BACKGROUND Enhanced recovery after surgery(ERAS)was introduced in China in 2007.Over time,the scope of ERAS has expanded from abdominal surgery to orthopedics,urology and other fields.Continuous development and resear...BACKGROUND Enhanced recovery after surgery(ERAS)was introduced in China in 2007.Over time,the scope of ERAS has expanded from abdominal surgery to orthopedics,urology and other fields.Continuous development and research has contributed to progress of ERAS in China.In 2019,to promote the application of ERAS in bone tumor surgery,we formed the“Consensus of Experts on Perioperative Management of Accelerated Rehabilitation in Major Surgery of Bone Tumors in China”.AIM To evaluate the effect of enhanced recovery after bone tumor surgery in perioperative management in China.METHODS One hundred and seven patients who underwent bone tumor surgery at the Second Affiliated Hospital of Xi’an Jiaotong University between May 2019 and April 2021 were randomized into a study group(53 cases)and a control group(54 cases).The study group adopted the ERAS protocol and the control group adopted conventional care.Main outcome measures included postoperative length of stay(LOS),postoperative complications,mortality,and 30-d readmission rates.Secondary outcomes included postoperative visual analog scale(VAS)score of pain,number of blood transfusions,drainage volume in 24 h after operation,patient satisfaction 30 d after discharge,VAS score at 30 d after discharge,and daily standing walking time.RESULTS There were no significant differences in the baseline data,clinical features and surgical site between the two groups.The LOS in the study group with the ERAS protocol was 7.72±3.34 d compared with 10.28±4.27 d in the control group who followed conventional care.The incidence of postoperative nausea and vomiting(PONV)in the study group was 19%and 37%in the control group.The VAS scores of pain on postoperative day 1(POD1)and POD3 in the study group were 4.79±2.34 and 2.79±1.53 compared with 5.28±3.27 and 3.98±2.27 in the control group.The drainage volume in 24 h after the operation was 124.36±23.43 mL in the study group and 167.43±30.87 mL in the control group.The number of blood transfusions in the study group was also lower.The patient satisfaction rate was higher in the study group than in the control group.CONCLUSION The ERAS protocol in the perioperative period of bone tumor surgery can decrease LOS,PONV,and postoperative pain,blood transfusion and 24-h drainage,improve patient satisfaction and accelerate recovery.展开更多
INTRODUCTION Sepsis is defined as an infection associated with systemic manifestations of inflammation,which has become the most common complication in the perioperative period caused by severe burn/trauma and major s...INTRODUCTION Sepsis is defined as an infection associated with systemic manifestations of inflammation,which has become the most common complication in the perioperative period caused by severe burn/trauma and major surgical operation.^([1,2])The incidence of sepsis in adults is estimated to be 149–240/100 000 per year,and that of severe sepsis and septic shock is 56–91/100 000per year.In the last decade,the short-term展开更多
AIM:To investigate the effects of on ocular surface microbiota in patients who received intravitreal injections.METHODS:Samples of ocular surface microbiota were obtained from 41 eyes of 41 patients who visited the De...AIM:To investigate the effects of on ocular surface microbiota in patients who received intravitreal injections.METHODS:Samples of ocular surface microbiota were obtained from 41 eyes of 41 patients who visited the Department of Ophthalmology.Patients were separated for three groups.Group A did not receive perioperative managements or intravitreal injection.Group B1 received only once and B2 received more than twice.In operating room,the samples were collected on the ocular surface.Operating taxonomic units(OTUs) clustering and alpha/beta diversity analysis was performed.The microbial 16S rRNA from samples were analyzed using the Hi Seq 2500 platform.RESULTS:Alpha diversity did not differ in each group,and beta diversity differed in the B2 group.Beta diversity showed a significant difference between Group A and B2(P=0.048).With the perioperative managements before intravitreal injection,the composition and relative abundance were altered.Top 10 microbiota on phylum and genus level,and then microbiota notably changed at genus level were listed.Gram-negative bacteria were varied more.Furthermore,Proteus was not found in Groups A and B1,but it was appeared after the patients received perioperative management and intravitreal injections in Group B2.CONCLUSION:With the perioperative managements,the balance of microbiota on the ocular surface is destroyed,and relative composition and abundance of microbiota on the ocular surface is obviously altered.The clinical doctors should pay more attention on the consequence of perioperative managements before intravitreal injection.展开更多
Objective To study perioperative management in treatment of traumatic intracranial hemorrhage in patients with pretraumatic anticoagulation therapy of oral warfarin.Methods 10 patients of traumatic intracranial hemorr...Objective To study perioperative management in treatment of traumatic intracranial hemorrhage in patients with pretraumatic anticoagulation therapy of oral warfarin.Methods 10 patients of traumatic intracranial hemorrhage with pretraumatic anticoagulation therapy of oral warfarin received vitamin K,FFP and PCC展开更多
Prediabetes and diabetes are important disease processes which have several perioperative implications.About one third of the United States population is considered to have prediabetes.The prevalence in surgical patie...Prediabetes and diabetes are important disease processes which have several perioperative implications.About one third of the United States population is considered to have prediabetes.The prevalence in surgical patients is even higher.This is due to the associated micro and macrovascular complications of diabetes that result in the need for subsequent surgical procedures.A careful preoperative evaluation of diabetic patients and patients at risk for prediabetes is essential to reduce perioperative mortality and morbidity.This preoperative evaluation involves an optimization of preoperative comorbidities.It also includes optimization of antidiabetic medication regimens,as the avoidance of unintentional hypoglycemic and hyperglycemic episodes during the perioperative period is crucial.The focus of the perioperative management is to ensure euglycemia and thus improve postoperative outcomes.Therefore,prolonged preoperative fasting should be avoided and close monitoring of blood glucose should be initiated and continued throughout surgery.This can be accomplished with either analysis in blood gas samples,venous phlebotomy or point-of-care testing.Although capillary and arterial whole blood glucose do not meet standard guidelines for glucose testing,they can still be used to guide insulin dosing in the operating room.Intraoperative glycemic control goals may vary slightly in different protocols but overall the guidelines suggest a glucose range in the operating room should be between 140 mg/dL to 180 mg/dL.When hyperglycemia is detected in the operating room,blood glucose management may be initiated with subcutaneous rapid-acting insulin,with intravenous infusion or boluses of regular insulin.Fluid and electrolyte management are other perioperative challenges.Notably diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic state are the two most serious acute metabolic complications of diabetes that must be recognized early and treated.展开更多
The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery.Utility of a multi-disciplinary unit in man...The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery.Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care.Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients.The many areas of potential variability in the pre,intra and post-operative timeline of pituitary surgery are readily identifiable.Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.展开更多
This study aimed to explore the characteristics of perioperative nursing of experimental goats using self-made axial-flow blood pump implantation and provided theoretical nursing knowledge and practice-based evidence ...This study aimed to explore the characteristics of perioperative nursing of experimental goats using self-made axial-flow blood pump implantation and provided theoretical nursing knowledge and practice-based evidence for the clinical application of domestically manufactured artificial cardiac pumps. Methods: Seven experimental goats were used in this study, three for pre-testing and four for the formal experiments. According to the surgical requirements for axial-flow blood pump implantation into the cardiac apex, we creatively designed and made a series of highly practical animal surgical instruments including a composite disassemblable bed for experimental animal transferring and monitoring, a multifunctional animal surgery bed, and portable medical supporting equipment. We also applied for two national invention patents and one utility model patent. Active measures were taken to ensure careful preparation before surgery, close collaboration during surgery, and effective management of complications after surgery. Results: Two of the four experimental goats died during surgery because of a massive hemorrhage caused by distal anastomotic failure and air embolism-induced cardiac arrest caused by air leakage from the outlet into the heart due to poor connection of the auxiliary pressure tap (used to measure left ventricular pressure). The mean survival time of the remaining three experimental goats was 22.7 hours. Conclusion: This study was the first to systematically and comprehensively investigate the perioperative nursing management of axial-flow blood pump implantation using animal models. These findings could greatly promote further clinical applied nursing research of self-made artificial cardiac pump implantation in experimental goats.展开更多
BACKGROUND Glycogen storage disease(GSD)is an autosomal recessive inborn metabolic disorder.Patients with GSD are prone to hypoglycaemia,hyperlactacidemia and bleeding.GSD type 1b(GSD-1b)patients specifically can deve...BACKGROUND Glycogen storage disease(GSD)is an autosomal recessive inborn metabolic disorder.Patients with GSD are prone to hypoglycaemia,hyperlactacidemia and bleeding.GSD type 1b(GSD-1b)patients specifically can develop neutropenia,recurrent bacterial infection and inflammatory bowel disease(IBD).Documentation of the long-term outcomes of surgical management of GSD-1b has been scarce,especially for Asian patients.We herein describe a case of GSD-1b complicated by IBD-like colitis and coloduodenal fistula.The patient was managed successfully with surgical intervention.CASE SUMMARY A 20-year-old Chinese lady confirmed by genetic testing to have GSD-1b was initially managed with uncooked cornstarch and granulocyte-colony stimulating factor.With recurrent abdominal symptoms,her condition was treated as clinical“Crohn’s disease”with mesalazine,prednisolone and azathioprine conservatively.Colonoscopy showed a tight stricture at the hepatic flexure.Subsequent computerized tomographic colonography revealed a phlegmon at the ileocaecal region with a suspected coloduodenal fistula.Eventually an exploratory laparotomy was performed and severe colitis at the ascending colon with coloduodenal fistula was confirmed.Right hemicolectomy with primary anastomosis and repair of the duodenum were performed.Surgical management of complications from GSD-1b associated IBD-like colitis has rarely been described.First-line treatment would usually be conservative.Surgical intervention like hemicolectomy is mainly reserved for refractory cases.CONCLUSION Surgical management of coloduodenal fistula in GSD-1b patients is a feasible and safe option when failed conservative management.展开更多
A case of liver transplantation in the department of general surgery of the third affiliated hospital of Inner Mongolia medical school was collected and analyzed on the basis of diagnosis,physical examination and trea...A case of liver transplantation in the department of general surgery of the third affiliated hospital of Inner Mongolia medical school was collected and analyzed on the basis of diagnosis,physical examination and treatment.Liver transplantation was very complicated,accompanied by various postoperative complications.So this paper aims to share experience of perioperative management of liver transplantation among physicians.展开更多
BACKGROUND Pulmonary arterial hypertension(PAH)in pregnancy is one of the major obstetric complications and is considered a contraindication to pregnancy as it is classified as a class IV risk in the revised risk clas...BACKGROUND Pulmonary arterial hypertension(PAH)in pregnancy is one of the major obstetric complications and is considered a contraindication to pregnancy as it is classified as a class IV risk in the revised risk classification of pregnancy by the World Health Organisation.Pregnancy,with its adaptive and expectant mechanical and hormonal changes,negatively affects the cardiopulmonary circulation in pregnant women.Do patients with repaired simple congenital heart disease(CHD)develop other pulmonary and cardiac complications during pregnancy?Can pregnant women with sudden pulmonary hypertension be treated and managed in time?In this paper,we present a case of a 39-year-old woman who underwent cesarean section at 33 wk'gestation and developed PAH secondary to repaired simple CHD.Our research began by a PubMed search for"pulmonary hypertension"and"pregnancy"and"CHD"case reports.Three cases were selected to review PAH in pregnancy after correction of CHD defects.These studies were reviewed,coupled with our own clinical experience.CASE SUMMARY Herein,a case involving a woman who underwent atrial septal defect repair at the age of 34,became pregnant five years later,and had a sudden onset of PAH and right heart failure secondary to symptoms of acute peripheral edema in the third trimester of her pregnancy.As a result,the patient underwent a cesarean section and gave birth to healthy twins.Within three days after cesarean delivery,her cardiac function deteriorated as the pulmonary artery pressure increased.Effec-tive postpartum management,including diuresis,significant oxygen uptake,vasodilators,capacity and anticoagulants management,led to improvements in cardiac function and oxygenation.The patient was discharged from hospital with a stable recovery and transferred to local hospitals for further PAH treatment.CONCLUSION This case served as a reminder to obstetricians of the importance of pregnancy after repair of CHD.It is crucial for patients with CHD to receive early correction.It suggests doctors should not ignore edema of twin pregnancy.Also,it provides a reference for the further standardization of antenatal,in-trapartum and postpartum management for patients with CHD worldwide.展开更多
A novel coronavirus that emerged in late 2019 rapidly spread around the world.Most severe cases need endotracheal intubation and mechanical ventilation,and some mild cases may need emergent surgery under general anest...A novel coronavirus that emerged in late 2019 rapidly spread around the world.Most severe cases need endotracheal intubation and mechanical ventilation,and some mild cases may need emergent surgery under general anesthesia.The novel coronavirus was reported to transmit via droplets,contact and natural aerosols from human to human.Therefore,aerosol-producing procedures such as endotracheal intubation and airway suction may put the healthcare providers at high risk of nosocomial infection.Based on recently published articles,this review provides detailed feasible recommendations for primary anesthesiologists on infection prevention in operating room during COVID-19 outbreak.展开更多
BACKGROUND Neoadjuvant or perioperative chemotherapy combined with surgery can reduce postoperative recurrence and improve the long-term survival rate of patients with locally advanced resectable gastric carcinoma.Niv...BACKGROUND Neoadjuvant or perioperative chemotherapy combined with surgery can reduce postoperative recurrence and improve the long-term survival rate of patients with locally advanced resectable gastric carcinoma.Nivolumab combined with chemotherapy has been recommended by the National Comprehensive Cancer Network guidelines as a first-line therapy for advanced gastric carcinoma/adenocarcinoma of the gastroesophageal junction and serves as the basis for immunotherapy combined with chemotherapy to become a neoadjuvant therapy.Herein,we report a case in which pathologic complete response was achieved by neoadjuvant administration of toripalimab,Herceptin,and docetaxel,oxaliplatin,calcium folinate,and fluorouracil(FLOT)chemotherapy followed by surgery for human epidermal growth factor receptor 2(HER2)-and programmed deathligand 1(PD-L1)-positive locally advanced gastric carcinoma.We hope that this case will shed some light on neoadjuvant therapy for gastric carcinoma.CASE SUMMARY The patient was diagnosed with locally advanced adenocarcinoma of the cardia.Immunohistochemistry of the baseline tissues suggested that the tissues were HER2-(fluorescent in situ hybridization)and PD-L1-positive(combined positive score=1).The patient underwent surgery following a four-cycle neoadjuvant therapy comprising Herceptin,toripalimab,and FLOT chemotherapy.The postoperative pathological findings showed mild atypical hyperplasia of the local glands with chronic mucosal inflammation(proximal stomach),no clear residual tumor(tumor regression grade 0),no regional lymph node metastasis,and negative upper and lower cut ends.The levels of tumor markers were reduced to normal levels after re-examination.With good postoperative recovery,the four-cycle preoperative chemotherapy was continued at the same dosage as that previously administered.After the treatment,the patient was monitored every 3 mo with a follow-up of 12 mo(4 times).As of February 27,2022,he was in a good condition without disease progression.The clinical trial registration number is E2019401.CONCLUSION There are many ongoing studies on neoadjuvant immunotherapy combined with chemotherapy or radiotherapy;however,most of these studies are phase II studies with small cohorts.According to the results of some current studies,these combined regimens have shown promising results in terms of efficacy and safety.However,the clinical efficacy and safety of the neoadjuvant therapies used in these combined regimens need to be confirmed by additional prospective phase III clinical trials,and further exploration of molecular markers for effective populations is required.展开更多
Parabiosis is a surgical method of animal modeling with a long history.It has been widely used in medical research,particularly in the fields of aging,stem cells,neuroscience,and immunity in the past two decades.The p...Parabiosis is a surgical method of animal modeling with a long history.It has been widely used in medical research,particularly in the fields of aging,stem cells,neuroscience,and immunity in the past two decades.The protocols for parabiosis have been improved many times and are now widely accepted.However,researchers need to consider many details,from surgical operation to perioperative management,to reduce mortality and maintain the parabiosis union.Although parabiosis has certain inevitable limitations,it still has broad application prospects as an irreplaceable animal model in the medical research field.展开更多
Liver transplantation(LT)is currently the only effective treatment option for endstage liver disease.The importance of animal models in transplantation is widely recognized among researchers.Because of the well-charac...Liver transplantation(LT)is currently the only effective treatment option for endstage liver disease.The importance of animal models in transplantation is widely recognized among researchers.Because of the well-characterized mouse genome and the greater diversity and availability of both genetically modified animals and research reagents,mouse orthotopic LT(MOLT)has become an ideal model for the investigation of liver biology,tissue injury,regulation of alloimmunity and tolerance induction,and the pathogenesis of specific liver diseases.However,due to its complicated and technically demanding procedure,the model has merely been used by only a few research groups in the world for years.For a new learner,training lasting at least a couple of months or even years is required.Most of the investigators have emphasized the importance of elaborate techniques and dedicated instruments in establishing a MOLT model,but some details are often neglected.The nontechnical details are also significant,especially for researchers who have little experience in mouse microsurgery.Here,we review and summarize the crucial technical and nontechnical details in establishing the model of MOLT based on scientific articles and our experience in six aspects:animal selection,anesthesia,perioperative management,organ procurement,back-table preparation,and implantation surgery.We aim to enable research groups to shorten the learning curve and implement the mouse LT procedure with high technical success.展开更多
BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is high...BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is highly essential to assess the influence the pandemic has on acute appendicitis.AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing,China.Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019.Preoperative management,intraoperative protective measures,and postoperative management were conducted.RESULTS After screening,six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group.The results of the nucleic acid test were negative.Of the 76 patients enrolled in the simple group,nine patients received medication therapy,and all others underwent surgery.From this same group,66 patients were diagnosed with suppurative appendicitis,and one patient was diagnosed with perforated appendicitis after surgery.There were 14 patients in the complex group,for which the postoperative diagnosis indicated perforated appendicitis.The proportion of men with perforated appendicitis was higher than that in 2019(P<0.05).The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019(P<0.05).The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019(P<0.05).The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019(P<0.05).Online consultation after discharge was selected in 59 cases(65.6%).No perioperative infection with COVID-19 or long-term postoperative complications were found.CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.展开更多
BACKGROUND Postpancreatectomy hemorrhage(PPH)is the most severe type of complication after pancreatic surgery,although the effect of antithrombotic therapy(ATT)on PPH is largely unknown.The safety and efficacy of chem...BACKGROUND Postpancreatectomy hemorrhage(PPH)is the most severe type of complication after pancreatic surgery,although the effect of antithrombotic therapy(ATT)on PPH is largely unknown.The safety and efficacy of chemical thromboprophylaxis for venous thromboembolism(VTE)remains controversial.AIM To elucidate the effect of ATT on PPH.METHODS Published articles between 2013 and 2020 were searched from PubMed and Google Scholar,and after careful reviewing of all studies,studies concerning ATT and pancreatic surgery were included.Data such as study design,type of surgical procedures,type of antithrombotic drugs,and surgical outcome were extracted from the studies.RESULTS Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic review.Fourteen were cohort studies,with only three being prospective in nature.Two studies demonstrated that in patients receiving chronic ATT,which were mostly managed by heparin bridging,the risk of PPH was higher compared with those without ATT,and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than others.The remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT,even under preoperative aspirin continuation.Concerning chemical thromboprophylaxis for VTE,most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis;however,its effectiveness against VTE has not been statistically demonstrated,particularly among Asian patients.CONCLUSION Pancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH,although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still controversial.Further investigation using reliable studies with good design is required to establish definite protocols or guidelines.展开更多
BACKGROUND Cement-related embolism is a rare but potentially fatal complication in spinal surgery.Cardiac echocardiography can provide valuable information for the early identification.CASE SUMMARY A 66-year-old woman...BACKGROUND Cement-related embolism is a rare but potentially fatal complication in spinal surgery.Cardiac echocardiography can provide valuable information for the early identification.CASE SUMMARY A 66-year-old woman who underwent lumbar vertebroplasty and internal fixation under general anesthesia experienced an episode of supraventricular tachycardia and ventricular tachycardia at the end of surgery.Point-of-care echocardiogram revealed a foreign body in the right heart.After conservative treatment in the intensive care unit,her family decided on comfort care and she expired.CONCLUSION Transthoracic echocardiography may provide early valuable information in patients undergoing vertebroplasty,and mild-moderate pericardial effusion may be a significant sign of a poor outcome.展开更多
Pancreatic surgery contains several major procedures of pancreatectomy.Surgical trauma,severe complications and preoperative nutritional disorders will affect postoperative recovery and clinical outcomes of patients.P...Pancreatic surgery contains several major procedures of pancreatectomy.Surgical trauma,severe complications and preoperative nutritional disorders will affect postoperative recovery and clinical outcomes of patients.Perioperative whole-course nutrition management focus on rational nutritional care from admission to discharge even post-hospital follow-up,including preoperative nutritional screening,perioperative nutrition assessment and intervention.The whole-course strategy has been validated in some other fields by RCTs and is also seemed to be suitable for pancreatic surgery.However,few high-grade evidences have been published and controversy still exists.This review aims to reflect the current situation,consensus and controversy of perioperative nutrition management in pancreatic surgery,expecting to provide necessary guidance for clinical research and practice.展开更多
文摘BACKGROUND Enhanced recovery after surgery(ERAS)was introduced in China in 2007.Over time,the scope of ERAS has expanded from abdominal surgery to orthopedics,urology and other fields.Continuous development and research has contributed to progress of ERAS in China.In 2019,to promote the application of ERAS in bone tumor surgery,we formed the“Consensus of Experts on Perioperative Management of Accelerated Rehabilitation in Major Surgery of Bone Tumors in China”.AIM To evaluate the effect of enhanced recovery after bone tumor surgery in perioperative management in China.METHODS One hundred and seven patients who underwent bone tumor surgery at the Second Affiliated Hospital of Xi’an Jiaotong University between May 2019 and April 2021 were randomized into a study group(53 cases)and a control group(54 cases).The study group adopted the ERAS protocol and the control group adopted conventional care.Main outcome measures included postoperative length of stay(LOS),postoperative complications,mortality,and 30-d readmission rates.Secondary outcomes included postoperative visual analog scale(VAS)score of pain,number of blood transfusions,drainage volume in 24 h after operation,patient satisfaction 30 d after discharge,VAS score at 30 d after discharge,and daily standing walking time.RESULTS There were no significant differences in the baseline data,clinical features and surgical site between the two groups.The LOS in the study group with the ERAS protocol was 7.72±3.34 d compared with 10.28±4.27 d in the control group who followed conventional care.The incidence of postoperative nausea and vomiting(PONV)in the study group was 19%and 37%in the control group.The VAS scores of pain on postoperative day 1(POD1)and POD3 in the study group were 4.79±2.34 and 2.79±1.53 compared with 5.28±3.27 and 3.98±2.27 in the control group.The drainage volume in 24 h after the operation was 124.36±23.43 mL in the study group and 167.43±30.87 mL in the control group.The number of blood transfusions in the study group was also lower.The patient satisfaction rate was higher in the study group than in the control group.CONCLUSION The ERAS protocol in the perioperative period of bone tumor surgery can decrease LOS,PONV,and postoperative pain,blood transfusion and 24-h drainage,improve patient satisfaction and accelerate recovery.
文摘INTRODUCTION Sepsis is defined as an infection associated with systemic manifestations of inflammation,which has become the most common complication in the perioperative period caused by severe burn/trauma and major surgical operation.^([1,2])The incidence of sepsis in adults is estimated to be 149–240/100 000 per year,and that of severe sepsis and septic shock is 56–91/100 000per year.In the last decade,the short-term
基金Supported by Key Research and Development Program of Shaanxi Province in China (No.2017SF-028)the Natural Science Foundation of Shaanxi Province (No.2019JQ-953)the Fundamental Research Funds for the Central Universities sponsored by Xi’an Jiaotong University (No.11913291000038/11913200000213)。
文摘AIM:To investigate the effects of on ocular surface microbiota in patients who received intravitreal injections.METHODS:Samples of ocular surface microbiota were obtained from 41 eyes of 41 patients who visited the Department of Ophthalmology.Patients were separated for three groups.Group A did not receive perioperative managements or intravitreal injection.Group B1 received only once and B2 received more than twice.In operating room,the samples were collected on the ocular surface.Operating taxonomic units(OTUs) clustering and alpha/beta diversity analysis was performed.The microbial 16S rRNA from samples were analyzed using the Hi Seq 2500 platform.RESULTS:Alpha diversity did not differ in each group,and beta diversity differed in the B2 group.Beta diversity showed a significant difference between Group A and B2(P=0.048).With the perioperative managements before intravitreal injection,the composition and relative abundance were altered.Top 10 microbiota on phylum and genus level,and then microbiota notably changed at genus level were listed.Gram-negative bacteria were varied more.Furthermore,Proteus was not found in Groups A and B1,but it was appeared after the patients received perioperative management and intravitreal injections in Group B2.CONCLUSION:With the perioperative managements,the balance of microbiota on the ocular surface is destroyed,and relative composition and abundance of microbiota on the ocular surface is obviously altered.The clinical doctors should pay more attention on the consequence of perioperative managements before intravitreal injection.
文摘Objective To study perioperative management in treatment of traumatic intracranial hemorrhage in patients with pretraumatic anticoagulation therapy of oral warfarin.Methods 10 patients of traumatic intracranial hemorrhage with pretraumatic anticoagulation therapy of oral warfarin received vitamin K,FFP and PCC
文摘Prediabetes and diabetes are important disease processes which have several perioperative implications.About one third of the United States population is considered to have prediabetes.The prevalence in surgical patients is even higher.This is due to the associated micro and macrovascular complications of diabetes that result in the need for subsequent surgical procedures.A careful preoperative evaluation of diabetic patients and patients at risk for prediabetes is essential to reduce perioperative mortality and morbidity.This preoperative evaluation involves an optimization of preoperative comorbidities.It also includes optimization of antidiabetic medication regimens,as the avoidance of unintentional hypoglycemic and hyperglycemic episodes during the perioperative period is crucial.The focus of the perioperative management is to ensure euglycemia and thus improve postoperative outcomes.Therefore,prolonged preoperative fasting should be avoided and close monitoring of blood glucose should be initiated and continued throughout surgery.This can be accomplished with either analysis in blood gas samples,venous phlebotomy or point-of-care testing.Although capillary and arterial whole blood glucose do not meet standard guidelines for glucose testing,they can still be used to guide insulin dosing in the operating room.Intraoperative glycemic control goals may vary slightly in different protocols but overall the guidelines suggest a glucose range in the operating room should be between 140 mg/dL to 180 mg/dL.When hyperglycemia is detected in the operating room,blood glucose management may be initiated with subcutaneous rapid-acting insulin,with intravenous infusion or boluses of regular insulin.Fluid and electrolyte management are other perioperative challenges.Notably diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic state are the two most serious acute metabolic complications of diabetes that must be recognized early and treated.
文摘The contemporary embrace of endoscopic technology in the approach to the anterior skull base has altered the perioperative landscape for patients requiring pituitary surgery.Utility of a multi-disciplinary unit in management decisions facilitates the delivery of optimal care.Evolution of technology and surgical expertise in pituitary surgery mandates ongoing review of all components of the care central to these patients.The many areas of potential variability in the pre,intra and post-operative timeline of pituitary surgery are readily identifiable.Core undertakings and contemporary controversies in the peri-operative management of patients undergoing endoscopic transsphenoidal pituitary surgery are assessed against the available literature with a view to providing guidance for the best evidence-based practice.
文摘This study aimed to explore the characteristics of perioperative nursing of experimental goats using self-made axial-flow blood pump implantation and provided theoretical nursing knowledge and practice-based evidence for the clinical application of domestically manufactured artificial cardiac pumps. Methods: Seven experimental goats were used in this study, three for pre-testing and four for the formal experiments. According to the surgical requirements for axial-flow blood pump implantation into the cardiac apex, we creatively designed and made a series of highly practical animal surgical instruments including a composite disassemblable bed for experimental animal transferring and monitoring, a multifunctional animal surgery bed, and portable medical supporting equipment. We also applied for two national invention patents and one utility model patent. Active measures were taken to ensure careful preparation before surgery, close collaboration during surgery, and effective management of complications after surgery. Results: Two of the four experimental goats died during surgery because of a massive hemorrhage caused by distal anastomotic failure and air embolism-induced cardiac arrest caused by air leakage from the outlet into the heart due to poor connection of the auxiliary pressure tap (used to measure left ventricular pressure). The mean survival time of the remaining three experimental goats was 22.7 hours. Conclusion: This study was the first to systematically and comprehensively investigate the perioperative nursing management of axial-flow blood pump implantation using animal models. These findings could greatly promote further clinical applied nursing research of self-made artificial cardiac pump implantation in experimental goats.
文摘BACKGROUND Glycogen storage disease(GSD)is an autosomal recessive inborn metabolic disorder.Patients with GSD are prone to hypoglycaemia,hyperlactacidemia and bleeding.GSD type 1b(GSD-1b)patients specifically can develop neutropenia,recurrent bacterial infection and inflammatory bowel disease(IBD).Documentation of the long-term outcomes of surgical management of GSD-1b has been scarce,especially for Asian patients.We herein describe a case of GSD-1b complicated by IBD-like colitis and coloduodenal fistula.The patient was managed successfully with surgical intervention.CASE SUMMARY A 20-year-old Chinese lady confirmed by genetic testing to have GSD-1b was initially managed with uncooked cornstarch and granulocyte-colony stimulating factor.With recurrent abdominal symptoms,her condition was treated as clinical“Crohn’s disease”with mesalazine,prednisolone and azathioprine conservatively.Colonoscopy showed a tight stricture at the hepatic flexure.Subsequent computerized tomographic colonography revealed a phlegmon at the ileocaecal region with a suspected coloduodenal fistula.Eventually an exploratory laparotomy was performed and severe colitis at the ascending colon with coloduodenal fistula was confirmed.Right hemicolectomy with primary anastomosis and repair of the duodenum were performed.Surgical management of complications from GSD-1b associated IBD-like colitis has rarely been described.First-line treatment would usually be conservative.Surgical intervention like hemicolectomy is mainly reserved for refractory cases.CONCLUSION Surgical management of coloduodenal fistula in GSD-1b patients is a feasible and safe option when failed conservative management.
文摘A case of liver transplantation in the department of general surgery of the third affiliated hospital of Inner Mongolia medical school was collected and analyzed on the basis of diagnosis,physical examination and treatment.Liver transplantation was very complicated,accompanied by various postoperative complications.So this paper aims to share experience of perioperative management of liver transplantation among physicians.
文摘BACKGROUND Pulmonary arterial hypertension(PAH)in pregnancy is one of the major obstetric complications and is considered a contraindication to pregnancy as it is classified as a class IV risk in the revised risk classification of pregnancy by the World Health Organisation.Pregnancy,with its adaptive and expectant mechanical and hormonal changes,negatively affects the cardiopulmonary circulation in pregnant women.Do patients with repaired simple congenital heart disease(CHD)develop other pulmonary and cardiac complications during pregnancy?Can pregnant women with sudden pulmonary hypertension be treated and managed in time?In this paper,we present a case of a 39-year-old woman who underwent cesarean section at 33 wk'gestation and developed PAH secondary to repaired simple CHD.Our research began by a PubMed search for"pulmonary hypertension"and"pregnancy"and"CHD"case reports.Three cases were selected to review PAH in pregnancy after correction of CHD defects.These studies were reviewed,coupled with our own clinical experience.CASE SUMMARY Herein,a case involving a woman who underwent atrial septal defect repair at the age of 34,became pregnant five years later,and had a sudden onset of PAH and right heart failure secondary to symptoms of acute peripheral edema in the third trimester of her pregnancy.As a result,the patient underwent a cesarean section and gave birth to healthy twins.Within three days after cesarean delivery,her cardiac function deteriorated as the pulmonary artery pressure increased.Effec-tive postpartum management,including diuresis,significant oxygen uptake,vasodilators,capacity and anticoagulants management,led to improvements in cardiac function and oxygenation.The patient was discharged from hospital with a stable recovery and transferred to local hospitals for further PAH treatment.CONCLUSION This case served as a reminder to obstetricians of the importance of pregnancy after repair of CHD.It is crucial for patients with CHD to receive early correction.It suggests doctors should not ignore edema of twin pregnancy.Also,it provides a reference for the further standardization of antenatal,in-trapartum and postpartum management for patients with CHD worldwide.
文摘A novel coronavirus that emerged in late 2019 rapidly spread around the world.Most severe cases need endotracheal intubation and mechanical ventilation,and some mild cases may need emergent surgery under general anesthesia.The novel coronavirus was reported to transmit via droplets,contact and natural aerosols from human to human.Therefore,aerosol-producing procedures such as endotracheal intubation and airway suction may put the healthcare providers at high risk of nosocomial infection.Based on recently published articles,this review provides detailed feasible recommendations for primary anesthesiologists on infection prevention in operating room during COVID-19 outbreak.
基金Supported by Chinese Research Hospital Association,No.Y2019FH-DTCC-SC3。
文摘BACKGROUND Neoadjuvant or perioperative chemotherapy combined with surgery can reduce postoperative recurrence and improve the long-term survival rate of patients with locally advanced resectable gastric carcinoma.Nivolumab combined with chemotherapy has been recommended by the National Comprehensive Cancer Network guidelines as a first-line therapy for advanced gastric carcinoma/adenocarcinoma of the gastroesophageal junction and serves as the basis for immunotherapy combined with chemotherapy to become a neoadjuvant therapy.Herein,we report a case in which pathologic complete response was achieved by neoadjuvant administration of toripalimab,Herceptin,and docetaxel,oxaliplatin,calcium folinate,and fluorouracil(FLOT)chemotherapy followed by surgery for human epidermal growth factor receptor 2(HER2)-and programmed deathligand 1(PD-L1)-positive locally advanced gastric carcinoma.We hope that this case will shed some light on neoadjuvant therapy for gastric carcinoma.CASE SUMMARY The patient was diagnosed with locally advanced adenocarcinoma of the cardia.Immunohistochemistry of the baseline tissues suggested that the tissues were HER2-(fluorescent in situ hybridization)and PD-L1-positive(combined positive score=1).The patient underwent surgery following a four-cycle neoadjuvant therapy comprising Herceptin,toripalimab,and FLOT chemotherapy.The postoperative pathological findings showed mild atypical hyperplasia of the local glands with chronic mucosal inflammation(proximal stomach),no clear residual tumor(tumor regression grade 0),no regional lymph node metastasis,and negative upper and lower cut ends.The levels of tumor markers were reduced to normal levels after re-examination.With good postoperative recovery,the four-cycle preoperative chemotherapy was continued at the same dosage as that previously administered.After the treatment,the patient was monitored every 3 mo with a follow-up of 12 mo(4 times).As of February 27,2022,he was in a good condition without disease progression.The clinical trial registration number is E2019401.CONCLUSION There are many ongoing studies on neoadjuvant immunotherapy combined with chemotherapy or radiotherapy;however,most of these studies are phase II studies with small cohorts.According to the results of some current studies,these combined regimens have shown promising results in terms of efficacy and safety.However,the clinical efficacy and safety of the neoadjuvant therapies used in these combined regimens need to be confirmed by additional prospective phase III clinical trials,and further exploration of molecular markers for effective populations is required.
基金This study was supported by the National Natural Science Foundation of China(81601112,81801090)Top Project of Youth Incubation Program of Military Medical Science and Technology(19QNP065)+1 种基金Sichuan Department of Science and Technology Fund(2018SZ0141,2019YSF0213)China’s Post-doctoral Science Fund(2017M623357),and Sichuan Medical Association Fund(Q17008)。
文摘Parabiosis is a surgical method of animal modeling with a long history.It has been widely used in medical research,particularly in the fields of aging,stem cells,neuroscience,and immunity in the past two decades.The protocols for parabiosis have been improved many times and are now widely accepted.However,researchers need to consider many details,from surgical operation to perioperative management,to reduce mortality and maintain the parabiosis union.Although parabiosis has certain inevitable limitations,it still has broad application prospects as an irreplaceable animal model in the medical research field.
基金the Science and Technology Department of Jilin Province,No.20180622004JCthe Finance Department of Jilin Province,No.2017F004The First Hospital of Jilin University,No.LCPYJJ2017007.
文摘Liver transplantation(LT)is currently the only effective treatment option for endstage liver disease.The importance of animal models in transplantation is widely recognized among researchers.Because of the well-characterized mouse genome and the greater diversity and availability of both genetically modified animals and research reagents,mouse orthotopic LT(MOLT)has become an ideal model for the investigation of liver biology,tissue injury,regulation of alloimmunity and tolerance induction,and the pathogenesis of specific liver diseases.However,due to its complicated and technically demanding procedure,the model has merely been used by only a few research groups in the world for years.For a new learner,training lasting at least a couple of months or even years is required.Most of the investigators have emphasized the importance of elaborate techniques and dedicated instruments in establishing a MOLT model,but some details are often neglected.The nontechnical details are also significant,especially for researchers who have little experience in mouse microsurgery.Here,we review and summarize the crucial technical and nontechnical details in establishing the model of MOLT based on scientific articles and our experience in six aspects:animal selection,anesthesia,perioperative management,organ procurement,back-table preparation,and implantation surgery.We aim to enable research groups to shorten the learning curve and implement the mouse LT procedure with high technical success.
基金Jiaxing Key Discipline of Medicine-Oncology(Supporting Subject),No.2019-zc-11.
文摘BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is highly essential to assess the influence the pandemic has on acute appendicitis.AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing,China.Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019.Preoperative management,intraoperative protective measures,and postoperative management were conducted.RESULTS After screening,six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group.The results of the nucleic acid test were negative.Of the 76 patients enrolled in the simple group,nine patients received medication therapy,and all others underwent surgery.From this same group,66 patients were diagnosed with suppurative appendicitis,and one patient was diagnosed with perforated appendicitis after surgery.There were 14 patients in the complex group,for which the postoperative diagnosis indicated perforated appendicitis.The proportion of men with perforated appendicitis was higher than that in 2019(P<0.05).The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019(P<0.05).The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019(P<0.05).The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019(P<0.05).Online consultation after discharge was selected in 59 cases(65.6%).No perioperative infection with COVID-19 or long-term postoperative complications were found.CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.
文摘BACKGROUND Postpancreatectomy hemorrhage(PPH)is the most severe type of complication after pancreatic surgery,although the effect of antithrombotic therapy(ATT)on PPH is largely unknown.The safety and efficacy of chemical thromboprophylaxis for venous thromboembolism(VTE)remains controversial.AIM To elucidate the effect of ATT on PPH.METHODS Published articles between 2013 and 2020 were searched from PubMed and Google Scholar,and after careful reviewing of all studies,studies concerning ATT and pancreatic surgery were included.Data such as study design,type of surgical procedures,type of antithrombotic drugs,and surgical outcome were extracted from the studies.RESULTS Nineteen published articles with a total of 37863 patients who underwent pancreatic surgery were included in the systematic review.Fourteen were cohort studies,with only three being prospective in nature.Two studies demonstrated that in patients receiving chronic ATT,which were mostly managed by heparin bridging,the risk of PPH was higher compared with those without ATT,and one study showed that patients with direct-acting oral anticoagulants managed by heparin bridging had significantly higher postoperative bleeding rates than others.The remaining six studies reported that pancreatic surgery can be safely performed in patients receiving chronic ATT,even under preoperative aspirin continuation.Concerning chemical thromboprophylaxis for VTE,most studies have shown a potentially high risk of PPH in patients undergoing chemical thromboprophylaxis;however,its effectiveness against VTE has not been statistically demonstrated,particularly among Asian patients.CONCLUSION Pancreatic surgery in chronically ATT-received patients can be safely performed without an increase in the occurrence of PPH,although the safety and efficacy of chemical thromboprophylaxis for VTE during pancreatic surgery is still controversial.Further investigation using reliable studies with good design is required to establish definite protocols or guidelines.
文摘BACKGROUND Cement-related embolism is a rare but potentially fatal complication in spinal surgery.Cardiac echocardiography can provide valuable information for the early identification.CASE SUMMARY A 66-year-old woman who underwent lumbar vertebroplasty and internal fixation under general anesthesia experienced an episode of supraventricular tachycardia and ventricular tachycardia at the end of surgery.Point-of-care echocardiogram revealed a foreign body in the right heart.After conservative treatment in the intensive care unit,her family decided on comfort care and she expired.CONCLUSION Transthoracic echocardiography may provide early valuable information in patients undergoing vertebroplasty,and mild-moderate pericardial effusion may be a significant sign of a poor outcome.
基金supported by the Capital Characteristic Clinical Project Supported by Beijing Municipal Science&Technology Commission(No.Z181100001718216)Beijing Hospital Nova Project(No.BJ-2020-082).
文摘Pancreatic surgery contains several major procedures of pancreatectomy.Surgical trauma,severe complications and preoperative nutritional disorders will affect postoperative recovery and clinical outcomes of patients.Perioperative whole-course nutrition management focus on rational nutritional care from admission to discharge even post-hospital follow-up,including preoperative nutritional screening,perioperative nutrition assessment and intervention.The whole-course strategy has been validated in some other fields by RCTs and is also seemed to be suitable for pancreatic surgery.However,few high-grade evidences have been published and controversy still exists.This review aims to reflect the current situation,consensus and controversy of perioperative nutrition management in pancreatic surgery,expecting to provide necessary guidance for clinical research and practice.
