Objective:To study the clinical effect of early postoperative enteral nutrition and parenteral nutrition after radical ex-cision of gastric cancer to provide a better way of treating gastric cancers. Methods:Retrospective analysis of 140 gastric cancer pa-tients who were admitted to the PLA General Hospital between February 2009 and February 2011 was conducted. These patients were randomized into two groups based on the clinical trial, i.e., 70 in the control group received an intravenous parenteral nutrition for the treatment, and for the other 70 in the observation group, jejunostomy was done 1 to 5 days after the radical surgery by using Supportan as the enteral nutritional agent with a dose of at TPF-T 500 mL/d to 1 000 mL/d. The postoperative long-term survival rate of the pa-tients, the serum albumin, hemoglobin, alanine aminotransferase, aspartate aminotransferase levels before and after the treatment, as well as the situation of IgA, IgG, IgM and CD4+cells, NK cells, and B lymphocytes in the blood at the first and the seventh day after surgery were observed in the patients. Results:After the implementation of early enteral nutrition in the observation group, the 1-and 3-year survival rates were 84.29% (59/70) and 61.43% (43/70) respectively, whereas in the control group, the survival rates were 64.29% (45/70) and 47.143% (33/70) respectively, with statistically significant differences between the two groups (P<0.05). At the first and seventh day after surgery, the serum albumin, hemoglobin, alanine aminotransferase, and aspartate aminotransferase levels were significantly better in the observation group than in the control group, with statistically significant differences between the two (P<0.05). Compared with the parameters in the observation group at the first day after surgery and those in the control groups at the eighth day after surgery, the levels of IgA , IgG, IgM and CD42+cells, NK cells, and B lymphocytes were significantly increased in the obser-vation group at the seventh day after surgery. The differences among them were statistically significant (P<0.05). Conclusion: Early postoperative enteral nutrition for the gastric cancer patients undergoing radical surgery can be effective in improving the nutrition level of the patients and in enhancing their long-term survival rate, Thus, the treatment has value in clinical application.

Objective: To evaluate the intestinal trophic effects and adverse reactions of nasojejunal and jejunostomy tube im-plants on patients with total gastrectomy. Methods:A total of 86 patients with advanced gastric cancer were randomly and equally di-vided into two groups. Groups A and B received enteral nutrition therapies through nasojejunal and jejunostomy feeding tube implants, respectively. The therapeutic efficacy of the two methods of enteral nutrition therapy and the corresponding adverse reactions observed in the two groups were compared. Results:Group B patients demonstrated shorter anal evacuation and defecation times than group A patients, the difference is statistically significant (P<0.05). Moreover, the bodyweight, total protein, and albumin levels of the patients significantly decreased in both groups after enteral nutrition therapy was administered (P<0.05). Postoperative nutritive indexes were higher in group B than in group A;however, no significant difference was obtained between the two groups (P>0.05). Nonetheless, the patients in group B tolerated the treatment well compared with those in group A (P<0.05). The complication rates of groups A and B were 18.6%and 23.3%, respectively, but this difference was not significant (P>0.05). Conclusion:Patients subjected to total gastrecto-my showed higher tolerance to jejunal tube implants for enteral nutrition than to nasojejunal tube implants, indicating that jejunal tube implants can be used to improve the nutritional status of patients.

Objective: To evaluate the minimally invasive splayed incisions in the internal fixation with a conventional calcaneal plate for calcaneal fractures of sanders types Ⅱ and Ⅲ. Methods: This prospective study was conducted from May 1st, 2016 to December 1st, 2017 in the 40 patients with calcaneal fracture at Department of Orthopedics, Shanghai Pudong Hospital. Their ages ranged from 23 to 55 years (average, 39.5 years). According to the Sanders classification, 27 fractures were type Ⅱ and 13 type Ⅲ. They were all treated with a conventional calcaneal plate through minimally invasive splayed incisions. The Böhler and Gissane angles, the height, width and length of the affected calcaneus were compared between preoperation, 3 months after operation and the last follow-up; the clinical function of the affected feet was graded using the Maryland foot score; postoperative complications were observed. Results: The 40 patients were followed up for an average of 12.5 months (from 11 to 16 months). All the skin incisions healed well with no skin necrosis or wound infection. No injury to the sural nerve occurred. All the fractures healed after an average of 8 weeks (from 7 to 10 weeks). All the patients resumed their routine daily activities and returned to their former work post after an average time of 4.1 months (from 3 to 6 months). At pre-operation, 3 months after operation and the last follow-up, their Böhler angles were respectively 19.2°±6.3°, 30.5°±6.4° and 29.9°±6.5°; their Gissane angles 103.9°±14.8°, 119.3°±5.6° and 119.8°±6.3°; their calcaneal heights (32.5±3.5) mm, (36.8±1.5) mm and (36.5±1.8) mm; their calcaneal widths (36.8±3.4) mm, (33.1±3.8) mm and (33.0±3.2) mm; their lengths (61.4±4.5) mm, (65.5±6.9) mm and (65.5±9.4) mm. In all the patients, the Böhler and Gissane angles and the calcaneal heights and lengths increased significantly while the calcaneal widths decreased significantly at 3 months after operation and the last follow-up (P<0.05). There were no significant differences between 3 months after operation and the last follow-up in the Böhler or Gissane angle, the height, width or length of the affected calcaneus (P>0.05). Their Maryland foot scores showed 35 excellent cases, 4 good cases and one fair case, giving an excellent and good rate of 97.5%. Conclusions A conventional calcaneal plate plus minimally invasive splayed incisions can be effective for calcaneal fractures of Sanders types Ⅱ and Ⅲ, leading to reduced wound complications, anatomical restoration of calcaneal morphology, and smooth subtalar articular surface.

Objective To evaluate the feasibility and clinical efficacy of preoperative simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with neoadjuvant chemotherapy of capecitabine in patients with locally-advanced low rectal cancer.Methods Between 2015 and 2016,26 patients admitted to 301 Hospital who were diagnosed with locally-advanced low rectal cancer,which was located within 5 cm from the anal verge,were enrolled in this investigation.Dose fractionation pattern was delivered:58.75 Gy in 25 fractions (2.35 Gy/fraction) for rectal cancer and lymph node metastasis and 50 Gy in 25 fractions for the pelvic lymphatic drainage area and simultaneously combined with capecitabine chemotherapy (825 mg/m2,bid d 1-5 weekly).One cycle of capecitabine (1 250 mg/m2,twice daily,d 1-14)was given at one week after the completion of chemoradiotherapy (CRT).Total mesorectal excision (TME)was performed at 6 to 8 weeks after the completion of CRT.The primary endpoints included pathological complete response rate (ypCR) and sphincter-preserving rate.The secondary endpoints included acute toxicity,tumor downstaging rate and postoperative complications.Results Twenty-six patients successfully completed neoadjuvant CRT,25 of them underwent surgical resection and one patient failed to receive surgery due to pxrianal edema.Postoperative ypCR rate was 32％ (8/25),the sphincter-preserving rate was 60％ (15/25),the tumor downstaging rate was 92％ (23/25) and the R0 resection rate was 100％.During the period of CRT,grade 1 and 2 adverse events occurred in 24 patients,grade 3 radiation dermatitis was noted in 2 cases.No ≥ grade 4 acute adverse event was observed.Postoperative complications included ureteral injury in one case and intestinal obstruction in one patient.Conclusions Preoperative SIB-IMRT combined with neoadjuvant chemotherapy of capecitabine is a feasible and safe treatment for patients with locallyadvanced low rectal cancer,which yields expected ypCR rate,R0 resection rate and sphincter-preserving rate.Nevertheless,the long-term clinical benefits remain to be elucidated.Clinical Trial Registry Chinese Clinical Trial Registry,registration number:ChiCTR-ONC-12002387.

Objective:To evaluate the efficacy of preoperative neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer.Methods:Clinical data of 46 patients with low rectal tumors located within 6 cm from the edge of anal admitted to our hospital between February 2014 and December 2018 were retrospectively analyzed. SIB-IMRT technique was adopted for preoperative radiotherapy. Rectal tumors and positive lymph nodes were irradiated with a dose of 58.75 Gy in 25 fractions (2.35 Gy/fraction), and pelvic lymphatic drainage area was given with 50 Gy in 25 fractions (2.0 Gy/fraction). Oral administration of capecitabine was delivered for concurrent chemotherapy. Radical surgery for rectal cancer was performed at 6 to 12 weeks after the end of chemoradiotherapy. The overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), local recurrence-free survival (LRFS) and metastasis-free survival (MFS) were calculated by using Kaplan- Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox’s regression model. Results:After a median follow-up of 47 months, local recurrence occurred in 3 patients and distant metastasis in 6 patients. The ypCR rate was 26%(12/46), the sphincter-preservation rate was 74%(34/46), the R 0 resection rate was 100%(44/44), the overall tumor response TN down staging rate was 87%(40/46), and the postoperative complication rate was 13%(6/46). The 3-year OS, DFS, and PFS were 93%, 91% and 87%, respectively. In univariate analysis, ypN staging was an important factor affecting OS, DFS, PFS, LRFS and MFS (all P<0.05). In multivariate analysis, ypN staging was significantly correlated with DFS, PFS, LRFS and MFS (all P<0.05). Conclusions:Preoperative SIB-IMRT 58.75 Gy in 25 fractions combined with capecitabine chemotherapy is a safe and efficacious treatment for patients with low and locally advanced rectal cancer, which improves the ypCR rate and quality of life, and yields tolerable adverse reactions. Nevertheless, the long-term survival benefits remain to be validated.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

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.
Abdomen ; surgery ; Adult ; Aged ; China ; Cross-Sectional Studies ; Female ; General Surgery ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; prevention & control ; Preoperative Period ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; prevention & control