BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity o...BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.展开更多
BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,whil...BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.展开更多
BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outco...BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.展开更多
Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of diffe...Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.展开更多
Postoperative cognitive dysfunction is a seve re complication of the central nervous system that occurs after anesthesia and surgery,and has received attention for its high incidence and effect on the quality of life ...Postoperative cognitive dysfunction is a seve re complication of the central nervous system that occurs after anesthesia and surgery,and has received attention for its high incidence and effect on the quality of life of patients.To date,there are no viable treatment options for postoperative cognitive dysfunction.The identification of postoperative cognitive dysfunction hub genes could provide new research directions and therapeutic targets for future research.To identify the signaling mechanisms contributing to postoperative cognitive dysfunction,we first conducted Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses of the Gene Expression Omnibus GSE95426 dataset,which consists of mRNAs and long non-coding RNAs differentially expressed in mouse hippocampus3 days after tibial fracture.The dataset was enriched in genes associated with the biological process"regulation of immune cells,"of which Chill was identified as a hub gene.Therefore,we investigated the contribution of chitinase-3-like protein 1 protein expression changes to postoperative cognitive dysfunction in the mouse model of tibial fractu re surgery.Mice were intraperitoneally injected with vehicle or recombinant chitinase-3-like protein 124 hours post-surgery,and the injection groups were compared with untreated control mice for learning and memory capacities using the Y-maze and fear conditioning tests.In addition,protein expression levels of proinflammatory factors(interleukin-1βand inducible nitric oxide synthase),M2-type macrophage markers(CD206 and arginase-1),and cognition-related proteins(brain-derived neurotropic factor and phosphorylated NMDA receptor subunit NR2B)were measured in hippocampus by western blotting.Treatment with recombinant chitinase-3-like protein 1 prevented surgery-induced cognitive impairment,downregulated interleukin-1βand nducible nitric oxide synthase expression,and upregulated CD206,arginase-1,pNR2B,and brain-derived neurotropic factor expression compared with vehicle treatment.Intraperitoneal administration of the specific ERK inhibitor PD98059 diminished the effects of recombinant chitinase-3-like protein 1.Collectively,our findings suggest that recombinant chitinase-3-like protein 1 ameliorates surgery-induced cognitive decline by attenuating neuroinflammation via M2 microglial polarization in the hippocampus.Therefore,recombinant chitinase-3-like protein1 may have therapeutic potential fo r postoperative cognitive dysfunction.展开更多
BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopi...BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.展开更多
BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgica...BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.展开更多
BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel us...BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.展开更多
This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients f...This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients following percuta-neous coronary intervention.It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management.MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhan-cing intrinsic motivation.Research has demonstrated its effectiveness in posto-perative recovery for oncological surgery,stroke,organ transplants,and gastroin-testinal procedures,as well as in managing chronic conditions such as diabetes,obesity,and periodontal disease.The approach is patient-centered,adaptable,cost-effective,and easily replicable,though its limitations include reliance on the therapist’s expertise,variability in individual responses,and insufficient long-term follow-up studies.Future research could focus on developing individualized and precise intervention models,exploring applications in digital health management,and confirming long-term outcomes to provide more compre-hensive support for patient rehabilitation.展开更多
This editorial assesses the prognostic value of preoperative inflammatory and nutritional biomarkers in patients undergoing surgical resection for pancreatic cancer.Lu et al evaluated the ability of seven biomarkers t...This editorial assesses the prognostic value of preoperative inflammatory and nutritional biomarkers in patients undergoing surgical resection for pancreatic cancer.Lu et al evaluated the ability of seven biomarkers to predict postoperative recovery and long-term outcomes.These biomarkers were albumin-to-globulin ratio,prognostic nutritional index(PNI),systemic immune-inflammation index,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,nutritional risk index,and geriatric nutritional risk index.The PNI was found to be a strong predictor of both overall and recurrence-free survival,underscoring its clinical relevance in managing patients with pancreatic cancer.展开更多
Postoperative pain is an acute pain that appears due to the surgical act, reaching its maximum intensity in the first 24 - 48 hours after surgery. Postoperative pain control reduces possible postoperative complication...Postoperative pain is an acute pain that appears due to the surgical act, reaching its maximum intensity in the first 24 - 48 hours after surgery. Postoperative pain control reduces possible postoperative complications, as well as the patient’s stay in the medical institution. Objective: This study compared the effectiveness and side effects of oral transmucosal fentanyl citrate (OTFC) with IV morphine in the control of postoperative pain. Methods: Seventy-three patients (Fentanyl group: 27, morphine group: 46) were included. Changes in pain were evaluated with Visual Analog Scale (VAS) and Pain Relief Scale, Pain Intensity Differences (PID), Sum of Pain Intensity Differences (SPID), and Total Pain Relief (TOTPAR). At time zero, 15, 30, 45 min and 1, 2, 3, 4, 5 and 6 h. Results: The decrease in pain intensity measured by VAS was similar in both groups with no significant differences at any of the measurement points. Both products produced a significant increase in the Pain Relief scale, with no differences between groups at any of the measurement times. There were no differences between groups when comparing PID. Comparing SPID between groups, there were no differences at 15, 30 minutes, then there were significant differences in favor of the Fentanyl group up to 6 hours. Both products produced a significant increase in the TOPAR scale, with no differences between groups at any of the measurement times. The appearance of adverse effects was similar in both groups. Conclusions: Both products produced a significant reduction in the measures of pain intensity (VAS), increase of SPID, as well as a significant increase in the Pain Relief scale, a significant increase in the TOPAR scale, with no differences between the groups. The number of adverse effects was similar. The convenience of OTFC administration allows its administration without the special conditions needed for the administration of IV morphine.展开更多
BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early...BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early postoperative stoma complications in colorectal cancer patients and to construct a nomogram prediction model for predicting the probability of these complications.METHODS A retrospective study of 462 patients who underwent postoperative ostomy for colorectal cancer in the Gastrointestinal Department of the Anhui Provincial Cancer Hospital.The patients’basic information,surgical details,pathological results,and preoperative inflammatory and nutritional indicators were reviewed.We used univariate and multivariate logistic regression to analyze the risk factors for early postoperative stoma complications in colorectal cancer patients and constructed a nomogram prediction model to predict the probability of these complications.RESULTS Binary logistic regression analysis revealed that diabetes[odds ratio(OR)=3.088,95%confidence interval(CI):1.419-6.719],preoperative radiotherapy and chemotherapy(OR=6.822,95%CI:2.171-21.433),stoma type(OR=2.118,95%CI:1.151-3.898),Nutritional risk screening 2002 score(OR=2.034,95%CI:1.082-3.822)and prognostic nutritional index(OR=0.486,95%CI:0.254-0.927)were risk factors for early stoma complications after colorectal cancer surgery(P<0.05).On the basis of these results,a prediction model was constructed and the area under the re-ceiver operating characteristic curve was 0.740(95%CI:0.669-0.811).After internal validation,the area under the receiver operating characteristic curve of the validation group was 0.725(95%CI:0.631-0.820).The calibration curves for the modeling group and validation group are displayed.The predicted results have a good degree of overlap with the actual results.CONCLUSION A previous history of diabetes,preoperative radiotherapy and chemotherapy,stoma type,Nutritional risk screening 2002 score and prognostic nutritional index are risk factors for early stoma complications after colorectal cancer surgery.The nomogram prediction model constructed on the basis of the results of logistic regression analysis in this study can effectively predict the probability of early stomal complications after colorectal cancer surgery.展开更多
Postoperative ileus(POI)remains a prevalent and significant challenge following abdominal surgeries,precipitating patient distress,prolonged hospital stays,and escalated medical expenditures.Conventionally addressed v...Postoperative ileus(POI)remains a prevalent and significant challenge following abdominal surgeries,precipitating patient distress,prolonged hospital stays,and escalated medical expenditures.Conventionally addressed via pharmacological interventions,POI is increasingly being explored through adjunctive therapeutic strategies,with acupuncture gaining recognition as a promising option.Acupuncture has demonstrated encouraging potential in promoting gastrointestinal motility in patients with POI.Moreover,recent research has shed light on the therapeutic mechanisms underlying its efficacy.This article aims to present a comprehensive overview of acupuncture as a treatment for POI,highlighting advancements in clinical research and recent elucidations of its mechanistic underpinnings.It aspires to contribute a pivotal reference point for scholars and enthusiasts keen on garnering a deeper understanding of acupuncture’s role in managing POI.展开更多
Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web...Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web of Science,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Technology Journal Database(VIP)from database inception to November 1,2024.Randomized controlled trials(RCTs)that examine the use of EA to improve GI function,reduce pain,and promote ability ofself-care after GI cancer surgery were included.Based on the type of control interventions,separate meta-analyses were conducted for EA vs postoperative nursing(PN)and EA vs sham acupuncture(SA).The primary outcomes were the time to first flatus(TFF)and the time to first defecation(TFD).The secondary outcomes included the time to recovery of bowel sounds(TRBS),the time to tolerance of liquid diet(TTLD),the time to tolerance of semiliquid diet(TTSD),the time to independent walking(TIW),the length of hospitalization(LH),and visual analog scale(VAS)immediate resting pain scores measured on the first,second and third postoperative days(POD 1–3).Results are reported as mean differences(MDs)with 95%confidence intervals(CIs).RevMan 5.3 was used for meta-analysis,StataSE 15.1 was used for sensitivity analyses and Egger’s tests.This study was registered on PROSPERO(CRD42022314754).Results A total of 19 RCTs involving 1902 participants were included,all of which were conducted in China between 2004 and 2023.When EA compared with PN,the meta-analysis showed EA significantly reduce TFF(n=673,MD=-13.14,95%CI=[-18.97 to-7.31],P<0.00001),TFD(n=598,MD=-19.86,95%CI=[-27.83 to-11.89],P<0.00001),TRBS(n=216,MD=-12.44,95%CI=[-15.00 to-9.87],P<0.00001),TTLD(n=268,MD=-18.14,95%CI=[-24.98 to-11.29],P<0.00001),TTSD(n=141,MD=-20.44,95%CI=[-33.84 to-7.04],P=0.003),VAS on POD 1(n=299,MD=-0.52,95%CI=[-0.92 to-0.11],P=0.01),VAS on POD 2(n=256,MD=-0.91,95%CI=[-1.23 to-0.60],P<0.00001),VAS on POD 3(n=203,MD=-0.57,95%CI=[-0.80 to-0.34],P<0.00001),while no significantly decreasing in the LH(n=322,MD=-1.16,95%CI=[-2.56 to 0.24],P=0.10).As EA compared with SA,EA could significantly reduce TFF(n=782,MD=-15.78,95%CI=[-24.96 to-6.60],P=0.0008),TFD(n=782,MD=-20.42,95%CI=[-36.14 to-4.70],P=0.01),LH(n=782,MD=-1.37,95%CI=[-2.69 to-0.05],P=0.04),TIW(n=743,MD=-0.33,95%CI=[-0.62 to-0.04],P=0.03).13 studies reported that EA reduced the incidence of postoperative complications,and 7 studies reported safety assessments of acupuncture-related adverse events,including hematoma,residual needling,sharp pain,pain,soreness or swelling after needle removal,with no serious adverse events.Conclusion EA can significantly promote the recovery of GI function,reduce postoperative pain,enhance ability of self-care in patients undergoing surgery for GI cancers.展开更多
Cholecystectomy is a commonly performed surgical procedure globally,primarily for symptomatic cholelithiasis or related gallbladder conditions.Advances in surgical techniques,such as laparoscopic and robotic approache...Cholecystectomy is a commonly performed surgical procedure globally,primarily for symptomatic cholelithiasis or related gallbladder conditions.Advances in surgical techniques,such as laparoscopic and robotic approaches,have enhanced patient results and reduced hospital stays.However,postoperative care is crucial for optimizing recovery,preventing complications,and enhancing quality of life.Nurses have a critical role in achieving these objectives,starting from immediate postoperative evaluation through long-term monitoring.This review outlines essential nursing considerations and evidence-based practices for postoperative care following cholecystectomy.Key areas encompass pain control,respiratory assistance,early mobilization,wound and drain management,nutritional advice,psychosocial aid,and discharge preparation.By integrating current research and clinical guidelines,this review aims to serve as an authoritative resource to assist nurses in improving postoperative outcomes and patient satisfaction.展开更多
In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients c...In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients compared to relying solely on preoperative markers,which has significant implications for customizing adjuvant therapy and potentially improving outcomes for this aggressive form of cancer.However,the study’s single-center design and short follow-up period may limit the generalizability of its findings and potentially introduce reporting bias.Future studies could consider additional confounding factors,such as adjuvant chemotherapy and variations in surgical techniques,to improve the model’s accuracy.Furthermore,it would be valuable to validate the nomogram in broader,prospective cohorts and explore the inclusion of additional markers like circulating tumor DNA to refine further its predictive power and applicability across diverse patient populations.展开更多
BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicat...BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicated by diabetes is highly pre-valent in clinical settings.AIM To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.METHODS A retrospective analysis was conducted on the clinical data of 203 diabetic pa-tients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023.Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial suscept-ibility.Based on a one-year follow-up,patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data.Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.RESULTS Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS.A total of 134 pathogenic bacteria strains were isolated and identified,including 81 strains(60.4%)of gram-positive bacteria and 53 strains(39.6%)of gram-negative bacteria.Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin,while remaining highly sensitive to vancomycin,gentamicin,and rifampicin.Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin,but showed high sensitivity to imipenem,meropenem,cefepime,and ceftazidime.Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels,smoking history,Lund-Mackay scores,visual analog scale(VAS)scores,nasal septum deviation,allergic rhinitis,bronchial asthma,postoperative infection,long-term use of nasal decongestants,and adherence to medical prescriptions.Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.CONCLUSION In CRS patients with nasal polyps(CRSwNP),the detection rate of nasal pathogens is relatively high,and most of the isolated bacteria exhibit antimicrobial resistance.Additionally,the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.展开更多
Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psych...Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psychomotor agitation,and restlessness.Postoperative delirium(POD),a common complication particularly in elderly patients,significantly impacts recovery by prolonging mechanical ventilation,neurosurgical intensive care unit stays,and overall hospitalization durations,while severely diminishing patients’quality of life after discharge.Despite its prevalence,POD remains underrecognized in clinical practice,with significant gaps in its diagnosis and management.This review explores the definition,diagnostic criteria,underlying pathogenesis,and associated risk factors of POD in neurosurgical patients,aiming to offer valuable insights for improving clinical diagnosis and therapeutic strategies.展开更多
BACKGROUND Colorectal cancer(CRC)recurrence within a year post-surgery poses significant challenges for stage II/III patients.Few models currently predict this early recu-rrence with multi-dimensional considerations f...BACKGROUND Colorectal cancer(CRC)recurrence within a year post-surgery poses significant challenges for stage II/III patients.Few models currently predict this early recu-rrence with multi-dimensional considerations for risk stratification.AIM To develop a model for predicting the risk of recurrence within one year after sur-gery in patients with stage II/III CRC.METHODS We conducted a retrospective cohort study at Zhejiang Provincial Hospital of Chinese Medicine,including 349 stage II/III CRC patients.Clinical data were collected,and the dataset was randomly divided into training(n=244)and testing(n=105)sets.Univariate and multivariate logistic regression analyses identified risk factors for postoperative recurrence.Then a nomogram model was constructed and evaluated via receiver operating characteristic curves,calibration curves and decision curve analysis.RESULTS During the one-year follow-up,10.9%(38/349)of patients experienced recurrence.Univariate analysis identified tumor size,lymph node metastasis(N2 stage),neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,fatigue,and appetite loss as significant correlates of recurrence.Multivariate logistic regression con-firmed N2 stage,appetite loss,tumor size,and neutrophil-to-lymphocyte ratio as independent risk factors.The nomogram model showed excellent performance.The area under the receiver operating characteristic was 0.98(95%confidence interval:0.97-1.00)in training set and 0.91(95%confidence interval:0.84-0.97)in testing set.The decision curve analysis curves showed strong concordance between predicted and observed recurrence probabilities.CONCLUSION The model effectively predicts early postoperative recurrence in stage II/III CRC,integrating clinical,inflam-matory,and symptomatic factors.展开更多
BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may r...BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may reduce the incidence of postoperative wound infections and complications.AIM To explore the effects of anticipatory care on the management of postoperative infections and complications in pediatric patients diagnosed with acute appen-dicitis.METHODS This prospective randomized controlled study included data from 78 pediatric patients who underwent acute appendicitis surgery at Shijiazhuang Sixth Hos-pital(Hebei Province,China)between February 2021 and March 2024.Patients were divided into two groups:The intervention and control groups(n=39 each)were based on a random numbers table method.Both groups received routine postoperative nursing care,whereas the intervention group received additional anticipatory care.Statistical analyses were performed using independent sample t-tests,χ2 tests,analysis of variance,and rank-sum tests.RESULTS Postoperative pain scores and hospital length of stay were significantly lower in the intervention group than those in the control group(P<0.05 and P<0.001,respectively).Postoperative wound infection and overall complication rates were significantly lower in the intervention group than those in the control group(5.13%vs 23.08%,P<0.001;15.38%vs 46.15%,P<0.001,respectively).Furthermore,parental satisfaction scores were significantly higher in the intervention group than those in the control group(P<0.05).Logistic regression identified high C-reactive protein level as a risk factor for postoperative infections and complications,whereas proactive(i.e.anticipatory)nursing intervention was a protective factor.CONCLUSION This study provided a scientific basis for the implementation of anticipatory care in the postoperative management of pediatric patients experiencing acute appendicitis.展开更多
文摘BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.
文摘BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.
基金Supported by Wang Zhengguo Foundation for Traumatic Medicine“Sequential Medical Research Special Foundation”,No 2024-XGM05.
文摘BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.
文摘Objective To identify risk factors contributing to prolonged postoperative length of stay(LOS)in very elderly patients following hip fracture surgery,with a focus on postoperative complications and the impact of different anesthesia approaches.Methods This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31,2013 and December 31,2023.Relevant perioperative data were collected.The primary outcome was postoperative LOS,and the study cohort was divided into two groups:postoperative LOS≤7 days and LOS>7 days.Logistic regression was performed to identify factors related to prolonged postoperative LOS.Results A total of 155 patients were included.The average age was 92.7±2.6 years.There were 73(47%)patients with postoperative LOS>7 days.Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS(OR=2.12,95%CI[1.09,4.16],P=0.028).Neither the type of anesthesia(regional vs.general anesthesia,OR=1.00,95%CI[0.53,1.90],P=0.993)nor the method of airway management(laryngeal mask ventilation vs.spontaneous breathing,OR=1.46,95%CI[0.58,3.76],P=0.424;endotracheal intubation vs.spontaneous breathing,OR=0.82,95%CI[0.39,1.69],P=0.592)showed a significant association with a prolonged postoperative LOS.Preoperative chronic obstructive pulmonary disease(OR=2.78,95%CI[1.05,7.65],P=0.040)and preoperative neutrophil count(OR=1.13,95%CI[1.01,1.26],P=0.029)were both significantly associated with the occurrence of postoperative pneumonia,while anesthesia type and airway management method were not.Conclusions Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery,whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia.Preoperative comorbidities,especially respiratory conditions and systemic inflammation,potentially play a substantial role in postoperative recovery.
基金supported by the National Natural Science Foundation of China,Nos.81730033,82171193(to XG)the Key Talent Project for Strengthening Health during the 13^(th)Five-Year Plan Period,No.ZDRCA2016069(to XG)+1 种基金the National Key R&D Program of China,No.2018YFC2001901(to XG)Jiangsu Provincial Medical Key Discipline,No.ZDXK202232(to XG)。
文摘Postoperative cognitive dysfunction is a seve re complication of the central nervous system that occurs after anesthesia and surgery,and has received attention for its high incidence and effect on the quality of life of patients.To date,there are no viable treatment options for postoperative cognitive dysfunction.The identification of postoperative cognitive dysfunction hub genes could provide new research directions and therapeutic targets for future research.To identify the signaling mechanisms contributing to postoperative cognitive dysfunction,we first conducted Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses of the Gene Expression Omnibus GSE95426 dataset,which consists of mRNAs and long non-coding RNAs differentially expressed in mouse hippocampus3 days after tibial fracture.The dataset was enriched in genes associated with the biological process"regulation of immune cells,"of which Chill was identified as a hub gene.Therefore,we investigated the contribution of chitinase-3-like protein 1 protein expression changes to postoperative cognitive dysfunction in the mouse model of tibial fractu re surgery.Mice were intraperitoneally injected with vehicle or recombinant chitinase-3-like protein 124 hours post-surgery,and the injection groups were compared with untreated control mice for learning and memory capacities using the Y-maze and fear conditioning tests.In addition,protein expression levels of proinflammatory factors(interleukin-1βand inducible nitric oxide synthase),M2-type macrophage markers(CD206 and arginase-1),and cognition-related proteins(brain-derived neurotropic factor and phosphorylated NMDA receptor subunit NR2B)were measured in hippocampus by western blotting.Treatment with recombinant chitinase-3-like protein 1 prevented surgery-induced cognitive impairment,downregulated interleukin-1βand nducible nitric oxide synthase expression,and upregulated CD206,arginase-1,pNR2B,and brain-derived neurotropic factor expression compared with vehicle treatment.Intraperitoneal administration of the specific ERK inhibitor PD98059 diminished the effects of recombinant chitinase-3-like protein 1.Collectively,our findings suggest that recombinant chitinase-3-like protein 1 ameliorates surgery-induced cognitive decline by attenuating neuroinflammation via M2 microglial polarization in the hippocampus.Therefore,recombinant chitinase-3-like protein1 may have therapeutic potential fo r postoperative cognitive dysfunction.
基金Supported by the National Natural Science Foundation of China,No.81302124.
文摘BACKGROUND Red blood cell distribution width(RDW)is associated with the development and progression of various diseases.AIM To explore the association between pretreatment RDW and short-term outcomes after laparoscopic pancreatoduodenectomy(LPD).METHODS A total of 804 consecutive patients who underwent LPD at our hospital between March 2017 and November 2021 were retrospectively analyzed.Correlations between pretreatment RDW and clinicopathological characteristics and short-term outcomes were investigated.RESULTS Patients with higher pretreatment RDW were older,had higher Eastern Cooperative Oncology Group scores and were associated with poorer short-term outcomes than those with normal RDW.High pretreatment RDW was an independent risk factor for postoperative complications(POCs)(hazard ratio=2.973,95%confidence interval:2.032-4.350,P<0.001)and severe POCs of grade IIIa or higher(hazard ratio=3.138,95%confidence interval:2.042-4.824,P<0.001)based on the Clavien-Dino classification system.Subgroup analysis showed that high pretreatment RDW was an independent risk factor for Clavien-Dino classi-fication grade IIIb or higher POCs,a comprehensive complication index score≥26.2,severe postoperative pancreatic fistula,severe bile leakage and severe hemorrhage.High pretreatment RDW was positively associated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and was negatively associated with albumin and the prognostic nutritional index.CONCLUSION Pretreatment RDW was a special parameter for patients who underwent LPD.It was associated with malnutrition,severe inflammatory status and poorer short-term outcomes.RDW could be a surrogate marker for nutritional and inflammatory status in identifying patients who were at high risk of developing POCs after LPD.
文摘BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.
基金Supported by the Taichung Veterans General Hospital,No.TCVGH-1125401B.
文摘BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
文摘This editorial highlights a recently published study examining the effectiveness of music therapy combined with motivational interviewing(MI)in addressing an-xiety and depression among young and middle-aged patients following percuta-neous coronary intervention.It further explores existing evidence and potential future research directions for MI in postoperative rehabilitation and chronic disease management.MI aims to facilitate behavioral change and promote healthier lifestyles by fostering a trusting relationship with patients and enhan-cing intrinsic motivation.Research has demonstrated its effectiveness in posto-perative recovery for oncological surgery,stroke,organ transplants,and gastroin-testinal procedures,as well as in managing chronic conditions such as diabetes,obesity,and periodontal disease.The approach is patient-centered,adaptable,cost-effective,and easily replicable,though its limitations include reliance on the therapist’s expertise,variability in individual responses,and insufficient long-term follow-up studies.Future research could focus on developing individualized and precise intervention models,exploring applications in digital health management,and confirming long-term outcomes to provide more compre-hensive support for patient rehabilitation.
文摘This editorial assesses the prognostic value of preoperative inflammatory and nutritional biomarkers in patients undergoing surgical resection for pancreatic cancer.Lu et al evaluated the ability of seven biomarkers to predict postoperative recovery and long-term outcomes.These biomarkers were albumin-to-globulin ratio,prognostic nutritional index(PNI),systemic immune-inflammation index,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,nutritional risk index,and geriatric nutritional risk index.The PNI was found to be a strong predictor of both overall and recurrence-free survival,underscoring its clinical relevance in managing patients with pancreatic cancer.
文摘Postoperative pain is an acute pain that appears due to the surgical act, reaching its maximum intensity in the first 24 - 48 hours after surgery. Postoperative pain control reduces possible postoperative complications, as well as the patient’s stay in the medical institution. Objective: This study compared the effectiveness and side effects of oral transmucosal fentanyl citrate (OTFC) with IV morphine in the control of postoperative pain. Methods: Seventy-three patients (Fentanyl group: 27, morphine group: 46) were included. Changes in pain were evaluated with Visual Analog Scale (VAS) and Pain Relief Scale, Pain Intensity Differences (PID), Sum of Pain Intensity Differences (SPID), and Total Pain Relief (TOTPAR). At time zero, 15, 30, 45 min and 1, 2, 3, 4, 5 and 6 h. Results: The decrease in pain intensity measured by VAS was similar in both groups with no significant differences at any of the measurement points. Both products produced a significant increase in the Pain Relief scale, with no differences between groups at any of the measurement times. There were no differences between groups when comparing PID. Comparing SPID between groups, there were no differences at 15, 30 minutes, then there were significant differences in favor of the Fentanyl group up to 6 hours. Both products produced a significant increase in the TOPAR scale, with no differences between groups at any of the measurement times. The appearance of adverse effects was similar in both groups. Conclusions: Both products produced a significant reduction in the measures of pain intensity (VAS), increase of SPID, as well as a significant increase in the Pain Relief scale, a significant increase in the TOPAR scale, with no differences between the groups. The number of adverse effects was similar. The convenience of OTFC administration allows its administration without the special conditions needed for the administration of IV morphine.
文摘BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early postoperative stoma complications in colorectal cancer patients and to construct a nomogram prediction model for predicting the probability of these complications.METHODS A retrospective study of 462 patients who underwent postoperative ostomy for colorectal cancer in the Gastrointestinal Department of the Anhui Provincial Cancer Hospital.The patients’basic information,surgical details,pathological results,and preoperative inflammatory and nutritional indicators were reviewed.We used univariate and multivariate logistic regression to analyze the risk factors for early postoperative stoma complications in colorectal cancer patients and constructed a nomogram prediction model to predict the probability of these complications.RESULTS Binary logistic regression analysis revealed that diabetes[odds ratio(OR)=3.088,95%confidence interval(CI):1.419-6.719],preoperative radiotherapy and chemotherapy(OR=6.822,95%CI:2.171-21.433),stoma type(OR=2.118,95%CI:1.151-3.898),Nutritional risk screening 2002 score(OR=2.034,95%CI:1.082-3.822)and prognostic nutritional index(OR=0.486,95%CI:0.254-0.927)were risk factors for early stoma complications after colorectal cancer surgery(P<0.05).On the basis of these results,a prediction model was constructed and the area under the re-ceiver operating characteristic curve was 0.740(95%CI:0.669-0.811).After internal validation,the area under the receiver operating characteristic curve of the validation group was 0.725(95%CI:0.631-0.820).The calibration curves for the modeling group and validation group are displayed.The predicted results have a good degree of overlap with the actual results.CONCLUSION A previous history of diabetes,preoperative radiotherapy and chemotherapy,stoma type,Nutritional risk screening 2002 score and prognostic nutritional index are risk factors for early stoma complications after colorectal cancer surgery.The nomogram prediction model constructed on the basis of the results of logistic regression analysis in this study can effectively predict the probability of early stomal complications after colorectal cancer surgery.
基金Supported by Clinical Key Project of Peking University Third Hospital,No.BYSY2023049Funding from State Key Laboratory of Female Fertility Promotion,Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital,No.BYSYSZKF2023027.
文摘Postoperative ileus(POI)remains a prevalent and significant challenge following abdominal surgeries,precipitating patient distress,prolonged hospital stays,and escalated medical expenditures.Conventionally addressed via pharmacological interventions,POI is increasingly being explored through adjunctive therapeutic strategies,with acupuncture gaining recognition as a promising option.Acupuncture has demonstrated encouraging potential in promoting gastrointestinal motility in patients with POI.Moreover,recent research has shed light on the therapeutic mechanisms underlying its efficacy.This article aims to present a comprehensive overview of acupuncture as a treatment for POI,highlighting advancements in clinical research and recent elucidations of its mechanistic underpinnings.It aspires to contribute a pivotal reference point for scholars and enthusiasts keen on garnering a deeper understanding of acupuncture’s role in managing POI.
基金Supported by the Capital Health Development Research Special Program:2022-4-7016。
文摘Objective To evaluate the efficacy and safety of electroacupuncture(EA)for postoperative recovery in patients with gastrointestinal(GI)cancers.Methods We retrieved articles from PubMed,Embase,OVID,Cochrane Library,Web of Science,CINAHL,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang,and Technology Journal Database(VIP)from database inception to November 1,2024.Randomized controlled trials(RCTs)that examine the use of EA to improve GI function,reduce pain,and promote ability ofself-care after GI cancer surgery were included.Based on the type of control interventions,separate meta-analyses were conducted for EA vs postoperative nursing(PN)and EA vs sham acupuncture(SA).The primary outcomes were the time to first flatus(TFF)and the time to first defecation(TFD).The secondary outcomes included the time to recovery of bowel sounds(TRBS),the time to tolerance of liquid diet(TTLD),the time to tolerance of semiliquid diet(TTSD),the time to independent walking(TIW),the length of hospitalization(LH),and visual analog scale(VAS)immediate resting pain scores measured on the first,second and third postoperative days(POD 1–3).Results are reported as mean differences(MDs)with 95%confidence intervals(CIs).RevMan 5.3 was used for meta-analysis,StataSE 15.1 was used for sensitivity analyses and Egger’s tests.This study was registered on PROSPERO(CRD42022314754).Results A total of 19 RCTs involving 1902 participants were included,all of which were conducted in China between 2004 and 2023.When EA compared with PN,the meta-analysis showed EA significantly reduce TFF(n=673,MD=-13.14,95%CI=[-18.97 to-7.31],P<0.00001),TFD(n=598,MD=-19.86,95%CI=[-27.83 to-11.89],P<0.00001),TRBS(n=216,MD=-12.44,95%CI=[-15.00 to-9.87],P<0.00001),TTLD(n=268,MD=-18.14,95%CI=[-24.98 to-11.29],P<0.00001),TTSD(n=141,MD=-20.44,95%CI=[-33.84 to-7.04],P=0.003),VAS on POD 1(n=299,MD=-0.52,95%CI=[-0.92 to-0.11],P=0.01),VAS on POD 2(n=256,MD=-0.91,95%CI=[-1.23 to-0.60],P<0.00001),VAS on POD 3(n=203,MD=-0.57,95%CI=[-0.80 to-0.34],P<0.00001),while no significantly decreasing in the LH(n=322,MD=-1.16,95%CI=[-2.56 to 0.24],P=0.10).As EA compared with SA,EA could significantly reduce TFF(n=782,MD=-15.78,95%CI=[-24.96 to-6.60],P=0.0008),TFD(n=782,MD=-20.42,95%CI=[-36.14 to-4.70],P=0.01),LH(n=782,MD=-1.37,95%CI=[-2.69 to-0.05],P=0.04),TIW(n=743,MD=-0.33,95%CI=[-0.62 to-0.04],P=0.03).13 studies reported that EA reduced the incidence of postoperative complications,and 7 studies reported safety assessments of acupuncture-related adverse events,including hematoma,residual needling,sharp pain,pain,soreness or swelling after needle removal,with no serious adverse events.Conclusion EA can significantly promote the recovery of GI function,reduce postoperative pain,enhance ability of self-care in patients undergoing surgery for GI cancers.
文摘Cholecystectomy is a commonly performed surgical procedure globally,primarily for symptomatic cholelithiasis or related gallbladder conditions.Advances in surgical techniques,such as laparoscopic and robotic approaches,have enhanced patient results and reduced hospital stays.However,postoperative care is crucial for optimizing recovery,preventing complications,and enhancing quality of life.Nurses have a critical role in achieving these objectives,starting from immediate postoperative evaluation through long-term monitoring.This review outlines essential nursing considerations and evidence-based practices for postoperative care following cholecystectomy.Key areas encompass pain control,respiratory assistance,early mobilization,wound and drain management,nutritional advice,psychosocial aid,and discharge preparation.By integrating current research and clinical guidelines,this review aims to serve as an authoritative resource to assist nurses in improving postoperative outcomes and patient satisfaction.
文摘In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients compared to relying solely on preoperative markers,which has significant implications for customizing adjuvant therapy and potentially improving outcomes for this aggressive form of cancer.However,the study’s single-center design and short follow-up period may limit the generalizability of its findings and potentially introduce reporting bias.Future studies could consider additional confounding factors,such as adjuvant chemotherapy and variations in surgical techniques,to improve the model’s accuracy.Furthermore,it would be valuable to validate the nomogram in broader,prospective cohorts and explore the inclusion of additional markers like circulating tumor DNA to refine further its predictive power and applicability across diverse patient populations.
文摘BACKGROUND In diabetic patients,persistent hyperglycemia creates an optimal environment for the proliferation of pathogenic bacteria,resulting in severe complications.Con-sequently,chronic rhinosinusitis(CRS)complicated by diabetes is highly pre-valent in clinical settings.AIM To analyze the results of nasal secretion cultures in diabetic patients with CRS and identify the factors influencing postoperative recurrence.METHODS A retrospective analysis was conducted on the clinical data of 203 diabetic pa-tients with CRS with nasal polyps who underwent the Messerklinger technique at Qingdao Hiser Hospital Affiliated of Qingdao University between January 2021 and January 2023.Preoperative nasal secretions were cultured to determine the types and distribution of pathogenic bacteria and assess antimicrobial suscept-ibility.Based on a one-year follow-up,patients were categorized into recurrence and nonrecurrence groups to analyze differences in their clinical data.Univariate and multivariate analyses were used to identify factors influencing postoperative recurrence.RESULTS Pathogens were detected in 153 of the 203 nasal secretion specimens collected from diabetic patients with CRS.A total of 134 pathogenic bacteria strains were isolated and identified,including 81 strains(60.4%)of gram-positive bacteria and 53 strains(39.6%)of gram-negative bacteria.Gram-positive bacteria exhibited relatively high resistance to penicillin G and erythromycin,while remaining highly sensitive to vancomycin,gentamicin,and rifampicin.Gram-negative bacteria demonstrated relatively high resistance to cefazolin and gentamicin,but showed high sensitivity to imipenem,meropenem,cefepime,and ceftazidime.Univariate analysis revealed statistically significant differences between the recurrence and nonrecurrence groups in fasting blood glucose levels,smoking history,Lund-Mackay scores,visual analog scale(VAS)scores,nasal septum deviation,allergic rhinitis,bronchial asthma,postoperative infection,long-term use of nasal decongestants,and adherence to medical prescriptions.Multivariate regression analysis identified fasting blood glucose levels and VAS-measured nasal symptom severity scores as independent factors influencing postoperative recurrence.CONCLUSION In CRS patients with nasal polyps(CRSwNP),the detection rate of nasal pathogens is relatively high,and most of the isolated bacteria exhibit antimicrobial resistance.Additionally,the blood glucose level of patients with CRS combined with CRSwNP is a risk factor for postoperative recurrence.
基金Supported by Science and Technology Program of Nantong City,No.Key003Nantong Young Medical Expert,No.46+2 种基金the Science and Technology Program of Nantong Health Committee,No.MA2019003,No.MA2021017,and No.MSZ2024038Science and Technology Program of Nantong City,No.JCZ2022040Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD022,and No.KD2024KYJJ289.
文摘Delirium is a transient and acute syndrome of encephalopathy,characterized by disturbances in consciousness,orientation,cognition,perception,and emotional regulation,often accompanied by hallucinations,illusions,psychomotor agitation,and restlessness.Postoperative delirium(POD),a common complication particularly in elderly patients,significantly impacts recovery by prolonging mechanical ventilation,neurosurgical intensive care unit stays,and overall hospitalization durations,while severely diminishing patients’quality of life after discharge.Despite its prevalence,POD remains underrecognized in clinical practice,with significant gaps in its diagnosis and management.This review explores the definition,diagnostic criteria,underlying pathogenesis,and associated risk factors of POD in neurosurgical patients,aiming to offer valuable insights for improving clinical diagnosis and therapeutic strategies.
文摘BACKGROUND Colorectal cancer(CRC)recurrence within a year post-surgery poses significant challenges for stage II/III patients.Few models currently predict this early recu-rrence with multi-dimensional considerations for risk stratification.AIM To develop a model for predicting the risk of recurrence within one year after sur-gery in patients with stage II/III CRC.METHODS We conducted a retrospective cohort study at Zhejiang Provincial Hospital of Chinese Medicine,including 349 stage II/III CRC patients.Clinical data were collected,and the dataset was randomly divided into training(n=244)and testing(n=105)sets.Univariate and multivariate logistic regression analyses identified risk factors for postoperative recurrence.Then a nomogram model was constructed and evaluated via receiver operating characteristic curves,calibration curves and decision curve analysis.RESULTS During the one-year follow-up,10.9%(38/349)of patients experienced recurrence.Univariate analysis identified tumor size,lymph node metastasis(N2 stage),neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,fatigue,and appetite loss as significant correlates of recurrence.Multivariate logistic regression con-firmed N2 stage,appetite loss,tumor size,and neutrophil-to-lymphocyte ratio as independent risk factors.The nomogram model showed excellent performance.The area under the receiver operating characteristic was 0.98(95%confidence interval:0.97-1.00)in training set and 0.91(95%confidence interval:0.84-0.97)in testing set.The decision curve analysis curves showed strong concordance between predicted and observed recurrence probabilities.CONCLUSION The model effectively predicts early postoperative recurrence in stage II/III CRC,integrating clinical,inflam-matory,and symptomatic factors.
文摘BACKGROUND Acute appendicitis is common among pediatric patients,and postoperative infections and complications are significant factors that affect recovery.As a“forward-looking”nursing model,anticipatory care may reduce the incidence of postoperative wound infections and complications.AIM To explore the effects of anticipatory care on the management of postoperative infections and complications in pediatric patients diagnosed with acute appen-dicitis.METHODS This prospective randomized controlled study included data from 78 pediatric patients who underwent acute appendicitis surgery at Shijiazhuang Sixth Hos-pital(Hebei Province,China)between February 2021 and March 2024.Patients were divided into two groups:The intervention and control groups(n=39 each)were based on a random numbers table method.Both groups received routine postoperative nursing care,whereas the intervention group received additional anticipatory care.Statistical analyses were performed using independent sample t-tests,χ2 tests,analysis of variance,and rank-sum tests.RESULTS Postoperative pain scores and hospital length of stay were significantly lower in the intervention group than those in the control group(P<0.05 and P<0.001,respectively).Postoperative wound infection and overall complication rates were significantly lower in the intervention group than those in the control group(5.13%vs 23.08%,P<0.001;15.38%vs 46.15%,P<0.001,respectively).Furthermore,parental satisfaction scores were significantly higher in the intervention group than those in the control group(P<0.05).Logistic regression identified high C-reactive protein level as a risk factor for postoperative infections and complications,whereas proactive(i.e.anticipatory)nursing intervention was a protective factor.CONCLUSION This study provided a scientific basis for the implementation of anticipatory care in the postoperative management of pediatric patients experiencing acute appendicitis.
