THE CITY BIKE AS A SAFE MODE OF TRANSPORT DURING THE COVID-19 PANDEMIC

The insertion of a city bike that complements the public transport system in large agglomerations, and mainly in the most crowded city centers, seems to be a very good solution that can contribute to reducing air pollution and reducing noise levels. In many situations, bicycle transport can perfectly fill deficiencies in public transport, e.g. at night, on holidays and on days when buses run to a limited extent. The article presents the functioning of the city bike system in Lublin since 2014. The first part of this article presents basic data on the city bike system in Lublin together with a map of bicycle stations, followed by data on the number of rentals, rental time, number of bicycle users, etc. Selected user opinions obtained on the basis of the survey were also presented. Finally, based on the analysis, final conclusions were formulated. The city bike system is used by about 10% of the population of the city of Lublin.

As urban populations grow, there is a growing need for efficient and sustainable modes, such as bicycling. The shortage of bicycle demand data is a barrier to design, planning, and research efforts in bicycle transportation before. In July 2013, the New York City implements the bike-sharing system, Citi Bike, and makes their data available for analysis. Data used in this study includes the information about active stations, average bicycles available, total annual membership, maintenance issues, events of vandalism and calls and emails to system center. Through statistic description, partial correlation analysis and principle component analysis, final variables are obtained. Finally, a Poisson regression model was adopted for the analysis. The analysis results are useful for understanding the influential factors including temperatures and weathers, which reflected by seasons generally, and supplements associated with rules or policy of bike-sharing system. In addition, the inferential results of these models provide guidance on future planning of station and bike supplement.

Green transportation is a kind of "people-oriented" environment-friendly transportation, and bicycle transportation is an effective means to realize the development of urban green transportation. Many cities around the world are carrying out bicycle revival work. China used to be a big country of bicycles. In recent years, with the expansion of cities and the sudden increase in the number of cars, the living space of bicycles is gradually shrinking and the number of bicycles is also declining, which is not conducive to the sustainable development of urban environment.Taking Copenhagen as an example, this paper analyzes the development status of bicycle traffic from the three levels of infrastructure construction, laws and regulations, and personal traffic awareness, and summarizes the practical points of the city's bicycle traffic, hoping to get enlightenment from the development of China's urban bicycle traffic.

Objective To investigate the psychological status of clinical nurses in a class A hospital facing the novel coronavirus pneumonia (NCP), in order to provide effective psychological and social intervention. Methods A total of 867 clinical nurses were randomly selected from the Mianyang Central Hospital. The general information questionnaire, standard self-assessment anxiety scale (SAS) and crisis intervention classification assessment scale (TAF) were used to conduct self-assessment questionnaire survey. Then the data were analyzed by the SPSS22.0 software. Results 38.8% of the nurses had a low risk of infection, 18.0% of them had a medium risk, 29.6% had a medium high risk, and 13.6% had a high risk. The SAS scores of clinical nurses in this hospital were statistically significant different, compared with the Chinese norm value (P<0.05). The difference between TAF score and the degree of crisis response of nursing students in SARS period was statistically significant (P<0.05). The majority of clinical nurses had less crisis response to NCP, with 80.7% of them suffered mild cognitive, emotional and behavioral damage, and only 2.0% suffered severe damage. Analysis of related factors showed that department, self-test risk of infection, length of service had significant influence on SAS and TAF scores of clinical nurses (P<0.05). Conclusion During the period of NCP prevalence, no obvious anxiety and crisis reaction among clinical nurses is found in the third grade hospital. However, the psychological changes of clinical nurses with middle-age, from key epidemic prevention departments and in high risk of self-test infection are more likely to produce anxiety and crisis reaction. Therefore, appropriate and timely psychological intervention should be given. Key words: novel coronavirus pneumonia; clinical nurse; psychological status

At present, coronavirus disease 2019 (COVID-19) remains a significant challenge for health workers around the world. This survey aims to highlight the status of the implementation of occupational protection measures for nurses working on the front line against COVID-19, and to analyze the problems in the process of wearing protective equipment.This cross-sectional study was conducted among 165 nurses who worked in COVID-19-stricken areas in China in March 2020. The questionnaire covered 3 aspects, namely: general information, the current condition of protective equipment wearing, and the wearing experience of protective equipment.A total of 160 (96.97%) valid questionnaires were collected. The average time of wearing protective equipment for the nurses surveyed was 6.38 ± 3.30 hours per working day. For first-line nurses with low risk of infection, repeated wear of protective equipment was as follows: medical protective mask 30.77%, double latex gloves 8.46%, goggles/protective mask 15.38%, protective suit 15.38%; less wear of protective equipment were as follows: work cap 7.69%, surgical mask 7.69%, single layer latex gloves 30.77%, goggles/protective mask 30.77%, and isolation gown 46.15%. For nurses who were at moderate risk of infection, repeated wear of protective equipment was as follows: surgical mask 62.22%, goggles/protective mask 68.89%, and isolation gown 65.56%; less wear: work cap 3.33%, medical protective mask 15.56%, latex gloves 15.56%, goggles/protective mask 5.56%, and protective suit 16.67%. For front-line nurses with high risk of infection, repeated wear of protective equipment was as follows: surgical mask 64.91%, more than double latex gloves 8.77%, goggles/protective mask 75.44%, isolation gown 75.44%; less wear: work cap 1.75%, medical protective mask 1.75%, latex gloves 26.32%, goggles/ protective mask 1.75%, protective suit 1.75%. The main discomforts of wearing protective equipment were poor vision due to fogging (81.88%), stuffiness (79.38%), poor mobility (74.38%), sweating (72.5%), and skin damage (61.25%).More detailed personal protection standards should be developed, and the work load of nurses should be reduced. Actions should be taken to ensure the scientific implementation of personal protective measures. To solve practical clinical problems, future protective equipment may focus on the research and development of protective equipment applicable for different risk levels, as well as the research on integrated design, fabric innovation, and reusability.

Objective: To investigate the effect of red blood cell folate on the prognosis of high-risk human papillomavirus (HR-HPV) infection. Methods: A total of 564 participants with low-grade cervical intraepithelial neoplasias (CINⅠ) were selected from the community-based married women cohort established in 2014. The general baseline information and factors related to HPV infection were collected. Meanwhile, HPV genotyping and levels of folate were measured. The subjects were divided into different levels of exposure group according to the folate levels and followed up for 24 months to observe the changes of HR-HPV infection status. There were four changes, including persistent infection, infection turned negative, from negative to positive and constant negative by comparing HR-HPV infection status at baseline and follow-up to 24 months. Results: 483 participators completed 24 months of follow-up observation, with a follow-up rate of 85.64% (483/564). The rates of persistent infection, infection turned negative, from negative to positive, and the constant negative were 52.45% (75/143), 47.55% (68/143), 19.71% (67/340), 80.29% (273/340), respectively. Our results demonstrated that the risk of persistent infection (aRR=2.50, 95%CI: 1.55-4.02) and from negative to positive (aRR=4.55, 95%CI: 2.52-8.23) in the low level of folate were significantly higher than that in the high level of folate, especially the risk of homotype persistent infection (aRR=2.72, 95%CI: 1.51-4.90). The risk of persistent infection (trend χ2=20.62, P<0.001), from negative to positive (trend χ2=31.76, P<0.001), persistent homotypic infection (trend χ2=20.09, P<0.001) increased with the decrease of red blood cell folate level. On the contrary, no similar results were found in persistent heterotypic infection. Conclusions: A low level of red blood cell folate could increase the risk of HR-HPV persistent infection and from negative to positive. In women with HR-HPV infection, the risk of persistent homotypic infection is higher.

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Development and validation of a user-friendly risk nomogram for the prediction of catheter-associated urinary tract infection in neuro-intensive care patients

On March 19, 2020 the WHO declared coronavirus disease (COVID-19), caused by SARS-CoV-2, as a pandemic and it was crucial during the rapid spread of COVID-19 to postpone all elective and non-emergency endoscopic procedures.[1] In April 2020 the Saudi Gastroenterology Association published a position statement to guide gastroenterologists in Saudi Arabia on endoscopy services during the COVID-19 pandemic,[2] similar to other international societies worldwide.[34] The pandemic has led to a challenge for endoscopists as many urgent cases were deferred. In order to care for our patients, it was a must to resume endoscopic services gradually for those cases as soon as it is feasible with the least possible risk of exposing staff, patients, and healthcare providers. The decision of reopening ultimately depends on each endoscopy unit and the capacity of healthcare institution in terms of testing and tracing as well as staffing. The endoscopy unit at King Saud University Medical City (KSUMC) decided to start the process of reopening especially with substantial decrease in the number of COVID-19 cases requiring ventilators. A task-force was formed to provide a roadmap for safe reopening, which in turn could facilitate and guide other units towards restarting outpatient and routine procedures, with a phased approach based upon categories.[2] Nevertheless, the suggested protocol should be updated based on best available local public health information from the Ministry of Health. The main purpose of this commentary is to present recommendations during the gradual reopening of endoscopy units, where indeed it is anticipated that readiness to resume endoscopic procedures will vary based on the status of each endoscopy unit and the guidance from the concerned health authorities. Our unit, which performs around 6000 procedures annually, had more than 800 requests pending since the start of the pandemic, with numerous inquiries from patients seeking information about the risk of infection or the precautions to be taken when attending the unit. Currently, there are no formal evidence-based recommendations from clinical societies or healthcare authorities on resuming endoscopy procedures although, a few reports from international societies are emerging[56] highlighting the potential rearrangements of care and resetting of the endoscopy flow. During the preparation we faced multiple layers of complexity on the reopening scenario, however, this is a novel situation with limited options and we tried our best to keep the process simple and applicable. Table 1 shows the general information which addresses the staff's, patients, and caregivers, safety recommendations pre-procedure and on the day of the procedure. Scheduling the procedures was prioritized based on its urgency and the potential of serious outcomes if the procedure was delayed. The reopening was divided into three phases and Table 2 shows the details of each phase along with the workflow. A significant number of COVID-19 infections are being transmitted from asymptomatic individuals[7] thus requiring all patients to be tested for SARS-CoV-2 within 48-72 hours of a scheduled procedure. Flowcharts 1 and 2 demonstrate the specific steps for pre-procedure protocols for phases 1 and 2 respectively, and the role of individual endoscopy staff as shown in Figure 1a and b.Table 1: General Information for the endoscopy staff and patients prior to and on the day of the procedureTable 2: Definition and workflow of the re-opening phasesFigure 1: (a). Flowchart 1 demonstrate the specific steps for pre-procedure protocols for phase one. (b). Flowchart 2 demonstrate the specific steps for pre-procedure protocols for phase twoIn conclusion, the COVID-19 pandemic will continue to be a burden on our healthcare systems. The decision to reopen endoscopy units should be taken based on the locally available resources respecting infection control recommendations. Finally reopening endoscopic activity should be made in phases with clear guidance for each phase. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Objective: To investigate the levels of cytomegalovirus (CMV) infection and associated risk factors in corneal transplant recipients who experienced transplant failure. Methods: This was a case-control study. Clinical data from 576 cases (576 eyes) of patients who underwent repeat corneal transplant surgery at the Department of Ophthalmology, Peking University Third Hospital, due to corneal transplant failure from January 2016 to May 2022 were collected. Of these, 305 were male and 271 were female, with a median age of 44.0 (0.7, 91.0) years. The CMV infection rate was analyzed based on the detection of CMV DNA in aqueous humor or corneal tissue during corneal transplant surgery. Patients were divided into the CMV group (CMV DNA positive) and the control group (herpes virus DNA negative). The main research indicators included the CMV infection rate, clinical characteristics, and risk factors in corneal transplant recipients. Chi-square tests and binary logistic analysis were used to compare differences between the two groups in general information, systemic diseases, ocular lesions, ocular surgical history, and local and systemic medications. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for each CMV infection risk factor. Results: The overall CMV infection rate was 21.9%(126/576), with annual rates ranging from 10.9% to 37.7% from 2016 to 2021. After applying inclusion and exclusion criteria, 378 patients were included in the control trial, with 126 in the CMV group and 252 in the control group. Statistically significant differences between the two groups were observed in systemic immune-related corneal lesions [CMV group: 38 (30.2%), control group: 26 (10.3%)], local immune and inflammatory corneal lesions [CMV group: 46 (36.5%), control group: 40 (15.9%)], congenital corneal opacity [CMV group: 46 (36.5%), control group: 48 (19.0%)] total number of corneal transplants (CMV group: 178 times, control group: 276 times), corneal deep neovascularization crossing the graft [CMV group: 104 (82.5%), control group: 68 (27.0%)] and severe opacity [CMV group: 44 (34.9%), control group: 30 (11.0%)]. Binary logistic regression analysis showed that systemic immune-related corneal lesions (OR=4.044, 95%CI 1.810-9.033, P<0.001), local immune and inflammatory corneal lesions (OR=3.554, 95%CI 1.569-8.052, P=0.002), congenital corneal opacity (OR=2.606, 95%CI 1.216-5.589, P=0.014), total number of corneal transplants (OR=3.206, 95%CI 1.753-5.864, P<0.001), corneal deep neovascularization crossing the graft (OR=8.347, 95%CI 3.967-17.559, P<0.001), and severe opacity (OR=3.063, 95%CI 1.221-7.682, P=0.017) were independent risk factors for CMV infection after corneal transplant. Conclusions: CMV infection was present in more than 1/5 of corneal transplant recipients who experienced transplant failure. CMV infection after corneal transplant may be related to immune rejection reactions and ocular inflammatory responses. Inflammatory corneal lesions associated with systemic or local immune abnormalities, congenital corneal opacity, and multiple corneal transplants may exacerbate the levels of inflammatory factors during the perioperative period of corneal transplant, increasing the risk of post-transplant CMV infection, leading to the infiltration of deep neovascularization and severe opacity in the cornea.

Objective To investigate the clinical value of enteral nutrition strategy on clinical prognosis and outcome of patients with abdominal surgery, and to provide evidence for clinical treatment. Methods From January 2008 to December 2012, one hundred patients received abdominal surgery in Baoji People’s Hospital. According to the strategy of enteral nutrition, the patients were divided to early group (60 cases, <48 h) and delayed group (40 cases, ≥48 h). Clinical indexes such as APACHE Ⅱ score, GCS score, diabetes and hypertension history, type of surgery, parenteral nutrition support, ventilator free days, initial time of enteral nutrition, soft diet time, hospital stay, number of infections and deaths, results of blood and urine bacterial culture, fungi culture, deep tracheal culture, pus culture, whether intravenous injection for nutritional support, were recorded and compared. The correlation between the two groups were also analyzed. Results In terms of abdominal surgery in patients with general information, the two groups were not significantly different in sex, age, APACHE Ⅱ score, GCS score, whether or not differences with diabetes or hypertension, emergency and emergency surgery, laparoscopic and open surgical operation type. There was significant difference between the two groups in terms of the type of operation and whether or not they received parenteral nutrition (χ2=5.02, 8.72, P=0.03,<0.01). In the early group, ventilator free days, initial time of enteral nutrition, soft diet time, hospital stay, the number of infection cases were significantly lower than those in the delayed group (χ2=5.81, t=3.56, 4.26, 5.27, 6.58, all P<0.05). Correlation analysis showed that the initial time of enteral nutrition was positively correlated with hospital stay (r=0.59, P<0.05). Conclusion Early enteral nutrition support can effectively reduce the risk of postoperative infection in patients undergoing abdominal surgery, but may not be of clinical value in improving prognosis. Key words: Surgical procedures, operative; Enteral nutrition; Prognosis; Treatment outcome; Abdominal surgery

Background: COVID-19 has become a serious public health issue throughout the world’s healthcare system due to its rapid spread. Because COVID-19 is so contagious, workers must be properly trained to prevent the virus from spreading to them. Protective clothing, sanitised gloves, and respirators are just a few examples of the safety precautions that need to be taken. Dental institutions and their affiliated health centres and research stations have been severely impacted by the coronavirus outbreak. According to the World Health Organisation (2020), the risk of fast infection is higher among individuals who are close to or who operate near the COVID-19 patients, for instance, family members or health practitioners. This research was conducted to determine the level of knowledge, preparedness, and perception of COVID-19 among dentists in the private and public dental sectors. Methods: A cross-sectional study was conducted that used a non-probability sampling method. The data were collected through online questionnaires between February 2021 and June 2021, where standardized close-ended questions were asked via Google forms from dentists in public and private dental sectors in five regions of Saudi Arabia. A total of 145 people responded to the questionnaire; three of them decided not to participate in the study, while 30 respondents failed to select the correct answer to the quality assurance question. The remaining 112 respondents were included in the analysis. This study was approved by the Ethics Committee of Prince Sultan Military College of Health Sciences (IRB-2021-DOH-021). Results: The findings showed that most dentists (58%) had high knowledge of COVID-19, which was followed closely by those who had average knowledge (34.8%), while the rest (7.1%) had insufficient knowledge about COVID-19. In terms of evaluating the level of preparedness, which included the method of prevention and practice of dentists while dealing with COVID19, results showed that most of the respondents (42.9%) indicated that they have the highest preparedness level. Concerning the level of perception of dentists toward COVID-19, the results showed that the majority (48.2%) of dentists had the highest perception. However, the perception level was higher compared to their level of preparedness but lower compared to their level of knowledge. Conclusion: Dentists in KSA have enough understanding of COVID-19 transmission and general information. As the number of COVID-19 cases in KSA and other countries continue to grow, dentists must stay up to date on the latest information concerning the disease. Continuous educational programs are required to improve the understanding of infection management.

Multidrug-resistant infection in COVID-19 patients: A meta-analysis

Remarkable progress has been made in preventing nonbacterial congenital infection through the use of rubella and measles immunizations, hepatitis B immunoprophylaxis, zidovudine treatment of human immunodeficiency virus (HIV)-infected mothers, and prompt diagnosis and treatment of maternal syphilis. Intrauterine diagnosis and effective therapy are available for congenital toxoplasmosis, and intrauterine diagnosis of parvovirus B19 infection enables life-saving in utero transfusion when necessary. Further, serious fetal damage evident on fetal ultrasound can be attributed to cytomegalovirus by amniotic fluid cultures, and there is greater understanding of the risk of herpes simplex infections (1). Even with these major strides, the paediatrician continues to be called on and challenged to identify the rare, infected neonate. One of the greatest challenges facing doctors is to decide when the diagnosis of congenital infection should be pursued. Few would argue with the need to investigate infants with the clinical findings noted in Table 1. Recommended clinical, microbiological and other investigations are described in Tables 2 and ​and3.3. Herpes simplex virus, usually acquired perinatally rather than congenitally, can present without skin lesions as ‘neonatal sepsis’ or pneumonitis (2). Consideration of appropriate diagnostic testing should be given to infants with these findings, noting that one of the earliest laboratory clues is elevated liver enzymes. As well, the infant whose mother has had no antenatal care needs evaluation for congenital syphilis (and preventive management of other infections), with appropriate follow-up as listed in Table 4. TABLE 1: Findings in infants with congenital infection TABLE 2: Recommended clinical investigations for suspected congenital infections TABLE 3: Recommended microbiological testing for suspected congenital infections TABLE 4: Evaluation of mother and infant in the absence of antenatal care Pathogens most frequently related to intrauterine infections – syphilis, toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex – are commonly grouped under the acronym STORCH. A more complete acronym, CHEAP TORCHES, has been suggested (3). This includes chicken pox, hepatitis (B, C and E), enterovirus, AIDS and parvovirus. The list of ‘other’ infections continues to grow with identification of new etiologies, ie, lymphocytic choriomeningitis virus (4) and Q fever (5), and the resurgence of others, ie, malaria and tuberculosis (6). The futility of STORCH testing of a single serum has been demonstrated repeatedly (7). In preference to a single serum, every effort should be made to recover the organism from the neonate, to test paired maternal sera to document seroconversion during pregnancy, and to follow maternal and infant blood samples over several months. Negative maternal and neonatal serology generally excludes the possibility of fetal infection except in very recent and HIV infections. Maternal serology, if positive, does not pinpoint the time of the mother’s infection but simply indicates infection at some time in her life. The more important seroconversion may be demonstrated using stored blood from earlier in the pregnancy as well as from previous pregnancies, eg, blood banked in other screening programs. Passively acquired maternal antibody from those mothers with antibody confounds the infants’s serological testing for a number of months. Serial titres taken postnatally that show a rise in titre at age two to four months or persistent titres at age six to eight months usually establish the diagnosis. Exceptions are CMV antibody, which may also be peri- or postnatally acquired, and HIV. Immunoglobulin (Ig) M-associated antibody in mother and neonate is notoriously unreliable except rubella-specific IgM and toxoplasmosis-specific IgM, the latter as a screen before reference laboratory testing or further review. Cord blood has yielded false positive and negative results for syphilis and other infections (8), and its use is not recommended. Some infected infants, normal at birth, will have central nervous system and other manifestations of their congenital infection later in childhood and adolescence. Obviously, early detection of all such infants would require comprehensive screening programs as is the case for syphilis and hepatitis B. To date, in Canada, this action has not been justified for toxoplasmosis or CMV infections. However, details in the maternal history, including exposures and illnesses during pregnancy, results of routine antenatal screening and results of fetal ultrasonography, can help dictate the need for further investigation. These details are summarized in Table 5. TABLE 5: Maternal history suggestive of congenital infection Several points need emphasis. The majority of infected infants are born to mothers with asymptomatic infection, but maternal illness, if present, may be helpful to diagnosis. When reviewing the results of serological screening in pregnancy, it should be noted that the mothers of infants with congenital rubella syndrome may have positive serology and appear immune at the time of early pregnancy testing because the infection occurred during the first weeks of gestation. What is more useful are the results of earlier testing, eg, blood from a previous pregnancy showing rubella susceptibility. Findings on fetal ultrasonography associated with but not exclusive to congenital infection include intrauterine growth retardation, hydrops, placentamegaly, hydrocephalus, microcephalus, intracranial calcifications, myocarditis, hepatosplenomegaly, echogenic bowel, hepatic calcifications, meconium peritonitis, ascites and limb reduction (9). Routine investigation for congenital infection of an infant with only prematurity or intrauterine growth retardation is unlikely to yield positive results and is, therefore, not recommended (10). To detect those infants in whom further clinical evaluation (ie, cranial computed tomography scan, opthalmology examination) or laboratory investigations may be worthwhile, the aforementioned review of maternal history (Table 5) may be useful. Identification of a congenital infection as early as possible in life has both diagnostic and therapeutic advantages. The newborn period is often the only point at which laboratory testing and follow-up allow confirmation of a congenital infection. Thereafter, congenital infection can only be presumed because postnatal acquisition cannot always be ruled out. For example, it is only possible to detect congenital CMV infection by the presence of CMV in urine specimens obtained in the first two or three weeks of life. After that time, perinatal or postnatal acquisition cannot be excluded. Antimicrobial therapy is effective in preventing or minimizing the risk of sequelae in infants with syphilis and toxoplasmosis if initiated shortly after birth. In summary, an appropriate index of suspicion, a reasonable clinical evaluation and judicious microbiological evaluation are the current best effort to identify infants with congenital infection at an opportune time, early in life. Unfortunately, many suspected infections remain undiagnosed. Prevention remains the goal, and guidelines for women planning pregnancy can be found in Table 6. TABLE 6: General information about infections for women planning pregnancy

The incidence of seroma and postoperative pain after Gilbert type III inguinal hernia repair is high. To reduce postoperative complications, this study investigated the clinical efficacy of laparoscopic closed hernia ring combined with a patch repair for Gilbert type III indirect inguinal hernia. Through a prospective randomized controlled study, a total of 193 patients with Gilbert type III indirect inguinal hernia admitted to Nanchong Central Hospital affiliated with Chuanbei Medical College from May 2020 to December 2021 were selected and randomly divided into the inner ring closed group (85 patients) and the inner ring non-closed group (95 patients). The patients in both groups underwent laparoscopic tension-free repair of their inguinal hernias. General information such as operative time, postoperative hospital stay, and hospital cost were compared between the two groups, and the patients were followed up at 1, 7, 14, 21, and 28 days and then 3, 6, and 12 months after surgery to compare complications such as incidence of seroma, volume of the seroma fluid, incidence of pain, and visual analogue scale (VAS) pain score. There was no conversion to open procedures in any of the patients. The operation time of the closed group was significantly longer than that of the non-closed group (64.2 ± 12.2 vs. 55.3 ± 9.5 min, P < 0.01). The proportion of patients with postoperative pain in the two groups was 39 (46%) vs. 59 (62%), P = 0.029 on 7 days; 17 (20%) vs. 33 (35%), P = 0.028 on 14 days; and 6 (7%) vs. 22 (23%), P = 0.003 on 21 days in the postoperative closed group and was significantly lower than that in the non-closed group, while we found that the non-closed group had a higher VAS pain score than that of the closed group (2.36 ± 0.61 vs. 1.95 ± 0.71, P = 0.003 on 7 days and 2.12 ± 0.49 vs. 1.65 ± 0.49, P = 0.002 on 14 days) after surgery according to the statistical results of the VAS pain score. The incidence of postoperative seroma and the amount of seroma fluid decreased gradually in both groups, but when comparing the two groups, the proportion of cases of seroma in the closed group on 7 days [45 (53%) vs. 79 (83%), P < 0.01]; 14 days [23 (27%) vs. 43 (45%), P = 0.011]; and 21 days [10 (12%) vs. 29 (31%), P = 0.002] after the operation were significantly less than that in the non-closed group. For the comparison of the amount of seroma fluid between the groups, the seroma fluid volume in the non-closed group was greater than that in the closed group (34.48 ± 20.40 vs. 43.87 ± 16.40 ml, P = 0.006, 7 days) and (21.79 ± 8.42 vs. 30.74 ± 10.39 ml, P = 0.002, 14 days) after surgery. There were no differences in the length of stay, total hospital costs, or postoperative complications (urinary retention, intestinal obstruction, nausea, vomiting, bleeding, and infection) between the two groups, and the differences were not statistically significant (P > 0.05). The postoperative follow-up period was 3-20 months, and no chronic pain or recurrence occurred during the postoperative follow-up period in either group. Closure of the hernia ring is safe and effective for laparoscopic hernia repair for Gilbert type III inguinal hernia, and it significantly reduces the incidence of postoperative seroma and further reduces the postoperative pain without increasing the risk of postoperative infection and recurrence.