简介：AbstractObjective:Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based pathways designed to reduce complications, promote recovery, and improve outcomes following surgery. These protocols have been successfully applied for the management of head and neck cancer, but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in otolaryngology. Our goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology operations.Methods:A systematic literature review was conducted using MEDLINE, EMBASE, SCOPUS, and gray literature. We identified studies that evaluated ERAS protocols among patients undergoing otologic, laryngeal, nasal/sinus, pediatric, and general otolaryngology operations. We assessed the outcomes and ERAS components across protocols as well as the study design and limitations.Results:A total of eight studies fulfilled the inclusion criteria and were included in the analysis. Types of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy, functional endoscopic sinus surgery, tympanoplasty and mastoidectomy, and septoplasty. A reduction in postoperative length of stay and hospital costs was reported in two and three studies, respectively. Comparative studies between ERAS and control groups showed persistent improvement in pre- and postoperative anxiety and pain levels, without an increase in postoperative complications and readmission rates.Conclusions:A limited number of studies discuss implementation of ERAS protocols for outpatient operations in otolaryngology. These clinical pathways appear promising for these procedures as they may reduce length of stay, decrease costs, and improve pain and anxiety postoperatively.

简介：AIMToprovideanupdatedassessmentofthesafetyandefficacyofenhancedrecoveryaftersurgery(ERAS)protocolsinelectivegastriccancer(GC)surgery.METHODSPubMed,Medline,EMBASE,WorldHealthOrganizationInternationalTrialRegister,andCochraneLibraryweresearcheduptoJune2017forallavailablerandomizedcontrolledtrials(RCTs)comparingERASprotocolsandstandardcare(SC)inGCsurgery.ThirteenRCTs,withatotalof1092participants,wereanalyzedinthisstudy,ofwhom545underwentERASprotocolsand547receivedSCtreatment.RESULTSNosignificantdifferencewasobservedbetweenERASandcontrolgroupsregardingtotalcomplications(P=0.88),mortality(P=0.50)andreoperation(P=0.49).Theincidenceofpulmonaryinfectionwassignificantlyreduced(P=0.03)followinggastrectomy.However,thereadmissionrateafterGCsurgerynearlytripledunderERAS(P=0.009).ERASprotocolssignificantlydecreasedthelengthofpostoperativehospitalstay(P<0.00001)andmedicalcosts(P<0.00001),andacceleratedbowelfunctionrecovery,asmeasuredbyearliertimetothefirstflatus(P=0.0004)andthefirstdefecation(P<0.0001).Moreover,ERASprotocolswereassociatedwithalowerlevelofseruminflammatoryresponse,higherserumalbumin,andsuperiorshorttermqualityoflife(QOL).CONCLUSIONCollectively,ERASresultsinacceleratedconvalescence,reductionofsurgicalstressandmedicalcosts,improvednutritionalstatus,andbetterQOLforGCpatients.However,high-qualitymulticenterRCTswithlargesamplesandlong-termfollow-upareneededtomorepreciselyevaluateERASinradicalgastrectomy.

简介：AbstractEnhanced recovery after surgery (ERAS) protocols have been developed in numerous surgical specialties as a means of systematically improving patient recovery, functional outcomes, cost savings, and resource utilization. Such multidisciplinary initiatives seek to minimize variability in several aspects of perioperative patient care, helping to reduce inpatient length of hospital stay, complications, and the overall resource and financial burden of surgical care. Head and neck oncology patients stand to benefit from the implementation of comprehensive ERAS protocols, as these patients have complex medical needs that may dramatically impact multiple aspects of their recovery, including breathing, eating, nutrition, pain, speech, swallowing, and communication. Implementing ERAS protocols for head and neck cancer patients may present unique challenges, and require significant interdisciplinary coordination and collaboration. We therefore sought to provide a comprehensive guide to the planning and institution of such ERAS systems at institutions undertaking care of head and neck cancer patients. Key elements to consider in the implementation of successful ERAS protocols for this population include organizing a team consisting of frontline leaders such as nursing staff, medical specialists, and associated health professionals; designing interventions based on systematically evaluated, high-quality literature; and instituting a clear methodology for regularly updating protocols and auditing the success or potential limitations of a given intervention. Potential obstacles to the success of ERAS interventions for head and neck cancer patients include challenges in systematically tracking progress of the protocol, as well as resource limitations in a given health system.

简介：AbstractEnhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.

简介：

简介：AbstractBackground:Postoperative chylous ascites is an infrequent condition after colorectal surgery and is easily treatable. However, its effect on the long-term oncological prognosis is not well established. This study aimed to investigate the short-term and long-term impact of chylous ascites treated with neoadjuvant therapy followed by rectal cancer surgery and to evaluate the incidence of chylous ascites after different surgical approaches.Methods:A total of 898 locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery between January 2010 and December 2018 were included. The clinicopathological data and outcomes of the patients with chylous ascites were compared with those of the patients without chylous ascites. The primary endpoint was recurrence-free survival (RFS). To balance baseline confounders between groups, propensity score matching (PSM) was performed for each patient with a logistic regression model.Results:Chylous ascites was detected in 3.8% (34/898) of the patients. The incidence of chylous ascites was highest after robotic surgery (6.9%, 6/86), followed by laparoscopic surgery (4.2%, 26/618) and open surgery (1.0%, 2/192, P = 0.021). The patients with chylous ascites had a significantly higher number of lymph nodes harvested (15.6 vs. 12.8, P = 0.009) and a 3-day longer postoperative hospital stay (P = 0.017). The 5-year RFS rate was 64.5% in the chylous ascites group, which was significantly lower than the rate in the no chylous ascites group (79.9%; P = 0.007). The results remained unchanged after PSM was performed. The chylous ascites group showed a nonsignificant trend towards a higher peritoneal metastasis risk (5.9% vs. 1.6%, P = 0.120). Univariate analysis and multivariate analysis confirmed chylous ascites (hazard ratio= 3.038, P < 0.001) as an independent negative prognostic factor for RFS.Conclusions:Considering the higher incidence of chylous ascites after laparoscopic and robotic surgery and its adverse prognosis, we recommend sufficient coagulation of the lymphatic tissue near the vessel origins, especially during minimally invasive surgery.

简介：

简介：AbstractBackground:Patients’ recovery after surgery is the major concern for all perioperative clinicians. This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’ recovery of gastrointestinal (GI) function and quality of life after colorectal surgeries, an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored.Methods:A prospective randomized controlled clinical trial was conducted, patients were recruited from January 2018 to September 2019 in this study. Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery (S-ERAS) group or enhanced recovery after surgery based on pre-operative rehabilitation (group PR-ERAS). In the group PR-ERAS, on top of recommended peri-operative strategies for enhanced recovery, formatted rehabilitation exercises pre-operatively were carried out. The primary outcome was the quality of GI recovery measured with I-FEED scoring. Secondary outcomes were quality of life scores and strength of handgrip; the incidence of adverse events till 30 days post-operatively was also analyzed.Results:A total of 240 patients were scrutinized and 213 eligible patients were enrolled, who were randomly allocated to the group S-ERAS (n = 104) and group PR-ERAS (n = 109). The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS (79.0% vs. 64.3%, P < 0.050). The subscores of life ability and physical well-being at post-operative 72 h were significantly improved in the group PR-ERAS using quality of recovery score (QOR-40) questionnaire (P < 0.050). The strength of hand grip post-operatively was also improved in the group PR-ERAS (P < 0.050). The incidence of bowel-related and other adverse events was similar in both groups till 30 days post-operatively (P > 0.050).Conclusions:Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery. Newer, more surgery-specific rehabilitation recovery protocol merits further exploration for these patients.Trial Registration:ChiCTR.org.cn, ChiCTR-ONRC-14005096

简介：Transcranialmagneticstimulation(TMS)representsausefulnon-invasiveapproachtostudyingcorticalphysiology,inadditiontothedescendingmotorpathways(Hallett,2000),andmayalsobeusedtoinvestigatetheintracorticalfacilitatoryandinhibitorymechanisms.

简介：Objective:Toinvestigatetheclinicalefficacyofacupunctureintreatinghiccupsafterabdominalsurgery.Methods:Seventy-twopatientswithhiccupsafterabdominalsurgerywererandomlyallocatedto3groups,atreatmentgroup,acontrolgroupandacombinationgroup

简介：Objective:Theaimofthepresentstudywastoconstructariskassessmentmodelwhichwastestedbydisease-freesurvival(DFS)ofesophagealcancerafterradicalsurgery.Methods:Atotalof164consecutiveesophagealcancerpatientswhohadundergoneradicalsurgerybetweenJanuary2005andDecember2006wereretrospectivelyanalyzed.Thecutpointofvalueatrisk(VaR)wasinferredbystem-and-leafplot,aswellasbyindependent-samplest-testforrecurrence-freetime,furtherconfirmedbycrosstabchi-squaretest,univariateanalysisandCoxregressionanalysisforDFS.Results:ThecutpointofVaRwas0.3onthebasisofourmodel.Therateofrecurrencewas30.3%(30/99)and52.3%(34/65)inVaR<0.3andVaR≥0.3(chi-squaretest,χ2=7.984,P=0.005),respectively.The1-,3-,and5-yearDFSofesophagealcancerafterradicalsurgerywas70.4%,48.7%,and45.3%,respectivelyinVaR≥0.3,whereas91.5%,75.8%,and67.3%,respectivelyinVaR<0.3(Log-ranktest,χ2=9.59,P=0.0020),andfurtherconfirmedbyCoxregressionanalysis[hazardratio=2.10,95%confidenceinterval(CI):1.2649-3.4751;P=0.0041].Conclusions:Themodelcouldbeappliedforintegratedassessmentofrecurrenceriskafterradicalsurgeryforesophagealcancer.

简介：Edaravonehasbeenshowntoreduceischemia/reperfusion-inducedperipheralnerveinjury.However,thetherapeuticeffectofedaravoneonperipheralnerveinjurycausedbymechanicalfactorsisunknown.Inthepresentstudy,weestablishedaperipheralnerveinjurymodelbycrushingthesciaticnerveusinghemostaticforceps,andthenadministerededaravone3mg/kgintraperitoneally.Thesciaticfunctionalindexandsuperoxidedismutaseactivityofthesciaticnervewereincreased,andthemalondialdehydelevelwasdecreasedinanimalsintheedaravonegroupcomparedwiththoseinthemodelgroup.Bcl-2expressionwasincreased,butBaxexpressionwasdecreasedinanteriorhorncellsoftheL4–6spinalcordsegments.Theseresultsindicatedthatedaravonehasaneuroprotectiveeffectfollowingperipheralnerveinjurycausedbymechanicalfactorsthroughalleviatingfreeradicaldamagetocellsandinhibitinglipidperoxidation,aswellasregulatingapoptosis-relatedproteinexpression.

简介：Strokeisaleadingcauseofdeathanddisabilityinadultsworldwide.Fordecades,theprimaryapproachandgoaloftherapyforstrokehasfocusedonneuroprotection,namelytreatingtheinjuredtissue,withinterventionsdesignedtoreducethevolumeofcerebralinfarction.Enormouseffortinthelaboratoryhasbeendevotedtothedevelopmentof

简介：Thepursuitofhighoilrecoveryratehasbeenapersistentobjectiveforoilindustry.Pseudomonassp.LP-7andBacillussp.PAH-2wereisolatedfromoil-contaminatedsurfacesoilsamplesofanoilfield.Theantimicrobialdegradationrates(ADRs)ofpolymersachievedbyLP-7andPAH-2wereevaluatedatatemperatureof35°Cinthemineralsaltmediaduringtheshakenflasktrial.TheADRsofcopolymersynthesizedbyusingasurfactantwithaconcentrationof5%couldreach8.4%forPAH-2and15.3%forLP-7.TheADRsofcopolymercouldreach10.4%forPAH-2and21.3%forLP-7,whenthepolymerconcentrationwas2g/L.AllresultsconfirmedthattheADRsofcopolymersincreasedwithanincreasingcontentofHDDE(capsaicinderivativemonomer)inthepolymer.ThecopolymersalsomanifestedexcellentantimicrobialdegradationperformanceinthepresenceofCu2+,Zn2+,andPb2+ions,respectively,whichhadgreatpotentialforapplicationsinenhancedoilrecovery.

简介：无

简介：AIMTo算术地代表在角膜的几何学和intracorneal戒指的飞机植入的ectatic(ICRS)之间的交叉以便在keratoconus(KC)决定角膜的反应到ICRS外科。此后，角膜的戒指飞机交叉被建模介绍这个概念和keratectasia.METHODSThe的治疗的ICRS外科的一张最新导出的指导地形学的诺模图的早结果到圆锥形的节。戒指效果是结果：戒指尺寸，位置(陡峭对扁平)，地点(从角膜的几何中心的距离)，和在戒指弯曲和隧道弯曲之间的差异。Femtosecond激光被用来创造隧道，切口地点根据诺模图被选择以便不管圆锥形的节有的refraction.RESULTSThe的散光轴把最厚的戒指放在角膜的最陡峭的部分在角膜的陡峭的区域的更延长的形状比在里面扁平的区域，取决于角膜的sagittal弯曲。相等的戒指尺寸比在扁平的区域在陡峭的区域有更多的变平的效果。厚片断应该不管折射的柱体轴在角膜的陡峭的部分下面被植入。在陡峭的区域的单个片断在KC的早、中等的盒子中是足够的。新诺模图比常规nomogram.CONCLUSIONThe最新发源的在未改正的视觉尖酸(UCVA)和改正最好的视觉尖酸(BCVA)向更多的地志的整齐提供了散光和更好的改进的重要减小诺模图能比常规诺模图生产更好的结果。而且基于这个概念，一张新诺模图能集成于与允许的修改焦点的asphericity创造指导地形学的、设定的、椭圆的隧道的激光软件设定不规则地变得陡峭的ectatic角膜的焦点的变平的femtosecond。

简介：BackgroundDeepsternawoundinfection(DSWI)aftermediansternotomyforcardiacsurgeryisoneofthemostcomplexandpotentiallylife-threateningcomplications.ItsverydifficulttotreatDSWI,andthereislackofagreementregardingthebesttherapystrategy.Thus,weaimedtosummarizeourexperiencesofsurgicaltreatmentforDSWI,inwhichsatisfactoryclinicalresultswereobtained.MethodsWeretrospectivelyanalyzed17caseswhosufferedfromDSWIaftercardiacsurgeryinourdepartmentfromJanuary2010toJune2015.Therewere8maleand9femalepatientswiththeiraverageageof62.7±9.5years(range42~75years).Allpatientsreceivedreservationofpartofsternumcombinedwithvacuum-assistedsuctiondrainageandbilateralpectoralismajormyocutaneousadvancementflaps.ResultsTheaverageintervalbetweencardiacsurgeryanddiagnosedDSWIwas10.9±6.5days(range5~21days).Timeofvacuum-assistedsuctiondrainagewas11.6±4.8days(range5~15days)andwoundhealingtimewas27.3±7.2days(range23~35days).Allpatientshadanuneventfulpostoperativerecoveryandgoodwoundhealing.Follow-uptimewas33.7±13.3months(range8~74months).Norecurrentinfectionwasobserved.ConclusionsReservationofpartofsternumcombinedwithvacuum-assistedsuctiondrainageandbilateralpectoralismajormyocutaneousadvancementflapsisasimpleandeffectivesurgicalstrategyforthetreatmentofDSWIaftercardiacsurgery.

简介：Objective:Survivalandtreatmentofpatientswithmicroinvasivebreastcancer(MIBC)remaincontroversial.Inthispaper,weevaluatedwhetheradjuvantchemotherapyisnecessaryforpatientswithMIBCtoidentifyriskfactorsinfluencingitsprognosisanddecidetheindicationforadjuvantchemotherapy.Methods:Inthisretrospectivestudy,108patientswithMIBCwererecruitedaccordingtoseventheditionofthestagingmanualoftheAmericanJointCommitteeonCancer(AJCC).Thesubjectsweredividedintochemotherapyandnon-chemotherapygroups.Wecomparedthe5-yeardisease-freesurvival(DFS)andoverallsurvival(OS)ratesbetweengroups.Furthermore,weanalyzedthefactorsrelatedtoprognosisforpatientswithMIBCusingunivariateandmultivariateanalyses.Wealsoevaluatedtheimpactofadjuvantchemotherapyontheprognosticfactorsbysubgroupanalysisaftermedianfollow-uptimeof33months(13-104months).Results:The5-yearDFSandOSratesforthechemotherapygroupwere93.7%and97.5%,whereasthoseforthenonchemotherapygroupwere89.7%and100%.Resultsindicatethat5-yearDFSwassuperior,butOSwasinferior,intheformergroupcomparedwiththelattergroup.However,nostatisticalsignificancewasobservedinthe5-yearDFS(P=0.223)orOS(P=0.530)rateofthetwogroups.Mostrelevantpoor-prognosticfactorswereKi-67overexpressionandnegativehormonalreceptors.Cumulativesurvivalwas98.2%vs.86.5%betweenlowKi-67(≤20%)andhighKi-67(>20%).ThehazardratioofpatientswithhighKi-67was16.585[95%confidenceinterval(CI),1.969-139.724;P=0.010].Meanwhile,ER(-)/PR(-)patientswithMIBChadcumulativesurvivalof79.3%comparedwith97.5%forER(+)orPR(+)patientswithMIBC.ThehazardratioforER(-)/PR(-)patientswithMIBCwas19.149(95%CI,3.702-99.057;P<0.001).SubgroupanalysisshowedthatchemotherapycouldimprovetheoutcomesofER(-)/PR(-)patients(P=0.014),butnotthosewhooverexpressKi-67(P=0.105).Conclusions:PatientswithMIBCwhooverexpressKi-67and

简介：AbstractObesity has become a global health problem. Lifestyle modification and medical treatment only appear to yield short-term weight loss. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it sustains weight reduction and results in the remission of obesity-associated comorbidities for obese individuals. However, patients who undergo this surgery may develop hypoglycemia. To date, the diagnosis is challenging and the prevalence of post-RYGB hypoglycemia (PRH) is unclear. RYGB alters the anatomy of the upper gastrointestinal tract and has a combined effect of caloric intake restriction and nutrient malabsorption. Nevertheless, the physiologic changes after RYGB are complex. Although hyperinsulinemia, incretin effects, dysfunction of β-cells and α-cells, and some other factors have been widely investigated and are reported to be possible mediators of PRH, the pathogenesis is still not completely understood. In light of the important role of the gut microbiome in metabolism, we hypothesized that the gut microbiome might also be a critical link between RYGB and hypoglycemia. In this review, we mainly highlight the current possible factors predisposing individuals to PRH, particularly related to the gut microbiota, which may yield significant insights into the intestinal regulation of glucose metabolic homeostasis and provide novel clues to improve the treatment of type 2 diabetes mellitus.

简介：BackgroundVocalcordmovementdisorder(VCMD)isalaryngealdisordercharacterizedbyparadoxicaladductionofthevocalcordsduringininspiration,expirationorboth.ThenursingexperienceofpatientswithVCMDafteraorticdissectionsurgeryislimited.MethodsWeretrospectivelyanalyzedtheclinicaldataandnursingrecordsof269patientsafteraorticdissectionsurgeryinGuangdongGeneralHospitalbetweenMay2010andMay2012.Weobservedthepatients’pronunciation,andjudgediftherewasdysphagiaundergoingwaterdrinkingtesttwohoursafterextubation,toconfirmwhetherpatientshadVCMD.ResultsSeventeenpatientshadVCMDafteraorticdissectionsurgery,ofwhom2sufferedhoarseness,3haddysphasiaand12hadbothhoarsenessanddysphasia.Aftertimelytreatmentandcarefullynursing,allthepatientsrecoveredwell.ConclusionsWiththeenhancedcareofpatientswithaorticdissection,observinghoarsenessappearanceanddrinkingexperimentimmediatelyafterextubationcandetectVCMDassoonaspossible.Furtherrehabilitationtrainingandpsychologycarecanpreventbuckingandaspirationeffectively,andpromotingrecoveryandimprovingpatient’slifequality.