Research progress regarding potential effects of traditional Chinese medicine on postoperative intestinal obstruction

Construction and Development of an Enhanced Recovery After Surgery Program for the Surgical Management of Patients With Spinal Metastasis: A Modified Delphi Study

OBJECTIVE

As an effective treatment for spinal metastasis (SM), ERAS protocol can significantly reduce the length of hospital stay and complications in patients. Establishing an ERAS program for perioperative care after SM surgery is a clinical problem that needs to be addressed urgently. We aimed to develop an Enhanced Recovery After Surgery (ERAS) program and Surgical Safety Checklist (SSC) that conferred clinical benefit to patients with SM and made it relatively easy to manage the condition. We believe that our findings could help establish and promote the continuous improvement of additional ERAS programs for SM.

METHODS

This is a modified Delphi study. We used a two-round process using data acquired from a review of relevant literature and involving a multidisciplinary panel of experts from different hospitals in China. The modified Delphi survey was conducted from February 1, 2024 to April 20, 2024. The experts were invited to evaluate each of the current relevant ERAS recommended topics to determine the appropriateness of inclusion in the ERAS program and SSC with the 5-point Likert scale. Used the results to create specific ERAS and SSC (70% consensus) programs. Close to consensus (65%-69% consensus) findings were considered for the follow-up survey.

RESULTS

A multicenter, multidisciplinary group of physicians (n = 75), including clinical workers, researchers, anesthesiologists, nursing specialists, psychologists, nutritionists, and caregivers, with experience in managing patients with SM, were asked to participate. Using the modified Delphi process, we arrived at a consensus for the ERAS program. This included 37 consolidated items in the domains in the following order: preoperative, intraoperative, postoperative, and discharge. The SSC included 37 consolidated items in the domains in the following order: before the induction of anesthesia, before skin incision, and before the patient leaves the operating room.

CONCLUSION

This study, based on the modified Delphi process, helped us develop ERAS and SCC consensus-driven best practice recommendations, including suggestions related to perioperative anesthesia, surgery, and nursing for SM. We hope that this study, in which we integrated both traditional Chinese and Western medical treatment protocols, can provide a basis for a rapid rehabilitation program for surgical interventions in SM.

The Therapeutic Potential of Four Main Compounds of Zanthoxylum nitidum (Roxb.) DC: A Comprehensive Study on Biological Processes, Anti-Inflammatory Effects, and Myocardial Toxicity

Zanthoxylum nitidum (Roxb.) DC. (Z. nitidum) is a traditional Chinese medicinal plant that is indigenous to the southern regions of China. Previous research has provided evidence of the significant anti-inflammatory, antibacterial, and anticancer properties exhibited by Z. nitidum. The potential therapeutic effects and cardiac toxicity of Z. nitidum remain uncertain. The aim of this research was to investigate the potential therapeutic properties of the four main compounds of Z. nitidum in cardiovascular diseases, their impact on the electrical activity of cardiomyocytes, and the underlying mechanism of their anti-inflammatory effects. We selected the four compounds from Z. nitidum with a high concentration and specific biological activity: nitidine chloride (NC), chelerythrine chloride (CHE), magnoflorine chloride (MAG), and hesperidin (HE). A proteomic analysis was conducted on the myocardial tissues of beagle dogs following the administration of NC to investigate the role of NC in vivo and the associated biological processes. A bioinformatic analysis was used to predict the in vivo biological processes that MAG, CHE, and HE were involved in. Molecular docking was used to simulate the binding between compounds and their targets. The effect of the compounds on ion channels in cardiomyocytes was evaluated through a patch clamp experiment. Organ-on-a-chip (OOC) technology was developed to mimic the physiological conditions of the heart in vivo. Proteomic and bioinformatic analyses demonstrated that the four compounds of Z. nitidum are extensively involved in various cardiovascular-related biological pathways. The findings from the patch clamp experiments indicate that NC, CHE, MAG, and HE elicit a distinct activation or inhibition of the IK1 and ICa-L in cardiomyocytes. Finally, the anti-inflammatory effects of the compounds on cardiomyocytes were verified using OOC technology. NC, CHE, MAG, and HE demonstrate anti-inflammatory effects through their specific interactions with prostaglandin-endoperoxide synthase 2 (PTGS2) and significantly influence ion channels in cardiomyocytes. Our study provides a foundation for utilizing NC, CHE, MAG, and HE in the treatment of cardiovascular diseases.

Prediction of the risk of severe small bowel obstruction and effects of Houpu Paiqi mixture in patients undergoing surgery for small bowel obstruction

AIM

Small bowel obstruction is a common condition that requires emergency surgery. Slow recovery of bowel function after surgery or the occurrence of one or more complications can exacerbate the disease and result in severe small bowel obstruction (SSBO), significantly impacting recovery. It is characterized by a failure to regain enteral nutrition promptly, requiring long-term intensive care. Therefore, it is necessary to identify factors that predict SSBO, to allow early intervention for patients likely to develop this condition.

METHODS

Of the 260 patients who underwent emergency or elective surgery for small bowel obstruction between January 2018 and December 2022, 45 developed SSBO. The least absolute shrinkage and selection operator regression model was applied to optimize factor selection and multivariable logistic regression analysis was used to construct a predictive model. The performance and clinical utility of the nomogram were determined and internal validation was conducted. In addition, the effects of the Houpu Paiqi mixture on postoperative recovery were analyzed by comparing the clinical data of 28 patients who were treated with the mixture and 61patients who did not receive it.

RESULTS

The predictors included in the prediction nomogram were age, peritonitis, intestinal resection and anastomosis, complications, operation time, Acute Physiology and Chronic Health Evaluation II score, white blood cell count, and procalcitonin level. The model had an area under the receiver operating characteristic curve of 0.948 (95% confidence interval: 0.814-0.956). Decision curve analysis demonstrated that the SSBO risk nomogram had a good net clinical benefit. In addition, treatment with the Houpu Paiqi mixture reduced postoperative exhaust time, postoperative defecation time, time to first postoperative liquid feed, and length of stay in hospital.

CONCLUSIONS

We developed a nomogram that can assist clinicians in identifying patients at greater risk of SSBO, which may aid in early diagnosis and intervention. Additionally, we found that the Houpu Paiqi mixture promoted postoperative recovery.

Multiple prescription pattern recognition model based on Siamese network

Prescription data is an important focus and breakthrough in the study of clinical treatment rules, and the complex multidimensional relationships between Traditional Chinese medicine (TCM) prescription data increase the difficulty of extracting knowledge from clinical data. This paper proposes a complex prescription recognition algorithm (MTCMC) based on the classification and matching of TCM prescriptions with classical prescriptions to identify the classical prescriptions contained in the prescriptions and provide a reference for mining TCM knowledge. The MTCMC algorithm first calculates the importance level of each drug in the complex prescriptions and determines the core prescription combinations of patients through the Analytic Hierarchy Process (AHP) combined with drug dosage. Secondly, a drug attribute tagging strategy was used to quantify the functional features of each drug in the core prescriptions; finally, a Bidirectional Long Short-Term Memory Network (BiLSTM) was used to extract the relational features of the core prescriptions, and a vector representation similarity matrix was constructed in combination with the Siamese network framework to calculate the similarity between the core prescriptions and the classical prescriptions. The experimental results show that the accuracy and F1 score of the prescription matching dataset constructed based on this paper reach 94.45% and 94.34% respectively, which is a significant improvement compared with the models of existing methods.

Value of Humanized Nursing under Emergency Green Channel on Gastrointestinal Function Recovery in Patients with Acute Intestinal Obstruction after Operation

Acute intestinal obstruction (AIO) is one of the most common surgical acute abdomens. Emergency green channel refers to a fast and efficient service system provided by hospitals for critically ill patients. It is the key to ensure that emergency patients receive timely, standardized, efficient and thoughtful medical services, improve the success rate of rescue, and reduce medical risks. Acute intestinal obstruction is mainly treated by surgery in the clinic. Previous reports have shown that the application of different nursing methods in the operation of acute intestinal obstruction has different effects on the results of surgical treatment. In this study, the clinical data of 80 patients with AIO were retrospectively analyzed to explore the value of humanistic care under the emergency green channel in promoting the recovery of gastrointestinal function after AIO surgery.