Establishment and evaluation of a nomogram model for predicting postoperative frailty in elderly patients with gastrointestinal tumors / 中国实用护理杂志

Objective:To analyze the influencing factors of postoperative frailty in elderly patients with gastrointestinal tumors, establish a nomogram model for predicting postoperative frailty and evaluate its efficacy, so as to provide reference basis for formulating perioperative frailty management plans for elderly gastrointestinal tumor patients in the later stage.Methods:Convenience sampling method was used to select 376 elderly patients with gastrointestinal tumors who underwent surgical treatment in the First Affiliated Hospital of Anhui Medical University from December 2021 to August 2022 as the study objects. On the 5th day after surgery according to Tilburg Frailty Indicator, the patients were diagnosed whether they developed postoperative frailty and were divided into postoperative frailty group and postoperative non-frailty group. General data, laboratory indicators and clinical data of patients were collected. Univariate analysis and multivariate Logistic regression analysis were used to screen the independent influencing factors of postoperative frailty in elderly patients with gastrointestinal tumors. R software was used to establish a nomogram prediction model and conduct internal validation to evaluate the differentiation, calibration and clinical applicability of the model.Results:A total of 265 males and 111 females included aged (70.04 ± 5.89) years old, with 222 (59.0%) patients experienced postoperative frailty in this study. Multivariate analysis showed that low Barthel Index score ( OR=0.941, 95% CI 0.903-0.980), low hemoglobin ( OR=0.976, 95% CI 0.963-0.989), high Charison Comorbid Index score ( OR=1.457, 95% CI 1.128-1.882), preoperative frailty ( OR=4.369, 95% CI 1.486-12.841), and pathological stage Ⅲ-Ⅳ ( OR=2.053, 95% CI 1.253-3.364) were independent influencing factors for postoperative frailty of elderly gastrointestinal tumors (all P<0.05). The AUC before and after internal validation of the nomogram model was 0.811 (95% CI 0.768-0.854) and 0.803 (95% CI 0.762-0.856) respectively. The results of Hosmer-Lemeshow test showed good goodness of fit ( χ2=4.09, P>0.05). Decision curve analysis showed that the model had certain clinical applicability. Conclusions:Based on the risk factors of postoperative frailty in elderly patients with gastrointestinal tumors, the nomogram prediction model was established, which has good differentiation, consistency and clinical applicability, and can provide reference for clinical staff to make perioperative frailty management plan.

Obstacle analysis of evidence-based nursing application of standardized management of stress hyperglycemia during perioperative period in gastrointestinal tumor patients / 中国实用护理杂志

Objective:To carry out evidence-based nursing for standardized management of stress hyperglycemia in perioperative period of gastrointestinal tumor patients, and to formulate indicators, analyze obstacles and promoting factors, formulate action strategies.Methods:Guided by the Johns Hopkins evidence-based nursing model, evidence were searched, evaluated and summarized. Clinical indicators and review methods were formulated to carry out quality review. From November 2021 to April 2022, the medical staff and patients in the gastrointestinal surgery department of the First Affiliated Hospital of Anhui Medical University who met the inclusion criteria were conducted, and the incidence of compliance rate was calculated. Based on the results of the baseline review, the obstacles and contributing factors were analyzed.Results:A total of 26 pieces of best evidence were included and 14 indicators were formulated for 48 medical staff and 45 patients to clinical review, among which the compliance rate of 7 indicators was less than 60%. The main obstacle factors were lack of procedures and instruments for management of perioperative stress hyperglycemia in gastrointestinal tumor patients, lack of knowledge of medical staff, etc. The main promoting factors were organizational support, good atmosphere of medical team cooperation, strong willingness to change, etc.Conclusions:There is a big gap between the clinical practice and the best evidence of perioperative stress hyperglycemia management in patients with gastrointestinal tumor. Action strategies should be put forward for obstacles and promoting factors to promote evidence transformation.

Correlation between Helicobacter pylori infection and gastrointestinal tumor in the physical examination population in Xi'an City / 公共卫生与预防医学

Objective To analyze the spatial distribution of Helicobacter Pylori (Hp) infection and its correlation with gastrointestinal tumors in the physical examination population of Xi'an city, and to provide reference for the prevention of gastrointestinal tumors in this area. Methods A total of 23 200 subjects who underwent physical examination in 25 public hospitals in Xi'an from January 2019 to January 2023 were selected as the research objects. The basic Information of the patients was derived through the Hospital Information System (HIS), and all subjects underwent 13C-breath test and gastroenterological endoscope. ArcGIS 10.6 software was used to draw a statistical map of Hp infection in Xi 'an for spatial autocorrelation analysis. Hp infection in patients with different gastrointestinal tumors was analyzed. Results In this study population, there were 10 858 cases of Hp infection , with an infection rate of 46.80% ; among them , 5 491 cases were male, with an infection rate of 46.60% , and 5,367 cases were female, with an infection rate of 47.01% , and there was no significant difference in the infection rate between genders (P>0.05). The prevalence of HP infection was higher in the 30-year-old and 20-year-old groups, 55.62% and 42.71%, respectively, and the infection rate showed a first increase and then a decreasing trend with age (χ2trend = 6201.21, 6945.22 , P2=13.49, 16.16, 17.27, 24.66, P<0.05 for all). Conclusion The distribution of Hp infection in the physical examination population of Xi'an city has the characteristics of spatial aggregation and is related to gastrointestinal tumor diseases. It is suggested to carry out Hp infection education for the population in key areas to prevent the occurrence of gastrointestinal tumor diseases.

Desmoid-type fibromatosis of the mesentery: a clinicopatho-logical and genetic analysis of 9 cases / 浙江大学学报·医学版

Nine cases of mesenteric desmoid-type fibromatosis were diagnosed and treated in Taizhou Hospital, Wenzhou Medical University between January 2010 and May 2022, including 2 females and 7 males, aged 16 to 59 years. The lesions were in the mesentery of small intestine with 7 cases, ileocecal junction with 1 cases and transverse colon with 1 case. The tumors had an unclear boundary and no envelope, the section was solid, gray and tough. The mean maximum diameter was (10.7±8.5) cm (range 3.5-33.0 cm). Microscopically, fusiform fibroblasts and myofibroblasts were parallel, bunched or staggered, buried in a large amount of extracellular collagen. The cell morphology was relatively consistent, without obvious atypia, and mitosis was rare. Immunohistochemistry showed that the tumor cells were positive for vimentin (9/9), β-catenin (9/9), while smooth muscle actin (5/9) stains were focally positive. Ki-67 proliferation index was 1%-10%. Cytokeratin Pan, S-100, STAT6, CD117, DOG1, CD34, desmin and anaplastic lymphoma kinase stains were negative. Genetic analysis showed that there were 7 cases of c.121G>A(p.Thr41Ala) mutation of CTNNB1 gene, 1 case of c.121G>A(p.Thr41Ala) and 1 case of c.134C>T(p.Ser45Phe) double mutation, and 1 case of wild type. Tumors were surgically resected in all 9 cases. Eight cases had no recurrence or metastasis, 1 case had recurrence 6 months later, and no recurrence or metastasis after additional surgical resection.

Effects of sarcopenia on physical performance and nutritional status in elderly patients with gastrointestinal tumors / 中华临床营养杂志

Objective:To investigate the effect of sarcopenia on physical performance and nutritional status in elderly patients with gastrointestinal tumors.Methods:a total of 120 eligible in-patients were enrolled from gastrointestinal surgery department of a Grade A tertiary hospital in Ningbo city from September 2021 to January 2022. General clinical data were collected, nutritional risk was screened using Nutritional Risk Screening 2002 (NRS 2002), physical performance was assessed by Short Physical Performance Battery (SPPB), skeletal muscle index at the third lumbar vertebra level (L3 SMI) was calculated using abdominal CT scan, and grip strength/muscle strength, gait speed by 6 Meter Timed Walk Test and calf circumference were measured. Subjects were divided into sarcopenia and non-sarcopenia group according to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS). Impacting factors of sarcopenia and the correlation between muscle mass and physical performance in elderly patients with gastrointestinal tumors were analyzed.Results:The overall prevalence rate of sarcopenia in elderly patients with gastrointestinal tumors was 28.3% (34/120) and it was 28.9% (22/76) and 27.3% (12/44) in males and females respectively. There were statistically significant differences in age, tumor stage, nutritional risk, body mass index, calf circumference, L3 SMI, grip strength/muscle strength, gait speed and SPPB score between patients with and without sarcopenia (P<0.05). Muscle strength/grip strength, L3 SMI and gait speed were closely correlated with the occurrence of sarcopenia in elderly patients with gastrointestinal tumors (P<0.05). The L3 SMI was positively correlated with physical performance as assessed with SPPB in both groups.Conclusions:Sarcopenia is a common complication in elderly patients with gastrointestinal tumors with multiple influencing factors. Timely nutritional intervention and exercise intervention should be incorporated into the treatment of elderly gastrointestinal tumor patients with sarcopenia in order to improve nutrition status.

Analysis of microbiota characteristics in tumor tissues sampled under gastroscope / 中华微生物学和免疫学杂志

Objective:To investigate the characteristics of bacterial community in upper gastrointestinal tumors.Methods:The study population was patients with upper gastrointestinal tumors (esophageal cancer and gastric cancer). Gastroscopy was performed on the enrolled patients ( n=17), and the specimens were taken from the tumor sites. At the same time, non-tumor tissues more than 4 cm away from the tumor tissues were taken as the control. After total DNA was extracted and purified, high-throughput 16S DNA gene sequencing was used to detect the microbiota in tumor tissues and control tissues. Bioinformatics analysis was carried out and the differences between groups were compared. Results:16S DNA PCR showed that there was no significant difference in bacterial load between tumor tissues and control tissues. The α-diversity and β-diversity indexes showed that the community composition of the two groups was similar; the samples were discrete and the colony composition was different, but there was no significant difference between the two groups. The results of Venn diagram showed that there were more operational taxonomic units (OTUs) in non-tumor tissues than in tumor tissues (2 068 vs 1 358), indicating that the bacterial species in normal tissues were more abundant than those in tumor tissues. Compared with the control tissues, the percentages of Prevotellaceae ( Prevotella), Lactobacaceae ( Lactobacillus) and Fusobacteriaceae ( Fusobacterium) in tumor tissues were relatively higher (the average percentage was more than twice that of the control). Further paired comparison of the top ten bacteria in the family and genus abundance of the two groups of samples showed that Pseudomonas decreased significantly in tumor tissues at the family ( P=0.041) and genus ( P=0.041) levels, while Prevotella was significantly enriched in tumor tissues at the family ( P=0.031) and genus ( P=0.007) levels. Conclusions:The bacterial community in the tumor microenvironment of the upper gastrointestinal tumor changed, and the species enriched in the tumor site were mainly oral common anaerobic bacteria, such as Prevotellaceae ( Prevotella), Lactobacaceae ( Lactobacillus) and Fusobacteriaceae ( Fusobacterium), especially Prevotellaceae ( Prevotella).

Investigation on the status and influencing factors of caregivers′ empowerment after gastrointestinal tumor surgery / 中国实用护理杂志

Objective:To describe the status and influencing factors of the empowerment of caregivers after gastrointestinal tumor.Methods:From March 2019 to October 2019, using convenience sampling method, 124 pairs of gastrointestinal tumor patients and caregivers who were hospitalized in the general surgery and anorectal surgery of the department of Shandong Tai′an City Central Hospital and the Second Affiliated Hospital of Shandong First Medical University were selected as the subjects. A general information questionnaire, Main Caregivers′Empowerment Measurement were used as research tools. To investigate the empowerment ability of caregivers of patients with gastrointestinal tumors after operation.Results:The total caregiver′s empowerment score was 168.81 ± 19.49. The scores of each dimension ranged from high to low: relationship with caregivers (3.83 ± 0.43), expectation of care outcomes (3.80 ± 0.43), awareness of caregiving roles (3.70 ± 0.51), caregivers′ subjectivity (3.37 ± 0.60), caregiving beliefs (3.34 ± 0.67), caregiving knowledge and skills (3.27 ± 0.73), personal resources (2.94 ± 0.65), goodwill caregiving (2.85 ± 0.65) , the scruples around (2.75 ± 0.88). Multiple linear regression results showed that, patient gender, whether the disease is first attack, whether the patient is aware of the disease, the caregiver marriage, and the caregiver working status were the influencing factors of the caregiver′s empowerment ability after gastrointestinal tumor operation ( t values were -8.15-8.72, R2=0.62, all P<0.05). Conclusions:There is room for further improvement in the empowerment of caregivers after gastrointestinal tumor surgery, especially in personal resources, goodwill care and scruples around. The results suggest that medical staff should guide caregivers to emancipate their minds, enhance the breadth of empowerment, and promote self care and fast rehabilitation of patients.

Perioperative changes of body weight, skeletal muscle and fat mass in patients with benign and malignant gastrointestinal tumors and the comparison / 中华临床营养杂志

Objective:To describe and compare the perioperative changes of body weight, skeletal muscle and fat mass in patients with benign and malignant gastrointestinal tumors.Methods:All adult patients admitted to the surgery department of a referral hospital in Beijing with voluntary consent were included in the study. For all participants, preoperative medical history were collected and body composition measurements were performed 1-2 days prior to the surgery and 3-6 days after the surgery. Pathological results and tumor diagnosis were recorded.Results:A total of 80 participants completed the study. There was no significant difference in weight and body composition between patients with benign and malignant tumors before operation, but patients experiencing a weight loss of more than 5% in the past 6 months were dramatically more in malignant tumor group compared with benign tumor group (9.1% vs. 42.0%, P=0.024). With the parenteral and enteral nutrition support, there was no significant difference in the changes of weight, muscle, or fat mass between benign and malignant tumor patients in different stages (all P>.05). Patients with malignant tumors were divided into severe weight loss group and observational group with the percentage weight loss cut-off of 5%. Analysis showed that patients in the severe weight loss group had significantly decreased weight [(-4.3±1.6)kg vs. (-1.9±1.1)kg, P<0.01], BMI[(-1.3±0.9)kg/m 2vs. (-0.7±0.4)kg/m 2, P<0.01], muscle[(-1.2±2.0)kg vs. (-0.4±1.2)kg, P=0.046] and fat mass [(-2.6±2.0)kg vs. (-1.1±0.9)kg, P=0.018] compared with observational group, while visceral [(-0.5±0.6)kg vs. (-0.2±0.7)kg, P=0.107] and subcutaneous fat [(-2.2±1.9)kg vs. (-1.4±1.8)kg, P=0.235] of two groups had no significant difference. Univariate analysis revealed age as the only influencing factor for perioperative weight loss ( P=0.036). Fat loss was predominant in the overall weight loss compared with muscle loss ( P=0.026) among patients with gastrointestinal malignant tumors. Conclusion:With parenteral and enteral nutrition support, there is no significant difference in perioperative changes of weight, muscle or fat mass among patients with benign and malignant tumors. Muscle and fat loss both have contributed to the overall weight loss, which is noteworthy.

Clinical research progress for nivolumab in the treatment of advanced gastric cancer / 中国肿瘤临床

The gastric cancer incidence rate is the highest in East Asia and South and Central America. The rates are particularly high in Japan and Korea, where gastric cancer is the main cause of death in men, and in China, where gastric cancer is a leading cause of cancer-related mortality. Presently, the 5-year survival rate of advanced gastric cancer is estimated to be approximately 5%-20%, and there is no effective treatment. Immunotargeting drugs can reverse the immune escape associated with the immune checkpoint pathway, thus changing the treatment strategy for patients with advanced gastric cancer. As a humanized IgG4 monoclonal antibody designed to bind programmed death-1 (PD-1) and block the interaction between PD-1 and its ligand, nivolumab was the first immune-checkpoint inhibitor approved for gastric cancer in China. This drug made a breakthrough in the“shortage of the posterior line”in the treatment of gastric cancer in China. In this paper, the mechanism of action, clinical trials, immune-related adverse events, hyper-progressive disease, pseudo-progression of the tumor, biomarkers, and other aspects of the latest research progress on nivolumab are reviewed.

Clinical Observation of Effects of Modified Xiangsha Liujunzi Tang Application on Adverse Reaction of Moderately/Highly Emetogenic Chemotherapy for Gastrointestinal Tumors / 中国实验方剂学杂志

Objective:To investigate the effects of external application of modified Xiangsha Liujunzi Tang in improving gastrointestinal reaction，immune function， and quality of life in patients with gastrointestinal tumors after moderately/highly emetogenic chemotherapy. Method:A total of 140 inpatients （from January 2018 to May 2021） with gastrointestinal malignancies diagnosed by the Oncology Department of Integrated Traditional Chinese and Western Medicine of China-Japan Friendship Hospital and treated with moderately/highly emetogenic chemotherapy were randomly divided into an experimental group （<italic>n</italic>=70） and a control group （<italic>n</italic>=70） according to the Good Clinical Practice （GCP）. Participants were given routine antiemetic treatment once 20 minutes before chemotherapy （tropisetron 5 mg + dexamethasone 5 mg or methylprednisolone 40 mg）. On this basis， the patients in the experimental group were treated with external application of modified Xiangsha Liujunzi Tang for 1 week on the second day after chemotherapy （the selected points were Zhongwan， Neiguan and Zusanli， 6 hours a day， and the application was changed every day）， and the patients in the control group were applied with comfort patch at the same time. The gastrointestinal reaction grade， subset concentration of lymphocytes， and Karnofsky score in two groups before and one week after chemotherapy were recorded， and all data were analyzed by SPSS 19.0 statistical software. Result:The grades of chemotherapy-related gastrointestinal reaction in two groups after treatment decreased as compared with that before treatment （<italic>P</italic><0.05）. The experimental group was superior to the control group after treatment in terms of grade decrease （<italic>P</italic><0.05）. The total response rate of the experimental group was 81.43% （57/70）， higher than 62.86% （44/70） in the control group （<italic>χ</italic>²=9.73， <italic>P</italic><0.05）. Stratified analysis was performed on the experimental group. Compared with the conditions before treatment， the grade of gastrointestinal reaction in patients with esophageal cancer and colorectal cancer of the experimental group decreased after treatment （<italic>P</italic><0.05）， and that in patients of different genders decreased after treatment （<italic>P</italic><0.05）. The results of immune function showed that there was no significant difference in the concentrations of CD3⁺， CD4⁺， CD8⁺， and NK cell subsets of the control group before and after treatment， while the concentrations of CD3⁺， CD4⁺， and NK cell subsets of the experimental group were higher than those before treatment and even superior to those in the control group （<italic>P</italic><0.05）. The Karnofsky score of quality of life in the experimental group was higher than that in the control group， with quality of life improved （<italic>P</italic><0.05）. Conclusion:External application of modified Xiangsha Liujunzi can improve the gastrointestinal reaction，immune function， and quality of life of patients with gastrointestinal tumors after moderately/highly emetogenic chemotherapy.

Treatment strategy for gastrointestinal tumor under the outbreak of novel coronavirus pneumonia in China / 中华胃肠外科杂志

The outbreak of the novel coronavirus pneumonia (NCP) has become a public health emergency in China. Chinese authorities and health agencies had devoted great efforts to control this disease. As surgeons specialized in the treatment of gastrointestinal tumors, we should always be aware of the prevention for NCP and incorporate this awareness into every detail of clinical practice. For the patients with gastrointestinal tumors, pre-admission screening should be done in order to rule out NCP. Real-time RT-PCR panel and chest CT scan should be conducted for patients with fever (>37.3℃), travel history to Hubei Province within 14 days, or contact history with residents from Wuhan district within 14 days. Prevention measures for both medical staffs and the screen-negative admitted patients should also be enhanced because false negative is possible. Medical instruments should be properly discarded or disinfected according to standardized procedures established by the local center for disease control and prevention (CDC). Surgical operation should be reduced at a minimal level to prevent cross infection in this special period.Surgical intervention for benign tumor should be postponed. For malignant tumor, multidisciplinary therapy (MDT) is recommended and non-surgical anti-tumor therapy should be selected with higher priority. Neoadjuvant therapy is highly recommended for gastrointestinal cancer at advanced stages that meet the indications of NCCN guideline (gastric cancer T stage ≥ 2/rectal cancer T stage ≥ 3/unresectable colon cancer). Gastric or esophagogastricjunction (EGJ) malignant tumor with obstruction can be managed with gastric tube decompression or stent placement to relieve the symptoms. Transnasal enteral feeding tube intubation/percutaneous endoscopic gastrostomy could be adopted to ensure enteral nutrition supply. For colorectal malignancy with simple intestinal obstruction, stent placement can achieve a high success rate, which not only helps avoid emergency surgery, but also creates a better condition for subsequent surgery. Transcatheter arterial embolization for hemostasis is an alternative choice for gastrointestinal tumor with bleeding. However, emergency operation still must be performed for patients with acute uncontrolled bleeding, obstruction or after other alternative treatment measures fail. All cases with suspicious or confirmed with NCP must be reported to the local CDC department. All invasive intervention must be performed in a designated isolation area. Tertiary prevention measure must be adopted for all anesthetists with additional face mask or medical goggle protection to prevent respiratory droplet transmission. Preventive enterostomy is preferable in lower digestive tract surgery. Thoroughly disinfecting the operating room after surgery is necessary. Fever after surgery must be carefully differentiated whether it's caused by post-surgery abdominal infection/inflammation or NCP. Single-room isolation and related examinations should be performed according to the standard procedures. We believe that with the unprecedentedly joint efforts of doctors and patients, we will eventually win this war against NCP.

Analysis of factors influencing postoperative gastrointestinal function recovery in patients undergoing hyperthermic intraperitoneal chemotherapy / 上海交通大学学报（医学版）

Objective · To investigate the effect of hyperthermic intraperitoneal chemotherapy on postoperative gastrointestinal function recovery in patients with gastrointestinal cancer. Methods · Sixty-two cases of gastrointestinal cancer patients were enrolled who accepted cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, from July 2014 to June 2017. The gastrointestinal function of patients were evaluated according to the I-FEED scoring system. The patients were divided into normal recovery group (I-FEED score＜6, n=38) and delayed recovery group (I-FEED score ≥ 6, n=24). Univariate and multivariate Logistic analyses were performed on characteristic factors that may affect the recovery of postoperative gastrointestinal function including gender, age, presence of diabetes, preoperative albumin, and so on. Results · There were significantly differences in the preoperative serum albumin level (P=0.040), intraoperative bleeding (P=0.044), the time of extraction of the peritoneal cavity drainage tube (P=0.026), the time of urethral tube extraction (P=0.021) and the time of hospitalization (P=0.017) in the two groups of patients with normal or delayed gastrointestinal function recovery. Multivariate Logistic regression results suggested that preoperative serum albumin level may be beneficial for the recovery of postoperative gastrointestinal function (OR=0.84, 95％ CI 0.17-4.27, P=0.041).Conclusion · The preoperative serum albumin level can be used as an independent predictor of postoperative gastrointestinal functional recovery in patients with gastrointestinal cancer after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.

Effect of emotional resilience group training on fatigue and sleep quality of patients with gastrointestinal cancer / 中华行为医学与脑科学杂志

Objective To observe the effect of emotional resilience group training on fatigue and sleep quality of patients with gastrointestinal cancer.Methods A total of 321 hospitalized patients with gastrointestinal cancer were randomly divided into experimental group (160 cases) and control group (161 cases) by random number table.Two groups of patients were treated with routine nursing care.In addition,the experimental group was given 8 weeks of emotional resilience group training once a week.The effect of intervention was assessed by the cancer fatigue scale (CFS) and Pittsburgh sleep index (PSQI) before and after the intervention.Result There was no significant difference in CFS and PSQI between the two groups before intervention (t=0.18,1.82,P＞0.05).After intervention,there was no significant difference in the total scores and each dimension scores of CFS and PSQI in the control group (P＞0.05).The total scores of CFS and PSQI in the intervention group (13.72± 1.33 and 10.62± 1.01) were significantly lower than those before intervention (25.35 ± 2.07 and 17.38 ± 2.69).The dimensions of CFS,sleep quality,sleeping time,sleep disorder,hypnotic drug use and daytime dysfunction were significantly lower than those before intervention (P＜0.01,P＜0.05).After intervention,there were significant differences in scores of CFS,somatic,cognitive and emotional dimensions between the two groups (t=18.21,-36.94,-13.17,-6.17,P＜0.01),and the scores of PSQI,sleep quality,sleeping time,sleep disorder,hypnotic use and daytime dysfunction were statistically different between the two groups (t=19.96,-82.86,-16.59,-9.39,-28.00,-9.25,P＜ 0.01).Conclusion Emotional resilience group training can effectively reduce the fatigue of patients with gastrointestinal cancer and improve sleep quality.

Analysis of factors influencing postoperative gastrointestinal function recovery in patients undergoing hyperthermic intraperitoneal chemotherapy / 上海交通大学学报（医学版）

Objective • To investigate the effect of hyperthermic intraperitoneal chemotherapy on postoperative gastrointestinal function recovery in patients with gastrointestinal cancer. Methods • Sixty-two cases of gastrointestinal cancer patients were enrolled who accepted cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, from July 2014 to June 2017. The gastrointestinal function of patients were evaluated according to the I-FEED scoring system. The patients were divided into normal recovery group (I-FEED score<6, n=38) and delayed recovery group (I-FEED score ≥ 6, n=24). Univariate and multivariate Logistic analyses were performed on characteristic factors that may affect the recovery of postoperative gastrointestinal function including gender, age, presence of diabetes, preoperative albumin, and so on. Results • There were significantly differences in the preoperative serum albumin level (P=0.040), intraoperative bleeding (P=0.044), the time of extraction of the peritoneal cavity drainage tube (P=0.026), the time of urethral tube extraction (P=0.021) and the time of hospitalization (P=0.017) in the two groups of patients with normal or delayed gastrointestinal function recovery. Multivariate Logistic regression results suggested that preoperative serum albumin level may be beneficial for the recovery of postoperative gastrointestinal function (OR=0.84, 95% CI 0.17-4.27, P=0.041). Conclusion • The preoperative serum albumin level can be used as an independent predictor of postoperative gastrointestinal functional recovery in patients with gastrointestinal cancer after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.

Clinical application of linked color imaging in gastrointestinal endoscopy / 中国实用内科杂志

Linked color imaging(LCI) was a novel image-enhanced endoscopic technology, which has been gradually applied in clinical practice. Several studies have verified that LCI could improve the endoscopic diagnostic accuracy for gastrointestinal mucosal lesions via increasing the contrast between abnormal and normal mucosa. Although the value of LCI in clinical application has already been widely acknowledged by clinicians both at home and abroad, there are still some problems like the improper usage of LCI and the unclear definition of certain LCI terms, which hinders the further clinical application and related research on LCI. Thus, this issue was discussed together by famous experts on gastrointestinal endoscopy in China, and the main points were summarized and written following related clinical guidelines in this field according to the recent research and clinical evidence on the LCI diagnosis for gastrointestinal lesions.

Effect of goal-directed fluid therapy guided by SVV on gastrointestinal function in patients undergoing resection of gastrointestinal tumor / 临床麻醉学杂志

Objective To investigate the effect of SVV guided fluid therapy on blood gas and lipopolysaccharide (LPS),procalcitonin (PCT) in patients undergoing resection of gastrointestinal tumor.Methods Sixty patients aged 60 85 years from Jan,2016 to Feb,2017 falling into ASA physical status Ⅱ or Ⅲ,scheduled for elective radical operations for gastrointestinal cancers,were includ ed and randomly divided into two groups (n =30 each) using a random number table:ScvO2 guided fluid therapy (group C),SVV guided fluid therapy (group G).MAP,HR and CVP of patients were recorded at the same time before anesthesia (T0),tumor removal (T1) and the end of surgery (T2)respectively.PH,BE,HCO3-and Lac of venous blood samples and artery blood samples at T0-T2,6 hours after surgery(T3) were recorded.Venous blood samples were collected at T0,T3 to detect LPS and PCT.Crystalloid requirements,colloid requirements,total volume,bleeding volume,peritoneal fluid volume and the use of dopamine were recorded.The time of PACU,time when the patients first exhausted and was fed after operation,length of hospital stay after operation were recorded.Results Compared with group C,BE of artery blood was obviously increased at T2,T3 in group G (P＜0.05);the Lac of artery at T2 and the Lac of artery and venous blood at T3 in group G was obvi ously decreased.LPS and PCT were decreased at T3 in group G (P＜0.05).Compared with group C,the needed colloid was increased in group G,the needed crystalloid and total volume of fluid infused were decreased in group G (P＜0.05).Compared with group C,the time of PACU starting to exhaust and feed,length of hospital was shortened in group G (P＜0.05).Conclusion SW guided goal directed fluid therapy is more conductive to maintain the acid base and reduce the incidence of in fection for the patients with gastrointestinal tumor operation,promote the recovery of gastrointestinal function and decrease the length of hopital after operations.

Research on the status and influencing factors of spiritual needs of gastrointestinal cancer patients / 中国实用护理杂志

Objective To explore the status and influencing factors of spiritual needs of patients with gastrointestinal cancer, so as to help the medical staffs to provide spiritual care for patients with gastrointestinal cancer. Methods The general information questionnaire, disease information questionnaire and the Spiritual Needs Assessment for Patients(SNAP) were used to investigate the spiritual needs of 116 patients with gastrointestinal cancer, analyze the influencing factors of the spiritual needs. Results The spiritual needs score of the patients with gastrointestinal cancer were 32-92(69.7 ± 16.9) points. Regression analysis showed that the influencing factors were religious belief, age of illness and number of children (R2=0.480, F=12.353, P<0.01). Conclusions The level of spiritual needs of the gastrointestinal cancer patients is at middle level.With different religious beliefs, age of illness and children number, the level of spiritual needs is different.

Effect analysis of case management in the perioperative period of patients with gastrointestinal tumor / 中国实用护理杂志

Objective To investigate the effect of case management in the perioperative period of patients with gastrointestinal tumor. Methods The quasi-experiment study were took to design the research. A total of 100 patients were enrolled in this study. Patients were divided into control group (n=50) and intervention group (n=50) by the admission time. The control group received routine nursing care, while the intervention group received routine perioperative care and case management during the perioperative period. The uncertainty of illness was compared between the two groups at the time point admission, on discharge and 5 weeks after surgery. The satisfaction during the process of treatment services, postoperative complications and return visit rate were compared too. After 5 weeks follow up, 10 cases in the control group and 4 cases in the intervention group were lost to follow-up, 86 cases were included in data analysis. Results Two groups patients all had medium uncertainty of illness at the three-different time points(preoptrative, 1 day before discharge and 5 weeks after surgery). The scores of the control group were 103.38 ± 14.94, 109.58 ± 16.06 and 113.90 ± 15.95 respectively.Those of the intervention patients were 108.02 ± 15.29,109.89 ± 16.52 and 113.41 ± 14.70.The uncertainty of illness elevated on the 5th week after surgery. Significant statistical differences were identified in the uncertainty of illness within each group (F=14.117, P<0.01). Significant statistical difference was identified in the visit rate, 100% (46/46)vs.87.5% (35/40) (χ2=6.105,P<0.05). The score of preoperative satisfaction of intervention patients (14.41 ± 1.13) was obviously higher than that of control patients (13.58 ± 1.55) (t=-1.89, P<0.05). Whereas, incidence of postoperative complications was not statistically significant between two groups. Conclusions The specificity of gastrointestinal tumor and the complexity of treatment bring about great pressure to patients. As the type of entire journey care model, the case management could integrate the fragmented management of conditional management model. Meantime, it also could effectively improve the medical experience and outpatient visit rate of patients with gastrointestinal tumor.

Tumor de estroma gastrointestinal en intestino delgado / Gastrointestinal stromal tumor in the small intestine

Aunque comprenden menos de 1 por ciento de todos los tumores gastrointestinales, los tumores de estroma gastrointestinal son los tumores mesenquimatosos más comunes del aparato digestivo. Son tumoraciones heterogéneas que varían en tamaño, morfología y conducta biológica. Se comportan virtualmente como tumores benignos hasta cánceres muy agresivos, muchas veces metastásicos. El tumor de estroma gastrointestinal puede producirse en cualquier punto del tracto gastrointestinal desde el esófago hasta el ano. Se presenta un caso de un hombre de 49 años que acude a consulta por molestias abdominales. Se realizan estudios que impresionan paquete ganglionar. En la videolaparoscopía se evidenció una tumoración a nivel de yeyuno que se reseca y extrae. El resultado de la biopsia informa un tumor fusocelular del estroma gastrointestinal tipo GIST de la pared del intestino delgado con diferenciación leiomatosa (leiomioma) de bajo grado, de posible comportamiento agresivo(AU)

Although they represent less than one percent of all the gastrointestinal tumors, the stromal tumors are the most common mesenchymal tumors in the digestive system. They are heterogeneous tumors that vary in size, morphology and biological behavior. Their virtual behavior ranges from benign tumors to very aggressive cancers, often metastatic. Gastrointestinal stromal tumor may appear in any point of the gastrointestinal tract from the esophagus to the anus. Here is a 49 years-old man who went to the doctor´s because of abdominal pains. The studies showed ganglionic package. Video-laparoscopy showed tumor at the jejunum that was excised and removed. The result of the biopsy revealed a fusocellular tumor of the gastrointestinal stroma of GIST type in the small intestine wall with low grade differentiation (leiomyoma) of possible aggressive behavior(AU)

Clinical Observation and Economic Evaluation of 3 Kinds of Drugs Preventing Chemotherapy-induced Liv-er Damage in Patients with Gastrointestinal Tumors / 中国药房

OBJECTIVE:To observe the preventive effects and safety of 3 kinds of drugs on chemotherapy-induced liver dam-age in patients with gastrointestinal tumors,and to evaluate economics. METHODS:A total of 128 patients with gastrointestinal malignant tumor and systemic chemotherapy indication selected from our hospital during 2014-2015 were divided into group A(42 cases),B(46 cases)and C(40 cases)according to random number table. Since the first day of chemotherapy,group A,B and C were given Reduced glutathione for injection(1.2 g),Magnesium isoglycyrrhizinate injection(100 mg)and Polyene phosphati-dylcholine injection(465 mg)for preventing chemotherapy-induced liver damage respectively,for 7 d. The preventive effects and ADR occurrence were observed in 3 groups,and the economic analysis was conducted. RESULTS:Total response rates of group A,B and C were 90.48%,97.83% and 87.50%,and that of group B was significantly higher than other 2 groups,with statistical significance(P<0.05). But there was no statistical significance between group A and C(P>0.05). The costs of group A,B and C were 1 465.86,1 518.94,1 554.04 yuan,and cost-minimization analysis was adopted to evaluate the plans of group A and C. The plan of group A was more economical. Cost-effectiveness analysis was used to evaluate the plans of group A and B,cost-effectiveness ratio of group A and B were 1 620.09 and 1 552.63;incremental cost-effectiveness ratio was 722.18, and the plan of group B was more economical. The above conclusion was supported by the results of sensitivity analysis. Three patients in group B suffered from transient elevated blood pressure and then recovered 2-3 d after drug withdrawal. CONCLU-SIONS:The preventive effects and economics of Magnesium isoglycyrrhizinate injection is better than Reduced glutathione for injection and Polyene phosphatidylcholine injection for chemotherapy-induced liver damage in patients with gastrointestinal tu-mors. The blood pressure of patients should be monitored closely during application. Reduced glutathione for injection is more suitable for patients with primary hypertensive disease.