Failure of enhanced recovery programs after laparoscopic radical gastrectomy: a single-center retrospective study.

BACKGROUND: Enhanced recovery programs (ERPs), as a rapid rehabilitation method, have been widely used in gastric cancer patients. Although many related studies have confirmed their effectiveness, some patients may still experience poor clinical outcomes. This study analyzed risk factors associated with ERP failure after laparoscopic radical gastrectomy. METHODS: We analyzed the outcomes of 212 patients who underwent ERP following laparoscopic radical gastrectomy between March 2017 and December 2019. The ERP included preoperative education, short periods of fasting, non-mechanical intestinal preparation, early ambulation and oral feeding. ERP failure was defined as more than 7 days of hospitalization due to postoperative complications, unplanned readmission within 30 days of surgery, or death. RESULTS: The mean patient age was 62 years (range 39-89 years). Surgical procedures included total gastrectomy (n = 161) and distal gastrectomy (n = 51). Overall, 38 (17.9%) patients failed to complete the program, with no mortality. Univariable analysis (P < 0.15) revealed that ERP failure was associated with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, tumor location, preoperative education, combined operation, long operation time, and significant blood loss. Multivariable analysis (P < 0.05) showed that age, ASA grade III, combined operation and preoperative education were independent risk factors for ERP failure. CONCLUSIONS: We showed that an advanced age, a high ASA grade, lack of a preoperative education and combined surgery were independent risk factors associated with ERP failure after laparoscopic gastrectomy. Therefore, a preoperative patient evaluations and education are important for the success of ERPs.

Importance of NUDT15 c.415C>T phenotype in treatment of inflammatory bowel disease with azathioprine and occurrence of severe myelosuppression: A case report.

Azathioprine is one of the main drugs in the treatment of inflammatory bowel disease (IBD). It has been widely used in the remission and maintenance treatment of IBD. Some patients may experience some degree of myelosuppression, but very few patients experience severe myelosuppression. Here, we report a 20-year-old male Asian patient with severe myelosuppression due to azathioprine treatment of IBD. In this case, the azathioprine-related genotyping test showed that homozygous wild-type TPMT*3 but a c.415C>T homozygous mutation was found in NUDT15. Our report strengthens the association between genetic polymorphisms of azathioprine-metabolizing enzymes and severe myelosuppression. Therefore, we recommend routine NUDT15 c.415C>T phenotype testing prior to long-term azathioprine treatment to avoid severe myelosuppression.

Super-Resolution Network with Information Distillation and Multi-Scale Attention for Medical CT Image.

The CT image is an important reference for clinical diagnosis. However, due to the external influence and equipment limitation in the imaging, the CT image often has problems such as blurring, a lack of detail and unclear edges, which affect the subsequent diagnosis. In order to obtain high-quality medical CT images, we propose an information distillation and multi-scale attention network (IDMAN) for medical CT image super-resolution reconstruction. In a deep residual network, instead of only adding the convolution layer repeatedly, we introduce information distillation to make full use of the feature information. In addition, in order to better capture information and focus on more important features, we use a multi-scale attention block with multiple branches, which can automatically generate weights to adjust the network. Through these improvements, our model effectively solves the problems of insufficient feature utilization and single attention source, improves the learning ability and expression ability, and thus can reconstruct the higher quality medical CT image. We conduct a series of experiments; the results show that our method outperforms the previous algorithms and has a better performance of medical CT image reconstruction in the objective evaluation and visual effect.

Telephone follow-up by clinical pharmacists can improve treatment outcomes in patients with peptic ulcers: A prospective randomized study.

OBJECTIVE: The purpose of this study was to investigate the effect of pharmaceutical care by clinical pharmacists through telephone follow-up on the treatment outcomes in patients with peptic ulcers who had been discharged from the hospital. METHODS: A total of 120 patients with peptic ulcers discharged from the hospital were randomly divided into an intervention group and a control group, with 60 patients in each group. The patients in the two groups received different services. RESULTS: A total of 108 patients with peptic ulcers were enrolled in this study, including 53 in the intervention group and 55 in the control group. This study showed that the Helicobacter pylori eradication rate (19/23, 82.61% vs 13/29, 44.83%), awareness of peptic ulcer disease, medication compliance, diet compliance, and life compliance in the patients in the intervention group were higher than those in the patients in the control group. The H pylori eradication group had higher follow-up scores than the noneradication group. Sex and body mass index (BMI) did not affect the results in either group, but age did. In the control group, younger patients scored higher than older patients, whereas in the intervention group, this difference disappeared for diet compliance and life compliance, and significant differences remained for awareness of basic knowledge regarding peptic ulcer (AOKPU) and medication compliance. CONCLUSION: As a form of clinical pharmaceutical care, telephone follow-up by clinical pharmacists is recommended for discharged patients with peptic ulcers because it can improve treatment outcomes after discharge.

Can an incomplete ERAS protocol reduce postoperative complications compared with conventional care in laparoscopic radical resection of colorectal cancer? A multicenter observational cohort and propensity score-matched analysis.

Background: The patients undergoing laparoscopic radical colorectomy in many Chinese hospitals do not achieve high compliance with the ERAS (enhanced recovery programs after surgery) protocol. Methods: The clinical data from 1,258 patients were collected and divided into the non-ERAS and incomplete ERAS groups. Results: A total of 1,169 patients were screened for inclusion. After propensity score-matched analysis (PSM), 464 pairs of well-matched patients were generated for comparative study. Incomplete ERAS reduced the incidence of postoperative complications (p = 0.002), both mild (6.7% vs. 10.8%, p = 0.008) and severe (3.2% vs. 6.0%, p = 0.008). Statistically, incomplete ERAS reduced indirect surgical complications (27,5.8% vs. 59, 12.7) but not local complications (19,4.1% vs. 19, 4.1%). The subgroup analysis of postoperative complications revealed that all patients benefited from the incomplete ERAS protocol regardless of sex (male, p = 0.037, 11.9% vs. 17.9%; female, p = 0.010, 5.9% vs. 14.8%) or whether neoadjuvant chemotherapy was administered (neoadjuvant chemotherapy, p = 0.015, 7.4% vs. 24.5%; no neoadjuvant chemotherapy, p = 0.018, 10.2% vs. 15.8%). Younger patients (<60 year, p = 0.002, 7.6% vs. 17.5%) with a low BMI (<22.84, 9.4% vs. 21.1%, p < 0.001), smaller tumor size (<4.0 cm, 8.1% vs. 18.1%, p = 0.004), no fundamental diseases (8.8% vs. 17.0%, p = 0.007), a low ASA score (1/2, 9.7% vs. 16.3%, p = 0.004), proximal colon tumors (ascending/transverse colon, 12.2% vs. 24.3%, p = 0.027), poor (6.1% vs. 23.7%, p = 0.012)/moderate (10.3% vs. 15.3%, p = 0.034) tumor differentiation and no preoperative neoadjuvant radiotherapy (10.3% vs. 16.9%, p = 0.004) received more benefit from the incomplete ERAS protocol. Conclusion: The incomplete ERAS protocol decreased the incidence of postoperative complications, especially among younger patients (<60 year) with a low BMI (<22.84), smaller tumor size (<4.0 cm), no fundamental diseases, low ASA score (1/2), proximal colon tumors (ascending/transverse colon), poor/moderate differentiation and no preoperative neoadjuvant radiotherapy. ERAS should be recommended to as many patients as possible, although some will not exhibit high compliance. In the future, the core elements of ERAS need to be identified to improve the protocol.

How Should the Surgical Approach In Thyroidectomy Be Selected? A Prospective Study Comparing the Trauma of 3 Different Thyroidectomy Surgical Approaches.

OBJECTIVE: To compare the trauma of 3 different surgical approaches and provide a reference for clinicians in choosing the operative procedure. PATIENTS AND METHODS: A total of 150 patients were divided into the total endoscopic thyroidectomy (TET), endoscopic-assisted thyroidectomy (EAT), and conventional open thyroidectomy (COT) groups, with 50 patients in each group. The peripheral blood C-reactive protein (CRP) levels at different postoperative time points, operative time, intraoperative blood loss, postoperative drainage volume, postoperative pain, degree of satisfaction with the incision appearance, postoperative extubation time, and swallowing discomfort 3 months after surgery were compared among the groups that received different surgical approaches. RESULTS: The operative time of TET was longer than that of COT and EAT. The intraoperative blood loss was significantly lower in the TET and EAT groups than in the COT group. The postoperative drainage volume was lowest after EAT and highest after TET. The extubation time was significantly shorter after EAT than after TET and COT. The 6-hour CRP level was significantly higher after TET than after EAT and COT, and the 24-hour CRP level was better in the EAT group than in the other 2 groups. The CRP levels at 72 hours postoperatively were lowest in the EAT group and highest in the TET group. Postoperative pain was significantly lower after EAT than after TET and COT. Cosmetic satisfaction was highest in the TET group and lowest in the COT group. Swallowing discomfort was lowest in the EAT group and highest in the TET group. There was a positive correlation between the drainage volume on the first postoperative day, the drainage tube removal time, dysphagia, and the CRP level in each period. There was a positive correlation between pain, cosmetic satisfaction and CRP in 2 of the time periods. CONCLUSIONS: All 3 types of thyroidectomy are safe and reliable in benign tumor resection. Therefore, in clinical practice, the age, sex, and cosmetic needs of the patients, and the oncological safety should all be considered to provide patients with the most appropriate recommendations. In view of oncological safety, TET should be carefully selected for malignant tumor resection.

Mitogen-activated protein kinases mediate the oxidative burst and saponin synthesis induced by chitosan in cell cultures of Panax ginseng.

Chitosan (CHN) specially induced the activities of 39 kD and 42 kD protein kinases in ginseng cells, which could be suppressed by an inhibitor of mitogen-activated protein kinase (MAPK) pathway, PD98059. The immunoprecipitation (IP) using MAPK antibody or kinase assay in vitro also showed that CHN-induced 42 kD and 39 kD protein kinases belonged to the MAPK family. PD98059 suppressed CHN-induced transcriptions of ginseng squalene synthase and ginseng squalene epoxidase genes (gss and gse), CHN-induced accumulation of beta-Amyrin synthase (beta-AS) and synthesis of saponin. These results showed that CHN-induced activities of MAPKs were necessary for the CHN-induced saponin synthesis. EGTA and LaCl3 suppressed CHN-induced 39 kD and 42 kD MAPK activities. Ruthenium red (RR) could suppress CHN-induced 39 kD activity. All of them suppressed CHN-induced saponin synthesis. These results indicated that CHN-induced increment of cytosolic calcium was necessary for CHN-induced saponin synthesis. PD98059 also suppressed CHN-induced oxidative burst (including the increment of activity of plasma membrane NADPH oxidase and production of H2O2), but diphenylene iodonium (DPI), dimethylthiourea (DMTU) and 2,5-dihydroxycinnamic acid methyl ester (DHC) could not suppress CHN-induced MAPK activities, which indicated that MAPK was possibly function upstream of CHN-induced oxidative burst.

Fungal elicitor induces singlet oxygen generation, ethylene release and saponin synthesis in cultured cells of Panax ginseng C. A. Meyer.

Singlet oxygen is a high-energy molecular oxygen species. As one of the most active intermediates involved in chemical and biochemical reactions, singlet oxygen plays essential roles in plant responses to UV and strong light. Here, we report that Cle, an elicitor derived from fungal cell walls, induces the generation of singlet oxygen in cell cultures of ginseng, Panax ginseng. Cle treatment also triggers the activation of plasma membrane NADPH oxidase and 1-aminocyclopropane-1-carboxylic acid oxidase (ACO), subsequently leading to ethylene release and increased saponin synthesis, as shown by increased mRNA expression of squalene synthase (SQS) and squalene epoxidase (SQE), and accumulation of beta-amyrin synthase (beta-AS). Suppression of Cle-induced singlet oxygen generation or inhibition of ethylene production blocks saponin synthesis, whereas treatment of ginseng cells with ethylene or singlet oxygen induces the synthesis of saponin. Together, these results indicate that Cle-induced production of both singlet oxygen and ethylene is required for saponin synthesis, and that singlet oxygen may function upstream of ethylene during Cle-induced saponin synthesis.