A novel method of verifying appropriate nasogastric tube placement: animal and human studies.

Nasogastric tube (NGT) insertion is frequently required in patients with stroke and impaired consciousness; however, the procedure is often complicated by swallowing dysfunction. This study assessed the effectiveness of the 1-mL water-swallowing induction method for facilitating NGT placement in this population. A total of 102 patients with stroke and impaired consciousness were recruited from Nantong University Affiliated Hospital between 2022 and 2024 and randomly assigned to a control group (traditional neck-flexion technique) or an observation group (1-mL water-swallowing induction method). Primary outcomes included the success rate of NGT insertion, mean duration of the first insertion attempt, and adverse events such as mucosal bleeding, severe coughing, and facial or lip cyanosis. Secondary outcomes included changes in heart rate and oxygen saturation during tube placement. Each group comprised 28 patients in a drowsy state and 23 in a stuporous state (n=51 per group). The observation group achieved a significantly higher success rate of NGT insertion compared with the control group (P<0.05). Although the mean time required for a successful first insertion attempt was longer in the observation group (P<0.05), the incidences of mucosal bleeding and severe coughing were significantly lower (P<0.05). Furthermore, changes in heart rate and oxygen saturation were less pronounced in the observation group than in the control group (P<0.05). The 1-mL water-swallowing induction method improved the success rate of NGT placement in patients with stroke having an impaired consciousness and reduced procedure-related adverse events.

Point-of-care ultrasound (POCUS) is used to verify the position of the nasogastric tube as an alternative to conventional methods. This study aims to determine the diagnostic accuracy of POCUS in detecting nasogastric tube placement in emergency patients. This was a prospective diagnostic accuracy study conducted at an emergency department between August and November 2021. We included 72 consecutively recruited patients aged 18 years and older who were planned for nasogastric tube insertion. The index and reference tests were ultrasound and chest X-ray, respectively. Nasogastric tube placement was detected by ultrasound and X-ray methods in all patients. Sensitivity, specificity and predictive values were calculated. Seventy-two patients (mean age: 69.49 ± 13.75, 55.6% male) were included. According to neck and gastric ultrasound, 58 nasogastric tubes (80.6%) could be detected. When POCUS was compared to X-rays, 56 (84.9%) were true positive and two (33.3%) were false positive. Fourteen nasogastric tubes (19.4%) could not be detected. When POCUS was compared to X-rays, four (66.7%) were true negative and 10 (15.1%) were false negative. A combination of neck and gastric ultrasound had a sensitivity of 84.84% (95% CI, 73.9%-92.49%), a specificity of 66.6% (95% CI, 22.28%-95.67%), a positive predictive value of 96.55% (95% CI, 89.99%-98.87%) and a negative predictive value of 28.57% (95% CI, 15.19%-47.19%). The percentage agreement was high (0.83%), and Gwet's AC1 statistic rated as moderate (AC1 = 0.46). POCUS can be used as a diagnostic tool in detecting nasogastric tube placement in the stomach but should be confirmed with a chest X-ray in patients with a negative ultrasound result.

Purpose: This study aimed to evaluate the effectiveness of intraoperative Guardix-SG application in reducing postoperative ileus (POI) and preventing adhesive small bowel obstruction (SBO) following radical cystectomy (RC) for bladder cancer.Materials and Methods: A single-arm, prospective observational study was conducted from April 2022 to February 2025. Sixty-seven patients undergoing RC with pelvic lymph node dissection received intraoperative Guardix-SG application after urinary reconstruction. Patients with prior abdominal surgery or pelvic radiotherapy were excluded. POI was defined as (1) the absence of flatus or stool by postoperative day (POD) 6 (definition 1) or (2) intolerance to oral intake by POD 5 requiring nasogastric decompression or intravenous support (definition 2). Adhesive SBO was defined as radiologic or clinical bowel obstruction without a mechanical cause. Outcomes were monitored for 3 months. Predictors of POI (definition 2) were identified using multivariable logistic regression.Results: The median age was 69.0 (interquartile range, 62.5–75.0) years, and 88.1% of participants were male. Robot-assisted surgery was performed in 62.7% of cases, and ileal conduit diversion was most common (64.2%). The incidence of POI was 3.0% (2 of 67) by definition 1 and 19.4% (13/67) by definition 2. Nasogastric tube placement was required in 6.0% (4 of 67). No cases of adhesive SBO or gastrointestinal reoperation were observed. Multivariable analysis identified lower body mass index as an independent predictor of POI (odds ratio, 0.74; 95% confidence interval, 0.57–0.96; p=0.023). No significant associations were found with surgical approach, diversion type, or operative time. Compared with previous studies reporting SBO rates of 3%–5% and POI rates of 14%–27%, the observed complication rates were lower or comparable.Conclusion: Intraoperative Guardix-SG application resulted in favorable bowel outcomes after radical cystectomy, with no observed SBO and a reduced incidence of POI.

Recurrence patterns and survival outcomes in advanced epithelial ovarian cancer (EOC) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remain poorly understood. This post hoc analysis aimed to evaluate patterns of initial recurrence in patients with advanced EOC. This analysis of the KOV-HIPEC1 trial included 142 patients with recurrent EOC divided into HIPEC and non-HIPEC groups. Baseline characteristics, recurrence patterns, and post-recurrence survival (PRS) were analyzed. Among 142 patients with recurrent disease, recurrence patterns were comparable between the HIPEC and non-HIPEC groups, including rates of peritoneal seeding (80.0% vs. 70.1%, p=0.178), lymphatic involvement (47.7% vs. 49.4%, p=0.844), and parenchymal metastases (10.8% vs. 15.6%). In the BRCA-mutated subgroup, peritoneal seeding was significantly more common in the HIPEC group than in the non-HIPEC group (81.8% vs. 33.3%, p=0.036). PRS did not differ significantly between the HIPEC and control groups (p=0.571). Gastrointestinal events at recurrence were less frequent in the HIPEC group, including intestinal obstruction (1.9% vs. 9.3%), ostomy formation (0% vs. 3.1%), intestinal surgery (0% vs. 5.6%) and nasogastric tube placement (1.9% vs. 7.4%). No significant differences in recurrence pattern or survival outcome were observed between CRS with HIPEC and CRS alone. However, distinct recurrence patterns observed in BRCA-mutated patients suggest potential biological differences that may influence treatment outcomes. A trend toward reduced gastrointestinal morbidity in the HIPEC group, potentially reflecting a more subtle, less invasive recurrence pattern. Further research is warranted to elucidate these observations.

A biologically transparent illumination (BTI) system has been proposed as an adjunctive method for confirming nasogastric tube (NGT) placement by visualizing a light in the stomach. However, its clinical applicability in critically ill patients remains unclear. We conducted a preliminary prospective observational study to evaluate the clinical feasibility and detectability of a BTI system for NGT placement in critically ill patients. Ten critically ill patients underwent NGT placement using a BTI system after admission to the intensive care unit (ICU). The detected BTI light was assessed in the epigastric region, and the NGT tip was subsequently confirmed using X-ray. The BTI light was visible in five patients, while X-ray confirmed stomach placement in all. Notably, in patients with obesity, massive ascites, or a considerable distance between the NGT tip and the skin surface, the BTI system did not detect the light. No complications during the procedure were reported. This early clinical experience indicates that although BTI detectability is limited by patient-specific anatomical factors, the system may serve as a supportive, hypothesis-generating approach for bedside confirmation of NGT placement in critically ill patients. Further studies are needed to identify the patient groups that benefit most from the BTI system.

To assess the efficacy and safety of onasemnogene abeparvovec (OA) in children with spinal muscular atrophy (SMA) treated between 2021 and 2025 at a Moscow regional rare disease referral center (Morozov Children's City Clinical Hospital). This study included 20 children with a confirmed diagnosis of 5q spinal muscular atrophy (SMA). Safety was evaluated in all 20 patients for up to 3.5 years following treatment, with adverse events graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v.5.0. Efficacy was analyzed in 16 patients at 8 to 37 months post-injection. Motor function was assessed using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND), while general motor development was evaluated using the Hammersmith Infant Neurological Examination, Section 2 (HINE-2). Key motor milestones were compared to established World Health Organization (WHO) norms. Data was analyzed by stratifying patients into two groups: those identified through expanded newborn screening (Group 1) and those diagnosed via high-risk screening (Group 2). In Group 1, the mean age at treatment initiation was 1.9 (1.4-2.8) months, with a mean weight of 4.8 (3.7-6.25) kg. In Group 2, the mean age at treatment was 14.8 (5.5-47) months, with a mean weight of 9 (6-13.7 )kg. Within one week post-OA administration, most patients (19/20) experienced clinical symptoms, including hyperthermia (Group 1: 8/9; Group 2: 10/11), increased regurgitation/vomiting (Group 1: 5/9; Group 2: 6/11), and decreased appetite/refusal to feed (Group 1: 3/9; Group 2: 9/11). These symptoms were more severe in Group 2, requiring intravenous and symptomatic therapy, nasogastric tube placement, and parenteral nutrition in some cases. Grade 1-2 thrombocytopenia (CTCAE v.5) was observed one week post-OA in three patients from Group 2. Elevated hepatic transaminases were observed in 16/20 children: Group 1 - 6/9 (66%), Group 2 - 10/11 (90%). In Group 1, all children experienced Grade 1 elevations (CTCAE v.5), while in Group 2, 6 children had Grade 1 elevations (54%), 2 had Grade 2 (18%), 1 had Grade 3 (9%), and 1 had Grade 4 (>20x ULN) (9%). Asymptomatic troponin I elevations were recorded in 6 children from Group 1 and 4 from Group 2. The median duration of prednisolone administration was 13 weeks (8-24) in Group 1 and 21 weeks (12-42) in Group 2. In Group 1, the mean CHOP INTEND score increased by 11.5 at 4 months, the HINE-2 score increased by 10.5 points at 4 months and 15.5 points at 6 months from baseline; all children achieved main motor milestones according to WHO norms. In Group 2, the mean CHOP INTEND score increased by 4 at 6 months and 7.2 points at 12 months from baseline; the HINE-2 score increased by 2.3 points at 6 months and 4.7 points at 12 months from baseline; five children improved their functional status, and 6/9 children acquired new motor skills. This study presents the findings of a long-term assessment of the efficacy and safety profile of drug OA in pediatric patients across various age groups and functional ability levels, including individuals identified through expanded newborn screening. Younger patients exhibited a significantly lower incidence of adverse events and demonstrated superior therapeutic efficacy. The majority of older children experienced either positive progression or stabilization of their condition, outcomes that were largely contingent upon their initial functional status and the duration of the pre-treatment waiting period.

Early recognition of postoperative ileus remains difficult. To determine if myoelectric activity recorded by a non-invasive, wireless patch system correlated with onset of postoperative ileus/bowel dysfunction. Single-arm, prospective study. The surgeon was blinded to myoelectric bowel activity until study completion. Single surgeon, tertiary referral center. Consecutive adult patients undergoing abdominal colorectal surgery. Three wireless patches acquiring myoelectrical gastrointestinal activity were placed on the abdomen following surgery and removed before hospital discharge/reoperation. All patients followed an enterprise-specific enhanced recovery protocol. Ileus (nausea, vomiting, abdominal distention requiring nasogastric tube placement) or bowel dysfunction (similar symptoms without nasogastric tube needed) detected clinically within 30 postoperative days. Daily gut activity GutPrints (histogram of frequencies of all peaks detected in 10-minute time windows) were created for every 4-hour period following surgery, averaged, and plotted for each of the groups. Peaks in the 8 to 12 cpm (cycles per minute) range were assigned to intestinal activity and the energy under the peaks were summed through day 1, day 2 and day 3 and compared among patients. Patch application on 46 enrolled cases undergoing abdominal colorectal surgery (open in 17, robotic in 11, laparoscopic in 18) was not associated with any adverse events. Hyperactive intestinal activity was significantly higher in 12 patients developing postoperative ileus/bowel dysfunction within 16 hours postoperatively (p = 0.041) with a more pronounced difference at 20 and 24 hours (p = 0.016 and p = 0.013, respectively). Data was collected blindly during standard postoperative care, therefore integration of technology into clinical practice remains to be tested. Noninvasive measurement of intestinal myoelectrical activity allowed early identification of postoperative ileus/bowel dysfunction. Future studies will assess the possible advantages deriving from the integration of this system into clinical practice. See Video Abstract.

Mechanical Bowel Preparation With Oral Antibiotics in Kids: A Necessary Step or Unnecessary Burden?

Esophageal cancer (EC) remains a leading cause of cancer-related mortality worldwide. For patients with locally advanced, non-metastatic EC, advances in perioperative care, and surgical techniques have led to improved outcomes; however, significant variation persists, and standardization remains limited. This study aimed to characterize current practice patterns among expert surgeons at high-volume European centers through a structured, in-depth survey. Eight expert upper gastrointestinal surgeons from European centers performing >60 esophagectomies annually participated in comprehensive interviews. Topics included preoperative care pathways for distal esophageal/gastroesophageal junction adenocarcinoma, technical aspects of Ivor Lewis esophagectomy, and postoperative recovery protocols. Additional focus areas included multidisciplinary team involvement, allied health integration, research program participation, and follow-up strategies. Widespread agreement (7-8 of 8 centers) was observed in several domains: national EC care regionalization, multidisciplinary cancer conference review of all patients, institutional EC research programs, use of prospective national/international databases, application of CROSS chemoradiotherapy for squamous cell carcinoma, and perioperative FLOT chemotherapy for adenocarcinoma. Common surgical techniques included minimally invasive Ivor Lewis esophagectomy, two-field lymphadenectomy with en-bloc thoracic duct ligation, nasogastric tube placement, omental wrap of the anastomosis, and Enhanced Recovery After Surgery-based postoperative protocols. The majority of centers (5-6/8) performed routine preoperative optimization (nutrition, smoking cessation, frailty screening, oral hygiene/microbiome assessment), jejunostomy placement, and postoperative contrast swallow studies. Areas with notable variability (≤4/8 centers) included intraoperative crural closure, pyloric drainage procedures, gastric conduit sizing, postoperative pain management, and follow-up imaging timelines. High-volume European centers demonstrated strong alignment in several programmatic and perioperative elements of EC care, particularly around enhanced recovery pathways and preoperative optimization. Nonetheless, key intraoperative and postoperative variations persist, highlighting opportunities for future research, consensus building, and standardization to improve patient outcomes.

Congenital internal hernias causing small bowel obstruction are extremely rare in adults, with only approximately 28 cases reported in the literature. The condition carries a high mortality rate-up to 50% even with treatment, and nearly 100% without intervention. Diagnosis is particularly challenging due to the nonspecific nature of symptoms and often inconclusive imaging findings. We present a patient diagnosed with a trans mesenteric hernia resulting from a congenital defect. The patient failed conservative management, which included bowel rest, nasogastric tube placement, and monitoring with KUB X-rays. A diagnostic laparoscopy was performed and subsequently converted to a laparotomy. Intraoperative findings revealed a 6 cm defect in the mesentery with approximately 60 cm of small bowel herniating through, showing signs of early ischemia. Bowel viability was restored following reduction, and the mesenteric defect was closed. Congenital mesenteric defects, though rare, are an important consideration in the differential diagnosis of de novo small bowel obstruction, particularly in adults with a virgin abdomen and no history of prior abdominal surgery. Early recognition and prompt surgical intervention are essential, as timely management can significantly reduce the risk of morbidity and mortality.

Dysphagia is common in patients with oral cancer undergoing flap reconstruction surgery. Surgical resection and reconstruction can affect the sensory and motor functions associated with swallowing. Studies on dysphagia have not investigated patients with oral cancer undergoing flap reconstruction surgery. In this hospital-based retrospective study, we examined the occurrence rates, risk factors, and clinical outcomes of dysphagia in patients with oral cancer undergoing flap reconstruction surgery. Data were collected from the Chang Gung Research Database, which includes structured and unstructured electronic medical records. These data covered the period from January 1 to November 30, 2022. A total of 892 patients were included in the study. Dysphagia was identified on the basis of NANDA International Nursing Diagnoses criteria. Univariate and multivariable logistic regression models were used for data analysis. Of a total of 892 patients, 679 (76.1%) experienced dysphagia. Body mass index, smoking status, alcohol consumption, betel nut chewing, pain score, neck lymph node dissection, radiotherapy, and chemotherapy were identified as significant risk factors for dysphagia. Compared with those without dysphagia, patients with dysphagia had significantly higher rates of nasogastric tube placement and tracheostomy at discharge, longer hospital stays, and higher readmission rates. Dysphagia is common in patients with oral cancer undergoing flap reconstruction surgery and is associated with certain risk factors and clinical outcomes. Enhancing postoperative care and implementing targeted interventions can facilitate the development of precise treatment plans aimed at reducing the incidence of dysphagia and improving the overall quality of care for patients undergoing flap reconstruction surgery.

Disclosure: G. Madrigal Loria: None. N.E. Fretes Oviedo: None. M.D. Lundholm: None.Background: Anaplastic thyroid cancer (ATC) is a rare, aggressive malignancy with a poor prognosis. Its occurrence post-liver transplantation is extremely rare, with limited cases reported. Post-transplant immunosuppression may contribute to oncogenesis, tumor dedifferentiation, and rapid progression, complicating diagnosis and treatment. Case Presentation: A 68-year-old male with Lynch syndrome, prostate cancer (cT1cN0M0, on active surveillance), and cholangiocarcinoma (pT2aN0M0) underwent deceased donor liver transplantation (DBD-OLT) four weeks prior and was on tacrolimus. He presented with progressive neck swelling, dysphagia, weight loss, low-grade fevers, and dyspnea. He had no family history of thyroid disease, and only an incidental 9-mm low-density left thyroid nodule preoperatively. On presentation, he had a firm, mobile mass in the left inferior neck. Laboratory results showed leukocytosis, mildly suppressed TSH (0.048 mIU/L), normal FT4/FT3, and negative thyroid peroxidase antibody and thyroid-stimulating immunoglobulin. CT imaging revealed thyroid enlargement, with the left thyroid nodule increasing to 17 mm over six weeks, accompanied by inflammatory changes and lymphadenopathy. Initial treatment with high-dose corticosteroids for suspected thyroiditis was ineffective. Given prior Candida infection, micafungin was started. Fine-needle aspiration (FNA) and core biopsy revealed anaplastic thyroid carcinoma (ATC), with tumor cells negative for BRAFV600E, NRAS, TTF-1, p40, SOX-10, desmin, and CD34. PET/CT demonstrated extensive metastasis to lymph nodes, lungs, pleura, newly transplanted liver, and bones. These abnormalities were new from pre-transplant pan-CT scans. Due to worsening airway obstruction from secretions, the patient had tracheostomy and nasogastric tube placement for tube feeds. Given the extensive disease burden, palliative radiation therapy was administered. The patient’s condition continued to rapidly decline, and medical oncology determined he was not a candidate for systemic cancer therapy. After discussions with his family, he was transitioned to home palliative care, where he passed away two weeks later. Conclusion: Anaplastic thyroid cancer following liver transplantation is exceptionally rare. This case highlights the highly aggressive nature of ATC, particularly in the setting of post-transplant immunosuppression. Given the exceptionally poor prognosis of ATC and limited therapeutic options in the post-transplant setting, further research is needed to better understand the incidence, risk factors, and optimal treatment strategies for this rare condition.Presentation: Sunday, July 13, 2025

Objective. Digital tomosynthesis (DT) bridges the gap between planar x-rays and computed tomography, offering rapid, low-dose 3D imaging. A mobile chest DT device could transform procedures such as nasogastric tube placement and early cancer detection. Adaptix Ltd. has developed 3D imaging systems using cold-cathode x-ray emitter arrays on flat panel source (FPS) units for veterinary and orthopaedic applications. Designing a chest DT device using multiple FPSs presents new challenges, requiring simulations that can efficiently explore the large design space and rapidly identify optimal configurations.Approach. We developed Scimitar, a geometry-based simulation framework that models x-ray radiation coverage in chest DT systems. It evaluates design viability and performance using irradiation uniformity metrics and integrates a genetic algorithm to optimise key system parameters. Scimitarfurther facilitates the evaluation of collimator designs, FPS arrangements, engineering constraints, and dynamic adaptation to different patient volumes.Main results. Square collimators generally outperformed circular designs due to better alignment with the cuboid target volume. Across FPS configurations, optimisation consistently yielded maximum source-to-image distances, minimal emitter spacing, and x-ray cone angles near 30°. A four-panel cross arrangement achieved highest uniformity. Imposing engineering constraints such as increased emitter spacing led to approximately linear reductions in uniformity. Introducing vertical offsets to central panels yielded modest gains, though still underperformed compared to configurations without central panels. Dynamic cone angle adjustment enabled device adaptation to different patient sizes, with the four-panel cross consistently delivering the best results.Significance. Scimitarefficiently optimises chest DT designs under various constraints and assumptions. This work identifies promising configurations, highlights design trade-offs, and demonstrates adaptability across patient sizes. As understanding of system requirements evolve, Scimitar's adaptability will enable it to remain a valuable tool in guiding the development of clinically effective, low-dose, mobile 3D imaging devices.

While sarcopenia is a common complication after stroke, few tools exist to identify patients at high risk. This study aimed to develop and validate a risk prediction model for sarcopenia among stroke patients. Clinical data were prospectively collected from 313 stroke patients across 2 medical centers between October 2024 and March 2025. A total of 251 patients from Kunming First People’s Hospital formed the training cohort, while 62 patients from Kunming Yanan Hospital comprised the external validation cohort. Independent predictors of sarcopenia were identified using univariate and multivariate logistic regression analyses. A nomogram was constructed based on the final model and validated externally. Body mass index (BMI), serum albumin level, nasogastric tube placement, NIH Stroke Scale (NIHSS) score, and history of stroke were identified as independent predictors (P < .05). The model showed good discriminative ability, with areas under the receiver operating characteristic curve (AUC) of 0.891 (95% CI: 0.848–0.891) for the training set and 0.743 (95% CI: 0.610–0.743) for the validation set. Calibration curves demonstrated good agreement between predicted and observed outcomes in both cohorts. This risk prediction model may assist clinicians in identifying stroke patients at high risk for sarcopenia, facilitating early intervention and improving clinical outcomes.

Dysphagia patients are at increased risk of stroke-associated pneumonia (SAP). This bicenter study evaluated whether dietary restrictions, specifically nil per os (NPO) and texture-modified food (TMF), reduce SAP incidence in post-stroke dysphagia (PSD). Data from 160 consecutive acute PSD patients treated in two university stroke units were retrospectively analyzed. The primary outcome was SAP incidence; secondary outcomes included length of hospitalization, mortality, and nasogastric tube placement. Stroke severity, male sex, and age emerged as significant SAP risk factors. On admission, 63% of SAP patients were already on NPO, 33.3% received TMF, and only 3.7% had unrestricted oral intake. Notably, NPO patients were 2.5 times more likely to develop SAP than those without dietary restrictions (p = 0.008). Most SAP cases were diagnosed before any oral intake, with the majority occurring by day three. These findings align with emerging evidence highlighting the role of oral hygiene factors and immune alterations in pulmonary bacterial defense. This study provides no support for NPO or TMF as effective pneumonia prophylaxis in PSD. Instead, early intervention and comprehensive care strategies are essential to mitigate SAP risk. Appropriate dysphagia diets enhancing residual swallowing capacity could positively impact both SAP rates and dysphagia rehabilitation.

Application of pressure at the gastric tube tip manometry for nasogastric tube positioning in neurocritical care: A prospective diagnostic study.

Naloxegol, a peripherally acting mu-opioid receptor antagonist, is used to treat opioid-induced constipation. However, its effectiveness following adult spinal deformity surgery remains poorly understood. The objective of this study was to examine naloxegol's impact on postoperative bowel function in patients undergoing adult spinal deformity surgery. A retrospective analysis was conducted of consecutive spinal deformity surgeries from a single surgeon's practice, comparing outcomes before and after the introduction of universal postoperative naloxegol administration (12.5 mg daily for 7 days). Multivariable logistic regression and propensity score-matched analyses were used to evaluate the relationship between naloxegol use and markers of postoperative ileus (POI). Two hundred thirty-four patients (72.2% female, mean age 60.7 [SD 15.8] years, mean BMI 28.8 [SD 5.1]) were analyzed. One hundred fifty-four (65.8%) of these patients were opioid-naïve and 80 (34.1%) received naloxegol. The naloxegol group had significantly lower odds of lateral lumbar interbody fusion (OR 0.13, p = 0.0001) and shorter operative times (5.65 vs 6.75 hours, p = 0.0008). There was no statistical association between naloxegol and postoperative abdominal imaging, nasogastric tube placement, or gastroenterology consultation in either the matched or multivariate analyses (p > 0.05). A gastroenterology consultation (n = 15 patients, 6.5%) was positively associated with anterior lumbar interbody fusion (OR 5.54, p = 0.010) and diabetes (OR 12.37, p = 0.001) and negatively associated with preoperative opioid use (OR 0.18, p = 0.036). Postoperative abdominal imaging correlated positively with the number of vertebrae fused (OR 1.09, p = 0.031) and negatively with preoperative opioid use (OR 0.44, p = 0.026). Weighted time-to-event analysis found a difference in time to first flatus (p = 0.0282), but not in time to bowel movement (p = 0.5600) with naloxegol. Postoperative naloxegol had no significant impact on bowel function recovery or markers of POI after spinal deformity surgery. Patients with a history of opioid exposure required fewer consultations and imaging. Further research is required to understand whether pre-induction administration impacts POI and return to bowel function.

Gastric volumetry: A simplified calculation method based on CT-scan.

IntroductionPatients in intensive care units (ICUs) frequently require mechanical ventilation, with approximately half needing invasive ventilation through an orotracheal tube. For these patients, gastric tube (GT) insertion is routinely performed to administer nutrition and medications or to drain gastric contents. The insertion route (oral or nasal) may affect the incidence of ventilator-associated pneumonia (VAP), a significant ICU care complication. This study aims to compare the impact of oral versus nasal GT insertion on the incidence of VAP in intubated ICU patients.Methods and analysisThe SONG trial (NCT 05915663) is a multicentre, open-label, two-period, two-intervention, cluster randomised crossover superiority trial. 16 French ICUs will participate. ICUs will be randomised to periods of nasogastric or orogastric tube placement. The trial includes a practice standardisation period, followed by two 12-month inclusion periods separated by a monitoring and washout period. The primary endpoint is the incidence rate of VAP at day 28, confirmed by three independent physicians. Secondary endpoints include the ease of GT insertion, measured by the number of attempts.Ethics and disseminationThis study received approval from a central ethical review board on 12 April 2024 (CPP Sud-est VI, registration number 23.00943.000175). Patients are included after informed consent or, when not possible, from next of kin. If none are available, the investigator will proceed with emergency inclusion, following French law. When consent is initially obtained from the next of kin or through emergency inclusion, the investigator will seek consent from the patient as soon as possible. Data will be anonymised and patient confidentiality maintained. Results will be published in peer-reviewed journals and presented at scientific meetings.Trial registration numberNCT05915663.