Current and future surgery strategies for spinal cord injuries

Spinal cord trauma is a prominent cause of mortality and morbidity. In developed countries a spinal cord injury(SCI) occurs every 16 min. SCI occurs due to tissue destruction, primarily by mechanical and secondarily ischemic. Primary damage occurs at the time of the injury. It cannot be improved. Following the primary injury, secondary harm mechanisms gradually result in neuronal death. One of the prominent causesof secondary harm is energy deficit, emerging from ischemia, whose main cause in the early stage, is impaired perfusion. Due to the advanced techniques in spinal surgery, SCI is still challenging for surgeons. Spinal cord doesn't have a self-repair property. The main damage occurs at the time of the injury primarily by mechanical factors that cannot be improved. Secondarily mechanisms take part in the following sections. Spinal compression and neurological deficit are two major factors used to decide on surgery. According to advanced imaging techniques the classifications systems for spinal injury has been changed in time. Aim of the surgery is to decompress the spinal channel and to restore the spinal alinement and mobilize the patient as soon as possible. Use of neuroprotective agents as well as methods to achieve cell regeneration in addition to surgery would contribute to the solution.

Iatrogenic bile duct injuries from biliary tract surgery

BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after primary surgery.Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury(IBDI) were managed at the Department of Surgery,First Affiliated Hospital,Xi’an Jiaotong University.All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS:Recovery of the patients was uneventful.All patients were followed-up at the surgical outpatient department for six months to three years.So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries,and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.

Promoting axonal regeneration following nerve surgery： a perspective on ultrasound treatment for nerve injuries

Nerve injury is often associated with limited axonal regeneration and thus leads to delayed or incomplete axonal reinnervation.As a consequence of slow nerve regeneration,target muscle function is often insufficient and leads to a lifelong burden.Recently,the diagnosis of nerve injuries has been improved and likewise surgical reconstruction has undergone significant developments.However,the problem of slow nerve regeneration has not been solved.In a recent meta-analysis,we have shown that the application of low-intensity ultrasound promotes nerve regeneration experimentally and thereby can improve functional outcomes.Here we want to demonstrate the experimental effect of low intensity ultrasound on nerve regeneration,the current state of investigations and its possible future clinical applications.

Resection and reconstruction in high-grade pancreatic head injuries

This study by Chui et al adds further important evidence in the treatment of highgrade pancreatic injuries and endorses the concept of the model of pancreatic trauma care designed to optimize treatment,minimize morbidity and enhance survival in patients with complex pancreatic injuries.Although the authors have demonstrated favorable outcomes based on their limited experience of 5 patients who underwent a pancreaticoduodenectomy(PD),including 2 patients who were“unstable”and did not have damage control surgery(DCS),we would caution against the general recommendations promoting index PD without DCS in“unstable”grade 5 pancreatic head injuries.

Injuries Requiring Surgery in Folk Dancers： A Retrospective Cohort Study of 9 Years

Background： In this study, we examined professional folk dancer injuries which required surgery and if there are any associated factors like age, gender, dexterity, dance style and to evaluate the return to their full capacity. Materials and Methods： Seventy five members of the Fire of Anatolia dance group （mean age： 26.8 ± 5.2; 18-38 years） performers were evaluated. The dancers suffered 14 orthopedic injuries requiring surgery （3 meniscus tears, 2 anterior cruciate ligament tears one of which is with posterolateral corner tear, 1 posterior cruciate ligament tear, 1 patellar dislocation, 1 scaphoid fracture, 1 extensor tendon cut in hand, 1 infrapatellar bursitis, 2 Hoffa’s fat pad syndromes, 2 symptomatic medial plicaes） during a nine-year period. Follow-up time was 51 ± 41.9 （29.5-92） months. Results： Following surgeries, the dancers could restart rehearsals in 12.7 ± 9 （range： 4 to 36） weeks and perform live on the stage in 16.2 ± 12.2 （range： 5 to 52） weeks on average. Conclusion： Males were 8.64 times more likely to suffer an injury requiring surgery compared to the females （p = 0.003） and twelve （85.7%） of these injuries were lower extremity injuries and were all located in the knee in Anatolian folk dancers.

A 2-year follow-up survey of 523 cases with peripheral nerve injuries caused by the earthquake in Wenchuan, China

We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classiifed into three types： type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open tran-section nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmaco-therapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity de-clined with increasing duration of being trapped. In the ifrst year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor （0 or 1） after a 1-year period of treatment, further treatment was not effective.

Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit

BACKGROUND The management of high-grade pancreatic trauma is controversial.AIM To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries.METHODS A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma(AAST) Grade Ⅲor greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified.RESULTS Over a twenty-year period, 14 patients underwent pancreatic resection for highgrade injuries. Seven patients sustained AAST Grade Ⅲinjuries and 7 were classified as Grades Ⅳ or Ⅴ. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy(PD). Overall, there was a predominance of blunt aetiologies(11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases(7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies.CONCLUSION We advocate that high-grade pancreatic trauma should be managed in high-volume hepatopancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.

Maxillofacial Injuries at the Komfo Anokye Teaching Hospital, Kumasi, Ghana: A Preliminary Study

Background: The aetiology and pattern of maxillofacail injuries vary in different parts of the world and even the same country. The purpose of the study was to determine the epidemiology of maxillofacial injuries at a tertiary Hospital in Ghana. Methodology: This is a six-month (January to June 2015) prospective study. Information on age, sex, aetiology, injury type etc. was collected using a specialized design data collection form. Data was analyzed using the SPSS 17th version. Ethical approval was obtained. Result: The total study sample was 111 with a male to female ratio of 2.5:1. Majority (34.2%) were within the ages of 21 to 30 years. Majority of the victims were urban dwellers. Most of the injuries occurred on the highway (42.3%) and in the evening (35.2%). Only a small percentage (5.4%) of the road traffic crashes (RTC) victims were in some form of protection. Twenty-one (18.9%) of the injuries were intentional, of which 18 (85.7%) were assault. The commonest maxillofacial injury was a combination of soft and hard tissues 72 (64.7%). The commonest cause of maxillofacial soft tissue injuries was RTC, 72.8%. Laceration (55.6%) was the most common soft tissue injury recorded. Mandibular fractures constituted the commonest hard tissue injuries. Conclusion: This study has shown that road traffic crashes are the most common cause of injuries to the maxillofacial region. The mandible is the most frequent site of fracture, while the commonest soft tissue injury is laceration. Majority of the victims were young energetic males and adherence to road traffic regulations was very low.

Ultrasonic piezotome surgery: is it a benefit for our patients and does it extend surgery time? A retrospective comparative study on the removal of 100 impacted mandibular 3rd molars

Aim of the study was to evaluate if there is a constant and significant reduction in traumaticity when mas- sively traumatic oral surgical procedures such as the removal of third molars are conducted with only ul- trasonic surgical devices (Piezotomes) expressed in a reduction of postsurgical pain and swelling on the patient’s side since such clinical experiences by the authors suggested this. Since oral surgeons criticize a higher time consumption for surgeries with Piezoto- mes also the objective time consumption was evalu- ated and compared to the traditional methods. Mate- rial and Methods: 56 female and male patients were selected that already underwent a removal of an im- pacted third mandibular molar on one side with rota- ry instruments by bone destructive burring with a still persisting comparable third mandibular molar on the contralateral side complaining about recur- rent pain episodes and were already documented for pain and swelling before. The ultrasonic surgical re- moval with the Piezotome was conducted with a buc- cal osteotomy of the compacta lateral to the impacted third molar, preservation of the resected compacta in saline solution, removal of the third molar by single or multiple dentotomy and full anatomical restitution of the surgical site with the preserved buccal com- pacta. The swelling was documented by kephalome- try 24/48/72 hours and 1 week post surgery, the pain index by the total consumption of ibuprofen-400 mg—tablets. Lesions of the mandible nerve were documented. Netto surgery time was taken from the first incision to the last suture of the procedure. Re-sults: 6 patients had to be excluded from evaluation due to incomplete post surgical follow up. A signify-cant (***, p > 0.999) decrease in pain and swelling of 50% was detected both for the parameters swelling and pain with Piezotome-surgery. No lesions of the mandible nerve were detected with Piezotome sur- gery whereas surgery with rotary instruments re- sulted in 16% hypesthesia at least up to one week. Although netto surgery time was approximately 50% longer when done with the Piezotome at the begin-ning the time consumption normalized with the growing experience of the surgeons back to the time schedule when surgery was performed with rotary instruments revealing no significant differences (-, p < 0.73). Conclusions: The results of this retrospective study suggest that Piezotome-surgery is superior in atraumaticity and soft-tissue safety compared to tra- ditional procedures with burs and grants the patients significantly less post surgical pain and swelling. Al- though—as it is with all new surgical tools and pro- tocols—surgery time is longer at the beginning when purely working with ultrasonic surgical devices time consumption reduces to normal values after a learn- ing curve.

Computer-Assisted Surgery for Mandibular Reconstruction Using a Patient-Specific Titanium Mesh Tray and Particulate Cancellous Bone and Marrow

Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.

Application of multidisciplinary team-based integrated traditional Chinese medicine and Western medicine in rotator cuff injury patients undergoing arthroscopic surgery

BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to ensure therapeutic efficacy.AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine(TCM-WM)under the multidisciplinary team(MDT)model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs.METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024.They were divided into a control group(n=48)that received routine rehabilitation treatment and an experimental group(n=52)that received TCM-WM under the MDT model(e.g.,acupuncture,TCM traumatology and orthopedics,and rehabilitation).The results of the Constant–Murley Shoulder Score(CMS),Visual Analogue Scale(VAS),Shoulder Pain and Disability Index(SPADI),muscular strength evaluation,and shoulder range of motion(ROM)assessments were analyzed.RESULTS After treatment,the experimental group showed significantly higher CMS scores in terms of pain,functional activity,shoulder joint mobility,and muscular strength than the baseline and those of the control group.The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group.In addition,the experimental group showed significantly enhanced muscular strength(forward flexor and external and internal rotator muscles)and shoulder ROM(forward flexion,abduction,and lateral abduction)after treatment compared with the control group.CONCLUSION TCM-WM under the MDT model improved shoulder joint function,relieved postoperative pain,promoted postoperative functional recovery,and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.

Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump Cardiac Surgery Patients: A Single-Center Investigation in Bangladesh

Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.

Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh

Background: Serum albumin, a vital plasma protein, helps maintain intravascular colloidal osmotic pressure, cardiac output, and renal function. Low preoperative serum albumin is linked to poor outcomes, including acute kidney injury (AKI), after off-pump coronary artery bypass (OPCAB) surgery. This study aimed to assess the relationship between preoperative serum albumin levels and early postoperative renal injury. Methods: This prospective comparative cross-sectional study was conducted from August 2019 to February 2021 at the National Heart Foundation Hospital & Research Institute, Bangladesh. It included 160 adult patients with normal preoperative renal function undergoing OPCAB. Patients were divided into two groups: Group A (serum albumin ≥ 4.0 gm/dl) and Group B (serum albumin Results: Preoperative serum albumin was significantly different between groups (Group A: 4.21 ± 0.05 gm/dl, Group B: 3.69 ± 0.04 gm/dl, p = 0.028). Group B had a higher incidence of hypertension (71.25% vs. 51.25%, p st and 3rd postoperative days were higher in Group B (p th day. Postoperative AKI occurred in 18.75% of Group A and 36.25% of Group B. Multivariate regression indicated that low preoperative serum albumin is an independent risk factor for postoperative AKI (p = 0.012, OR = 1.815, CI: 0.675 - 1.162). Conclusion: Preoperative serum albumin level is a valuable predictor of postoperative renal function. Ensuring high normal serum albumin levels before surgery can help minimize the risk of postoperative AKI.

Positioning patients for spine surgery: Avoiding uncommon position-related complications

Positioning patients for spine surgery is pivotal for optimal operating conditions and operative-site exposure. During spine surgery, patients are placed in positions that are not physiologic and may lead to complications. Perioperative peripheral nerve injury(PPNI) and postoperative visual loss(POVL) are rare complications related to patient positioning during spine surgery that result in significant patient disability and functional loss. PPNI is usually due to stretch or compression of the peripheral nerve. PPNI may present as a brachial plexus injury or as an isolated injury of single nerve, most commonly the ulnar nerve. Understanding the etiology, mechanism and pattern of injury with each type of nerve injury is important for the prevention of PPNI. Intraoperative neuromonitoring has been used to detect peripheral nerve conduction abnormalities indicating peripheral nerve stress under general anesthesia and to guide modification of the upper extremity position to prevent PPNI. POVL usually results in permanent visual loss. Most cases are associated with prolonged spine procedures in the prone position under general anesthesia. The most common causes of POVL after spine surgery are ischemic optic neuropathy and central retinal artery occlusion. Posterior ischemic opticneuropathy is the most common cause of POVL after spine surgery. It is important for spine surgeons to be aware of POVL and to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters. Modification of risk factors extrinsic to the patient may help reduce the incidence of PPNI and POVL.

Pulmonary complications after spine surgery

Spine surgery is one of the fastest growing branches of orthopedic surgery. Patients often present with a relatively high acuity and, depending on surgical approach, morbidity and mortality can be comparatively high. Among the most prevalent and most frequently fatalitybound perioperative complications are those affecting the pulmonary system; evidence of clinical or subclinical lung injury triggered by spine surgical procedures is emerging. Increasing burden of comorbidity among the patient population further increases the likelihood of adverse outcome. This review is intended to give an overview over some of the most important causes of pulmonary complications after spine surgery, their pathophysiology and possible ways to reduce harm associated with those conditions. We discuss factors surrounding surgical trauma, timing of surgery, bone marrow and debris embolization, transfusion associated lung injury, and ventilator associated lung injury.

Practical approaches to effective management of intestinal radiation injury:Benefit of resectional surgery

AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy.During follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative management.RESULTS:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one patient.All patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.

Machine learning approach to predict acute kidney injury after liver surgery

BACKGROUND Acute kidney injury(AKI)after surgery appears to increase the risk of death in patients with liver cancer.In recent years,machine learning algorithms have been shown to offer higher discriminative efficiency than classical statistical analysis.AIM To develop prediction models for AKI after liver cancer resection using machine learning techniques.METHODS We screened a total of 2450 patients who had undergone primary hepatocellular carcinoma resection at Changzheng Hospital,Shanghai City,China,from January 1,2015 to August 31,2020.The AKI definition used was consistent with the Kidney Disease:Improving Global Outcomes.We included in our analysis preoperative data such as demographic characteristics,laboratory findings,comorbidities,and medication,as well as perioperative data such as duration of surgery.Computerized algorithms used for model development included logistic regression(LR),support vector machine(SVM),random forest(RF),extreme gradient boosting(XGboost),and decision tree(DT).Feature importance was also ranked according to its contribution to model development.RESULTS AKI events occurred in 296 patients(12.1%)within 7 d after surgery.Among the original models based on machine learning techniques,the RF algorithm had optimal discrimination with an area under the curve value of 0.92,compared to 0.87 for XGBoost,0.90 for DT,0.90 for SVM,and 0.85 for LR.The RF algorithm also had the highest concordance-index(0.86)and the lowest Brier score(0.076).The variable that contributed the most in the RF algorithm was age,followed by cholesterol,and surgery time.CONCLUSION Machine learning algorithms are highly effective in discriminating patients at high risk of developing AKI.The successful application of machine learning models may help guide clinical decisions and help improve the long-term prognosis of patients.

Near-infrared spectroscopy in adult cardiac surgery： between conflicting results and unexpected uses

Neurological complications after cardiac surgery, rang- ing from permanent stroke to transient dysfunction, repre- sent a key issue in the management of geriatric patients. Many patients aged 70 or more have history of neurological dysfunctions, which increases the risk of complications and sequelae, Severe neurologic diseases, such as strokes, occur in up to 6% of patients undergoing cardiac surgery. Therefore, in the setting of fragile patients, prevention is more important than treatment. There are several intraop- erative mechanisms of neurological injury, such as embo- lism, inflammation, intraoperative anemia,

Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery

BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains unknown.AIM To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.METHODS A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.RESULTS Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380(AKI: 38.12% vs 14.85%, P < 0.001;severe AKI: 14.36% vs 1.98%, P = 0.001).CONCLUSION NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.

Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery

BACKGROUND:Several risk scoures have been used in predicting acute kidney injury(AKI)of patients undergoing general or specific operations such as cardiac surgery.This study aimed to evaluate the use of two AKI risk scores in patients who underwent non-cardiac surgery but required intensive care.METHODS:The clinical data of patients who had been admitted to ICU during the first 24 hours of ICU stay between September 2009 and August 2010 at the Cancer Institute,Chinese Academy of Medical Sciences & Peking Union Medical College were retrospectively collected and analyzed.AKI was diagnosed based on the acute kidney injury network(AKIN) criteria.Two AKI risk scores were calculated:Kheterpal and Abelha factors.RESULTS:The incidence of AKI was 10.3%.Patients who developed AKI had a increased ICU mortality of 10.9%vs.1.0%and an in-hospital mortality of 13.0 vs.1.5%,compared with those without AKI.There was a significant difference between the classification of Kheterpal's AKI risk scores and the occurrence of AKI(P<0.001).There was no significant difference between the number of Abelha's AKI risk scores and the occurrence of AKI(P=0.499).Receiver operating characteristic curves demonstrated an area under the curve of 0.655±0.043(P=0.001,95%confidence interval:0.571-0.739) for Kheterpal's AKI risk score and 0.507±0.044(P=0.879,95%confidence interval:0.422-0.592) for Abelha's AKI risk score.CONCLUSION:Kheterpal's AKI risk scores are more accurate than Abelha's AKI risk scores in predicting the occurrence of AKI in patients undergoing non-cardiac surgery with moderate predictive capability.