Background: Surgical treatment is the key to cure localized gastric cancer. There is no strong evidence that supports the value of omentectomy. Thus, a meta-analysis was conducted to compare the safety and efficiency of partial and total omentectomy in patients with gastric cancer. Methods: PubMed, Embase, and Cochrane Library databases were searched. All studies that compared total and partial omentectomy as treatments for gastric cancer were included. The primary outcomes were patients’ overall survival and disease-free survival, while the secondary outcomes were perioperative outcome and postoperative complications. Results: A total of nine studies were examined, wherein 1043 patients were included in the partial omentectomy group, and 1995 in the total omentectomy group. The partial omentectomy group was associated with better overall survival (hazard ratio: 0.80, 95% CI: 0.66 to 0.98, p = 0.04, I2 = 0%), shorter operative time, and lesser blood loss than the total omentectomy group. In addition, no statistically significant difference was observed in the number of dissected lymph nodes, length of hospital stays, complication rate, and disease-free survival. Conclusions: Our results show that, compared with total omentectomy in gastric cancer surgery, partial omentectomy had non-inferior oncological outcomes and comparable safety outcomes.

Most nail gun injuries involve the extremities and result from work-related accidents. Injuries to the brain or thorax are relatively rare, and cases with injuries to both regions are even rarer and often lethal. Initial evaluation, resuscitation, and surgical planning can be challenging for emergency physicians and surgeons. We present the details of a man with multiple nail gun injuries to the brain, lung, and heart following a suicide attempt. The patient presented to the emergency department in shock. After immediate resuscitation, emergent sternotomy, and subsequent craniotomy, he was discharged without significant morbidity. According to the literature, this is the only reported case involving multiple nail gun injuries to the brain, lungs, and heart. The mortality rate of multiple nail gun injuries involving the head and chest is approximately 20%. Rapid evaluation, immediate resuscitation, and appropriate imaging and surgery are crucial for increasing survival and achieving a good prognosis. Emergency sternotomy for cardiac injury is the foremost priority, and the timing of craniotomy depends on the patient’s vital sign status and whether brain injury is evident. A preprint of this article is available online: DOI: 10.21203/rs.3.rs-35448/v1.

BACKGROUND: Hip fracture is a common disease in the elderly. Among these patients, surgical intervention for hip fracture should be carefully considered because of old age and multiple comorbidities. There are still insufficient comparisons between patients treated with surgery and those treated non-surgically.OBJECTIVES: We studied hip fracture patients >90 years of age to compare the different outcomes between surgical and non-surgical treatments.DESIGN: Retrospective observational study.METHODS: Patients aged > 90 years who visited the emergency department with hip fractures between March 2010 and October 2019 were identified. Overall survival was estimated using multivariate Cox proportional hazards models. We compared the mortality rates at 30 days, 1 year, and 2 years between surgical and non-surgical patients. We also recorded the length of hospital stay, intra-admission, and 30-day complication and readmission rates.RESULTS: A total of 152 patients who underwent surgery (OP group) and 32 who received conservative treatment (non-OP group) were included. The estimated median survival time was 58.47 months in the OP group, which was significantly higher than the 24.28 months in the non-OP group. After adjusting for covariates, including age, sex, Charlson Comorbidity Index (CCI), injury severity score, and fracture type, the risk of death was reduced by surgery (hazard ratio [HR]=0.427; 95% confidence interval [CI]: 0.207-0.882; p=0.021). CCI was also an independent risk factor for poor survival rate (HR=1.3; 95% CI: 1.115-1.515; p=0.001). After adjusting for several factors, surgery within 48 h improved overall survival (HR: 2.518; 95% CI: 1.299-4.879; p=0.006).CONCLUSION: Our study suggests that surgery is likely to provide better outcomes for extremely old patients with hip fractures. Operative management should be recommended because it decreases the short-term complication rate and provides better long-term survival than non-operative management. Operation performed within 48 h of admission has better overall survival than that performed after >48 hours.

Background: Most nail gun injuries occur at the extremities due to working accidents. Injuries to the brain or thorax are relatively rare, and cases with both injuries are even rarer. Initial evaluation, resuscitation and surgical planning can be challenging. Case presentation: Here, we present a case with nail gun injuries to the brain, lung, and heart by suicide attempt. The patient presented to the emergency department under shock. After resuscitation and surgical intervention, he was discharged without significant morbidity. Conclusions: Multiple nail gun injuries, especially those to vital organs such as the brain, lung, and heart, can be challenging to emergency physicians and surgeons. Imaging tools, treatment strategies, and possible complications are discussed in this article to provide optimized outcomes in such situations.