Nomogram for predicting adhesive small bowel obstruction following emergency gastrointestinal surgery.

BACKGROUND: Postoperative adhesions are frequent and significant complications that typically arise following abdominal surgery. Currently, the existing evidence for predicting the risk of adhesive small bowel obstruction (ASBO) after emergency gastrointestinal surgery (EGS) remains inadequate. A reliable perioperative model that quantifies the risk of ASBO after EGS serves as a practical tool for guiding individually tailored surveillance. METHODS: A consecutive series of 1296 patients who underwent EGS for radiologically confirmed bowel/visceral inflammation or perforation between 2012 and 2022 at a tertiary academic medical center were included in this study to establish a best-fit nomogram. The nomogram was externally validated by assessing discrimination and calibration using an independent cohort from a separate medical center. RESULTS: A total of 116 patients (8.9%) developed at least one episode of ASBO after EGS during a median follow-up duration of 26 months. The results of multivariable logistic analysis indicated that male sex (P = 0.043), preoperative albumin level (P = 0.002), history of pelvic radiotherapy (P = 0.038), laparotomy (P = 0.044), and intensive care unit stay ≥ 72 h (P = 0.047) were identified as independent risk factors for developing ASBO. By incorporating these predictors, the developed nomogram exhibited good accuracy in risk estimation, as evidenced by a guide-corrected C-index score of 0.852 (95% CI 0.667-0.920) in the external validation cohort. Decision curve analysis and clinical impact curve demonstrated a clinically effective predictive model. CONCLUSION: By incorporating the nomogram as a supplemental tool in perioperative management, it becomes possible to accurately assess the individual's likelihood of developing ASBOs. This quantification enables surgeons to implement appropriate preventive measures, ultimately leading to improved outcomes.

Application Effect of Somatostatin Combined with Transnasal Ileus Catheterization in Patients with Acute Intestinal Obstruction and Advanced Gastric Cancer.

Objective: To explore the application of somatostatin combined with nasal plug catheterization in patients with advanced gastric cancer and acute intestinal obstruction. Methods. This study included 94 cases of patients with acute intestinal obstruction and advanced gastric cancer, and according to the length of hospital stay, the patients were randomly divided into two groups: the control group and the study group, with 47 cases in each group. Based on the observations made by the team in the control group given somatostatin combined treatment, we observed two groups of patients with gastrointestinal function, serum index, quality of life, therapeutic effect, and adverse reactions. Results. Abdominal distention, abdominal pain duration, and normal exhaust time were significantly shorter in the study group than in the control group. The study group was higher than the control group in terms of gastrointestinal decompression volume, drainage volume, and abdominal circumference reduction within 24 hours (P < 0.05). After treatment, the levels of CRP, IgA, LPS, and FABP were lower than before, and the levels of CRP, IgA, LPS, and FABP in the former group were much lower than those in the latter group (P < 0.05). Compared with before treatment, the former GIQLI scale score was significantly higher than the latter (P < 0.05). After treatment, the efficiency is much higher than the latter (P < 0.05). After treatment, the former significantly lowers the incidence of postoperative complications of the latter (P < 0.05). Conclusion. For patients with advanced gastric cancer and acute intestinal obstruction, it is safe and feasible to use somatostatin combined with transnasal intestinal obstruction catheterization to restore gastrointestinal function, improve inflammatory response, and promote the improvement of quality of life with high safety and feasibility.

Septic shock caused by acute appendicitis complicated with abscess formation within mesoappendix: A case report.

INTRODUCTION: Acute appendicitis is the most common surgical emergency and may present with a wide variety of clinical manifestations. In rare circumstances, appendicitis can cause life-threatening complications e.g. septic shock. We present a case of septic shock caused by acute appendicitis complicated with abscess formation within the mesoappendix. PRESENTATION OF CASE: A 42-year-old male was presented with migratory right lower abdominal pain, accompanied by septic shock and acute kidney failure. We performed emergency appendectomy and unexpectedly observed an abscess within the mesoappendix during surgery. The patient received antibiotic therapy perioperatively. Escherichia coli and Klebsiella pneumoniae subspecies were isolated from the intraoperative pus specimen, and Bifidobacterium was isolated from his preoperative blood culture. Histopathology revealed acute suppurative appendicitis. The patient recovered uneventful and was discharged 5 days after surgery. DISCUSSION: We believe that the septic shock was associated with the small abscess formation in the mesoappendix. Bacteria within the mesoappendix could enter the bloodstream through the mesoappendiceal vessel and then septic shock and kidney failure occurred sequentially. We assume that the abscess within the mesoappendix was caused by a tiny perforation from the mesoappendiceal side. CONCLUSION: The case of acute appendicitis complicated with abscess formation within mesoappendix explains one of the causes which may lead to septic shock.

[Analysis of high risk factors for acute complex appendicitis in adults].

OBJECTIVE: To explore the high risk factors of adult complex appendicitis, and to provide a reference for the development of a reasonable treatment strategy for acute appendicitis. METHODS: A retrospective case-control study was conducted to collect clinical data of 312 adult patients with acute appendicitis confirmed by pathology undergoing appendectomy, including open and laparoscopic surgery, from May 2011 to August 2016 at Affiliated Hospital of Qingdao University. Age <14 years old, pregnant women, complicating abscess around the appendix, AIDS, blood system diseases, autoimmune diseases, inflammatory bowel disease or progressive cancer patients were excluded. According to the intra-operative findings and pathological types, patients were divided into complex appendicitis(112 cases, including gangrene and perforation) and non-complex appendicitis (200 cases, including simple and non-perforated appendicitis, ie suppurative appendicitis). After comparing the clinical data of these two groups, statistically significant variables were induded for multivariate logistic regression analysis to identify risk factors of complex appendicitis, and to establish a regression model. Enter method was applied to establish the regression equation: P=ExpiΣBiXi/1+ExpΣBiXi, and to calculate the relative risk of each variable. Meanwhile, retrospective and prospective verification was performed on this predictive model (cases of acute appendicitis from September 2016 to December 2017 were further collected). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of complex appendicitis were calculated with the regression model. RESULTS: Comparison of the clinical data between the complex appendicitis group and the non-complex appendicitis group showed that differences of 10 preoperative indexes were statistically significant, including period from abdominal pain to admission [(59.1±42.6) hours vs. (47.5±34.4) hours, t=3.051, P=0.002], white blood cell count [(12.9±3.7)×109/L vs. (9.2±4.0)×109/L, t=9.755, P<0.001], neutrophil count [(9.8±4.0)× 109/L vs.(7.1±3.9)×109/L, t=6.020, P<0.001], neutrophil percentage[(84.5±8.7)% vs.(68.2±16.0)%, t=12.754, P<0.001], C-reactive protein levels [(86.0±45.4) µg/L vs. (55.9±35.8) µg/L, t=7.614, P<0.001], serum albumin levels [(334.0±4.8) g/L vs. ( 41.0±4.3) g/L, t=16.055, P<0.001], vomiting ratio [44.6%(50/112) vs. 23.5%(47/200), χ²=14.980, P<0.001], high fever(≥39°C) ratio [16.1%(18/112) vs. 7.5%(15/200), χ²=5.577, P=0.022], the proportion of patients ≥60 years old [22.3%(25/112) vs. 13.0%(26/200), χ²=4.562, P=0.038] and previous history of appendicitis [16.1%(18/112) vs. 7.5%(15/200), χ²=5.577, P=0.022]. The above 10 variables were included in the logistic regression model for multivariate analysis. The results showed that six variables were associated with complex appendicitis. According to their strength, they were old age (≥60 years old) X1(OR=5.094), high fever (≥39°C) X2(OR=4.464), neutrophil count X6 (OR=1.269), neutrophil percentage X4 (OR=1.077), C-reactive protein level X5 (OR=1.027), and serum albumin level X3 (OR=0.763). A predictive regression model was established: P=1/[1+e(0.557+1.628X1+1.496X2-2.7X3+0.74X4+0.27X5+0.238X6)], whose sensitivity and specificity of judging complex appendicitis were 76.8%(86/112) and 90.0%(180/200),respectively. Sensitivity and specificity for predictive value of complex appendicitis in further prospective validation of the model were 76.2%(48/63) and 81.1% (30/37), respectively. CONCLUSIONS: Age ≥ 60 years old, body temperature ≥39°C, increased neutrophil count, neutrophil percentage and C-reactive protein levels, and hypoalbuminemia are risk factors for complex appendicitis. The establishment of predictive model may help determine complex appendicitis.

Personalized stepwise vascular control during complex hepatectomy involving hepatocaval confluence.

BACKGROUND: This study introduces an innovative stepwise vascular control technique to address the high risk of massive bleeding from main hepatic veins and the retro-hepatic inferior vena cava during hepatectomy involving hepatocaval confluence. METHODS: From January 2010 to July 2016, 80 patients underwent stepwise vascular occlusion during complex liver resection involving hepatocaval confluence. Relevant clinical data were collected and compared with those obtained in parallel studies. The protocol has been registered in the Protocol Registration and Results System as protocol NCT02996006. RESULTS: All 80 patients underwent portal triad (PT), infra-hepatic inferior vena cava (IIVC) and supra-hepatic inferior vena cava (SIVC) preparation for occlusion in that order; PT, PT + SIVC and PT + IIVC + SIVC occlusions were performed during liver resection for six, 42 and 32 patients, respectively. The PT, IIVC and SIVC clamping times were 12.9 ± 2.5, 9.1 ± 2.1 and 5.1 ± 1.4 min, respectively. The mean blood loss was 504.1 ± 234.5 mL. Sixteen patients received blood transfusions. Haemodynamic parameters remained stable. No patients had life-threatening complications or died (Clavien-Dindo grade IV or V). Compared with other techniques used in parallel studies, this technique has the advantage of decreased blood loss in less warm ischaemia time. CONCLUSION: For complex hepatectomy involving hepatocaval confluence, this newly described stepwise vascular control technique was efficacious and feasible for controlling intraoperative bleeding.

[The hyposensitization of oval cell to antiproliferative effect of transforming growth factor ß1 by hepatitis B virus X gene].

OBJECTIVE: To determine whether hepatitis B virus X (HBX) protein expression affect the oval cells' response to anti-proliferative effect of transforming growth factor ß1 (TGFß1) in oval cells. METHODS: Real-time PCR, Western blot analysis were performed to detect the expression of TGFßRII in HBX-transfected oval cells named HBX-EGFP-LE/6, and EGFP-LE/6, LE/6 control cells. In addition, exogenous TGFß1 was added into all three oval cell lines, MTT assay was preformed to clarify different responses to the anti-proliferative effect of TGFß1. RESULTS: The TGFßRII mRNA levels in LE/6 and EGFP-LE/6 cells were (10.2 ± 1.8) and (8.8 ± 0.9) folds of those in HBX-EGFP-LE/6 cells, the difference was significant (P < 0.05). HBX protein expression also reduced the protein levels of TGFßRII in HBX-EGFP-LE/6 oval cells, compared to the control cells. The MTT results exhibited that, after TGFß1 addition, proliferative inhibition rate in the HBX-EGFP-LE/6 cells was 18.1% ± 1.5% while those in control cells were 42.2% ± 2.8% and 41.9% ± 5.0%, the difference was significant (P < 0.01). CONCLUSION: HBX protein expression affects TGFßRII transcriptional activity and protein synthesis, and insensitive oval cells to anti-proliferative effect of TGFß1.