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Development and validation of a nomogram for predicting postoperative in-hospital poor outcome in abdominal related emergency general surgery diseases complicated with sepsis

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Chinese Medical Journal 2021年第20期134卷 2512-2514页

作者： Wei-Yong Sheng Ping Cheng Peng Xu Qing-Yong Chen Yang Wang Jin-Xiang Zhang Department of emergency general surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430022China

To the Editor:Patients who undergo emergency general surgery(EGS)procedures are up to eight times more likely to die than those undergoing the same procedure electively.[1]The development of an appropriate EGS risk stratification tool could facilitate accurate triage of high-risk patients,thereby supporting surgical decision-making,informed consent,and identification of EGS patients for transfer to a higher level of care.[2]However,the ideal EGS risk stratification tool does not exist *** 2016,a uniform system[American Association for the surgery of Trauma(AAST)grade]for measuring anatomic severity of 16 common EGS diseases has been reported by the AAST Patient Assessment ***,the committee pointed out that this system is not intended to serve alone as a predictor of *** important factors of the outcome,such as physiological status,comorbidities,age,and complexity of operation procedures,should be integrated into the system for risk stratification.[3]In our EGS center,the spectrum of diseases is mainly abdominal related diseases among the 16 diseases including acute appendicitis,acute cholecystitis,acute diverticulitis of the colon,hernias,infectious colitis,intestinal obstruction,acute pancreatitis,pelvic inflammatory disease,perirectal abscess,and perforated peptic *** have identified abdominal related EGS diseases complicated with sepsis to be a major cause of morbidity and mortality in our EGS *** assumed that the integration of anatomical severity of EGS diseases plus physiological severity and other parameters(eg,intra-operative variables,age,and comorbidities)together could work ***,this study aimed to develop and validate a nomogram for predicting post-operative in-hospital outcome in abdominal related EGS diseases complicated with sepsis.

关键词： diseases surgery predicting

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Factors associated with refractory pain in emergency patients admitted to emergency general surgery

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World Journal of emergency Medicine 2021年第1期12卷 12-17页

作者： William Gilliam Jackson FBarr Brandon Bruns Brandon Cave Jordan Mitchell Tina Nguyen Jamie Palmer Mark Rose Safura Tanveer Chris Yum Quincy K.Tran Johns Hopkins University Baltimore 21218USA Research Associate Program in emergency Medicine and Critical Care Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimore 21201USA R Adams Cowley Shock Trauma Center University of Maryland School of MedicineBaltimore 21201USA Department of surgery University of Maryland School of MedicineBaltimore 21201USA Louisiana State University Louisiana 70803USA University of Maryland School of Medicine Baltimore 21201USA Department of emergency Medicine University of Maryland School of MedicineBaltimore 21201USA

BACKGROUND: Oligoanalgesia in emergency departments (EDs) is multifactorial. A previousstudy reported that emergency providers did not adequately manage patients with severe paindespite objective findings for surgical pathologies. Our study aims to investigate clinical andlaboratory factors, in addition to providers’ interventions, that might have been associated witholigoanalgesia in a group of ED patients with moderate and severe pains due to surgical ***: We conducted a retrospective study of adult patients who were transferred directlyfrom referring EDs to the emergency general surgery (EGS) service at a quaternary academic centerbetween January 2014 and December 2016. Patients who were intubated, did not have adequaterecords, or had mild pain were excluded. The primary outcome was refractory pain, which wasdefi ned as pain reduction <2 units on the 0–10 pain scale between triage and ED ***: We analyzed 200 patients, and 58 (29%) had refractory pain. Patients with refractory painhad signifi cantly higher disease severity, serum lactate (3.4±2.0 mg/dL vs. 1.4±0.9 mg/dL, P=0.001), and lessfrequent pain medication administration (median [interquartile range], 3 [3–5] vs. 4 [3–7], P=0.001), whencompared to patients with no refractory pain. Multivariable logistic regression showed that the number of painmedication administration (odds ratio [OR] 0.80, 95% confi dence interval [95% CI] 0.68–0.98) and ED serumlactate levels (OR 3.80, 95% CI 2.10–6.80) were signifi cantly associated with the likelihood of refractory ***: In ED patients transferring to EGS service, elevated serum lactate levelswere associated with a higher likelihood of refractory pain.

关键词： Serum lactate Refractory pain emergency general surgery emergency department

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Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions

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World Journal of Gastrointestinal surgery 2024年第2期16卷 270-275页

作者： Davina Perini Jacopo Martellucci Department of emergency Emergency and Minimally Invasive Surgery UnitCareggi University HospitalFirenze 50041Italy

Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency *** trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective *** is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been *** present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal ***,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute *** the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute *** then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two *** emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality *** need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.

关键词： Indocyanine green Fluorescence Navigation surgery Angiography emergency surgery Decision-making

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emergency surgery in COVID-19 outbreak:Has anything changed?Single center experience

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World Journal of Clinical Cases 2020年第17期8卷 3691-3696页

作者： Francesco D'Urbano Nicolo Fabbri Margherita Koleva Radica Eleonora Rossin Paolo Carcoforo Department of Morphology Experimental Medicine and SurgerySection of General SurgeryUniversity of FerraraFerrara 44100Italy Unit of general surgery Azienda UnitàSanitaria Locale di FerraraFerrara 44100Italy

BACKGROUND The current coronavirus disease 19(COVID-19)pandemic is changing the organization of health care and has had a direct impact on the management of surgical *** the general surgery Department of Sant’Anna University Hospital in Ferrara,Italy,surgical activities were progressively reduced during the peak of the COVID-19 outbreak in *** this period,only one operating room was available for elective cancer surgeries and another for emergency ***,the number of beds for surgical patients had to be reduced to provide beds and personnel for the new COVID-19 *** To compare 2 different period(from March 9 to April 92019 and from March 9 to April 92020),searching differences in terms of number and type of interventions in emergency surgery of a main University Hospital in Ferrara,a city in Emilia Romagna region,North of *** This retrospective study was carried out at the general surgery Department of Sant’Anna University Hospital in Ferrara,*** examined the number of emergency surgeries performed and patient outcomes during the peak of the COVID-19 outbreak in Italy and subsequent total *** then drew a comparison with the number of surgeries performed and their outcomes during the same period in *** study examined all adult patients who underwent emergency surgery from March 9 to April 9,2019(n=46),and those who underwent surgery during the first month of the lockdown,from March 9 to April 9,2020(n=27).Analyses were adjusted for age,gender,American Society of Anesthesiologists classification scores and types of *** A total of 27 patients underwent emergency surgery at Sant’Anna University Hospital in Ferrara during the first month of the *** represents a 41.3%reduction in the number of patients who were hospitalized and underwent emergency surgery compared to the same period in *** complication rate during the pandemic period was substantially higher than it was during the an

关键词： COVID-19 emergency surgery Outbreak

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Preoperative colonic stents vs emergency surgery for acute left-sided malignant colonic obstruction: meta-analysis with systematic review of the literature

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World Journal of Meta-Analysis 2017年第1期5卷 1-13页

作者： Belinda De Simone Fausto Catena Federico Coccolini Salomone Di Saverio Massimo Sartelli Arianna Heyer Nicola De Angelis Gian Luigi De Angelis Luca Ansaloni Department of emergency and Trauma surgery University Hospital of Parma Department of general and emergency surgery Papa XXIII Hospital Department of general surgery Maggiore Hospital of Bologna Department of emergency and general surgery Macerata’s Hospital Department of Medical Sciences University of California Liver Transplantation and general surgery Unit Henry Mondor Hospital Department of Gastroenterology University Hospital of Parma

AIM To investigate by meta-analytic study and systematic review, advantages of colonic stent placement in comparison with emergency *** We conducted an extensive literature search by PubMed, Google Scholar, Embase and the Cochrane Libraries. We searched for all the papers in English published till February 2016, by applying combinations of the following terms: Obstructive colon cancer, colon cancer in emergency, colorectal stenting, emergency surgery for colorectal cancer, guidelines for obstructive colorectal cancer, stenting vs emergency surgery in the treatment of obstructive colorectal cancer, selfexpanding metallic stents, stenting as bridge to surgery. The study was designed following the PrismaStatement. By our search, we identified 452 studies, and 57 potentially relevant studies in full-text were reviewed by 2 investigators; ultimately, 9 randomized controlled trials were considered for meta-analysis and all the others were considered for systematic *** In the meta-analysis, by comparing colonic stenting(CS) as bridge to surgery and emergency surgery, the pooled analysis showed no significant difference between the two techniques in terms of mortality [odds ratio(oR) = 0.91], morbidity(oR = 2.38) or permanent stoma rate(oR = 1.67); primary anastomosis was more frequent in the stent group(oR = 0.45; P = 0.004) and stoma creation was more frequent in the emergency surgery group(oR = 2.36; P = 0.002). No statistical difference was found in disease-free survival and overall survival. The pooled analysis showed a significant difference between the colonic stent and emergency surgery groups(oR = 0.37), with a significantly higher 1-year recurrence rate in the stent group(P = 0.007).CONCLUSION CS improves primary anastomosis rate with significantly high 1-year follow-up recurrence and no statistical difference in terms of disease-free survival and overall survival.

关键词： Colonic stent Self-expandable metallic stent Obstructive left colon cancer emergency surgery Endo-laparoscopic approach Oncological outcome

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Predictors of mortality in patients with acute smallbowel perforation transferred to ICU after emergency surgery:a single-centre retrospective cohort study

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Gastroenterology Report 2022年第1期10卷 305-312页

作者： Jianzhang Wu Ping Shu Hongyong He Haojie Li Zhaoqing Tang Yihong Sun Fenglin Liu Department of general surgery Zhongshan HospitalFudan UniversityShanghaiP.R.China

Background Although small-bowel perforation is a life-threatening emergency even after immediate surgical intervention,studies have rarely investigated surgical outcomes due to its relatively low *** study aimed to investigate the outcomes of emergency surgery for patients with small-bowel perforation transferred to the intensive care unit(ICU)and the risk factors for *** Consecutive patients with small-bowel perforation who were confirmed via emergency surgery and transferred to the ICU in Zhongshan Hospital,Fudan University(Shanghai,China)between February 2011 and May 2020 were retrospectively *** records were reviewed to determine clinical features,laboratory indicators,surgical findings,and *** A total of 104 patients were included in this study,among whom 18(17.3%),59(56.7%),and 27(26.0%)underwent perforation repair,segmental resection with primary anastomosis,and small-bowel ostomy,*** tumours were the leading cause of perforation in these patients(40.4%,42/104).The overall post-operative complication rate and mortality rates were 74.0%(77/104)and 19.2%(20/104),*** tumour-related perforation(odds ratio[OR],4.659;95%confidence interval[CI],1.269–17.105;P=0.020)and high post-operative arterial blood-lactate level(OR,1.479;95%CI,1.027–2.131;P=0.036)were identified as independent risk factors for post-operative mortality in patients with small-bowel perforation transferred to the *** Patients with small-bowel perforation who are transferred to the ICU after emergency surgery face a high risk of post-operative complications and ***,those patients with malignant tumour-related perforation and higher post-operative blood-lactate levels have poor prognosis.

关键词： small-bowel perforation blood lactate APACHE-II score malignant tumour

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Role of Ultrasound Lung Comets in the Diagnosis of Acute Heart Failure in emergency Department: A Systematic Review and Meta-analysis

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Biomedical and Environmental Sciences 2018年第8期31卷 596-607页

作者： LIAN Rui ZHANG Guo Chao YAN Sheng Tao SUN Li Chao ZHANG Su Qiao ZHANG Guo Qiang Department of emergency Medicine China-Japan Friendship Hospital Department of general surgery China-Japan Friendship Hospital

Objective A new technique of transthoracic lung ultrasonography(TLS) has emerged and demonstrated promising results in acute heart failure diagnosis at an early stage. However, the diagnostic value of ultrasound lung comets(ULCs) for acute heart failure(AHF) performed in busy emergency department(ED) is uncertain. The present meta-analysis aimed to assess the diagnostic efficiency of ULCs in AHF. Methods We conducted a search on online journal databases to collect the data on TLS performed for diagnosing AHF published up to the end of July 2017. The sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), and summary receiver operating characteristic(SROC) curve were calculated. The post-test probability of AHF was calculated by using Bayes analysis. Results We enrolled a total of 15 studies involving 3,309 patients. The value of sensitivity, specificity, PLR, NLR, DOR, area under the SROC curve, and Q* index was 85%, 91%, 8.94, 0.14, 67.24, 0.9587, and 0.9026, respectively. We detected significant heterogeneity among included studies, and therefore, all these results were analyzed under the random-effect model. We also explored possible sources of heterogeneity among the studies by using meta-regression analysis. Results suggest that the time interval between patient’s admission to bedside TLS examination was closely related to TLS accuracy. Conclusion This meta-analysis demonstrated that detecting ULCs is a convenient bedside tool and has high accuracy for early AHF diagnosis in ED. TLS could be recommended to be applied for early diagnosis of AHF in ED.

关键词： Transthoracic lung ultrasonography Lung comets sign Dyspnea Acute heart failure Diagnostic test Meta-analysis

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Subcapsular hepatic haematoma of the right lobe following endoscopic retrograde cholangiopancreatography: Case report and literature review

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World Journal of Gastroenterology 2016年第17期22卷 4411-4415页

作者： Marco Antonio Zappa Alberto Aiolfi Ilaria Antonini Cinzia Domenica Musolino Andrea Porta Department of general and emergency surgery Ospedale S Famiglia Fatabenefratelli 22036 Erba Italy

Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients’ haemodynamic and clinic.

关键词： Endoscopic guidewire Endoscopic retrograde cholangiopancreatography Abdominal pain Subcapsular hepatic hematoma Embolization

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Incorporating red blanket protocol within code crimson:Streamlining definitive trauma care amid the chaos

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World Journal of Critical Care Medicine 2025年第1期14卷 14-19页

作者： Sohil Pothiawala Savitha Bhagvan Andrew MacCormick emergency Medicine Woodlands HealthSingapore 737628Singapore Trauma and emergency Services Auckland City HospitalAuckland 1023New Zealand Department of general surgery Middlemore HospitalAuckland 2025New Zealand

The care of a patient involved in major trauma with exsanguinating haemorrhage is time-critical to achieve definitive haemorrhage control,and it requires coordinated multidisciplinary *** initial resuscitation of a patient in the emergency department(ED),Code Crimson activation facilitates rapid decisionmaking by multi-disciplinary specialists for definitive haemorrhage control in operating theatre(OT)and/or interventional radiology(IR)*** this decision has been made,there may still be various factors that lead to delay in transporting the patient from ED to OT/*** Blanket protocol identifies and addresses these factors and processes which cause delay,and aims to facilitate rapid and safe transport of the haemodynamically unstable patient from ED to OT,while minimizing delay in resuscitation during the *** two processes,Code Crimson and Red Blanket,complement each *** would be ideal to merge the two processes into a single protocol rather than having two separate *** these quality improvement strategies and coor-dinated processes within the trauma framework of the hospitals/healthcare systems will help in further improving the multi-disciplinary care for the complex trauma patients requiring rapid and definitive haemorrhage control.

关键词： Red blanket protocol Code crimson Haemorrhage Trauma

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Low-grade slightly elevated and polypoid colorectal adenomas display differential β-catenin-TCF/LEF activity, c-Myc, and cyclin D1 expression

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World Journal of Gastroenterology 2017年第17期23卷 3066-3076页

作者： Tian-wen Yang Yun-han Gao Sha-Ying Ma Qiang wu Zhong-fu Li Department of Gastroenterology Yongchuan Hospital Chongqing Medical University Department of general surgery Chongqing Emergency Medical Center

AIM To comparatively investigate the cellular and molecular characteristics of low-grade slightly elevated adenomas and polypoid *** Colorectal tumors were collected from 24 patients with slightly elevated adenomas and 23 patients with polypoid adenomas. five commonly mutated genes(APC, BRAf, KRAS, NRAS, and PIK3CA) were selected for mutational analysis. Paraffin-embedded tumor sections were used to calculate the apoptotic index(AI) and Ki-67 labeling index(KLI). Two pure colorectal epithelial cell lines were created by pooling the slightly elevated and polypoid tumors. western blots, luciferase assays for β-catenin-T-cell factor protein/β-cateninlymphoid enhancer factor(β-catenin-TCf/LEf)-driven transcriptional activity, and caspase activity assays were conducted on the two cell *** Slightly elevated lesions showed a significantly lower APC mutational frequency and a significantly higher KRAS mutational frequency(both P < 0.05). Slightly elevated lesions showed a significantly lower AI(P < 0.05). β-catenin and β-catenin-TCf/LEf-driven transcriptional activity was significantly upregulated in slightly elevated lesions(both P < 0.05). In slightly elevated lesions, c-Myc was significantly downregulated, while cyclin D1 was significantly upregulated(both P < 0.05). β-catenin-TCf/LEf-driven transcriptional activity was negatively correlated with c-Myc(ρ =-0.78). Slightly elevated lesions displayed significant Bcl-2 and Bcl-x L upregulation(both P < 0.05) along with significant decreases in caspase-9 and caspase-3 activity(both P < 0.05). c-Myc was negatively correlated with Bcl-2 and Bcl-x L(ρ =-0.74 and-0.78, respectively).CONCLUSION The lower apoptotic activity of low-grade slightly elevated adenomas can be partly attributed to upregulated β-catenin pathway activity and downregulated c-Myc expression.

关键词： Cancer Carcinoma Colorectal Adenoma β-catenin Non-polypoid

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