Comparative observation of the effectiveness and safety of remimazolam besylate versus dexmedetomidine in gastrointestinal surgery in obese patients

BACKGROUND Surgery for obese patients carries a higher risk of anesthesia complications compared with surgery for nonobese patients.Thus,a safe and effective anesthesia strategy is necessary to improve the medical experience of such patients and ensure their safety.AIM To compared the effectiveness and safety of remimazolam besylate versus dexmedetomidine(DEX)in gastrointestinal surgery in obese patients.METHODS The study cohort included 60 obese patients undergoing gastrointestinal surgery between July 2021 and April 2023,comprising 30 patients who received DEX intervention(control group)and 30 patients who received remimazolam besylate intervention(research group).Heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2)),safety(nausea and vomiting,bradycardia,hypotension,and apnea),anesthesia and examination indices[induction time,anesthesia recovery time,and postanesthesia care unit(PACU)discharge time],sedation effect(Ramsay Sedation Scale),and postoperative pain visual analog scale were comparatively analyzed before anesthesia(T0),during anesthesia(T1),and after anesthesia(T2).RESULTS At T1,the research group showed significantly smaller changes in HR,RR,MAP,and SpO_(2) than the control group,with a significantly lower adverse reaction rate and shorter induction,anesthesia recovery,and PACU discharge times.Additionally,the intra-and postoperative Ramsay Sedation Scale scores were statistically higher in the research group than in the control group.CONCLUSION Remimazolam besylate was significantly more effective than DEX in gastrointestinal surgery in obese patients and had a higher safety profile and value in clinical promotion.

Practical effect of different teaching modes in teaching gastrointestinal surgery nursing

BACKGROUND With the continuous development and progress of medical technology,the position of surgical nursing in the field of clinical medicine is becoming in-creasingly prominent.As an important branch of the surgical field,the nursing requirements and difficulty of gastrointestinal surgery are also increasing.In order to improve the teaching quality of nursing care in gastrointestinal surgery,many educators and researchers are actively exploring new teaching methods.Among them,the teaching method case-based learning(CBL),scene-simulated learning(SSL),task-based learning(TBL),combining self-evaluation and training mode is considered as an effective method.This method aims to help students to better master knowledge and skills and improve their comprehensive quality by cultivating their self-evaluation ability.AIM To explore the practical effect of CBL-SSL-TBL combined with training mode and student self-assessment in nursing teaching of gastrointestinal surgery.METHODS Seventy-one nursing interns in our hospital from December 2020 to December 2021 were selected.According to different teaching modes,they were divided into observation group CBL-SSL-TBL combined with training mode combined with student self-assessment and control group(conventional teaching mode),of which 36 were in observation group and 35 were in control group.The results of operational skills,theoretical knowledge,nursing students'satisfaction,learning effectiveness questionnaire and teaching effect were compared between the two groups.RESULTS Compared between the two groups,the operational skills and theoretical knowledge scores of the observation group were higher than those of the control group,and the difference was statistically significant(P<0.05).Compared between the two groups,the total satisfaction ratio of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).Compared between the two groups,the observation group was lower than the control group in the questionnaire results of learning efficacy,and the difference was statistically significant(P<0.05).Compared between the two groups,the proportion of thinking ability,subjective initiative and understanding of theoretical knowledge in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).CONCLUSION The use of CBL-SSL-TBL combined with training mode and student self-assessment in gastrointestinal surgery nursing teaching can improve the operational skills of nursing interns,theoretical knowledge and satisfaction scores of nursing students,improve the results of learning efficiency questionnaire and teaching effect,which can be popularized in clinical teaching.

Indocyanine green dye and its application in gastrointestinal surgery:The future is bright green

Indocyanine green(ICG)is a water-soluble fluorescent dye that is minimally toxic and widely used in gastrointestinal surgery.ICG facilitates anatomical identi-fication of structures(e.g.,ureters),assessment of lymph nodes,biliary mapping,organ perfusion and anastomosis assessment,and aids in determining the adequacy of oncological margins.In addition,ICG can be conjugated to artificially created antibodies for tumour markers,such as carcinoembryonic antigen for colorectal,breast,lung,and gastric cancer,prostate-specific antigen for prostate cancer,and cancer antigen 125 for ovarian cancer.Although ICG has shown promising results,the optimization of patient factors,dye factors,equipment,and the method of assessing fluorescence intensity could further enhance its utility.This review summarizes the clinical application of ICG in gastrointestinal surgery and discusses the emergence of novel dyes such as ZW-800 and VM678 that have demonstrated appropriate pharmacokinetic properties and improved target-to-background ratios in animal studies.With the emergence of robotic technology and the increasing reporting of ICG utility,a comprehensive review of clinical application of ICG in gastrointestinal surgery is timely and this review serves that aim.

Effects of an Omaha System-based follow-up regimen on self-care and quality of life in gastrointestinal surgery patients

BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery patients.METHODS A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing methods.The group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing intervention.Medical Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two groups.RESULTS Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all P<0.05);in group A,the level of health knowledge,personal care abilities,self-perception,self-awareness score and ESCA total score were more outstanding than group B(all P<0.05);in group A the frequency of defecation,hematochezia,endoscopic performance,the total evaluation score by physicians and the disease activity were lower than group B(all P<0.05);in the group A,the total scores of knowledge in general,diet,drug,and complication and CCKNOW were higher than group B(all P<0.05);in group A,the necessity of taking medicine,score of medicine concern and over-all score of BMQ were more significant than group B(all P<0.05);at last in the group A,the scores of systemic and intestinal symptoms,social and emotional function,and IBDQ in the group A were higher than group B(all P<0.05).CONCLUSION For gastrointestinal surgery patients,the Omaha System-based sequel protocol can improve disease awareness and intervention compliance,help them to face the disease positively,reduce disease activity,and improve patients’self-nursing ability and quality of life.

Extracellular matrices for gastrointestinal surgery:Ex vivo testing and current applications

AIM:To assess the effects of bile and pancreatic juice on structural and mechanical resistance of extracellular matrices(ECMs) in vitro.METHODS:Small-intestinal submucosa(SIS),porcine dermal matrix(PDM),porcine pericardial matrix(PPM) and bovine pericardial matrix(BPM) were incubated in human bile and pancreatic juice in vitro.ECMs were examined by macroscopic observation,scanning electron microscopy(SEM) and testing of mechanical resistance.RESULTS:PDM dissolved within 4 d after exposure to bile or pancreatic juice.SIS,PPM and PDM retained their integrity for > 60 d when incubated in either digestive juice.The effect of bile was found to be far more detrimental to mechanical stability than pancreatic juice in all tested materials.In SIS,the loss of mechanical stability after incubation in either of the digestive secretions was less distinct than in PPM and BPM [mFmax 4.01/14.27 N(SIS) vs 2.08/5.23 N(PPM) vs 1.48/7.89 N(BPM)].In SIS,the extent of structural damage revealed by SEM was more evident in bile than in pancreatic juice.In PPM and BPM,structural damage was comparable in both media.CONCLUSION:PDM is less suitable for support of gastrointestinal healing.Besides SIS,PPM and BPM should also be evaluated experimentally for gastrointestinal indications.

Paradigm shift in gastrointestinal surgery−combating sarcopenia with prehabilitation:Multimodal review of clinical and scientific data

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes.These included an increased risk of total complications,major complications,re-admissions,infections,severe infections,30 d mortality,longer hospital stay and increased hospitalization expenditures.A program to enhance recovery after surgery was meant to address these complications;however,compliance to the program since its introduction has been less than ideal.Over the last decade,the concept of prehabilitation,or"pre-surgery rehabilitation",has been discussed.The presurgical period represents a window of opportunity to boost and optimize the health of an individual,providing a compensatory"buffer"for the imminent reduction in physiological reserve postsurgery.Initial results have been promising.We review the literature to critically review the utility of prehabilitation,not just in the clinical realm,but also in the scientific realm,with a resource management point-of-view.

Bacterial translocation in patients undergoing major gastrointestinal surgery and its role in postoperative sepsis

Bacteria of the human intestinal microflora have a dual role.They promote digestion and are part of a defense mechanism against pathogens.These bacteria could become potential pathogens under certain circumstances.The term“bacterial translocation”describes the passage of bacteria of the gastrointestinal tract through the intestinal mucosa barrier to mesenteric lymph nodes and other organs.In some cases,the passage of bacteria and endotoxins could result in blood stream infections and in multiple organ failure.Open elective abdominal surgery more frequently results in malfunction of the intestinal barrier and subsequent bacterial translocation and blood stream infections than laparoscopic surgery.Postoperative sepsis is a common finding in patients who have undergone non-elective abdominal surgeries,including trauma patients treated with laparotomy.Postoperative sepsis is an emerging issue,as it changes the treatment plan in surgical patients and prolongs hospital stay.The association between bacterial translocation and postoperative sepsis could provide novel treatment options.

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review,a critical process to ensure the quality of World Journal of Gastrointestinal Surgery. The editors and authors of the articles submitted to the

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review,a critical process to ensure the quality of World Journal of Gastrointestinal Surgery.The editors and authors of the articles submitted to the journal are grateful to the following reviewers for evaluating the articles(including those published in this issue and those rejected for this issue)during the last editing time period.

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Gastrointestinal Surgery. The editors and authors of the articles submitted to the journal

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Gastrointestinal Surgery. The editors and

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Gastrointestinal Surgery. The

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review,a critical process to ensure the quality of World Journal of Gastrointestinal Surgery.The editors and authors of the articles submitted to the journal

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review,a critical process to ensure the quality of World Journal of Gastrointestinal Surgery. The editors and authors of the articles submitted to the journal are grateful to the

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

We acknowledge our sincere thanks to our reviewers.Many reviewers have contributed their expertise and time to the peer review,a critical process to ensure the quality of our World Series Journals.Both the editors of the journals and authors of the manuscripts submitted to the journals are grateful to the following reviewers for reviewing the

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Gastrointestinal Surgery. The editors and authors of the articles submitted to the journal

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Gastrointestinal Surgery. The

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review, a critical process to ensure the quality of World Journal of Gastrointestinal Surgery. The editors and authors of the articles submitted to the journal are grateful to the following reviewers for evaluating the articles (including those published in this issue and those rejected for this issue) during the last editing time period.Ned Abraham, MBBS, FRACS, FRCS, PhD, Coffs Colorectal and Capsule Endoscopy Centre, University of New South Wales, 187 Rose Av-enue, PO Box 2244, Coffs Harbour, NSW 2450,

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and time to the peer review,a critical process to ensure the quality of World Journal of Gastrointestinal Surgery.The editors and authors of the articles submitted to the journal are grateful to the following reviewers for evaluating

Acknowledgments to reviewers of World Journal of Gastrointestinal Surgery

Many reviewers have contributed their expertise and timeto the peer review, a critical process to ensure the quality of World Journal of Gastrointestinal Surgery.