Surgical intervention for acute pancreatitis in the COVID-19 era

Effect of different positive end-expiratory pressure levels in patients undergoing laparoscopic cholecystectomy under general anesthesia

Objective

To investigate the effect of different levels of positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Methods

This retrospective study included patients who underwent laparoscopic cholecystectomy under general anesthesia in the Xuzhou Hospital of Traditional Chinese Medicine from January, 2023 to March, 2024. Based on the PEEP levels, patients were grouped into 0cm group (0cmH2O), 5cm group (5cmH2O), 8cm group (8cmH2O), and 10cm group (10cmH2O). Mean arterial pressure (MAP), mean airway pressure (Pmean), peak airway pressure (Ppeak), and blood gas status levels (oxygenation index[OI], arterial partial pressure of oxygen [PaO2], and arterial partial pressure of carbon dioxide [PaCO2]) of all four groups were measured at five minutes after the intubation (T1), five minutes after pneumoperitoneum (T2), and 30 minutes after pneumoperitoneum (T3).

Results

A total of 84 patients (37 males and 47 females) were included in this study. The number of patients in the 0cm group, 5cm group, 8cm group, and 10cm group were 24, 24, 21, and 15, respectively, and there were no significant differences in the baseline data among the four groups. There were significant differences in Pmean, Ppeak, and MAP between the four groups at T2 and T3. The increase in PEEP was accompanied by a gradual increase in Pmean and Ppeak (P<0.05). There were significant differences in OI, PaCO2, and PaO2 among the four groups at T2 and T3. With the increase in PEEP, OI and PaO2 values continued to increase while PaCO2 continued to decrease (P<0.05).

Conclusions

During laparoscopic cholecystectomy under general anesthesia, PEEP = 5cmH2O can inhibit a significant decrease in MAP while ensuring the patient's blood gas and respiratory mechanics status, which can ensure hemodynamic stability.

Impact of closed management on gastrointestinal function and mental health of Chinese university students during COVID-19

BACKGROUND

The innovative closed management of universities may have influenced the physical and mental health of students during the fourth stage of the COVID-19 pandemic in China. The study aimed to assess the gastrointestinal and mental health status of students in this stage and to explore the possible risk factors and mechanisms to provide a reference for future school responses to similar stressful events.

METHOD

A multicenter, cross-sectional survey was administered to 598 college students from 10 Chinese universities. The study used the 7-item Generalized Anxiety Disorder Scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), Fear of COVID-19 Scale (FCV-19 S), and the Diagnostic Tendency of Functional Bowel Disease Scale (DT-FBD) to evaluate anxiety, depression, fear of COVID-19 and likelihood of being diagnose diagnosed with functional bowel disease (FBD), respectively.

RESULTS

A total of 516 college students completed the questionnaire. The proportions of students with more severe anxiety, more severe depression, greater fear of COVID-19, and a greater likelihood of being diagnosed with FBD were 49.8%, 57.0%, 49%, and 49%, respectively. These symptoms were significantly and positively correlated with the frequency of irregular sleep and eating (p < 0.05). Students in high-risk areas were more likely to experience anxiety and depression than students in areas with low/medium risk (odds ratio [OR] = 1.90, 95% confidence interval [CI]: 1.12-3.24, p = 0.017; OR = 2.14, 95% CI: 1.11-4.11, p = 0.022). A high likelihood of being diagnosed with FBD was positively associated with the severity of anxiety and depression symptoms and fear of COVID-19 (all p < 0.001). Moreover, mediation analysis revealed the following pathway in college students: fear of COVID-19 → depression and anxiety → poor diet → likelihood of being diagnosed with FBD.

CONCLUSION

College students generally exhibited higher more severe anxiety and depression symptoms and psychological symptoms with a greater higher propensity likelihood of being to be diagnosed with FBD. Good lifestyle habits, especially adequate sleep and a regular diet, can alleviate these problems. In addition, appropriate psychological intervention is very important.