Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery

BACKGROUND Fast-track surgery(FTS)is a modern nursing approach that has gained popularity in the perioperative phase of surgery.AIM To investigate the impact of FTS on perioperative care for hepatobiliary surgery.METHODS A retrospective analysis was performed on 98 patients who underwent hepato-biliary surgery and were admitted to our hospital from August 2021 to October 2023.They were divided into an observation group and a control group with 49 patients in each group according to different nursing directions.The control group was treated with standard nursing and the observation group was treated with FTS concept nursing.The length of hospital stay,visual analog scale(VAS)score,wound complications,nursing satisfaction,self-rating scale(SAS)score,and SF-36 quality of life(QoL)score were compared between the two groups before and after care.RESULTS The duration of hospitalization,hospitalization cost,operation time,first im-plantation time,exhaust time,and first defecation time were shorter than the observation group(P<0.05).Additionally,the observation group showed a sig-nificant difference between the VAS and SAS scores on days 1,3,and 7(P<0.05).The complication rate in the observation group was 4.05%was significantly lower than the 18.36%in the control group,and the comparison groups were statistically significant(χ2=5.018,P=0.025).The observation group had a significantly higher level of nurse satisfaction(94.92%)than the control group(79.59%;χ2=6.078,P=0.014).Both groups showed higher QoL scores after nursing care,with higher scores in the observation group than in the control group(P=0.032).CONCLUSION FTS in patients undergoing hepatobiliary surgery can effectively improve negative mood,QoL,and nursing sa-tisfaction;reduce wound complications;and accelerate patient rehabilitation.

Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.

Fast-track program vs traditional care in surgery for gastric cancer

AIM:To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.METHODS:PubMed,Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013,and only randomized trials were included.The references of relevant studies were manually searched for further studies that may have been missed.Search terms included"gastric cancer","fast track"and"enhanced recovery".Five outcome variables were considered most suitable for analysis:postoperative hospital stay,medical cost,duration to first flatus,C-reactive protein(CRP)level and complications.Postoperative hospital stay was calculated from the date of operation to the date of discharge.Fixed effects model was used for meta-analysis.RESULTS:Compared with traditional care,fasttrack program could significantly decrease the postoperative hospital stay[weighted mean difference(WMD)=-1.19,95%CI:-1.79--0.60,P=0.0001,fixed model],duration to first flatus(WMD=-6.82,95%CI:-11.51--2.13,P=0.004),medical costs(WMD=-2590,95%CI:-4054--1126,P=0.001),and the level of CRP(WMD=-17.78,95%CI:-32.22--3.35,P=0.0001)in laparoscopic surgery for gastric cancer.In open surgery for gastric cancer,fast-track program could also significantly decrease the postoperative hospital stay(WMD=-1.99,95%CI:-2.09--1.89,P=0.0001),duration to first flatus(WMD=-12.0,95%CI:-18.89--5.11,P=0.001),medical cost(WMD=-3674,95%CI:-5025--2323,P=0.0001),and the level of CRP(WMD=-27.34,95%CI:-35.42--19.26,P=0.0001).Furthermore,fast-track program did not significantly increase the incidence of complication(RR=1.39,95%CI:0.77-2.51,P=0.27,for laparoscopic surgery;and RR=1.52,95%CI:0.90-2.56,P=0.12,for open surgery).CONCLUSION:Our overall results suggested that compared with traditional care,fast-track program could result in shorter postoperative hospital stay,less medical costs,and lower level of CRP,with no more complications occurring in both laparoscopic and open surgery for gastric cancer.

Safety of fast-track rehabilitation after gastrointestinal surgery:Systematic review and meta-analysis

AIM: To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery.

Fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: A meta-analysis

AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P<0.001)compared with a pooled RR of 0.69(95%CI:0.34-1.40,P>0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.

Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraoperative blood loss, and intraoperative blood transfusion volume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization

Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.

Fast-track program in laparoscopic liver surgery:Theory or fact?

AIM:To analyze our results after the introduction of a fast-track(FT) program after laparoscopic liver surgery in our Hepatobiliarypancreatic Unit.METHODS:All patients(43) undergoing laparoscopic liver surgery between March 2004 and March 2010 were included and divided into two consecutive groups:Control group(CG) from March 2004 until December 2006 with traditional perioperative cares(17 patients) and fast-track group(FTG) from January 2007 until March 2010 with FT program cares(26 patients).Primary endpoint was the influence of the program on the postoperative stay,the amount of re-admissions,morbidity and mortality.Secondarily we considered duration of surgery,use of drains,conversion to open surgery,intensive cares needs and transfusion.RESULTS:Both groups were homogeneous in age and sex.No differences in technique,time of surgery or conversion to open surgery were found,but more malignant diseases were operated in the FTG,and then transfusions were higher in FTG.Readmissions and morbidity were similar in both groups,without mortality.Postoperative stay was similar,with a median of 3 for CG vs 2.5 for FTG.However,the 80.8% of patients from FTG left the hospital within the first 3 d after surgery(58.8% for CG).CONCLUSION:The introduction of a FT program after laparoscopic liver surgery improves the recovery of patients without increasing complications or re-admissions,which leads to a reduction of the stay and costs.

Fast-track rehabilitation program vs conventional care after colorectal resection:A randomized clinical trial

AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P < 0.01).The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P < 0.05).Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P < 0.05).The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care(5 d vs 7 d,P < 0.01).No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.

Fast density peak-based clustering algorithm for multiple extended target tracking

The key challenge of the extended target probability hypothesis density (ET-PHD) filter is to reduce the computational complexity by using a subset to approximate the full set of partitions. In this paper, the influence for the tracking results of different partitions is analyzed, and the form of the most informative partition is obtained. Then, a fast density peak-based clustering (FDPC) partitioning algorithm is applied to the measurement set partitioning. Since only one partition of the measurement set is used, the ET-PHD filter based on FDPC partitioning has lower computational complexity than the other ET-PHD filters. As FDPC partitioning is able to remove the spatially close clutter-generated measurements, the ET-PHD filter based on FDPC partitioning has good tracking performance in the scenario with more clutter-generated measurements. The simulation results show that the proposed algorithm can get the most informative partition and obviously reduce computational burden without losing tracking performance. As the number of clutter-generated measurements increased, the ET-PHD filter based on FDPC partitioning has better tracking performance than other ET-PHD filters. The FDPC algorithm will play an important role in the engineering realization of the multiple extended target tracking filter.

基于Kano-FAST-E的鞋面压合机优化设计

目的降低鞋面压合机设备作业过程中的失误率、优化人机交互体验。方法基于Kano模型调研分析作业人员与企业经理对当前设备的使用感受及需求;利用FAST理论重新定义设备的功能区域并指导设计展开;基于人机工程学理论(E),对设计方案的功能布局和结构尺寸进行优化,提升人机操作效率;利用眼动试验对改进前后的功能布局进行对比分析验证,并借助李克特量表对设计方案进行用户满意度评价。结果完成鞋面压合机的优化设计实践,提升了设备的人机性能和用户满意度,有效提高了作业人员认读效率、减少视觉疲劳和错误操作。结论改进后的鞋面压合机赋予了工人更加安全、高效且人性化的操作模式,验证了Kano-FAST-E的设计策略对该设备的人机优化设计具有指导意义,也为同类设备的开发实践提供参考。

A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program

Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.

Speeds Criteria vs. Modified Aldrete and Fast-Track Criteria for Evaluating Recovery in Outpatients

Background: The authors have developed criteria utilizing the mnemonic “SPEEDS” (saturation, pain, extremity movement, emesis, dialogue, stable vitals signs) to evaluate and predict which patients would not require phase I nursing intervention and could transition to phase II recovery. Methods: Seventy-three adult surgery patients underwent a standardized general anesthetic. Patients were evaluated with the modified Aldrete, Fast-Track and SPEEDS criteria immediately before leaving the OR and then 5, 10, 15 and 30 minutes after arrival in the recovery area. Results: Significantly more patients met phase I bypass criteria when evaluated with Modified Aldrete (90%) and Fast-Track (94%) as compared to SPEEDS (77%) (p 0.0429 modified Aldrete vs. SPEEDS, p 0.0038 Fast-Track vs. SPEEDS). However, SPEEDS was more sensitive having a lower number of patients meeting phase II criteria yet requiring phase I intervention (32%) vs. Fast-track (43%) and Modified Aldrete (44%) (p 0.001 SPEEDS vs. modified Aldrete and Fast-Track). SPEEDS was more accurate (74%) in predicting which patients should move directly to phase II compared to modified Aldrete (42%) (p 0.001) and Fast-track (59%) (p = 0.05). Conclusion: SPEEDS criteria are as specific and more sensitive in determining phase I nursing interventions for ambulatory surgery patients when compared to Fast-Track and modified Aldrete criteria.

Pakistan needs to speed up its human immunodeficiency virus control strategy to achieve targets in fast-track acquired immune deficiency syndrome response

In last fifteen years remarkable success in the fight against human immunodeficiency virus(HIV) is achieved globally. The number of HIV infections has decreased and the number of people on antiretroviral therapy is increased. This all is possible by strong political commitments and heavy investments in the fight against HIV. Pakistan is among few Asian countries in which HIV cases are increasing year by year since 1990. There are 94000 cases of HIV in Pakistan and only 14000 are registered with government. The main source of HIV infection in Pakistan is the use of contaminated injection equipment among people who inject drugs(PWID). The overall prevalence of HIV among PWID in Pakistan is 27.2%. There are five cities in Pakistan in which HIV prevalence is above 40% in PWIDs. In June 2016, United Nations political declaration on acquired immune deficiency syndrome(AIDS) provided a global mandate to fast-track the AIDS response over the next five years to achieve the targets in Sustainable Development Goals. To achieve the targets in fasttrack AIDS response, the global leaders showed strong commitments to invest $ 26 billion per year by 2020. Pakistan needs to speed up its HIV control program. There is a dire need to locate all HIV positive people and enroll them in the treatment program. Pakistan also needs to calculate exact number of people living with HIV, increase HIV treatment centers and increase HIV awareness. Recently, Global Fund invested handsome money in the fight against HIV. Let's hope the country will have effective HIV control strategy to achieve the HIV elimination target by 2030.

一种快速鲁棒的LOG-FAST角点算法

基于高时间效率的FAST算法,提出了一种快速鲁棒的FAST-LOG角点算法。使用直方图均衡化方法对图像进行增强,提高图像成分的清晰度并消除图像中光照强度的影响;运用拉普拉斯-高斯函数对图像进行卷积,实现图像的高斯平滑和增强边缘,及对噪声最大化的抑制;最后使用FAST算子检测角点。对比实验证明,新算子对于添加高斯噪声的分辨率为640*480的图像,其检测时间可达到0.05s;对光照不同的图像具有相近的检测性能;角点重复率可达98%。该算子可应用于实时视频图像的处理,为开发基于视觉的实时智能车辆预警系统提供了新的研究思路。

一种新的FAST-Snake目标跟踪方法

提出一种新的FAST-Snake目标跟踪方法,利用改进的FAST角点特征匹配来估计目标轮廓在帧间的全局仿射变换,将投影轮廓点作为Snake模型的初始化轮廓.为提高跟踪实时性,在Snake能量模型中定义了先验约束能,并用限定搜索方向的贪婪算法(Greedy algorithm)实现局部轮廓优化.实验包括三维目标数据库及真实场景视频,验证了提出方法的均方误差(Mean square error,MSE)及收敛速度评估均优于对比算法,并具备对复杂运动及局部遮挡的适应能力.

关节镜下外-内缝合法结合Fast-Fix系统治疗膝关节盘状半月板外侧撕裂伤

膝关节盘状半月板在东方人种中多见，由于其充填并占据胫股关节间隙，不仅影响膝关节活动，而且易于受到挤压、扭转等暴力而导致损伤。盘状半月板损伤以分层损伤为主，部分患者合并有外侧边缘撕裂伤。

控制FAST馈源的宏-微机器人系统

本文介绍了大射电望远镜 FAST光机电一体化设计方案 ,给出了由贵州 KARST地貌的地理位置得到的线馈源扫描运动轨迹 ,对六悬索并联索系结构和 Stewart平台组成的并联宏

采用局部-全局区域重检测机制的无人机长期跟踪算法

为解决基础跟踪器面对遮挡和移出视野等长期跟踪场景时易出现跟踪失败等问题,提出了一种基于局部-全局区域重检测的无人机长期跟踪算法。设计了基础滤波器,将高置信度样本与其结合,并融入自适应时空正则化,解决了滤波器退化问题,提高了模型鲁棒性以及复杂场景下的性能;优化了滤波器更新策略,通过评价跟踪结果进行自适应更新;设计快速尺度滤波器,解决了跟踪过程中的尺度变化问题;设计了局部-全局区域重检测机制,跟踪失败时启动重检测器恢复跟踪目标,先完成局部区域重检测,若恢复跟踪失败,再利用全局区域重检测器继续恢复目标跟踪状态。实验结果表明:所提算法在UAV20L数据集上的精确度和准确率分别可达0.724和0.621,与基于时空正则化相关滤波器的跟踪算法(STRCF)相比分别提升了25.9%和20.6%,与同类主流算法相比,跟踪效果得到提升,证明了算法的有效性。

DEAE-Sepharose Fast Flow分离纯化刺芹侧耳木质素降解酶

[目的]为Pleurotus eryngii—Co60-7木质素降解酶的分离纯化和综合利用提供试验依据。[方法]采用DEAE—Sepharose^TM Fast Flow离子交换介质，分别考察缓冲液pH值、流速和洗脱方式等对刺芹侧耳木质素降解酶分离纯化的影响，确定了最佳分离纯化层析条件。[结果]DEAE-Sephalose^TM Fast Flow分离纯化Pleurotus eryngii-Co60-7木质素降解酶的最佳层析条件为：选择20mmol／L，pH值为5．0醋酸钠一醋酸缓冲体系，3ml／min的流速，进行分步洗脱（100、200～300和1000mmoL／L NaCl的三步洗脱），可较好地实现刺芹侧耳发酵液木质素降解酶初分，该纯化操作目标蛋白回收率达85％，纯化分离因素为2．71。[结论]该技术在分离纯化刺芹侧耳木质素降解酶上可行，具有潜在的工业应用价值。