ObjectiveTo investigate the correlations of preoperative peripheral blood ghrelin levels and the albumin (ALB) / body mass index (BMI) ratio with the risk and severity of postoperative complications in gastric cancer. MethodsThe patients who underwent radical gastrectomy for gastric cancer at the 908th Hospital of the Joint Logistic Support Force of the People’s Liberation Army of China from September 2021 to June 2023 were enrolled. The incidence of postoperative complications during hospitalization was analyzed. Univariate and multivariate logistic regression analyses was used to analyze the effects of preoperative peripheral blood ghrelin levels and the ALB/BMI ratio on the risk of postoperative complications in gastric cancer. The predictive value of preoperative peripheral blood ghrelin levels, the ALB/BMI ratio, and their combination for postoperative complications in gastric cancer was evaluated using receiver operating characteristic (ROC) curves. Spearman correlation analysis was performed to analyze the correlation between preoperative peripheral blood ghrelin levels or the ALB/BMI ratio and the Clavien-Dindo grade of postoperative complications in gastric cancer. ResultsA total of 294 patients undergoing radical gastrectomy for gastric cancer were enrolled in this study, among whom 56 developed postoperative complications, with an overall complication rate of 19.05%. Univariate analysis revealed that age, preoperative comorbidities, combined organ resection, preoperative peripheral blood ghrelin levels, and ALB/BMI ratio were associated with postoperative complications following radical gastrectomy for gastric cancer (both P<0.05). Multivariate logistic regression analysis showed that, after adjusting for age, preoperative comorbidities, and combined organ resection, elevated ghrelin levels (OR=0.471, P<0.001) and increased ALB/BMI ratio (OR=0.454, P<0.001) remained independent protective factors against postoperative complications. The areas under the ROC curves (AUC) for preoperative peripheral blood ghrelin levels alone, the ALB/BMI ratio alone, and their combination in predicting postoperative complications in gastric cancer were 0.734, 0.749, and 0.864, respectively (all P<0.001). The DeLong test showed that the AUC of the combined prediction model was significantly higher than that of ghrelin levels alone and the ALB/BMI ratio alone (Z=2.985, P=0.003; Z=2.627, P=0.009). Spearman correlation analysis revealed that preoperative peripheral blood ghrelin levels and ALB/BMI ratio were negatively correlated with the severity of postoperative complications in gastric cancer (rs=–0.647, P<0.001; rs=–0.670, P<0.001). ConclusionsThe results indicate that preoperative peripheral blood ghrelin levels and ALB/BMI ratio of gastric cancer are related to the risk and severity of postoperative complications. The combined detection of the two has a high predictive value for postoperative complications of gastric cancer, which can provide a reference for preoperative prediction of the risk and severity of complications, but the research results still need to be further demonstrated by a prospective multi-center study.
ObjectiveTo explore the effectiveness of open reduction and internal fixation for bipolar fracture-dislocation of the forearm.MethodsBetween June 2014 and March 2019, 14 patients with bipolar fracture-dislocation of the forearm were treated. There were 9 males and 5 females, aged from 19 to 52 years (mean, 34.9 years). There were 8 cases of falling injuries, 4 cases of traffic accident injuries, 1 case of sports injury, and 1 case of machine strangulation injury. The time from injury to admission was 2-48 hours, with an average of 16.6 hours. All patients were closed injuries. All patients were treated with open reduction and internal fixation; the upper radioulnar joints were treated with circumferential ligament repair or lateral collateral ligament repair according to the joint stability. And the patients with lower radioulnar joint instability were also treated with the TightRope plate with loop fixation. After 3 weeks of plaster fixation, the patients started functional exercises. The fracture healing time, stability and range of motion of wrist and elbow joints, and forearm rotation function were recorded. The effectiveness was evaluated by Anderson’s forearm function score at last follow-up.ResultsThe incisions healed by first intention. All 14 cases were followed up 12-36 months with an average of 24.8 months. All fractures healed, with an average healing time of 14.9 weeks (range, 12-18 weeks). The stabilities of the upper and lower radioulnar joints restored well. At last follow-up, the elbow flexion and extension range of motion was 65°-160°, with an average of 124.6°; the wrist flexion and extension range of motion was 115°-165°, with an average of 155.0°; the forearm rotation range of motion was 65°-165°, with an average of 154.6°. According to Anderson’s forearm function score, 8 cases were excellent, 5 cases were good, and 1 case was unsatisfactory. ConclusionThe treatment of bipolar fracture-dislocation of the forearm needs comprehensive consideration and individualized treatment plan. The focus is to restore the anatomical structure of the radius and ulna and firm internal fixation, stabilize the upper and lower radioulnar joints, and perform functional exercises as soon as possible after operation to obtain satisfactory effectiveness.
