Surgical site infection following abdominal surgery in China: a multicenter cross-sectional study / 中华胃肠外科杂志

OBJECTIVE@#To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China.@*METHODS@#The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI.@*RESULTS@#A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI.@*CONCLUSIONS@#The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.

Clinical efficacy of transanal specimen extraction in modified Da Vinci robot-assisted anterior resection of rectosigmoid tumor / 中华消化外科杂志

Objective To explore the clinical efficacy of transanal specimen extraction in modified Da Vinci robot-assisted anterior resection of rectosigmoid tumor.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 47 patients who underwent Da Vinci robot-assisted anterior resection of rectosigmoid tumor using transanal specimen extraction in the Second Xiangya Hospital of Central South University from March to October 2016 were collected.Excisional intestinal canal was intraoperatively taken out from the anus instead of abdominal minor incision.Observation indicators:(1) operation and postoperative recovery;(2)postoperative pathological examination situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients and tumor recurrence or metastasis up to June 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Operation and postoperative recovery:47 patients underwent successful operations,without conversion to open surgery.Of 47patients,8 underwent coloanal ultralow anastomosis,3 underwent prophylactic terminal ilenm stoma fistulization and 1 underwent intersphincteric resection after turning inside out resectable specimen.Operation time,volume of intraoperative blood loss,time for out-of-bed activity,time to anal exsufflation and time of postoperative drainagetube removal were (222±73)minutes,(21±9)mL,(1.7-±0.8)days,(2.3±l.0)days and (6±5)days,respectively.Among 3 patients with postoperative complications,2 with anastomotic fistula were cured by conservative treatment,and 1 with urinary retention removed urethra catheter at 4 weeks postoperatively.All the 47 patients had good recovery,and duration of hospital stay was (10±4)days.(2) Postoperative pathological examination situations:number of lymph node dissected was 15-± 7,with R0 resection.Tumor pathological diagnosis:rectosigmoid adenocarcinoma was detected in 38 patients (1 with high-differentiated tumor,32 with moderate-differentiated tumor and 5 with low-differentiated tumor),mixed carcinoma in 4 patients,tubulovillous adenoma in 2 patients,mucinous adenocarcinoma in 1 patient,neuroendocrine carcinoma in 1 patient and focal cacinoma in 1 patient.The maximum diameter of tumor was (3.5± 1.5) cm.Postoperative pathological T stage:4,9,18 and 14 patients were detected in stage T1,T2,T3 and T4a.Postoperative pathological N stage:30,8 and 7 patients were detected in stage N0,N1 and N2.Postoperative pathological TNM stage:stage Ⅰ,Ⅱ and Ⅲ were respectively in 11,19 and 15 patients.There was no clinical stage in 2 patients with tubulovillous adenoma.(3) Follow-up:of 47 patients,42 were followed up for 7-15 months,with a median time of 11 months.During the follow-up,38 patients had tumor-free survival,3 had tumor recurrence or metastases and 1 died.Conclusion Transanal specimen extraction is safe and feasible in modified Da Vinci robot-assisted anterior resection of rectosigmoid tumor,with minimal invasion and satisfactory short-term outcomes.

Impact of a eukaryotic translation initiation factor 3a polymorphism on susceptibility to gastric cancer

Objective: To investigate single nucleotide polymorphisms in the eukaryotic translation initiation factor 3a [eIF3a] gene and the risk for gastric cancer within the Chinese population

Subjects and Methods: A total of 322 patients with gastric cancer were selected as the patient group and 340 non-gastric cancer patients were selected as the control group using the case-control method. Polymerase chain reaction-sequence-specific primer technology was leveraged to genotype the rs77382849 single nucleotide polymorphism in the eIF3a gene. The demographic characteristics of the study population and other exposures to risk factors were collected. Unconditional logistic regression analysis was performed to determine the association between the risk factors and gastric cancer

Results: A higher frequency of the eIF3a rs77382849 GG homozygote genotype was observed in the gastric cancer patients compared with the controls [63.98 vs. 54.41%, p < 0.05]. After adjustment of exposure risks, such as age, gender, smoking, and drinking, the rs77382849 single nucleotide polymorphism was still associated with susceptibility to gastric cancer. When the eIF3a rs77382849 GG homozygote genotype was used as the reference group, the GA genotype [GA vs. GG: OR = 0.545, 95% CI: 0.386-0.769, p = 0.001] and AA genotype [AA vs. GG: OR = 0.245, 95% CI: 0.072-0.836, p = 0.025] were both correlated with a significantly decreased risk for gastric cancer development

Conclusion: An association between eIF3a rs77382849 polymorphism and susceptibility to gastric cancer was observed in these Chinese patients

Expression of checkpoint kinase 1 and polo-like kinase 1 and its clinicopathological significance in benign and malignant lesions of the stomach / 中南大学学报(医学版)

OBJECTIVE@#To determine the expressive level of checkpoint kinase 1 (CHK1) and polo-like kinase 1 (PLK1) and to detect their clinicopathological significance in benign and malignant lesions of the stomach.@*METHODS@#Envision Tm immunohistochemistry was used to detect the expression level of CHK1 and PLK1 in conventional paraffin-embedded sections from specimens of primary foci (n=59)and metastatic foci of lymph node (n=42) of gastric cancer, peritumoral tissues (n=20), and benign lesions of the stomach (n=95).@*RESULTS@#The positive rates of CHK1 were significantly higher in gastric cancer than that in different types of benign lesions(P0.05). The positive rates of CHK1 and PLK1 were significantly lower in the non-metastatic lymph node than that in the metastatic lymph node (P<0.05). The positive rate of CHK1 was significantly lower in histologic grade II than that in the histologic grade III+IV (P<0.05). Positive correlation was found between the expression of CHK1 and PLK1 in gastric cancer tissues (P<0.01).@*CONCLUSION@#The expression level of CHK1 and /or PLK1 might be important biological markers of kinases to reflect the carcinogenesis, progression, biological behaviors, and guide clinical auxiliary treatment of gastric cancer.

Expressions of S-Phase Kinase-Associated Protein 2 and p27 Protein in Gastric Carcinoma and Pericancerous Tissues / 中国普外基础与临床杂志

Objective To study the expressions of SKP2 and p27 in gastric carcinoma and pericancerous tissues and to detect the relationship between their expressions and clinicopathological features. Methods Forty-nine cases of gastric carcinoma spicemen and 20 cases of tissue adjacent to the carcinoma were cut and made into paraffin-embedded slices. The expressions of SKP2 and p27 were then detected by SP immunohistochemical method. Results The positive expression rate and score of SKP2 were both significantly higher in the gastric carcinoma tissues than those in pericancerous tissues (P

Treatment of Secondary Metastatic Hepatocarcinoma / 中国医师杂志

Objective To explore the values of various surgical techniques in the treatment of secondary hepatocarcinoma.Methods One hundred thirty-four patients with secondary hepatocarcinoma were respectively divided into three groups,hepatectomy(group Ⅰ), other surgical treatments(group Ⅱ) and chemotherapy or/and interventional therapy(group Ⅲ). Retrospective analysis was performed to all patients above mentioned.The three groups were compared each other for survival rate.Results The survival rate among three groups was significantly different.There was a higher survival rate in hepatectomy group.Conclusions Hepatectomy is the most effective method to cure secondary hepatocarcinoma.