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Predicting short-term major postoperative complications in intestinal resection for Crohn’s disease:A machine learning-based study

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 717-730页

作者： Fang-Tao Wang Yin Lin Xiao-Qi Yuan Ren-Yuan Gao Xiao-Cai Wu Wei-Wei Xu Tian-Qi Wu Kai Xia Yi-Ran Jiao Lu Yin Chun-Qiu Chen Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery Shanghai Tenth People’s HospitalTongji University School of MedicineShanghai 200072China

BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of ***,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient *** To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following *** A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December *** study participants were randomly allocated to either a training cohort or a validation *** logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed *** Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for *** AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF *** logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was *** for the surgical approach,the other three variables ranked among the top four important variables in the novel ML *** Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial ***

关键词： Crohn’s disease Postoperative complications Nomogram Random forest intestinal resection

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Influencing factors and preventive measures of infectious complications after intestinal resection for Crohn’s disease

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World Journal of Gastrointestinal Surgery 2024年第10期16卷 3363-3370页

作者： Shi-Rong Lv Xiao Huang Li-Yun Zhou Jie Shi Chu-Chu Gong Ming-Ke Wang Ji-Shun Yang Naval Medical Center of PLA Naval Medical UniversityShanghai 200052China

The incidence of Crohn’s disease(CD)has increased in recent years,with most patients requiring intestinal *** after intestinal resection for CD can lead to poor prognosis and recurrence,among which infectious complic-ations are the most *** study aimed to investigate the common risk factors,including medications,preoperative nutritional status,surgery-related factors,microorganisms,lesion location and type,and so forth,causing infectious complications after intestinal resection for CD,and to propose corresponding preventive *** findings provided guidance for identifying suscept-ibility factors and the early intervention and prevention of infectious complic-ations after intestinal resection for CD in clinical practice.

关键词： Crohn’s disease intestinal resection Postoperative infectious complications Influencing factors Preventive measures

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Machine learning as a tool predicting short-term postoperative complications in Crohn’s disease patients undergoing intestinal resection: What frontiers?

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World Journal of Gastrointestinal Surgery 2024年第9期16卷 2755-2759页

作者： Raffaele Pellegrino Antonietta Gerarda Gravina Division of Hepatogastroenterology Department of Precision MedicineUniversity of Campania Luigi VanvitelliNaples 80138Italy

The recent study,“Predicting short-term major postoperative complications in intestinal resection for Crohn’s disease:A machine learning-based study”invest-igated the predictive efficacy of a machine learning model for major postoperative complications within 30 days of surgery in Crohn’s disease(CD)***-ploying a random forest analysis and Shapley Additive Explanations,the study prioritizes factors such as preoperative nutritional status,operative time,and CD activity *** the retrospective design’s limitations,the model’s robu-stness,with area under the curve values surpassing 0.8,highlights its clinical *** findings align with literature supporting preoperative nutritional therapy in inflammatory bowel diseases,emphasizing the importance of compre-hensive assessment and *** a significant advancement,further research is crucial for refining preoperative strategies in CD patients.

关键词： Machine learning Crohn’s disease intestinal resection Postoperative complications Preoperative assessment Nutritional optimization Predictive model Gastrointestinal surgery Surgery

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intestinal resection: Indications and Prognostic Factors at the General Surgery Department of Kankan Regional Hospital

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Surgical Science 2024年第11期15卷 588-597页

作者： Koundouno Aly Mampan Fofana Housein Bah Mamadou Foinké Koundouno Saa Amadou Leno Tamba Keita Lancinè Fanta Koivogui Yaraboye Camara Sékou Tiguidan Koundouno Samuel Sanoh Lamine Doumbouya Moussa Cherif Mamady Sacko Mamoudou Sano Amara Thiam Mohamed Department of Surgery Kankan Regional Hospital Kankan Guinea Department of General Surgery Ignace Deen National Hospital CHU of Conakry Conakry Guinea Department of General Surgery Conakry Military Hospital Conakry Guinea The Nelson Mandla Health School in Matoto Conakry Guinea Department of Maternity Kankan Regional Hospital Kankan Guinea

Introduction: intestinal resection is the disconnection or removal of part of the intestine with its meso. The aim was to describe the indications and prognostic factors for intestinal resections at the surgical department of Kankan Regional Hospital. Patients and Methods: This was a retrospective descriptive study covering the files of patients who had undergone intestinal resections in the surgery department of the Kankan regional hospital over a period of 4 years from 1st January 2019 to December 31, 2022. Results: We collected 164 cases of intestinal resection representing 4.19% of all surgical procedures. (N = 3909). The average age of our patients was 37.78 years with extremes of 1 and 90 years. The male gender was predominant (64.6%) and the sex ratio was 1.8. The majority of patients consulted after 72 hours. Acute intestinal obstruction was the pathology motivating the most intestinal resection 42.90% followed by acute peritonitis 33%, digestive fistula 4.3%, tumors 3.6% and wounds 2.4%. intestinal necrosis with 91 cases (56.5%) constituted the first indication for resection in our study followed by intestinal perforations 41 cases (24.9%). We performed an anastomotic resection of the small intestine in 70 cases (42.9%), an ileostomy in 4 cases (2.4%), a right hemi colectomy in 26 cases (15.9%), a left hemi colectomy in 2 cases (1.2%), segmental colectomy plus immediate anastomosis in 57 cases (34.2%) and 5 cases of colostomy. We recorded 48 deaths (29.3%). Conclusion: intestinal resection is a common procedure in our context. These indications are multiple. An improvement in the prognosis should be achieved by reducing the diagnostic and treatment time associated with the training of surgical staff.

关键词： intestinal resection Anastomosis Indication Mortality

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Postoperative Outcomes in Exploratory Laparotomy and intestinal resection in Children: A Secondary Descriptive Observational Analysis

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Open Journal of Pediatrics 2021年第4期11卷 618-626页

作者： Claudine Kumba Department of Pediatric Anesthesia and Critical Care Necker Enfants Malades University Hospital Assistance Publique H&ocirc pitaux de Paris APHP University of Paris Paris France

Background: We previously reported independent predictors of intraoperative and postoperative morbidity. These were age, American Society of Anesthesiologists Score (ASA), emergency situations, surgery and transfusion. ASA was the independent predictor of mortality. We conducted a secondary analysis of this previous retrospective study in patients who underwent exploratory laparotomy and intestinal resection. Objectives: The objective was to describe intraoperative and postoperative outcomes in patients who underwent exploratory laparotomy and intestinal resection in the initial study and to present a research protocol for intraoperative and postoperative optimization. Methods: Secondary analysis of the initial study was used. The Ethics Committee approved the study. Results: There were 54 patients with a median age of 15.5 [0 - 172] months. Thirty-seven (68.5%) patients underwent intestinal resection, nine (16.7%) underwent exploratory laparotomy

关键词： Exploratory Laparotomy intestinal resection Children Intraoperative and Postoperative Outcomes Intraoperative Goal-Directed Therapies

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Postoperative diarrhea in Crohn's disease:Pathogenesis,diagnosis,and therapy

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World Journal of Clinical Cases 2023年第1期11卷 7-16页

作者： En-Hao Wu Zhen Guo Wei-Ming Zhu Department of General Surgery Affiliated Jinling HospitalMedical School of Nanjing UniversityNanjing 210002Jiangsu ProvinceChina

Diarrhea is a frequent symptom in postoperative patients with Crohn’s diseases(CD),and several different mechanisms likely account for postoperative diarrhea in CD.A targeted strategy based on a comprehensive underst... 详细信息

关键词： Postoperative diarrhea Crohn’s disease intestinal resection Bile acid malabsorption Treatment

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Machine learning in predicting postoperative complications in Crohn’s disease

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2745-2747页

作者： Li-Fan Zhang Liu-Xiang Chen Wen-Juan Yang Bing Hu Department of Gastroenterology and Hepatology West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina Digestive Endoscopy Medical Engineering Research Laboratory West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

Crohn's disease(CD)is a chronic inflammatory bowel disease of unknown origin that can cause significant disability and morbidity with its *** to the unique nature of CD,surgery is often necessary for many patients during their lifetime,and the incidence of postoperative complications is high,which can affect the prognosis of ***,it is essential to identify and manage post-operative *** learning(ML)has become increasingly im-portant in the medical field,and ML-based models can be used to predict post-operative complications of intestinal resection for ***,a valuable article titled“Predicting short-term major postoperative complications in intestinal resection for Crohn's disease:A machine learning-based study”was published by Wang et *** appreciate the authors'creative work,and we are willing to share our views and discuss them with the authors.

关键词： Crohn’s disease intestinal resection Postoperative complications Machine learning Explainability

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Acute small bowel obstruction caused by endometriosis:A case report and review of the literature

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World Journal of Gastroenterology 2008年第21期14卷 3430-3434页

作者： Antonella De Ceglie Claudio Bilardi Sabrina Blanchi Massimo Picasso Massimo Conio Marcello Di Muzio Alberto Trimarchi Department of Gastroenterology Giovanni Paolo ⅡCancer InstituteBari 70126Italy Department of Gastroenterology General HospitalSanremo 18038Italy Department of Pathology General HospitalSanremo 18038Italy Department of Surgery General HospitalSanremo 18038Italy

Gastrointestinal involvement of endometriosis has been found in 3%-37% of menstruating women and exclusive localization on the ileum is very rare(1%-7%).Endometriosis of the distal ileum is an infrequent cause of intestinal obstruction,ranging from 7% to 23% of all cases with intestinal *** report a case in which endometrial infiltration of the small bowel caused acute obstruction requiring emergency surgery,in a woman whose symptoms were not related to *** of the resected specimen showed that endometriosis was mainly prevalent in the muscularis propria and submucosa and that the mucosa was not ulcerated but had inflammation and glandular *** lymph node involvement,with a cystic glandular pattern was also detected.

关键词： Endometriosis Small bowel Ileum Obstruction Abdominal pain intestinal resection

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Morphological,kinetic,membrane biochemical and genetic aspects of intestinal enteroplasticity

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World Journal of Gastroenterology 2009年第7期15卷 774-787页

作者： Laurie A Drozdowski M Tom Clandinin Alan BR Thomson Medical Affairs Mead Johnson Nutritionals Department of Agriculture Food and Nutritional SciencesUniversity of Alberta Division of Internal Medicine Department of MedicineUniversity of Alberta

The process of intestinal adaptation("enteroplasticity") is complex and *** a number of trophic nutrients and non-nutritive factors have been identified in animal studies,successful,reproducible clinical trials in humans are *** mechanisms underlying this adaptive process may direct research toward strategies that maximize intestinal function and impart a true clinical benefit to patients with short bowel syndrome,or to persons in whom nutrient absorption needs to be *** this review,we consider the morphological,kinetic and membrane biochemical aspects of enteroplasticity,focus on the importance of nutritional factors,provide an overview of the many hormones that may alter the adaptive process,and consider some of the possible molecular *** most of the data is derived from rodent studies,wherever possible,the results of human studies of intestinal enteroplasticity are provided.

关键词： Diabetes Diet Hormonal regulation intestinal resection Mechanisms Morphology Nutrientabsorption Short bowel syndrome Signals

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