Surgery
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Multicenter Study
Impact of prothrombin time-International Normalized Ratio on outcome of patients with septic shock receiving polymyxin B cartridge hemoperfusion.
Although most patients with septic shock have a poor outcome, some may survive after blood purification treatment such as polymyxin B cartridge hemoperfusion (PMX). ⋯ Prolonged PT-INR is an independent risk factor for 28-day mortality in patients receiving PMX for septic shock.
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Comparative Study Clinical Trial
Comparison of the staging of regional lymph nodes using the sixth and seventh editions of the tumor-node-metastasis (TNM) classification system for the evaluation of overall survival in gastric cancer patients: findings of a case-control analysis involving a single institution in China.
It has recently been reported that the sixth edition of the tumor-node-metastasis (TNM) classification system for gastric cancer involving the staging of regional lymph nodes (N) has inappropriate cut-offs with regard to counts of metastatic lymph nodes. It remains controversial, however, as to whether the seventh edition of this classification system is completely accurate in staging N for the prediction of the prognosis of gastric cancer. Our aim was to determine which of these two editions of the TNM classification system was superior with regard to the prediction of the prognosis of Chinese patients with gastric cancer. ⋯ The seventh edition proved more reliable and accurate than the sixth edition of the TNM classification system in categorizing the number of metastatic lymph nodes for the purpose of predicting the OS of patients with gastric cancer after curative resection.
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Comparative Study
Comparison of postoperative complication risk prediction approaches based on factors known preoperatively to surgeons versus patients.
Estimating the risk of postoperative complications can be performed by surgeons with detailed clinical information or by patients with limited information. Our objective was to compare three estimation models: (1) the All Information Model, using variables available from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP); (2) the Surgeon Assessment Model, using variables available to surgeons preoperatively, and (3) the Patient-Entered Model, using information that patients know about their own health. ⋯ Although a small decline in model performance was observed, the magnitude suggests that it may not be clinically meaningful as the risk predictions offered are superior to simply providing unadjusted complications rates. The Surgeon Assessment and Patient-Entered models with fewer predictors can be used with relative confidence to predict a patient's risk.
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Clinical Trial
Functional abdominal wall reconstruction improves core physiology and quality-of-life.
One of the goals of modern ventral hernia repair (VHR) is restoring the linea alba by returning the rectus muscles to the midline. Although this practice presumably restores native abdominal wall function, improvement of abdominal wall function has never been measured in a scientific fashion. We hypothesized that a dynamometer could be used to demonstrate an improvement in rectus muscle function after open VHR with restoration of the midline, and that this improvement would be associated with a better quality-of-life. ⋯ Restoration of the linea alba during VHR is associated with improved abdominal wall functionality. Analysis of rectus muscle function using a dynamometer showed statistical improvement by isokinetic and isometric measurements, all of which were associated with an improvement in quality-of-life.
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Although duration of hospital stay commonly is used as a surrogate outcome for surgical recovery, it is not applicable in the setting of short-stay surgery (<24 hours). The objective of our study was to describe the trajectory of recovery after short-stay abdominal surgery by using measures of physical activity and health-related quality of life (HRQL) and identify predictors of prolonged, postdischarge recovery. ⋯ Despite uniformly early discharge, a substantial proportion of patients (∼33%) had suboptimal recovery 2 months after short-stay surgery. Measures of physical activity and HRQOL provide complementary information and reflect the variability in trajectories of recovery after surgery.