Objective To apply the method of evidence-based medicine to identify the best therapy option for an emergency patient with upper gastrointestinal hemorrhage. Methods According to time and logical sequence of clinical events, a complete decision tree was built after the following steps to find the best treatment: clear decision-making, drawing decision tree graphics, listing the outcome probability, giving appropriate values to the final outcome, calculating and determining the best strategies. Results The performance of endoscopic therapy for the patient with upper gastrointestinal hemorrhage within the first six hours had little effect on the prognosis. Interventional therapy after the failure of endoscopic therapy had less mortality than direct surgical exploration. Conclusion Making clinical decision analyses via drawing the decision tree can help doctors clarify their ideas, get comprehensive views of clinical problems, and ultimately choose the best treatment strategy for patients.
ObjectiveTo analyze the relationship between preoperative pulmonary function indexes and postoperative pneumonia (POP) in patients undergoing upper gastrointestinal surgery.MethodsThe clinical data of 303 patients who underwent lung function examination and upper gastrointestinal surgery in West China Hospital, Sichuan University from September 2020 to January 2021 were prospectively collected and analyzed. There were 217 males and 86 females, with an average age of 61.61±10.42 years. Pulmonary function was evaluated from four aspects including ventilatory function, pulmonary volume, diffusion function and airway resistance. Relevant pulmonary function indicators were displayed as the percentage of actual measured value to predicted value (%pred). The outcome index was pneumonia within 30 days after the surgery. Logistic regression was used to analyze the relationship between preoperative pulmonary function indicators and POP.ResultsA total of 196 patients with gastric cancer and 107 patients with esophageal cancer were included, and the incidence of POP in patients undergoing upper gastrointestinal surgery was 26.7% (81/303). Patients with preoperative low peak expiratory flow (PEF%pred) had a 3.094 times higher risk of developing POP than those with normal PEF%pred [OR=3.094, 95%CI (1.362, 7.032), P=0.007]. The incidence of POP had no correlation with the other preoperative indicators.ConclusionPreoperative PEF%pred may be an important indicator for predicting the occurrence of POP in patients undergoing upper gastrointestinal surgery.
Objective To explore the clinical comprehensive therapy of Peutz-Jeghers syndrome. Methods From January 2000 to December 2010，71 cases of Peutz-Jeghers syndrome underwent endoscopic polyp resection firstly，and those with unresectable lesions or with severe complications underwent rescue laparotomy. After endoscopic or surgical treatment，the patients took Celecoxib capsules voluntarily for 6 to 9 months under informed consents. All cases were followed up from 6 months to 8 years. Results Twenty-nine patients had familial history of Peutz-Jeghers syndrome among the 71 patients （41 males and 30 females）. Sixty-two cases underwent 94 surgeries and intussusception was the most common cause of laparotomy. Sixty-five patients underwent 169 double-balloon endoscopy （DBE） therapies，and a total of 1 714 polyps were resected by DBE polypectomy. The largest major axis of small-bowel polyp was 8 cm. No severe complications occurred after DBE polypectomy except for 3 cases of intestinal perforation. Eight patients took Celecoxib capsule，3 of them were treated more than 6 months，and DBE examination showed the gastrointestinal polyps reduced in number and size. Conclusion The comprehensive treatment （including of endoscopic therapy，operation，and drug intervention） is a safe and effective clinical model to treat Peutz-Jeghers syndrome．
Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups: distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin (SS), cholecystokinin (CCK) and motilin (MTL) of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased (Plt;0.01). The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group (Plt;0.01). The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group (Plt;0.01). The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight (Plt;0.01). The decreasing level of fat free mass (FFM) was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group (Plt;0.01), and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged (Plt;0.05). The gastrointestinal symptoms score among three groups was significantly different (Plt;0.05). Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastrectomy group. Patients received total gastrectomy lose much body weight and FFM and get higher edema index.
Objective
To analyze clinical value of early enteral nutrition following radical resection of gastric cancer.
Methods
Seventy-six patients with gastric cancer underwent radical resection from May 1, 2016 to July 1, 2016 in the West China Hospital of Sichuan University were included according to the inclusion criteria and exclusion criteria, then were randomly divided into observation group (36 cases) and control group (40 cases). The patients in the observation group received the enteral nutrition on day 2 following the surgery, in the control group received the conventional management. The gastrointestinal recovery and the adverse reaction were compared in these two groups. The preoperative and postoperative laboratory indicators and the body weight of the patients in both groups were analyzed.
Results
① The general data such as age, gender, and body weight had no significant differences in these two groups (P>0.05). ② The first anus exhaust time and the first defecation time of the observation group were significantly shorter than those of the control group (P<0.05). ③ The adverse reaction rate of the observation group was significantly lower than that of the control group (P<0.05). ④ On admission, the serum albumin, urea nitrogen, creatinine, and lymphocyte count had no significant differences in these two groups (P>0.05). On day 5 after the operation, the serum albumin of the observation group was significantly higher than that of the control group (P<0.05). ⑤ The body weight had no significant difference in these two groups before the operation (P>0.05), which in the observation group was significantly heavier than that of the control group on day 30 after the operation (P<0.05).
Conclusion
Preliminary results of limited cases in this study show that early enteral nutrition following radical resection of gastric cancer is safe and effective, it could promote gastrointestinal function resumption and effectively improve nutritional status.
Objective To investigate the infection rate and observe the healing courses of the incision after gastrointestinal surgery which was managed by positioning extraperitoneal U-type latex drainage strip. Methods Two hundred patients after abdominal operation were divided into drainage group (n=97) and control group (n=103). Drainage group were treated with positioning extraperitoneal U-type latex drainage strip, while control group were treated with no latex drainage strip. The infection rate of incision, the mean time in hospital and mean time of incision healing were observed. Results The infection rate of drainage group was significantly lower than that of control group 〔7.22% (7/97) vs. 18.45% (19/103), P=0.024〕. The mean time in hospital and the mean time of incision healing in drainage group were significantly shorter than those in control group 〔(8.86±1.48) d vs. (14.12±2.63) d， P=0.000； (8.24±1.02) d vs. (12.32±3.47) d， P=0.000〕. Conclusion The infection rate and the healing course of incision of gastrointestinal surgery could be improved by positioning extraperitoneal U-type latex drainage strip.
ObjectiveTo investigate the prevalence of the nutritional risks, the relationship between application of nutritional support and the clinical outcome of patients with gastrointestinal major surgery in the Frist People's Hospital of Shuangliu.
MethodsGastrointestinal major surgery patients in Department of General Surgery in the Frist People's Hospital of Shuangliu from March 2010 to March 2014 were consecutively enrolled. Patients who provided informed consent were screened by NRS 2002, tracking nutrition support status and analysis the relationship between nutrition support and clinical outcome. In this study, the clinical outcome index included postoperative complications and hospitalization time.
ResultsThere were totally 130 cases enrolled, 112 cases completed assessment by NRS 2002. The prevalence of nutritional risk was 75.9%(85/112), there were totally 57 patients(50.9%) received nutrition support, and all for parenteral nutrition. The prevalence of postoperative complication was 46.4%(52/112). The prevalence of postoperative complication in patients who had nutritional risk and received nutritional support was 41.7%(15/36), whereas, in patients who had nutritional risk but not received nutritional support was 73.5%(36/49), there was statistically significant difference between the 2 groups(P=0.002). In patients who not had nutritional risk, the postoperative complication rate was only 3.7%(1/27).
ConclusionsBecause of noninvasive and easy to operate, NRS 2002 are adpted to hospitalized patients with gastrointestinal major surgery. Because of the specific of disease metabolism, the higher nutritional risk occurres in patients with gastrointestinal major surgery, appropriate nutritional support for this kinds of patients can reduce the incidence of postoperative complication, and improve the prognosis.
Objective To investigate the mechanism of bone morphogenetic protein-4 (BMP4) in promoting the recovery of small intestinal mucosal barrier function during the recovery period of small intestine ischemia-reperfusion (I/R) injury. Methods Twenty-eight C57BL/6J male mice aged 6–8 weeks were randomly selected and assigned to small intestine I/R group (n=24) and sham operation (SO) group (n=4) by random number table method. Small intestine I/R injury models of 24 mice were established, then 4 mice were randomly selected at 6, 12, 24 and 48 h after I/R established modeling and killed to observe the morphological changes of small intestinal mucosa and detect the expression of BMP4 mRNA in the jejunal epithelial cells, the other 8 mice were allocated for the experimental observation at the recovery period of small intestine I/R injury (24 h after I/R was selected as the observation time point of recovery period of small intestine I/R injury according to the pre-experimental results). Twelve mice were randomly divided into I/R-24 h-BMP4 group (recombinant human BMP4 protein was injected intraperitoneally), I/R-24 h-NS (normal saline) group (NS was injected intraperitoneally), and I/R-24 h-blank group (did nothing), 4 mice in each group. Then the small intestinal transmembrane electrical impedance (TER) was measured by Ussing chamber. The expressions of BMP4 protein and tight junction proteins (occludin and ZO-1), Notch signaling pathway proteins (Notch1 and Jagged1), and Smad6 protein were detected by Western blot. Results At 24 h after I/R injury, the injuries of villous epithelium, edema, and a small part of villi were alleviated. The BMP4 mRNA expressions at 6, 12, 24 and 48 h after I/R injury in the small intestinal epithelial cells were increased as compared with the SO group. Compared with the I/R-24 h-NS group and the I/R-24 h-blank group, the TER was increased, and the expression levels of occludin, ZO-1, p-Smad6, Notch1, Jagged1 were increased in the I/R-24 h-BMP4 group. Conclusion From the preliminary results of this study, during recovery period of small intestine I/R injury, the expression of BMP4 in small intestinal epithelial cells is increased, permeability of jejunal mucosal barrier is increased, which might promote the recovery of small intestinal mucosal barrier function by activating the Notch signaling pathway (Notch1 and Jagged1), Smad classic signaling pathway, and promoting the increase of tight junction protein expression (occludin and ZO-1).
ObjectiveTo summarize the progress of research on the interaction between bariatric surgery and intestinal flora at home and abroad in recent years, in order to provide new ideas for promoting recovery after bariatric surgery. MethodThe domestic and international literature of intestinal flora changes after bariatric surgery was searched and reviewed. ResultsThe main changes of the intestinal flora after bariatric surgery showed that the abundance of thick-walled bacteria was decreased and the numbers of Bacteroides and Aspergillus were increased. Some common complications after bariatric surgery such as anastomotic fistula, nutritional deficiencies, and inflammation were related to the intestinal flora imbalance. Supplementation with probiotics, prebiotics, dietary interventions, or fecal microbial transplantation were expected to reduce the incidence of complications after bariatric surgery. ConclusionsBariatric surgery is a durable and effective method for treating obesity and its comorbidities. Changes in individual intestinal flora after bariatric surgery have an impact on both weight loss outcomes and postoperative complications, and it is important to find ways to reduce postoperative complications after bariatric surgery by improving intestinal flora.
Objective
To summarize progress on diagnosis and treatment of advanced gastrointestinal stromal tumor (GIST).
Method
Through the retrieval of relevant literatures, the advances in the diagnosis and treatment of advanced GIST in recent years were reviewed.
Results
The diagnosis of advanced GIST mainly depends on imaging examination such as CT, MRI and endoscopy or endoscopic ultrasound. The diagnosis can be confirmed by needle biopsy for advanced GIST patients considering preoperative imatinib treatment. At present, the imatinib is the first-line therapy for patients with advanced GIST, followed by sunitinib and other novel targeted drugs. A multidisciplinary treatment strategy that included targeted therapeutic agents, combining with surgical resection, radiofrequency ablation and embolism chemotherapy have brought dramatic clinical benefit for advanced GIST.
Conclusions
GIST is easy to metastasis, clinicians should ensure early diagnosis and early treatment. In course of imatinib treatment, an individualized therapeutic regimen should be applied to treat advanced GIST based on specific situation of patients.
