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Effectiveness of Positioning in Unconscious Adults During Nasogastric Intubation on Correct Placement and Intubation Time

Nasogastric intubation is a common procedure in hospitals that causes adverse outcomes if performed incorrectly. There is currently insufficient guidance for patient positioning, which increases the success of nasogastric intubation at the bedside. Therefore, a systematic review with a meta-analysis was performed to determine the effectiveness of changing an unconscious adults' positions compared with the supine position to improve the correct placement of a nasogastric tube, intubation time, and complications. The Cochrane Library, MEDLINE, Embase, PubMed, and CINAHL databases were searched from inception to April 2019 for randomized controlled trials. The Cochrane Collaboration Risk of Bias tool was used to assess the quality of eligible studies. Cochrane Review Manager 5.3 software was used to analyze the data. A total of 288 articles were obtained in the literature search, 10 of which were included in the analysis. Most of the included trials were at low risk of bias. All postures were significantly effective, though neck flexion had the highest success rate (odds ratio = 4.87, 95% confidence interval [2.48, 9.57], Z = 4.6, p < .00001, I2 = 0%) for nasogastric intubation. In terms of the time required for the procedure, compared with the usual posture, although the total effects were significant ( MD =-10.33, 95% confidence interval [-15.38, -5.29], Z = 4.02, p < .00001, I2 = 98%), only neck flexion and lifting of the larynx reduced the time. The meta-analysis suggests that patient positioning improves the success rate of nasogastric intubation and increases safety. Finally, the authors developed a procedural instruction sheet to aid practitioners with nasogastric intubation.

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A RARE CASE REPORT OF RECURRENT INFLAMMATORY FIBROID POLYP IN THE ILEUM

Inflammatory fibroid polyp (IFP) is a rare clinically benign mesenchymal tumor originating in the submucosa of the gastrointestinal tract. It has been generally considered to bear no malignant or metastatic potential and can be cured after resection. Herein, we present an unusual case of an IFP in the ileum showing extension to the muscularis propria and recurring in 3 years after endoscopic submucosal dissection (ESD) and surgical resection. A 41-year-old woman was admitted to the emergency department due to abdominal pain, abdominal distention, and vomit for 4 days. She had an ESD 3 years ago as a result of IFPs in the middle esophagus and gastric horn. She also had a small bowel resection for intussusception resulting from IFP 2 years previously. She had no family history of IFP. An intussusception was found 1 m away from the ileocecal valve and a red tumor about 5 cm in diameter was revealed after manipulation reduction, with several small polypoid protuberant masses in the adjacent intestine. The diseased bowel was excised and a primary side-to-side anastomosis was performed. The morphological and immunoprofile features were typical of IFP. The patient was required to fast after operation until she farted, and she was discharged 1 week later, asymptomatic. Therefore, IFP might show its aggressively neoplastic potential with infiltrative growth patterns and recur locally after inadequate resection. A sufficient surgical resection is recommended when the lesion has been found definitely to invade the muscularis and even the subserosa. However, more studies are required to seek for the exact etiology and mechanism of its invasiveness and recurrence due to the scarcity of current reports.

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