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Intra-abdominal infections (IAI) is common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The principles of IAI management included early diagnosis, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using critical care resources, combined with an optimal surgical approach. In order to facilitate clinical management, establish a global standard and provide guidance for clinicians, the World Society of Emergency Surgery (WSES), the Global Alliance for Infection in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) worked together to complete an international multi-society document, which provided the evidence-based clinical pathways. Herein, we made a comprehensive interpretation for the clinical pathways combined with the latest domestic and international research developments, aiming to provide evidence for domestic doctors on the diagnosis and treatment of IAI, and ultimately benefit patients.
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World Society of Emergency Surgery (WSES), in conjunction with Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) developed guideline about the management of acute abdomen in immunocompromised patients, which was published in the World Journal of Emergency Surgery (WJES) on August 9, 2021. The guidelines elaborate on the definition, classification, diagnosis and treatment of immunocompromised patients. In addition, based on evidence-based medicine, it provides guidance and suggestion on the management of specific acute abdominal infections in immunocompromised patients, common acute abdominal infections in transplanted patients, patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), as well as perioperative steroid management. An interpretation of the guideline was performed to accomplish a better understanding the current status and recommendations for the management of acute abdominal conditions in immunocompromised patients, and to make forward suggestions on its limitations.
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Objective To evaluate the effect of case-based learning combined with standardized patients in probation of nuclear radionuclide therapy.Methods 360 interns were randomly assigned separately into CBL+SP group and LBL group (180 people),case based on SP as the center of clinical teaching mode was used for CBL+SP group,while traditional classroom teaching mode was used for LBL group.Theoretical test,case analysis and teaching satisfaction survey were used to evaluate the two teaching mode,using SPSS 20.0 software for statistical analysis of the data.t test was used for two independent samples of both theoretical test and case analysis and chi-square test was used for teaching satisfaction survey.Results The score of theory and case analysis of CBL+SP group was higher than that of LBL group,and the difference had statistical significance [(83.26 ± 4.18) vs.(80.36 ± 3.62),t=-7.041,P=0.000;(85.79 ± 4.15) vs.(81.26 ± 3.96),t=-10.844,P=0.000].Satisfaction survey showed that satisfaction degree of CBL+SP group in stimulating and training the correct clinical thinking,grasping the information skills and cultivating their ability to analyze and solve the problem was higher than that of LBL group,and the difference had statistical significance (x2=40.319,x2=33.620,x2=23.493,x2=23.283;P=0.000).Conclusion Case-based learning combined with standardized patients in probation of nuclear radionuclide therapy can obtain satisfactory teaching effort.
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Objective To investigate the effect of fatty liver graft on early poor prognosis in postoperative liver transplant adult patients.Methods The clinical data of 125 adult patients undergoing liver transplantation (LT) from fatty liver graft from January 2008 to October 2012 were retrospectively analyzed.Patients were divided into poor-prognosis group and non-poor-prognosis group.18 clinical factors were compared between these two groups by single factor and multiple factor Logistic regression analysis.Results Degree of steatosis (x2 =10.088,P =0.004),recipients' age (t =-3.917,P =0.002),pre-LTserum creatinine values (Z =-2.623,P =0.009),liver warm ischemia time (Z =-2.305,P =0.021),cold ischemia time (Z =-3.394,P =0.001) were identified to be statistically significant by the single factor analysis (P ＜ 0.05);By multivariate stepwise Logistic regression analysis on the above parameters,cold ischemia time (x2 =10.141,P =0.001,OR =1.003) and degree of steatosis (x2 =8.360,P =0.004,OR =4.619) were found as the independent risk factors,into the regression equation:Y =0.003 × cold ischemia time + 1.530 × degree of steatosis-4.243.Conclusions Donor liver cold ischemia time,degree of steatosis are independent risk factors for poor prognosis in early stage after liver transplantation.
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BACKGROUND:Single photon emission computed tomography (SPECT)measurement is capable of detecting very early cerebral circulatory disorders accurately and assessing the time-window and the possibility of reversible brain function after reperfusion at various post-ischemia time points.OBJECTIVE: To establish the swine model of ischemic stroke, to assess the time-window of reversible ischemia and to evaluate the significance of SPECT cerebral ischemia-perfusion imaging on predicting very early time window.DESIGN: Randomized, controlled and experimental study.SETTING: Neurological department of a municipal hospital.MATERIALS: From January to August 2002, it was completed at the Laboratory Animal Research Center of Qingdao Municipal Hospital. Twelve 4 months old domestic swine (Sus scrofa), males and females and weighing 8-10 kg, were selected and fed with conventional method.INTERVENTIONS: Twelve swine pigs were divided into block group and reperfusion group, 6 in each group. In all the pigs, common carotid artery in one lateral was blocked by a clamp. Animals in block group sacrificed at 2, 4, 5, 6, 8 and 10 hour respectively. In perfusion group, clamps were removed at 2, 4, 5, 6, 8 and 10 hour respectively, and then the animals were killed 24 hours later. Before sacrifice, all the animals underwent SPECT examination, regional cerebral blood flow (rCBF) measurement and CT scan. After sacrifice, 1 mm3 brain tissues were taken from each lobe and were stained by HE staining. Then light microscope and electron microscope were used to study the histological changes.MAIN OUTCOME MEASURES: SPECT and brain CT scan were used to investigate the cytological changes in brain tissues after various length of ischemiaRESULTS: Twelve swine pigs entered the statistical analysis procedure.By using light microscope and electron microscope, it was found that at 5 hour after operation, neurons in operational side were a little swelled, with swelled mitochondria, a mitochondria crests loss and a progressive plasma loss in a few neurons. While in those with clamps removed within 4 hours after turn off, brain tissue structures were mainly restored.CONCLUSION: SPECT is capable of detecting ischemic brain injury immediately. It is proved by histological evidence that a more-than-5-hour ischemia will cause irreversible changes in neurons.