Multidimensional model of laparoscopic suturing training for laparoscopic pancreatic surgery / 中华肝胆外科杂志

Objective:To evaluate the effect of multidimensional model of laparoscopic suture training in spread of laparoscopic pancreatic surgery.Methods:The surgeons who took advanced training in Department of Gastroenterology and Pancreatic Surgery in Zhejiang Provincial People’s Hospital from September 2018 to March 2020 were enrolled. Theoretical presentation, simulation training and assessment, clinical practices were included in the multidimensional training model. The " mattress suture" module (2 mattress sutures) in the LAP Mentor laparoscopic advanced simulator was used as the initial assessment and post-training assessment. The average needle loading time, time to form a knot, total time, accuracy rate of precise needle passage through the entrance and exit dots, and total aggressive tissue handing provided in the LAP Mentor were analyzed pre- and post-training. The trained surgeons were followed up for their clinical work in own hospitals.Results:A total of 13 surgeons were trained, including 4 deputy chief physicians, 7 attending physicians over 3 years, and 2 attending physicians under 3 years. The trainees had only primary laparoscopic surgery experience and no laparoscopic pancreatic surgery experience. After training in the above scheme, the average needle loading time was shortened from (93.6±31.6) s to (45.7±13.6) s, and the time to form a knot was reduced from (138.9±46.2) s to (62.1±22.9) s, and total time to accomplish the suture shortened from (15.9±3.8) min to (6.7±3.5) min. The accuracy rate of precise needle passage through the entrance and exit dots increased from (63.7±10.3)% to (89.6±9.8)%. The total aggressive tissue handing decreased from (18.2±12.5) to (6.7±4.9). All those data showed statistical differences ( P<0.05). During follow-up, all traineescan operate the laparoscopic pancreatic surgery proficiently. One trainee completed his first laparoscopic pancreaticoduodenctomy as the primary surgeon, and one trainee complete the splenic vein branch suture to stop hemostasis during laparoscopic pancreatectomy with spleen-preserving spleen, and 3 trainees completed laparoscopic pancreaticoduodenctomy as the first assistant surgeons with good outcomes. Conclusion:Multidimensional model of laparoscopic suture training can improve the trainee's suture skill and help perform complex laparoscopic pancreatic surgery with self-confidence.

How to Promote Bedside Placement of the Postpyloric Feeding Tube: A Network Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The optimal method of achieving fast, safe, and accurate postpyloric tube placement at the bedside remains controversial. This study investigated whether facilitating techniques of bedside placement would improve the rate of successful placement of postpyloric tubes when compared with the standard technique and whether strategies should be confined to adult or pediatric patients. METHODS: We searched electronic databases for eligible literatures that compared different methods of postpyloric tube placement, evaluating the successful rate of postpyloric tube placement. Two reviewers reviewed the quality of the studies and performed data extraction independently. Pairwise and network meta-analyses were performed to integrate the efficacy. RESULTS: Fourteen clinical trials involving 753 patients were included. Pairwise meta-analyses demonstrated that prokinetic agents (odds ratio [OR], 2.263; 95% confidence interval [CI]: 1.140-4.490; P = .02) were associated with a higher success rate as compared with the standard technique, and gastric air insufflation was associated with a higher success rate as compared with prokinetic agents (OR, 3.462; 95% CI, 1.63-7.346; P = .001) in adult patients. In network analyses, prokinetic agents and gastric air insufflation were also consistently associated with a higher success rate in adult patients. Trend analyses of rank probabilities revealed gastric air insufflation had the cumulative probability of being the most efficacious strategy (78%), especially in adult patients (88%). CONCLUSIONS: Gastric air insufflation seems to be clinically better for promoting bedside placement of postpyloric feeding tubes in adults. Clinicians should no longer use prokinetic agents in pediatric patients or patients without impaired motility.

Effect of gastric versus post-pyloric feeding on the incidence of pneumonia in critically ill patients: observations from traditional and Bayesian random-effects meta-analysis.

BACKGROUND & AIMS: Administration of enteral feeding is associated with a higher risk of nosocomial pneumonia. Herein, we systematically review the impact of gastric versus post-pyloric feeding on the incidence of pneumonia. METHODS: We searched the MEDLINE, EMBASE, Web of Science, and CCTRD (1966 to August 2011) for studies comparing gastric and post-pyloric feeding in critically ill patients. Two reviewers reviewed the quality of the studies and performed data extraction independently. Main outcome measures were the incidence of nosocomial pneumonia, aspiration, and vomiting. The meta-analysis was performed using traditional and Bayesian random-effects model. RESULTS: Our initial searches yielded 563 studies. Of these, we identified 15 randomized clinical trials enrolling 966 participants. Post-pyloric feeding was associated with reduction in pneumonia compared with gastric feeding (relative risk [RR] 0.63, 95% confidence interval [CI] 0.48-0.83, p = 0.001; I² = 0%). The risk of aspiration (RR, 1.11; 95% CI, 0.80-1.53, p = 0.55; I² = 0%) and vomiting (RR, 0.80; 95% CI, 0.38-1.67, p = 0.56; I² = 65.3%) were not significantly different between patients treated with gastric and post-pyloric feeding. CONCLUSIONS: Comparing with gastric feeding, post-pyloric route can reduce incidence of pneumonia in critically ill patients.

Association between lymphotoxin-α intron +252 polymorphism and sepsis: a meta-analysis.

BACKGROUND: We evaluated the association of lymphotoxin-α (LTA, also known as tumour necrosis factor-ß) promoter +252 A/G polymorphism with sepsis. METHODS: A systematic search was performed in MEDLINE, EMBASE, and Web of Science (for the period January 1966 to June 2010). Two reviewers independently selected studies on the genetic association of LTA +252 A/G polymorphism with sepsis and independently extracted data onto standardized forms. RESULTS: Twenty-seven studies with 4399 septic patients were included based on predefined inclusion criteria. As compared to AG + GG, the LTA AA genotype was significantly associated with an increased development of sepsis in the overall population (odds ratio (OR) 1.33, 95% confidence interval (CI) 1.09-1.62; p = 0.006). An association between mortality from sepsis and AA genotype was also found in the overall population (OR 1.89, 95% CI 1.27-2.80; p = 0.002). Stratification by ethnicity indicated that the contribution to both sepsis susceptibility and mortality may be stronger in Caucasians (OR 1.44, 95% CI 1.08-1.91 and OR 2.47, 95% CI 1.52-4.00, respectively) than in other ethnicities. CONCLUSIONS: The LTA +252 A/G polymorphism is associated with both susceptibility to and mortality from sepsis.

Diagnostic value of the soluble triggering receptor expressed on myeloid cells-1 in bacterial infection: a meta-analysis.

OBJECTIVE: To evaluate the accuracy of the soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as a diagnostic test for bacterial infection. DESIGN: Meta-analysis of 13 diagnostic studies. DATA SOURCE: Medline; Embase; Web of Science (from January 1966 to January, update to August 2008); and Cochrane Controlled Clinical Trials Register Database (through first quarter 2008). MEASUREMENTS AND RESULTS: A meta-analysis of all 73 studies was performed. Thirteen studies fulfilled the inclusion criteria (980 patients, 557 patients with bacterial infection, 423 with non-bacterial infection); global prevalence was 56.8%. The global sensitivity was 0.82 (95% confidence interval CI, 0.68-0.90), the specificity was 0.86 (95% CI, 0.77-0.91), the positive likelihood ratio (PLR) was 5.66 (95% CI, 3.41-9.38), the negative likelihood ratio (NLR) was 0.21 (95% CI, 0.12-0.40), and the diagnostic odds ratio (DOR) was 26.35 (95% CI, 10.32-67.28). The area under the curve of the summary receiver operator characteristic (SROC) was 0.86 (95% CI, 0.77-0.91), with a Q point value of 0.84. The sensitivity of the sTREM-1 assay for diagnosis of urinary tract infection was low (0.18, 95% CI, 0.05-0.51). CONCLUSIONS: sTREM-1 represents a reliable biological marker of bacterial infection, but it may be not a sufficient biological marker for infection of the urinary tract as a result of its low sensitivity. Whether sTREM-1 guidance can reduce antibiotic use as well as the measurement of sTREM-1 in different types of infection will require additional prospective studies.

Influence of Left Ventricular Diastolic Function on Blood flow Frequency Diagram of Pulmonary Veins / 中华超声影像学杂志

Pulse wave Doppler technique was used to detect the blood flow of pulmonary veins of 30 normal cases,50 patients with hypertension,heart disease,coronary heart disease,whose compensatory function of left atria are normal,and 20 patients suffering from bypertension,heart disease or coronary heart disease,whose function of left atria are deconpensated.The results showed that the systolic(s) and diastolic (D)heak velocities,atrial systolic(A),peaks and D/S ratio of the blood flow frequency diagram of pulmonary veins are new indexes to evaluate diastolic function of left ventricle.using the above barameters comprehensively,correct estimation of left ventricnlar diastolic function can be achieved.