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Objective:To analyze the clinical efficacy of different treatment modalities and prognostic factors of patients with Masaoka-Koga stage Ⅲ thymoma.Methods:Clinical data of patients diagnosed with Masaoka-Koga stage Ⅲ thymoma admitted to Affiliated Cancer Hospital of Zhengzhou University from January 2000 to December 2018 were analyzed retrospectively. A total of 133 patients had complete treatment and follow-up data. Kaplan-Meier method was used to calculate the cumulative survival rate, log-rank method was used to compare the survival between two groups, and Cox regression model was used for multivariate analysis.Results:The median follow-up time was 50 months (3-221 months). The median overall survival (OS) was 51 (3-221) months, and the median disease-free survival (DFS) was 45 (2-221) months. The survival rate in the radical surgery group was better than that in the palliative surgery group. The 5- and 10-year OS rates in radical surgery group were 88.2% and 74.4% respectively, while in palliative surgery group were 51.8% and 32.4% respectively ( P<0.001). The 5- and 10-year DFS rates in radical surgery group were 72.2% and 45.5%, respectively, while in palliative surgery group were 32.3% and 16.1% respectively ( P=0.001). The OS in the surgery combined with radiotherapy group was better than that in the surgery alone group. The 5- and 10-year OS rates in the radical surgery group were 82.8% and 64.2% respectively, while in the palliative surgery group were 55.8% and 50.2% ( P=0.033). There was no significant difference in DFS between two groups ( P=0.176). Multivariate analysis showed that age < 50 years old ( HR=0.264, P=0.001), radical resection ( HR=0.134, P<0.001), surgery combined with radiotherapy ( HR=2.778, P=0.009) were independently associated with better OS. Age < 50 years old ( HR=0.550, P=0.046), radical resection ( HR=0.555, P=0.042), and invasion of single organ ( HR=0.111, P=0.003) were independently associated with better DFS. Conclusions:OS and DFS in patients undergoing radical surgery are significantly better than those in their counterparts treated with palliative surgery, which is the most important factor affecting prognosis. Surgery combined with radiotherapy yields better OS. It is necessary to design a rigorous and reasonable multicenter prospective study to evaluate the efficacy of various treatment modalities and prognostic factors.
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Objective:To investigate the application value of computed tomography (CT) examination of lymph node short diameter in evaluating left recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 628 patients with thoracic esophageal squamous cell carcinoma who were admitted to 2 medical centers (236 cases in the Sun Yat-sen University Cancer Center and 392 cases in the Affiliated Cancer Hospital of Zhengzhou University) from October 2009 to December 2016 were collected. There were 462 males and 166 females, aged from 38 to 85 years, with a median age of 62 years. Observation indicators: (1) operation status, dissection and metastasis of left recurrent laryngeal nerve lymph node; (2) efficacy of CT examination of the left recurrent laryngeal nerve lymph node short diameter in evaluating postoperative lymph node metastasis; (3) determination of the optimal cut-off value; (4) examination results using different diagnostic criteria. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages. The area under curve (AUC) of receiver operating characteristic curve (ROC) was used to estimate the efficiency of detection methods. The maximum value of Youden index corresponded to the optimal cut-off point. Results:(1) Operation status, dissection and metastasis of left recurrent laryngeal nerve lymph node: among the 628 patients, there were 572 cases undergoing two-field lymph node dissection while 56 cases undergoing three-field lymph node dissection, there were 408 cases undergoing minimally invasive surgery while 220 cases undergoing open surgery. Sixty of 628 patients had left recurrent laryngeal nerve lymph node metastasis. A total of 1 666 left recurrent laryngeal nerve lymph nodes were dissected from the 628 patients, among which 75 were metastatic lymph nodes, with a metastasis rate of 4.502%(75/1 666). (2) Efficacy of CT examination of the left recurrent laryngeal nerve lymph node short diameter in evaluating postoperative lymph node metastasis: the AUC of CT examination of the left recurrent laryngeal nerve lymph node short diameter in predicting postoperative lymph node metastasis was 0.854 (95% confidence interval as 0.792 to 0.916, P<0.05). (3) Determination of the optimal cut-off value: the Youden indices were 0.556, 0.384, 0.258, 0.063 and 0.003 respectively when using 5 mm, 6 mm, 7 mm, 8 mm, 9 mm or 10 mm as the optimal cut-off value for CT examination of the left recurrent laryngeal nerve lymph node short diameter. The short diameter as 5 mm was the optimal cut-off value for CT examination of the left recurrent laryngeal nerve lymph node short diameter. (4) Examination results using different diagnostic criteria: the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, cases being missed diagnosis were respectively 66.3%, 92.3%, 89.5%, 46.3%, 96.0%, 20 and 5.0%, 99.8%, 90.7%, 75.0%, 90.9%, 57 when using short diameter ≥5 mm or ≥10 mm in CT examination of the left recurrent laryngeal nerve lymph node as the diagnostic criteria for left recurrent laryngeal nerve lymph node metastasis of thoracic esophageal squamous cell carcinoma. Conclusions:CT examination of lymph node short diameter can be used to evaluate left recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma. The sensitivity, specificity and accuracy is preferable when using short diameter ≥5 mm in CT examina-tion of the left recurrent laryngeal nerve lymph node as the diagnostic criteria for left recurrent laryngeal nerve lymph node metastasis of thoracic esophageal squamous cell carcinoma.
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Objective:To evaluate the clinical effect of interspinous process fusion (BacFuse) in the treatment of lumbar disc herniation (LDH) with rheumatoid arthritis (RA).Methods:A retrospective analysis of the clinical data of 50 patients with RA and LDH from May 2013 to June 2018 in department of orthopedics, Beijing Friendship Hospital, Capital Medical University was conducted. Among them, there were 9 males and 41 females, aged (66.60±4.23) years, with an age ranging from 54 to 84 years. According to different surgical methods, the patients were divided into posterior lumbar interbody fusion (PLIF) group ( n=26) and BacFuse group ( n=24). Operative time, intraoperative blood loss and operative complications of the two groups were observed. Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) scores were used to evaluate the clinical effect at preoperative, 3 days of postoperative and the last follow-up. The measurement data were expressed as mean±standard deviation( Mean± SD), comparison between groups used t test and the count data were expressed as percentage(%), the chi-square test was used for comparison between the two groups. The clinical effect of the two groups were compared by repeated analysis of variance. Results:In the PLIF group, the operation time and bleeding volume were (174.62±55.59) min, (309.62±30.26) mL, respectively. In the BacFuse group, the operation time and bleeding volume were (71.25±12.96) min, (57.92±9.32) mL, respectively. The differences between the two groups were statistically significant ( P<0.05). The operative complications in the PLIF group (8 cases) was significantly higher than that in the BacFuse group (2 cases) , the difference between the two groups was statistically significant ( χ2 = 3.926, P=0.048). There were significant differences between every two scores among the preoperative, 3 days of postoperative and last follow-up in ODI of the PLIF group( F=760.231, P<0.001). The preoperative, 3 days of postoperative and last follow-up ODI scores of the BacFuse group were significant differences between every two scores ( F= 952.525, P<0.001). There were no significant differences in ODI scores between the two groups [( t=-1.13, P=0.263), ( t=0.706, P=0.483), ( t=0.389, P=0.699)]. There were significant differences between every two scores among the preoperative, 3 days of postoperative and last follow-up in JOA of the PLIF group( F=406.012, P<0.001). The preoperative, 3 days of postoperative and last follow-up in JOA scores of the BacFuse group were significant difference between every two scores ( F=457.760, P<0.001). There were no significant differences in JOA scores between the two groups [( t=0.825, P=0.414), ( t=1.909, P=0.062), ( t=1.086, P=0.283). Conclusions:Compared with PLIF, BacFuse has a similar clinical effect in the treatment of LDH with RA, but BacFuse is less invasive and has fewer postoperative complications. BacFuse is an effective minimally surgical method for the treatment of LDH with RA.
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Objective:To compare the clinical outcomes of percutaneous vertebroplasty (PVP) and the Vesselplasty for kümmell′s disease.Methods:A retrospective case-control study was used.The clinical data of 62 patients with kümmell′s disease were selected in Beijing Friendship Hospital, Capital Medical University, from January 2017 to January 2019. There were 19 males and 43 females, aged (70.94±7.69) years, with range from 60 to 85 years. The patients were divided into two groups according to different operation methods. The 36 patients treated by PVP and 26 patients treated by Vesselplasty were followed up at least one year after operation. The follow-up time was (17.55±4.22) months. The operation time, incidence of cement leakage, preoperative and postoperative Cobb′s angle, visual analogue score (VAS) 1 week and 1 year after operation were observed. The measurement data were expressed as mean±standard deviation ( Mean± SD), independent sample t-test was used for comparison between groups. The count data were expressed as percentage (%), chi-square test was used for comparison between groups. Results:All the operation was successfully completed. No serious complications such as paraplegia, bone cement allergy, pulmonary embolism were occurred. The operation time was no significant difference between the two groups ( P< 0.05). The incidence of cement leakag was 41.67% (15/36) in PVP group and 11.54% (3/26) in Vesselplasty group. The latter was significantly lower than the former, with statistically significant differences between the two groups ( P< 0.05). In PVP group, the Cobb′s angles of preoperation, postoperation 1 year and difference were (26.23 ± 5.62)°, (17.46 ± 3.01)° and (8.78 ± 4.62)°, respectively, in Vesselplasty group, they were (28.74 ± 6.68)°, (16.68 ± 2.79)° and (12.07 ± 5.72)°, respectively. Cobb′s angle of the two groups was significantly improved after operation. In the comparison between the groups, the improvement of the Cobb′s angle in the Vesseplasty group was better than that of the PVP group, and the difference was statistically significant ( P< 0.05). The VAS score in PVP group was (8.42±1.03) scores in preoperation, (3.06±1.01) scores in 1 week, (0.81±0.75) scores in 1 year. The VAS score in Vesselplasty group was (8.35±1.02) scores in preoperation, (2.88±1.11) scores in 1 week and (1.04±0.87) scores in 1 year. Compared with pre-operation, the VAS scores of the two groups decreased significantly at 1 week and 1 year after operation, and the difference was statistically significant ( P<0.05). There was no significant difference in VAS between groups 1 week after operation and 1 year after operation ( P>0.05). Conclusion:Vesselplasty can effectively control the flow and distribution of bone cement in the vertebral body, effectively reduce the leakage of bone cement, and better correct kyphosis.
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Objective @#To learn the epidemic distribution of avian influenza virus in external environments in Liaoning Province,and to provide evidence for the prevention and control of avian influenza.@*Methods @#The environmental samples were collected monthly during 2016 and 2017（including samples from emergency monitoring in June to August,2016 and March to May,2017）from live poultry markets,live poultry wholesale markets,large-scale poultry farms（households）,free-range poultry famers and poultry processing factories in Liaoning Province. Real-time polymerase chain reaction assay was used to detect nucleic acid of Influenza A as well as H5,H7 and H9 subtypes in the environmental samples. The distribution of avian influenza virus in external environments in Liaoning Province was analyzed.@*Results @#A total of 4 037 environmental samples were collected and detected from 2016 to 2017,there were 177 copies of type A avian influenza virus and the positive rate of avian influenza A virus was 4.38%. The positive rate in 2017 was 6.26%, which was higher than 2.40% in 2016（P<0.05）. H9 subtype had the highest positive rate of 3.07%;H7 subtype was first detected in 2017. The positive rates of avian influenza virus from the first to fourth quarters of a year were 8.54%,4.88%,2.17% and 1.45%,respectively. The positive rates of avian influenza virus in live poultry markets were 8.08%,the highest among different sites,and the subtypes were mainly H9. The positive rates of avian influenza virus in samples of poultry cage and poultry washing sewage were 23.47% and 15.96%. H5 and H9 subtypes were detected in all types of samples,and H7 subtypes or mixed types were detected in samples of feces,poultry cage,poultry drinking water and chopping board.@*Conclusion @#The subtypes of avian influenza virus in the environments of Liaoning Province were mostly H9 and H5,and the H7 was first detected in 2017. Live poultry markets should be the key monitoring sites,especially in winter and spring.
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Objective To compare the clinical outcomes of unilateral extreme extrapedicular puncture versus bilateral transpedicular puncture in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture.Methods A prospective cohort study was performed.Ninety-seven patients of osteoporotic vertebral compression fractures treated were selected from January 2016 to January 2018 in Beijing Friendship Hospital,Capital Medical University.There were 36 males and 61 females,aged (72.19 ±7.41) years,with an age range of 60-80 years.All the patients underwent PVP with different puncture methods were divided into unilateral puncture group(n =52) and bilateral puncture group(n =45).PVP was performed in the unilateral extreme extrapedicular puncture group by unilateral puncture of the pedicle,and PVP was performed by bilateral puncture of the pedicle in the bilateral transpedicular puncture group.All patients completed at least one year of follow-up after operation.The operation time,fluoroscopy times,cement volume,incidence of cement leakage,visual analogue score (VAS) of 1 week and 1 year after operation were observed.The measurement data were expressed as mean ± standard deviation (Mean ± SD),count data were expressed as percentage,the independent sample t test and the x2 test were used for comparison between groups,and the paired t test was used for comparison within the group.Results The operation was successfully completed in both groups.No serious complications such as paraplegia,bone cement allergy,pulmonary embolism were occurred.In the unilateral puncture group,the operation time were (21.90 ± 3.16) min,the fluoroscopy times were (15.46 ± 2.86) times,the cement volume were (3.47 ± 0.41) ml and the incidence of cement leakage was 44.23％ (23/52),in the bilateral puncture group,the operation time were (31.64±6.90) min,the fluoroscopy times were (23.31 ± 2.39) times,the cement volume were (4.66 ± 0.61) ml and the incidence of cement leakage was 68.89％ (31/45).The operation time,fluoroscopy times,cement volume and incidence of cement leakage of unilateral puncture group were significantly less than those of bilateral puncture group.The difference was statistically significant (P ＜ 0.05).The VAS score in unilateral puncture group was (8.18 ± 0.77) scores in preoperation,(3.39 ± 0.69) scores in 1 week,(1.07 ± 0.90) scores in 1 year.The VAS score in bilateral puncture group was (7.93 ± 0.92) scores in preoperation,(3.14 ±0.83) scores in 1 week and (0.90 ±0.82) scores in 1 year.Compared with pre-operation,the VAS scores of the two groups decreased significantly at 1 week and 1 year after operation,and the difference was statistically significant (P ＜ 0.05).However,there was no significant difference in VAS between groups at 1 week after operation and 1 year after operation (P ＞ 0.05).Conclusions Compared with bilateral transpedicular puncture,PVP through unilateral extrapedicular puncture can achieve the same clinical effect.However,the latter can significantly reduce the operation time,the cement volume,fluoroscopy times and the incidence of cement leakage.
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Objective@#To compare the clinical outcomes of unilateral extreme extrapedicular puncture versus bilateral transpedicular puncture in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture.@*Methods@#A prospective cohort study was performed. Ninety-seven patients of osteoporotic vertebral compression fractures treated were selected from January 2016 to January 2018 in Beijing Friendship Hospital, Capital Medical University. There were 36 males and 61 females, aged (72.19±7.41) years, with an age range of 60-80 years. All the patients underwent PVP with different puncture methods were divided into unilateral puncture group(n=52) and bilateral puncture group(n=45). PVP was performed in the unilateral extreme extrapedicular puncture group by unilateral puncture of the pedicle, and PVP was performed by bilateral puncture of the pedicle in the bilateral transpedicular puncture group. All patients completed at least one year of follow-up after operation. The operation time, fluoroscopy times, cement volume, incidence of cement leakage, visual analogue score (VAS) of 1 week and 1 year after operation were observed. The measurement data were expressed as mean±standard deviation (Mean±SD), count data were expressed as percentage, the independent sample t test and the χ2 test were used for comparison between groups, and the paired t test was used for comparison within the group.@*Results@#The operation was successfully completed in both groups. No serious complications such as paraplegia, bone cement allergy, pulmonary embolism were occurred. In the unilateral puncture group, the operation time were (21.90±3.16) min, the fluoroscopy times were (15.46±2.86) times, the cement volume were (3.47±0.41) ml and the incidence of cement leakage was 44.23% (23/52), in the bilateral puncture group, the operation time were (31.64±6.90) min, the fluoroscopy times were (23.31±2.39) times, the cement volume were (4.66±0.61) ml and the incidence of cement leakage was 68.89% (31/45). The operation time, fluoroscopy times, cement volume and incidence of cement leakage of unilateral puncture group were significantly less than those of bilateral puncture group. The difference was statistically significant (P< 0.05). The VAS score in unilateral puncture group was (8.18±0.77) scores in preoperation, (3.39±0.69) scores in 1 week, (1.07±0.90) scores in 1 year. The VAS score in bilateral puncture group was (7.93±0.92) scores in preoperation, (3.14±0.83) scores in 1 week and (0.90±0.82) scores in 1 year. Compared with pre-operation, the VAS scores of the two groups decreased significantly at 1 week and 1 year after operation, and the difference was statistically significant (P<0.05). However, there was no significant difference in VAS between groups at 1 week after operation and 1 year after operation (P>0.05).@*Conclusions@#Compared with bilateral transpedicular puncture, PVP through unilateral extrapedicular puncture can achieve the same clinical effect. However, the latter can significantly reduce the operation time, the cement volume, fluoroscopy times and the incidence of cement leakage.
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OBJECTIVE To observe the clinical characteristics and curative effect inpatients with benign paroxysmal positional vertigo(BPPV). METHODS The data of 1000 BPPV patients were retrospectively analyzed. RESULTS 1. There was no significant difference in age between men and women; There was significant difference in incidence between men and women; 2. The single semicircular canal was involved in 993 cases, 2 semicircular canals were involved in 7 cases, canalolithiasis in 818 cases, cupulolithiasis in 175 cases; 3. The posterior semicircular canalwas involved in 587 cases, horizontal semicircular canal in 402 cases, anterior semicircular canal in four cases. The incidence of the right side was significantly higher than that of the left side; 4. The average treatment times of canalolithiasis and cupulolithiasiswere statistically different; 5. BPPV canalolithiasis and cupulolithiasisonetimerepositi on cure rate is 62.5％ and 42.3％ respectively; 6. There was no correlation between nystagmus velocity,affected sideand reposition times in horizontal BPPV. CONCLUSION BPPV has the following characteristicscs. First of all, popularin the middle-aged, elderly population and more common in women, single semicircular canal involve predominantly. Second, most of BPPV involve posterior semicircular canal, horizontal semicircular canal lesion take the second place and anterior semicircular canal lesion was least. Most of BPPV occur in the right side andiscanalolithias type. Thirdly, the average treatment times of BPPV of cupulolithiasis type is more than that of canalolithiasistype.
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Objective To observe the effects of comprehensive treatment of aerobic exercise and medicine on the levels of serum immunoglobulins and cytokines in rats with chronic abacterial prostatitis (CAP).Methods Forty healthy adult male SD rats were randomly divided into the normal control group,CAP model control group,exercise treatment group,medicine treatment group and exercise and medicine comprehensive treatment group,8 cases in each group.The CAP rat model was prepared by the injection of Xiaozhiling,and after 7 d of rat model construction,the exercise treatment group and exercise and medicine comprehensive treat ment group conducted once swimming exercise at fixed time every day,6 d per week for 4 continuous weeks;the medicine treatment group and exercise and medicine comprehensive treatment group were given Qianlieshutong Capsule aqueous solution for gavage treatment every day;the normal control group,model control group and exercise treatment group performed gastric gavage with sterile normal saline.On 14,28 d of the treatment process the rats in each group were sacrificed.The indicators such as serum immunoglobulins and cytokines in rats were detected by using ELISA.Results On 14 d,compared with the normal control group,the levels of serum IgG,IgA,IgM,TNF-α,IL-1β and IL-6 in each experimental group were increased significantly (P＜ 0.05),while which had no statistically significant difference between the exercise treatment group and model control group and between the comprehensive treatment group and medicine treatment group(P＞0.05);on 28 d,the levels of IgG,IgM,TNF-α,IL-1β and IL-6 in the exercise treatment group were significantly lower than those in the model control group(P＜0.05),the levels of IgG,IgA,TNF-α,IL-1β and IL-6 in the comprehensive treatment group were significantly lower than those in the medicine treatment group (P＜0.05),moreover were close to those in the normal control group(P＞0.05).Conclusion Aerobic exercise can reduce the levels of serum immunoglobulins and cytokines in CAP rats,and the effect is more obviousin CAP rats treated by comprehensive therapy combined with medicine.
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Objective@#To study the different clinicopathological characteristics between classic and epithelioid renal angiomyolipoma, and the relationships between clinicopathological characteristics and biological behaviors as basis for clinical treatment.@*Methods@#The clinicopathological and follow-up data for the patients diagnosed with renal angiomyolipoma between 2004 and 2011 were retrospectively reviewed and analyzed.@*Results@#There were 414 cases of renal angiomyolipoma diagnosed over 8 years ago, accounting for 8.1% (414/5 287) of all renal parenchymal tumors. The patients included 122 male and 292 female (male-to-female ratio of 1.0∶2.4), mean age 44.0 years (range 15-74 years). Of these, 195(47.1%) tumors occurred in the left kidney, 212(51.2%) in the right kidney and seven (1.7%) were bilateral. Clinically, some cases presented with hypochondrial pain, hematuria or palpable masses. Histologically, 394(95.2%) were classic angiomyolipoma, 20(4.8%) were epithelioid angiomyolipoma; 54, 23 and 7 cases had hemorrhage, necrosis and cystic degeneration, respectively; and 5, 30 and 14 cases had perirenal fat invasion, atypical cells and polymorphic/giant tumor cell. There was a positive correlation between atypical cells and epithelioid tumor type, respectively. The other clinicopathological parameters did not correlate with histological type. Follow-up data was available in 360 patients, with follow-up period of 3 to 99 months. One case died from other causes. The remaining patients were free of disease.@*Conclusions@#Angiomyolipoma is a common renal parenchyma tumor. Clinically, it is usually biologically benign. Histologically, it can be either classic or epithelioid types. The epithelioid type should be differentiated from the classic renal cell carcinoma, Mit family translocation renal tumor and renal hemangioblastoma. Atypical cells, more commonly found in the epithelioid angiomyolipoma, do not affect the clinical prognosis of patients.
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Esophageal cancer is located in the 8th position of the incidence of malignant tumors and the 6th most common cause of cancer-related mortality in the world, while China has the highest incidence and mortality of esophageal cancer. Esophageal squamous cell carcinoma (ESCC), the predominant histologic type of esophageal cancer in China, accounts for about 90%. Despite recent improvement of surgical techniques and philosophy, however, the prognosis of ESCC patients treated with surgery is still poor, and 5-year survival remains unsatisfactorily low. So far, the pathogenesis of esophageal squamous cell carcinoma is still unclear, and effective prevention is also out of the question. To find the main factors affecting the prognosis of esophageal squamous cell carcinoma, and to improve the survival of patients, are the main directions of all scholars. Postoperative pathology of esophageal squamous cell carcinoma is considered to be one of the most important predictors of prognosis. Currently, the evaluation of postoperative esophageal prognosis mainly depends on TNM staging, but some criteria of its specific content and staging remains controversial. In this paper recent domestic and foreign related researches and clinical trials reports are collected, and the postoperative pathological features affecting esophageal squamous cell carcinoma prognosis were reviewed.
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Objective To observe the effects of comprehensive treatment of aerobic exercise and medicine on the levels of serum immunoglobulins and cytokines in rats with chronic abacterial prostatitis (CAP).Methods Forty healthy adult male SD rats were randomly divided into the normal control group,CAP model control group,exercise treatment group,medicine treatment group and exercise and medicine comprehensive treatment group,8 cases in each group.The CAP rat model was prepared by the injection of Xiaozhiling,and after 7 d of rat model construction,the exercise treatment group and exercise and medicine comprehensive treat ment group conducted once swimming exercise at fixed time every day,6 d per week for 4 continuous weeks;the medicine treatment group and exercise and medicine comprehensive treatment group were given Qianlieshutong Capsule aqueous solution for gavage treatment every day;the normal control group,model control group and exercise treatment group performed gastric gavage with sterile normal saline.On 14,28 d of the treatment process the rats in each group were sacrificed.The indicators such as serum immunoglobulins and cytokines in rats were detected by using ELISA.Results On 14 d,compared with the normal control group,the levels of serum IgG,IgA,IgM,TNF-α,IL-1β and IL-6 in each experimental group were increased significantly (P＜ 0.05),while which had no statistically significant difference between the exercise treatment group and model control group and between the comprehensive treatment group and medicine treatment group(P＞0.05);on 28 d,the levels of IgG,IgM,TNF-α,IL-1β and IL-6 in the exercise treatment group were significantly lower than those in the model control group(P＜0.05),the levels of IgG,IgA,TNF-α,IL-1β and IL-6 in the comprehensive treatment group were significantly lower than those in the medicine treatment group (P＜0.05),moreover were close to those in the normal control group(P＞0.05).Conclusion Aerobic exercise can reduce the levels of serum immunoglobulins and cytokines in CAP rats,and the effect is more obviousin CAP rats treated by comprehensive therapy combined with medicine.
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Objective To analyze the clinical efficacy of improved incision septoplasty in treatment of allergic rhinitis and its effect on the life quality of patients.Methods A total of 42 patients with persistent allergic rhinitis and merge nasal septum in our hospital from July 2013 to April 2015 were divided into observation group and control group.The observation group were treated by improved incision septoplas-ty,and the control group received traditional KillIan incision treatment.The clinical efficacy,survival quality and visual analog scale between two groups were compared.Results After treatment,The total efficiency rate of observation group(94.24%)was significantly higher than that of control group(85.71%)(χ2 =7.15,P <0.05).The nasal congestion,nasal itching,sneezing and other symptoms score of observa-tion group were significantly lower than those of control group(P <0.05).The score of nasal problems,eye problems,eye problems and non-nasal sleep disorders in observation group were also significantly lower than those in control group(P <0.05).Intraoperative situation of ob-servation group was significantly better than that of control group(P <0.05).Conclusion Improved incision septoplasty has a good clinical efficacy for patients with persistent allergic rhinitis and merge nasal septum,which can significantly improve the clinical symptoms and life quality of patients.
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<p><b>OBJECTIVE</b>We analyzed the lymph node (MLNs) metastasis of thoracic esophageal squamous cell carcinoma (ESCC) to explore the patterns of lymphatic spread and the rational surgical procedure and extent of lymph node dissection for ESCC.</p><p><b>METHODS</b>We retrospectively evaluated 313 consecutive patients treated in our hospital between January 2010 and May 2014 who underwent minimally invasive esophagectomy (MIE) for ESCC. The information of lymph node status was obtained and the features of lymph node metastasis were analyzed.</p><p><b>RESULTS</b>Of the 313 cases, 122 (39.0%) were found to have lymph node metastasis. In the 4461 dissected lymph nodes, metastasis was identified in 294 (6.6%) lymph nodes. The recurrent laryngeal nerve lymph nodes were the most frequent metastatic nodes with a metastasis rate of 25.2%, followed by the paracardiac and left gastric artery lymph nodes (18.2%). Chi-square test showed that the lymph node metastasis is associated with tumor invasion and tumor differentiation (P<0.001 for both). Metastases were more frequently found in the recurrent laryngeal nerve lymph nodes in patients with tumors in the upper third esophagus and with histologically poor differentiation (P<0.05 for both). The metastasis rate of para-cardiac and left gastric artery lymph nodes was associated with tumor in the lower third of esophagus, T stage and differentiation (all P<0.05). Logistic regression analysis showed that tumor differentiation and location are independent factors affecting the metastasis of recurrent laryngeal nerve lymph nodes (P<0.05 for all). T stage, tumor differentiation and location were independent factors associated with metastasis of para-cardiac and left gastric artery lymph nodes (P<0.05 for all).</p><p><b>CONCLUSIONS</b>(1) Metastases of thoracic esophageal carcinoma are often found in the recurrent laryngeal nerve lymph nodes, para-cardiac and left gastric artery lymph nodes. (2) Extensive lymph node dissection should be performed for ESCC with poor differentiation and deep tumor invasion.</p>
Subject(s)
Humans , Carcinoma, Squamous Cell , General Surgery , Esophageal Neoplasms , Pathology , General Surgery , Esophagectomy , Lymph Node Excision , Lymph Nodes , Pathology , Lymphatic Metastasis , Lymphatic Vessels , Recurrent Laryngeal Nerve , Retrospective StudiesABSTRACT
Objective To investigate the application value and feasibility of enhanced recovery after surgery (ERAS) in thoracoscopic and laparoscopic esophagectomy for esophageal cancer.Methods The clinical data of 304 patients with esophageal cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from December 2013 and July 2014 were retrospectively analyzed.All the patients underwent esophagogastric partial resection, esophagogastric cervical anastomosis and 2-field lymph node dissection under general anesthesia.The management of 195 patients guided by ERAS were allocated to the ERAS group and 109 patients receiving perioperative traditional treatments were allocated to the control group.Observing indicators included : (1) enteral and parenteral nutritional support treatments;(2) nutrient indexs: levels of serum albumin (Alb) and prealbumin;(3) the recovery of gastrointestinal function: time to anal exsufflation and defecation;(4) postoperative complications and the grading according to Clavien standard;(5) duration of postoperative hospital stay and treatment expenses;(6) risk factors affecting postoperative complications by multivariate analysis;(7) independent risk factors affecting occurrence rate of postoperative complications by univariate analysis.Measurement data with normal distribution were presented as (x) ± s and analyzed using the t test.Nonnormal distribution data were analyzed by the Wilcoxon rank sum test.Comparison of repeated data was analyzed by the repeated measures ANOVA.Categorical variables were analyzed using the chi-square test or Fisher's exact probability.The multiple linear regression analysis and Logistic regression were used to measure the multivariate analysis of continuous variables and binary variable, respectively.Results (1) During the enteral and parenteral nutritional support treatments, 11 patients with surgery-related complications in the ERAS group didn't receive oral intake at postoperative day 1,26 proceeded the intravenous rehydration at postoperative day 4 due to calorie intake less than 80％ of calorie requirement, and enteral nutritional support treatment was well-tolerated in the control group.(2) Comparison of nutrient indexs : the levels of serum Alb and prealbumin at postoperative day 1, 3 and 5 were (37.2±3.9)g/L, (39.1 ±3.5)g/L, (38.5 ±3.0)g/L and (0.20 ±0.06)g/L, (0.13 ±0.04)g/L, (0.13 ±0.04)g/L in the ERAS group, (37.7 ±2.8)g/L, (39.0 ±3.6)g/L, (38.4 ±3.8)g/L and (0.18 ± 0.06) g/L, (0.13 ± 0.04) g/L, (0.13 ± 0.04) g/L in the control group, respectively, showing no significant difference in the postoperative changing trends between the 2 groups (F =0.357, 0.453, P ＞ 0.05).(3) The recovery of gastrointestinal function : time to first anal exsufflation and first defecation were (2.1 ± 0.8) days and (3.4 ± 1.2) days in the ERAS group, (3.2 ± 0.9) days and (5.5 ± 1.5) days in the control group, respectively,showing significant differences between the 2 groups (t =-10.505,-13.174, P ＜0.05).(4) There was no death in the perioperative period.The overall incidences of postoperative complications and number of patients with severe complications were 26.15％ (51/195) and 8 in the ERAS group, 30.28％ (33/109) and 8 in the control group, with no significant difference between the 2 groups (x2=0.594, 1.469, P ＞ 0.05).Eight and 10 patients in the ERAS and control groups underwent gastrointestinal decompression, 6 and 8 patients in the ERAS and control groups underwent retreatment in the intensive care unit (ICU), 3 and 2 patients in the ERAS and control groups were readmitted to the hospital at 3 weeks after discharge, with no significant difference in the above indexes (x2=0.185, 2.892, P ＞0.05).(5)The duration of postoperative hospital stay and treatment expenses were (6.8 ±2.4)days and (25 088 ±10 336)yuan in the ERAS group, (11.1 ±3.4)days and (38 819± 14 854)yuan in the control group, showing significant differences between the 2 groups (t =-12.782,-9.452,P ＜ 0.05).(6) The age, gender, preoperative weight loss ＞ 10％, tumor staging, tumor differentiation,neoadjuvant chemotherapy and time of food intake were risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the univariate analysis (x2=2.484, 2.333, 0.061, 8.553,2.459, 0.163, 3.462, P ＜ 0.05).(7) The age, preoperative weight loss ＞ 10％, tumor staging and neoadjuvant chemotherapy were independent risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the multivariate analysis (OR =0.365, 10.761,0.290, 8.140, 95％ confidence interval :0.198-0.671, 4.122-28.095, 0.130-0.645, 3.946-16.791, P ＜0.05), but time of food intake was not an independent risk factor (OR =0.540, 95％ CI: 0.280-1.041, P ＞ 0.05).Conclusions ERAS in the esophageal minimally invasive surgery for esophageal cancer is safe and feasible, with the advantages of shorter recovery time of gastrointestinal function and duration of hospital stay, lower treatment expenses and a better application value compared with traditional treatment.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility of no nasogastric intubation and early oral feeding at will after thoracolaparoscopic esophagectomy for patients with esophageal cancer.</p><p><b>METHODS</b>Between January 2013 and January 2014, the feasibility of no nasogastric intubation and early oral feeding at postoperative day(POD) 1 after thoracolaparoscopic esophagectomy was prospectively investigated in 156 patients (trial group) with esophageal cancer in the Henan Cancer Hospital. One hundred and sixty patients previously managed in the same unit who were treated routinely after thoracolaparoscopic esophagectomy were served as control group.</p><p><b>RESULTS</b>Of 156 patients of trial group, 6(3.8%) patients could not take food early as planned because of postoperative complications. The overall complication rate in trial group was 19.2%(30/156), which was 25.0%(30/160) in control group (P=0.217). The anastomotic leakage in trial group and control group was 2.6%(4/156) and 4.3%(7/160) respectively (P=0.380). Compared with control group, time to first flatus [(2.1±0.9) d vs. (3.3±1.1) d, P<0.001], bowel movement [(4.4±1.3) d vs. (6.6±1.0) d, P<0.001] and postoperative hospital stay [(8.3±3.2) d vs. (10.4±3.6) d, P<0.001] were significantly shorter in trial group.</p><p><b>CONCLUSIONS</b>No nasogastric intubation and early oral feeding postoperatively in patients with thoracolaparoscopic esophagectomy is feasible and safe. This management can shorten postoperative hospital stay and fasten postoperative bowel function recovery.</p>
Subject(s)
Humans , Eating , Esophageal Neoplasms , General Surgery , Esophagectomy , Fasting , Feasibility Studies , Intubation, Gastrointestinal , Postoperative Complications , Postoperative PeriodABSTRACT
OBJECTIVE@#To summary the clinical therapy experience of thyroid carcinoma invading cervical esophagus and trachea full thickness and reconstruction of them to improve the survival rate and quality of life of these patients.@*METHOD@#In 33 patients with thyroid carcinoma inviding cervical esophagus and trachea, 7 patients were operated with total thyroid resection, 22 patients were operated with one lobectomy and the other side subtotal thyroid resection,and 4 patients were operated with partial lobectomy. Trachea local recection and intubation were performed on 19 patients, partial laryngectomy and pyriform sinus resection with trachea local recection and intubation were performed on 4 patients,and 10 cases were operated with tracheal sleeve resection and end to end anastomos.@*RESULT@#All patients were primary healing without tracheal anastomosis fistula, tracheal wall necrosis, esophageal fistula and pharyngeal fistula. One case had hypoparathyroidism after the operation and took a favorable turn a month later. Seven cases were dead (21. 21%). 1-year, 3-year, 5-year survival rates of the thyroid papillary carcinoma inviding cervical esophagus and trachea were 100.0%, 93.8% and 70.3%; 1-year, 3-year, 5-year survival rates of the thyroid carcinoma inviding cervical esophagus and trachea were 96.6%, 79.0% and 61.4%.@*CONCLUSION@#Thyroid carcinoma invading cervical esophagus and trachea full-thickness can be treated with surgical methods, and tracheal sleeve resection and end to end anastomos are the suitable methods.
Subject(s)
Humans , Carcinoma , Pathology , General Surgery , Carcinoma, Papillary , Esophagus , Pathology , Laryngectomy , Neoplasm Invasiveness , Quality of Life , Plastic Surgery Procedures , Survival Rate , Thyroid Cancer, Papillary , Thyroid Neoplasms , Pathology , General Surgery , Trachea , Tracheal Neoplasms , Pathology , General SurgeryABSTRACT
Objective:To compare three different routes for nutritional support after thoracolaparoscopic esophagectomy. Meth-ods:The clinical data of 310 esophageal cancer patients undergoing thoracolaparoscopic esophagectomy in Affiliated Cancer Hospital of Zhengzhou University from January 2010 to October 2013 were analyzed (early oral feeding group:110, nasojejunal tube feeding group:102, and jejunostomy tube feeding group:98). The serum albumin and body weights were compared among the three groups be-fore operation and four days after operation. The postoperative recovery time of the first exhaust time and hospitalization days were al-so compared. The fistula of esophageal anastomosis, pulmonary infection, and complications from intubation such as throat inflamma-tion were also compared. Results:No postoperation mortality occurred in the three groups. In addition, no significant difference was ob-served between the nasojejunal tube group and jejunostomy group for the first exhaust time and hospitalization days. The recovery of the early oral feeding group was significantly faster than the other two groups. Postoperative acute dilatation of the stomach and func-tional delayed gastric emptying were not found in the three groups. The anastomotic leakage and pulmonary infection rate had no signif-icant difference. The throat inflammation from intubation in the nasojejunal tube feeding group was significantly more than that in the jejunostomy tube feeding group. Eleven percent of the patients removed the tube by themselves. In the jejunostomy tube feeding group, five patients suffered from postoperative fistula drainage, including one case with serious symptoms. Five patients had incomplete ileus. Conclusion:Early oral feeding is a suitable nutritional support route after thoracolapascopic esophagectomy and it is a good way to re-duce operation stress, improve patient compliance, induce fast recovery, and shorten hospitalization days.
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BACKGROUND:Elderly patients with femoral neck fractures have poor regulatory mechanism, accompanied by a variety of comorbidities and complications, so the treatment and rehabilitation of perioperative femoral neck fracture is very important. OBJECTIVE:To review the prosthesis selection and complication treatment in perioperative femoral neck fracture in elderly patients. METHODS:A computer-based research was conducted in PubMed database and CNKI database for the articles published since 2000, the key words were“elderly, femoral neck fracture, perioperative, treatment and rehabilitation, hip fracture”in Chinese and English. The clinical researches were selected. The subjects were the femoral neck fracture patients with the age over 65 years. The review literatures and the literatures with smal cases and old were eliminated, and final y 20 literatures were included for analysis. RESULTS AND CONCLUSION:Due to the osteoporosis of the elderly patients, the internal fixation often failed. For the Garden Ⅲ and Ⅳ femoral neck fracture patients with the age over 65 years, as long as there is no clear contraindication for surgery, the hip replacement is often used for the treatment. The tolerance of the patients should be accurately evaluated before replacement, and the blood pressure, blood glucose and various medical complications should be control ed;the rehabilitation training after replacement is also essential. The common complications in elderly patients after replacement include stress ulcer, deep venous thrombosis, neuropsychiatric symptoms, urinary tract infections and the surgical infection.
ABSTRACT
Objective To compare the outcomes between modified McKeown minimally invasive approach and open left chest-neck incision approach esophagectomy for treatment cancer of mid-to-distal thoracic esophagus.Methods We retrospectively analyzed clinical data from 128 patients with mid-to-distal thoracic esophageal cancer who underwent thoracoscopic and laparoscopic esophagectomy from March 2009 to March 2012.One hundred and fifty patients were served as control that underwent open left chest-neck incision approach esophagectomy in the same period.Results All the operations were performed successfully.There was significant difference between modified McKeown minimally invasive approach and open left chest-neck incision approach esophagectomy with regard to respiratory complications (10.9 ％ vs.20.7％),pneumonia (4.7％ vs.11.3 ％),atelectasis (3.1％ vs.10.5 ％,),pleural effusion (3.1％ vs.10.0％) and delayed gastric emptying (8.6 ％ vs.1.3 ％) (P ＜ 0.05).Hospital stay was significantly shorter in the minimally-invasive group than the open group [(11.7 ± 3.6) days vs.(13.9 ± 6.5) days,P＜0.05],and had significantly less blood loss [(88.1 ±41.8) ml vs.(360.5 ±80.6) ml,P＜0.05] and the number of lymph nodes harvested (22.9 ±5.7 vs.16.8 ±4.5,P ＜0.05).No significant differences were observed on the operative time,mortality and other complication between the two groups.Conclusion Modified McKeown minimally invasive approach esophagectomy is techeniqually feasible and safely which have lower blood loss,lower respiratory complication,shorter hospital stay and more number of lymph nodes harvested comparing to open left chest-neck incision approach.