Application of understanding teaching mode combined with hierarchical training in standardized training of gastrointestinal surgical nurses / 中华医学教育探索杂志

Objective:To explore the application of understanding teaching mode combined with hierarchical training in the standardized training of nurses in gastrointestinal surgery department.Methods:Sixty-three nurses who had standardized training in gastrointestinal surgery department in West China Hospital, Sichuan University from January 2018 to January 2022 were selected as the study objects, among which, 32 nurses from January 2018 to July 2020 were set as the control group, taking regular training method, and 31 nurses from August 2020 to January 2022 were set as the observation group, taking the understanding teaching mode combined with hierarchical training method. The core competence scores of the two groups after training were compared, the scores of basic theory and practical skills of the two groups were compared, and the satisfaction degree of nurses during training was compared between the two groups. SPSS 22.0 was used to perform t-test. Results:After the training, the scores of core competence in the observation group were higher than that in the control group, and the difference was statistically significant ( P < 0.05). The scores of theoretical assessment (96.59±3.22) and practical skills (97.09±2.88) in the observation group were significantly higher than those in the control group (91.52±2.45)(91.14±2.85) ( P < 0.05). The total satisfaction scores of the observation group (93.48 ± 2.52) was higher than that of the control group (86.80 ± 2.22), and the difference was statistically significant ( P < 0.05). Conclusion:It is suggested that understanding teaching mode and joint hierarchical training can improve the core ability and assessment score of nurses in gastrointestinal surgery department, and improve the satisfaction of nurses.

Application of "4C" teaching method combined with two-way evaluation method in nursing teaching of gastrointestinal surgery / 中华医学教育探索杂志

Objective:To explore the application effect of "connections, concepts, concrete practice and conclusions (4C)" teaching method combined with two-way evaluation method in nursing teaching of gastrointestinal surgery, so as to provide reference for personnel training and quality control of practice.Methods:A historical controlled study was conducted to prospectively include the nursing interns received by the Department of Gastrointestinal Surgery of the hospital from May 2020 to May 2022 as the subjects of this study. The interns were divided into the control group (64 interns from May 2020 to May 2021) and the research group (93 interns from June 2021 to May 2022) according to the order of admission of nursing interns. The control group was taught by traditional nursing teaching method, while the research group was taught by "4C" teaching method combined with two-way evaluation method. The scores of theoretical knowledge and operation of nursing students in the two groups were compared after 6 weeks of practice. The self-directed learning ability of nursing students in the two groups was compared before and after 6 weeks of practice [Chinese version of self-rating scale of self-directed learning (SRSSDL)]. The evaluation of teaching quality between two groups of nursing students were compared. SPSS 25.0 was used for t-test and Chi-square test. Results:One person in the control group voluntarily quit the internship, and two in the observation group voluntarily quit the internship. Finally, 63 people in the control group and 91 people in the research group entered the study. There was no statistical significant difference between the two groups in baseline data ( P>0.05). At 6 weeks of practice, the scores of theoretical knowledge (87.96±4.62) and operation (92.60±4.25) in the study group were higher than those in the control group [(86.02±4.53) and (88.27±4.31)] ( P<0.05). At 6 weeks of practice, the total scores of learning awareness, learning behavior, learning strategies, learning evaluation, interpersonal skills and self-directed learning ability of the two groups were higher than those before practice, and the study group was higher than the control group ( P<0.05). After 2 weeks, 4 weeks and 6 weeks of practice, the scores of the two groups of nursing students in evaluating the teaching quality of the teachers increased gradually compared with that of the first week of practice ( P<0.05). Conclusion:The "4C" teaching method combined with the two-way evaluation method in the nursing teaching of gastrointestinal surgery can improve the nursing students' theoretical knowledge, practical operation ability and self-directed learning ability, and is conducive to the improvement of teaching quality.

Study on the role of ET-led one-to-one teaching method in the wound stoma teaching of gastrointestinal surgery residents / 中华医学教育探索杂志

Objective:To explore the role of one-to-one teaching led by international enterostomal therapist (ET) in the standardized training of wound stoma in gastrointestinal surgery.Methods:A total of 36 interns who underwent standardized training in the Gastrointestinal Surgery Department of The First Affiliated Hospital of Kangda College of Nanjing Medical University from July 2019 to January 2020 were selected as the control group, and the traditional teaching was adopted. Other 38 interns who were trained from May 2020 to October 2020 wre grouped into research group, and ET-led one-to-one teaching was adopted. The scores of theoretical knowledge and practical operation skills of gastrointestinal surgery wound stoma were compared between the two groups after the training, and the scores of case analysis, problem analysis and solving, knowledge application and comprehensive ability before and after the training were compared. Besides, satisfaction with methods and teaching effectiveness was compared. SPSS 25.0 was used for t test and chi-square test. Results:The clinical theoretical knowledge [(93.45±5.28) vs. (90.11±6.39)] and practical operation skills assessment scores [(92.25±6.18) vs. (89.13±5.36)] of the research group were all significantly higher than those of the control group after training ( P<0.05); the scores of case analysis ability, problem analysis and solving ability, knowledge application ability, and comprehensive ability of the two groups after the training were significantly higher than those before the training ( P<0.05), and the above scores in the research group were all higher than those in the control group ( P<0.05); the satisfaction of the interns in the study group with teaching methods and teaching effects was higher than that in the control group ( P<0.05). Conclusion:Applying ET-led one-to-one teaching to the wound and stoma teaching of gastrointestinal surgery residents can significantly improve their assessment performance, teaching satisfaction, and the teaching effect, and improve their case analysis ability, problem analysis and solving ability, knowledge application ability, and comprehensive ability.

Retrospect of standardized diagnosis and registration of surgical complications for gastro-intestinal cancer in China / 中华消化外科杂志

Registration of postoperative complications for surgical oncology including gastrointestinal cancer has received increasing attention with persistent researches on gastrointes-tinal tumor in China. The popularization of standardized gastric surgery and introduction of new technologies and concepts, including minimally invasive surgery, enhanced recovery after surgery, and neoadjuvant therapy, have promoted the conduction of clinical studies, e.g. the Chinese Laparoscopic Gastrointestinal Surgery Study Group series studies, on their safety, and further standardized the diagnosis and registration of postoperative complications as short-term study endpoints. Since then, for diagnosis and registration of complications in gastrointestinal surgery in China, the basis has evolved from clinical experience to clinical research. Since 2015, platforms such as China Gastrointestinal Cancer Surgical Union have been established to further promote the recording of real-world clinical data in more centers across the whole country. In recent years, the expert consensus on the diagnosis and registration of complications has been published sub-sequently and the prospective multicenter real-world complication registration study has been carried out. All of these efforts will facilitate medical centers especially the primary medical centers into the era of standardized diagnosis and registration of complications on a real-world basis.The authors review the standardized diagnosis and registration of surgical complications for gastrointes-tinal cancer in China, aiming to provide references to standardization of clinical practice of gastro-intestinal surgery.

Predictive value of Onodera's prognostic nutrition index for clinical outcomes in elderly patients after gastrointestinal surgery / 中华临床营养杂志

Objective:To investigate the association between Onodera's prognostic nutritional index (OPNI) and postoperative adverse outcomes in elderly gastrointestinal surgery patients and assess the predictive value.Methods:A total of 230 elderly patients who received gastrointestinal surgery were prospectively enrolled. Clinical data, including age, sex, preoperative laboratory parameters, surgery process and clinical outcomes, were collected. The optimal cut-off value of OPNI was obtained using NRS 2002, a well-recognized nutritional risk screening tool, as the standard. The associations of OPNI, geriatric nutritional risk index (GNRI) and albumin with in-hospital mortality, complication incidence and duration of postoperative hospital stay were evaluated using Chi-square test or nonparametric test as appropriate. Confounders were identified through univariate analysis and logistic and linear regression models were developed to validate the correlation and assess the predictive value of OPNI for postoperative clinical outcomes.Results:The optimal cut-off value for the OPNI was 41.25, which yielded a sensitivity of 72.7% and a specificity of 59.9% with area under the curve (AUC) at 0.682. The incidence of OPNI-based malnutrition (defined as OPNI < 41.25) was 50% (115/230). Univariate analysis indicated that patients with OPNI < 41.25 had a significantly higher mortality (8.70% versus 2.61%, P = 0.046) and complication incidence (20.00% versus 9.57%, P = 0.026) and significantly longer postoperative hospital stay (11.17 d versus 8.49 d, P = 0.009) than patients with OPNI ≥ 41.25. Patients with GNRI < 98 had a longer postoperative hospital stay than those with GNRI ≥ 98 (10.71 d versus 7.55 d, P = 0.001) while there was no significant difference in mortality or complication incidence between the two groups ( P > 0.05). As for subgroups divided according to albumin levels (< 35 g/L or ≥35 g/L), no significant differences in mortality, postoperative complications incidence, or duration of postoperative hospital stay were observed ( P > 0.05). Multivariate analysis verified that OPNI < 41.25 was an independent risk factor for the development of postoperative complications ( OR: 2.660, 95% CI: 1.079-6.557, P = 0.034) and prolonged postoperative hospital stay ( R2 = 0.135, regression coefficient = 2.73, P = 0.047), where the AUC of the regression model for complications was 0.812 (95% CI: 0.741-0.882). GNRI < 98 was the independent risk factor for prolonged postoperative hospital stay ( R2 = 0.134, regression coefficient = 2.797, P = 0.049). Conclusion:OPNI is an independent risk factor for adverse clinical outcomes after gastrointestinal surgery in elderly patients and demonstrates good predictive value with the cut-off value of 41.25.

Next era of the thirty-year Chinese laparoscopic surgery: past, present, and future / 中华胃肠外科杂志

Laparoscopic gastrointestinal surgery has experienced 30 years of development in China, and has now entered a high plateau stage at the technical level. Laparoscopic surgery, once an emerging technology, is gradually becoming a "traditional surgery". Meanwhile, laparoscopic gastrointestinal surgery is gradually moving towards a new situation of multi-disciplinary and multi-technical integration. High-quality clinical studies are constantly being reported, and new tools and techniques are emerging. In the next era, the development of laparoscopic gastrointestinal surgery will focus more on international research, digital surgery, high-tech operating rooms, etc. An urging requirement is to understand and face the current intensified involution and other practical problems, and to create another glorious innovation for Chinese laparoscopic gastrointestinal surgery in the next 30 years.

Demonstration and significance on proximal segment of dorsal mesogastrium / 中华胃肠外科杂志

In radical gastrectomy, D2 systemic lymphadenectomy, which includes complete resection of the bursa sac and omentum, and D2 extended lymphadenectomy outside the bursa sac, is a standard procedure accepted by gastrointestinal surgeons generally. However, a series of clinical trials showed that both D2 extended lymphadenectomy and bursectomy could not improve oncologic benefit, but increase surgical risk. These findings showed a lot of conflicts in gastric cancer surgery, gastrointestinal surgery, even in oncological surgery. It was demonstrated that bursa sac and greater omentum were neither mesogastrium nor the proximal segment of dorsal mesogastrium (PSDM), which has been identified recently. Local physiological structures (such as blood vessels and lymphatic nodes) and pathological events (such as lymph nodes metastasis and metastasis V) only occur in mesentery in broad sense (i.e. PSDM). Broken PSDM during radical gastrectomy can result in cancer cell leakage into the operational field. Therefore, complete PSDM excision in the D2 field (D2+CME) is suggested as a better procedure for local advanced gastric cancer, which can get benefits not only in surgical hazard, but also in oncologic result. The results of PSDM research could lead to three changes: (1) resolving some long standing problems in gastric cancer surgery, gastrointestinal surgery, and even oncologic surgery; (2) opening an new era for finding and utilizing extra-intestinal mesentery in broad sense; (3) formulating the theory of membrane anatomy which may update, iterate and upgrade related information of classical anatomy, pathology, surgery and oncology.

Scientific paradigm of membrane anatomy / 中华胃肠外科杂志

Anatomical plane and fascia have been described in medical behaviors for hundreds of years since the appearance of anatomy and operation. Generally, these descriptions can be sorted into three theories, i.e. plane surgery, fascia theory and mesentery anatomy. However, these theories are difficult to satisfy the scientific paradigm that includes consistency in description, independence in validation, potential to solve practical problems, and the interaction of the above-mentioned theries. Recently, membrane anatomy was proposed as the anatomy of mesentery and its beds in broad sense. Behind it lies fascia membrane/serous membrane structure, as well as inherent life events and general order. Mesentery in broad sense is described as the fascia membrane/serous membrane in serous cavity, which envelops and suspends the organ/tissue and its feeding structures to the posterior wall of the body. Anatomy is the setting/structure, in which life events/functions occur. In the research and discussion of membrane anatomy, abiding by the scientific paradigm and upholding the scientific spirit are the only way to obtain reliable knowledge and the criterion for in-depth scientific research.

Role of pre-operative serum albumin level in predicting the post-operative outcomes in gastrointestinal surgery

Background: The prevalence of protein-energy malnutrition in surgical patients is seen in 30-50% of surgical patients with gastrointestinal disease. Malnutrition and hypalbuminaemia contribute to increased morbidity and mortality. Serum albumin level is a low-cost key element in nutritional assessment. Clavien-Dindo classification of post-operative complications enables stratification of post-operative complication.Methods: We retrospectively analysed the prospectively maintained data of 136 patients who underwent major gastro intestinal procedures from October 2019 to March 2020. We assessed the pre-operative; intra operative parameters, outcome variables and the postoperative complications were graded according to Clavien-Dindo severity, length of ICU stay, length of hospitalization and mortality.Results: Out of the 136 patients (M: F=3:2), the procedures were hepatopancreaticobiliary (n=40), colorectal (n=39), small bowel (n=36) and esophago-gastric (n=19). Pre-operative serum albumin was identified to be single most statistically significant pre-operative variable predicting post-operative complication of Clavien-Dindo severity grade III and above. The ROC curve of the serum albumin level predicting the severe post-operative complication suggested optimal cut off value of 3.1 gm/dl (AUC=0.76; 5% CI=0.64-0.87; p<0.001). Linear regression analysis of serum albumin level predicting the severe post-operative complication suggested good correlation with (r2=0.133; b=0.689; p<0.001). Further analysis of serum albumin level in predicting the length of ICU and the hospital stays suggested a significant negative correlation with both of these dependent outcome variables. The serum albumin level correlated inversely with the length of ICU stay and hospitalization.Conclusions: Low pre-operative albumin (serum level <3.1 gm/dl) in patients undergoing major gastrointestinal surgery predicts severe post-operative complications, prolonged ICU and hospital stays.

Estimation of the effects of music therapy on the anxiety and patient’s perception during an upper gastrointestinal endoscopy procedure: a randomised controlled trial

Background: An upper gastrointestinal (GI) endoscopy procedure is an invasive medical procedure that is used in diagnosis and treatment of various intestinal disorders. Patients posted for upper GI endoscopy procedures often experience significant levels of pre-procedural fear, anxiety and discomfort during the procedure which can negatively affect cooperation levels during the procedure with the attending doctor. A very few studies have explored the beneficial effects of music therapy in this regard and so our study was planned.Methods: A prospective randomised controlled trial was conducted with a sample of 54 patients who were enrolled for this study. They were randomly divided into two groups - group 1 consisting of 27 patients, receiving a music therapy intervention and group 2 consisting of 27 patients who served as a control group. Group 1 received a receptive music therapy intervention in the form vocal, relaxing, improvisational music with patient preferred chants for fifteen minutes before and during the endoscopy procedure. Group 2 did not receive a music therapy intervention.Results: The results indicated that the post intervention, state-anxiety levels was significantly lower in the music therapy group compared to the control group with (p=0.001). Patients’ cooperation levels during the procedure with the attending doctor was significantly higher in the music therapy group than in the control group (p=0.001).Conclusions: Repeated music therapy intervention is highly beneficial in reducing state anxiety levels and improving cooperation levels during the GI endoscopy procedure.

Short-term preoperative parenteral nutrition benefits malnourished patients undergoing major gastrointestinal surgery

Background: Pre-operative nutritional support is of paramount in malnourished patients undergoing major gastrointestinal (GI) surgery. We aimed to investigate the outcomes of short term pre-operative parenteral nutrition in nutritionally depleted patients undergoing major GI surgeries.Methods: A retrospective study from tertiary care centre in South India, where nutritionally at risk patients undergoing major GI surgeries from 2016-2018 were identified and reviewed. Two groups –who received total or peripheral parenteral nutrition (TPN and PPN) and only enteral nutrition..Results: Of 80 patients who were nutritionally depleted underwent major GI surgery, 38 patients received pre-operative parenteral nutrition (PN) support for mean 11 days. Patients who received pre-op PN had similar outcomes (overall complication rate n=26, 68.4% vs n=32, 76.2% p=0.43), when compared to patients who received pre-op enteral nutrition conditioning. Though a small group of patients received peripheral PN supplementation, there was no difference in overall complication rate, when compared with TPN group (n=14, 58.3% vs n=12, 85.7%, p=0.08).Conclusions: Parenteral nutrition either total or supplemental is a useful adjunct pre-operatively for poorly nourished patients and should be utilized to build nutrition prior to major GI surgery. Pre-operative peripheral parenteral nutrition as supplement seems to be beneficial in patients undergoing GI surgery, pending large studies.

Assessment of preoperative serum albumin level and its correlation with postoperative wound complication in major elective abdominal surgeries

Background: Patients who have signs of malnutrition have a higher risk of complications and an increased risk of death in comparison with patients who have adequate nutritional reserves. It is common and occurs in about 30% of surgical patients with gastrointestinal diseases and in up to 60% of those in whom hospital stay has been prolonged because of postoperative complications. The serum albumin level is the most readily available and clinically useful parameter. A serum albumin level greater than 3.5 g% suggests adequate protein stores and it confers a protective effect through several biological mechanisms. It predicts perioperative morbidity and mortality.Methods: Our study was conducted on a cohort of 100 Patients admitted in Department of General surgery Hamidia Hospital for major elective surgery between October 2016 and September 2017. Sample size taken was 100.Results: The present study shows that patients with serum albumin less than 3 g/dl has more postoperative complications and patients with serum albumin >3.5 g/dl has less postoperative complications which was statistically significant. The study concludes that as the serum albumin level increases the complication rate decreases.Conclusions: Our study shows that sr. albumin is a good indicator of postoperative complications. The patients with sr. albumin <3.0 g/dl had a higher complication rate which was statistically significant (p<0.05). Patients with sr. albumin >3.5 g/dl had less complications which was statistically significant (p<0.05). The correlation between the serum albumin and complication rate was statistically significant in the malignant diseases when considered separately.

Analysis of clinico-demographic risk factors for postoperative pulmonary complications following gastrointestinal surgery

Background: Postoperative pulmonary complications (PPC) are one of the commonest complications following gastrointestinal surgery. They lead to increased mortality, increased length of intensive care unit (ICU) stay, and higher cost of treatment. Identifying the risk factors of PPC helps in predicting its occurrence and to develop preventive measures. The objectives of the present study were to study the clinical and demographic risk factors for PPC following gastrointestinal surgery.Methods: The study was designed as an observational descriptive analytic study. All the patients ≥18 years of age undergoing gastrointestinal surgery were included. The patients with preoperative lung pathology requiring ICU care or ventilatory support and patients with lung metastasis were excluded. The demographic and clinical parameters at admission were recorded. The details of pulmonary complications like the time of occurrence after surgery and the mode of treatment for pulmonary complications were noted. The risk association was assessed for statistical significance.Results: A total of 100 patients were underwent various gastrointestinal surgeries during the study period. The incidence of PPC was 34% in our study. Age, education status, smoking, and presence of comorbidities were found to be positively associated with an increased incidence of PPCs. The serum albumin of less than 3.5gm and the haemoglobin of less than 8 gm were also associated with an increased incidence of PPC. Pleural effusion was the commonest PPC seen in 15 (44.1%) patients followed by pneumonia in 9 (26.5%).Conclusions: Age, smoking, education status, serum albumin, haemoglobin, emergency surgery, elective postoperative ventilation, nasogastric intubation and blood loss in the intraoperative period were found to associated with increased risk of PPCs.

Impact of Intravenous Omega-3-Enriched Lipid Emulsion on Liver Enzyme and Triglyceride Serum Levels of Children Undergoing Gastrointestinal Surgery / 대한소아소화기영양학회지

Quality improvement of diagnosis and treatment of gastrointestinal cancer: establishment and implementation of the China Gastrointestinal Cancer Surgery Union Database / 中华胃肠外科杂志

Since the China Gastrointestinal Cancer Surgery Union was established, it has continuously collected the annual reports of 95 gastrointestinal surgery centers nationwide from 2014 to 2017, and collected data on more than 130 000 cases of gastric cancer. This article combines the experience of associated databases at home and abroad to analyze the construction of the China Gastrointestinal Cancer Surgery Union Database, and explore the role of multi-center cooperation and big data analysis in the promotion of gastrointestinal surgery. For a complete database to successfully achieve its ultimate goal, it needs clear goals, continuous funding, a qualified management team, consensus on data content, a high completion rate, and the support and cooperation of an advanced processing system. As a high-quality database with clear construction goals and database project construction based on the goals, while promoting the level of clinical diagnosis and treatment, it is also widely used in risk prediction model development, audit supervision, epidemiological research, health service research, and clinical hypothesis testing, etc. How to build a high-quality database to give a full promotion in clinical diagnosis and treatment is a huge challenge. Although the construction of medical databases in China has just started, we believe that with the further improvement in understanding, management and analysis capabilities for surgical databases, more databases including the China Gastrointestinal Cancer Surgery Union Database will make greater contributions in promoting the development of diagnosis and treatment of gastrointestinal cancer in China and the world.

Actualidad y tendencias de la cirugía gastrointestinal robótica / Current news and trends in gastrointestinal robotic surgery

Resumen La cirugía ha pasado de ser una ciencia rudimentaria caracterizada por el padecimiento de insufribles dolores por falta de anestésicos, de realizarse en lugares poco acondicionados y de utilizarse instrumental poco ortodoxo con consecuencias nefastas para el desenlace de los procedimientos debido principalmente a las infecciones, a ser un campo desarrollado donde la tecnología juega un rol trascendental para el objetivo final que es el bienestar del paciente. En las últimas décadas, la cirugía ha pasado del acceso abierto al laparoscópico, cirugía por orificios naturales (NOTES), cirugía laparoscópica de puerto único, hasta la cirugía robótica. Es un hecho que estamos en un momento de la historia de la humanidad en el cual el desarrollo de las tecnologías a cambiado nuestra vida cotidiana, así como también el de nuestra practica quirúrgica diaria y no podemos ser ajenos a esta. El propósito de esta revisión es mostrar la situación actual de la cirugía robótica gastrointestinal y sus perspectivas a futuro. Para esto se realizó una búsqueda en la base de datos medline con las palabras claves "review robotic surgery, robotic digestive surgery, robotic bariatric surgery, robotic esophagectomy, robotic gastrectomy, robotic hepatectomy, robotic pancreatectomy, robotic hernia repair". Además una búsqueda de datos en la web sobre "intutive investorpresentation, future of robotic surgery, digital surgery, new robotic system in surgery, trends in robotic surgery".

It is a fact that we are at a moment in the history of humanity in which the development of technologies has changed our daily lives, as well as that of our daily surgical practice. The fast evolution in technology has allowed surgery to evolve from a rudimentary science characterized by painful, highly invasive procedures, to a rapidly developing and precise field with ever improving patient outcomes. In recent decades, gastrointestinal surgery has gone from open access to laparoscopy, natural orifice transluminal endoscopic surgery (NOTES), single-port laparoscopic surgery, and more recently, robotic assisted surgery. The purpose of this review is to show the current situation of robotic gastrointestinal surgery and its future prospects. A literature review was conducted in the Medline database with the keywords "revision of robotic surgery, robotic digestive surgery, bariatric robotic surgery, robotic esophagectomy, robotic gastrectomy, robotic hepatectomy, robotic pancreatectomy, robotic hernia repair". In addition, online search engine data was conducted using the following key words "intutive investor presentation, future of robotic surgery, digital surgery, new robotic system in surgery, trends in robotic surgery"

Therapeutic alternatives for the prevention of intra peritoneal adhesions

Intestinal adhesions are bands of fibrous tissue created by the intimate contact of two injured surface tissues; these appear in 93% of the patient undergoing intra-abdominal or gastrointestinal surgery. The comorbidities associated with the formation of adhesions have an impact on quality care offered to patients, leading to an increase in healthcare. Goals of this study was to perform a review that includes different therapeutic alternatives in basic and clinical research to prevent the formation of postoperative abdominal peritoneal adhesions. A bibliographic search was conducted in different databases including Pub med, Medline, Cochrane, science direct, from the years 2000 to 2018 using the keywords: gastrointestinal adhesions, small bowel obstruction, prophylaxis, treatment. Only experimental and clinical articles were selected. The development of peritoneal adhesions in most of the experimental studies occurred with cecal abrasion, studying the effect of biodegradable materials, drugs and gels such as mXG Hydrogel. Nanofiber membranes, agents created with recombinant technology such as periostin antisense oligonucleotide and aerosol applications such as polysaccharide 4DryField PH, are positioned to replace in the future the actual limited mechanical barriers application commonly used in abdominal surgery such as seprafilm and interceed. There are several anti-adhesion agents in experimental phase with different mechanism of action that could be used in the short term to prevent the formation of post-surgical intestinal adhesions. The inclusion of gastrointestinal surgeons in basic research is increasing and necessary with multidisciplinary collaboration. It is expected in short term the study and development of a greater number of materials to minimize tissue trauma and decrease the formation of post-surgical adhesions.

Intercostal celiotomy for removal of proventriculus foreign body in muscovy duck (Cairina moschata): case report / Celiotomia intercostal para remoção de corpo estranho do proventrículo de pato-do-mato (Cairina Moschata): relato de caso]

Ducks, geese and swans are included in the Anatidae family, Anseriformes order. The leading injuries causes to waterfowl are tangling in fishing materials and foreign bodies ingestion. A muscovy duck (Cairina moschata) was referred for treatment at Veterinary Teaching Hospital and a radiographic examination showed the presence of a hook in the coelom. Surgical exposure and incision of the proventriculus was made through left intercostal access and the hook along with a fishing line were gently removed. The animal began to feed voluntarily at the fourth post-operative day and two weeks after the procedure the patient was clinically well and was released to wild. This surgical approach differs in some aspects from the listed techniques in the known literature. It proved to be a viable and appropriate alternative to treat this affection since it did not cause any trans- or post-operative complications and enabled rapid recovery and subsequent patient release.(AU)

Patos, gansos e cisnes estão incluídos na família Anatidae, ordem Anseriformes. Entre as principais causas de ferimentos em aves aquáticas, o embaraço com materiais de pesca e a ingestão de corpos estranhos são os mais citados. Um pato-do-mato (Cairina moschata) foi encaminhado para tratamento no Hospital Veterinário e, mediante exame radiográfico, verificou-se a presença de um anzol na cavidade celomática, provavelmente no proventrículo. Utilizando-se o acesso intercostal esquerdo, foi feita a exposição e a incisão do proventrículo. Por meio dessa incisão, o anzol com um segmento de linha de pesca foi delicadamente retirado. O animal começou a se alimentar voluntariamente no quarto dia pós-operatório e duas semanas após o procedimento o paciente se encontrava clinicamente bem e apto à soltura. Esta abordagem cirúrgica difere, em alguns aspectos, das técnicas listadas na literatura e provou ser uma alternativa viável e adequada ao caso, não causando complicações e permitindo recuperação rápida, com posterior soltura do animal.(AU)

A decade′s review for the foundation, establishment and development of the Department of Minimally Invasive Gastrointestinal Surgery in Peking University Cancer Hospital / 中华胃肠外科杂志

Department of minimally invasive gastrointestinal surgery in Peking University Cancer Hospital (also named as Department of Gastrointestinal Surgery IV) was established on April 7, 2009. Up to now, ten years have passed since its foundation. As the first department built in specialized cancer hospital, which mainly focuses on laparoscopic surgery, its foundation and development has a very important historical and practical significance in the development of surgical oncology in China. Reviewing the rapid growth of the Department of Minimally Invasive Gastrointestinal Surgery over the past decade, on the one hand, it has benefited from the opportunities of the times and the support of leaders in Peking University Cancer Hospital at that time. More importantly, the progress owes to the pioneering Professor Su Xiangqian, who is brave and innovative, with indomitable spirit and advanced management philosophy. With rigorous training, the ability of the team has been steadily enhanced, the competitiveness has been gradually improved, and the development direction which focuses on laparoscopic gastric cancer surgery and laparoscopic colorectal cancer surgery has been established. Now, the Department of Minimally Invasive Gastrointestinal Surgery has become a well-known domestic gastrointestinal tumor center. In the past ten years, under the leadership of Professor Su Xiangqian, the growth of this team is innovative and comprehensive: (1) Introduce the internationally advanced Baldrige medical service management framework, and propose the "management by principle" concept to improve the core competitiveness of the department; (2) Establish an academic brand by laparoscopic standardized surgery training courses for gastrointestinal tumors, promote cooperation and exchange at home and abroad, and participate in international multi-center clinical research projects; (3) Adhere to the "formation of a research-oriented department, conducting clinical and basic research simultaneously" as the development direction; (4) Stick to the core development concept of team building and cultivate professional talents. Looking forward to the future, our team will not forget the beginning of the heart, and move forward! In the next ten years, we will break through ourselves and continue to pursue the higher level!

Effects of enhanced recovery after surgery on postoperative recovery, psychological state of patients with laparoscopic gastrointestinal surgery / 中国中西医结合急救杂志

Objective To explore the effects of enhanced recovery after surgery (ERAS) on postoperative recovery, psychological state and complications of patients with laparoscopic gastrointestinal surgery. Methods Ninety-eight patients with laparoscopic gastrointestinal surgery admitted to Huzhou Central Hospital from January 2016 to December 2017 were enrolled and they were divided into two groups (49 cases in each group) according to difference in nursing. During peri-operative period, the routine nursing group was given routine nursing; while the ERAS nursing group received the nursing of ERAS. The postoperative recovery, inflammatory response and nutritional status, complications, psychological state and nursing satisfaction were compared between the two groups. Results Compared with the routine nursing group, the gastrointestinal tract exhaust time, common food intake time, incision healing time, ambulation time and hospital stay were significantly shorter in ERAS nursing group [gastrointestinal tract exhaust time (days): 2.43±1.02 vs. 3.46±1.15, common food intake time (days): 4.24±1.36 vs. 6.23±1.52, incision healing time (days): 7.62±1.54 vs. 9.63±1.63, ambulation time (days): 8.80±2.32 vs. 11.24±2.02, hospital stay (days):10.23±2.12 vs.14.56±2.37, all P < 0.05]. After operation, the high-sensitivity C-reactive protein (hs-CRP) in the two groups was increased first and then decreased, and the levels of transferrin (TRF) and prealbumin (PA) were decreased first and then increased, and the differences were statistically significant at different time points within-groups (P < 0.05), and the changes of indexes in the 5 days after operation in the ERAS nursing group were more significant than those in the routine nursing group [hs-CRP (mg/L): 27.4±6.2 vs. 35.6±9.1, TRF (g/L): 1.89±0.05 vs. 1.81±0.06, PA (mg/L):340±20 vs. 280±20, all P < 0.05]. The postoperative incidences of nausea and vomiting and sore throat in ERAS nursing group were significantly lower than those in routine nursing group [nausea and vomiting: 32.65% (16/49) vs. 67.35% (33/49), sore throat: 12.24% (6/49) vs. 51.02% (25/49), both P < 0.05], and there were no significant differences in postoperative incidences of abdominal distension, incision infection, pulmonary infection and anastomotic leakage between the two groups [abdominal distension: 4.08% (2/49) vs. 6.12% (3/49), incision infection: 4.08% (2/49) vs. 6.12% (3/49), pulmonary infection: 2.04% (1/49) vs. 6.12% (3/49), anastomotic leakage: 2.04% (1/49) vs. 4.08% (2/49), all P >0.05]. The scores of self-rating anxiety scale (SAS) at discharge in the two groups were lower than those before operation, and the degree of decrease in ERAS nursing group was greater than that in routine nursing group (39.21±4.64 vs. 46.56±4.53, P < 0.05). The nursing satisfaction rate in ERAS nursing group was significantly higher than that in routine nursing group [95.92% (47/49) vs. 77.55% (38/49), P < 0.05]. Conclusion ERAS for laparoscopic gastrointestinal surgery not only can promote the recovery of gastrointestinal function, improve the nutritional status and reduce inflammatory response and postoperative complications, but also can relieve anxiety, shorten hospital stay and elevate nursing satisfaction, therefore it is worthy to promote and apply in clinical nursing.