Enhanced recovery after surgery (ERAS) has been rapidly developing by combining several techniques with evidence-based adjustments, including preoperative education, preoperative carbohydrate loading, epidural or regional anesthesia, early initiation of enteral nutrition, ambulation and multi-modal pain management. The core part of ERAS is to reduce and reverse surgical stress and therefore greatly improve clinical outcome. Under the guidance of ERAS, perioperative management of robotic gastric cancer operation should follow the basic principles of ERAS and clinical pathway to maximize the advantages of the robotic surgery. ERAS protocol is safe and feasible for patients undergoing robotic radical gastrectomy and it can reduce surgical stress, shorten hospital stay, improve quality of life and does not increase complications, whose mechanism may be associated with the reduction of inflammation and insulin resistance, the decrease of resting energy exposure, and the protection of mitochondria function. It is worth emphasizing that it is very important to fully understand the changes of pathophysiology during perioperative period, to strictly implement the ERAS pathway based on optimized evidence-based medicine, to cooperate closely with the multidisciplinary team, to observe and manage the postoperative complications dynamically by systemic classification. The improvement of ERAS program on the outcome of patients should be summarized regularly and the new interventional strategies should be evaluated further according to the international standard.
Anesthesia, Epidural ; Anesthesia, Local ; Convalescence ; Critical Pathways ; Enteral Nutrition ; Gastrectomy ; instrumentation ; methods ; rehabilitation ; Humans ; Length of Stay ; Pain Management ; Patient Education as Topic ; Postoperative Care ; methods ; standards ; Postoperative Complications ; prevention & control ; Preoperative Care ; Quality of Life ; Recovery of Function ; Robotic Surgical Procedures ; rehabilitation ; Stomach Neoplasms ; surgery

OBJECTIVETo assess the correlation between five anthropometric parameters and the distance from tibial tuberosity to medial malleolus in 100 volunteers.

METHODSSix anthropometric parameters were measured in 50 male and 50 female medical students using a metallic scale: medial knee joint line to ankle joint line (K-A), medial knee joint line to medial malleolus (K-MM), tibial tuberosity to ankle joint (TT-A), tibial tuberosity to medial malleolus (TT- MM), olecranon to 5th metacarpal head (O-MH) and body height (BH). Nail size predicted based upon TT-MM measurement was chosen as ideal nail size. A constant was derived for each of the six anthropometric parameters which was either added or subtracted to each measurement to derive nail size. A regression equation was applied to BH measurements. Nail sizes calculated were compared with that obtained from TT-MM measurement and accuracy was evaluated. Accuracy of O-MH and BH regression equations recommended by other authors were calculated in our data.

RESULTSAdding 11 mm to TT-A distance had highest accuracy (81%) and correlation (0.966) in predicting nails correctly. Subtracting 33 mm from K-MM measurement and 25 mm from K-A distance derived accurate sizes in 69% and 76% respectively. Adding 6 mm to O-MH distance had a poor accuracy of 51%. Nail size prediction based upon body height regression equation derived correct nail sizes in only 34% of the cases. Regression equation analysis by other authors based on O-MH and BH distances yielded correct sizes in 11% and 5% of the cases respectively.

CONCLUSIONTT-A, K-A and K-MM measurements can be used simultaneously to increase accuracy of nail size prediction. This method would be helpful in determining nail size preoperatively especially when one anatomic landmark is difficult to palpate.

Adult ; Anthropometry ; Body Height ; Bone Nails ; Female ; Fracture Fixation, Intramedullary ; instrumentation ; Humans ; Male ; Preoperative Care ; Tibial Fractures ; surgery

Duodeno-colonic fistula is an enterocolonic fistula that occurs as a complication of Crohn's disease. Symptoms of duodeno-colonic fistula are similar to those of Crohn's disease, such as weight loss and diarrhea. The treatment of choice is surgery, although medical treatment may also be considered. However, surgery is recommended when all available medical therapies have been ineffective. In this case, we report a secondary duodeno-colonic fistula due to Crohn's disease that was temporarily managed by an endoscopic procedure with a detached endoloop and hemoclips as a bridging therapy to final surgical repair.
Adult ; Crohn Disease/complications/*diagnosis ; Endoscopy, Digestive System/instrumentation/methods ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/surgery ; Preoperative Care ; Tomography, X-Ray Computed

Based on GB/T16886.4-2003 Standard, the coagulation effects of 5 cardiovascular system external communicating devices made consist of metal and polymer were assessed using the partial thromboplastin time (PTT) and Lee-White coagulation time (CT) tests. The results indicate that PTT test is a stable and valuble method for evaluating the coagulating pathway disturbance of the devices. In line with GB/T 16886.4-2003 Standard, PTT test is a recommendable method for evaluating the external communicating devices Based on GB/T14233.2-2005 Standard, CT test is a method more liable to variation, compared with PTT test. This is due to the complex relativity in the test itself, due to all the factors of coagulating cascade, and due to the individual difference of animal. The question of how to select proper negative control for coagulation evaluation of the Cardiovascular System External Communicating Devices in clinical setting for CT test should be addressed and studied.
Blood Coagulation ; Blood Coagulation Tests ; Cardiology ; instrumentation ; Equipment Safety ; Humans ; Metals ; adverse effects ; Partial Thromboplastin Time ; Polymers ; adverse effects ; Preoperative Care

Brain Neoplasms ; surgery ; Computer Simulation ; Humans ; Imaging, Three-Dimensional ; methods ; Male ; Middle Aged ; Neurosurgical Procedures ; instrumentation ; methods ; Patient Care Planning ; Preoperative Care

In this paper is introduced an image guided oral implant system (IGOIS), including the 3D surface-model generation through Marching Cubes algorithm and large-scale triangular mesh simplification, the realization of pre-operative planning module with computer graphics and image processing technology, the non-invasive point-to-point registration with the fabrication of tooth-supported polymer resin templates and ICP algorithm, and the development of the real-time navigation system software by programming in VTK and VC+ +6.0. The experimental test for a patient's rapid prototype model shows that with the support of IGOIS, the precision achieved in the planning phase can be transferred to the patient so that the accuracy of the oral implant surgery under difficult conditions is improved.
Computer Simulation ; Dental Implantation ; instrumentation ; methods ; Dental Implants ; Humans ; Imaging, Three-Dimensional ; methods ; Models, Biological ; Preoperative Care ; methods ; Radiographic Image Interpretation, Computer-Assisted ; methods ; Surgery, Computer-Assisted ; methods ; User-Computer Interface

Adult ; Female ; Hemodynamics ; drug effects ; physiology ; Humans ; Hypertension ; diagnosis ; drug therapy ; physiopathology ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngoscopy ; methods ; Male ; Middle Aged ; Monitoring, Physiologic ; instrumentation ; methods ; Preoperative Care ; instrumentation ; methods ; Reproducibility of Results ; Sensitivity and Specificity ; Time Factors

PURPOSE: We classified the Orbscan anterior elevation maps in normal eyes (under myopic, emmetropic and hyperopic conditions) and in those after myopic refractive surgery. We did this classification to demonstrate how Orbscan anterior elevation maps are useful in screening for the existence and extent of previous myopic refractive surgery. Such a classification can help clinicians interpret preoperative and postoperative topographies. METHODS: We measured for visual acuity and refractive power in 4800 eyes. After a slit-lamp examination, a corneal topography exam was performed with an Orbscan corneal topography system. The eyes were divided into two groups, with Group I representing those who had not had refractive surgery (4438 eyes). Group II included those who had undergone previous refractive surgery to correct myopia (362 eyes). RESULTS: In Group I, the central island type (43.0%) was the most common, followed by the temporal ridge (25.8%), the with-the-rule regular ridge (16.7%), the against-the-rule regular ridge (6.6%), the nasal ridge (4.0%), and the saddle type (2.1%). In Group II, the depressed lake type (69.9%) was most common, followed by the de-centered ablation type (21.3%). The trend line of the postoperative central anterior surface elevation (E) and the ablation power of refractive surgery were calculated. Ablation power of refractive surgery=0.0047 E+0.0083 CONCLUSIONS: This study demonstrates that it is possible to use Orbscan anterior elevation maps to screen for the extent of previous refractory surgery used in the correction of myopia. This study may also be useful in understanding the shapes of Orbscan anterior elevation maps before and after myopic refractive surgery as well as in determining the degree of ablated myopic refractive power and decentration.
Vision Screening/*instrumentation ; Retrospective Studies ; Preoperative Care ; Postoperative Period ; Myopia/*diagnosis/surgery ; *Keratomileusis, Laser In Situ ; Humans ; Equipment Design ; *Corneal Topography ; Cornea/*pathology ; Adult

OBJECTIVETo compare mini-probe endoscopic ultrasonography (MCUS) with computed tomography (CT) in preoperative T and N staging of esophageal cancer, and to find out the MCUS parameters to judge lymph node metastasis for esophageal cancer.

METHODSThirty-five patients received both MCUS and CT preoperatively, on both of which the T and N stages were determined. The accuracy, sensitivity, specificity, positive predicting value and negative predicting value were compared with the postoperative pathological results.

RESULTSThe accuracy of MCUS was 85.7% in T staging and 85.7% and 80.0% in N staging by the two different methods, which were 45.7% and 74.3%, respectively, by CT.

CONCLUSIONMCUS is better than CT in preoperative staging for esophageal cancer. The ratio of short to long axis (S/L) combined with short axis is a useful way to determine lymph node metastasis.

Adult ; Aged ; Double-Blind Method ; Endosonography ; instrumentation ; methods ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Esophagus ; diagnostic imaging ; Female ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; methods ; Preoperative Care ; Tomography, X-Ray Computed

OBJECTIVETo analyze the surgical patients treated with straight wire appliance for guidelines of clinical using of the appliance.

METHODSTotally 51 patients from Joint Clinic of Orthodontic Surgery, Peking University School of Stomatology with dentofacial deformities treated with straight wire appliance were analyzed. The patients were aged from 15 years to 34 years 5 months, average 18 years 9 months. Among whom, 16 are males, while the other 35 are females.

RESULTSEighteen patients were treated with extraction of teeth, while other 33 cases were nonextraction case. The duration of average presurgical orthodontic treatment was 13.3 months, and 10.4 months was for postsurgical orthodontic treatment, totally active treatment time was 25.5 months.

CONCLUSIONSStraight wire appliance would benefit a lot for three dimensional control of teeth when doing pre- and post-surgical orthodontic treatment. Good results could be achieved without wire bending.

Adolescent ; Adult ; Female ; Humans ; Male ; Malocclusion, Angle Class II ; therapy ; Malocclusion, Angle Class III ; therapy ; Orthodontic Wires ; Orthodontics, Corrective ; instrumentation ; methods ; Postoperative Care ; Preoperative Care ; Treatment Outcome ; Young Adult