ObjectiveTo conduct an analysis and identify potential risk factors associated with postoperative complications in patients diagnosed with malignant gastrointestinal tumors who underwent laparoscopic surgery. MethodsFrom January 2023 to October 2023, 500 patients with malignant gastrointestinal tumors who underwent laparoscopic surgery at the Department of General Surgery, the First Medical Center of PLA General Hospital were prospectively selected as the research objects. The incidence of postoperative complications (Clavien-Dindo gradeⅡ and higher) was observed, and then 500 patients were divided into a complication group and a non-complication group. The preoperative physical conditions, operative time and bleeding volume related to the operation were compared and analyzed between the two groups. According to the analysis results and clinical experience, appropriate variables were selected to be included in the multivariate binary logistic regression model for analysis, in order to determine the risk factors for postoperative complications in patients with malignant gastrointestinal tumors. ResultsOf the 500 patients, 453 had no postoperative complications (non-complication group), and 47 had postoperative complications (complication group), with an incidence of 9.4%. Univariate analysis showed that there were significant differences between the complication group and the non-complications group in gender, abdominal girth, preoperative hypoalbuminemia, drinking history, protein diet habits, primary diseases, operative time and intraoperative blood loss (P<0.05), while there were no significant differences between the two groups in age, body mass index, preoperative grip strength, 6 m walking test time, preoperative anemia, hypertension, diabetes, cardiovascular and cerebrovascular diseases, smoking history, education level, exercise habits and preoperative NRS 2002 nutritional score (P>0.05). Multivariate binary logistic regression analysis showed that gender, daily protein diet and exercise frequency, operation time >200 min and intraoperative blood loss >150 mL could be used as independent predictors of postoperative complications in patients with malignant gastrointestinal tumors (P<0.05). ConclusionFor female malignant gastrointestinal tumor patients with low daily protein intake, inadequate physical activity, prolonged operation duration, and massive intraoperative bleeding, perioperative management should be taken in advance and the occurrence of postoperative complications should be vigilant.
Objective To analyze the drug resistance genes, virulence genes and homologies of carbapenem-resistant Klebsiella pneumoniae (CRKP) colonized and infected patients in surgical intensive care unit based on whole genome sequencing. Methods Whole genome sequencing analysis was performed on CRKP infected strains isolated from the Department of General Surgery Intensive Care Unit and the Department of Liver Surgery Intensive Care Unit of Zhongshan Hospital, Fudan University in March 2021 and CRKP colonized strains isolated from the above departments between January and March 2021. The drug resistance genes, virulence genes and homologies of the strains were analyzed. ResultsA total of 16 CRKP strains were included, including 10 colonized strains and 6 infected strains. Except for the β-lactamase drug resistance gene CTX (16.7% vs. 100.0%, P<0.05), there was no significant difference in the detection rate of other drug resistance genes between CRKP infected strains and colonized strains (P>0.05). The cluster analysis of drug resistance genes of some strains was relatively close. Whole genome sequencing analysis showed that CRKP strains carried a variety of virulence genes, and the detection rates of entB, irp2, iroN, and rmpA genes were 100.0%, 87.5%, 37.5%, and 62.5%, respectively. There was no significant difference in the detection rate of virulence genes between CRKP infected strains and colonized strains (P>0.05). Homology analysis showed that some strains had close homologous relationships, and there was the possibility of cross transmission. Conclusions Some of CRKP infection strains and colonization strains in surgical intensive care unit patients have the risk of cross transmission. In the future, we should strengthen the prevention and control of nosocomial infection to reduce the incidence of infection.