Effect of Sequential Early Enteral Nutrition on Postoperative Rehabilitation and Complications in Gastric Cancer Patients

Objective:To analyze the effect of sequential early enteral nutrition in patients with gastric cancer after surgery.Methods:A total of 139 gastric cancer patients,treated between October 2021 and October 2023,were randomly selected and divided into two groups:Group A(68 cases,receiving early enteral nutrition)and Group B(71 cases,receiving sequential early enteral nutrition),using computer randomization.The effects of the interventions on both groups were compared.Results:Seven days post-operation,the levels of nutritional indicators in Group B were significantly higher than those in Group A(P<0.05).Group B showed significantly better levels of inflammatory factors and immune factors compared to Group A seven days post-operation(P<0.05).The postoperative complication rate in Group B was 4.23%,2 significantly lower than that in Group A,which was 16.18%(χ=5.477,P=0.019).Conclusion:The utilization of sequential early enteral nutrition in gastric cancer patients after surgery demonstrated notable improvements in nutritional status and inflammation markers,along with enhanced immunity,effectively reducing postoperative complications.

Diagnostic efficiency and complication rate of CT-guided lung biopsy： a single center experience of the procedures conducted over a 10-year period

Background Computed tomography （CT）-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions. The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population. Methods CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010. A chest radiograph was taken after the biopsy. Data about basic patient information, final diagnosis, and complications secondary to biopsy procedure （pneumothorax and bleeding） were extracted. Results The diagnostic efficiency of CT-guided lung biopsy was 94.8%; only 53 patients did not get a final diagnosis from lung biopsy. Final diagnoses found 639 malignant lesions （63.0%） and 322 benign lesions （31.8%）. Pneumothorax occurred in 131 patients and 15 required insertion of an intercostal drain. Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients. The overall complication rate was 18.5%. Conclusions CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy. It can be safely performed in clinical trials.

Effect of Preoperative Double-J Ureteral Stenting before Flexible Ureterorenoscopy on Stone-free Rates and Complications

The effect of preoperative Double-J(DJ)ureteral stenting before flexible ureterorenoscopy(FURS)in the treatment for urinary stones was evaluated.We retrospectively enrolled 306 consecutive patients who underwent FURS from Jan.2014 to Dec.2017.All the patients were classified into two groups according to whether they had DJ ureteral stenting before FURS.Baseline characteristics(age,sex,stone location,stone size,surgical success rate,operation time,stone-free rate of the first day after surgery,stone-free rate of the first month after surgery,total complication rate)were compared using Chi-square test for categorical variables and Kruskal-Wallis test for continuous variables.In total,306 patients were included in this study.The group of DJ stenting before FURS included 203(66.3%)patients,and non-DJ stenting before FURS was observed in 103(33.7%)patients.The group of DJ stenting before FURS was significantly associated with a shorter operation time(53.8 vs.59.3 min,P<0.001),a higher stone-free rate of the first day after surgery(69.0%vs.51.5%,P=0.003).However,statistical significant differences were not found in the age,sex,stone location,stone size,surgical success rate,stone-free rate of the first month after surgery(89.2%vs.81.6%,P=0.065)and total complication rate(5.4%vs.9.7%,P=0.161)between the two groups.Preoperative DJ ureteral stenting before FURS could reduce the operation time and increase stone-free rate of the first day after surgery.However,it might not benefit the stone-free rate of the first month after surgery and reduce the complication rate.Preoperative DJ stenting should be not routinely performed.

Relationship between Inflammatory Response and Estimated Complication Rate after Total Hip Arthroplasty

Background：After total hip arthroplasty （THA）,there is a noteworthy inflammatory response.The inflammatory response is associated with postoperative recovery and complications.However,there had been few reports on the relationship between inflammatory response and postoperative complication rate.The aim of the present study was to investigate early inflammatory response in the first 3 days after THA,and to identify the relationship between inflammatory response and estimated complication rate after surgery.Methods：It was a prospective,nonrandomized cohort study.There were 148 patients who underwent unilateral THA in our hospital enrolled.Blood samples were collected preoperatively in the morning of the surgery and at 24,48,and 72 h after surgery.C-reactive protein （CRP） and interleukin-6 （IL-6） in peripheral blood were measured.The modified physiological and operative severity score for the enumeration of the morbidity （POSSUM） was recorded pre-and intra-operatively.Based on the score,estimated complication rate was calculated.Harris score was used to assess hip function before and after surgery.Results：IL-6 levels reached the peak at 24 h after surgery and CRP at 48 h.After that,both of the levels decreased.The mean Harris scores significantly increased from 41.62 ± 23.47 before surgery to 72.75 ± 9.13 at 3 days after surgery.The Harris scores after surgery did not have a significant relation with either IL-6 or CRP peak levels （P=0.165,P =0.34 l,respectively）.Both CRP and IL-6 peak levels significantly and positively correlated with estimated complication rate after surgery.The estimated complication rate calculated using the POSSUM system was 43 cases of 148 patients.Actually,there were only 28 cases that were observed to get postoperative complications during hospitalization.However,there was no significant difference between estimated and observed complication rates （P =0.078）.In the group with complications,the CRP and IL-6 peak levels were significantly higher than those in the group without complications （both P 〈 0.001）.Conclusions：There were significantly positive relationships between both peak levels of CRP and IL-6 and estimated complication rate after THA.Inflammatory response could predict the incidence of complications after THA.

The Impact of Risk-Based Cancer Care Planning on the Complications and Self-Care Ability of Cervical Cancer Patients Undergoing Radiotherapy

Objective:To explore the impact of the application and implementation of risk-based cancer care planning in patients with cervical cancer radiotherapy on the complications and self-care ability of patients.Method:This study recruited selected patients who came for cervical cancer radiotherapy in a tertiary hospital in Xianyang City,Shaanxi Province from November 2020 to November 2021.One hundred patients were recruited.Nursing management was carried out,and cancer care planning under the concept of conventional care and risk were applied.The effects of different nursing methods on patients were compared and analyzed.Results:The patients in the experimental group had higher scores of self-care ability and lower complication rate.All data were significantly different from those of the control group(P<0.05),and the nursing effect on the experimental group was better.Conclusion:The application and implementation of the risk-based cancer care planning in patients who received cervical cancer radiotherapy has significant clinical effects,which is beneficial to reduce the incidence of patients’adverse reactions and promote patient recovery.

Comparison of the treatment duration and nursing requirements of the EarWell infant ear correction system for different types of auricle deformities

Objective:To observe whether the Ear Well infant ear correction system makes any difference in terms of the treatment effect,duration,complication rate,and nursing care requirements in different types of infant auricle deformities.Methods:A total of 93 infant patients with auricular deformity(age:<3 months of age)who were diagnosed and treated in Guangzhou Children and Women’s Medical Center from April 2018 to September 2020 were selected and treated with the Ear Well infant ear correction system.We observed and recorded the effects of the Ear Well infant ear correction system,the treatment duration,the number of rebound cases,and complications that are likely to occur during treatment,and noted the related factors causing complications and the relative requirements for nursing care.Results:The Earwell infant ear correction system could effectively correct infant auricle deformities.Among the 93 cases,90 cases had positive therapeutical outcome and the effective rate was 96.77%.The treatment duration for lop ear and protruding ear was longer than for other auricle deformities;the deformity recoil and the treatment compilation rates were much higher for these 2 deformity types,and the difference was statistically significant(P<0.05).Conclusions:The treatment suggestion for the wearing duration of the Ear Well infant ear correction system for lop ear and protruding ear is a prolonged duration compared with that for other infant auricle deformities.Fur ther,the requirements for nursing care intensity and infant patient’s guardian’s nursing knowledge and skill are obviously increased for these 2 types of auricle deformities.

Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise?

AIM： To determine the rates of success and complications of precut biliary sphincterotomy （PBS） based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy （ES）. METHODS： A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center, The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcorne measures of the study were success and complications of PBS with a comparison to complications of ES.RESULTS： A total of 2939 endoscopic retrograde chola ngiopancreatographies （ERCPs） were performed during the study period, including 818 （28%） ES and 150 （5%） PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt （total 87%）. Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% （10/50） vs 5% （38/818）, P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist＇s first attempt at precut （P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588）. CONCLUSION： Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.

Early patellar tendon rupture after total knee arthroplasty: A direct repair method

BACKGROUND Patellar tendon rupture after total knee arthroplasty(TKA)is a catastrophic complication.Although the occurrence of this injury is rare,it can lead to significant dysfunction for the patient and is very tricky to deal with.There has been no standard treatment for early patella tendon rupture after TKA,and long-term follow-up data are lacking.AIM To introduce a direct repair method for early patella tendon rupture following TKA and determine the clinical outcomes and complications of this method.METHODS During the period of 2008 to 2021,3265 consecutive TKAs were retrospectively reviewed.Twelve patients developed early patellar tendon rupture postoperatively and were treated by a direct repair method.Mean follow-up was 5.7 years.Demographic,operative,and clinical data were collected.The clinical outcomes were assessed using the Western Ontario and McMaster Universities(WOMAC)score,the Hospital for Special Surgery(HSS)score,knee range of motion,extensor lag,and surgical complications.Descriptive statistics and paired t test were employed to analyze the data.RESULTS For all 12 patients who underwent direct repair for early patellar tendon rupture,3 patients failed:One(8.3%)for infection and two(17.6%)for re-fracture.The two patients with re-fracture both underwent reoperation to reconstruct the extensor mechanism and the patient with infection underwent revision surgery.The range of motion was 109.2°±10.6°preoperatively to 87.9°±11°postoperatively,mean extensor lag was 21°at follow-up,and mean WOMAC and HSS scores were 65.8±30.9 and 60.3±21.7 points,respectively.CONCLUSION This direct repair method of early patellar tendon rupture is not an ideal therapy.It is actually ineffective for the recovery of knee joint function in patients,and is still associated with severe knee extension lag and high complication rates.Compared with the outcomes of other repair methods mentioned in the literature,this direct repair method shows poor clinical outcomes.

Neck dissection does not add to morbidity or mortality of laryngectomy

Objectives:To examine the national rates of complications,readmission,reoperation,death and length of hospital stay after laryngectomy.To explore the risks of neck dissection with laryngectomy using outcomes.Methods:The American College of Surgeons National Quality Improvement Program(ACS-NSQIP)database was reviewed retrospectively.The database was analyzed for patients undergoing laryngectomy with and without neck dissection.Demographic,perioperative complication,reoperation,readmission,and death variables were analyzed.Results:754 patients who underwent total laryngectomy during this time were found.Demographic analysis showed average age was 63 years old,566(75.1%)were white,and 598(79.3%)were male.Of these patients,520(69.0%)included a neck dissection while 234(31.0%)did not.When comparing patients who received a neck dissection to those who did not,there were no significant differences in median length of hospital stay(12.5 days w/vs.13.3 days w/o,P=0.99),rates of complication(40%w/vs.35%w/o,P=0.23),reoperation(13.5%w/vs.14%w/o,P=0.81),readmission(14%w/vs.18%w/o,P=0.27),and death(1.3%w/vs.1.3%w/o,P>0.99).Furthermore,neck dissection did not increase the risk of complication(P=0.23),readmission(P=0.27),reoperation(P=0.81),death(P=0.94),or lengthened hospital stay(P=0.38).Conclusions:Concurrent neck dissection does not increase postoperative morbidity or mortality in patients undergoing total laryngectomies.These results may help physicians make decisions regarding concurrent neck dissection with total laryngectomy.