Application of enhanced recovery after gastric cancer surgery: An updated meta-analysis

AIM To provide an updated assessment of the safety and efficacy of enhanced recovery after surgery(ERAS) protocols in elective gastric cancer(GC) surgery.METHODS Pub Med, Medline, EMBASE, World Health Organization International Trial Register, and Cochrane Library were searched up to June 2017 for all available randomized controlled trials(RCTs) comparing ERAS protocols and standard care(SC) in GC surgery. Thirteen RCTs, with a total of 1092 participants, were analyzed in this study, of whom 545 underwent ERAS protocols and 547 received SC treatment.RESULTS No significant difference was observed between ERAS and control groups regarding total complications(P = 0.88), mortality(P = 0.50) and reoperation(P = 0.49). The incidence of pulmonary infection was significantly reduced(P = 0.03) following gastrectomy. However, the readmission rate after GC surgery nearly tripled under ERAS(P = 0.009). ERAS protocols significantly decreased the length of postoperative hospital stay(P < 0.00001) and medical costs(P < 0.00001), and accelerated bowel function recovery, as measured by earlier time to the first flatus(P = 0.0004) and the first defecation(P < 0.0001). Moreover, ERAS protocols were associated with a lower level of serum inflammatory response, higher serum albumin, and superior shortterm quality of life(QOL).CONCLUSION Collectively, ERAS results in accelerated convalescence, reduction of surgical stress and medical costs, improved nutritional status, and better QOL for GC patients. However, high-quality multicenter RCTs with large samples and long-term follow-up are needed to more precisely evaluate ERAS in radical gastrectomy.

Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report

BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status.The gallstones may sometime be spilled into the peritoneal cavity,resulting in intra-abdominal ab-scess if the gallstones were not retrieved.The diagnosis of intra-abdominal ab-scess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies,such as abdominal ultrasonography or computed tomo-graphy(CT).Here we present a case of abscess formation from unretrieved gall-stone following laparoscopic cholecystectomy,which mimics the imaging findings of metastatic gallbladder ade-nocarcinoma.CASE SUMMARY This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery.After adjuvant chemotherapy,the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered.Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.CONCLUSION Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery.For spilled gall bladder stones,surgeons may consider regular computerized tomography follow-up,and if necessary,laparoscopic examination can be used as a means of confirming the diagnostic and treatment.

Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients

AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student's t test and oneway analysis of variance. Spearman's rank correlation coefficients were calculated to evaluate the association between the scores and variables. RESULTS: The prevalence of malnutrition at admissionwas 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status. CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status in case of gastric cancer patients after gastrectomy.

In vitro antitumor immune response induced by fusion of dendritic cells and colon cancer cells

AIM:The prevention of recurrence of colon cancer (CC) after operation is very important for improvement of the prognosis of CC patients,especially those with micro- metastasis.The generation of fused cells between dendritic cells (DCs) and tumor cells maybe an effective approach for tumor antigen presentation in immunotherapy.In this study, we fused human colon caner SW480 cells and human peripheral blood-derived DCs to induce an antitumor activity against human CC. METHODS:CC SW480 cells and human peripheral blood- derived DCs were fused with 500 mL/L polyethylene glycol (PEG). RESULTS:The specific T cell responses activated by fusion cells (FCs),were observed.About 100 mL/L to 160 mL/L of the PEG-treated non-adherent cells with fluorescences were considered to be dendritomas that highly expressed the key molecules for antigen presentation in our five cases.In vitro studies showed that fusions effectively activated CD8^+ T lymphocytes to secrete interferon-γ.The early apoptotic ratio of the colon cancer SW480 cells was higher than that of controls,which was affected by cytotoxic T lymphocytes (CTLs) stimulated by dendritomas. CONCLUSION:The data indicate that fusion of tumor cells with DCs is an attractive strategy to induce tumor rejection.

Endoscopic mucosal resection of colorectal polyps in typical UK hospitals

AIM:To evaluate the outcomes of endoscopic mucosal resection(EMR) for colorectal polyps,with particular regard to procedural complications and recurrence rate,in typical United Kingdom(UK) hospitals that perform an average of about 25 colonic EMRs per year.METHODS:A total of 239 colorectal polyps(≥ 10 mm) resected from 199 patients referred to Rochdale Infirmary,Salford Royal Hospital and Royal Oldham Hospital for EMR between January 2003 and January 2009 were studied.RESULTS:The mean size of polyps resected was 19.6 ± 12.4 mm(range 10-80 mm).The overall major complication rate was 2.1%.Complications were less frequent with non-adenomas compared with the other groups(Pearson's χ 2 test,P < 0.0001).Resections of largersized polyps were more likely to result in complications(unpaired t-test,P = 0.021).Recurrence was associated with histology,with carcinoma-in-situ more likely to recur compared with low-grade dysplasia [hazard ratio(HR) 186.7,95% confidence interval(95% CI):8.81-3953.02,P = 0.001].Distal lesions were also more likely to recur compared with right-sided and transverse colon lesions(HR 5.93,95% CI:1.35-26.18,P = 0.019).CONCLUSION:EMR for colorectal polyps can be performed safely and effectively in typical UK hospitals.Stricter follow-up is required for histologically advanced lesions due to increased recurrence risk.

Effect of somatostatin in advanced gastric cancer after D2 radical gastrectomy

AIM:To study the effect of somatostatin in patients with advanced gastric cancer who received D2 lymphadenectomy and vagina vasorum dissection.METHODS:Using a prospective,single-blind,placebocontrolled design,patients with advanced gastric cancer were randomized into a study group(n=61)and a control group(n=59).Patients in the study group were given somatostatin for 5-7 d starting 6 h after the operation,and patients in the control group were given normal saline.Preoperative and nonoperative complications in the perioperative period,as well as differenttypes of postoperative drainage in the two groups were compared.RESULTS:There was no significant difference between the study group and the control group for preoperative clinicopathological indicators.We found no significant difference between the two groups for the overall incidence of complications,but a lower percentage of peritoneal effusion was observed in the treatment group(1.6%vs 10.2%,P<0.05).There were no significant differences between the two groups in the incidence of postoperative pancreatic dysfunction and chylous fistula.However,there were significant differences in the amylase concentration in drainage fluid,volume and duration of drainage,volume and duration of chylous fistula and peritoneal drainage,and volume and duration of gastric tube drainage.The study group did not show any increase in mean hospitalization cost and the cost reduced when the postoperative complications occurred.CONCLUSION:Postoperative somatostatin reduces volume and duration of surgical drainage and related complications.Somatostatin may improve safety of gastric cancer surgery,reducing postoperative complications and promoting recovery.

Microbiologic risk factors of recurrent choledocholithiasis postendoscopic sphincterotomy

BACKGROUND Choledocholithiasis is a severe disorder that affects a significant portion of the world’s population.Treatment using endoscopic sphincterotomy(EST)has become widespread;however,recurrence post-EST is relatively common.The bile microbiome has a profound influence on the recurrence of choledocholithiasis in patients after EST;however,the key pathogens and their functions in the biliary tract remain unclear.AIM To investigate the biliary microbial characteristics of patients with recurrent choledocholithiasis post-EST,using next-generation sequencing.METHODS This cohort study included 43 patients,who presented with choledocholithiasis at the Guangdong Second Provincial General Hospital between May and June 2020.The patients had undergone EST or endoscopic papillary balloon dilation and were followed up for over a year.They were divided into either the stable or recurrent groups.We collected bile samples and extracted microbial DNA for analysis through next-generation sequencing.Resulting sequences were analyzed for core microbiome and statistical differences between the diagnosis groups;they were examined using the Kyoto Encyclopedia of Genes and Genomes pathway hierarchy level using analysis of variance.Correlation between the key genera and metabolic pathways in bile,were analyzed using Pearson’s correlation test.RESULTS The results revealed distinct clustering of biliary microbiota in recurrent choledocholithiasis.Higher relative abundances(RAs)of Fusobacterium and Neisseria(56.61%±14.81%vs 3.47%±1.10%,8.95%±3.42%vs 0.69%±0.32%,respectively)and the absence of Lactobacillus were observed in the bile of patients with recurrent disease,compared to that in stable patients.Construction of a microbiological co-occurrence network revealed a mutual relationship among Fusobacterium,Neisseria,and Leptotrichia,and an antagonistic relationship among Lactobacillales,Fusobacteriales,and Clostridiales.Functional prediction of biliary microbiome revealed that the loss of transcription and metabolic abilities may lead to recurrent choledocholithiasis.Furthermore,the prediction model based on the RA of Lactobacillales in the bile was effective in identifying the risk of recurrent choledocholithiasis(P=0.03).CONCLUSION We demonstrated differences in the bile microbiome of patients with recurrent choledocholithiasis compared to that in patients with stable disease,thereby adding to the current knowledge on its microbiologic etiology.

Conservative reconstruction using stents as salvage therapy for disruption of esophago-gastric anastomosis

Esophagectomy with extended lymphadenectomy and gastric conduit reconstruction is a radical procedure for the treatment of esophageal cancer that is associated with a high morbidity rate.Gastric conduit necrosis is a fatal complication that occurs in 2%of patients.Conventionally,two-stage salvage surgery consisting of removal of the necrotic gastric conduit followed by reconstruction has been performed;however,this procedure has a high morbidity rate.We describe a61-year-old man who underwent minimally invasive esophagectomy complicated by slowly progressive gastric conduit necrosis associated with complete neck drainage and a stable overall condition.There was a 2 cm gap in the anastomosis.Because there was no evidence of residual gastric conduit necrosis,a removable,covered self-expanding metal stent(SEMS)was inserted to bridge the anastomosis.The stent was fixed to the patient's ear with silk thread through the lasso on its proximal end to prevent migration.Eight weeks after insertion,the stent was removed easily without any associated complications.The anastomotic defect was completely bridged with granulation tissue,showing progressive epithelialization without leakage or stenosis.The patient was discharged home in good general health.This is the first report of the successful conservative management of esophago-gastric conduit anastomosis disruption with SEMS placement.

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Significant cohort of non-alcoholic fatty liver disease with portal vein thrombosis in transplant waiting list

AIM: To characterize non-alcoholic fatty liver disease(NAFLD) presentation with esophageal varices. METHODS: We carried out a retrospective cohort study on 258 patients with esophageal varices at a single tertiary referral center. These patients underwent diagnosis of several liver diseases, including: NAFLDassociated cirrhosis, hepatitis B, hepatitis C, Wilson disease, autoimune liver diseases, and others. RESULTS: Of the 258 patients, 39% of patients exhibited esophageal varices due to NAFLD-associated cirrhosis. Of the 38(14.7%) patients developed hepatocellular carcinoma during follow-up, 52% were due to hepatitis B, 26% due to hepatitis C and 13.2% due to NAFLD. Of the 258 patients, 50.0% with NAFLD, 33.3% with hepatitis B, 26.3% with hepatitis C, and 58.3% with other diseases were alive at the end of the 5-year period with a significant difference according to the Kaplan-Meier log Rank test(P = 0.040). Portal vein thrombosis was detected in 47.5% of patients with NAFLD, in 29% of patients with hepatitis B, in 17% of patients with hepatitis C, and in 62% of patients with other related diseases(P < 0.0001). CONCLUSION: Our study showed a proportionally greater elevation in liver transplant candidacy in patients with NAFLD and portal vein thrombosis. Older patients were more prone to developing cirrhosis, hepatocellular carcinoma and a high mortality rate. However, younger patients exhibited more portal vein thrombosis and gastric varices.

Appendicitis with psoas abscess successfully treated by laparoscopic surgery

Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-year-old male who was introduced to our institution due to an intractable right psoas abscess. Imaging tests had been performed over the previous 3 years; however, clinicians could not find the origin of the abscess and failed to resolve the problem. A successful operation was performed via a laparoscopic approach, and 17 mo have passed without recurrence. The advantage of laparoscopic surgery is well understood in cases of appendicitis with abscesses. However, the indication for laparoscopic approach is not clear for retroperitoneal abscesses. From our experience, we can conclude that appendicitis with retroperitonealabscesses can be managed and treated using a laparoscopic approach.

Relationship of meteorological factors and air pollutants with medical care utilization for gastroesophageal reflux disease in urban area

BACKGROUND Gastroesophageal reflux disease(GERD)is a highly prevalent disease of the upper gastrointestinal tract,and it is associated with environmental and lifestyle habits.Due to an increasing interest in the environment,several groups are studying the effects of meteorological factors and air pollutants(MFAPs)on disease development.AIM To identify MFAPs effect on GERD-related medical utilization.METHODS Data on GERD-related medical utilization from 2002 to 2017 were obtained from the National Health Insurance Service of Korea,while those on MFAPs were obtained from eight metropolitan areas and merged.In total,20071900 instances of GERD-related medical utilizations were identified,and 200000 MFAPs were randomly selected from the eight metropolitan areas.Data were analyzed using a multivariable generalized additive Poisson regression model to control for time trends,seasonality,and day of the week.RESULTS Five MFAPs were selected for the prediction model.GERD-related medical utilization increased with the levels of particulate matter with a diameter≤2.5μm(PM2.5)and carbon monoxide(CO).S-shaped and inverted U-shaped changes were observed in average temperature and air pollutants,respectively.The time lag of each variable was significant around nine days after exposure.CONCLUSION Using five MFAPs,the final model significantly predicted GERD-related medical utilization.In particular,PM2.5 and CO were identified as risk or aggravating factors for GERD.

Relationship of the preoperative NRS 2002 score,PG-SGA score,and serum indices with postoperative complications in patients with gastric cancer

Objective To examine the utility of the Nutrition Risk Screening 2002(NRS 2002),Patient-Generated Subjective Global Assessment(PG-SGA)and serum factors for the preoperative evaluation of gastric cancer patients.Methods We examined 181 gastric cancer patients treated at the First Affiliated Hospital of Guangxi Medical University from January 2015 to January 2018.Nutritional assessments were administered within 48 h of admission.The body mass index(BMI)and serum factors were measured,and information on preoperative nutritional support and postoperative complications was recorded.Results Both the NRS 2002 and PG-SGA had positive correlations with age(P<0.05),and negative correlations with albumin,prealbumin,transferrin,hemoglobin,BMI,and bodyweight(P<0.05).The NRS 2002 and PG-SGA scores were positively correlated with each other(r=0.683,P<0.01),but had poor consistency(κ=0.357,P<0.01).During the preoperative period,33.2%of patients received nutritional support,mainly enteral nutrition.The nutritional risk group(NRS 2002≥3)received more support than the group without nutritional risk(NRS 2002<3;P<0.05).Patients with nutritional risk or malnutrition who received preoperative nutritional support had fewer postoperative complications than unsupported patients.The overall rate of complications was 12.2%,and the rate of severe complications(gradeⅢor above)was 5.5%.The malnutrition and nutritional risk groups had higher rates of severe complications.Conclusions The combined application of the NRS 2002,PG-SGA,BMI,and serum nutritional indices was useful for the nutritional screening and assessment of preoperative gastric cancer patients.The NRS 2002 and PG-SGA provided guidance on the need for nutritional support during the preoperative period.

Antitumor activity of mutant bacterial cytosine deaminase gene for colon cancer

AIM： To evaluate bacterial cytosine deaminase （bCD） mutant D314A and 5-fluorocytosine （5-FC） for treatment of colon cancer in a mouse model. METHODS： Recombinant lentivirus vectors that contained wild-type bCD gene （bCDwt）, and bCD mutant D314A gene （bCD-D314A） with green fluorescence protein gene were constructed and used to infect hu- man colon carcinoma LoVo cells, to generate stable transfected cells, LoVo/null, LoVo/bCDwt or LoVo/bCD- D314A. These were injected subcutaneously into Balb/c nude mice to establish xenograft models. Two weeks post-LoVo cell inoculation, PBS or 5-FC （500 mg/kg） was administered by intraperitoneal （i.p.） injection once daily for 14 d. On the day after LoVo cell injection, mice were monitored daily for tumor volume and survival. RESULTS： Sequence analyses confirmed the construction of recombinant lentiviral plasmids that contained bCDwt or bCD-D314A. The lentiviral vector had high elficacy for gene delivery, and RT-PCR showed that bCDwt or bCD-D314A gene was transferred to LoVo cells. Among these treatment groups, gene delivery or 5-FC administration alone had no effect on tumor growth. However, bCDwt/5-FC or bCD-D314A/5-FC treatment inhibited tumor growth and prolonged survival of mice significantly （P 〈 0.05）. Importantly, the tumor volume in the bCD-D314A/5-FC-treated group was lower than that in the bCDwt/5-FC group （P 〈 0.05）, and bCD- D314A plus 5-FC significantly prolonged survival of mice in comparison with bCDwt plus 5-FC （P 〈 0.05）. CONCLUSION： The bCD mutant D314A enhanced significantly antitumor activity in human colon cancer xenograft models, which provides a promising approach for human colon carcinoma therapy.

Local advanced rectal cancer perforation in the midst of preoperative chemoradiotherapy:A case report and literature review

Standard chemoradiotherapy(CRT) for local advanced rectal cancer(LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT.

Surgical management of spontaneous rupture of primary liver cell carcinoma:a case report

Primary liver cell carcinoma (PLCC) or Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor in Nigeria. It is a difficult problem in surgery for the diagnosis and therapy of spontaneous liver rupture. The clinical presentation can be varied owing to its clinical signs being usually not specific; therefore, correct diagnosis and management are very important. Without any treatment, the outcome is poor and survival rate is only 10%. Surgeons operate on those patients who present with ruptured PLCC; consisting of packing, hepatic artery ligation and hepatectomy. However, it is often associated with a high mortality rate; as high as 70%, even for the less invasive procedures like packing, argon beam coagulation or hepatic artery ligation. We present a 24-year old lady who had ligation of hepatic artery at an emergency laparotomy for ruptured primary liver cell carcinoma.

A case of postoperative spontaneous intussusception after laparoscopic low anterior resection for rectal cancer

Background:Intussusception refers to a condition in which a segment of the intestine invaginates into the lumen of an adjacent segment of the intestine.Postoperative intussusception after gastrointestinal surgery is an uncommon clinical condition,and there is only one case report of small bowel intussusception after rectal cancer surgery.Here,we report a case of spontaneous small bowel intussusception following laparoscopic total mesorectal excision for rectal cancer.Case presentation:A 56-year-old female military officer was referred to the Colorectal Surgical Department for midrectal cancer,8cm from the anal verge.The patient underwent laparoscopic low anterior resection and diverting loop ileostomy.On postoperative day 3,the patient complained of vomiting and abdominal pain,and a follow-up abdomino-pelvic computed tomography scan showed an ileo-ileal type intussusception.After two days of surgical observation,the clinical symptoms were not resolved.The patient underwent exploratory laparotomy.On exploration,intussusception was found 40 cm proximal to the loop ileostomy site.Segmental resection of the ileum was carried out,and there was no pathological leading point on the resected ileum.The patient was discharged on postoperative day 14 after the second operation and has remained in good health for two years.Conclusion:We present a case of spontaneous small bowel intussusception after laparoscopic total mesorectal excision for rectal cancer that was treated by surgical resection 5 days after the index surgery.

Effects of Subcutaneous Closed Suction Drain for the Prevention of Incisional SSI in Patients with Colorectal Perforation

Objective: To determine if a subcutaneous closed suction drain decreases the incidence of wound complications in patients undergoing emergency surgery for colorectal perforation. Materials and Methods: Data on 47 patients who underwent emergency operations for colorectal perforation were examined retrospectively. The clinical features of these cases with or without the use of the J-VACTM Drainage System were examined, and statistical analysis was performed. Results: In these high-risk cases, the overall incidence of incisional surgical site infection (SSI) was 36.2%. The incidence of incisional SSI in these cases with and without the J-VACTM Drainage System was 16.7% and 56.5%, respectively. Conclusion: Our results suggest that a subcutaneous closed suction drain is effective for preventing incisional SSI in patients who have undergone emergency operations for colorectal perforation.

Application of Succus Entericus Reinfusion in a Patient with Rectal Cancer and Jejunal Diverticulum: A Case Report and Literature Review

We herein report the case of a patient with rectal adenocarcinoma who underwent low anterior resection in our hospital. The patient experienced general peritonitis, septic shock, and ardent fever on postoperative day 3. An exploratory operation revealed a perforated proximal jejunal diverticulum.The patient then underwent total parenteral nutrition and succus entericus reinfusion. The metabolic disturbances and cacotrophy rapidly improved after reinfusion of intestinal secretions, and the patient was successfully cured without requiring a prolonged period of parenteral nutrition. Our data support the saying “If the gut is working, use it.” Our report also confirms the value of succus entericus reinfusion in the successful treatment of a spontaneous perforation of Meckel’s diverticulum after low anterior resection of the rectum.

Impact of citrus fruit and hesperidin intake on multiple health outcomes:An umbrella review

Citrus fruits are rich sources of several biologically active flavonoids such as hesperidin,naringin,and polymethoxylated flavones.We evaluated the evidence of associations between citrus fruit or hesperidin intake and multiple health outcomes.An umbrella review was conducted for studies performed in humans.Overall,246 articles were initially identified by searching in 4 databases.Twenty-two meta-analyses and systematic reviews with 28 health outcomes met the inclusion criteria.Citrus fruit intake had beneficial effects on all-cause mortality(relative risk[RR].0.90;95%confidence interval[95%CI],0.86 to 0.94),cardiovascular diseases(RR,0.78;95%CI,0.66 to 0.92),coronary heart disease(RR,0.91;95%CI,0.86 to 0.96),stroke(RR,0.74;95%CI,0.65 to 0.84),type 2 diabetes mellitus(RR,0.85;95%CI,0.78 to 0.92),and several cancers.Dose-response analyses indicated that each 100-g/d increase in citrus fruit intake could reduce the risks of all-cause mortality by 6%(RR,0.94;95%CI,0.88 to 1.00),stroke by 22%(RR,0.78;95%CI,0.69 to 0.90),and cardia gastric cancer by 40%(RR,0.60;95%CI,0.44 to 0.83).Citrus fruit intake also had beneficial effects on the lipid profile and body weight control(weighted mean difference,−1.28;95%CI,−1.82 to−0.74).Grapefruits could reduce the systolic blood pressure(weighted mean difference,−2.43,95%CI,−4.77 to−0.09).Hesperidin supplementation significantly improved inflammation.Citrus fruit intake was generally safe and beneficial for multiple health outcomes in humans.However,grapefruit and pomelo juice may affect the bioavailability of various medications,so care should be exercised before increasing the intake of these fruits or their juices.