Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to predict that outcome. METHODS： We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS： Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD （12.8 ＋ 3.9 vs 12.6 ＋ 4.7, P = 0.9） or in the mean CTP （7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8） between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures （MELD： 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP： 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008）. The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them （AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3）. CONCLUSION： The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Cancellation Causes of Elective Surgical Procedures in a Major Pediatric Surgery Department

Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3rd, 2017, and January 31st, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.

Surgical Procedures,Pathological Features and Prognosis in Young Women with Breast Cancer in China--a Single Institute Experience

Objective:To compare the differences in surgical procedures,pathological features and prognosis between young and elderly women with breast cancer in China.Methods:A retrospective study compared the data of surgical procedures,pathological features and prognosis of 61 cases of young females(≤40 years)and 507 cases of elderly females(>40 years),treated in our department from August 2011 to July 2018.This data was analyzed using SPSS 23.0 program.Results:10.74% of total cases,in this period of time,involve young females.In terms of surgical procedures,24.59%of young patients underwent breast conserving surgery(8.48% elderly,respectively),and 13.11%underwent reconstruction surgery(1.18% elderly,respectively),with statistically significant differences existing between the two groups(P<0.05).Progesterone receptor(PR)expression in young women was significantly higher than in elderly females(P<0.05).There were no significant differences between the two groups in the proportion of invasive ductal carcinoma(IDC),axillary lymph node metastasis(ALNM),expression of estrogen receptor(ER),human epidermal growth factor receptor-2(HER-2)and Ki-67,but the lymphatic metastasis stage showed an increasing rate with younger age.No significant difference was found in 3-year disease-free survival(DFS)and overall survival(OS).Conclusion:The selection rate of breast conserving and reconstructive surgery in young women with breast cancer is significantly higher than that in elderly women.The younger the patient,the more frequently the PR positive expression,and the more likely ALNM to occur.The 3-year prognosis of the young and elderly patients is similar.

State of Play of Anesthesia for Outpatient Medical and Surgical Procedures in the City of Kinshasa

Context and Objective: The practice of outpatient anaesthesia has many advantages over anesthesia with conventional hospitalisation, particularly in the reduction of post-operative complications and the faster resumption of activity, etc. No study has been carried out on this subject in our community;this study was carried out in order to come up with a concrete state of play when it comes to outpatient anesthesia for medical and surgical procedures in the city of Kinshasa. Methodology: This was a cross-sectional study, which took place in seven hospitals in the city of Kinshasa from 1 November 2020 to 31 January 2021. The population consisted of all patients who received outpatient anesthesia and the included patients had signed an informed consent. The variables of the study were the general profile of patients, surgical procedures and indications, anesthetic data and patient evolution. Statistical analyses were performed with SPPS 21.0 with p Results: We collected data from 971 patients who had undergone anesthesia in the seven medical facilities in the city of Kinshasa. Among these patients, 394 had benefited from outpatient anesthesia, i.e. a frequency of outpatient anesthesia estimated at 40.5%. Three hundred and ninety-four (394) patients were selected. They were 58.6% women and 41.4% men i.e. a sex ratio M/F of 0.7. The mean age was 39.3 ± 18.7 years with the extremes of 1 and 82 years. Gastroscopy was the most performed (operative) procedure (21.6%). Patients were classified as ASA 1 in 75.1%, narcosis (80.7%) using propofol (80.2%) was the most used anesthetic technique and performed by a specialist doctor in Anesthesia in 65.5%. Suxamethonium was the most used curare in 13.2%. Fentanyl was the most used opioid in 14.5%. Bupivacaine (10.9%) was the most widely used local anesthetic. Eleven patients or 3.2% had complications and, i.e. (0.8%) were hospitalized, class ASA II appeared to be a factor associated with complications. Conclusion: Ambulatory anesthesia is a reality in the city of Kinshasa;however, it is still underdeveloped and mainly concerns explorations (gastroscopy, colonoscopy, laparoscopy…) and some minor procedures. This anesthesia mainly uses propofol and is done by the specialist doctor. A high-powered study and an evaluation of this practice in the light of international recommendations would be useful.

Operating procedures of traditional Chinese medicine breast massage

Traditional Chinese medicine breast massage,also known as breast Tuina or manual expression of breast milk,is a technique of using certain manipulations to act on specific positions or acupoints of the breast to promote blood and lymphatic circulation of breast and facilitate the discharge of stagnant milk.This technique is widely used in China to treat breastfeeding problems such as breast engorgement,mastitis,and postpartum hypogalactia.In this article,we introduce the definition and standardization process of breast massage,elaborate the operating procedures of breast massage in detail,and summarize and discuss the current situation of its clinical application,so as to provide a reference for its wide application and in‑depth research.

Surgical procedures of thoracic ossification of the ligamentum flavum

Objective To investigate different surgical procedures for treatment of thoracic ossification of ligamentum flavum.Methods From January 1994 to June 2008,56 cases of thoracic ossification of ligamentum flavum underwent

CHANGES OF INTERLEUKIN-6 AND RELATED FACTORS AS WELL AS GASTRIC INTRAMUCOSAL pH DURING COLORECTAL AND ORTHOPAEDIC SURGICAL PROCEDURES

Objective To investigate the changes of perioperative serum levels of interleukin-6(IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. Methods Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation.Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol.pHi and plasma lactate were also measured at the same time points.Results Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation.CRP was not detectable until the first day after operation.Peak concentration of IL-6 had positive relationship with CRP.These variables changed more significantly in colorectal group than that in orthopaedic group (P<0.05).pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P<0.05).Conclusion IL-6 may reflect tissue damage more sensitively than CRP.Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.

Application of Plan-Do-Check-Action cycle and fishbone diagram analysis in optimizing surgical procedures to improve satisfaction degree of doctor-nurse-patient

Background:To study the application of management tools such as Plan-Do-Check-Action(PDCA)cycle and fishbone diagram in optimizing surgical procedures to improve the satisfaction of doctor-nurse-patient.Methods:The fundus surgery nursing team of our hospital began to implement the PDCA cycle management mode to optimize the surgical procedure from July 2017,set up a project activity improvement team,unified the surgical labeling processing plan,and made the fundus surgery procedure,and established the preoperative health education for surgical patients,and standardized the training content of post-rotating doctors and interns.Results:The satisfaction degree to surgical procedure after implementation of doctors and nurses was higher than that before implementation.Conclusions:Using PDCA cycle and fishbone diagram analysis tools to manage the surgical procedure optimization can better integrate doctor-nurse medical care,improve the efficiency and accuracy of the surgical procedure delivery and operation,and optimize the satisfaction of the three parties of doctor-nurse-patient.

Comparison of the Efficacy of Ultrasound-Guided Microwave Ablation of Parathyroid Adenoma with Surgical Procedures

Objective: To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. Methods: The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. Results: The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Conclusion: Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.

Operational procedures of auricular point sticking technology

As an external treatment technique of traditional Chinese medicine(TCM),auricular point sticking,which is rooted in holographic biology theory and TCM viscera and meridian theory,is a safe and effective treatment method.This article introduces the technology overview and development process.The auricular point sticking technique for constipation is taken as an example to specify the basic requirements,assessment,operational points,acupoint selection and matters needing attention during the implementation of the auricular acupressure technique,providing a reference for the operating procedures of this technique in the clinical treatment of other diseases such as insomnia,diarrhea,colds,hypertension,headache,and dysmenorrhea.

Establishment and implementation of safety check project for invasive procedures outside the operating room

Objective:This study aimed to describe the implementation of the surgical safety check policy and the surgical safety checklist for invasive procedures outside the operating room(OR)and evaluate its effectiveness.Methods:In 2017,to improve the safety of patients who underwent invasive procedures outside of the OR,the hospital quality and safety committee established the surgery safety check committee responsible for developing a new working plan,revise the surgery safety check policy,surgery safety check Keywords:Invasive procedures outside the operating room Safety management Surgical safety checklist Patient safety form,and provide training to the related staff,evaluated their competency,and implemented the updated surgical safety check policy and checklist.The study compared the data of pre-implementation(Apr to Sep 2017)and two post-implementation phases(Apr to Sep 2018,Apr to Sep 2019).It also evaluated the number of completed surgery safety checklist,correct signature,and correct timing of signature.Results:The results showed an increase in the completion rate of the safety checklist after the program implementation from 41.7%(521/1,249)to 90.4%(3,572/3,950),the correct rates of signature from 41.9%(218/521)to 99.0%(4,423/4,465),and the correct timing rates of signature from 34.4%(179/521)to 98.5%(4,401/4,465),with statistical significance(P<0.01).Conclusion:Implementing the updated surgery safety check significantly is a necessary and effective measure to ensure patient safety for those who underwent invasive procedures outside the OR.Implementing surgical safety checks roused up the clinical staff's compliance in performing safety checks,and enhanced team collaboration and communication.

AP1000 Operation Procedures System and Development

This paper makes a brief introduction on AP1000 operation procedure system, including procedure classification, function and composition. In addition, key points of work flow process and the advantages of AP1000 operation procedures are described, among which the application of CPS （computerized procedure system） on AP1000 operation area and human factor engineering are highlighted. Moreover, based on current situation, this paper offers several suggestions on procedure development for Sanmen AP 1000 nuclear power project, i.e. first, ensure the quality of operation procedures; then determine the way how we are going to use operation procedures in English version; finally realize CPS Chinesization and localization gradually by digesting and absorbing API000 technology.

Monte Carlo Study of 3D Stray Radiation during Interventional Procedures

In interventional medical procedures, other than the highly important issue of optimizing image quality and patient exposure using the primary beam, there remains a continuing need for the study of staff exposure from the scattered radiation. Herein, investigation is made of the 3D stray-radiation distribution, the simulation being made of a realistic interventional scenario through use of the Monte Carlo code Geant4 (version 10.3). The simulation is conducted based on the high definition reference Korean-man (HDRK-man) computational phantom and a GE Infinia 3/8” C-arm machine, focusing on the effect of variation of kVp and field of view (FoV) on the scattered particles’ spatial distribution. With direct measurement of the absorbed dose remaining challenging, not least in respect of the organs at risk, we computed the scatter fractions, defined as the ratio of the air kerma free-in-air to the entrance surface air kerma (ESAK), which are both easily quantifiable. Scatter fraction distributions were simulated for X-ray tube outputs (and half-value layers, HVL) of 60 kVp (2.3 mm Al), 80 kVp (3.2 mm Al) and 120 kVp (4.3 mm Al) and FoV of 15, 20, 25 and 30 cm. The distributions are obtained for different height levels, corresponding to the lens of the eye, and the lung and prostate, all radiosensitive organs. Investigations are made for eight likely locations around the patient. At fixed FoV results reveal an inverse relationship between ESAK and kVp, also that change in kVp from 60 to 80 has a greater effect than from 80 to 120. For change in FoV at fixed kVp, the scatter fraction remains constant. The particular staff locations are found to be optimal in seeking mitigation of dose. Moreover, the combined usage of numerical human model and Monte Carlo simulation can be considered as an added value to the radiation safety research field, especially to the interventional radiology staff and to the patient.

Sono-Guided Endostripping: An Appropriate Alternative for Endovascular Varice Procedures

Objective: This article is aimed at introducing Sono-Guided Endostripping Technique of the Great Saphenous vein and comparing it with radiofrequency ablation in 104 patients. Methods: 52 patients underwent Sono-Guided Endostripping and 52 patients had radiofrequency ablation with Celon Olympus device. They were followed for 3 months with physical examination and Doppler Sonography for possible complications and recanalization. Results: Recanalization rate was 11.5% in RFAs while it was 0.0% in the Endostripping group. There were no significant differences for other complications (hematoma, DVT, paresthesia) but pain, which had 1.21 and 3.15 VAS scores for RFA and Endostripping groups, respectively. Recanalization rate was more in RFA comparing with the Endostripping group (11.5% vs. 0.0%,?P?< 0.013). RFA was more expensive. Conclusion: Sono-Guided Endostripping is a safe and cost-effective method (due to no need for using RFA probe);however, the patient must be admitted to the hospital and take appropriate anesthesia. Cosmetic result of the technique is fairly comparable with RFA scars in the thigh and leg.

Investigation and analysis of clinical trial research nurse to perform standard operating procedures

Objective： The aim of this study was to investigate the situations and factors that cause nurses not to follow standard operating procedures （SOPs） during the clinical trial process. Methods： Five cases involving patients enrolled in a clinical trial were divided into two groups, pre-SOP training and post-SOP training, to compare and observe the process problems and whether nurses fol- lowed SOPs in clinical trials. The causes of problems were analyzed and corrective measures were proposed. Results： Our results indicate significant improvement in compliance with SOPs after training. There were three occurrences of irregular behavior after training compared with 21 occurrences of irregular behavior before training. Conclusions： The quality of clinical trials can be improved if nurses strictly follow SOPs.

Procedures for congenital choledochal cysts and curative effect analysis in adults

Objective: To evaluate the procedures and timing of operation as well as long-term postoperative effect of congenital choledochal cysts (CCC) in adults. Methods: The procedures and timing of operation, effective rate, re-operation rate and incidence of car- cinoma after operation for 70 adult patients with CCC from January 1980 to June 1999 were analyzed retrospectively. Results: The re-operation rate of external drainage was 86% (6/7). The effective rate of internal drain- age was significantly lower than that of cyst resection (3/10 vs 45/49, X^2=20. 94, P<0.001). The re-op- eration rate and incidence of carcinoma of internal drainage were higher than those of cyst resection (5/ 10 vs 3/49, X^2=13. 64, P<0. 001 and 3/10 vs 3/49, X^2=5. 18, P<0. 025). The reoperation rate of e- mergency surgery was higher than that of selective operation (8/10 vs 6/56, X^2=24. 37, P<0.001). Conclusions: External drainage should be the first- aid measure and the therapy of choice on emergency basis. Internal drainage should never be attempted. Cyst resection with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice in selective operation.

Automatic Synthesis of Batch Process Operating Procedures

A three-step synthesis strategy for the automatic synthesis of operating procedures in batch processoperations is presented in this paper.The first step is pre-operation which consists of a set of checks that mustbe considered before starting the basic process operation.The second step is operation which is described by a setof basic control instructions.The third step is post-operation described by a set of instructions that must becarried out when the basic process operation is terminated.The three-step synthesis method has been imple-mented as part of a prototype recipe management system.

Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants: Lessons learned from single-balloon enteroscopy-assisted ERCP

Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.

Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.

Operating Room Nurses’ Role in Multidisciplinary Surgical Coordination for a Patient with a Large Abdominal Tumor and Multiple Pelvic Fractures

In this study,we have summarized the coordination of operating room nurses participating in the multidisciplinary team in diagnosing and treating a patient with a large abdominal tumor and multiple pelvic fractures.To perform surgical treatment on patients with various conditions,it is crucial to consider the patients from a holistic perspective.Thus,the existing medical model has shifted from a“disease-centered”approach focusing on single-disciplinary diagnosis and treatment,to a“patient-centered”approach that involves multiple disciplines in diagnosis and therapy.Operating room nurses,as crucial collaborators of surgeons,should make necessary adjustments to enhance their comprehension of patients,improving the overall quality of surgical coordination.