• BCLC stage 0-A
• Hepatocellular carcinoma
• Laparoscopic hepatectomy
• Open hepatectomy
• Robotic hepatectomy

• Humans
• Robotic Surgical Procedures/methods
• Propensity Score
• Female
• Male
• Liver Neoplasms/surgery
• Liver Neoplasms/pathology
• Laparoscopy/methods
• Hepatectomy/methods
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/pathology
• Middle Aged
• Retrospective Studies
• Operative Time
• Aged
• Neoplasm Staging
• Length of Stay/statistics & numerical data
• Blood Loss, Surgical/statistics & numerical data
• Treatment Outcome
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Adult

• 82160500 Innovative Research Group Project of the National Natural Science Foundation of China
• 2022GXNSFAA035642 Natural Science Foundation of Guangxi Zhuang Autonomous Region

• Acupuncture
• Gastric Cancer
• Gastrointestinal Motility
• Postoperative Ileus
• Recovery Time

• acute appendicitis
• adhesive intestinal obstruction
• appendectomy
• children
• single-hole laparoscopic
• unplanned re-operation

• Complications
• Grip strength
• Minimally invasive surgery
• Postoperative ileus
• Prospective cohort study

• Humans
• Male
• Female
• Prospective Studies
• Middle Aged
• Ileus/etiology
• Ileus/epidemiology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Hand Strength
• Aged
• Minimally Invasive Surgical Procedures/adverse effects
• Adult
• Abdomen/surgery
• Incidence
• Risk Factors

• enteric glia
• enteric nervous system
• intestinal inflammation

• electroacupuncture
• meta‐analysis
• postoperative ileus

• Humans
• Abdomen/surgery
• Defecation
• Electroacupuncture/methods
• Ileus/prevention & control
• Ileus/etiology
• Postoperative Complications/prevention & control
• Postoperative Complications/etiology
• Randomized Controlled Trials as Topic
• Time Factors
• Treatment Outcome

• CiteSpace
• Postoperative ileus
• Scientometric analysis
• Trends
• VOSviewer
• Visualization

• acupuncture
• association rules
• colorectal cancer
• machine-learning
• postoperative ileus

• National Natural Science Foundation of China

• Gut microbiota
• Intestinal motility
• Metabolites
• Postoperative ileus
• Probiotics
• Review

• 81900524 National Natural Science Foundation of China
• ZR2020MH252 Natural Science Foundation of Shandong Province
• ZR2020MH205 Natural Science Foundation of Shandong Province

Postoperative intestinal ileus is common after laparoscopic surgery, the incidence of those after hysterectomy was 9.2%. Anesthesia is one of the independent risk factors of postoperative ileus. Dexmedetomidine has been widely used in perioperative anesthesia and previous reports suggested that intraoperative dexmedetomidine may be associated with the improvement of gastrointestinal function recovery after abdominal surgery. We hypothesized that dexmedetomidine could improve gastrointestinal function recovery after laparoscopic hysteromyomectomy. Participants in elective laparoscopic hysteromyomectomy were enrolled with a single dose of 0.5 μg kg⁻¹ dexmedetomidine or the same volume of placebo intravenously administered for 15 min, followed by continuous pumping of 0.2 μg kg⁻¹ h⁻¹ of corresponding drugs until 30 min before the end of surgery. The primary outcome was the time to first flatus. Secondary outcomes were the time to first oral feeding and the first defecation, the occurrence of flatulence, pain score and postoperative nausea and vomiting until 48 h after the surgery. Eventually, 106 participants (54 in dexmedetomidine group and 52 in placebo group) were included for final analysis. The time to first flatus (SD, 25.83 [4.18] vs 27.67 [3.77], P = 0.019), oral feeding time (SD, 27.29 [4.40] vs 28.92 [3.82], P = 0.044), the time to first defecation (SD, 59.82 [10.49] vs 63.89 [7.71], P = 0.025), abdominal distension (n%, 12 (22.2) vs 21 (40.4), P = 0.044), PONV at 24 h (n%, 10 (18.5) vs 19 (36.5), P = 0.037), NRS 6 h (3.15(0.68) vs 3.46 (0.87), P = 0.043) and NRS 12 h (3.43 (0.88) vs 3.85 (0.85), P = 0.014) of dexmedetomidine group were significantly shorter than those of the placebo group. Intraoperative dexmedetomidine reduced the time to first flatus, first oral feeding, and first defecation. These results suggested that this treatment may be a feasible strategy for improving postoperative gastrointestinal function recovery in patients undergoing laparoscopic hysteromyomectomy.

Postoperative ileus (POI) is an important complication of gastrointestinal (GI) surgery. Acupuncture has been increasingly used in treating POI. This study aimed to assess the effectiveness and safety of acupuncture for POI following GI surgery.

Seven databases (PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wan fang Data, VIP Database for Chinese Technical Periodicals, and Chinese Biomedical Literature Database) and related resources were searched from inception to May 30, 2021. Randomized controlled trials (RCTs) reporting the acupuncture for POI in GI were included. The quality of RCTs was assessed by the Cochrane Collaboration Risk of Bias tool, and the certainty of the evidence was evaluated by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. A meta-analysis was performed by using RevMan 5.4 software.

Eighteen RCTs involving 1413 participants were included. The meta-analysis showed that acupuncture could reduce the time to first flatus (TFF) (standardized mean difference [SMD] = −1.14, 95% confidence interval [CI]: −1.54 to −0.73, P < 0.00001), time to first defecation (TFD) (SMD = −1.31, 95% CI: −1.88 to −0.74, P < 0.00001), time to bowel sounds recovery (TBSR) (SMD = −1.57, 95% CI: −2.14 to −1.01, P < 0.00001), and length of hospital stay (LOS) (mean difference [MD] = −1.68, 95% CI: −2.55 to −0.80, P = 0.0002) compared with usual care. A subgroup analysis found that acupuncture at distal acupoints once daily after surgery had superior effects on reducing TFF and TFD. A sensitivity analysis supported the validity of the finding. Acupuncture also manifested an effect of reducing TFF, TFD and TBSR compared with sham acupuncture but the result was not stable. Relatively few trials have reported whether adverse events have occurred.

Acupuncture showed a certain effect in reducing POI following GI surgery with very low-to-moderate quality of evidence. The overall safety of acupuncture should be further validated. More high-quality, large-scale, and multicenter original trials are needed in the future.

• Acupuncture
• Colorectal surgery
• Enhanced recovery
• Laparoscopy
• Postoperative ileus

• P2X7 receptor
• anti-inflammation
• macrophages
• postoperative ileus

• Adenosine Triphosphate
• Animals
• Anti-Inflammatory Agents/therapeutic use
• Disease Models, Animal
• Ileus/drug therapy
• Ileus/etiology
• Ileus/metabolism
• Ileus/veterinary
• Inflammation/drug therapy
• Inflammation/veterinary
• Mice
• Mice, Inbred C57BL
• Postoperative Complications/drug therapy
• Postoperative Complications/veterinary
• Purinergic P2X Receptor Antagonists/pharmacology
• Purinergic P2X Receptor Antagonists/therapeutic use
• Quality of Life
• Receptors, Purinergic P2X7/therapeutic use

• COMPLEMENTARY MEDICINE
• Endoscopic surgery
• Functional bowel disorders
• Gastrointestinal tumours

• Colorectal Neoplasms/complications
• Colorectal Neoplasms/surgery
• Electroacupuncture/methods
• Humans
• Ileus/etiology
• Ileus/therapy
• Laparoscopy/adverse effects
• Multicenter Studies as Topic
• Postoperative Complications/therapy
• Randomized Controlled Trials as Topic
• Treatment Outcome

• National Key R&D Program of China

• Colorectal cancer
• Gut microbiota
• Intestinal muscularis inflammation
• LPS
• Postoperative ileus

• Cholinergic anti-inflammatory pathway
• Ileus
• Inflammation
• Intestinal barrier
• SIRS
• Vagal nerve stimulation

Purpose: The aims of this study were to combine CT images with Ki-67 expression to distinguish various subtypes of lung adenocarcinoma and to pre-operatively predict the Ki-67 expression level based on CT radiomic features.

Methods: Data from 215 patients with 237 pathologically proven lung adenocarcinoma lesions who underwent CT and immunohistochemical Ki-67 from January 2019 to April 2021 were retrospectively analyzed. The receiver operating curve (ROC) identified the Ki-67 cut-off value for differentiating subtypes of lung adenocarcinoma. A chi-square test or t-test analyzed the differences in the CT images between the negative expression group (n = 132) and the positive expression group (n = 105), and then the risk factors affecting the expression level of Ki-67 were evaluated. Patients were randomly divided into a training dataset (n = 165) and a validation dataset (n = 72) in a ratio of 7:3. A total of 1,316 quantitative radiomic features were extracted from the Analysis Kinetics (A.K.) software. Radiomic feature selection and radiomic classifier were generated through a least absolute shrinkage and selection operator (LASSO) regression and logistic regression analysis model. The predictive capacity of the radiomic classifiers for the Ki-67 levels was investigated through the ROC curves in the training and testing groups.

Results: The cut-off value of the Ki-67 to distinguish subtypes of lung adenocarcinoma was 5%. A comparison of clinical data and imaging features between the two groups showed that histopathological subtypes and air bronchograms could be used as risk factors to evaluate the expression of Ki-67 in lung adenocarcinoma (p = 0.005, p = 0.045, respectively). Through radiomic feature selection, eight top-class features constructed the radiomic model to pre-operatively predict the expression of Ki-67, and the area under the ROC curves of the training group and the testing group were 0.871 and 0.8, respectively.

Conclusion: Ki-67 expression level with a cut-off value of 5% could be used to differentiate non-invasive lung adenocarcinomas from invasive lung adenocarcinomas. It is feasible and reliable to pre-operatively predict the expression level of Ki-67 in lung adenocarcinomas based on CT radiomic features, as a non-invasive biomarker to predict the degree of malignant invasion of lung adenocarcinoma, and to evaluate the prognosis of the tumor.

• Ki-67
• computed tomography
• lung adenocarcinoma
• non-invasive biomarker
• pre-operative prediction
• radiomics

• Gastrointestinal tract
• Ilaprazole
• Inflammation
• Postoperative ileus

• Anastomotic leak
• Anastomotic stricture
• Colorectal surgery
• Urinary retention

• inflammatory mechanisms
• intestinal manipulation
• knockout mice
• postoperative ileus
• steroid receptor coactivator-3

• Animals
• Cytokines/metabolism
• Disease Models, Animal
• Female
• Gastrointestinal Motility
• Ileus/etiology
• Ileus/immunology
• Ileus/metabolism
• Ileus/physiopathology
• Inflammation Mediators/metabolism
• Intestine, Small/immunology
• Intestine, Small/metabolism
• Intestine, Small/physiopathology
• Jejunum/immunology
• Jejunum/metabolism
• Jejunum/physiopathology
• Mice, 129 Strain
• Mice, Inbred C57BL
• Mice, Knockout
• Muscle, Smooth/immunology
• Muscle, Smooth/metabolism
• Muscle, Smooth/physiopathology
• Neutrophil Infiltration
• Nuclear Receptor Coactivator 3/genetics
• Nuclear Receptor Coactivator 3/metabolism
• Peroxidase/metabolism
• Postoperative Complications/etiology
• Postoperative Complications/immunology
• Postoperative Complications/metabolism
• Postoperative Complications/physiopathology
• Tissue Culture Techniques
• Mice

• 81601227 National Natural Science Foundation of China
• 81970462 National Natural Science Foundation of China
• 2016J05203 Natural Science Foundation of Fujian Province
• 2015J01548 Natural Science Foundation of Fujian Province
• 3502Z20154008 the Science and Technology Planning Projects of Xiamen Science & Technology Bureau
• 3502Z20149004 the Science and Technology Planning Projects of Xiamen Health and Family Planning Commission

To investigate the outcomes of laparoendoscopic single-site adrenalectomy (LESS-A) compared to multi-port laparoendoscopic adrenalectomy (m-LA).

Studies comparing LESS-A with m-LA were identified from PubMed, Embase, and Cochrane Library before June 2020. Post-operative pain, resumption outcomes, and perioperative outcomes were analyzed. We conducted meta-analyses using the Mantel-Haenszel method with random-effects model. Subset analyses were conducted according to peritoneal and retroperitoneal approaches. A small study effect was illustrated using funnel plots and Egger's test.

One randomized controlled trial (RCT) and nineteen retrospective cohort studies involving 1554 patients were included for analyzed. Pooled analysis showed that LESS-A had significantly lower postoperative pain scores (MD −0.77, 95%CI −1.45 to −0.10) and less pain medication used (RR 0.74, 95%CI 0.60 to 0.91) compared to m-LA. Besides, LESS-A had significantly shorter hospital stays (MD −0.75, 95%CI −1.18 to −0.33), shorter duration of oral intake resumption (MD −0.33, 95%CI −0.60 to −0.06), and better cosmetic satisfaction (SMD 1.15, 95%CI 0.21 to −2.09). As for perioperative outcomes, LESS-A led to significant longer operative time (MD 13.43, 95%CI 4.08 to 22.77). No significant differences were observed in terms of the remaining perioperative outcomes.

LESS-A is associated with less post-operative pain and quicker recovery duration. However, the longer operative time of LESS-A compared with m-LA is a drawback.

•

Multi-port laparoscopic adrenalectomy (m-LA) is widely used for treatment of benign adrenal tumor.

• Adrenalectomy
• Laparoendoscopic single-site
• Multi-port laparoendoscopic

The effect of perioperative acupuncture on accelerating gastrointestinal function recovery has been reported in colorectal surgery and distal gastrectomy (Billroth-II). However, the evidence in pancreatectomy and other gastrectomy is still limited. A prospective, randomized controlled trial was conducted between May 2018 and August 2019. Consecutive patients undergoing pancreatectomy or gastrectomy in our hospital were randomly assigned to the electroacupuncture (EA) group and the control group. The patients in the EA group received transcutaneous EA on Bai-hui (GV20), Nei-guan (PC6), Tian-shu (ST25), and Zu-san-li (ST36) once a day in the afternoon, and the control group received sham EA. Primary outcomes were the time to first flatus and time to first defecation. In total, 461 patients were randomly assigned to the groups, and 385 were analyzed finally (EA group, n = 201; control group, n = 184). Time to first flatus (3.0 ± 0.7 vs 4.2 ± 1.0, P < 0.001) and first defecation (4.2 ± 0.9 vs 5.4 ± 1.2, P < 0.001) in the EA group were significantly shorter than those in the control group. Of patients undergoing pancreatectomy, those undergoing pancreaticoduodenectomy and intraoperative radiation therapy (IORT) surgery benefitted from EA in time to first flatus (P < 0.001) and first defecation (P < 0.001), while those undergoing distal pancreatectomy did not (P_flatus=0.157, P_defecation=0.007) completely. Of patients undergoing gastrectomy, those undergoing total gastrectomy and distal gastrectomy (Billroth-II) benefitted from EA (P < 0.001), as did those undergoing proximal gastrectomy (P=0.015). Patients undergoing distal gastrectomy (Billroth-I) benefitted from EA in time to first defecation (P=0.012) but not flatus (P=0.051). The time of parenteral nutrition, hospital stay, and time to first independent walk in the EA group were shorter than those in the control group. No severe EA complications were reported. EA was safe and effective in accelerating postoperative gastrointestinal function recovery. Patients undergoing pancreaticoduodenectomy, IORT surgery, total gastrectomy, proximal gastrectomy, or distal gastrectomy (Billroth-II) could benefit from EA. This trial is registered with NCT03291574.

• acupuncture
• gynecological surgery
• postoperative ileus
• protocol
• systematic review

• Acupuncture Therapy/methods
• Adult
• Female
• Gynecologic Surgical Procedures/adverse effects
• Humans
• Ileus/etiology
• Ileus/therapy
• Meta-Analysis as Topic
• Postoperative Complications/etiology
• Postoperative Complications/therapy
• Randomized Controlled Trials as Topic
• Research Design
• Systematic Reviews as Topic
• Treatment Outcome

• TLR3
• TRIF
• innate immune response
• macrophages
• postoperative ileus

• postoperative ileus (POI)
• pretreatment
• transcutaneous electrical acupoint stimulation (TEAS)

• Acupuncture Points
• Adolescent
• Adult
• Aged
• Colon
• Humans
• Ileus/etiology
• Ileus/prevention & control
• Laparoscopy
• Middle Aged
• Pain, Postoperative/prevention & control
• Prospective Studies
• Randomized Controlled Trials as Topic
• Transcutaneous Electric Nerve Stimulation
• Treatment Outcome
• Young Adult

• National Natural Science Foundation of China

The aim of this study was to study the feasibility and acceptability of electroacupuncture (EA) for preventing postoperative gastrointestinal complications in patients undergoing thoracoscopic segmentectomy/lobectomy.

Sixty patients who underwent video-assisted thoracoscopic (VATS) segmentectomy/lobectomy received either EA treatments plus usual care (EA group) or usual care alone (UC group). Patients in the EA group were given 30 minutes of bilateral electroacupuncture on 3 acupoints [Neiguan (PC6), Zusanli (ST36), and Shangjuxu (ST37)] at 3 time points (24 hours before surgery, and 4 hours and 24 hours after surgery). The primary outcomes were recruitment, retention, acceptability of the EA intervention, incidence and severity of abdominal distension (AD), and time to first flatus and defecation. Secondary outcomes included postoperative nausea and vomiting (PONV), pain intensity, and duration of hospital stay.

We recruited 60 participants and 59 were randomized into 2 groups for this study: 30 in the EA group and 29 in the UC group. In total, 57 participants completed the study. With the exception of one participant in the EA group, all participants completed all three sessions of EA. The one exclusion was a case where a paravertebral block was not used during the surgery. Qualitative findings from the acceptability questionnaire indicated that participants viewed the EA treatment as acceptable. After EA treatment, there was a small but statistically significant improvement in participants’ acceptance of EA for alleviating postoperative gastrointestinal discomfort (P=0.001). The EA group showed improved outcomes compared to the UC group in terms of time to first flatus (20.8±4.6 versus 24.1±6.2 hours, P=0.026) and defecation (53.9±6.0 versus 57.5±7.2 hours, P=0.046). No significant differences appeared regarding AD, rescue medication, or duration of hospitalization. PONV and pain intensity were similar in both groups at the recorded time periods.

EA is feasible and acceptable to patients undergoing VATS surgery. Our preliminary findings of EA promoting postoperative recovery of gastrointestinal function warrants large randomized controlled trials.

Oxidative stress reflects an imbalance between oxidants and antioxidants in favor of the oxidants capable of evoking tissue damage. Like hydrogen sulfide (H₂S) and nitric oxide (NO), carbon monoxide (CO) is an endogenous gaseous mediator recently implicated in the physiology of the gastrointestinal (GI) tract. CO is produced in mammalian tissues as a byproduct of heme degradation catalyzed by the heme oxygenase (HO) enzymes. Among the three enzymatic isoforms, heme oxygenase-1 (HO-1) is induced under conditions of oxidative stress or tissue injury and plays a beneficial role in the mechanism of protection against inflammation, ischemia/reperfusion (I/R), and many other injuries. According to recently published data, increased endogenous CO production by inducible HO-1, its delivery by novel pharmacological CO-releasing agents, or even the direct inhalation of CO has been considered a promising alternative in future experimental and clinical therapies against various GI disorders. However, the exact mechanisms underlying behind these CO-mediated beneficial actions are not fully explained and experimental as well as clinical studies on the mechanism of CO-induced protection are awaited. For instance, in a variety of experimental models related to gastric mucosal damage, HO-1/CO pathway and CO-releasing agents seem to prevent gastric damage mainly by reduction of lipid peroxidation and/or increased level of enzymatic antioxidants, such as superoxide dismutase (SOD) or glutathione peroxidase (GPx). Many studies have also revealed that HO-1/CO can serve as a potential defensive pathway against oxidative stress observed in the liver and pancreas. Moreover, increased CO levels after treatment with CO donors have been reported to protect the gut against formation of acute GI lesions mainly by the regulation of reactive oxygen species (ROS) production and the antioxidative activity. In this review, we focused on the role of H₂S and NO molecular sibling, CO/HO pathway, and therapeutic potential of CO-releasing pharmacological tools in the regulation of oxidative stress-induced damage within the GI tract with a special emphasis on the esophagus, stomach, and intestines and also two solid and important metabolic abdominal organs, the liver and pancreas.

• dimethyl fumarate
• heme oxygenase-1
• hemin
• mouse
• postoperative ileus

Prolonged postoperative ileus (PPOI) is a prolonged state of “pathological” gastrointestinal (GI) tract dysmotility. There are relatively few studies examining the influence of preoperative nutritional status on the development of PPOI in patients who underwent GI surgery. The association between preoperative albumin and PPOI has not been fully studied. We hypothesized that preoperative albumin may be an independent indicator of PPOI.

To analyze the role of preoperative albumin in predicting PPOI and to establish a nomogram for clinical risk evaluation.

Patients were drawn from a prospective hospital registry database of GI surgery. A total of 311 patients diagnosed with gastric or colorectal cancer between June 2016 and March 2017 were included. Potential predictors of PPOI were analyzed by univariate and multivariable logistic regression analyses, and a nomogram for quantifying the presence of PPOI was developed and internally validated.

The overall PPOI rate was 21.54%. Advanced tumor stage and postoperative opioid analgesic administration were associated with PPOI. Preoperative albumin was an independent predictor of PPOI, and an optimal cutoff value of 39.15 was statistically calculated. After adjusting multiple variables, per unit or per SD increase in albumin resulted in a significant decrease in the incidence of PPOI of 8% (OR = 0.92, 95%CI: 0.85-1.00, P = 0.046) or 27% (OR = 0.73, 95%CI: 0.54-0.99, P = 0.046), respectively. Patients with a high level of preoperative albumin (≥ 39.15) tended to experience PPOI compared to those with low levels (< 39.15) (OR = 0.43, 95%CI: 0.24-0.78, P = 0.006). A nomogram for predicting PPOI was developed [area under the curve (AUC) = 0.741] and internally validated by bootstrap resampling (AUC = 0.725, 95%CI: 0.663-0.799).

Preoperative albumin is an independent predictive factor of PPOI in patients who underwent GI surgery. The nomogram provided a model to screen for early indications in the clinical setting.

• Albumin
• Prolonged postoperative ileus
• Gastrointestinal surgery
• Nomogram
• Complications

• Aged
• Colorectal Neoplasms/blood
• Colorectal Neoplasms/surgery
• Digestive System Surgical Procedures/adverse effects
• Female
• Humans
• Ileus/diagnosis
• Ileus/epidemiology
• Ileus/etiology
• Incidence
• Male
• Middle Aged
• Nomograms
• Postoperative Complications/diagnosis
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Predictive Value of Tests
• Preoperative Period
• Reference Values
• Retrospective Studies
• Risk Assessment/methods
• Risk Factors
• Serum Albumin, Human/analysis
• Stomach Neoplasms/blood
• Stomach Neoplasms/surgery
• Time Factors

Prolonged postoperative ileus (PPOI) is one of the common complications in gastric cancer patients who underwent gastrectomy. Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI. We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.

To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.

Between June 2016 and March 2017, the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database. Clinical data of patients who fulfilled the criteria were obtained. Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI. A nomogram for PPOI was developed and verified by bootstrap resampling. The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve. The clinical usefulness of our model was evaluated using the net benefit curve.

This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy. The incidence of PPOI was 19.75% in patients with gastrectomy. Age older than 60 years, open surgery, advanced stage (III–IV), and postoperative use of opioid analgesic were independent risk factors for PPOI. We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy. This nomogram had an excellent diagnostic performance [area under the curve (AUC) = 0.836, sensitivity = 84.4%, and specificity = 75.4%]. This nomogram was further validated by bootstrapping for 500 repetitions. The AUC of the bootstrap model was 0.832 (95%CI: 0.741–0.924). This model showed a good fitting and calibration and positive net benefits in decision curve analysis.

We have developed a prediction nomogram of PPOI for gastric cancer. This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.

• Prolonged postoperative ileus
• Gastric cancer
• Complication
• Nomogram
• Bootstrap

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Analgesics, Opioid/adverse effects
• Feasibility Studies
• Female
• Gastrectomy/adverse effects
• Humans
• Ileus/diagnosis
• Ileus/epidemiology
• Ileus/etiology
• Incidence
• Logistic Models
• Male
• Middle Aged
• Models, Biological
• Neoplasm Staging
• Nomograms
• Postoperative Complications/diagnosis
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Prognosis
• Prospective Studies
• ROC Curve
• Risk Assessment/methods
• Risk Factors
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Time Factors

Gastrointestinal prokinetic agents function as serotonin-4 receptor (5-HT₄R) agonists to activate myenteric plexus neurons to release acetylcholine (ACh), which then induce anti-inflammatory action. Details of this pathway, however, remain unknown. The aim of this study is to clarify the anti-inflammatory mechanism underlying the 5-HT₄R agonist, mosapride citrate (MOS)-induced anti-inflammatory action on postoperative ileus (POI). POI models were generated from wild-type C57BL6/J (WT), 5-HT₄R knock-out (S4R KO), α7 nicotinic AChR KO (α7 R KO), and M2 muscarinic ACh receptor KO (M2R KO) mice. MOS attenuated leukocyte infiltration in WT. MOS-induced anti-inflammatory action was completely abolished in both S4R KO and S4R KO mice upon wild-type bone marrow transplantation. MOS-induced anti-inflammatory action against macrophage infiltration, but not neutrophil infiltration, was attenuated in α7 R KO mice. Selective α7nAChR agonists (PNU-282987 and AR-R17779) also inhibited only macrophage infiltration in POI. MOS-mediated inhibition of neutrophil infiltration was diminished by atropine, M2AChR antagonist, methoctramine, and in M2R KO mice. Stimulation with 5-HT₄R inhibits leukocyte infiltration in POI, possibly through myenteric plexus activation. Released ACh inhibited macrophage and neutrophil infiltration likely by activation of α7nAChR on macrophages and M2AChR. Thus, macrophage and neutrophil recruitment into inflamed sites is regulated by different types of AChR in the small intestine.

• ATB-346
• GYY4137
• hydrogen sulfide
• naproxen
• postoperative ileus

• interleukin-10
• intestinal motility
• macrophages
• neutrophils
• postoperative ileus

• after abdominal surgery
• gastrointestinal functional recovery
• randomized controlled trial
• yikou-sizi powder hot compress

• Adult
• Aged
• Colorectal Neoplasms/surgery
• Female
• Gastrointestinal Diseases/surgery
• Gastrointestinal Motility/physiology
• Humans
• Hysterectomy/adverse effects
• Laparoscopy/adverse effects
• Male
• Medicine, Chinese Traditional/methods
• Middle Aged
• Outcome Assessment, Health Care
• Postoperative Complications/therapy
• Recovery of Function/drug effects
• Recovery of Function/physiology

• Anti-inflammatory activity
• Daikenchuto
• Neutrophil infiltration
• Postoperative ileus
• Zingiberis processum rhizoma

Intestinal dysfunction is one of the most common complications in patients after abdominal surgery. Daikenchuto (DKT), a traditional herbal medicine, is recently employed to improve postoperative intestinal dysfunction. The aim of this meta-analysis was to assess the efficacy of DKT in improving intestinal dysfunction after abdominal surgery.

PubMed, Embase, and the Cochrane library were systematically searched to identify randomized controlled trails (RCTs) in adult patients undergoing abdominal surgery, who were randomly distributed to administrate DKT and placebo. The primary outcomes included the time to first postoperative flatus or bowel movement. We used random-effects models to calculate summary mean differences (MDs) with 95% confidence intervals (CIs).

Nine RCTs totaling 1,212 patients (618 in DKT, 594 in control group) were included in our study. Compared with control group, DKT can effectively improve postoperative intestinal dysfunction by shortening the time to first postoperative flatus (MD, −0.41; 95% confidence interval [CI], −0.66 to −0.16; P = 0.001) with significant heterogeneity (I² = 71%, P = 0.004), and bowel movement (MD, −0.65; 95% CI, −0.97 to −0.32; P < 0.001) without significant heterogeneity (I² = 40%, P = 0.14). Sensitivity analyses by indication of surgery and type of surgery yielded similar results.

These data provide limited evidence that DKT shows efficacy on improving intestinal dysfunction after abdominal surgery. However, the results should be interpreted cautiously, due to the heterogeneity of the studies included. Thus, the efficacy of DKT on improving postoperative intestinal dysfunction warrants further investigation.

• Abdominal surgery
• Dai-kenchu-to
• Intestinal dysfunction
• Meta-analysis
• Randomized controlled trials

Postoperative ileus (POI) is characterized by impaired propulsive function of the gastrointestinal tract after surgery. Although inflammation is considered to be an important pathogenesis of POI, significant data are lacking. We aim to correlate the recovery time of postoperative dysmotility with that of inflammation and mucosal permeability.

An experimental POI model of guinea pig was used. Contractile activity of the circular muscle of the stomach, jejunum, ileum, and proximal colon was measured through a tissue bath study. Inflammatory cells were counted, and the expression of calprotectin and tryptase were analyzed. The expression of protease-activated receptor 2 (PAR-2), claudin-1, and claudin-2 were analyzed with immunofluorescence.

The small bowel and colon showed decreased contractile amplitude in the POI groups compared to control. In contrast to the colon, the contractile amplitude of the small bowel significantly recovered in the POI group at 6 hours after the operation compared to the control group. Inflammation was highly significant in the POI groups compared to the control and sham groups, especially in the colon. Immunofluorescence showed increased PAR-2 expression in the POI groups compared to sham. The decreased claudin-1 expression and increased claudin-2 expression may suggest increased mucosal permeability of the small bowel and colon in the POI groups.

Increased inflammation and mucosal permeability may play an important role in the differential recovery stages in POI. These data may provide further insights into the pathophysiology and potential new therapeutic prospects of POI.

• Ileus
• Inflammation
• Permeability

•

Muscularis macrophages densily colonize the outermost layer of the gastrointestinal tract.

Macrophages residing in the muscularis externa of the gastrointestinal tract are highly specialized cells that are essential for tissue homeostasis during steady-state conditions as well as during disease. They are characterized by their unique protective functional phenotype that is undoubtedly a consequence of the reciprocal interaction with their environment, including the enteric nervous system. This muscularis macrophage-neuron interaction dictates intestinal motility and promotes tissue-protection during injury and infection, but can also contribute to tissue damage in gastrointestinal disorders such as post-operative ileus and gastroparesis. Although the importance of muscularis macrophages is clearly recognized, different aspects of these cells remain largely unexplored such their origin, longevity and instructive signals that determine their function and phenotype. In this review, we will discuss the phenotype, functions and origin of muscularis macrophages during steady-state and disease conditions. We will highlight the bidirectional crosstalk with neurons and potential therapeutic strategies that target and manipulate muscularis macrophages to restore their protective signature as a treatment for disease.

• Enteric nervous system
• Gastrointestinal disorders
• Intestinal macrophage
• Intestinal muscularis externa
• Neuro-immune interactions
• Tissue-macrophage ontogeny

• Animals
• Enteric Nervous System/immunology
• Gastrointestinal Motility/immunology
• Homeostasis/immunology
• Humans
• Intestinal Diseases/immunology
• Intestines/immunology
• Intestines/innervation
• Macrophages/immunology
• Muscle, Smooth/cytology
• Muscle, Smooth/immunology
• Muscle, Smooth/innervation
• Neurons/immunology

• Colorectal cancer
• Economic benefit
• Laparoscopic colectomy

• M1 and M2 macrophages
• TRH agonist
• abdominal surgery
• central vagal activation
• gastric emptying