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Extracellular matrices for gastrointestinal surgery:Ex vivo testing and current applications

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World Journal of Gastroenterology 2010年第32期16卷 4031-4038页

作者： Jens Hoeppner Goran Marjanovic Peter Helwig Ulrich Theodor Hopt Tobias Keck Department of General and Visceral surgery University of FreiburgFreiburg 79106Germany Department of Orthopedics and Traumatology University of FreiburgFreiburg 79106Germany

AIM:To assess the effects of bile and pancreatic juice on structural and mechanical resistance of extracellular matrices(ECMs) in ***:Small-intestinal submucosa(SIS),porcine dermal matrix(PDM),porcine pericardial matrix(PPM) and bovine pericardial matrix(BPM) were incubated in human bile and pancreatic juice in *** were examined by macroscopic observation,scanning electron microscopy(SEM) and testing of mechanical ***:PDM dissolved within 4 d after exposure to bile or pancreatic ***,PPM and PDM retained their integrity for > 60 d when incubated in either digestive *** effect of bile was found to be far more detrimental to mechanical stability than pancreatic juice in all tested *** SIS,the loss of mechanical stability after incubation in either of the digestive secretions was less distinct than in PPM and BPM [mFmax 4.01/14.27 N(SIS) vs 2.08/5.23 N(PPM) vs 1.48/7.89 N(BPM)].In SIS,the extent of structural damage revealed by SEM was more evident in bile than in pancreatic *** PPM and BPM,structural damage was comparable in both ***:PDM is less suitable for support of gastrointestinal *** SIS,PPM and BPM should also be evaluated experimentally for gastrointestinal indications.

关键词： Extracellular matrix Intestinal regeneration Ex-vivo testing gastrointestinal surgery gastrointestinal fistula Bioscaffolding

Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

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World Journal of Gastroenterology 2017年第5期23卷 891-898页

作者： Hirotaka Konishi Kazuma Okamoto Katsutoshi Shoda Tomohiro Arita Toshiyuki Kosuga Ryo Morimura Shuhei Komatsu Yasutoshi Murayama Atsushi Shiozaki Yoshiaki Kuriu Hisashi Ikoma Masayoshi Nakanishi Daisuke Ichikawa Hitoshi Fujiwara Eigo Otsuji Division of Digestive surgery Department of SurgeryKyoto Prefectural University of MedicineKajii-choKyoto city 6028566Japan

AIMTo investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal ***-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also *** formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all).CONCLUSIONEarly administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.

关键词： Quick-sequential organ failure assessment Thrombomodulin-α gastrointestinal surgery Systemic inflammatory response syndrome Acute disseminated intravascular coagulopathy

Safety of fast-track rehabilitation after gastrointestinal surgery:Systematic review and meta-analysis

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World Journal of Gastroenterology 2014年第41期20卷 15423-15439页

作者： Liu-Hua Wang Chun-Ming Lu Fang Fang Dao-Rong Wang Ping Li Yan Wang Department of General surgery Yizheng People’s Hospital Department of General surgery Armed Police Corps Hospital of Jiangsu Department of gastrointestinal surgery Subei People’s Hospital of Jiangsu Province the First Affiliated Hospital of Yang Zhou University

AIM: To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery.

关键词： Fast-track rehabilitation protocols Laparoscopic surgery Open surgery Enhanced recovery gastrointestinal surgery Complications Readmission Anastomotic leak Wound infection Obstruction

Peritoneal adhesions after laparoscopic gastrointestinal surgery

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World Journal of Gastroenterology 2014年第17期20卷 4917-4925页

作者： Valerio Mais Division of Gynecology Obstetrics and Pathophysiology of Human ReproductionDepartment of Surgical SciencesUniversity of Cagliari09124 CagliariItaly

Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2, N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against ad

关键词： Peritoneal adhesions Laparoscopy Abdomen gastrointestinal surgery Inflammation Learning curve Anti-adhesion Animal models Clinical studies Laparoscopic resection of gastrointestinal

Comparative observation of the effectiveness and safety of remimazolam besylate versus dexmedetomidine in gastrointestinal surgery in obese patients

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World Journal of gastrointestinal surgery 2024年第5期16卷 1320-1327页

作者： Yu-Fu Deng Xue-Run Jiang Zeng-Guang Feng Department of Anesthesiology Xiangtan Central HospitalXiangtan 411100Hunan ProvinceChina

BACKGROUND surgery for obese patients carries a higher risk of anesthesia complications compared with surgery for nonobese ***,a safe and effective anesthesia strategy is necessary to improve the medical experience of such patients and ensure their *** To compared the effectiveness and safety of remimazolam besylate versus dexmedetomidine(DEX)in gastrointestinal surgery in obese *** The study cohort included 60 obese patients undergoing gastrointestinal surgery between July 2021 and April 2023,comprising 30 patients who received DEX intervention(control group)and 30 patients who received remimazolam besylate intervention(research group).Heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2)),safety(nausea and vomiting,bradycardia,hypotension,and apnea),anesthesia and examination indices[induction time,anesthesia recovery time,and postanesthesia care unit(PACU)discharge time],sedation effect(Ramsay Sedation Scale),and postoperative pain visual analog scale were comparatively analyzed before anesthesia(T0),during anesthesia(T1),and after anesthesia(T2).RESULTS At T1,the research group showed significantly smaller changes in HR,RR,MAP,and SpO_(2) than the control group,with a significantly lower adverse reaction rate and shorter induction,anesthesia recovery,and PACU discharge ***,the intra-and postoperative Ramsay Sedation Scale scores were statistically higher in the research group than in the control *** Remimazolam besylate was significantly more effective than DEX in gastrointestinal surgery in obese patients and had a higher safety profile and value in clinical promotion.

关键词： Remimazolam besylate Dexmedetomidine Obesity gastrointestinal surgery Effectiveness Safety

The effect of intraoperative goal-directed fluid therapy in patients under anesthesia for gastrointestinal surgery

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World Journal of gastrointestinal surgery 2024年第9期16卷 2815-2822页

作者： Jun Zhang Xiao-Wen Li Bing-Feng Xie Department of Anesthesiology The Second Hospital of LongyanLongyan 364000Fujian ProvinceChina Department of gastrointestinal surgery Longyan First HospitalLongyan 364000Fujian ProvinceChina

BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal *** goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in *** To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal *** This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a *** experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,*** effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient *** Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(Pgastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting p

关键词： Intraoperative goal-directed fluid therapy gastrointestinal surgery Anesthesia management Postoperative recovery Complications Length of stay

Paradigm shift in gastrointestinal surgery−combating sarcopenia with prehabilitation:Multimodal review of clinical and scientific data

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World Journal of gastrointestinal surgery 2021年第8期13卷 734-755页

作者： Frederick H Koh Jason MW Chua Joselyn LJ Tan Fung-Joon Foo Winson J Tan Sharmini S Sivarajah Leonard Ming Li Ho Bin-Tean Teh Min-Hoe Chew Division of surgery Sengkang General HospitalSingapore 544886Singapore Institute of Molecular and Cell Biology Agency for Science Technology and ResearchSingapore 138673Singapore Duke-NUS Graduate Medical School National Cancer Centre SingaporeSingapore 169610Singapore

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and *** included an increased risk of total complications,major complications,re-admissions,infections,severe infections,30 d mortality,longer hospital stay and increased hospitalization expenditures.A program to enhance recovery after surgery was meant to address these complications;however,compliance to the program since its introduction has been less than *** the last decade,the concept of prehabilitation,or"pre-surgery rehabilitation",has been *** presurgical period represents a window of opportunity to boost and optimize the health of an individual,providing a compensatory"buffer"for the imminent reduction in physiological reserve *** results have been *** review the literature to critically review the utility of prehabilitation,not just in the clinical realm,but also in the scientific realm,with a resource management point-of-view.

关键词： Sarcopenia Prehabilitation surgery Frailty Value gastrointestinal surgery

Global geoepidemiology of gastrointestinal surgery rates in Crohn’s disease

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World Journal of gastrointestinal surgery 2024年第6期16卷 1835-1844页

作者： Simcha Weissman Muhammad Aziz Ayrton Bangolo Vignesh K Nagesh Htat Aung Midhun Mathew Lino Garcia Shiva A Chandar Praveena Karamthoti Harinder Bawa Aseel Alshimari Yabets Kejela Nazish Mehdi Chrishanti A Joseph Athri Kodali Rohan Kumar Priya Goyal Sanya Satheesha Fnu Nivedita Nicole Tesoro Tanni Sethi Gurpreet Singh Areej Belal Alina Intisar Hirra Khalid Samuel Cornwell Suchith B Suresh Kareem Ahmed Karabo K Marole Om P Anand Rahat B Reshi Tej I Mehta Sameh Elias Joseph D Feuerstein Department of Medicine Hackensack Meridian Health Palisades Medical CenterNorth BergenNJ 07047United States Division of Gastroenterology and Hepatology University of Toledo Medical CenterToledoOH 43614United States Department of Medicine University of WashingtonSeattleWA 98195United States Department of Radiology Johns Hopkins University HospitalBaltimoreMD 21218United States Division of Gastroenterology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA 02215United States

BACKGROUND Data regarding the worldwide gastrointestinal surgery rates in patients with Crohn’s disease(CD)remains *** To systematically review the global variation in the rates of surgery in *** A comprehensive search analysis was performed using multiple electronic databases from inception through July 1,2020,to identify all full text,randomized controlled trials and cohort studies pertaining to gastrointestinal surgery rates in adult patients with *** included continent based demographic data,CD surgery rates over time,as well as the geoepidemiologic variation in CD surgery *** analyses were conducted using *** Twenty-three studies spanning four continents were *** median proportion of persons with CD who underwent gastrointestinal surgery in studies from North America,Europe,Asia,and Oceania were 30%(range:1.7%-62.0%),40%(range:0.6%-74.0%),17%(range:16.0%-43.0%),and 38%*** clear association was found regarding the proportion of patients undergoing gastrointestinal surgery over time in North America(R^(2)=0.035)and Europe(R^(2)=0.100).A moderate,negative association was seen regarding the proportion of patients undergoing gastrointestinal surgery over time(R^(2)=0.520)in *** There appears to be significant inter-continental variation regarding surgery rates in *** evidencebased guidelines accounting for the geographic differences in managing patients with CD is ***,as a paucity of data on surgery rates in CD exists outside the North American and European continents,future studies,particularly in less studied locales,are warranted.

关键词： gastrointestinal surgery Crohn’s disease Geoepidemiology Inflammatory bowel disease Prevalence

Effects of an Omaha System-based follow-up regimen on self-care and quality of life in gastrointestinal surgery patients

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World Journal of gastrointestinal surgery 2023年第10期15卷 2179-2190页

作者： Ying-Dong Li Na Qu Jie Yang Chun-Yan Lv Yu Tang Ping Li Department of Gastroenterology Yantai Affiliated Hospital of Binzhou Medical UniversityYantai 264100Shandong ProvinceChina Department of Endoscopy Center Yantai Affiliated Hospital of Binzhou Medical UniversityYantai 264100Shandong ProvinceChina College of Basic Medicine Binzhou Medical UniversityYantai 264000Shandong ProvinceChina Department of Nursing Yantai Affiliated Hospital of Binzhou Medical UniversityYantai 264100Shandong ProvinceChina

BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery *** To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery *** A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing *** group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing *** Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two *** Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all Pgastrointestinal surgery patients,the Omaha System-ba

关键词： gastrointestinal surgery Omaha System Follow-up protocol Disease activity Intervention compliance Inflammatory bowel disease questionnaire