Objective:Surgical site infection (SSI) is a common health care-related infection after gastrointestinal surgery. Once SSI occurs after surgery, it can significantly prolong the postoperative hospital stay, increase the cost burden of patients and society, and even endanger the life safety of patients. The purpose of this study was to investigate the clinical phenotypes of gastrointestinal surgery, identify the clinical characteristics of SSI, and provide reference for the prevention of SSI after gastrointestinal surgery.Methods:This is a multicenter prospective cohort study that collected clinical data from all adult patients undergoing gastrointestinal surgery from March 2021 to February 2022 at 42 hospitals in China, including baseline and perioperative characteristics. Based on the variables associated with SSI, latent class analysis (LCA) was used to explore the population characteristics of SSI.Results:In total, 16 087 patients were included in the study, of whom 345 (2.1%) developed SSI. LCA analysis revealed that patients undergoing gastrointestinal surgery were classified into four clinical phenotypes, including α (3851), β (1538), γ (6387), and δ (4311). Type α had minimal abnormality on related system functions (ASA score > 2: 4.5% [173/3851]), and mainly underwent appendix surgery (98.9% [3808/3851]). The postoperative SSI incidence of type α was 0.4% (16/3,851), which belonged to the group of SSI low risk. The abnormality of system functions of type β (ASA score > 2: 17.4% [268/1538]) was worse than that of type α. Type β mainly underwent stomach surgery (72.4% [1113/1538]), and its incidence of postoperative SSI was 1.2% (18/1538), belonging to the group of SSI medium risk. The ASA score of type γ (ASA score > 2: 18.0% [1148/6387]) was comparable to that of type β. Type γ mainly received colorectal surgery (colon surgery: 40.1% [2562/6387]; rectal surgery: 33.6%[2143/6387]), and its incidence of postoperative SSI was 1.7% (106/6387), belonging to the group of SSI medium risk. Type δ (ASA score > 2: 23.5%[1015/4311]) was the most serious type with the highest proportion of open surgery. Type δ mainly underwent small intestine (54.0%[2327/4311]) and stomach surgery (32.3% [1392/4311]) and had the highest incidence of SSI (4.8% [205/4311]) and the highest mortality rate (0.6% [24/4311]), belonging to the group of SSI high risk. Compared with type α and β, the median length of hospital stay (α, β, γ, and δ: 5.0 days, 9.6 days, 13.0 days, and 16.0 days, P<0.001) and postoperative hospital stay (α, β, γ, and δ: 4.0days, 6.0days, 8.3 days, and 10.0 days, P<0.001) of type γ and δ were significantly increased, and the median medical costs (α, β, γ, and δ: 14 178.7 yuan, 39 514.2 yuan, 62 893.0 yuan and 57 266.6 yuan, P<0.001) were also significantly increased. Conclusion:LCA analysis elucidated four clinical phenotypes of patients undergoing gastrointestinal surgery. Type α had a low risk of SSI. Type β and γ had a medium risk of SSI, and type δ had a high risk of SSI.

Emergency surgery has always been an important component of general surgery, with major diseases including acute abdomen and trauma. With the differentiation and development of general surgery sub specialties, department of emergency surgery has begun to emerge, but its development faces various challenges, such as insufficient medical staff, inadequate treatment capabilities, and poor treatment outcomes. To change this situation, about 20 years ago, a new treatment model began to emerge in the United States, establishing a department of acute care surgery that integrates trauma, emergency general surgery, and surgical critical care. This model quickly spread worldwide and achieved remarkable achievements. In recent years, colleagues in the field of surgery in China have gradually recognized the advantages of this model and established acute care surgery. This article aims to elaborate on its development process, current situation, and future trends, providing reference for the prosperous development of acute care surgery in China.

Objective:Surgical site infection (SSI) is a common health care-related infection after gastrointestinal surgery. Once SSI occurs after surgery, it can significantly prolong the postoperative hospital stay, increase the cost burden of patients and society, and even endanger the life safety of patients. The purpose of this study was to investigate the clinical phenotypes of gastrointestinal surgery, identify the clinical characteristics of SSI, and provide reference for the prevention of SSI after gastrointestinal surgery.Methods:This is a multicenter prospective cohort study that collected clinical data from all adult patients undergoing gastrointestinal surgery from March 2021 to February 2022 at 42 hospitals in China, including baseline and perioperative characteristics. Based on the variables associated with SSI, latent class analysis (LCA) was used to explore the population characteristics of SSI.Results:In total, 16 087 patients were included in the study, of whom 345 (2.1%) developed SSI. LCA analysis revealed that patients undergoing gastrointestinal surgery were classified into four clinical phenotypes, including α (3851), β (1538), γ (6387), and δ (4311). Type α had minimal abnormality on related system functions (ASA score > 2: 4.5% [173/3851]), and mainly underwent appendix surgery (98.9% [3808/3851]). The postoperative SSI incidence of type α was 0.4% (16/3,851), which belonged to the group of SSI low risk. The abnormality of system functions of type β (ASA score > 2: 17.4% [268/1538]) was worse than that of type α. Type β mainly underwent stomach surgery (72.4% [1113/1538]), and its incidence of postoperative SSI was 1.2% (18/1538), belonging to the group of SSI medium risk. The ASA score of type γ (ASA score > 2: 18.0% [1148/6387]) was comparable to that of type β. Type γ mainly received colorectal surgery (colon surgery: 40.1% [2562/6387]; rectal surgery: 33.6%[2143/6387]), and its incidence of postoperative SSI was 1.7% (106/6387), belonging to the group of SSI medium risk. Type δ (ASA score > 2: 23.5%[1015/4311]) was the most serious type with the highest proportion of open surgery. Type δ mainly underwent small intestine (54.0%[2327/4311]) and stomach surgery (32.3% [1392/4311]) and had the highest incidence of SSI (4.8% [205/4311]) and the highest mortality rate (0.6% [24/4311]), belonging to the group of SSI high risk. Compared with type α and β, the median length of hospital stay (α, β, γ, and δ: 5.0 days, 9.6 days, 13.0 days, and 16.0 days, P<0.001) and postoperative hospital stay (α, β, γ, and δ: 4.0days, 6.0days, 8.3 days, and 10.0 days, P<0.001) of type γ and δ were significantly increased, and the median medical costs (α, β, γ, and δ: 14 178.7 yuan, 39 514.2 yuan, 62 893.0 yuan and 57 266.6 yuan, P<0.001) were also significantly increased. Conclusion:LCA analysis elucidated four clinical phenotypes of patients undergoing gastrointestinal surgery. Type α had a low risk of SSI. Type β and γ had a medium risk of SSI, and type δ had a high risk of SSI.

Emergency surgery has always been an important component of general surgery, with major diseases including acute abdomen and trauma. With the differentiation and development of general surgery sub specialties, department of emergency surgery has begun to emerge, but its development faces various challenges, such as insufficient medical staff, inadequate treatment capabilities, and poor treatment outcomes. To change this situation, about 20 years ago, a new treatment model began to emerge in the United States, establishing a department of acute care surgery that integrates trauma, emergency general surgery, and surgical critical care. This model quickly spread worldwide and achieved remarkable achievements. In recent years, colleagues in the field of surgery in China have gradually recognized the advantages of this model and established acute care surgery. This article aims to elaborate on its development process, current situation, and future trends, providing reference for the prosperous development of acute care surgery in China.

Humans ; Diabetic Neuropathies/diagnostic imaging* ; Diabetes Mellitus, Type 2 ; Ultrasonography ; Diabetic Foot/diagnostic imaging*

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective:To compare the effects of casein, whey and soy protein diet on treating colitis.Methods:Fifty C57BL/6 mice were randomly and equally divided into control group, general diet group, casein group, whey group and soy group with 10 mice in each group. Mice were fed with corresponding diets for 14 days. Acute colitis mice modelof general diet group, casein group, whey group and soy group were induced by dextran sulfate sodium (DSS) on the 7th day. The disease activity index (DAI) score was evaluated and recorded. The serum and colon tissues of each group on the 14th day were collected todetect the serum levels of IL-6, TNF-α and IL-10 by ELISA, and to calculate the pathological score of colon.Results:The DAI score of the whey group was significantly lower than that of the casein group and soy protein group (all P<0.05) , and higher than that of the control group ( P<0.05) . The pathological score of colon tissue of the control group was significantly lower as compared to other 4 groups (all P<0.05) , while above scoreof whey group was significantly lower than that of the casein group and soy protein group (all P<0.05) , but there was no significant difference between the whey group and general diet group. The levels of serum IL-6 and TNF-α in were significantly lower than those in the casein group and soy group (all P<0.05) , and serum IL-10 level in the whey group was significantly higher than that in general diet, casein and soy groups (all P<0.05) . The level of colon IL-10 in the whey group was significantly higher than that in the casein group and soy group (all P<0.05) . Conclusion:The efficacy of whey protein diet on treating acute colitis mice is better compared to general diet, casein and soy protein diet.

Enteral nutrition (EN) is an important way in the treatment of Crohn′s disease (CD) . Although the exact pathogenesis of CD is still unknown, CD patients have some significant pathological features compared with healthy population, including intestinal flora dysbiosis, excessive intestinal mucosal inflammation, intestinal mucosal damage, mesenteric fat abnormality, etc. This review explores the mechanism of EN in the treatment of CD in order to better understand the role of EN in modifying CD disease progression and to promote the clinical management of CD.

Objective:To compare the effects of casein, whey and soy protein diet on treating colitis.Methods:Fifty C57BL/6 mice were randomly and equally divided into control group, general diet group, casein group, whey group and soy group with 10 mice in each group. Mice were fed with corresponding diets for 14 days. Acute colitis mice modelof general diet group, casein group, whey group and soy group were induced by dextran sulfate sodium (DSS) on the 7th day. The disease activity index (DAI) score was evaluated and recorded. The serum and colon tissues of each group on the 14th day were collected todetect the serum levels of IL-6, TNF-α and IL-10 by ELISA, and to calculate the pathological score of colon.Results:The DAI score of the whey group was significantly lower than that of the casein group and soy protein group (all P<0.05) , and higher than that of the control group ( P<0.05) . The pathological score of colon tissue of the control group was significantly lower as compared to other 4 groups (all P<0.05) , while above scoreof whey group was significantly lower than that of the casein group and soy protein group (all P<0.05) , but there was no significant difference between the whey group and general diet group. The levels of serum IL-6 and TNF-α in were significantly lower than those in the casein group and soy group (all P<0.05) , and serum IL-10 level in the whey group was significantly higher than that in general diet, casein and soy groups (all P<0.05) . The level of colon IL-10 in the whey group was significantly higher than that in the casein group and soy group (all P<0.05) . Conclusion:The efficacy of whey protein diet on treating acute colitis mice is better compared to general diet, casein and soy protein diet.

Enteral nutrition (EN) is an important way in the treatment of Crohn′s disease (CD) . Although the exact pathogenesis of CD is still unknown, CD patients have some significant pathological features compared with healthy population, including intestinal flora dysbiosis, excessive intestinal mucosal inflammation, intestinal mucosal damage, mesenteric fat abnormality, etc. This review explores the mechanism of EN in the treatment of CD in order to better understand the role of EN in modifying CD disease progression and to promote the clinical management of CD.