Risk Scoring System of Mortality and Prediction Model of Hospital Stay for Critically Ill Patients Receiving Parenteral Nutrition.

Predicting the clinical progression of intensive care unit (ICU) patients is crucial for survival and prognosis. Therefore, this retrospective study aimed to develop the risk scoring system of mortality and the prediction model of ICU length of stay (LOS) among patients admitted to the ICU. Data from ICU patients aged at least 18 years who received parenteral nutrition support for ≥50% of the daily calorie requirement from February 2014 to January 2018 were collected. In-hospital mortality and log-transformed LOS were analyzed by logistic regression and linear regression, respectively. For calculating risk scores, each coefficient was obtained based on regression model. Of 445 patients, 97 patients died in the ICU; the observed mortality rate was 21.8%. Using logistic regression analysis, APACHE II score (15-29: 1 point, 30 or higher: 2 points), qSOFA score ≥ 2 (2 points), serum albumin level < 3.4 g/dL (1 point), and infectious or respiratory disease (1 point) were incorporated into risk scoring system for mortality; patients with 0, 1, 2-4, and 5-6 points had approximately 10%, 20%, 40%, and 65% risk of death. For LOS, linear regression analysis showed the following prediction equation: log(LOS) = 0.01 × (APACHE II) + 0.04 × (total bilirubin) - 0.09 × (admission diagnosis of gastrointestinal disease or injury, poisoning, or other external cause) + 0.970. Our study provides the mortality risk score and LOS prediction equation. It could help clinicians to identify those at risk and optimize ICU management.

Prognostic significance of suprapancreatic lymph nodes and its implication on D2 dissection.

There have been few studies on the prognostic significance of suprapancreatic lymph nodes (SPLNs), which are targeted in D2 dissections in patients with gastric cancer. The aim of this study was to investigate the prognostic significance of SPLNs by determining whether treatment outcomes of SPLN-positive gastric cancer are comparable to that of SPLN-negative cancer.This study enrolled patients with node-positive gastric cancer, who underwent curative surgery with D2 dissection, at the Samsung Medical Centre from 2007 to 2009. The survival outcomes of patients with and without metastatic SPLNs were analyzed.The total number of patients was 1086, with 377 patients (34.7%) having metastatic SPLNs. SPLN positivity was associated with a more advanced tumor status and the 5-year survival rate of the SPLN-positive group was significantly lower than that of the SPLN-negative group (59.5% vs 81.2%, P < .001). However, the survival was not significantly different between the 2 groups when comparing SPLN status within a given disease stage. Cox multivariate analysis revealed that SPLN metastasis was not an independent prognostic factor.SPLNs were not different from perigastric lymph nodes in terms of prognostic significance and SPLN metastasis should be regarded as a locoregional disease. Complete removal of SPLNs by D2 dissection is recommended for the locoregional control of gastric cancer.

Does the interval of screening endoscopy affect survival in gastric cancer patients?: A cross-sectional study.

Gastric cancer remains the second most common cancer in Korea; however, its mortality has decreased due to earlier diagnosis. In Korea, screening endoscopy has been performed nationwide since 1999. The aim of this study was to elucidate the benefit of screening endoscopy on actual survival in gastric cancer patients and to determine the optimal interval of screening endoscopy.We analyzed 1651 patients diagnosed with gastric adenocarcinoma who underwent surgical treatment between June 2008 and December 2014. Patients were divided into 4 groups according to the interval of screening endoscopy prior to their gastric cancer diagnosis. (Group I = within 1 year, Group II = >1 but <2 years, Group III = more than 2 years, Group IV = no prior endoscopic examination). Patient demographics, clinicopathologic characteristics, and postoperative surgical outcomes including overall survival were compared.The 5-year gastric cancer-specific survival rates of groups I and II were significantly higher than groups III and IV (90.9% vs 85.4%, P = 0.002, respectively). Multivariate analysis showed that screening interval was an independent factor for the diagnosis of advanced gastric cancer. The risk of advanced gastric cancer decreased in group I (odds ratio: 0.515, 95% confidence interval [CI] 0.369-0.719; P < 0.001) and group II (odds ratio: 0.678, 95% CI 0.517-0.889, P = 0.005).Screening endoscopy was helpful in increasing the survival of gastric cancer patients. A 2-year endoscopic screening interval is suitable to detect early-stage gastric cancer.

Comparison of Reduced Port Totally Laparoscopic-assisted Total Gastrectomy (Duet TLTG) and Conventional Laparoscopic-assisted Total Gastrectomy.

BACKGROUND: The aim of this study was to compare surgical outcomes of patients with gastric cancer undergoing reduced port totally laparoscopic-assisted total gastrectomy (duet TLTG) with those of patients undergoing conventional laparoscopic-assisted total gastrectomy (LATG). MATERIALS AND METHODS: Between January 2013 and 2015, 54 patients with gastric cancer underwent LATG at the Samsung Medical Center. Duet TLTG using 3 ports was performed in 30 patients, and conventional LATG using 5 ports was performed in 24 patients. Either extracorporeal or intracorporeal anastomosis was used for esophagojejunostomy. Surgical outcomes were compared between the operation methods. RESULTS: The operating time was similar for duet TLTG and conventional LATG [222 min (range, 163 to 287 min) vs. 233 min (range, 170 to 310 min), respectively; P=0.807]. Blood loss during surgery was also similar between duet TLTG and conventional LATG groups [100 mL (range, 50 to 400 mL) vs. 175 mL (range, 50 to 400 mL), respectively; P=0.249]. The median number of nodes dissected [duet TLTG vs. conventional LATG, 47 (20 to 67) vs. 41 (22 to 70), P=0.338] was not different between groups. Pain scores were 3.9, 3.3, and 2.9, and 3.9, 3.4, and 2.8, at postoperative days 1, 3, and 5, respectively, in the duet TLTG and the conventional LATG groups (P=0.857, 0.659, and 0.427, respectively). Overall complication rates in the duet TLTG and conventional LATG groups were not significantly different (36.7% vs. 16.7%, P=0.103). CONCLUSIONS: Duet TLTG is an acceptable procedure with quality of lymph node dissection, including the number of dissected lymph nodes and morbidity.

Should an Aberrant Left Hepatic Artery Arising from the Left Gastric Artery Be Preserved during Laparoscopic Gastrectomy for Early Gastric Cancer Treatment?

PURPOSE: During laparoscopic gastrectomy, an aberrant left hepatic artery (ALHA) arising from the left gastric artery (LGA) is occasionally encountered. The aim of this study was to define when an ALHA should be preserved during laparoscopic gastrectomy. MATERIALS AND METHODS: From August 2009 to December 2014, 1,340 patients with early gastric cancer underwent laparoscopic distal gastrectomy. One hundred fifty patients presented with an ALHA; of the ALHA was ligated in 116 patients and preserved in 34 patients. Patient characteristics, postoperative outcomes and perioperative liver function tests were reviewed retrospectively. Correlations between the diameter of the LGA measured on preoperative abdominal computed tomography and postoperative liver enzyme levels were analyzed. RESULTS: Pearson's correlation analysis showed a positive correlation between the diameter of the LGA and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels on postoperative day 1 in the ALHA-ligated group (P=0.039, P=0.026, respectively). Linear regression analysis estimated the diameter of the LGA to be 5.1 mm and 4.9 mm when AST and ALT levels were twice the normal limit on postoperative day 1. CONCLUSIONS: We suggest preserving the ALHA arising from a large LGA, having diameter greater than 5 mm, during laparoscopic gastrectomy to prevent immediate postoperative hepatic dysfunction.

Comparison of single-port and reduced-port totally laparoscopic distal gastrectomy for patients with early gastric cancer.

BACKGROUND: Laparoscopy-assisted distal gastrectomy (LADG) is a treatment method for patients with early gastric cancer; however, single- or reduced-port LADG for these patients has been rarely reported. OBJECTIVE: To compare surgical outcomes of patients with gastric cancer undergoing single-port totally laparoscopic distal gastrectomy (TLDG) to those of patients undergoing reduced-port (three ports) TLDG. METHODS: This retrospective study included 94 patients with early gastric cancer who underwent single-port or reduced-port TLDG at Samsung Medical Center between May 2014 and December 2014. Surgical outcomes were compared between operation methods. RESULTS: There are more female patients (54.2 vs. 19.6 %, p = 0.001) and less obese patients (21.1 ± 2.1 vs. 24.6 ± 3.2 kg/m(2), p = 0.001) in the single-port TLDG group. There were no significant differences in blood loss during surgery, the number of dissected lymph nodes, and the pain score at postoperative first day between two groups. The variance in operation time for the reduced-port TLDG was significantly greater than that for single-port TLDG (p = 0.01). Complication rates in the single-port and reduced-TLDG groups were similar (20.8 vs. 21.7 %, p = 1.000). No postoperative deaths occurred in either group. CONCLUSIONS: Single-port TLDG might be considered as a treatment option for a limited subset, such as females or less obese patients with early gastric cancer.

Morphological, Rheological, and Mechanical Properties of Polyamide 6/Polypropylene Blends Compatibilized by Electron-Beam Irradiation in the Presence of a Reactive Agent.

An immiscible polyamide 6 (PA6)/polypropylene (PP) blend was compatibilized by electron-beam irradiation in the presence of reactive agent. Glycidyl methacrylate (GMA) was chosen as a reactive agent for interfacial cross-copolymerization between dispersed PP and continuous PA6 phases initiated by electron-beam irradiation. The PA6/PP (80/20) mixture containing GMA was prepared using a twin-screw extruder, and then exposed to an electron-beam at various doses at room temperature to produce compatibilized PA6/PP blends. The morphological, rheological, and mechanical properties of blends produced were investigated. Morphology analysis revealed that the diameter of PP particles dispersed in PA6 matrix was decreased with increased irradiation dose and interfacial adhesion increased due to high surface area of treated PP particles. Complex viscosities (η*) and storage moduli (G') of blends increased with increasing irradiation dose and were higher than those of PA6 and PP. The complex viscosity of the blend irradiated at 200 kGy was 64 and 8 times higher than PA6 and PP, respectively. The elongation at break of blend irradiated less than 100 kGy was about twice that of PA6. Electron beam treatment improved the compatibility at the interface between PA6 and PP matrix in the presence of GMA.

Techniques of the Single-Port Totally Laparoscopic Distal Gastrectomy.

BACKGROUND: Single-port laparoscopic surgery for patients with early gastric cancer has been rarely reported. Our aim was to introduce techniques of the single-port totally laparoscopic distal gastrectomy (TLDG) in patients with early gastric cancer. METHODS: This procedure was performed using only one 3-3.5 cm skin incision on the umbilicus. One 12 mm and two 10 mm ports were used, and the flexible scope was used during the operation. Partial omentectomy with D1 + ß or more lymph node dissection was performed. Bowel continuity was restored by intracorporeal gastroduodenostomy using two linear staplers. RESULTS: A total of 30 patients underwent single-port TLDG from June to August 2014. Median age of patients was 55 years (range 33-77) and median body mass index of patients was 21.2 kg/m(2) (range 15.7-26.1). Sixteen of 30 patients (53.3 %) were female. Operating times were 122.6 min, and blood losses during operations were 103.2 ml on average. The median length of postoperative hospital stay was 7 days, and the median number of dissected lymph nodes was 40 (range 16-67). No patients had dissected lymph nodes <15. The rate of complications was 20 % (6/30 patients), and no patients had an incisional hernia. Two patients experienced ileus (6.7 %), another two patients experienced delayed gastric emptying (6.7 %), and one patient suffered from small bowel obstruction. There were no postoperative mortalities. CONCLUSIONS: The single-port TLDG for patients with early gastric cancer is feasible in very selected patients and in specialized gastric cancer centers with experience in multi-trocar laparoscopy and single-port laparoscopic surgery.

Gastric duplication cysts in adults: a report of three cases.

Gastric duplication cyst is a rare congenital anomaly of the gastrointestinal tract and is especially uncommon in adults. Most cases in adults are discovered incidentally on radiological examination or gastric endoscopy. Accurate diagnosis of these cysts before resection is difficult. Differential diagnoses are varied. Malignant transformation of a gastric duplication cyst is very rare. We present three cases of asymptomatic noncommunicating gastric duplication cysts in adults.

Comparison of Reduced Port Totally Laparoscopic Distal Gastrectomy (Duet TLDG) and Conventional Laparoscopic-Assisted Distal Gastrectomy.

BACKGROUND: Laparoscopic-assisted distal gastrectomy (LADG) is a treatment method for patients with early gastric cancer; however, single or reduced port LADG has been rarely reported. This study aimed to compare surgical outcomes of patients with gastric cancer undergoing reduced port totally laparoscopic distal gastrectomy (duet TLDG) to those of patients undergoing conventional LADG. METHODS: This retrospective study included 202 patients with early gastric cancer who underwent duet TLDG (102 patients) or conventional LADG (100 patients) at Samsung Medical Center between October 2013 and April 2014. RESULTS: Operating time was shorter for duet TLDG than for conventional LADG (mean ± SD 121.1 ± 19.3 min vs. 153.0 ± 38.1 min, P < 0.001). Blood loss during surgery was similar between duet TLDG and conventional LADG groups (91.4 ± 68.4 mL vs. 85.4 ± 59.8 mL, P = 0.506). Complication rates in the duet TLDG and conventional LADG groups were similar (15.7 % vs. 10.0 %, P = 0.294). The quality of lymph node dissection, including the median number of nodes dissected (median [range] duet TLDG vs. conventional LADG, 36 [17-76] vs. 34 [15-64], P = 0.570) and number of dissected nodes in each lymph node station, did not differ between groups. The median postoperative hospital stay was similar (7 [7-23] days vs. 7 [6-9], P = 0.423). Pain scores were 3.6, 3.2, and 2.8, and 3.7, 3.1, and 2.6, at postoperative days 1, 3, and 5, respectively, in the duet TLDG and conventional LADG groups (P = 0.408, 0.250, and 0.130). CONCLUSIONS: Reduced port duet TLDG for early gastric cancer is feasible in terms of patient safety and quality of lymph node dissection.

Techniques of reduced PRT laparoscopy-assisted distal gastrectomy (duet LADG).

BACKGROUND: Reduced-port laparoscopic surgery for patients with early gastric cancer has been rarely reported. The aim of this study was to introduce techniques of the reduced-port laparoscopy-assisted distal gastrectomy (duet LADG) in patients with early gastric cancer. METHODS: Duet LADG was performed by two persons, an operator and a scopist. Three 10 mm ports were used on the umbilicus and both sides of the lower abdomen. The same laparoscopic instruments were used for duet LADG as for conventional LADG. After the liver was retracted with a 1-0 nylon suture, partial omentectomy with D1 + ß or more lymph node dissection was made. After distal subtotal resection of the stomach, bowel continuity was restored by intracorporeal gastrojejunostomy using two linear staplers. A specimen was removed through the umbilical incision after the extension. RESULTS: A total of 30 consecutive patients underwent duet LADG from October to December 2013. The median age of the patients was 51 years (range 29-75 years), and their median body mass index was 23.2 kg/m(2) (range 18.5-29.6 kg/m(2)). Sixteen (53.3%) of 30 patients were female. Operating times for patients who received duet LADG were 121.2 ± 17.7 min. Blood loss during operations averaged 82 ml. The median number of dissected lymph nodes was 35 (range 24-66). There was no patient with fewer than 15 dissected lymph nodes. The rate of complications in patients who underwent duet LADG was 16.7% (5 of 30 patients). Two patients (6.7%) experienced ileus, and another 2 (6.7 %) patients experienced small bowel obstruction. One patient had pneumonia. There was no postoperative mortality. CONCLUSIONS: Duet LADG for patients with early gastric cancer is feasible without the need for additional ports, any special devices, or an assistant.