ABSTRACT
Esophageal cancer is a malignant tumor with a high incidence in China. At pesent, advanced esophageal cancer patients are still frequently encountered. The primary treatment for resectable advanced esophageal cancer is surgery-based multimodality therapy, including preoperative neoadjuvant therapy, such as chemotherapy, chemoradiotherapy or chemotherapy plus immunotherapy, followed by radical esophagectomy with thoraco-abdominal two-field or cervico-thoraco-abdominal three-field lymphadenectomy via minimally invasive approach or thoracotomy. In addition, adjuvant chemotherapy, radiotherapy, or chemoradiotherapy, or immunotherapy may also be administered if suggested by postoperative pathological results. Although the treatment outcome of esophageal cancer has improved significantly in China, many clinical issues remain controversial. In this article, we summarize the current hotspots and important issues of esophageal cancer in China, including prevention and early diagnosis, treatment selection for early esophageal cancer, surgical approach selection, lymphadenectomy method, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and nutritional support treatment.
Subject(s)
Humans , Esophageal Neoplasms/surgery , Combined Modality Therapy , Neoadjuvant Therapy/methods , Chemoradiotherapy , Chemotherapy, Adjuvant , Esophagectomy/methodsABSTRACT
Objective To analyze the causes and epidemiological characteristics of injury in Hunan Province, so as provide scientific basis for the development of intervention measures of injury. Methods The Excel 2007 software and SPSS 18.0 software were used to organize and analyze the injury surveillance system data. Results A total of 107 754 effective cases were collected in three years, and the male-female ratio was 1.65:1. The top three causes of injury were falls(36.0%), motor vehicle accident (20.6%) and sharp knife injury (11.8%). The locations of injuries were mainly roads (30.9%) and homes (28.3%). The top three activities at the time of injury were leisure activities (24.7%), driving (17.6%) and work (16.4%). 93.2% of injury was unintentional injury, and the degree of injury was mainly mild injury (74.3%). Conclusions The number of injuries is increasing year by year. The number of male injuries is more than that of females. Systematic research and intervention measures should focus on falls and motor vehicle accident .
ABSTRACT
Objective To investigate the changing trend of mortality and the spectrum regarding causes of death in the population of Hunan, and to analyze the health-related major diseases.Methods With retrospective study method, a sample survey on causes of death and the related information was carried out from 2004 to 2005 among the residents in Hunan province. Results were compared with the data from a retrospective survey on causes of death in Hunan during 1973-1975 and 1990-1992, respectively. Results The crude mortality rates and the standardized mortality ratios (SMR) of the reisidents in Hunan were 901.59/100 000 and 865.14/100 000 during the period of 1973-1975 while 588.64/100 000 and 537.42/100 000 druing the period of 1990-1992, and 608.27/100 000 and 413.67/100 000 during the period of 2004-2005, respectively. During the past 30 years, the SMR of the residents in Hunan decreased by 52.18% and the descending range from the rural areas was more than that of the urban areas, and higher in females than in males. The death proportion of infectious diseases, maternal and perinatal diseases, nutritional deficiencies decreased significantly (P＜0.01), but the death proportion of chronic non-communicable diseases increased significantly (P＜0.01). The changing ranges of the former two proportions were both larger in the rural areas than those in the urban areas. The highest proportions of deaths due to injury and poisoning during the past 30 years were both seen in the 5 year olds, followed by the age groups of 25 year olds (P＜0.01). During the period of 2004-2005, the death proportion of all the infectious diseases,maternal/perinatal diseases and nutritional deficiencies was 8.01% altogether, and those of chronic non-communicable diseases, injury and poisoning were 80.66% and 11.33%, respectively. During the past 30 years, the SMR of the three kinds of diseases all significantly decreased, more significantly seen in infectious diseases, maternal and perinatal diseases, and nutritional deficiencies but less in chronic non-communicable diseases. Among the death cases of chronic non-communicable diseases,the SMR of cerebrovascular disease, malignant tumor, and heart disease showed an increasing tendency and the sequences of them had been advanced to the first, the second, and the fourth in the death ranking during the period of 2004-2005, respectively. Conclusion The SMRs of the residents in the urban and rural areas from Hunan province showed a declining tendency.Cardiovascular, cerebrovascular diseases and malignant tumors had become the important diseases affecting the health of the people, while injury and poisoning had otherwise topped the causes of death among children and adolescents in Hunan province.
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Objective To explore the score criteria of severe hand, foot and mouth disease (HFMD) cases and to provide evidence for unified criteria and treatment on severe HFMD cases.Methods All severe cases and partial mild cases reported by two designated hospitals of HFMD in Fuyang during March to June, 2008 were scored by the methods of criteria constructed in advance.ROC curve was adopted to evaluate the score criteria and the gold standard was defined according to ICU, intubation and clinical outcomes, etc. Sensitivity, specificity and Youden' s index were used to determine the division scores on critical, severe and mild cases. Results 97% of the cases (34 cases) were scored less than 6 points. 88% of cases (24 cases) who were intubated or mechanical ventilated had the scores of 6 points or higher. 79% of deaths (11 cases) were scored 10 points or higher. The area of receiver operation characteristic (ROC) curve was 0.90 (95% CI: 0.83-0.98)between severe and mild cases and the area of ROC curve was 0.95 (95%CI: 0.92-0.98) between critical and severe, mild cases. When comprehensively considering the sensitivity and specificity,severe cases were best judged when score was 4 points (sensitivity, specificity and Youden' s index were 0.94, 0.68 and 0.62 respectively). When score was 6 points, critical cases were judged very well (sensitivity, specificity and Youden' s index were 0.92, 0.84 and 0.76 respectively). Conclusion Score criteria could be quantified to determine the degree of seriousness and with high-value for diagnosis on HFMD.