Correlation of Preoperative D-Dimer Levels and Postoperative Venous Thromboembolism in Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty

Background: The relationship of preoperative D-dimer and Venous thromboembolism (VTE) after total knee arthroplasty (TKA) and total hip arthroplasty (THA) remains controversial. The purpose of this study was to assess the value of D-dimer in the detection of early VTE after TKA and THA. Materials and Methods: A total of 312 patients were evaluated in this retrospective study from 2016 to 2020 at a tertiary care centre, Mumbai who were operated for THA and TKA. The measurement of plasma D-dimer level was done preoperatively and clinically symptomatic patients were evaluated and confirmed for VTE by Colour Doppler Sonography. The plasma D-dimer levels were correlated statistically with the sonographic VTE. Results: 11 patients developed Deep Vein Thrombosis (DVT) and 1 patient developed Pulmonary embolism (PE). Preoperative plasma D-dimer levels were significantly higher (P < 0.01) in patients who developed DVT postoperatively. Colour Doppler Sonography showed that 2 thrombi were seen in proximal veins (pelvic and femoral veins), and 2 thrombi were seen in distal veins (posterior tibial, peroneal, gastrocnemian veins) of the calf in THA patients, and all 8 thrombi were seen in the distal veins (posterior tibial, peroneal, gastrocnemian veins) of the calf in TKA patients. Conclusion: We infer that if the preoperative D-dimer levels were more than 0.5 mg/l, the chances of developing VTE postoperatively are more, which can be diagnosed clinically and further by other investigations. In this study, we have shown that doing preoperative D-dimer level can almost PREDICT the development of VTE and thus prevent complications.

Virtual reality for preoperative patient education: Impact on satisfaction, usability, and burnout from the perspective of new nurses

BACKGROUND Traditional paper-based preoperative patient education is a struggle for new nurses and requires extensive training.In this situation,virtual reality technology can help the new nurses.Despite its potential benefits,there are studies on patient satisfaction but there is limited information on the usability of virtual reality(VR)technology for new nurses in giving preoperative education to patients.AIM To investigate the impact on satisfaction,usability,and burnout of a system using VR technology in preoperative patient education.METHODS The study involved 20 nurses from the plastic surgery ward and 80 patients admitted between April and May 2019.Each nurse taught four patients:Two using traditional verbal education and two using virtual reality.The System Usability Scale,After-Scenario Questionnaire,and Maslach Burnout Inventory(MBI)were employed to evaluate the impact of these education methods.RESULTS The VR education groups showed a statistically higher satisfaction than the traditional verbal education groups.Among the three subscales of the MBI,emotional exhaustion and personal accomplishment improved statistically significantly.VR was also better in terms of usability.CONCLUSION This study suggests VR enhances usability and reduces burnout in nurses,but further research is needed to assess its impact on depersonalization and objective measures like stress and heart rate.

Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy:A singlecenter retrospective study

BACKGROUND The population of elderly patients with gastric cancer is increasing,which is a major public health issue in China.Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer.AIM To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy.METHODS A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020.RESULTS The overall rate of malnutrition was 31.8%.The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group(P<0.001).Nutritional characteristics in the malnourished group,including body mass index,prognostic nutritional index(PNI),albumin,prealbumin,and hemoglobin,were all significantly lower than those in the well-nourished group.The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the wellnourished group(22.1%vs 33.5%,P=0.001).Age≥70 years(HR=1.216,95%CI:1.048-1.411),PNI<44.5(HR=1.792,95%CI:1.058-3.032),operation time≥160 minutes(HR=1.431,95%CI:1.237-1.656),and postoperative complications grade III or higher(HR=2.191,95%CI:1.604-2.991)were all recognized as independent risk factors associated with delayed discharge.CONCLUSION Malnutrition is relatively common in elderly patients undergoing gastrectomy.Low PNI is an independent risk factor associated with delay discharge.More strategies are needed to improve the clinical outcome of these patients.

Influence of static cartoons combined with dynamic virtual environments on preoperative anxiety of preschool-aged children undergoing surgery

BACKGROUND Preschoolers become anxious when they are about to undergo anesthesia and surgery,warranting the development of more appropriate and effective interventions.AIM To explore the effect of static cartoons combined with dynamic virtual environments on preoperative anxiety and anesthesia induction compliance in preschool-aged children undergoing surgery.METHODS One hundred and sixteen preschool-aged children were selected and assigned to the drug(n=37),intervention(n=40),and control(n=39)groups.All the children received routine preoperative checkups and nursing before being transferred to the preoperative preparation room on the day of the operation.The drug group received 0.5 mg/kg midazolam and the intervention group treatment consisting of static cartoons combined with dynamic virtual environments.The control group received no intervention.The modified Yale Preoperative Anxiety Scale was used to evaluate the children’s anxiety level on the day before surgery(T0),before leaving the preoperative preparation room(T1),when entering the operating room(T2),and at anesthesia induction(T3).Compliance during anesthesia induction(T3)was evaluated using the Induction Compliance Checklist(ICC).Changes in mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)were also recorded at each time point.RESULTS The anxiety scores of the three groups increased variously at T1 and T2.At T3,both the drug and intervention groups had similar anxiety scores,both of which were lower than those in the control group.At T1 and T2,MAP,HR,and RR of the three groups increased.The drug and control groups had significantly higher MAP and RR than the intervention group at T2.At T3,the MAP,HR,and RR of the drug group decreased and were significantly lower than those in the control group but were comparable to those in the intervention group.Both the drug and intervention groups had similar ICC scores and duration of anesthesia induction(T3),both of which were higher than those of the control group.CONCLUSION Combining static cartoons with dynamic virtual environments as effective as medication,specifically midazolam,in reducing preoperative anxiety and fear in preschool-aged children.This approach also improve their compliance during anesthesia induction and helped maintain their stable vital signs.

Combined preoperative albumin bilirubin score and hepatectomy percentage for evaluate the liver regeneration after partial hepatectomy

Surgical resection is a pivotal therapeutic approach for addressing hepatic space-occupying lesions,with liver volume restoration and hepatic functional recovery being crucial for assessing surgical prognosis.The preoperative albumin-bilirubin(ALBI)score,encompassing serum albumin and bilirubin levels,can be determined via blood analysis,effectively mitigating human error and providing an accurate depiction of liver function.The hepatectomy ratio,which is the proportion of the liver volume removed to the total liver volume,is critical in preserving an adequate liver tissue volume to ensure postoperative hepatic functional compensation,minimize surgical complications,and reduce mortality rates.Incorporating the preoperative ALBI score and hepatectomy ratio aids surgeons in assessing the optimal timing and extent of partial hepatectomy.The introduction of preoperative albumin bilirubin score and hepatectomy percentage is beneficial for the surgeons to evaluate the timing and magnitude of partial liver resection.

Enhancing preoperative patient education through virtual reality:A leap forward in nursing practice

Integration of virtual reality(VR)technology into preoperative patient education has shown potential to improve nursing practice.The study by Kim et al examines the impact of VR on nurse satisfaction,usability,and burnout.A prospective study involving 20 nurses and 80 patients was conducted,comparing traditional paper-based education with VR-based education in the plastic surgery ward at Chungnam National University Hospital.Findings demonstrated that VR significantly enhanced satisfaction and usability among nurses,while also reducing emotional exhaustion,a critical factor in nurse burnout.Consistency in education quality was also improved,ensuring uniform patient care.These results underscore the importance of VR in reducing the stress of repetitive tasks,improving job satisfaction,and potentially enhancing nurse retention.Future research should explore the broader applications of VR in healthcare and address the logistical challenges of integrating this technology into routine clinical practice.The study by Kim et al highlights VR’s transformative potential in preoperative education for both patients and healthcare providers.

Hepatic perivascular epithelioid cell tumors:The importance of preoperative diagnosis

Accurate preoperative diagnosis is highly important for the treatment of perivascular epithelioid cell tumors(PEComas)because PEComas are mainly benign tumors and may not require surgical intervention.By analyzing the causes,properties and clinical manifestations of PEComas,we summarize the challenges and solutions in the diagnosis of PEComas.

Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Tumour response following preoperative chemotherapy is affected by body mass index in patients with colorectal liver metastases

BACKGROUND Colorectal cancer is the third most prevalent malignancy globally and ranks second in cancer-related mortality,with the liver being the primary organ of metastasis.Preoperative chemotherapy is widely recommended for initially or potentially resectable colorectal liver metastases(CRLMs).Tumour pathological response serves as the most important and intuitive indicator for assessing the efficacy of chemotherapy.However,the postoperative pathological results reveal that a considerable number of patients exhibit a poor response to preoperative chemotherapy.Body mass index(BMI)is one of the factors affecting the tumori-genesis and progression of colorectal cancer as well as prognosis after various antitumour therapies.Several studies have indicated that overweight and obese patients with metastatic colorectal cancer experience worse prognoses than those with normal weight,particularly when receiving first-line chemotherapy regimens in combination with bevacizumab.AIM To explore the predictive value of BMI regarding the pathologic response following preoperative chemotherapy for CRLMs.METHODS A retrospective analysis was performed in 126 consecutive patients with CRLM who underwent hepatectomy following preoperative chemotherapy at four different hospitals from October 2019 to July 2023.Univariate and multivariate logistic regression models were applied to analyse potential predictors of tumour pathological response.The Kaplan-Meier method with log rank test was used to compare progression-free survival(PFS)between patients with high and low BMI.BMI<24.0 kg/m^(2) was defined as low BMI,and tumour regression grade 1-2 was defined as complete tumour response.RESULTS Low BMI was observed in 74(58.7%)patients and complete tumour response was found in 27(21.4%)patients.The rate of complete tumour response was significantly higher in patients with low BMI(29.7%vs 9.6%,P=0.007).Multivariate analysis revealed that low BMI[odds ratio(OR)=4.56,95%confidence interval(CI):1.42-14.63,P=0.011],targeted therapy with bevacizumab(OR=3.02,95%CI:1.10-8.33,P=0.033),preoperative carcinoembryonic antigen level<10 ng/mL(OR=3.84,95%CI:1.19-12.44,P=0.025)and severe sinusoidal dilatation(OR=0.17,95%CI:0.03-0.90,P=0.037)were independent predictive factors for complete tumour response.The low BMI group exhibited a significantly longer median PFS than the high BMI group(10.7 mo vs 4.7 mo,P=0.011).CONCLUSION In CRLM patients receiving preoperative chemotherapy,a low BMI may be associated with better tumour response and longer PFS.

Effects of fluid therapy combined with a preoperative glucose load regimen on postoperative recovery in patients with rectal cancer

BACKGROUND Patients with rectal cancer undergoing radical resection often have poor post-operative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue,and have a high risk of complications.Therefore,it is of great significance to apply appropriate rehydration regimens to patients un-dergoing radical resection of rectal cancer during the perioperative period to improve the postoperative outcomes of patients.AIM To analyze the effects of goal-directed fluid therapy(GDFT)with a preoperative glucose load regimen on postoperative recovery and complications in patients undergoing radical resection for rectal cancer.METHODS Patients with rectal cancer who underwent radical resection(n=184)between January 2021 and December 2023 at our hospital were randomly divided into either a control group or an observation group(n=92 in each group).Both groups received a preoperative glucose load regimen,and routine fluid replacement and GDFT were additionally implements in the control and observation groups,res-pectively.The operative conditions,blood levels of lactic acid and inflammatory markers,postoperative recovery,cognitive status,hemodynamic indicators,brain oxygen metabolism,and complication rates were compared between the groups.RESULTS The colloidal fluid dosage,total infusion,and urine volume,as well as time to first exhaust,time to food intake,and postoperative length of hospital stay,were lower in the observation group(P<0.05).No significant differences were observed between the two groups in terms of operation time,bleeding volume,crystalloid liquid consumption,time to tracheal extubation,complication rate,heart rate,or mean arterial pressure(P>0.05).Compared with the control group,in the ob-servation group the lactic acid level was lower immediately after the surgery(P<0.05);the Mini-Mental State Examination score was higher on postoperative day 3(P<0.05);the pulse pressure variability(PPV)was lower at 30 min after pneumoperitoneum(P<0.05),though the differences in the PPV of the two groups was not significant at the remaining time points(P>0.05);tumor necrosis factor-αand interleukin-6 levels were lower on postoperative day 3(P<0.05);and the left and right regional cerebral oxygen saturation was higher immediately after the surgery and 30 min after pneumoperitoneum(P<0.05).CONCLUSION GDFT combined with the preoperative glucose load regimen is a safe and effective treatment strategy for im-proving postoperative recovery and risk of complications in patients with rectal cancer undergoing radical re-section.

Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.

Preoperative malnutrition in elderly gastric cancer patients and adverse postoperative outcomes of radical gastrectomy

Malnutrition is not only a prevalent condition among the elderly but also a common comorbidity in elderly people with gastric cancer(GC).Malnutrition is closely linked to high rates of postoperative complications and poor wound healing in elderly GC patients,which may lead to a higher incidence and mor-tality rate of GC.Malnutrition decreases the physical function of elderly GC patients after surgery,severely affecting their postoperative life quality and hindering subsequent treatments.This retrospective study was conducted by Zhao et al,focusing on the clinical baseline data,postoperative complications,and hospitalization times of elderly GC patients who underwent curative gastrectomy.Additionally,the underlying causes of poor outcomes for patients were discussed.This study may provide a solid basis for the clinical treatment of elderly GC patients in the future.Therefore,malnutrition can serve as a negative prognostic factor for curative surgery in GC patients.Addressing malnutrition and its adverse effects can benefit elderly GC patients from surgical treatment.

Association of preoperative antiviral treatment with incidences of post-hepatectomy liver failure in hepatitis B virus-related hepatocellular carcinoma

BACKGROUND Post-hepatectomy liver failure(PHLF)is a common consequence of radical partial hepatectomy in hepatocellular carcinoma(HCC).AIMS To investigate the relationship between preoperative antiviral therapy and PHLF,as well as assess the potential efficacy of hepatitis B virus(HBV)DNA level in predicting PHLF.METHODS A retrospective study was performed involving 1301 HCC patients with HBV who underwent radical hepatectomy.Receiver operating characteristic(ROC)analysis was used to assess the capacity of HBV DNA to predict PHLF and establish the optimal cutoff value for subsequent analyses.Logistic regression analyses were performed to assess the independent risk factors of PHLF.The increase in the area under the ROC curve,categorical net reclassification improvement(NRI),and integrated discrimination improvement(IDI)were used to quantify the efficacy of HBV DNA level for predicting PHLF.The P<0.05 was considered statistically significant.RESULTS Logistic regression analyses showed that preoperative antiviral therapy was independently associated with a reduced risk of PHLF(P<0.05).HBV DNA level with an optimal cutoff value of 269 IU/mL(P<0.001)was an independent risk factor of PHLF.All the reference models by adding the variable of HBV DNA level had an improvement in area under the curve,categorical NRI,and IDI,particularly for the fibrosis-4 model,with values of 0.729(95%CI:0.705-0.754),1.382(95%CI:1.341-1.423),and 0.112(95%CI:0.110-0.114),respectively.All the above findings were statistically significant.CONCLUSION In summary,preoperative antiviral treatment can reduce the incidence of PHLF,whereas an increased preoperative HBV DNA level has a correlative relationship with an increased susceptibility to PHLF.

Impact of preoperative therapy on surgical outcomes of laparoscopic total gastrectomy for gastric/gastroesophageal junction cancer

Objective: As laparoscopic surgery is widely applied for primarily treated gastric cancer(GC)/gastroesophageal junction cancer(GEJC) and gains many advantages, the feasibility of laparoscopic total gastrectomy(LTG) for GC/GEJC patients who have received preoperative therapy(PT) has come to the fore. This study aims to analyze the safety and feasibility of LTG after PT for GC/GEJC patients.Methods: We retrospectively analyzed the data of 511 patients with GC/GEJC undergoing LTG, of which 405received LTG(LTG group) and 106 received PT+LTG(PT-LTG group) at Nanfang Hospital between June 2018and September 2022. The surgical outcomes were compared between the two groups.Results: The surgical duration was significantly longer in the PT-LTG group(P<0.001), while the incidence of intraoperative complications(P=1.000), postoperative complications(LTG group vs. PT-LTG group: 26.2% vs.23.6%, P=0.587), the classification of complication severity(P=0.271), and postoperative recovery was similar between two groups. Notably, the incidence of anastomotic complications of esophagojejunostomy was also comparable between the two groups(LTG group vs. PT-LTG group: 5.9% vs. 5.7%, P=0.918). The univariate and multivariate analysis confirmed that positive proximal margin [positive vs. negative: odds ratio(OR)=14.094, 95%confidence interval(95% CI): 2.639-75.260, P=0.002], rather than PT, has an impact on anastomotic complications after LTG(OR=0.945, 95% CI: 0.371-2.408, P=0.905).Conclusions: PT did not increase the surgical risk of LTG for GC/GEJC. Therefore, considering the positive effect of PT on long-term survival, the broader application of PT and LTG for GC/GEJC is supported by our findings.

Efficacy and safety of preoperative immunotherapy in patients with mismatch repair-deficient or microsatellite instability-high gastrointestinal malignancies

BACKGROUND Programmed death protein(PD)-1 blockade immunotherapy significantly prolongs survival in patients with metastatic mismatch repair-deficient(dMMR)/microsatellite instability-high(MSI-H)gastrointestinal malignancies such gastric and colorectal cancer.However,the data on preoperative immunotherapy are limited.AIM To evaluate the short-term efficacy and toxicity of preoperative PD-1 blockade immunotherapy.METHODS In this retrospective study,we enrolled 36 patients with dMMR/MSI-H gastrointestinal malignancies.All the patients received PD-1 blockade with or without chemotherapy of CapOx regime preoperatively.PD1 blockade 200 mg was given intravenously over 30 min on day 1 of each 21-d cycle.RESULTS Three patients with locally advanced gastric cancer achieved pathological complete response(pCR).Three patients with locally advanced duodenal carcinoma achieved clinical complete response(cCR),followed by watch and wait.Eight of 16 patients with locally advanced colon cancer achieved pCR.All four patients with liver metastasis from colon cancer reached CR,including three with pCR and one with cCR.pCR was achieved in two of five patients with nonliver metastatic colorectal cancer.CR was achieved in four of five patients with low rectal cancer,including three with cCR and one with pCR.cCR was achieved in seven of 36 cases,among which,six were selected for watch and wait strategy.No cCR was observed in gastric or colon cancer.CONCLUSION Preoperative PD-1 blockade immunotherapy in dMMR/MSI-H gastrointestinal malignancies can achieve a high CR,especially in patients with duodenal or low rectal cancer,and can achieve high organ function protection.

Application of CD34 expression combined with three-phase dynamic contrast-enhanced computed tomography scanning in preoperative staging of gastric cancer

BACKGROUND Accurate preoperative staging of gastric cancer(GC),a common malignant tumor worldwide,is critical for appropriate treatment plans and prognosis.Dynamic three-phase enhanced computed tomography(CT)scanning for preoperative staging of GC has limitations in evaluating tumor angiogenesis.CD34,a marker on vascular endothelial cell surfaces,is promising in evaluating tumor angiogenesis.We explored the value of their combination for preoperative staging of GC to improve the efficacy and prognosis of patients with GC.Medical records of 106 patients with GC treated at the First People's Hospital of Lianyungang between February 2021 and January 2023 were retrospectively studied.All patients underwent three-phase dynamic contrast-enhanced CT scanning before surgery,and CD34 was detected in gastroscopic biopsy specimens.Using surgical and pathological results as the gold standard,the diagnostic results of three-phase dynamic contrast-enhanced CT scanning at different T and N stages were analyzed,and the expression of CD34-marked microvessel density(MVD)at different T and N stages was determined.The specificity and sensitivity of three-phase dynamic contrast-enhanced CT and CD34 in T and N staging were calculated;those of the combined diagnosis of the two were evaluated in parallel.Independent factors affecting lymph node metastasis were analyzed using multiple logistic regression.RESULTS The accuracy of three-phase dynamic contrast-enhanced CT scanning in diagnosing stages T1,T2,T3 and T4 were 68.00%,75.00%,79.41%,and 73.68%,respectively,and for diagnosing stages N0,N1,N2,and N3 were 75.68%,74.07%,85.00%,and 77.27%,respectively.CD34-marked MVD expression increased with increasing T and N stages.Specificity and sensitivity of three-phase dynamic contrast-enhanced CT in T staging were 86.79%and 88.68%;for N staging,89.06%and 92.86%;for CD34 in T staging,64.15%and 88.68%;and for CD34 in N staging,84.38%and 78.57%,respectively.Specificity and sensitivity of joint diagnosis in T staging were 55.68%and 98.72%,and N staging were 75.15%and 98.47%,respectively,with the area under the curve for diagnosis improving accordingly.According to multivariate analysis,a longer tumor diameter,higher pathological T stage,lower differ-entiation degree,and higher expression of CD34-marked MVD were independent risk factors for lymph node metastasis in patients with GC.CONCLUSION With high accuracy in preoperatively determining the invasion depth and lymph node metastasis of GC,CD34 expression and three-phase dynamic contrast-enhanced CT can provide a reliable basis for surgical resection.

Elevated preoperative plasma D-dimer dose not adversely affect survival of gastric cancer after gastrectomy with curative intent: A propensity score analysis

Objective： Elevated plasma D-dimer has been reported to be associated with advanced tumor stage and poor survival in several types of malignancies. The purpose of this study was to assess the potential impact of preoperative plasma D-dimer level（PDL） on overall survival（OS） of gastric cancer（GC） patients undergoing curative surgery by applying propensity score analysis.Methods： A total of 1,025 curatively resected GC patients in Tianjin Medical University Cancer Institute ＆Hospital were enrolled. Patients were categorized into two groups based on preoperative PDL： the elevated group（EG） and the normal group（NG）. To overcome bias due to the different distribution of covariates for the two groups, a one-to-one match was applied using propensity score analysis, after matching, prognostic factors were analyzed.Results： In analysis for the whole study series, patients in the EG were more likely to have a larger proportion of tumor size ≥5 cm（67.5% vs. 55.8%, P=0.006）, elder mean age（64.0±10.8 years vs. 60.5±11.6 years, P〈0.001） and advanced tumor（T）, node（N）, and TNM stage. Patients with elevated PDL demonstrated a significantly lower 5-year OS than those with normal PDL（27.0% vs. 42.6%, P〈0.001）, however, the PDL was not an independent prognostic factor for OS in multivariate analysis [hazard ratio： 1.13, 95% confidence interval（95% CI）： 0.92–1.39,P=0.236]. After matching, 163 patients in the EG and 163 patients in the NG had the same characteristics. The 5-year OS rate for patients in the EG was 27.0% compared with 25.8% for those in the NG（P=0.809, log-rank）.Conclusions： The poor prognosis of GC patients with elevated preoperative PDL was due to the advanced tumor stage and elder age rather than the elevated D-dimer itself.

Preoperative high level of D-dimers predicts unresectability of pancreatic head cancer

AIM: To assess the value of D-dimer level in determining resectability of pancreatic cancer.

Combination of preoperative fibrinogen and D-dimer as a prognostic indicator in pancreatic ductal adenocarcinoma patients undergoing R0 resection

BACKGROUND Patients with malignant tumors frequently exhibit hyperactivation of the coagulation system and secondary increased fibrinolytic activity.Fibrinogen and D-dimer are common indicators that are crucial in the coagulation/fibrinolysis system.Both indicators have been verified to have predictive value in the overall survival(OS)of many patients with solid malignancies.AIM To explore the prognostic significance of fibrinogen combined with D-dimer in pancreatic ductal adenocarcinoma(PDAC)patients undergoing radical R0 resection.METHODS We retrospectively analyzed the clinical data of 282 patients with PDAC undergoing radical R0 resection in the Cancer Hospital,Chinese Academy of Medical Sciences,between January 2010 and December 2019.The surv_cutpoint function of R language was used to determine the optimal cutoff values of the preoperative fibrinogen concentration and preoperative D-dimer concentration.Enrolled patients were further divided into the any-high group(high preoperative fibrinogen concentration and/or high preoperative D-dimer concentration)and the low-low group(low preoperative fibrinogen and D-dimer concentrations)according to the optimal cutoff values.RESULTS The optimal cutoff values of the preoperative fibrinogen concentration and preoperative D-dimer concentration were 3.31 g/L and 0.53 mg/L,respectively.Furthermore,multivariate Cox regression analysis showed that the preoperative fibrinogen concentration(HR:1.603,95%CI:1.201-2.140,P=0.001)and preoperative D-dimer concentration(HR:1.355,95%CI:1.019-1.801,P=0.036)exhibited obvious correlations with the OS of PDAC patients undergoing radical R0 resection.A prognostic analysis was further performed based on the subgroup results by using fibrinogen combined with D-dimer.The median OS duration of the low-low group(31.17 mo)was significantly longer than that of the any-high group(15.43 mo).Additionally,multivariate Cox regression analysis revealed that the degree of differentiation(P<0.001),lymph node metastasis(HR:0.663,95%CI:0.497-0.883,P=0.005),preoperative CA19-9 level(HR:1.699,95%CI:1.258-2.293,P=0.001),adjuvant therapy(HR:1.582,95%CI:1.202-2.081,P=0.001)and preoperative combined grouping(HR:2.397,95%CI:1.723-3.335,P<0.001)were independent predictors of OS in PDAC patients undergoing radical R0 resection.CONCLUSION Preoperative fibrinogen combined with D-dimer plays a predictive role in OS,and low preoperative fibrinogen and D-dimer concentrations can indicate prolonged OS in PDAC patients undergoing radical R0 resection.

Preoperative Fasting of More Than 14 Hours Increases the Risk of Time-to-Death after Cardiothoracic Surgery in Children:A Retrospective Cohort Study

Background:Prolonged preoperative fasting can cause hypoglycemia,hyperglycemia,and intravascular volume depletion in children.We aimed to examine whether prolonged preoperative fasting is associated with in-hospital mortality and other morbidities in pediatric cardiothoracic surgery.Methods:This retrospective cohort study included children aged 0–3 years who underwent cardiac surgery between July 2014 and October 2020.The patient demographic data,surgery-related and anesthesia-related factors,and postoperative outcomes,including hypoglycemia,hyperglycemia,sepsis,length of intensive care unit stay,and in-hospital mortality,were recorded.The main exposure and outcome variables were prolonged fasting and time-to-death after surgery,respectively.The associations between prolonged fasting and perioperative death were analyzed using multivariate Cox regression analysis.Results:In total,402 patients were recruited.The incidence of perioperative mortality was 21%(85/402).The proportion of perioperative deaths was significantly higher in the prolonged fasting group than that in the normal fasting group.The proportion of postoperative bacteremia and hypoglycemia was significantly higher in the very prolonged fasting group than that in the prolonged fasting group.After adjusting for preoperative conditions and anesthesia-and surgery-related factors,preoperative prolonged fasting>14.4 h was significantly associated with time-to-death(HR[95%CI]:2.2[1.2,3.9],p=0.036).The 30-day survival rates of fasting time>14.4 h,9.25–14.4 h,and<9.25 h were 0.67(0.55,0.81),0.79(0.72,0.87),and 0.85(0.79,0.91),respectively.Conclusions:Preoperative fasting of more than 14.4 h was associated with a two-fold increase in the hazard rate of time-to-death in children who underwent cardiac surgery.