Colonization of multidrug-resistant Gram-negative bacteria increases risk of surgical site infection after hemorrhoidectomy: a cross-sectional study of two centers in southern China.

PURPOSE: The present study aims to determine the rectoanal colonization rate and risk factors for the colonization of present multidrug-resistant bacteria (MDRBs). In addition, the relationship between MDRB colonization and surgical site infection (SSI) following hemorrhoidectomy was explored. METHODS: A cross-sectional study was conducted in the Department of Colorectal Surgery of two hospitals. Patients with hemorrhoid disease, who underwent hemorrhoidectomy, were included. The pre-surgical screening of multidrug-resistant Gram-negative bacteria (MDR-GNB) colonization was performed using rectal swabs on the day of admission. Then, the MDRB colonization rate was determined through the rectal swab. Logistic regression models were established to determine the risk factors for MDRB colonization and SSI after hemorrhoidectomy. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 432 patients met the inclusion criteria, and the MDRB colonization prevalence was 21.06% (91/432). The independent risk factors for MDRB colonization were as follows: patients who received ≥ 2 categories of antibiotic treatment within 3 months (odds ratio (OR): 3.714, 95% confidence interval (CI): 1.436-9.605, p = 0.007), patients with inflammatory bowel disease (IBD; OR: 6.746, 95% CI: 2.361-19.608, p < 0.001), and patients with high serum uric acid (OR: 1.006, 95% CI: 1.001-1.010, p = 0.017). Furthermore, 41.57% (37/89) of MDRB carriers and 1.81% (6/332) of non-carriers developed SSIs, with a total incidence of 10.21% (43/421). Based on the multivariable model, the rectoanal colonization of MDRBs (OR: 32.087, 95% CI: 12.052-85.424, p < 0.001) and hemoglobin < 100 g/L (OR: 4.130, 95% CI: 1.556-10.960, p = 0.004) were independently associated with SSI after hemorrhoidectomy. CONCLUSION: The rectoanal colonization rate of MDRBs in hemorrhoid patients is high, and this was identified as an independent risk factor for SSI after hemorrhoidectomy.

Novice Chinese Bariatric Nurses' Perceptions of Their Role as Bariatric Case Managers: A Qualitative Study.

INTRODUCTION: Bariatric case managers (BCM) are integral healthcare team members for patients undergoing bariatric surgery in China. As the demand for bariatric surgery increases in China, the number of BCMs has also risen. However, more is needed to know about the perceptions of novice bariatric nurses toward their role as case managers. This study aims to investigate the perceptions of novice Chinese bariatric nurses toward their roles during the early stages of their careers. METHODS: This qualitative study employed semi-structured individual interviews with 15 novice bariatric nurses who received training as BCMs. The interviews were audio-recorded, transcribed line-by-line, and analyzed thematically. The study was conducted in a bariatric surgery center of a public tertiary hospital in Southern China. RESULTS: Three themes emerged from the data related to the perceptions of being a BCM: "negotiating the ambiguity of the BCM role," "establishing a core set of behaviors for the BCM role," and "identifying areas of competence to develop a BCM role framework." The novice bariatric nurses expressed both positive and negative feelings toward their role. They highlighted the need for further training to improve their qualifications and the importance of support from colleagues, and hospital management. CONCLUSIONS: The findings illuminate the role of the BCM in China. Future research should investigate effective and acceptable job descriptions and cooperation modes between BCMs, colleagues and hospital management. We recommend using these findings to develop training programs for novice BCMs and improve their capacity to provide quality care to patients undergoing bariatric surgery.

Auricular Acupressure in Relieving PONV and Promoting Gastrointestinal Function Recovery in Females After Laparoscopic Sleeve Gastrectomy: A Prospective Randomized Controlled Trial.

BACKGROUND: The role of current pharmacological treatment after laparoscopic sleeve gastrectomy (LSG) is limited. The incidence of postoperative nausea and vomiting (PONV) after LSG remains high. Auricular acupressure (AA) is believed to relieve PONV after laparoscopic surgeries, but its role in patients with obesity after LSG has yet to be confirmed. METHODS: Ninety-five female patients who underwent LSG were randomized into two groups: AA combined with conventional anti-nausea medication (AA group, 47 patients) or conventional anti-nausea medication group (control group, 48 patients). Index of nausea and vomiting and retching (INVR) scores, postoperative anti-vomiting medication use, time of first anus exhausting, time of first fluid intake, and time of first to get out of bed were collected within 48 h after surgery. RESULTS: Demographic data of patients in both groups were balanced and comparable. INVR score (F = 7.505, P = 0.007), vomiting score (F = 11.903, P = 0.001), and retching score (F = 12.098, P = 0.001) were significantly lower in the AA group than that in the control group within 48 h postoperatively. Use of metoclopramide was significantly less in the AA group than in the control group (4.7 [5.5]) vs. 8.8 [7.6], P = 0.004); time to first anus exhausting was significantly less in the AA group than in the control group (17.50 [6.00] vs. 20.42 [8.62], P = 0.020). CONCLUSIONS: AA combined with conventional anti-vomiting agents can alleviate PONV in female patients after LSG, and AA can promote gastrointestinal exhaustion. TRIAL REGISTRATION: The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration no. ChiCTR2100047381 on June 13, 2021.

Correlation of T2DM and Anthropometric Measures with Total Small Bowel Length and Its Effects on Diabetes Remission After Bariatric Surgery.

BACKGROUND: The outcome of weight loss surgery is related to several factors, and for super-obese patients, the rate of weight loss failure and weight recovery after Roux-en-Y gastric bypass (RYGB) is high. Relevant studies have shown that the weight loss effect also correlates with total small bowel length (TSBL) and biliopancreatic (BP) and Roux limbs. However, there are few studies on the relationship between TSBL and anthropometric parameters, the BP limb, the Roux limb, and weight loss effect, and no relevant reports have been reported in China. OBJECTIVES: The objective was to study the relationship between the total length of the small intestine and anthropometric parameters in the Chinese population. The effect of the Roux limb/biliopancreatic limb (RL/BPL) ratio on weight loss and diabetes remission in RYGB patients 1 year after surgery was evaluated to find the appropriate ratio relationship. METHODS: In this prospective study, 148 patients between the ages of 19 and 68 years who underwent laparoscopic Roux-en-Y gastric bypass were enrolled. Height, weight, BMI, the BP limb, the Roux limb, fasting blood glucose (FBG), etc., were noted. To explore the correlation between the total length of the small intestine and these values. Subsequently, the 148 patients were followed up for 1 year after surgery. The patients diagnosed with T2DM before surgery were screened out, and 56 patients were finally identified according to the postoperative follow-up, in which BPL = 50 cm and RL = 150 cm, 175 cm, and 200 cm, respectively. RL/BPL was divided into 3, 3.5, and 4 groups according to the proportional relationship to explore the relationship between RL/BPL and diabetes remission and weight loss. RESULTS: (1) The study included 148 patients (61 women and 87 men). The mean age was 35.68 ± 10.46 years, weight = 127.46 ± 34.51 kg, height = 167.83 ± 9.16 cm, BMI = 44.94 ± 10.58 kg/m2. The average TSBL value was 714.41 ± 101.08 cm. Linear regression analysis showed that TSBL was positively correlated with height, weight, neck circumference, chest circumference, waist circumference, and Roux limb. (2) Fifty-six patients with T2DM who were followed up 1 year after surgery were divided into three groups. Group 1: BPL = 50 cm, RL = 150 cm (n = 20); group 2: BPL = 50 cm, RL = 175 cm (n = 26); group 3: BPL = 50 cm, RL = 200 cm (n = 10); RL/BPL = 3 was associated with higher weight loss than the other groups. The remission rate of diabetes did not differ between the three groups. CONCLUSIONS: TSBL was positively correlated with height, weight, neck circumference, chest circumference, waist circumference, and Roux limb. The TSBL of males was significantly higher than that of females. Among patients with T2DM who participated in the follow-up 1 year after surgery, RL/BPL = 3 (n = 20) had greater weight loss than the other groups.

Knowledge and Attitudes Towards Obesity and Bariatric Surgery in University Students: a National Survey.

BACKGROUND: Obesity has become a noticeable public health problem, especially in the young population. Bariatric surgery is growing in China but it is still new to the general public. Knowledge and attitudes towards obesity and bariatric surgery in university students are important to national health decision-making. OBJECTIVES: To study the knowledge and attitudes towards obesity and bariatric surgery among Chinese university students. METHODS: A self-designed questionnaire was distributed to university students to fill in online from June to July 2021. RESULTS: A total of 3199 questionnaires were received, with an effective rate of 98.58% (3154 questionnaires). 65.44% of whom had normal BMI and 12.14% of whom were overweight or in obesity. More than 80% of them had a high knowledge of the common causes and complications of obesity but lacked knowledge of the relationship between obesity and bone and joint, tumor or cancer, and reproductive diseases. 51.55% of them thought they needed to lose weight, especially female students (P < 0.01). Only 39% had regular physical exercise habits, 58.62% of them could reasonably control their diet, and more than 2/3 of them (67.82%) often stayed up late. Safety (29.77%) and effectiveness (29.3%) of bariatric surgery were not well accepted. Among medical students, education positively affected knowledge and attitudes towards bariatric surgery (P < 0.05). Mass media and social platforms were the main sources for obtaining obesity and weight-loss information. CONCLUSIONS: Chinese university students have insufficient knowledge of obesity and related complications, lack of scientific management of their own weight, and poor acceptance of bariatric surgery. More education is needed on this issue.

Perceptions and Attitudes Toward Obesity and its Management in Migrants and Rural Residents in China: a Cross-sectional Pilot Study.

BACKGROUND: The incidence of overweight and obesity in rural-to-urban migrants and rural residents is increasing rapidly. This study aims to explore the perceptions and attitudes toward obesity and its management among rural-urban migrants and rural residents who are left in rural regions, China. METHODS: We performed a cross-sectional survey investigating migrants and rural residents aged 18-45 in China from October to November 2020. We created a questionnaire. Two hundred five questionnaires were completed. RESULTS: Finally, 184 were included, of which 102 were migrants and 82 were non-migrants. More respondents were male (62%). There was no significant difference in BMI between the two groups. The migrants had good knowledge about obesity as a disease (75.5%) and agreed that obesity seriously threatens health (93.1%). It is worth noting that more non-migrant group believed that obesity was due to a lack of willpower (87.3% vs. 54.9%, p = 0.000) than the migrant group. More than half in both groups believed that obesity was caused by a bad lifestyle (69.6%) or addiction to food (58.7%). Half of the participants believed that biological factors caused obesity. Most participants in both groups still believed weight loss modalities were limited to exercise and diet while having extremely poor acceptance of pharmacotherapy and bariatric surgery. CONCLUSIONS: This study found that the migrants and rural residents had a good understanding of obesity as a disease, and better among migrants than rural residents. However, they showed significant uncertainty and misconceptions about the efficacy and safety of pharmacotherapy and bariatric surgery.

A Retrospective Evaluation of Pregnancy Outcomes Following Bariatric Surgery: A Single-Center Experience.

Background: Bariatric and metabolic surgery (BMS) is an effective treatment for obesity and its complications, but its effect on pregnancy outcomes is inconclusive. The present study aimed to investigate women's pregnancy status and outcomes as well as the impact of pregnancy intervals after BMS. Methods: The menstrual cycle and fertility status of women who underwent BMS in our centre between July 2010 and January 2021 were retrospectively analyzed and followed up until one-year post-delivery. The pregnancy outcomes after BMS were observed, including changes in weight, pregnancy interval, pregnancy complications, weight and health status of the newborn (premature birth, admission to neonatology, or deformity). Results: We identified 31 women who were successfully conceived after BMS. There were statistical differences in weight and menstrual status before and post-operation (P < 0.05), and 77.97% of them had remission or recovery of obesity-related comorbidities. Eighteen patients delivered successfully after BMS, but there were still 12 cases of spontaneous abortion and 1 case of induced abortion. The abortion rate in pregnancy intervals less than 2 years was higher than those ≥2 years (P = 0.045). Of the women who delivered successfully, 5 had pregnancy-specific complications, including gestational diabetes mellitus and hypertensive disorder of pregnancy. However, the growth and development of the newborn are normal since the birth follow-up. Conclusion: The present results suggest that the abortion rate in pregnancy intervals less than 2 years was higher than those ≥2 years. It is recommended that postoperative patients avoid pregnancy until their weight is stable to reduce the risk of adverse pregnancy outcomes.

Impact of Self-Monitoring on Weight Loss After Bariatric Surgery.

BACKGROUND: Weight loss after bariatric surgery varies among patients. Patients who do not comply with self-monitoring are predicted to lose less weight than those who comply with self-monitoring. OBJECTIVE: To assess the effect of compliance with self-monitoring behavior on long-term %excess weight loss (%EWL) and %total weight loss (%TWL) among patients receiving laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: We used retrospective analysis to evaluate the self-monitoring behavior of patients and their weight changes throughout a 2-year follow-up. The participants were divided into two groups: group 1 consisted of participants who kept self-monitoring behavior records for all follow-ups and group 2 consisted of participants who kept self-monitoring behavior records for only six months of follow-up. Our investigators used telephone interviews to collect the data. By comparing %EWL and %TWL, we assessed the possible relationship between the long-term self-monitoring behavior, weight loss outcome, and operation type. RESULTS: There were 384 included samples. %EWL was significantly different between group 1 and group 2, and group 1 participants had better outcomes regardless of operational method. In group 2, LRYGB patients had better %EWL outcomes than LSG patients. CONCLUSIONS: Patients with long-term self-monitoring behaviors have better %EWL and %TWL. Patients in LRYGB group had better weight loss outcomes than the LSG group.

Knowledge and Attitudes Towards Obesity and Bariatric Surgery in Chinese Nurses.

BACKGROUND: Obesity has become a global epidemic. Surgical treatment of obesity and metabolic disorders in China is increasing rapidly, but it is still a new discipline even to health professionals. As an important member of the multidisciplinary team, the knowledge and attitudes of nurses provide crucial health care to the patients and support to surgeons. OBJECTIVES: To study the Chinese nurses' knowledge of obesity and metabolic disorders, and attitudes towards bariatric surgery and to improve their capability of work in this new discipline. METHODS: This is a multicenter study, with the questionnaire distributed to cooperative hospitals in the form of an electronic questionnaire by the First Affiliated Hospital of Jinan University in April 2018. A questionnaire was designed to investigate nurses' demographic, knowledge, and attitude towards obesity, weight loss, and bariatric surgery. RESULTS: A total of 5311 questionnaires were received, with an effective rate of 91.8% (4878 questionnaires); 65.2% of nurses had a normal BMI. Nurses generally had a high knowledge of obesity and related cardiovascular diseases (98.6%) and type 2 diabetes mellitus (90.2%). However, there was a lack of knowledge in other related aspects, for example its relations to carcinoma (49.5%), gastroesophageal reflux disease (40.1%), and psychological disorders (49.1%), which are controversial issues in bariatric surgery. It was found that education (p < 0.05) had an important influence to nurses' knowledge about the comorbidities of obesity. Female nurses had a higher tendency to choose weight loss than males, but male nurses did physical exercise more frequently than females (p < 0.05). Their acceptance of safety (25.1%) and efficacy (22.9%) of bariatric surgery is low, with concerns predominantly about postoperative complications and adverse effects. Surgical nurses had a more optimistic attitude towards surgery (p < 0.05). CONCLUSIONS: Chinese nurses have poor knowledge of obesity-related metabolic disorders and also have poor acceptance of surgical treatment modalities. Our findings suggest that it is crucial to enhance the continuing education of Chinese nurses for obesity, metabolic disorders, and bariatric surgery.

Prognostic value of preoperative prognostic nutritional index in stage III gastric cancer after curative resection: a retrospective cohort study.

BACKGROUND AND OBJECTIVES: Nutrition and inflammation play a crucial role in the development of cancer. The prognostic value of the prognostic nutritional index (PNI) has been confirmed in some types of human cancers. This study analyzed the prognostic significance of the preoperative PNI in patients with stage III gastric cancer after curative surgery. METHODS AND STUDY DESIGN: In this retrospective study, we enrolled 274 patients who underwent curative operation for stage III gastric cancer. The correlation between the preoperative PNI and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analyses. RESULTS: The patients with a high PNI had a significantly higher median OS than did those with a low PNI (46.8 months vs 24.1 months, p=0.01). In the subgroup analysis, the survival benefit of the PNI was limited to the patients with poorly differentiated gastric cancer (high PNI, 46.8 months; low PNI, 21.8 months, p=0.004) and was not observed in those with well and moderately differentiated cancer (high PNI, 30.3 months; low PNI, 26.7 months, p=0.30). In the multivariate analysis, the PNI was an independent prognostic factor for OS. CONCLUSIONS: The PNI can be used as an independent prognostic biomarker for operable advanced gastric cancer.

Factors Influence the Acceptance of Surgical Treatment in Chinese Bariatric Surgery Candidates.

BACKGROUND: The prevalence of obesity and obesity-related disorders is rapidly increasing among the Chinese populations. Bariatric surgery is becoming more and more popular in China, yet little cases were performed compared with western countries. The acceptance of this new treatment modality in Chinese bariatric surgery candidates was seldom studied. OBJECTIVE: To investigate the factors affecting the choice of bariatric surgery in Chinese patients with obesity and metabolic disorders, so as to promote the popularization of bariatric surgery in developing countries like China METHODS: Patients with obesity and related metabolic disorders meet the indications for bariatric surgery in the Department of Metabolic and Bariatric Surgery in the First Affiliated Hospital of Jinan University between January 2016 and April 2017 were asked to answer a questionnaire about the demographics of the patients, social economic status, present and past history, family history, etc. The data collected and the relationship of the acceptance of bariatric surgery were analyzed. RESULTS: There were 157 patients (51 males, 32.5%; 106 females, 67.5%) with mean BMI 38.7 ± 8.1 kg/m2 answered the questionnaire. One hundred twenty-three of them (78%) accepted bariatric surgery. By univariate analysis, it was found that patients' weight, BMI, family support, medical insurance, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are correlated with the acceptance of bariatric surgery. By multivariate analysis, it was found that patients' weight (P = 0.024), BMI (P = 0.007), family support (P < 0.001), medical insurance (P < 0.001), past surgical history (P = 0.011), family history of T2DM (P = 0.020), and obesity-related comorbidities and symptoms (P = 0.030) are statistically significant and were positively correlated with the acceptance of bariatric surgery. Age, height, gender, history of smoking and alcohol consumption, family history of obesity, history of hypertension and T2DM, education level, and marital status were not statistically significant (P < 0.05). CONCLUSIONS: Patients with heavier weight, higher BMI, family support, medical insurance reimbursement, past surgical history, family history of T2DM, and obesity-related comorbidities and symptoms are more likely to consider bariatric surgery in Chinese bariatric surgery candidates. It will be important to provide appropriate healthcare education and support to patients focusing on both obesity-related health risks and options of surgical treatment so to improve their acceptance of bariatric surgery.