Prognostic Value of Postoperative Complication for Gastric Cancer

Background: The incidence of complications in gastric cancer (GC) patients after surgery was increasing, and it was not clear whether postoperative complications would have an impact on prognosis. The current study attempted to investigate the role of postoperative complication for prognosis on GC patients undergoing radical resection. Materials and Methods: Eligible studies were searched in three databases, including PubMed, Embase, and the Cochrane Library, in accordance with the searching strategy on September 4th, 2022. The survival values were most concerned; then, hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled up. All prognostic values, including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and recurrence-free survival (RFS), were allowed. Subgroup analysis based on complication types was used for further in-depth research. Results: A total of 29 studies involving 33,858 patients were included in this study. Intra-abdominal abscess (19.4%) was the most common complications in the included studies, followed by anastomotic leakage (17.0%) and pneumonia (16.4%). There were 23, 4, 6, and 10 studies that reported OS, DFS, DSS, and RFS, respectively. After analysis, postoperative complication was found to be an independent prognostic factor for OS (HR = 1.52, I2 = 1.14%, 95% CI = 1.42-1.61, P = .00), DFS (HR = 1.71, I2 = 0.00%,95% CI = 1.44-1.98, P < .05), DSS (HR = 1.60, I2 = 54.58%, 95% CI = 1.26-1.93, P < .1), and RFS (HR = 1.26, I2 = 0.00%, 95% CI = 1.11-1.41, P < .05). Subgroup analysis found that noninfectious complication was not significantly associated with OS (HR = 1.39, I2 = 0.00%, 95% CI = 0.96-1.82, P > .05). Conclusion: Surgeons needed to pay more attention to GC patients who developed postoperative complications, especially infectious complications, and take proactive management to improve the prognosis.

Catheter-related infection in infants due to an unusual lipophilic yeast--Malassezia furfur

Malassezia furfur (Pityrosporum orbiculare, P ovale), a lipophilic yeast that is part of the normal skin flora, causes tinea versicolor but has only rarely been associated with more serious infections. We report five episodes in four infants of catheter-related infection caused by this organism. All episodes occurred in infants who had survived serious neonatal disorders and were receiving prolonged therapy with intravenous fat emulsion. Sudden onset of fever without focal findings was the usual presentation; however, one afebrile patient had recurrent episodes of apnea, bradycardia, and cyanosis. Thrombocytopenia was a prominent finding. Patients were generally treated with amphotericin B. All patients recovered when the colonized catheter was removed or fat emulsion therapy was stopped. The yeast usually grew slowly in blood culture media but grew readily when subcultured onto Sabouraud's medium coated with sterile olive oil. Yeasts were readily identified in all four patients in whom a buffy coat Gram stain was obtained of blood from the central intravenous catheter. M furfur may be a fairly common but unrecognized cause of catheter-related sepsis in infants receiving long-term fat emulsion therapy. This organism should be sought whenever routine blood cultures are negative for bacteria and yeasts are observed in a buffy coat Gram stain.

Intracranial pressure. Sequential measurements in full-term and preterm infants

Intracranial pressure (ICP) was measured sequentially using a pressure-activated fiberoptic device that is placed over the anterior fontanel in 120 full-term and 53 preterm infants during the first week after birth. Mean birth weight in full-term infants was 3,527 g (range, 2,720 to 4,620 g) and in preterm infants was 1,695 g (range 1,130 to 2,440 g). Mean ICP was 12.6, 12.1, and 11.4 cm H2O on days 1,2, and 3 in full-term infants, and was 10.2, 17.0, 11.0, 8.9, 7.3 cm H20 on days 1, 2, 3, 5, 7 in preterm infants. The values in preterm infants did not seem to be related to differences in Apgar scores, but higher values were seen in infants treated with continuous positive airway pressure administered by nasal prongs (before the method of fixation was changed). More stable values have been seen recently in preterm infants, which may reflect changes in care (eg, less hypoxemia).

Amniotic fluid volume and composition following experimental manipulations in sheep

Twenty to thirty percent of amniotic fluid volume was replaced by isotonic solutions of saline, mannitol, or dextrose in chronically cannulated ovine fetuses. In all cases the sodium, potassium, and chloride concentrations returned to control values in 3 to 6 hours. Urea and creatinine behaved similarly in the saline and mannitol experiments, but rose above control values within 1 hour of dextrose replacement. Amniotic fluid volume increased with return of solute. Fetal urine drainage to the exterior abolished the rapid return of urea and creatinine concentrations in the dextrose experiments, although no changes in renal function occurred in any experiments. It was concluded that dextrose inhibited the exit of urea and creatinine from the amniotic compartment.

Excessive handling as a cause of hypoxemia

Continuous transcutaneous oxygen (TcPo2) monitoring was used to study low-birth-weight infants (15 control, 15 experimental) during their stay in the intensive care nursery (ICN). Twenty hours of continuous recordings were made of heart rate, respiratory rate, and TcPo2 in the first five days after birth. Personnel caring for the control infants were blind to the TcPo2 measurements. Those caring for the experimental group were instructed in the operation of the TcPo2 monitor and used the device to modify the timing and extent of procedures to minimize "undersirable time" (TcPo2 less than 40 or greater than 100 torr). Control group infants had an average of 40 min/20 hr in "undesirable time." When personnel used TcPo2 monitoring to modify care this "undesirable time" was reduced to 6 min/20 hr. This difference was statistically significant (P less than .001). Infants in the control group were handled more frequently, and experienced more hypoxemia. Of the hypoxemic time suffered by the control infants 75% was associated with handling. Only 5% of the hypoxemia or hyperoxemia was detected by blood Pao2 analysis or conventional monitors. Intermittent arterial blood gas sampling is an inadequate method for monitoring arterial oxygenation in low-birth-weight infants since hypoxemia and hyperoxemia are often missed. Continuous TcPo2 monitoring improves care by diminishing "undesirable time."