Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respir...Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respiratory viral infections,remains a substantial public health concern owing to its considerable disease burden,particularly in highrisk groups.Mounting epidemiological evidence has linked influenza to extreme heat and cold weather^([2–4]).展开更多
BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecti...BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecting oncological outcomes and postoperative complications.AIM To investigate the relationship between radiologically assessed pelvic anatomy and surgical outcomes as well as the impact on local recurrence following rectal cancer surgery.METHODS We retrospectively analyzed 107 patients with rectal adenocarcinoma treated with elective rectal surgery between January 1,2017,and September 1,2022.Pelvimetric measurements were performed using computed tomography(CT)-based two-dimensional methods(n=77)by assessing the pelvic inlet area in mm^(2),and magnetic resonance imaging(MRI)-based three-dimensional techniques(n=52)using the pelvic cavity index(PCI).Patient demographic,clinical,radiological,surgical,and pathological characteristics were collected and analyzed in relation to their pelvimetric data.RESULTS When patients were categorized based on CT measurements into narrow and normal/wide pelvis groups,a significant association was observed with male sex,and a lower BMI was more common in the narrow pelvis group(P=0.002 for both).A significant association was found between a narrow pelvic structure,indicated by low PCI,and increased surgical morbidity(P=0.049).Advanced age(P=0.003)and male sex(P=0.020)were significantly correlated with higher surgical morbidity.Logistic regression analysis identified four parameters that were significantly correlated with local recurrence:older age,early perioperative readmission,longer operation time,and a lower number of dissected lymph nodes(P<0.05).However,there were no significant differences between the narrow and normal/wide pelvis groups in terms of the operation time,estimated blood loss,or overall local recurrence rate(P>0.05).CONCLUSION MRI-based pelvimetry may be valuable in predicting surgical difficulty and morbidity in rectal cancer surgery,as indicated by the PCI.The observed correlation between low PCI and increased surgical morbidity suggests the potential importance of a preoperative MRI-based pelvimetric evaluation.In contrast,CT-based pelvimetry did not show significant differences in predicting surgical outcomes or cancer recurrence,indicating that the utility of pelvimetry alone may be limited in these respects.展开更多
AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality ...AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.展开更多
AIM:To evaluate to morbidity and mortality differences between 4 underlying heart diseases,myocardial infarction(MI),angina pectoris(Angina),heart failure(HF),and atrial fibrillation(AF),after radical surgery for gast...AIM:To evaluate to morbidity and mortality differences between 4 underlying heart diseases,myocardial infarction(MI),angina pectoris(Angina),heart failure(HF),and atrial fibrillation(AF),after radical surgery for gastric cancer.METHODS:We retrospectively collected data from 221 patients of a total of 15167 patients who underwent radical gastrectomy and were preoperatively diagnosed with a history of Angina,MI,HF,or AF in 8 hospitals.RESULTS:We find that the total morbidity rate is significantly higher in the MI group(44%) than the Angina(15.7%),AF(18.8%),and HF(23.1%) groups(P < 0.01).Moreover,we note that the risk for postoperative cardiac problems is higher in patients with a history of HF(23.1%) than patients with a historyof Angina(2.2%),AF(4.3%),or MI(6%; P = 0.01).The HF and MI groups each have 1 case of cardiogenic mortality.CONCLUSION:We conclude that MI patients have a higher risk of morbidity,and HF patients have a higher risk of postoperative cardiac problems than Angina or AF.展开更多
BACKGROUND: Assessing and evaluating mental health status can provide educational planners valuable information to predict the quality of physicians' performance at work. These data can help physicians to practice...BACKGROUND: Assessing and evaluating mental health status can provide educational planners valuable information to predict the quality of physicians' performance at work. These data can help physicians to practice in the most desired way. The study aimed to evaluate factors affecting psychological morbidity in Iranian emergency medicine practitioners at educational hospitals of Tehran.METHODS: In this cross sectional study 204 participants(emergency medicine residents and specialists) from educational hospitals of Tehran were recruited and their psychological morbidity was assessed by using a 28-question Goldberg General Health Questionnaire(GHQ-28). Somatization, anxiety and sleep disorders, social dysfunction and depression were evaluated among practitioners and compared to demographic and job related variables.RESULTS: Two hundreds and four participants consisting of 146(71.6%) males and 58(28.4%) females were evaluated. Of all participants, 55(27%) were single and 149(73%) were married. Most of our participants(40.2%) were between 30–35 years old. By using GHQ-28, 129(63.2%) were recognized as normal and 75(36.8%) suffered some mental health disorders. There was a signifi cant gender difference between normal practitioners and practitioners with disorder(P=0.02) while marital status had no significant difference(P=0.2). Only 19(9.3%) declared having some major mental health issue in the previous month.CONCLUSION: Females encountered more mental health disorders than male(P=0.02) and the most common disorder observed was somatization(P=0.006).展开更多
Morbidly adherent placenta (MAP) is a major cause of maternal morbidity and cause of severe fear and stress to the patient, family and the treating staff. Proper counseling and sympathetic case handling and management...Morbidly adherent placenta (MAP) is a major cause of maternal morbidity and cause of severe fear and stress to the patient, family and the treating staff. Proper counseling and sympathetic case handling and management is of great relief. Detailed explanation for the pathology and the treatment plan will support the psychology of the patient and surrounding.展开更多
Loneliness is one of the central themes in the works of Nathanial Hawthorne,which,to some extent,is a reflection of Hawthorn's keen sensitiveness to the existential anxiety of man in his times.The paper explores t...Loneliness is one of the central themes in the works of Nathanial Hawthorne,which,to some extent,is a reflection of Hawthorn's keen sensitiveness to the existential anxiety of man in his times.The paper explores the theme of alienation that is exposed in the The House of the Seven of Seven Gables by making a careful analysis of morbid mentality of Hepzibah,which is mainly displayed in Hepzibah's alienated feelings to the outside society and abnormal passion for Clifford.展开更多
BACKGROUND There are few if any life-span population-based studies of psychiatric disorderassociated biomedical and biophysical disorders and diseases(morbidity).AIM To scope the present state of research regarding th...BACKGROUND There are few if any life-span population-based studies of psychiatric disorderassociated biomedical and biophysical disorders and diseases(morbidity).AIM To scope the present state of research regarding the biomedical and biophysical morbidity associated with affective and mental disorder in epidemiological samples,and to examine the life-span relationship between affective disorders and biomedical/biophysical disorders to illustrate a novel approach employing the odds ratio to represent the intensity of biomedical and biophysical morbidity associated in time in a population.METHODS A repeatable systematic literature search of PubMed was represented in summary.Additionally,a regional population-based dataset was constructed and analyzed to represent the age-and sex-specific diagnoses(International Classification of Diseases Version 9,ICD-9)for those with and without affective disorder.The analysis presents a novel index of the relative age-specific frequency of life-span biomedical and biophysical diagnoses associated with affective disorder.RESULTS The volume of biomedical and biophysical morbidity associated with mental disorder literature has increased,yet few studies measure comprehensive temporal hyper-morbidity(over-representation of diseases over time,either before or after the index diagnostic event)in populations.Further,there have been only a few population-based studies examining the morbidity associated with affective disorder and only one that examines the full diagnostic range of lifespan morbidity.Substantial differences arose between males and females with more females than males having greater frequencies of diagnoses.The age-specific distributions of the maximum proportional diagnosis frequency ratios for each sex illustrate the greatest diagnosis-specific differences when comparing the biomedical and biophysical diagnoses of those with and without affective disorder when the same diagnosis was represented in each grouping at the same age.CONCLUSION Clinical research needs to focus on more than one or two comorbid biomedical or biophysical disorders at a time.Comprehensive population-based examination of the lifespan biomedical and biophysical multi-morbidity associated with affective disorder has the potential to directly inform clinical practice.Representing the proportional ratios of age-specific frequency of diagnoses for the full range of ICD-9 diagnoses is a novel analytical model.Diagnostic frequency appears a viable representation of a given disease state,such as affective disorder.Fortunately,the WPA has developed a global education section to better understand the biomedical and biophysical morbidity associated with all psychiatric disorders.This has been identified by the WPA as the psychiatric practice challenge of the 21st century.展开更多
Nosocomial infection （NI） is one of the most significant complications arising after open heart surgery, and leads to increased mortality, hospitalization time and health resource allocation. This study investigated...Nosocomial infection （NI） is one of the most significant complications arising after open heart surgery, and leads to increased mortality, hospitalization time and health resource allocation. This study investigated the morbidity, mortality, and independent risk factors associated with NI following open heart surgery. We retrospectively surveyed the records of 1606 consecutive cardiovascular surgical patients to identify those that developed NI. The NI selection criteria were based on the Centers for Disease Control and Prevention （CDC） guidelines. The term NI encompasses surgical site infection （SSI）, central venous catheter-related infection （CVCRI）, urinary tract infection （UTI）, respiratory tract infection and pneumonia （RTIP）, as well as other types of infections. Of 1606 cardiovascular surgery patients, 125 developed NI （7.8%, 125/1606）. The rates of NI following surgery for congenital malformation, valve replacement, and coronary artery bypass graft were 2.6% （15/587）, 5.5% （26/473） and 13.6% （32/236）, respectively. The NI rate following surgical repair of aortic aneurysm or dissection was 16.8% （52/310）. Increased risk of NI was detected for patients with a prior preoperative stay 〉3 days （OR=2.11, 95% CI=1.39-3.20）, diabetes （OR=2.00, 95%=CI 1.26-3.20）, length of surgery 〉6 h （OR=2.26, 95% CI=1.47-3.47）, or postoperative cerebrovascular accident （OR=4.08, 95% CI=1.79-9.29）. Greater attention should be paid toward compliance with ventilator and catheter regulations in order to decrease NI morbidity and mortality following cardiovascular procedures.展开更多
BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma(HCCA)is common;however,whether it has an impact on oncological prognosis is unknown.AIM To evaluate the influence of postoperati...BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma(HCCA)is common;however,whether it has an impact on oncological prognosis is unknown.AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled.The independent risk factors for morbidity in the 30 d after surgery were investigated,and links between postoperative morbidity and patient characteristics and outcomes were assessed.Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification,and major morbidities were defined as Clavien-Dindo≥3.Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival(RFS)and overall survival(OS).RESULTS Postoperative morbidity occurred in 146 out of 239 patients(61.1%).Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus,and obesity were independent risk factors. Postoperative morbidity was associated with decreasedOS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003;RFS: 16.0 mo vs 26.0 mo, respectively,P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity wasindependently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval(CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, majormorbidity was independently associated with decreased OS (HR: 2.175;95%CI: 1.470-3.216, P <0.001) and RFS (HR: 2.054;95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA.CONCLUSIONPostoperative morbidity (especially major morbidity) may be an independent risk factor forunfavorable prognosis in HCCA patients following curative resection.展开更多
Background:Gastric cancer is the 2 nd most common cause of cancer-related deaths,and the morbidity rate after surgery is reported to be as high as 46%.The estimation of possible complications,morbidity,and mortality a...Background:Gastric cancer is the 2 nd most common cause of cancer-related deaths,and the morbidity rate after surgery is reported to be as high as 46%.The estimation of possible complications,morbidity,and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit.This study aimed to determine the prognostic value of the preoperative platelet-tolymphocyte ratio(PLR)and neutrophil-to-lymphocyte ratio(NLR)and their relations with clinical outcomes and complications after gastrectomy for gastric cancer.Methods:This single-center,retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara,Turkey.A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications.The area under the curve was computed to compare the predictive power of the NLR and PLR.Then,the cutoff points were selected as the stratifying values for the PLR and NLR.Results:The area under the curve values of the PLR(0.60,95%CI 0.542–0.657)and NLR(0.556,95%CI 0.497–0.614)were larger than those of the other preoperative laboratory values.For the PLR,the diagnostic sensitivity and specificity were 50.00%and 72.22%,respectively,whereas for the NLR,the diagnostic sensitivity and specificity were 37.50%and 80.16%,respectively.The PLR was related to morbidity,whereas the relation of the NLR with mortality was more prominent.This study demonstrated that the PLR and NLR may predict mortality and morbidity via the ClavienDindo classification in gastric cancer patients.The variable was grade≥3 in the Clavien-Dindo classification,including complications requiring surgical or endoscopic interventions,life-threatening complications,and death.Both the PLR and NLR differed significantly according to Clavien-Dindo grade≥3.In this analysis,the PLR was related to morbidity,while the NLR relation with mortality was more intense.Conclusion:Based on the results of the study,the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.展开更多
Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complica...Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III morbidity, pancreatic stula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching signi cance were further analyzed in order to calculate a predictive score. Results: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 (P=0.04). Patients with PF presented higher CRP on POD2 (P=0.001), higher lactate on POD1 (P=0.007) and POD2 (P=0.008), and lower lymphocytes on POD1 (P=0.007) and POD2 (P=0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (P =0.048, P =0.038), lower lymphocytes on POD1 (P =0.001) and POD2 (P =0.003), and higher CRP on POD2 (P =0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was de ned according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥ 250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.展开更多
To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score. METHODSWe enr...To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score. METHODSWe enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old (Group A), and 333 patients were aged < 79 years old (Group B). We compared the surgical outcomes and survival of the two groups after IPTW. RESULTSPostoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B (P < 0.05). Overall survival (OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage I disease, OS was significantly lower in Group A (P < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection were independent prognostic values for OS. CONCLUSIONWhen the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.展开更多
Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine.While it was initially thought that cervical involvement was innocuous,natural history studies have substantiated t...Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine.While it was initially thought that cervical involvement was innocuous,natural history studies have substantiated the progressive nature of untreated disease.Over the past 50 years,there has been further elucidation in the pathophysiology of the disease,as well as significant advancements in medical and surgical therapy.The introduction of disease modifying drugs and biologic agents has reduced the amount of patients with advanced stages of the disease needing surgery.Advancement in instrumentation techniques has improved patient outcomes and fusion rates.The introduction of endoscopic approaches for ventral decompression may further lower surgical morbidity.In this review,we give a brief overview of the pertinent positives of the disease.A discussion of historical techniques and the evolution of surgical therapy into the modern era is provided.With improved medical therapies and lessinvasive approaches,we will likely continue to see less advanced cases of disease and less surgical morbidity.Nonetheless,a thorough understanding of the disease is crucial,as its systemic involvement and need for continued medical therapy have tremendous impact on overall complications and outcomes even in patients being seen for standard degenerative disease with comorbid rheumatoid.展开更多
AIM: To determine the morbidity and mortality associated with emergency laparotomy for a clinically acute abdomen in patients aged ≥ 80 years. METHODS: In this retrospective audit, octogenarians undergoing emergency ...AIM: To determine the morbidity and mortality associated with emergency laparotomy for a clinically acute abdomen in patients aged ≥ 80 years. METHODS: In this retrospective audit, octogenarians undergoing emergency laparotomy between 1st January 2005 and 1 st January 2010 were identified using the Galaxy Theatre System. Patients undergoing abdominal surgery through groin crease incisions or Lanz or Gridiron incisions were excluded. Also simple appendectomies were excluded. All patients were aged 80 years or more at the time of their surgery. Data were obtained using casenote review with a standardised proforma to determine patient age, American Society of Anesthesiologists (ASA) grade, indications for surgery, early (within 30 d) and late (after 30 d) complications, mortality and length of stay. Data were inserted into a Microsoft Excel spreadsheet and analysed. RESULTS: One hundred patients were identified from the database (Galaxy) as having undergone emergency laparotomy. Of those, 55 underwent the procedure for intestinal procedures and 37 for secondary peritonitis.There was a 2:1 female predominance; average age 85 and ASA grade 3. Bowel resection was required in 51 out of the 100 patients and 22 (43%) died. Other procedures included appendicectomy, adhesiolysis, repair of AAA graft leak and colostomies for the pathological process resulting in an acute abdomen. Twelve of 100 patients (12%) suffered intra-operative complications, including splenic and bowel-serosal tears. Seventy patients (70%) had postoperative complications including myocardial infarction, wound infection, haematoma and sepsis. Overall mortality was 45/100 patients (45%). The major causes of death were sepsis (19/45 patients, 42%), underlying cancer (13/45 patients, 29%); with others including bowel obstruction (2/45 patients, 4%), myocardial and intestinal ischaemia and dementia. CONCLUSION: Emergency laparotomy in octogenarians carries a significant morbidity and mortality. In particular, surgery requiring bowel resection has higher mortality than without resection.展开更多
AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy wer...AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.展开更多
AIM： To study the risk factors for morbidity and mortality following total gastrectomy. METHODS： We retrospectively reviewed the records of 125 consecutive patients who underwent total gastrectomy for gastric cancer...AIM： To study the risk factors for morbidity and mortality following total gastrectomy. METHODS： We retrospectively reviewed the records of 125 consecutive patients who underwent total gastrectomy for gastric cancer at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2003 and March 2008. RESULTS： The overall morbidity rate was 20.8% （27 patients） and the mortality rate was 3.2% （4 patients）. Morbidity rates were higher in patients aged over 60 [odds ratio （OR） 4.23 （95% confidence interval （CI） 1.09 to 12.05）], with preoperative comorbidity [with vs without, OR 1.25 （95% CI 1.13 to 8.12）], when the combined resection was performed [combined resection vs total gastrectomy only, OR 2.67 （95% CI 1.58 to 5.06）]. CONCLUSION： Age, preoperative comorbidity and combined resection were with the rate of morbidity gastric cancer. independently associated after total gastrectomy for展开更多
Laparoscopic sleeve gastrectomy(LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. Ho...Laparoscopic sleeve gastrectomy(LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease(GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h p H monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve(both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Rouxen-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX? Reflux Management System procedure and the Stretta? procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of p H monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5^(th) International Consensus Conference on sleeve gastrectomy.展开更多
BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate...BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.展开更多
BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attrib...BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.展开更多
基金supported by a Grant-inAid for Scientific Research(KAKENHI)from the Japan Society for the Promotion of Science(grant no.22J23183)。
文摘Climate change is a pressing global environmental issue^([1]).The gradual rise in global surface temperature is the most immediate and direct among its public health impacts.Influenza,the leading cause of human respiratory viral infections,remains a substantial public health concern owing to its considerable disease burden,particularly in highrisk groups.Mounting epidemiological evidence has linked influenza to extreme heat and cold weather^([2–4]).
文摘BACKGROUND Rectal cancer has increased in incidence,and surgery remains the cornerstone of multimodal treatment.Pelvic anatomy,particularly a narrow pelvis,poses challenges in rectal cancer surgery,potentially affecting oncological outcomes and postoperative complications.AIM To investigate the relationship between radiologically assessed pelvic anatomy and surgical outcomes as well as the impact on local recurrence following rectal cancer surgery.METHODS We retrospectively analyzed 107 patients with rectal adenocarcinoma treated with elective rectal surgery between January 1,2017,and September 1,2022.Pelvimetric measurements were performed using computed tomography(CT)-based two-dimensional methods(n=77)by assessing the pelvic inlet area in mm^(2),and magnetic resonance imaging(MRI)-based three-dimensional techniques(n=52)using the pelvic cavity index(PCI).Patient demographic,clinical,radiological,surgical,and pathological characteristics were collected and analyzed in relation to their pelvimetric data.RESULTS When patients were categorized based on CT measurements into narrow and normal/wide pelvis groups,a significant association was observed with male sex,and a lower BMI was more common in the narrow pelvis group(P=0.002 for both).A significant association was found between a narrow pelvic structure,indicated by low PCI,and increased surgical morbidity(P=0.049).Advanced age(P=0.003)and male sex(P=0.020)were significantly correlated with higher surgical morbidity.Logistic regression analysis identified four parameters that were significantly correlated with local recurrence:older age,early perioperative readmission,longer operation time,and a lower number of dissected lymph nodes(P<0.05).However,there were no significant differences between the narrow and normal/wide pelvis groups in terms of the operation time,estimated blood loss,or overall local recurrence rate(P>0.05).CONCLUSION MRI-based pelvimetry may be valuable in predicting surgical difficulty and morbidity in rectal cancer surgery,as indicated by the PCI.The observed correlation between low PCI and increased surgical morbidity suggests the potential importance of a preoperative MRI-based pelvimetric evaluation.In contrast,CT-based pelvimetry did not show significant differences in predicting surgical outcomes or cancer recurrence,indicating that the utility of pelvimetry alone may be limited in these respects.
文摘AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.
文摘AIM:To evaluate to morbidity and mortality differences between 4 underlying heart diseases,myocardial infarction(MI),angina pectoris(Angina),heart failure(HF),and atrial fibrillation(AF),after radical surgery for gastric cancer.METHODS:We retrospectively collected data from 221 patients of a total of 15167 patients who underwent radical gastrectomy and were preoperatively diagnosed with a history of Angina,MI,HF,or AF in 8 hospitals.RESULTS:We find that the total morbidity rate is significantly higher in the MI group(44%) than the Angina(15.7%),AF(18.8%),and HF(23.1%) groups(P < 0.01).Moreover,we note that the risk for postoperative cardiac problems is higher in patients with a history of HF(23.1%) than patients with a historyof Angina(2.2%),AF(4.3%),or MI(6%; P = 0.01).The HF and MI groups each have 1 case of cardiogenic mortality.CONCLUSION:We conclude that MI patients have a higher risk of morbidity,and HF patients have a higher risk of postoperative cardiac problems than Angina or AF.
文摘BACKGROUND: Assessing and evaluating mental health status can provide educational planners valuable information to predict the quality of physicians' performance at work. These data can help physicians to practice in the most desired way. The study aimed to evaluate factors affecting psychological morbidity in Iranian emergency medicine practitioners at educational hospitals of Tehran.METHODS: In this cross sectional study 204 participants(emergency medicine residents and specialists) from educational hospitals of Tehran were recruited and their psychological morbidity was assessed by using a 28-question Goldberg General Health Questionnaire(GHQ-28). Somatization, anxiety and sleep disorders, social dysfunction and depression were evaluated among practitioners and compared to demographic and job related variables.RESULTS: Two hundreds and four participants consisting of 146(71.6%) males and 58(28.4%) females were evaluated. Of all participants, 55(27%) were single and 149(73%) were married. Most of our participants(40.2%) were between 30–35 years old. By using GHQ-28, 129(63.2%) were recognized as normal and 75(36.8%) suffered some mental health disorders. There was a signifi cant gender difference between normal practitioners and practitioners with disorder(P=0.02) while marital status had no significant difference(P=0.2). Only 19(9.3%) declared having some major mental health issue in the previous month.CONCLUSION: Females encountered more mental health disorders than male(P=0.02) and the most common disorder observed was somatization(P=0.006).
文摘Morbidly adherent placenta (MAP) is a major cause of maternal morbidity and cause of severe fear and stress to the patient, family and the treating staff. Proper counseling and sympathetic case handling and management is of great relief. Detailed explanation for the pathology and the treatment plan will support the psychology of the patient and surrounding.
文摘Loneliness is one of the central themes in the works of Nathanial Hawthorne,which,to some extent,is a reflection of Hawthorn's keen sensitiveness to the existential anxiety of man in his times.The paper explores the theme of alienation that is exposed in the The House of the Seven of Seven Gables by making a careful analysis of morbid mentality of Hepzibah,which is mainly displayed in Hepzibah's alienated feelings to the outside society and abnormal passion for Clifford.
文摘BACKGROUND There are few if any life-span population-based studies of psychiatric disorderassociated biomedical and biophysical disorders and diseases(morbidity).AIM To scope the present state of research regarding the biomedical and biophysical morbidity associated with affective and mental disorder in epidemiological samples,and to examine the life-span relationship between affective disorders and biomedical/biophysical disorders to illustrate a novel approach employing the odds ratio to represent the intensity of biomedical and biophysical morbidity associated in time in a population.METHODS A repeatable systematic literature search of PubMed was represented in summary.Additionally,a regional population-based dataset was constructed and analyzed to represent the age-and sex-specific diagnoses(International Classification of Diseases Version 9,ICD-9)for those with and without affective disorder.The analysis presents a novel index of the relative age-specific frequency of life-span biomedical and biophysical diagnoses associated with affective disorder.RESULTS The volume of biomedical and biophysical morbidity associated with mental disorder literature has increased,yet few studies measure comprehensive temporal hyper-morbidity(over-representation of diseases over time,either before or after the index diagnostic event)in populations.Further,there have been only a few population-based studies examining the morbidity associated with affective disorder and only one that examines the full diagnostic range of lifespan morbidity.Substantial differences arose between males and females with more females than males having greater frequencies of diagnoses.The age-specific distributions of the maximum proportional diagnosis frequency ratios for each sex illustrate the greatest diagnosis-specific differences when comparing the biomedical and biophysical diagnoses of those with and without affective disorder when the same diagnosis was represented in each grouping at the same age.CONCLUSION Clinical research needs to focus on more than one or two comorbid biomedical or biophysical disorders at a time.Comprehensive population-based examination of the lifespan biomedical and biophysical multi-morbidity associated with affective disorder has the potential to directly inform clinical practice.Representing the proportional ratios of age-specific frequency of diagnoses for the full range of ICD-9 diagnoses is a novel analytical model.Diagnostic frequency appears a viable representation of a given disease state,such as affective disorder.Fortunately,the WPA has developed a global education section to better understand the biomedical and biophysical morbidity associated with all psychiatric disorders.This has been identified by the WPA as the psychiatric practice challenge of the 21st century.
文摘Nosocomial infection （NI） is one of the most significant complications arising after open heart surgery, and leads to increased mortality, hospitalization time and health resource allocation. This study investigated the morbidity, mortality, and independent risk factors associated with NI following open heart surgery. We retrospectively surveyed the records of 1606 consecutive cardiovascular surgical patients to identify those that developed NI. The NI selection criteria were based on the Centers for Disease Control and Prevention （CDC） guidelines. The term NI encompasses surgical site infection （SSI）, central venous catheter-related infection （CVCRI）, urinary tract infection （UTI）, respiratory tract infection and pneumonia （RTIP）, as well as other types of infections. Of 1606 cardiovascular surgery patients, 125 developed NI （7.8%, 125/1606）. The rates of NI following surgery for congenital malformation, valve replacement, and coronary artery bypass graft were 2.6% （15/587）, 5.5% （26/473） and 13.6% （32/236）, respectively. The NI rate following surgical repair of aortic aneurysm or dissection was 16.8% （52/310）. Increased risk of NI was detected for patients with a prior preoperative stay 〉3 days （OR=2.11, 95% CI=1.39-3.20）, diabetes （OR=2.00, 95%=CI 1.26-3.20）, length of surgery 〉6 h （OR=2.26, 95% CI=1.47-3.47）, or postoperative cerebrovascular accident （OR=4.08, 95% CI=1.79-9.29）. Greater attention should be paid toward compliance with ventilator and catheter regulations in order to decrease NI morbidity and mortality following cardiovascular procedures.
基金Supported by National Natural Science Foundation of China, No.81874211Personalized Training of Key Support Objects for The Talent People of The Army Medical University, No.XZ-2019-505-014
文摘BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma(HCCA)is common;however,whether it has an impact on oncological prognosis is unknown.AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled.The independent risk factors for morbidity in the 30 d after surgery were investigated,and links between postoperative morbidity and patient characteristics and outcomes were assessed.Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification,and major morbidities were defined as Clavien-Dindo≥3.Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival(RFS)and overall survival(OS).RESULTS Postoperative morbidity occurred in 146 out of 239 patients(61.1%).Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus,and obesity were independent risk factors. Postoperative morbidity was associated with decreasedOS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003;RFS: 16.0 mo vs 26.0 mo, respectively,P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity wasindependently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval(CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, majormorbidity was independently associated with decreased OS (HR: 2.175;95%CI: 1.470-3.216, P <0.001) and RFS (HR: 2.054;95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA.CONCLUSIONPostoperative morbidity (especially major morbidity) may be an independent risk factor forunfavorable prognosis in HCCA patients following curative resection.
文摘Background:Gastric cancer is the 2 nd most common cause of cancer-related deaths,and the morbidity rate after surgery is reported to be as high as 46%.The estimation of possible complications,morbidity,and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit.This study aimed to determine the prognostic value of the preoperative platelet-tolymphocyte ratio(PLR)and neutrophil-to-lymphocyte ratio(NLR)and their relations with clinical outcomes and complications after gastrectomy for gastric cancer.Methods:This single-center,retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara,Turkey.A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications.The area under the curve was computed to compare the predictive power of the NLR and PLR.Then,the cutoff points were selected as the stratifying values for the PLR and NLR.Results:The area under the curve values of the PLR(0.60,95%CI 0.542–0.657)and NLR(0.556,95%CI 0.497–0.614)were larger than those of the other preoperative laboratory values.For the PLR,the diagnostic sensitivity and specificity were 50.00%and 72.22%,respectively,whereas for the NLR,the diagnostic sensitivity and specificity were 37.50%and 80.16%,respectively.The PLR was related to morbidity,whereas the relation of the NLR with mortality was more prominent.This study demonstrated that the PLR and NLR may predict mortality and morbidity via the ClavienDindo classification in gastric cancer patients.The variable was grade≥3 in the Clavien-Dindo classification,including complications requiring surgical or endoscopic interventions,life-threatening complications,and death.Both the PLR and NLR differed significantly according to Clavien-Dindo grade≥3.In this analysis,the PLR was related to morbidity,while the NLR relation with mortality was more intense.Conclusion:Based on the results of the study,the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.
文摘Background: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during rst and second postoperative days (POD1, POD2) may be early indi- cators of complications. Methods: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III morbidity, pancreatic stula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching signi cance were further analyzed in order to calculate a predictive score. Results: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 (P=0.04). Patients with PF presented higher CRP on POD2 (P=0.001), higher lactate on POD1 (P=0.007) and POD2 (P=0.008), and lower lymphocytes on POD1 (P=0.007) and POD2 (P=0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (P =0.048, P =0.038), lower lymphocytes on POD1 (P =0.001) and POD2 (P =0.003), and higher CRP on POD2 (P =0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was de ned according to lymphocytes on POD1 < 650/μL and CRP on POD2 ≥ 250 mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer Lemeshow tests showed a good accuracy. Conclusions: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.
文摘To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score. METHODSWe enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old (Group A), and 333 patients were aged < 79 years old (Group B). We compared the surgical outcomes and survival of the two groups after IPTW. RESULTSPostoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B (P < 0.05). Overall survival (OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage I disease, OS was significantly lower in Group A (P < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection were independent prognostic values for OS. CONCLUSIONWhen the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.
文摘Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine.While it was initially thought that cervical involvement was innocuous,natural history studies have substantiated the progressive nature of untreated disease.Over the past 50 years,there has been further elucidation in the pathophysiology of the disease,as well as significant advancements in medical and surgical therapy.The introduction of disease modifying drugs and biologic agents has reduced the amount of patients with advanced stages of the disease needing surgery.Advancement in instrumentation techniques has improved patient outcomes and fusion rates.The introduction of endoscopic approaches for ventral decompression may further lower surgical morbidity.In this review,we give a brief overview of the pertinent positives of the disease.A discussion of historical techniques and the evolution of surgical therapy into the modern era is provided.With improved medical therapies and lessinvasive approaches,we will likely continue to see less advanced cases of disease and less surgical morbidity.Nonetheless,a thorough understanding of the disease is crucial,as its systemic involvement and need for continued medical therapy have tremendous impact on overall complications and outcomes even in patients being seen for standard degenerative disease with comorbid rheumatoid.
文摘AIM: To determine the morbidity and mortality associated with emergency laparotomy for a clinically acute abdomen in patients aged ≥ 80 years. METHODS: In this retrospective audit, octogenarians undergoing emergency laparotomy between 1st January 2005 and 1 st January 2010 were identified using the Galaxy Theatre System. Patients undergoing abdominal surgery through groin crease incisions or Lanz or Gridiron incisions were excluded. Also simple appendectomies were excluded. All patients were aged 80 years or more at the time of their surgery. Data were obtained using casenote review with a standardised proforma to determine patient age, American Society of Anesthesiologists (ASA) grade, indications for surgery, early (within 30 d) and late (after 30 d) complications, mortality and length of stay. Data were inserted into a Microsoft Excel spreadsheet and analysed. RESULTS: One hundred patients were identified from the database (Galaxy) as having undergone emergency laparotomy. Of those, 55 underwent the procedure for intestinal procedures and 37 for secondary peritonitis.There was a 2:1 female predominance; average age 85 and ASA grade 3. Bowel resection was required in 51 out of the 100 patients and 22 (43%) died. Other procedures included appendicectomy, adhesiolysis, repair of AAA graft leak and colostomies for the pathological process resulting in an acute abdomen. Twelve of 100 patients (12%) suffered intra-operative complications, including splenic and bowel-serosal tears. Seventy patients (70%) had postoperative complications including myocardial infarction, wound infection, haematoma and sepsis. Overall mortality was 45/100 patients (45%). The major causes of death were sepsis (19/45 patients, 42%), underlying cancer (13/45 patients, 29%); with others including bowel obstruction (2/45 patients, 4%), myocardial and intestinal ischaemia and dementia. CONCLUSION: Emergency laparotomy in octogenarians carries a significant morbidity and mortality. In particular, surgery requiring bowel resection has higher mortality than without resection.
文摘AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.
基金Supported by Grants from the Foundation of Science and Technology Department of Zhejiang Province, China, No.2004C34010
文摘AIM： To study the risk factors for morbidity and mortality following total gastrectomy. METHODS： We retrospectively reviewed the records of 125 consecutive patients who underwent total gastrectomy for gastric cancer at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2003 and March 2008. RESULTS： The overall morbidity rate was 20.8% （27 patients） and the mortality rate was 3.2% （4 patients）. Morbidity rates were higher in patients aged over 60 [odds ratio （OR） 4.23 （95% confidence interval （CI） 1.09 to 12.05）], with preoperative comorbidity [with vs without, OR 1.25 （95% CI 1.13 to 8.12）], when the combined resection was performed [combined resection vs total gastrectomy only, OR 2.67 （95% CI 1.58 to 5.06）]. CONCLUSION： Age, preoperative comorbidity and combined resection were with the rate of morbidity gastric cancer. independently associated after total gastrectomy for
文摘Laparoscopic sleeve gastrectomy(LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease(GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h p H monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve(both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Rouxen-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX? Reflux Management System procedure and the Stretta? procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of p H monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5^(th) International Consensus Conference on sleeve gastrectomy.
基金supported by the National Key Research and Development Program of China(2022YFC 3602501)the Pfizer Inc.(New York,USA)offices in Beijing,China。
文摘BACKGROUND Hypertension usually clusters with multiple comorbidities.However,the association between cardiometabolic multimorbidity(CMM)and mortality in hypertensive patients is unclear.This study aimed to investigate the association between CMM and all-cause and cardiovascular disease(CVD)mortality in Chinese patients with hypertension.METHODS The data used in this study were from the China National Survey for Determinants of Detection and Treatment Status of Hypertensive Patients with Multiple Risk Factors(CONSIDER),which comprised 5006 participants aged 19–91 years.CMM was defined as the presence of one or more of the following morbidities:diabetes mellitus,dyslipidemia,chronic kidney disease,coronary heart disease,and stroke.Cox proportional hazard models were used to calculate the hazard ratios(HR)with 95%CI to determine the association between the number of CMMs and both all-cause and CVD mortality.RESULTS Among 5006 participants[mean age:58.6±10.4 years,50%women(2509 participants)],76.4%of participants had at least one comorbidity.The mortality rate was 4.57,4.76,8.48,and 16.04 deaths per 1000 person-years in hypertensive patients without any comorbidity and with one,two,and three or more morbidities,respectively.In the fully adjusted model,hypertensive participants with two cardiometabolic diseases(HR=1.52,95%CI:1.09–2.13)and those with three or more cardiometabolic diseases(HR=2.44,95%CI:1.71–3.48)had a significantly elevated risk of all-cause mortality.The findings were similar for CVD mortality but with a greater increase in risk magnitude.CONCLUSIONS In this study,three-fourths of hypertensive patients had CMM.Clustering with two or more comorbidities was associated with a significant increase in the risk of all-cause and cardiovascular mortality among hypertensive patients,suggesting more intensive treatment and control in this high-risk patient group.
基金supported by the National Natural Science Foundation of China(Grants 12126602)the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610+5 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Academy of Research and Translation(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the SUSTech Presidential Postdoctoral Fellowshipthe Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.
