved postoperative recovery quality,and reduced complication rates,demonstrating substantial clinical value.
文摘Objective: to analyze the clinical effect of fast recovery nursing combined with nutritional support in patients with colorectal cancer radical operation. Methods: 78 patients with colorectal cancer in our hospital were selected from October 2017 to October 2019. All patients were divided into conventional group (39 cases) and intervention group (39 cases) by drawing lots. The clinical effects and nutritional indexes of the two groups after intervention were compared. Results: compared with the conventional group, the recovery of bowel sounds, the first exhaust and the time to get out of bed in the intervention group were significantly shorter than those in the conventional group (P < 0.05);compared with the conventional group, the levels of MAMC, TSH and ALB in the intervention group were significantly higher (P < 0.05). Conclusion: the application of rapid rehabilitation nursing combined with nutritional support in patients with colorectal cancer can significantly improve their nutritional status and shorten the recovery time.
文摘BACKGROUND MMP-2 also known as gelatinase A and MMP-7(matrilysin)are members of the zinc-dependent family of MMPs(Matrix metalloproteinase).MMP-2 and MMP-7 are remodeling enzymes that digest extracellular matrix;MMP-2 is extensively expressed during development and is upregulated at sites of tissue damage,inflammation,and in stromal cells of metastatic tumors.MMP-7 is expressed in the epithelial cells and in a variety of cancers including colon tumors.Plasma MMP-2 and MMP-7 levels were assessed before and after minimally invasive colorectal resection for cancer pathology.AIM To determine plasma MMP-2 and MMP-7 levels before and after minimally invasive colorectal resection for cancer pathology.METHODS Patients enrolled in a plasma bank for whom plasma was available were eligible.Plasma obtained from preoperative(Preop)and postoperative blood samples was used.Only colorectal cancer(CRC)patients who underwent elective minimally invasive cancer resection with preop,post-operative day(POD)1,3 and at least 1 late postop sample(POD 7-34)were included.Late samples were bundled into 7 d blocks(POD 7-13,14-20,etc.)and treated as single time points.Plasma MMP-2 and MMP-7 levels were determined via enzyme-linked immunosorbent assay in duplicate.RESULTS Total 88 minimally invasive CRC resection CRC patients were studied(right colectomy,37%;sigmoid,24%;and LAR/AR 18%).Cancer stages were:1,31%;2,30%;3,34%;and 4,5%.Mean Preop MMP-2 plasma level(ng/mL)was 179.3±40.9(n=88).Elevated mean levels were noted on POD1(214.3±51.2,n=87,P<0.001),POD3(258.0±63.9,n=80,P<0.001),POD7-13(229.9±62.3,n=65,P<0.001),POD 14-20(234.9±47.5,n=25,P<0.001),POD 21-27(237.0±63.5,n=17,P<0.001,)and POD 28-34(255.4±59.7,n=15,P<0.001).Mean Preop MMP-7 level was 3.9±1.9(n=88).No significant differences were noted on POD 1 or 3,however,significantly elevated levels were noted on POD 7-13(5.7±2.5,n=65,P<0.001),POD 14-20(5.9±2.5,n=25,P<0.001),POD 21-27(6.1±3.6,n=17,P=0.002)and on POD 28-34(6.8±3.3,n=15 P<0.001,)vs preop levels.CONCLUSION MMP-2 levels are elevated for 5 wk and MMP-7 levels elevated for weeks 2-6.The etiology of these changes in unclear,trauma and wound healing likely play a role.These changes may promote residual tumor growth and metastasis.
文摘Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum is involved. Herein, we report on one of 4 cases. The procedures, using a bipolar needle knife (B-Knife) to reduce the perforation risk and carbon dioxide instead of conventional air insufflation for patient comfort, achieved curative resections without any complications.
