BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship ...BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship with personality traits has not been previously investigated in the Lebanese population.AIM To examine the prevalence of preoperative anxiety,pain perception,and personality traits among Lebanese surgical patients,and to assess the associations between these factors.METHODS A descriptive cross-sectional study was conducted between April 2024 and January 2025 across Lebanese hospitals.A total of 392 adult patients were recruited through convenience sampling.Data were collected using a questionnaire that included sociodemographic,clinical,and surgical variables,the Amsterdam Preoperative Anxiety and Information Scale for anxiety,the Visual Analog Scale and Numerical Pain Rating Scale for preoperative pain,and the Ten-Item Personality Inventory for personality traits.Ethical approval was obtained from the Institutional Review Boards of Makassed General Hospital and Hammoud University Medical Center.RESULTS Overall,25%of participants experienced preoperative anxiety,and 34.5%reported moderate pain.Personality assessment showed that the majority of participants had moderate extraversion(84.1%),moderate emotional stability(65.1%),high conscientiousness(61%),high agreeableness(54.1%),and moderate openness(49.2%).High conscientiousness was significantly associated with higher pain perception(P<0.05),while high emotional stability was associated with lower levels of anxiety(P<0.05).No significant association was found between preoperative anxiety and pain(P>0.05).CONCLUSION This study challenges the assumption that preoperative anxiety and pain are directly correlated and highlights the role of personality traits in shaping patient experience.These findings support the potential value of integrating psychological profiling into preoperative care and lay the groundwork for developing personalized interventions to improve patient-centered surgical outcomes.展开更多
BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector compu...BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.展开更多
Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted betw...Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted between February 2023 and May 2023 in a public hospital in northern Turkey with 123 nurses who agreed to participate in the study.Results:The results showed that 64.2%of the nurses thought that preoperative hair removal should be done by shaving with a razor,74%thought that hair removal should be performed the night before the operation,and 70.7%thought that the patient/patient’s relative should perform preoperative hair removal.Conclusions:This study found that nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of SSI were not at the desired level.Following current resources and improving their levels of knowledge and practices are considered to be important for nurses.展开更多
This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based r...This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based risk scoring system origi-nally developed in South Korea.The scoring system incorporated five parame-ters:(1)Tumor size;(2)Portal venous phase density;(3)Necrosis;(4)Peripan-creatic infiltration;and(5)Suspected metastatic lymph nodes.While demonstra-ting satisfactory recurrence prediction capability without requiring complex tech-nologies,thereby supporting clinical utility in Chinese populations,the study exhibited notable limitations.Most analyzed patients lacked neoadjuvant chemo-therapy exposure,resulting in underrepresentation of low-risk subgroups.Addi-tionally,the short follow-up duration potentially compromised long-term progno-stic assessment.Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management.However,clinical implementation continues to confront challenges including variability in imaging parameters,incomplete understanding of molecular underpinnings,and confounding treatment effects.Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic,molecular,and clinical data.Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation,ultimately advancing personalized therapeutic strategies for PDAC.展开更多
The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preop...The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preoperative factors.By analyzing data from 376 patients across four Chinese medical centers,the researchers identified key variables influencing TO,including Child-Pugh classification,Eastern Cooperative Oncology Group score,hepatitis B status,and tumor size.The model,created using logistic regression and the extreme gradient boosting algorithm,demonstrated high predictive accuracy,with area under the curve values of 0.8825 for internal validation and 0.8346 for external validation.The integration of the Shapley additive explanation technique enhances the interpretability of the model,which is crucial for clinical decision-making.This research highlights the potential of machine learning to improve surgical planning and patient outcomes in ICC,opening possibilities for personalized treatment approaches based on individual patient characteristics and risk factors.展开更多
Currently,preoperative visits have problems such as monotonous forms and insufficient humanistic care,which affect patients’psychological states and surgical cooperation.This article analyzes the current situation of...Currently,preoperative visits have problems such as monotonous forms and insufficient humanistic care,which affect patients’psychological states and surgical cooperation.This article analyzes the current situation of preoperative visits and the mechanisms influencing patients’psychology,proposes optimization strategies and safeguard measures,and explores the mechanisms of information transmission,emotional support,trust establishment,and environmental familiarity on patients’psychology.It designs optimization plans from the aspects of personalized content,standardized processes,professional techniques,and diversified forms,supplemented by nurse training,system improvement,and quality evaluation to ensure implementation.Practice shows that the optimized preoperative visit can improve the psychological state of patients,enhance surgical cooperation,and optimize the nurse-patient relationship.The conclusion indicates that scientific and standardized preoperative visits can improve the quality of surgical care through multiple psychological effects and are an important link in perioperative care.展开更多
Objective: To assess the impact of preoperative psychological interventions on the care of patients undergoing elective surgery. Methods: Ninety-two patients scheduled for elective surgery in the surgical department b...Objective: To assess the impact of preoperative psychological interventions on the care of patients undergoing elective surgery. Methods: Ninety-two patients scheduled for elective surgery in the surgical department between August 2021 and August 2023 were selected and divided into groups using a random number table. The observation group received preoperative psychological interventions, while the reference group received standard preoperative care. Anxiety and depression scores, fear grading, vital signs, and self-efficacy levels were compared. Results: After the intervention, the anxiety and depression scores in the observation group were lower than those in the reference group, and the proportion of fear graded as Level I was higher. During the waiting period and 15 minutes before entering the operating room, vital sign levels in the observation group were lower than those in the reference group. Additionally, the self-efficacy scores of the observation group were significantly higher than those of the reference group (P < 0.05). Conclusion: Preoperative psychological interventions can alleviate negative emotions, stabilize preoperative vital signs, and significantly improve self-efficacy in patients undergoing elective surgery, demonstrating high feasibility for implementation.展开更多
BACKGROUND Rectal cancer is a common malignant tumor of the digestive system,with older patients representing the predominantly affected population.Magnetic resonance imaging(MRI)has been widely applied in preoperativ...BACKGROUND Rectal cancer is a common malignant tumor of the digestive system,with older patients representing the predominantly affected population.Magnetic resonance imaging(MRI)has been widely applied in preoperative tumor assessment;however,the value of high-resolution MRI(HR-MRI)combined with dynamic contrast-enhanced(DCE)scanning in the preoperative diagnosis of rectal cancer in older patients remains unclear.AIM To evaluate the value of HR-MRI combined with DCE scanning in the preoperative diagnosis of rectal cancer in older patients.METHODS This retrospective study included 148 consecutive older female patients with rectal cancer who were treated at our hospital between December 2020 and December 2024.Clinical data and HR-MRI and DCE scan findings were collected.Histopathological examination after surgical resection served as the gold standard.The diagnostic accuracy of MRI for preoperative T and N staging was calculated.Consistency,sensitivity,and specificity between HR-MRI combined with DCE scanning and pathological staging were analyzed using the k test.Among the 148 patients,the overall accuracy of T staging was 84.5%.Sensitivity for T1,T2,T3,and T4 staging was 75.00%,62.50%,89.47%,and 90.48%,respectively,whereas specificity was 100.00%,94.35%,79.25%,and 96.06%,respectively.T staging based on HR-MRI combined with DCE scanning showed good agreement with pathological staging(k=0.8176,P<0.001).For N staging,sensitivity and specificity were 54.88%and 84.85%for N0,36.96%and 72.55%for N1,and 70.00%and 73.44%for N2,respectively;agreement with pathological N staging was poor(k=0.259,P<0.001).CONCLUSION HR-MRI combined with DCE scanning demonstrates high diagnostic accuracy for T staging of rectal cancer in older patients and can provide a theoretical basis for treatment planning.However,its diagnostic accuracy for N staging requires improvement.展开更多
BACKGROUND Despite improved survival rates in rectal cancer treatment,many patients experience low anterior resection syndrome(LARS).The preoperative LARS score(POLARS)aims to address the limitations of LARS assessmen...BACKGROUND Despite improved survival rates in rectal cancer treatment,many patients experience low anterior resection syndrome(LARS).The preoperative LARS score(POLARS)aims to address the limitations of LARS assessment by predicting outcomes preoperatively to enhance surgical planning.AIM To investigate the predictive accuracy of POLARS in assessing the occurrence of LARS.METHODS This study enrolled a total of 335 patients who underwent laparoscopic or robotic low anal sphincter-preserving surgery for rectal tumors.Patients were categorized into three groups according to their POLARS score:no LARS(score 0-20),minor LARS(score 21-29),and major LARS(score 30-42).The QLQ-C30/CR29 scores were compared among these groups,and the agreement between POLARS predictions and the actual LARS scores was analyzed.RESULTS The study population was divided into three groups:major LARS(n=51,27.42%),minor LARS(n=109,58.6%),and no LARS(n=26,13.98%).Significant differences in the QLQ-C30 scales of social function,diarrhea,and financial impact were detected between the no LARS and major LARS groups(P<0.05)and between the minor LARS and major LARS groups(P<0.05).Similarly,significant differences were detected in the QLQ-CR29 scales for blood and mucus in the stool,fecal incontinence,and stool frequency between the no LARS and minor LARS groups(P<0.05),as well as between the minor LARS and major LARS groups(P<0.05).The predictive precision for major LARS using the POLARS score was 82.35%(42/51),with a recall of 35.89%(42/117).The mean absolute error(MAE)between the POLARS score and the actual LARS score was 8.92±5.47.In contrast,the XGBoost(extreme gradient boosting)model achieved a lower MAE of 6.29±4.77,with a precision of 84.39%and a recall of 74.05%for predicting major LARS.CONCLUSION The POLARS score demonstrated effectiveness and precision in predicting major LARS,thereby providing valuable insights into postoperative symptoms and patient quality of life.However,the XGBoost model exhibited superior performance with a lower MAE and higher recall for predicting major LARS compared to the POLARS model.展开更多
This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians...This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians in determining surgical indications,assessing patient conditions,and offering valuable assistance in formulating surgical strategies and predicting outcomes.Developed by a collaborative team of experts from the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,in conjunction with the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,these guidelines have been formulated through extensive research and evaluation,incorporating the latest technological advancements and studies on a global and domestic scale in vitreoretinal surgery.After extensive deliberations and incorporation of up-to-date clinical data,these guidelines have been developed to assist in standardizing preoperative examinations for vitreoretinal surgery.The overarching goals include improving medical quality,maximizing resource allocation,offering decision-making assistance,and safeguarding patient rights.This document provides a comprehensive analysis of preoperative assessments for vitreoretinal procedures,covering principles,methodologies,and precautions related to a range of diagnostic techniques including ultra-wide-angle fundus imaging,fluorescein angiography,indocyanine green angiography,ophthalmic B-ultrasound examinations,ultrasound biomicroscopy,optical coherence tomography,optical coherence tomography angiography,orbital CT scan,orbital MRI,and ophthalmic electrophysiology tests such as electroretinograms,visually evoked potentials,and visual field testing.展开更多
BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomogra...BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomography imaging(GSI)to improve diagnostic accuracy in lymph node metastasis(LNM)assessment.AIM To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.METHODS The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023.All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention.During the research,meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes.Moreover,for both metastatic and non-metastatic lymph nodes,the short diameter at the maximum crosssectional area(covering the axial,sagittal,and coronal planes),morphological features(including manifestations such as margin blurring,aggregation,and enhancement),and spectral parameters in the arterial and venous phases[specifically iodine concentration(IC),normalized IC(NIC),and the slope of the spectral curve(λHU)]were measured and recorded,and a comparative analysis was conducted.The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic(ROC)curve.Concurrently,receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.RESULTS The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897,with sensitivity,specificity,and accuracy of 92.59%,85.87%,and 89.50%,respectively.A total of 265 lymph nodes were analyzed from the 200 participants with CRC,with metastatic lymph nodes accounting for 56.60%.Compared with nonmetastatic lymph nodes,the short diameters of metastatic lymph nodes in the axial,sagittal,and coronal planes were significantly increased,whereas the IC values in the arterial and venous phases,the NIC value in the arterial phase,and theλHU values in the arterial and venous phases were significantly decreased.The short axial,sagittal,and coronal diameters,arterial-phase IC,venous-phase IC,arterial-phase NIC,arterial-phaseλHU,and venousphaseλHU for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631,0.681,0.659,0.862,0.808,0.831,0.801,and 0.706,respectively.CONCLUSION GSI exhibits substantial clinical significance in the preoperative assessment of CRC.Among the parameters assessed,the arterial-phase IC demonstrates the most outstanding diagnostic performance,effectively improving the diagnostic efficacy for preoperative LNM in CRC.展开更多
The investigation by Zhu et al on the assessment of cellular proliferation markers to assist clinical decision-making in patients with hepatocellular carcinoma(HCC)using a machine learning model-based approach is a sc...The investigation by Zhu et al on the assessment of cellular proliferation markers to assist clinical decision-making in patients with hepatocellular carcinoma(HCC)using a machine learning model-based approach is a scientific approach.This study looked into the possibilities of using a Ki-67(a marker for cell proliferation)expression-based machine learning model to help doctors make decisions about treatment options for patients with HCC before surgery.The study used reconstructed tomography images of 164 patients with confirmed HCC from the intratumoral and peritumoral regions.The features were chosen using various statistical methods,including least absolute shrinkage and selection operator regression.Also,a nomogram was made using Radscore and clinical risk factors.It was tested for its ability to predict receiver operating characteristic curves and calibration curves,and its clinical benefits were found using decision curve analysis.The calibration curve demonstrated excellent consistency between predicted and actual probability,and the decision curve confirmed its clinical benefit.The proposed model is helpful for treating patients with HCC because the predicted and actual probabilities are very close to each other,as shown by the decision curve analysis.Further prospective studies are required,incorporating a multicenter and large sample size design,additional relevant exclusion criteria,information on tumors(size,number,and grade),and cancer stage to strengthen the clinical benefit in patients with HCC.展开更多
BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such ...BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such as joint function,quality of life,and postoperative complications remain unclear.AIM To investigate the effects of preoperative psychological stress on selected parameters in older patients who underwent THA.METHODS Ninety older patients who underwent THA between January 2023 and August 2024 were divided into two groups by their preoperative self-rated anxiety scale and self-rated depression scale scores,including high-stress(n=42)and lowstress(n=48).The postoperative joint function,short form-36 health survey(SF36)score,incidence of postoperative complications,and other indicators were compared between the two groups.Pearson’s correlation coefficient analysis of the relationship among preoperative psychological stress,quality of life,and postoperative complications was performed.RESULTS Postoperative joint function and quality of life were lower in the high-stress group than they were in the low-stress group(P<0.05).The incidence of postoperative complications was higher in the high-stress group(29.27%)than it was in the low-stress group(9.30%)(P<0.05).Cor-relation analysis revealed that psychological stress was correlated with the Harris hip and SF-36 scores.Total scores on the scale,including physical function,physical pain,general health,mental health,social function,vitality,and emotional function,were negatively correlated(P<0.05).CONCLUSION Preoperative psychological stress results in adverse effects on quality of life and complications in older patients undergoing THA.Therefore,pre-operative psychological interventions should be strengthened to improve postoperative outcomes.展开更多
Objective:To design a preoperative checklist for coronary interventional surgery based on multidisciplinary collaboration,and verify its effect on improving the completeness rate of preoperative preparation,surgical p...Objective:To design a preoperative checklist for coronary interventional surgery based on multidisciplinary collaboration,and verify its effect on improving the completeness rate of preoperative preparation,surgical punctuality,and medical staff satisfaction.Methods:A multidisciplinary team was established involving the Department of Cardiology,Anesthesiology,Clinical Laboratory,and Interventional Surgery.Referring to the latest clinical guidelines and nursing standards,a preoperative checklist covering 8 core modules and 61 sub-items was formulated,including“1 day before surgery+day of surgery”and“doctor+nurse+patient+family member”.A total of 213 patients undergoing coronary interventional surgery in our hospital from August 2023 to February 2024(observation group)were selected to apply the checklist.The completeness rate of preoperative preparation and the on-time operation start rate were compared with 197 patients(control group)before the checklist application.The satisfaction of 34 medical staff was evaluated using a Likert 5-point scale.Results:The overall completeness rate of preoperative preparation in the observation group reached 95.72%(78.17%in the control group),among which the completeness rates of 6 sub-items such as medication,health education,and laboratory examinations reached 100%,and the completeness rate of consumables and equipment preparation was 97.1%;the on-time operation start rate was 97.3%;the satisfaction of the medical team with the checklist was 94.12%,which was significantly higher than that of the control group(82.61%),with statistically significant differences(p<0.05).Conclusion:The preoperative checklist for coronary interventional surgery designed through multidisciplinary collaboration can significantly improve the quality of preoperative preparation and surgical efficiency,and is highly recognized by the medical team,providing practical reference for perioperative safety management of interventional diagnosis and treatment.展开更多
AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pa...AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.展开更多
BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Alth...BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.展开更多
Objective:To strengthen preoperative preparation management and reduce preoperative preparation defects.Methods:We set up a special medical care management team to investigate the preoperative preparation in surgical ...Objective:To strengthen preoperative preparation management and reduce preoperative preparation defects.Methods:We set up a special medical care management team to investigate the preoperative preparation in surgical departments,analyze the causes of the shortcomings in preoperative preparation,and propose countermeasures.The medical staff jointly formulated plans related to preoperative preparation management including clear outline of responsibilities,strengthening of training,integrated medical care,timely feedback,and continuous improvement.Besides,the preoperative preparation of patients before and after the improvement measures were compared using statistical analysis.Results:The rate of inadequate preoperative preparation was 11.14 per thousand before the integrated management model was implemented.After the implementation of the integrated management model,the rate of inadequate preoperative preparation decreased to 2.99 per thousand,and the difference was statistically(P<0.05).Conclusion:The integrated management of preoperative preparation can help reduce the rate of preoperative complications and ensure the safety of surgery.展开更多
AIM:To investigate the effect of preoperative biliary drainage(PBD)in jaundiced patients with hilar cholangiocarcinoma(HCCA)undergoing major liver resections.METHODS:An observational study was carried out by reviewing...AIM:To investigate the effect of preoperative biliary drainage(PBD)in jaundiced patients with hilar cholangiocarcinoma(HCCA)undergoing major liver resections.METHODS:An observational study was carried out by reviewing a prospectively maintained database of HCCA patients who underwent major liver resection for curative therapy from January 2002 to December 2012.Patients were divided into two groups based on whether PBD was performed:a drained group and an undrained group.Patient baseline characteristics,preoperative factors,perioperative and short-term postoperative outcomes were compared between the two groups.Risk factors for postoperative complications were also analyzed by logistic regression test with calculating OR and 95%CI.RESULTS:In total,78 jaundiced patients with HCCA underwent major liver resection:32 had PBD prior to operation while 46 did not have PBD.The two groups were comparable with respect to age,sex,body mass index and co-morbidities.Furthermore,there was no significant difference in the total bilirubin(TBIL)levels between the drained group and the undrained group at admission(294.2±135.7 vs 254.0±63.5,P=0.126).PBD significantly improved liver function,reducing not only the bilirubin levels but also other liver enzymes.The preoperative TBIL level was significantly lower in the drained group as compared to the undrained group(108.1±60.6 vs 265.7±69.1,P=0.000).The rate of overall postoperative complications(53.1%vs 58.7%,P=0.626),reoperation rate(6.3%vs 6.5%,P=1.000),postoperative hospital stay(16.5 vs 15.0,P=0.221)and mortality(9.4%vs 4.3%,P=0.673)were similar between the two groups.In addition,there was no significant difference in infectious complications(40.6%vs 23.9%,P=0.116)and noninfectious complications(31.3%vs 47.8%,P=0.143)between the two groups.Univariate and multivariate analyses revealed that preoperative TBIL>170μmol/L(OR=13.690,95%CI:1.275-147.028,P=0.031),Bismuth-Corlette classification(OR=0.013,95%CI:0.001-0.166,P=0.001)and extended liver resection(OR=14.010,95%CI:1.130-173.646,P=0.040)were independent risk factors for postoperative complications.CONCLUSION:Overall postoperative morbidity and mortality rates after major liver resection are not improved by PBD in HCCA patients with jaundice.Preoperative TBIL>170μmol/L,Bismuth-Corlette classification and extended liver resection are independent risk factors linked to postoperative complications.展开更多
Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of pa...Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography(CT)colonography,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT colonography.CT colonography provides important information for the preoperative assessment of T staging.Wall deformities are associated with muscular or subserosal invasion.Lymph node metastases from colorectal cancer often present with calcifications.CT is superior to detect calcified metastases.Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery.T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure.N staging in patients with colorectal cancer is still challenging using any imaging modality.MRI is more accurate than CT for the evaluation of liver metastases.PET/CT colonography isvaluable in the evaluation of extra-colonic and hepatic disease.PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically.PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely.However,there is no definite evidence to support the routine clinical use of PET/CT colonography.展开更多
AIM： To evaluate the value of endoscopic ultrasono- graphy （EUS） in the preoperative TNM staging of gastric cancer. METHODS ： Forty-one patients with gastric cancer （12 early stage and 29 advanced stage） proved ...AIM： To evaluate the value of endoscopic ultrasono- graphy （EUS） in the preoperative TNM staging of gastric cancer. METHODS ： Forty-one patients with gastric cancer （12 early stage and 29 advanced stage） proved by esophagogastroduodenoscopy and biopsies preoperatively evaluated with EUS according to TNM （1997） classification of International Union Contrele Cancer （UICC）. Pentax EG-3630U/Hitachi EUB-525 echo endoscope with real-time ultrasound imaging linear scanning transducers （7.5 and 5.0 MHz） and Doppler information was used in the current study. EUS staging procedures for tumor depth of invasion （T stage） were performed according to the widely accepted five-layer structure of the gastric wall. All patients underwent surgery. Diagnostic accuracy of EUS for TNM staging of gastric cancer was determined by comparing preoperative EUS with subsequent postoperative histopathologic findings. RESULTS： The overall diagnostic accuracy of EUS in preoperative determination of cancer depth of invasion was 68.3% （41/28） and 83.3% （12/10）, 60% （20/12）, 100% （5/5）, 25% （4/1） for T1, T2, T3, and T4, respectively. The rates for overstaging and understaging were 24.4% （41110）, and 7.3% （4113）, respectively. EUS tended to overstage T criteria, and main reasons for overstaging were thickening of the gastric wall due to perifocal inflammatory change, and absence of serosal layer in certain areas of the stomach. The diagnostic accuracy of metastatic lymph node involvement or N staging of EUS was 100% （17/17） for NO and 41.7% （24/10） for N＋, respectively, and 66% （41127） overall.Misdiagnosing of the metastatic lymph nodes was related to the difficulty of distinguishing inflammatory lymph nodes from malignant lymph nodes, which imitate similar echo features. Predominant location and distribution of tumors in the stomach were in the antrum （20 patients）, and the lesser curvature （17 patients）, respectively. Three cases were found as surgically unresectable （T4 N＋）, and included as being correctly diagnosed by EUS. CONCLUSION： EUS is a useful diagnostic method for preoperative staging of gastric cancer for T and N criteria. However, EUS evaluation of malignant lymph nodes is still unsatisfactory.展开更多
文摘BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship with personality traits has not been previously investigated in the Lebanese population.AIM To examine the prevalence of preoperative anxiety,pain perception,and personality traits among Lebanese surgical patients,and to assess the associations between these factors.METHODS A descriptive cross-sectional study was conducted between April 2024 and January 2025 across Lebanese hospitals.A total of 392 adult patients were recruited through convenience sampling.Data were collected using a questionnaire that included sociodemographic,clinical,and surgical variables,the Amsterdam Preoperative Anxiety and Information Scale for anxiety,the Visual Analog Scale and Numerical Pain Rating Scale for preoperative pain,and the Ten-Item Personality Inventory for personality traits.Ethical approval was obtained from the Institutional Review Boards of Makassed General Hospital and Hammoud University Medical Center.RESULTS Overall,25%of participants experienced preoperative anxiety,and 34.5%reported moderate pain.Personality assessment showed that the majority of participants had moderate extraversion(84.1%),moderate emotional stability(65.1%),high conscientiousness(61%),high agreeableness(54.1%),and moderate openness(49.2%).High conscientiousness was significantly associated with higher pain perception(P<0.05),while high emotional stability was associated with lower levels of anxiety(P<0.05).No significant association was found between preoperative anxiety and pain(P>0.05).CONCLUSION This study challenges the assumption that preoperative anxiety and pain are directly correlated and highlights the role of personality traits in shaping patient experience.These findings support the potential value of integrating psychological profiling into preoperative care and lay the groundwork for developing personalized interventions to improve patient-centered surgical outcomes.
文摘BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.
文摘Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted between February 2023 and May 2023 in a public hospital in northern Turkey with 123 nurses who agreed to participate in the study.Results:The results showed that 64.2%of the nurses thought that preoperative hair removal should be done by shaving with a razor,74%thought that hair removal should be performed the night before the operation,and 70.7%thought that the patient/patient’s relative should perform preoperative hair removal.Conclusions:This study found that nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of SSI were not at the desired level.Following current resources and improving their levels of knowledge and practices are considered to be important for nurses.
文摘This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based risk scoring system origi-nally developed in South Korea.The scoring system incorporated five parame-ters:(1)Tumor size;(2)Portal venous phase density;(3)Necrosis;(4)Peripan-creatic infiltration;and(5)Suspected metastatic lymph nodes.While demonstra-ting satisfactory recurrence prediction capability without requiring complex tech-nologies,thereby supporting clinical utility in Chinese populations,the study exhibited notable limitations.Most analyzed patients lacked neoadjuvant chemo-therapy exposure,resulting in underrepresentation of low-risk subgroups.Addi-tionally,the short follow-up duration potentially compromised long-term progno-stic assessment.Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management.However,clinical implementation continues to confront challenges including variability in imaging parameters,incomplete understanding of molecular underpinnings,and confounding treatment effects.Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic,molecular,and clinical data.Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation,ultimately advancing personalized therapeutic strategies for PDAC.
文摘The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preoperative factors.By analyzing data from 376 patients across four Chinese medical centers,the researchers identified key variables influencing TO,including Child-Pugh classification,Eastern Cooperative Oncology Group score,hepatitis B status,and tumor size.The model,created using logistic regression and the extreme gradient boosting algorithm,demonstrated high predictive accuracy,with area under the curve values of 0.8825 for internal validation and 0.8346 for external validation.The integration of the Shapley additive explanation technique enhances the interpretability of the model,which is crucial for clinical decision-making.This research highlights the potential of machine learning to improve surgical planning and patient outcomes in ICC,opening possibilities for personalized treatment approaches based on individual patient characteristics and risk factors.
文摘Currently,preoperative visits have problems such as monotonous forms and insufficient humanistic care,which affect patients’psychological states and surgical cooperation.This article analyzes the current situation of preoperative visits and the mechanisms influencing patients’psychology,proposes optimization strategies and safeguard measures,and explores the mechanisms of information transmission,emotional support,trust establishment,and environmental familiarity on patients’psychology.It designs optimization plans from the aspects of personalized content,standardized processes,professional techniques,and diversified forms,supplemented by nurse training,system improvement,and quality evaluation to ensure implementation.Practice shows that the optimized preoperative visit can improve the psychological state of patients,enhance surgical cooperation,and optimize the nurse-patient relationship.The conclusion indicates that scientific and standardized preoperative visits can improve the quality of surgical care through multiple psychological effects and are an important link in perioperative care.
文摘Objective: To assess the impact of preoperative psychological interventions on the care of patients undergoing elective surgery. Methods: Ninety-two patients scheduled for elective surgery in the surgical department between August 2021 and August 2023 were selected and divided into groups using a random number table. The observation group received preoperative psychological interventions, while the reference group received standard preoperative care. Anxiety and depression scores, fear grading, vital signs, and self-efficacy levels were compared. Results: After the intervention, the anxiety and depression scores in the observation group were lower than those in the reference group, and the proportion of fear graded as Level I was higher. During the waiting period and 15 minutes before entering the operating room, vital sign levels in the observation group were lower than those in the reference group. Additionally, the self-efficacy scores of the observation group were significantly higher than those of the reference group (P < 0.05). Conclusion: Preoperative psychological interventions can alleviate negative emotions, stabilize preoperative vital signs, and significantly improve self-efficacy in patients undergoing elective surgery, demonstrating high feasibility for implementation.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-3-012B.
文摘BACKGROUND Rectal cancer is a common malignant tumor of the digestive system,with older patients representing the predominantly affected population.Magnetic resonance imaging(MRI)has been widely applied in preoperative tumor assessment;however,the value of high-resolution MRI(HR-MRI)combined with dynamic contrast-enhanced(DCE)scanning in the preoperative diagnosis of rectal cancer in older patients remains unclear.AIM To evaluate the value of HR-MRI combined with DCE scanning in the preoperative diagnosis of rectal cancer in older patients.METHODS This retrospective study included 148 consecutive older female patients with rectal cancer who were treated at our hospital between December 2020 and December 2024.Clinical data and HR-MRI and DCE scan findings were collected.Histopathological examination after surgical resection served as the gold standard.The diagnostic accuracy of MRI for preoperative T and N staging was calculated.Consistency,sensitivity,and specificity between HR-MRI combined with DCE scanning and pathological staging were analyzed using the k test.Among the 148 patients,the overall accuracy of T staging was 84.5%.Sensitivity for T1,T2,T3,and T4 staging was 75.00%,62.50%,89.47%,and 90.48%,respectively,whereas specificity was 100.00%,94.35%,79.25%,and 96.06%,respectively.T staging based on HR-MRI combined with DCE scanning showed good agreement with pathological staging(k=0.8176,P<0.001).For N staging,sensitivity and specificity were 54.88%and 84.85%for N0,36.96%and 72.55%for N1,and 70.00%and 73.44%for N2,respectively;agreement with pathological N staging was poor(k=0.259,P<0.001).CONCLUSION HR-MRI combined with DCE scanning demonstrates high diagnostic accuracy for T staging of rectal cancer in older patients and can provide a theoretical basis for treatment planning.However,its diagnostic accuracy for N staging requires improvement.
基金Supported by the Natural Science Foundation of Jiangsu Higher Education Institutions,No.22KJB510027the Project of the State Administration of Traditional Chinese Medicine of China,No.GZY-ZJ-KJ-24031.
文摘BACKGROUND Despite improved survival rates in rectal cancer treatment,many patients experience low anterior resection syndrome(LARS).The preoperative LARS score(POLARS)aims to address the limitations of LARS assessment by predicting outcomes preoperatively to enhance surgical planning.AIM To investigate the predictive accuracy of POLARS in assessing the occurrence of LARS.METHODS This study enrolled a total of 335 patients who underwent laparoscopic or robotic low anal sphincter-preserving surgery for rectal tumors.Patients were categorized into three groups according to their POLARS score:no LARS(score 0-20),minor LARS(score 21-29),and major LARS(score 30-42).The QLQ-C30/CR29 scores were compared among these groups,and the agreement between POLARS predictions and the actual LARS scores was analyzed.RESULTS The study population was divided into three groups:major LARS(n=51,27.42%),minor LARS(n=109,58.6%),and no LARS(n=26,13.98%).Significant differences in the QLQ-C30 scales of social function,diarrhea,and financial impact were detected between the no LARS and major LARS groups(P<0.05)and between the minor LARS and major LARS groups(P<0.05).Similarly,significant differences were detected in the QLQ-CR29 scales for blood and mucus in the stool,fecal incontinence,and stool frequency between the no LARS and minor LARS groups(P<0.05),as well as between the minor LARS and major LARS groups(P<0.05).The predictive precision for major LARS using the POLARS score was 82.35%(42/51),with a recall of 35.89%(42/117).The mean absolute error(MAE)between the POLARS score and the actual LARS score was 8.92±5.47.In contrast,the XGBoost(extreme gradient boosting)model achieved a lower MAE of 6.29±4.77,with a precision of 84.39%and a recall of 74.05%for predicting major LARS.CONCLUSION The POLARS score demonstrated effectiveness and precision in predicting major LARS,thereby providing valuable insights into postoperative symptoms and patient quality of life.However,the XGBoost model exhibited superior performance with a lower MAE and higher recall for predicting major LARS compared to the POLARS model.
基金Supported by National Natural Science Foundation of China(No.82160195No.82460203)Key Scientific and Technological Research Projects of China Medical Education Association(No.2024KTZ038).
文摘This guideline seeks to thoroughly investigate the standardized operational procedures for visual function and imaging examinations prior to vitreoretinal surgery.Preoperative assessments can greatly assist clinicians in determining surgical indications,assessing patient conditions,and offering valuable assistance in formulating surgical strategies and predicting outcomes.Developed by a collaborative team of experts from the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,in conjunction with the Ophthalmic Imaging and Intelligent Medicine Branch of the Chinese Medical Education Association,these guidelines have been formulated through extensive research and evaluation,incorporating the latest technological advancements and studies on a global and domestic scale in vitreoretinal surgery.After extensive deliberations and incorporation of up-to-date clinical data,these guidelines have been developed to assist in standardizing preoperative examinations for vitreoretinal surgery.The overarching goals include improving medical quality,maximizing resource allocation,offering decision-making assistance,and safeguarding patient rights.This document provides a comprehensive analysis of preoperative assessments for vitreoretinal procedures,covering principles,methodologies,and precautions related to a range of diagnostic techniques including ultra-wide-angle fundus imaging,fluorescein angiography,indocyanine green angiography,ophthalmic B-ultrasound examinations,ultrasound biomicroscopy,optical coherence tomography,optical coherence tomography angiography,orbital CT scan,orbital MRI,and ophthalmic electrophysiology tests such as electroretinograms,visually evoked potentials,and visual field testing.
文摘BACKGROUND The diagnostic accuracy for detecting metastatic lymph nodes in colorectal cancer(CRC)remains suboptimal.To address this limitation,our study investigates the potential of gemstone spectral computed tomography imaging(GSI)to improve diagnostic accuracy in lymph node metastasis(LNM)assessment.AIM To extensively investigate the clinical utility of GSI in the preoperative assessment of CRC.METHODS The subject population included 200 patients with CRC who were admitted to Zibo Central Hospital from January 2022 to December 2023.All patients underwent dual-phase contrast-enhanced scans in the arterial and venous phases using GSI before surgical intervention.During the research,meticulous quantification was conducted regarding the number of patients with CRC with LNM as well as the exact count of metastatic lymph nodes.Moreover,for both metastatic and non-metastatic lymph nodes,the short diameter at the maximum crosssectional area(covering the axial,sagittal,and coronal planes),morphological features(including manifestations such as margin blurring,aggregation,and enhancement),and spectral parameters in the arterial and venous phases[specifically iodine concentration(IC),normalized IC(NIC),and the slope of the spectral curve(λHU)]were measured and recorded,and a comparative analysis was conducted.The diagnostic efficacy of each index with differences was systematically assessed using the receiver operating characteristic(ROC)curve.Concurrently,receiver operating characteristic curves were constructed for LNM screening based on the short diameter at the maximum cross-sectional area of lymph nodes and each spectral parameter in the arterial and venous phases.RESULTS The area under the curve of GSI for diagnosing LNM in patients with CRC can reach 0.897,with sensitivity,specificity,and accuracy of 92.59%,85.87%,and 89.50%,respectively.A total of 265 lymph nodes were analyzed from the 200 participants with CRC,with metastatic lymph nodes accounting for 56.60%.Compared with nonmetastatic lymph nodes,the short diameters of metastatic lymph nodes in the axial,sagittal,and coronal planes were significantly increased,whereas the IC values in the arterial and venous phases,the NIC value in the arterial phase,and theλHU values in the arterial and venous phases were significantly decreased.The short axial,sagittal,and coronal diameters,arterial-phase IC,venous-phase IC,arterial-phase NIC,arterial-phaseλHU,and venousphaseλHU for diagnosing metastatic lymph nodes demonstrated area under the curve values of 0.631,0.681,0.659,0.862,0.808,0.831,0.801,and 0.706,respectively.CONCLUSION GSI exhibits substantial clinical significance in the preoperative assessment of CRC.Among the parameters assessed,the arterial-phase IC demonstrates the most outstanding diagnostic performance,effectively improving the diagnostic efficacy for preoperative LNM in CRC.
文摘The investigation by Zhu et al on the assessment of cellular proliferation markers to assist clinical decision-making in patients with hepatocellular carcinoma(HCC)using a machine learning model-based approach is a scientific approach.This study looked into the possibilities of using a Ki-67(a marker for cell proliferation)expression-based machine learning model to help doctors make decisions about treatment options for patients with HCC before surgery.The study used reconstructed tomography images of 164 patients with confirmed HCC from the intratumoral and peritumoral regions.The features were chosen using various statistical methods,including least absolute shrinkage and selection operator regression.Also,a nomogram was made using Radscore and clinical risk factors.It was tested for its ability to predict receiver operating characteristic curves and calibration curves,and its clinical benefits were found using decision curve analysis.The calibration curve demonstrated excellent consistency between predicted and actual probability,and the decision curve confirmed its clinical benefit.The proposed model is helpful for treating patients with HCC because the predicted and actual probabilities are very close to each other,as shown by the decision curve analysis.Further prospective studies are required,incorporating a multicenter and large sample size design,additional relevant exclusion criteria,information on tumors(size,number,and grade),and cancer stage to strengthen the clinical benefit in patients with HCC.
文摘BACKGROUND Total hip arthroplasty(THA)is an increasingly common treatment for older patients with hip osteoarthritis.Psychological stress is common before THA,although its clinical effects on selected parameters such as joint function,quality of life,and postoperative complications remain unclear.AIM To investigate the effects of preoperative psychological stress on selected parameters in older patients who underwent THA.METHODS Ninety older patients who underwent THA between January 2023 and August 2024 were divided into two groups by their preoperative self-rated anxiety scale and self-rated depression scale scores,including high-stress(n=42)and lowstress(n=48).The postoperative joint function,short form-36 health survey(SF36)score,incidence of postoperative complications,and other indicators were compared between the two groups.Pearson’s correlation coefficient analysis of the relationship among preoperative psychological stress,quality of life,and postoperative complications was performed.RESULTS Postoperative joint function and quality of life were lower in the high-stress group than they were in the low-stress group(P<0.05).The incidence of postoperative complications was higher in the high-stress group(29.27%)than it was in the low-stress group(9.30%)(P<0.05).Cor-relation analysis revealed that psychological stress was correlated with the Harris hip and SF-36 scores.Total scores on the scale,including physical function,physical pain,general health,mental health,social function,vitality,and emotional function,were negatively correlated(P<0.05).CONCLUSION Preoperative psychological stress results in adverse effects on quality of life and complications in older patients undergoing THA.Therefore,pre-operative psychological interventions should be strengthened to improve postoperative outcomes.
基金Taikang Xianlin Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University(Project No.:TKKYZX20231016)。
文摘Objective:To design a preoperative checklist for coronary interventional surgery based on multidisciplinary collaboration,and verify its effect on improving the completeness rate of preoperative preparation,surgical punctuality,and medical staff satisfaction.Methods:A multidisciplinary team was established involving the Department of Cardiology,Anesthesiology,Clinical Laboratory,and Interventional Surgery.Referring to the latest clinical guidelines and nursing standards,a preoperative checklist covering 8 core modules and 61 sub-items was formulated,including“1 day before surgery+day of surgery”and“doctor+nurse+patient+family member”.A total of 213 patients undergoing coronary interventional surgery in our hospital from August 2023 to February 2024(observation group)were selected to apply the checklist.The completeness rate of preoperative preparation and the on-time operation start rate were compared with 197 patients(control group)before the checklist application.The satisfaction of 34 medical staff was evaluated using a Likert 5-point scale.Results:The overall completeness rate of preoperative preparation in the observation group reached 95.72%(78.17%in the control group),among which the completeness rates of 6 sub-items such as medication,health education,and laboratory examinations reached 100%,and the completeness rate of consumables and equipment preparation was 97.1%;the on-time operation start rate was 97.3%;the satisfaction of the medical team with the checklist was 94.12%,which was significantly higher than that of the control group(82.61%),with statistically significant differences(p<0.05).Conclusion:The preoperative checklist for coronary interventional surgery designed through multidisciplinary collaboration can significantly improve the quality of preoperative preparation and surgical efficiency,and is highly recognized by the medical team,providing practical reference for perioperative safety management of interventional diagnosis and treatment.
文摘AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy. METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted. RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable. CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.
文摘BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.
文摘Objective:To strengthen preoperative preparation management and reduce preoperative preparation defects.Methods:We set up a special medical care management team to investigate the preoperative preparation in surgical departments,analyze the causes of the shortcomings in preoperative preparation,and propose countermeasures.The medical staff jointly formulated plans related to preoperative preparation management including clear outline of responsibilities,strengthening of training,integrated medical care,timely feedback,and continuous improvement.Besides,the preoperative preparation of patients before and after the improvement measures were compared using statistical analysis.Results:The rate of inadequate preoperative preparation was 11.14 per thousand before the integrated management model was implemented.After the implementation of the integrated management model,the rate of inadequate preoperative preparation decreased to 2.99 per thousand,and the difference was statistically(P<0.05).Conclusion:The integrated management of preoperative preparation can help reduce the rate of preoperative complications and ensure the safety of surgery.
文摘AIM:To investigate the effect of preoperative biliary drainage(PBD)in jaundiced patients with hilar cholangiocarcinoma(HCCA)undergoing major liver resections.METHODS:An observational study was carried out by reviewing a prospectively maintained database of HCCA patients who underwent major liver resection for curative therapy from January 2002 to December 2012.Patients were divided into two groups based on whether PBD was performed:a drained group and an undrained group.Patient baseline characteristics,preoperative factors,perioperative and short-term postoperative outcomes were compared between the two groups.Risk factors for postoperative complications were also analyzed by logistic regression test with calculating OR and 95%CI.RESULTS:In total,78 jaundiced patients with HCCA underwent major liver resection:32 had PBD prior to operation while 46 did not have PBD.The two groups were comparable with respect to age,sex,body mass index and co-morbidities.Furthermore,there was no significant difference in the total bilirubin(TBIL)levels between the drained group and the undrained group at admission(294.2±135.7 vs 254.0±63.5,P=0.126).PBD significantly improved liver function,reducing not only the bilirubin levels but also other liver enzymes.The preoperative TBIL level was significantly lower in the drained group as compared to the undrained group(108.1±60.6 vs 265.7±69.1,P=0.000).The rate of overall postoperative complications(53.1%vs 58.7%,P=0.626),reoperation rate(6.3%vs 6.5%,P=1.000),postoperative hospital stay(16.5 vs 15.0,P=0.221)and mortality(9.4%vs 4.3%,P=0.673)were similar between the two groups.In addition,there was no significant difference in infectious complications(40.6%vs 23.9%,P=0.116)and noninfectious complications(31.3%vs 47.8%,P=0.143)between the two groups.Univariate and multivariate analyses revealed that preoperative TBIL>170μmol/L(OR=13.690,95%CI:1.275-147.028,P=0.031),Bismuth-Corlette classification(OR=0.013,95%CI:0.001-0.166,P=0.001)and extended liver resection(OR=14.010,95%CI:1.130-173.646,P=0.040)were independent risk factors for postoperative complications.CONCLUSION:Overall postoperative morbidity and mortality rates after major liver resection are not improved by PBD in HCCA patients with jaundice.Preoperative TBIL>170μmol/L,Bismuth-Corlette classification and extended liver resection are independent risk factors linked to postoperative complications.
文摘Imaging studies are a major component in the evaluation of patients for the screening,staging and surveillance of colorectal cancer.This review presents commonly encountered findings in the diagnosis and staging of patients with colorectal cancer using computed tomography(CT)colonography,magnetic resonance imaging(MRI),and positron emission tomography(PET)/CT colonography.CT colonography provides important information for the preoperative assessment of T staging.Wall deformities are associated with muscular or subserosal invasion.Lymph node metastases from colorectal cancer often present with calcifications.CT is superior to detect calcified metastases.Three-dimensional CT to image the vascular anatomy facilitates laparoscopic surgery.T staging of rectal cancer by MRI is an established modality because MRI can diagnose rectal wall laminar structure.N staging in patients with colorectal cancer is still challenging using any imaging modality.MRI is more accurate than CT for the evaluation of liver metastases.PET/CT colonography isvaluable in the evaluation of extra-colonic and hepatic disease.PET/CT colonography is useful for obstructing colorectal cancers that cannot be traversed colonoscopically.PET/CT colonography is able to localize synchronous colon cancers proximal to the obstruction precisely.However,there is no definite evidence to support the routine clinical use of PET/CT colonography.
文摘AIM： To evaluate the value of endoscopic ultrasono- graphy （EUS） in the preoperative TNM staging of gastric cancer. METHODS ： Forty-one patients with gastric cancer （12 early stage and 29 advanced stage） proved by esophagogastroduodenoscopy and biopsies preoperatively evaluated with EUS according to TNM （1997） classification of International Union Contrele Cancer （UICC）. Pentax EG-3630U/Hitachi EUB-525 echo endoscope with real-time ultrasound imaging linear scanning transducers （7.5 and 5.0 MHz） and Doppler information was used in the current study. EUS staging procedures for tumor depth of invasion （T stage） were performed according to the widely accepted five-layer structure of the gastric wall. All patients underwent surgery. Diagnostic accuracy of EUS for TNM staging of gastric cancer was determined by comparing preoperative EUS with subsequent postoperative histopathologic findings. RESULTS： The overall diagnostic accuracy of EUS in preoperative determination of cancer depth of invasion was 68.3% （41/28） and 83.3% （12/10）, 60% （20/12）, 100% （5/5）, 25% （4/1） for T1, T2, T3, and T4, respectively. The rates for overstaging and understaging were 24.4% （41110）, and 7.3% （4113）, respectively. EUS tended to overstage T criteria, and main reasons for overstaging were thickening of the gastric wall due to perifocal inflammatory change, and absence of serosal layer in certain areas of the stomach. The diagnostic accuracy of metastatic lymph node involvement or N staging of EUS was 100% （17/17） for NO and 41.7% （24/10） for N＋, respectively, and 66% （41127） overall.Misdiagnosing of the metastatic lymph nodes was related to the difficulty of distinguishing inflammatory lymph nodes from malignant lymph nodes, which imitate similar echo features. Predominant location and distribution of tumors in the stomach were in the antrum （20 patients）, and the lesser curvature （17 patients）, respectively. Three cases were found as surgically unresectable （T4 N＋）, and included as being correctly diagnosed by EUS. CONCLUSION： EUS is a useful diagnostic method for preoperative staging of gastric cancer for T and N criteria. However, EUS evaluation of malignant lymph nodes is still unsatisfactory.
