Perioperative management of postoperative sigmoid colon cancer complicated by a large abdominal wall defect:A case report

BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.

Application of infrastructure construction standards in pain treatment room

This paper discusses the application of infrastructure standards in pain treatment rooms.The infrastructure construction standards of pain treatment room include hardware facility standards and software facility standards.The hardware facilities include the area of pain treatment room,basic equipment and apparatus,basic first-aid medicine.Software facilities include system,personnel qualification and personnel training.

Residual coronary artery tree description and lesion EvaluaTion(CatLet)score,clinical variables,and their associations with outcome predictions in patients with acute myocardial infarction

Background:We have recently developed a new Coronary Artery Tree description and Lesion EvaluaTion(CatLet)angiographic scoring system.Our preliminary studies have demonstrated its superiority over the the Synergy between percutaneous coronary intervention(PCI)with Taxus and Cardiac Surgery(SYNTAX)score with respect to outcome predictions for acute myocardial infarction(AMI)patients.The current study hypothesized that the residual CatLet(rCatLet)score predicts clinical outcomes for AMI patients and that a combination with the three clinical variables(CVs)-age,creatinine,and ejection fraction,will enhance its predicting values.Methods:The rCatLet score was calculated retrospectively in 308 consecutively enrolled patients with AMI.Primary endpoint,major adverse cardiac or cerebrovascular events(MACCE)including all-cause mortality,non-fatal AMI,transient ischemic attack/stroke,and ischemia-driven repeat revascularization,was stratified according to rCatLet score tertiles:rCatLet_low≤3,rCatLet_mid 4-11,and rCatLet_top≥12,respectively.Cross-validation confirmed a reasonably good agreement between the observed and predicted risks.Results:Of 308 patients analyzed,the rates of MACCE,all-cause death,and cardiac death were 20.8%,18.2%,and 15.3%,respectively.Kaplan-Meier curves for all endpoints showed increasing outcome events with the increasing tertiles of the rCatLet score,with P values<0.001 on trend test.For MACCE,all-cause death,and cardiac death,the area under the curves(AUCs)of the rCatLet score were 0.70(95%confidence intervals[CI]:0.63-0.78),0.69(95%CI:0.61-0.77),and 0.71(95%CI:0.63-0.79),respectively;the AUCs of the CVs-adjusted rCatLet score models were 0.83(95%CI:0.78-0.89),0.87(95%CI:0.82-0.92),and 0.89(95%CI:0.84-0.94),respectively.The performance of CVs-adjusted rCatLet score was significantly better than the stand-alone rCatLet score in terms of outcome predictions.Conclusion:The rCatLet score has a predicting value for clinical outcomes for AMI patients and the incorporation of the three CVs into the rCatLet score will enhance its predicting ability.Trial Registration:http://www.chictr.org.cn,ChiCTR-POC-17013536.

Revision and addendum to the manuscript titled“Propensity score matching study of 325 patients with spontaneous rupture of hepatocellular carcinoma”

We gratefully receive the comment entitled“Is transarterial embolization plus two-stage hepatectomy the optimal strategy for the treatment of spontaneous rupture of hepatocellular carcinoma?”(1).We apologize for the two typing errors in the paper:mortality rate of rupture of hepatocellular carcinoma(RHCC)patients was“0.8%”in the abstract should be changed as“0.9%”;“TNM stage”in the discussion should be replaced by“tumor diameter”.Thanks for the careful reading.