Metabolic-bariatric surgery(MBS)has become an important treatment for pathological obesity and metabolic diseases.However,common postoperative nutritional complications—such as protein-energy malnutrition,iron deficiency anemia,and vitamin B12 deficiency—significantly affect patients' long-term prognosis.Traditional nutritional management models rely on static monitoring and standardized supplementation,which are insufficient to address individual variability and dynamic postoperative changes.Artificial intelligence(AI),through integrating multimodal data(such as biochemical indicators,imaging information,and wearable device monitoring)and intelligent modeling,offers new approaches for dynamic monitoring,risk prediction,and personalized intervention.Based on literature from 2017 to 2025,this article systematically evaluates the application of AI in perioperative nutritional management for MBS,covering key technologies including machine learning,deep learning,and natural language processing.It also analyzes current challenges in clinical translation,such as data fragmentation,lack of model interpretability,and limited long-term validation.In the future,enhanced multi-center collaboration,the development of standardized databases,and explainable models will be essential to advancing nutritional management in MBS from empirical practice to precision medicine.

Objective:To explore the clinical effect of the whole-process management scheme of daytime minimally invasive liver resection surgery based on the enhanced recovery after surgery (ERAS) concept.Methods:This is a retrospective case series study. The data of 55 patients who underwent minimally invasive daytime liver resection surgery under the ERAS concept at the Department of General Surgery,Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2023 to August 2024. There were 22 males and 33 females;aged (48.2±15.1) years (range: 16 to 77 years). All patients were classified as Grade 2 according to the American Society of Anesthesiologists physical status classification. Among them, 7 cases were complicated with liver cirrhosis and 10 cases had fatty liver. A multidisciplinary team was formed, consisting of surgeons, anesthesiologists, rehabilitation physicians, psychologists, pharmacists, acute pain management team, operating room nurses, day surgery ward nurses, and ERAS specialized nurses. After strict evaluation by surgeons and anesthesiologists, patients suitable for daytime liver resection surgery were implemented with the ERAS whole-process management plan for liver resection on the basis of routine nursing care.Results:Among the 55 patients, 50 were discharged smoothly within 48 hours, while 5 were transferred to specialized departments for further treatment due to not meeting the discharge criteria, with a smooth daytime discharge rate of 90.9%. Among the 50 patients, 30 underwent laparoscopic surgery and 20 underwent robotic-assisted surgery. The surgery time was (91.6±28.2)minutes(range:45 to 165 minutes), with the intraoperative blood loss of only (30.5±25.5)ml(range:5 to 100 ml). Pathological examination results showed that among the 50 patients, 13 cases had hepatocellular carcinoma, 21 cases had hepatic hemangioma, 4 cases had hepatic cyst, 8 cases had focal nodular hyperplasia, 1 case had low-grade dysplastic nodule, 1 case had hepatolithiasis, 1 case had lymphoma, and 1 case had vascular, fibrous and lymphoid tissue proliferation. There were 44.0% patients who were able to get out of bed on the day of surgery. The hospital stay was (1.8±0.4)days(range:1 to 2 days), and the hospitalization cost was (34 499±20 330)yuan(range:11 724 to 73 488 yuan). No complications requiring special treatment outside the conventional pathway were observed during the hospital stay and follow-up period. At the 2-week outpatient follow-up, no significant abnormalities were found in all patients, and the wound healing was good.Conclusions:The daytime liver resection surgery based on the ERAS whole-process management plan has shown good feasibility in clinical practice. It helps to simplify medical process, shorten hospital stay, and reduce medical costs.

Objective:To preliminarily explore the correlation between the quantitative parameters of spectral CT before proton radiotherapy and the changes in apparent diffusion coefficient (ADC) of MRI before and after radiotherapy in chordoma patients.Methods:A retrospective analysis was conducted on imaging data from 28 patients with chordoma who underwent proton radiotherapy at Shandong Cancer Hospital and Institute from August 2022 to December 2024. Spectral CT images obtained prior to treatment were used to extract four quantitative parameters of the lesion area: relative iodine concentration (RIC), electron density (ED), effective atomic number (Z eff), and the slope of spectral attenuation curve (λHU). In parallel, MRI-DWI scans before and after treatment were collected to compute the ADC difference (ΔADC). The correlation between spectral CT parameters and ΔADC was assessed using scatter plots, simple linear regression, LOWESS curve fitting, correlation matrix, and bootstrap resampling methods. Results:The ADC of 28 patients was 1 137.05 (921.07, 1 643.91) before treatment, and 1 197.10 (994.75, 1 785.57) after treatment, and the ΔADC was 133.18 (-36.46, 253.04). The RIC was 0.45 (0.12, 0.67), the ED was 38.01±12.72, the Z eff was 8.40±0.64, and the λHU was -2.20±1.05. The scatter plots results indicated a positive distribution trend between RIC and ΔADC, and a negative trend between λHu and ΔADC. Simple linear regression showed that RIC had the highest goodness of fit with ΔADC ( R2=0.75) and the largest regression coefficient ( β=518.34), followed by λHU ( R2=0.64, β=-121.94). The goodness of fit between Z eff and ΔADC was low ( R2=0.25). No correlation was found between ED and ΔADC. LOWESS curve fitting showed a consistent trend with simple linear regression results, without significant deviation. The correlation matrix indicated that RIC was positively correlated with ΔADC ( r=0.88, P<0.001), Z eff was moderately positively correlated with ΔADC ( r=0.51, P=0.006), and λHU was negatively correlated with ΔADC ( r=-0.84, P<0.001). Bootstrap resampling analysis showed that the r values of RIC, Z eff, λHU and ΔADC were 0.87, 0.50, -0.80, respectively. Conclusions:The spectral CT parameter RIC of chordoma patients before proton radiotherapy is positively correlated with ΔADC, while λHU exhibits a negative correlation with ΔADC.

Objective To explore the application value of laparoscopic assisted ileostomy closure after prophylactic ileostomy.Methods A retrospective analysis was conducted on 63 cases of middle and low rectal cancer who received ileostomy closure after prophylactic ileostomy in natural orifice specimen extraction surgery(NOSES)from September 2017 to May 2023.Among them,31 cases underwent laparoscopic assisted ileostomy closure(observation group),and 32 cases underwent conventional open ileostomy closure(control group).The operative time,intraoperative blood loss,time to first ambulation,time to first flatus,time to first liquid diet,postoperative pain score,postoperative hospital stay time,and postoperative complications were compared between the two groups.Results All the 63 cases successfully underwent ileostomy closure.The observation group showed significantly better outcomes than the control group in operative time[(63.2±5.7)min vs.(93.5±4.7)min,t=-23.109,P=0.000],intraoperative blood loss[7.0(6.0,8.0)ml vs.22.5(21.0,24.0)ml,Z=-6.853,P=0.000],time to first ambulation[1.0(1.0,1.0)d vs.2.0(2.0,2.0)d,Z=-5.653,P=0.000],time to first flatus[1.0(1.0,2.0)d vs.2.0(2.0,2.0)d,Z=-5.304,P=0.000],time to first liquid diet[2.0(2.0,3.0)d vs.3.0(2.0,3.0)d,Z=-3.000,P=0.003],postoperative pain score[24 h:3.0(3.0,4.0)vs.4.0(3.0,4.0),Z=-4.501,P=0.000;48 h:2.0(2.0,2.0)vs.3.0(2.0,3.0),Z=-3.750,P=0.000;72 h:1.0(1.0,2.0)vs.2.0(2.0,2.0),Z=-2.996,P=0.003],and postoperative hospital stay[(6.8±1.6)dvs.(8.5±1.5)d,t=-4.297,P=0.000].The observation group had a lower postoperative incision infection rate than the control group[3.2％(1/31)vs.34.4％(11/32),x2=9.908,P=0.002],while no significant differences were observed in incision dehiscence,intestinal obstruction,or abdominal hemorrhage(P＞0.05).Conclusions For patients with middle and low rectal cancer who undergoing ileostomy closure after prophylactic ileostomy in NOSES,laparoscopic assisted ileostomy closure is safe and feasible.Compared with open surgery,it reduces incision infection rate,alleviates postoperative pain,shortens hospital stay,and promotes recovery.

Objective:To systematically retrieve, evaluate, extract, and integrate the best evidence on sleep disordered breathing (SDB) assessment and intervention in stroke patients to inform clinical practice.Methods:Based on the "6S" evidence model, the literature on SDB assessment and intervention in stroke patients was searched top-down on clinical decision-making websites, guideline websites, professional association websites, and databases. The search period was from the establishment of the database to September 1, 2024. The evidence-based team was formed to select the corresponding tool for quality assessment based on the type of literature. The evidence was also summarized using the Joanna Briggs Institute Center for Evidence-Based Health Care quality level of evidence and grade of recommendation.Results:A total of twenty papers were included, including six expert consensus, six guidelines, four clinical decision-making, two evidence summaries, and two systematic reviews. Eighteen pieces of evidence were summarized around four aspects of assessment, treatment, adherence, and health education.Conclusions:The assessment and intervention of SDB in stroke patients is multifaceted. It is recommended that healthcare professionals dynamically observe the actual condition of patients when applying the evidence to scientifically assess and manage SDB in stroke patients.

Metabolic-bariatric surgery(MBS)has become an important treatment for pathological obesity and metabolic diseases.However,common postoperative nutritional complications—such as protein-energy malnutrition,iron deficiency anemia,and vitamin B12 deficiency—significantly affect patients' long-term prognosis.Traditional nutritional management models rely on static monitoring and standardized supplementation,which are insufficient to address individual variability and dynamic postoperative changes.Artificial intelligence(AI),through integrating multimodal data(such as biochemical indicators,imaging information,and wearable device monitoring)and intelligent modeling,offers new approaches for dynamic monitoring,risk prediction,and personalized intervention.Based on literature from 2017 to 2025,this article systematically evaluates the application of AI in perioperative nutritional management for MBS,covering key technologies including machine learning,deep learning,and natural language processing.It also analyzes current challenges in clinical translation,such as data fragmentation,lack of model interpretability,and limited long-term validation.In the future,enhanced multi-center collaboration,the development of standardized databases,and explainable models will be essential to advancing nutritional management in MBS from empirical practice to precision medicine.

Objective:To systematically retrieve, evaluate, extract, and integrate the best evidence on sleep disordered breathing (SDB) assessment and intervention in stroke patients to inform clinical practice.Methods:Based on the "6S" evidence model, the literature on SDB assessment and intervention in stroke patients was searched top-down on clinical decision-making websites, guideline websites, professional association websites, and databases. The search period was from the establishment of the database to September 1, 2024. The evidence-based team was formed to select the corresponding tool for quality assessment based on the type of literature. The evidence was also summarized using the Joanna Briggs Institute Center for Evidence-Based Health Care quality level of evidence and grade of recommendation.Results:A total of twenty papers were included, including six expert consensus, six guidelines, four clinical decision-making, two evidence summaries, and two systematic reviews. Eighteen pieces of evidence were summarized around four aspects of assessment, treatment, adherence, and health education.Conclusions:The assessment and intervention of SDB in stroke patients is multifaceted. It is recommended that healthcare professionals dynamically observe the actual condition of patients when applying the evidence to scientifically assess and manage SDB in stroke patients.

Objective To explore the application value of laparoscopic assisted ileostomy closure after prophylactic ileostomy.Methods A retrospective analysis was conducted on 63 cases of middle and low rectal cancer who received ileostomy closure after prophylactic ileostomy in natural orifice specimen extraction surgery(NOSES)from September 2017 to May 2023.Among them,31 cases underwent laparoscopic assisted ileostomy closure(observation group),and 32 cases underwent conventional open ileostomy closure(control group).The operative time,intraoperative blood loss,time to first ambulation,time to first flatus,time to first liquid diet,postoperative pain score,postoperative hospital stay time,and postoperative complications were compared between the two groups.Results All the 63 cases successfully underwent ileostomy closure.The observation group showed significantly better outcomes than the control group in operative time[(63.2±5.7)min vs.(93.5±4.7)min,t=-23.109,P=0.000],intraoperative blood loss[7.0(6.0,8.0)ml vs.22.5(21.0,24.0)ml,Z=-6.853,P=0.000],time to first ambulation[1.0(1.0,1.0)d vs.2.0(2.0,2.0)d,Z=-5.653,P=0.000],time to first flatus[1.0(1.0,2.0)d vs.2.0(2.0,2.0)d,Z=-5.304,P=0.000],time to first liquid diet[2.0(2.0,3.0)d vs.3.0(2.0,3.0)d,Z=-3.000,P=0.003],postoperative pain score[24 h:3.0(3.0,4.0)vs.4.0(3.0,4.0),Z=-4.501,P=0.000;48 h:2.0(2.0,2.0)vs.3.0(2.0,3.0),Z=-3.750,P=0.000;72 h:1.0(1.0,2.0)vs.2.0(2.0,2.0),Z=-2.996,P=0.003],and postoperative hospital stay[(6.8±1.6)dvs.(8.5±1.5)d,t=-4.297,P=0.000].The observation group had a lower postoperative incision infection rate than the control group[3.2％(1/31)vs.34.4％(11/32),x2=9.908,P=0.002],while no significant differences were observed in incision dehiscence,intestinal obstruction,or abdominal hemorrhage(P＞0.05).Conclusions For patients with middle and low rectal cancer who undergoing ileostomy closure after prophylactic ileostomy in NOSES,laparoscopic assisted ileostomy closure is safe and feasible.Compared with open surgery,it reduces incision infection rate,alleviates postoperative pain,shortens hospital stay,and promotes recovery.

Objective:To explore the clinical effect of the whole-process management scheme of daytime minimally invasive liver resection surgery based on the enhanced recovery after surgery (ERAS) concept.Methods:This is a retrospective case series study. The data of 55 patients who underwent minimally invasive daytime liver resection surgery under the ERAS concept at the Department of General Surgery,Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2023 to August 2024. There were 22 males and 33 females;aged (48.2±15.1) years (range: 16 to 77 years). All patients were classified as Grade 2 according to the American Society of Anesthesiologists physical status classification. Among them, 7 cases were complicated with liver cirrhosis and 10 cases had fatty liver. A multidisciplinary team was formed, consisting of surgeons, anesthesiologists, rehabilitation physicians, psychologists, pharmacists, acute pain management team, operating room nurses, day surgery ward nurses, and ERAS specialized nurses. After strict evaluation by surgeons and anesthesiologists, patients suitable for daytime liver resection surgery were implemented with the ERAS whole-process management plan for liver resection on the basis of routine nursing care.Results:Among the 55 patients, 50 were discharged smoothly within 48 hours, while 5 were transferred to specialized departments for further treatment due to not meeting the discharge criteria, with a smooth daytime discharge rate of 90.9%. Among the 50 patients, 30 underwent laparoscopic surgery and 20 underwent robotic-assisted surgery. The surgery time was (91.6±28.2)minutes(range:45 to 165 minutes), with the intraoperative blood loss of only (30.5±25.5)ml(range:5 to 100 ml). Pathological examination results showed that among the 50 patients, 13 cases had hepatocellular carcinoma, 21 cases had hepatic hemangioma, 4 cases had hepatic cyst, 8 cases had focal nodular hyperplasia, 1 case had low-grade dysplastic nodule, 1 case had hepatolithiasis, 1 case had lymphoma, and 1 case had vascular, fibrous and lymphoid tissue proliferation. There were 44.0% patients who were able to get out of bed on the day of surgery. The hospital stay was (1.8±0.4)days(range:1 to 2 days), and the hospitalization cost was (34 499±20 330)yuan(range:11 724 to 73 488 yuan). No complications requiring special treatment outside the conventional pathway were observed during the hospital stay and follow-up period. At the 2-week outpatient follow-up, no significant abnormalities were found in all patients, and the wound healing was good.Conclusions:The daytime liver resection surgery based on the ERAS whole-process management plan has shown good feasibility in clinical practice. It helps to simplify medical process, shorten hospital stay, and reduce medical costs.

Objective:To explore the application effect of humanistic care nursing model in patients with gynecological tumors.Methods:Using the convenient sampling method, a total of 136 gynecological tumor patients who were hospitalized in Henan Cancer Hospital from March 2020 to March 2021 were selected as the research objects. Patients were divided into the observation group and the control group using the random number table method, with 68 patients in each group. The control group received routine nursing intervention during hospitalization, while the observation group received humanistic care based on routine nursing. The intervention effect was compared using Symptom Checklist 90 (SCL-90) , Pittsburgh Sleep Quality Index (PSQI) and Nursing Satisfaction Questionnaire.Results:After intervention, the SCL-90 and PSQI scores of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . After intervention, the scores of each item in the Nursing Satisfaction Questionnaire of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The application of humanistic care model in gynecological tumor patients can effectively improve their psychological status and sleep quality and increase patient satisfaction, which is worthy of clinical promotion.