Timing of surgical operation for patients with intra-abdominal infection:A systematic review and meta-analysis

BACKGROUND Intra-abdominal infections(IAIs)is the most common type of surgical infection,with high associated morbidity and mortality rates.In recent years,due to the use of antibiotics,various drug-resistant bacteria have emerged,making the treatment of abdominal infections more challenging.Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications.However,available evidence regarding the optimal timing of IAI surgery is still weak.In study,we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.AIM To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI,in terms of overall mortality.METHODS A systematic literature search was performed using PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Ovid,and ScienceDirect.The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method.Based on the timing of the surgical operation,we divided the literature into two groups:Early surgery and delayed surgery.For the early and delayed surgery groups,the intervention was performed with and after 12 h of the initial surgical intervention,respectively.The main outcome measure was the mortality rate.The literature search was performed from May 5 to 20,2021.We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20,2021,for ongoing trials.This study was registered with the International Prospective Register of Systematic Reviews.RESULTS We identified nine eligible trial comparisons.Early surgical exploration of patients with IAIs(performed within 12 h)has significantly reduced the mortality and complications of patients,improved the survival rate,and shortened the hospital stay.CONCLUSION Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.

Recent Advance in Synaptic Plasticity Modulation Techniques for Neuromorphic Applications

Manipulating the expression of synaptic plasticity of neuromorphic devices provides fascinating opportunities to develop hardware platforms for artifi-cial intelligence.However,great efforts have been devoted to exploring biomimetic mechanisms of plasticity simulation in the last few years.Recent progress in various plasticity modulation techniques has pushed the research of synaptic electronics from static plasticity simulation to dynamic plasticity modulation,improving the accuracy of neuromorphic computing and providing strategies for implementing neuromorphic sensing functions.Herein,several fascinating strategies for synap-tic plasticity modulation through chemical techniques,device structure design,and physical signal sensing are reviewed.For chemical techniques,the underly-ing mechanisms for the modification of functional materials were clarified and its effect on the expression of synaptic plasticity was also highlighted.Based on device structure design,the reconfigurable operation of neuromorphic devices was well demonstrated to achieve programmable neuromorphic functions.Besides,integrating the sensory units with neuromorphic processing circuits paved a new way to achieve human-like intelligent perception under the modulation of physical signals such as light,strain,and temperature.Finally,considering that the relevant technology is still in the basic exploration stage,some prospects or development suggestions are put forward to promote the development of neuromorphic devices.

Voltage-dependent plasticity and image Boolean operations realized in a WOx-based memristive synapse

The development of electronic devices that possess the functionality of biological synapses is a crucial step towards neuromorphic computing.In this work,we present a WOx-based memristive device that can emulate voltage-dependent synaptic plasticity.By adjusting the amplitude of the applied voltage,we were able to reproduce short-term plasticity(STP)and the transition from STP to long-term potentiation.The stimulation with high intensity induced long-term enhancement of conductance without any decay process,thus representing a permanent memory behavior.Moreover,the image Boolean operations(including intersection,subtraction,and union)were also demonstrated in the memristive synapse array based on the above voltage-dependent plasticity.The experimental achievements of this study provide a new insight into the successful mimicry of essential characteristics of synaptic behaviors.

Hepatolithiasis and surgical operation

Reply to the Editor: With the development of the treatment hepatolithiasis, I, as the responsible author of the article, has discussed the merits of the new operation dealing with regional hepatolithiasis-subcutaneous tunnel and hepatocholangioplasty with the use of the gallbladder (STHG).

The Use of 3D laparoscopy in Surgical Operation

Purpose： studying and analyzing the application effect of three dimensional （3D） laparoscopy m surgical operation. Method： We select 126 patients who were diagnosed celiac disease in our hospital between May 2015 and April 2016 as our research subjects. All of these patients have indications for laparoscopic surgery, and we divide them into two groups randomly （observation and control group）. While the observation group is treated by 3D laparoscopic operation system, and the control group is treated by 2D laparoscopic system. During the treatment ,we observe the operation time, intra-operative bleeding and hospitalization time between the two different methods. Result： During the operation, the operation time of observation is （135.5±23.84） minutes and intra-operative bleeding time is （130.2±20. 11） milliliters, which both them are significantly lower than control group （163.8±25.22）min, （146.3±27.42）ml. This difference is statistically significant （P 〈0.05）. On the other hand, there is no obvious difference between observation and conlrol about indwelling catheter time, postoperative hospitalization time and postoperative exhaust time. For the observation, the datum were （2.3±0.31） d, （8.1±1. 32） d, （3.2±0.58） d and they were no statistical significance. Conclusion： Compared with traditional laparoscopic surgery, the image of 3D laparoscopic surgery is more clear and stereoscopic. What＇s more, operators can have a good command of it easily to shorten operation time, which avoid surgery vascular damage and reduce bleeding amounts to some extent. It is a good assistant for clinical use.

A Short Term Review of Operated Cases in the Plastic Surgery Unit at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

Introduction: Surgical problems are of much disturbance to the world and should therefore be given serious attention. The prevalence of these surgical problems, has made plastic surgery become a broadly relevant and acceptable way for addressing problems like injuries, congenital anomalies, surgical infections and malignancies among others. Aim: This study is to quantify and characterize surgical procedures done in the plastic surgery theatre located in the new Accident and Emergency (A & E) Building of KATH. Materials and Methods: Data were obtained from the Operation Register/Theatre Books in the plastic surgery theatre at the A & E Centre on cases operated on from October 1, 2009 to September 30, 2012. Data entry, presentation and analysis were done using Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: Adults formed the majority of patients who sought for plastic surgery with a percentage of 70.3%. The male patients also outnumbered the females recording (61.5%) out of the total number of patients. Most of the cases recorded were acquired cases (93.2%). Reconstructive surgery was the commonest operation performed (30%);in 53.8% cases general anaesthesia was used. Conclusion: Among all the procedures used reconstructive surgery was the commonest surgery performed in the unit and general anaesthesia was the most type of anaesthesia used for the operations.

Applying Bruce Lee’s Jeet Kune Do Combat Philosophy in Plastic &Reconstructive Surgery—7 Principles for Success

At first glance, it may appear that martial arts and surgery do not relate to each other at all. However, martial arts and surgery are all one on the path of knowledge and self discovery. Innovations are constantly being developed;some techniques stand the test of time while others are relegated to history. Martial arts and surgery have also branched out for example boxing, taekwondo, jujitsu and wrestling for martial arts whereas surgery has branched out to orthopaedics, paediatrics, cardiothoracic and neurosurgery to name a few. Some choose to specialize while others choose to be a generalist. Learning methodologies in martial arts and plastic surgery are similar. Martial arts students are the equivalent of surgical residents, and both have to enroll in a school that prepares them to be practitioners of their respective arts. In the last century, formal martial arts academies and surgical residency training programs have sprung up. The standards and entrance requirements vary from school to school as do training methodology and philosophical concepts. In this article, we seek to analyze Bruce Lee’s martial arts’ philosophy of Jeet Kune Do (JKD) and that how we can apply it to our personal path in Plastic & Reconstructive Surgery.

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.

The Popularization and Application of Cold Storage Red Blood Cells or Whole Blood at -80 ℃ of the Rh(D) Negative Patients in Surgical Operation

Summary: The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 ℃ used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at -80 ℃ for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K +, Na +, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K + and blood Na + was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at -80 ℃ could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.

Cardiac surgical operation after renal transplantation

Several studies reported the impact of cardiac surgical operation on morbidity and mortality in renal transplant recipients as well as on renal graft function and safety and effect of immunosuppressant medication.1-3 However,few data are available about the risk and immunosuppressant medication in patients who undergo cardiac surgical operation after successful renal transplantation,especially in patients who underwent offpump coronary artery bypass grafting （CABG） with previous renal transplantation.This research provides important insights into the immunosuppressive management of a patient requiring valve replacement or CABG after renal transplantation during the perioperative period.

Acupuncture Treatment for the 88 Cases of Retention of Urine After Surgical Operation

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Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.

实时跟踪和虚拟成像技术辅助创伤骨科手术机器人治疗股骨颈骨折

目的:探究实时跟踪和虚拟成像技术(real-time tracking and virtual reality technology,RTVI)辅助创伤骨科手术机器人术中配准治疗股骨颈骨折的治疗效果。方法:回顾分析2020年9月至2022年9月应用创伤骨科机器人手术治疗的60例股骨颈骨折患者,根据术中是否使用RTVI技术辅助机器人手术将患者分成两组:RTVI组28例,男12例,女16例;年龄28~60(46.2±9.3)岁。单纯天玑手术机器人组32例,男15例,女17例;年龄32~58(48.2±7.8)岁。观察并记录两组配准透视次数、手术时间、术中透视次数、术中出血量、住院时间。所有患者术后接受定期随访,常规复查髋关节X线片,记录Garden对线指数、骨折愈合时间、术后并发症、Harris评分。结果:60例患者均获得随访,其中RTVI组随访9~16(13.0±1.2)个月,单纯天玑手术机器人组随访10~14(12.0±1.3)个月,两组比较差异无统计学意义(P>0.05)。随访期间两组股骨颈骨折均愈合良好,无内固定松动、切口感染等并发症发生。RTVI组配准透视次数、手术时间、术中透视次数优于单纯天玑手术机器人组(P<0.01)。而两组术中出血量、住院时间、Garden对线指数、骨折愈合时间、髋关节Harris评分比较,差异无统计学意义(P>0.05)。总结:RTVI技术辅助天玑手术机器人治疗股骨颈骨折手术虽然对其术后疗效影响不大,但可以有效减少手术时间,减低术中X线投射次数,降低患者术中辐射暴露风险。同时也缩短了术者的学习曲线,更好体现创伤骨科手术机器人的精准和高效。

慕课在普通外科住院医师规范化培训中的应用效果

目的分析慕课在普通外科住院医师规范化培训中的应用效果。方法选择2021年1月—2022年1月在佳木斯大学院临床医学院轮转的100名普通外科住培医师为研究对象,采用随机数字表法分为对照组(传统临床教学模式)和观察组(慕课结合传统临床教学模式),每组50名。比较2组的评判性思维、理论考核、操作技能、手术技巧、医患沟通能力评分及满意度。结果开课前,2组住培医师的评判性思维评分比较,差异无统计学意义(P>0.05);开课后,观察组住培医师的评判性思维评分高于对照组,差异有统计学意义(P<0.05)。观察组住培医师的理论考核、操作技能、手术技巧、医患沟通能力评分[(91.32±5.23)分、(94.66±3.54)分、(8.96±1.15)分、(9.32±0.23)分]高于对照组[(86.69±4.56)分、(88.67±5.64)分、(7.01±1.12)分、(7.69±1.56)分],差异均有统计学意义(P<0.05)。观察组住培医师的满意度高于对照组,差异有统计学意义(P<0.05)。结论慕课对普通外科住院医师规范化培训的综合应用价值更高,在对住培医师的临床教学中,采用慕课的教学模式能进一步提升外科住院医师的批判性思维、理论知识以及实践技能,同时外科住院医师对培训结果的满意度更高,该临床教学模式的综合价值较高。

术中超声临床应用进展:创新及发展精准外科

术中超声(IOUS)因其便利、可重复性好、成本较低等优势广泛用于外科手术。近年来,随着超声设备不断发展,IOUS对实现精准外科手术越来越重要。本文就IOUS临床应用进展进行述评。

低温等离子治疗儿童鼻咽部第二鳃裂囊肿分析

目的探讨儿童鼻咽部第二鳃裂囊肿的临床特征和治疗方式,提高诊治能力。方法回顾性分析河北省儿童医院收治的4例儿童鼻咽部第二鳃裂囊肿的临床资料,包括年龄、性别、症状、影像学资料和治疗过程。总结分析病变部位特点,B超、CT或MRI特征,术后病理结果及治疗方式。结果4例鼻咽部第二鳃裂囊肿患儿均表现为鼻咽侧壁咽鼓管咽口与腭咽弓后上方连线上的囊性肿物,囊壁较厚,影像学检查结果均为囊性病变。4例患儿选择内镜下低温等离子病变切除术,其中2例为内侧囊壁大部分切除术,将囊腔充分敞开,2例为囊肿全部切除术。术后病理提示衬覆纤毛柱状上皮或复层上皮,周围淋巴组织增生。术后随访1.5~3年无复发。结论儿童鼻咽部第二鳃裂囊肿临床罕见,诊断主要依靠病变部位及术后病理结果,内镜下低温等离子切除病变组织是微创、安全、有效的治疗方式。

多灶性肝母细胞瘤手术切除的单中心研究

目的探讨多灶性肝母细胞瘤(hepatoblastoma,HB)手术切除治疗的可行性及有效性。方法本研究为回顾性研究,以2014年4月至2022年12月首都医科大学附属北京儿童医院肿瘤外科收治的21例多灶性HB患儿为研究对象,收集患儿临床特征、手术方式及远期预后等资料,并与同期收治的58例中高危单灶性HB患儿进行疗效对比。结果21例多灶性HB患儿中,11例为2个瘤灶,4例为3个瘤灶,1例为5个瘤灶,5例肝内瘤灶超过5个且无法明确计数。21例均接受肿瘤切除手术,其中9例行解剖性肝切除术,11例行不规则肝切除或瘤灶剜除术,1例行联合肝脏离断及门静脉结扎的分次肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)。20例为R0切除,1例为R1切除,术后无一例发生严重并发症。本组多灶性HB患儿接受手术联合化疗的多学科综合治疗后,中位随访时间57个月,18例患儿无瘤生存,3例死亡。本组多灶性HB患儿3年无事件生存率(event-free survival,EFS)为57.58%,3年总生存率(overall survival,OS)为82.00%,局部进展累积发生率(cumulative incidence of local progression,CILP)为38.00%。同期收治的单灶性中高危HB患儿上述指标分别为91.84%、74.96%、20.04%。两组数据对比,差异无统计学意义(P>0.05)。结论多灶性HB经规范外科手术切除辅助术前、术后化疗,可以获得较为满意的预后。

急性A型主动脉夹层合并Neri C型冠状动脉受累细化分型的外科治疗策略

目的探讨急性A型主动脉夹层(acute type A aortic dissection,ATAAD)合并Neri C型冠状动脉(冠脉)受累细化分型的外科治疗策略。方法回顾性分析我院2020年11月~2024年2月21例ATAAD合并Neri C型冠脉受累的病例资料。夹层累及冠脉,发病时间<1周,行全主动脉弓替换、降主动脉支架象鼻人工血管置入、升主动脉置换及冠脉处理。细化分型及冠脉处理方法:C1型(冠脉开口局部损伤破裂,与假腔部分连接,冠脉开口内外膜无分离)7例以人工材料“铜钱样”修复;C2型(冠脉开口严重损伤撕脱,与假腔完全连接,冠脉近段累及轻微,内外膜局部分离,未形成套袖)3例以8 mm人工血管置换;C3型(冠脉开口严重损伤撕脱,与假腔完全连接,冠脉近段累及严重,内外膜完全分离,且形成套袖)11例以大隐静脉旁路移植。结果院内死亡2例(均为C3型),均心脏复跳困难,体外膜氧合(extracorporeal membrane oxygenation,ECMO)辅助循环,分别于术后当天、第2天死亡。19例出院患者出院前复查主动脉及冠脉CTA,无冠脉开口狭窄和桥血管狭窄。术后6、12、18个月复查主动脉及冠脉CTA。19例随访6~36个月,平均21个月,无冠脉开口狭窄和桥血管狭窄病例。纽约心脏协会(NYHA)心功能分级Ⅰ级15例,Ⅱ级4例。结论ATAAD合并Neri C型冠脉受累的细化分型对外科实施精准治疗具有指导性意义。

智能化手术安全核查流程的设计与应用

目的构建智能化手术安全核查流程,探讨其应用效果。方法将2023年8-10月的11204例手术设为改进前组,采用常规手术安全核查方式;2023年11月至2024年1月的11012例手术设为改进后组,采用智能化手术安全核查系统,实现手术安全核查执行情况的全流程闭环管理。结果流程改进后,手术安全核查的规范执行率显著高于改进前,护理安全隐患事件发生率显著低于改进前(均P<0.05)。结论智能化手术安全核查的构建与实施,能有效提升手术安全核查的规范率,减少护理安全隐患事件发生率,保障手术患者安全。