Nonsurgical risk factors for marginal ulcer following Roux-en-Y gastric bypass for obesity: a systematic review and meta-analysis of 14 cohort studies.

BACKGROUNDS: Marginal ulcer (MU) is a common complication of Roux-en-Y Gastric Bypass (RYGB). The primary goal of this meta-analysis was to identify potential risk factors for MU post-RYGB. METHODS: A comprehensive literature search was conducted on four databases (PubMed, Embase, Web of Science, and the Cochrane Library) to identify articles published from inception to 23 May 2023 that reported risk factors linked to ulcer occurrence post-RYGB. Hazard Ratio (HR) and Odds Ratio (OR) with respective 95% CI were calculated to estimate the impact of selected risk factors on MU. The risk factors were evaluated through multivariate analyses. The estimated risk factors were subjected to a random-effects model. Subgroup analysis based on study baseline characteristics and leave-one-out sensitivity analysis were also performed to investigate the potential sources of heterogeneity and assess the robustness of the findings. RESULT: Herein, 14 observational studies involving 77 250 patients were included. Diabetes, smoking, and steroid use were identified to be risk factors of MU, with pooled ORs of (1.812; 95% CI: 1.226-2.676; P =0.003), (3.491; 95% CI: 2.204-5.531; P< 0.001), and (2.804; 95% CI: 1.383-5.685; P =0.004), respectively. Other risk factors, such as alcohol consumption, male sex, and PPI use, were deemed not significant due to differences in data acquisition and effect estimates. CONCLUSION: Diabetes, smoking, and steroid use were identified as independent risk factors of MU. Enhancing awareness of these identified risk factors will lead to more effective preoperative prevention and targeted postoperative interventions for patients undergoing RYGB.

[Surgical site infection following abdominal surgery in China: a multicenter cross-sectional study].

OBJECTIVE: To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China. METHODS: The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI. RESULTS: A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI. CONCLUSIONS: The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.

Natural radioactivity levels in topsoil from the Pearl River Delta Zone, Guangdong, China.

Concentrations of the natural radionuclides ²³8U, ²²6Ra, ²³²Th and 4°K have been measured by γ-ray spectrometry in 796 topsoil samples from the Pearl River Delta Zone (PRDZ) of Guangdong, China. The mean concentrations for ²³8U, ²²6Ra, ²³²Th and 4°K were found to be 140 ± 37 Bq kg⁻¹, 134 ± 41 Bq kg⁻¹, 187 ± 80 Bq kg⁻¹ and 680 ± 203 Bq kg⁻¹ dry mass, respectively. These values were all higher than the mean values in soil for China and the world. Outdoor air-absorbed dose rates, calculated from activity concentrations of ²²6Ra, ²³²Th and 4°K, ranged from 86 to 237 nGy h⁻¹, with a mean value of 165 ± 46 nGy h⁻¹. The corresponding annual outdoor effective dose rate per person was estimated to be between 0.11 and 0.29 mSv y⁻¹, with a mean value of 0.20 ± 0.06 mSv y⁻¹, which was also higher than the world mean value of 0.07 mSv y⁻¹. The radium equivalent activity (Ra(eq)) and the external hazard index (I(r)) resulted from the natural radionuclides in soil, were also calculated and found to vary from 230 to 676 Bq kg⁻¹ and from 0.6 to 1.8, respectively. The Ra(eq) and the I(r) in all the investigated regions were up to 75% higher than the set limits of 370 Bq kg⁻¹ and 1.0, respectively.

[Competitive sorption of mixed organic pollutants by soils].

Binary sorption equilibria were measured using three different loading methods: METHOD (1): Naphthalene loaded before phenanthrene; Method (2): Both Solutes loaded simultaneously; Method (3): Naphthalene loaded after phenanthrene. Each having 110 reactors and 10 levels of initial concentrations for both tested organic solutes. This is very different from previous studies which employed one single initial concentration of the primary solute and multiple concentration levels of the competitor and loaded both solutes simultaneously. Results indicate that the adsorption behavior of the same solute on the same sorbent with competing solute is distinctly different from its single adsorption behaviors. Naphthalene isotherm becomes more linear as phenanthrene concentration increases in the binary systems tested using all three loading methods. In contrast, phenanthrene isotherm remains nonlinear when it was loaded after or loaded simultaneously with naphthalene. It becomes more linear as a function of naphthalene concentration only when phenanthrene was loaded before naphthalene. The Koc values decrease as a function of competing solute concentration (c(e)), and approach to the lowest value when this c, is about 0.5 Sw. IAST provides better predictions for the sorption only when the competing solute is at lower c(e)(< 0.01 Sw). Large-size and more hydrophobic phenanthrene competes favorably with the small-size and relatively less hydrophobic naphthalene, and the heterogeneity of natural organic matter associated with the soil may have strong influence on the competitive phenomena between the tested solutes.