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Objective:To investigate the predictive effect of postoperative blood lipid metabolism and C-reactive protein/albumin ratio (CAR) on anastomotic fistula after radical resection of esophageal cancer.Methods:A retrospective case-control study was conducted on 256 patients with esophageal squamous cell carcinoma (all aged >50 years) who underwent radical esophagectomy in the thoracic surgery of the Second Affiliated Hospital of Zhengzhou University from January 2017 to December 2020. Total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), ratio of C-reactive protein to albumin (CAR) and hemoglobin test index were collected. According to whether there was anastomotic fistula after operation, the patients were divided into anastomotic fistula group and non-anastomotic fistula group. The measurement data of normal distribution were compared by t-test, the measurement data of non-normal distribution were expressed by M( Q 1, Q 3), the comparison between groups was expressed by Mann-Whitney U test, and the counting data were expressed by (case(%)).The comparison between groups was performed by χ 2 test. Logistic regression model was used for multivariate analysis. ROC curve and Kappa value were used to evaluate the predictive value of total cholesterol and CAR in postoperative anastomotic fistula. Results:The preoperative body mass index (BMI) ((18.71±1.90) kg/m 2) in anastomotic fistula group was higher than that in non-anastomotic fistula group ((20.59±2.88) kg/m 2), and the difference was statistically significant ( t=3.48, P=0.001). The postoperative total cholesterol ((5.44±1.09) mmol/L), LDL-C ((3.82±1.15) mmol/L) and CAR(0.64(0.41, 0.95)) in anastomotic fistula group were higher than those in non-anastomotic fistula group ((4.54±0.94) mmol/L, (2.92±0.76) mmol/L, 0.27(0.13,0.45)). There were significant differences between the two groups (the statistical values were t=4.84, t=5.69, Z=5.16, all P<0.001)). The hemoglobin concentration of 103.20 (84.94,110.48) g/L was lower than that of non anastomotic fistula group (107.68 (99.20,125.20) g/L), the difference was statistically significant ( Z=2.82, P=0.005). Lower BMI( OR=0.652,95% CI 0.482-0.882), higher total cholesterol( OR=3.240,95% CI 1.430-7.340), lower hemoglobin ( OR=0.837,95% CI 0.777-0.902) and higher CAR( OR=2.161,95% CI 1.597-2.925) were the risk factors of anastomotic fistula in esophageal squamous cell carcinoma( P values were 0.006, 0.005, <0.001 and <0.001,respectively). ROC curve analysis showed that the areas under the curve of total cholesterol and CAR were 0.742 (95% CI:0.643-0.841, P<0.001) and 0.790 (95% CI:0.690-0.890, P<0.001) respectively. The cutoff values were 4.915 mmol/L and 0.605, the sensitivity were 80.0% and 80.0%, the specificity were 82.3% and 92.5%, respectively, and the Kappa values were 0.418 and 0.625 respectively (all P<0.001). Conclusion:Total cholesterol and CAR after radical resection of esophageal cancer have a certain predictive value for postoperative anastomotic fistula in patients with esophageal squamous cell carcinoma. The predictive result of CAR is better than that of total cholesterol.
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Objective To investigate the influence factors for immediate outcome after thymectomy for patients with myasthenia gravis (MG). Methods The clinical data of 108 patients with MG who received thymectomy in the Department of Thoracic Surgery, the Second Affiliated Hospital of Zhengzhou University from July 2009 to July 2012 were retrospectively investigated, including gender, age, duration of disease, clinical classification, pathological classification of thymus and anti-acetylcholine receptor antibodies (AChRab). The immediate outcome after thymectomy was also observed. Thirty-two cases of MG who had immediate outcome after thymectomy were enrolled into experimental group, while 76 cases who did not have immediate outcome after thymectomy were regarded as control group. Results The immediate outcome after thymectomy was associated with duration of disease (χ2=98.550, P<0.01), clinical classification (χ2=40.434, P<0.01), pathological classification of thymus (χ2=11.154, P=0.004) and AChRab (χ2=5.590, P=0.018). There were statistically significant differences between the two groups in the one-year (31.3% in the experimental group vs 14.5% in the control group, χ2=4.046, P=0.044), two-year (40.6% vs 21.1%, χ2=4.392, P=0.036) and three-year complete remission rates (46.9% vs 25.0%, χ2=4.995, P=0.025). Conclusion Duration of disease, clinical classification, pathological classification of thymus and AChRab could be influence factors for immediate outcome and complete remission for patients with MG after thymectomy.
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Objective To explore the expressions and clinical significance of epidermal growth factor receptor (EGFR),COOH-terminus tensin-like molecule (CTEN)and epithelial cadherin (E-cad)in non-small cell lung cancer (NSCLC).Methods The expressions of EGFR,CTEN and E-cad in 36 cases of normal lung tissue and 82 cases of NSCLC tissues were observed with immunohistochemical SP method and their correlation with NSCLC invasion,metastasis and prognosis was analyzed.Results The positive rate of EGFR,CTEN and E-cad was 58.5% (48/82),69.5% (57/82)and 28.1% (23/82)in 82 cases of lung cancer,while 13.9% (5/36),0.0% (0/36)and 100% (36/36)in normal tissues;the differences were all significant (P<0.05).EGFR,CTEN and E-cad expressions in NSCLC tissues were significantly correlated with tumor differentiation,TNM stage and lymph node metastasis (P<0 .0 5 ).The expressions of EGFR and CTEN were correlated with each other in NSCLC (r=0 .5 3 0 , P<0.001),while the expressions of EGFR and CTEN were correlated with that of E-cad (r=0.499,P<0.001;r=0.333,P=0.001 ).Multivariate Cox regression analysis showed that CTEN expression in NSCLC was an independent prognostic factor (P<0.05 ).Conclusion EGFR,CTEN and E-cad may play a role in the development,invasion and metastasis of NSCLC and have some significance in predicting the prognosis of NSCLC.
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Objective To discover the effect of pleurodesis with single utility port vido-assested thoracic surgery on patients with malignant pleural effusion.Methods Clinical pleurodesis data of 24 patients with malignant pleural effusion were analyzed retrospectively.Results After treatment,all the patients were no perioperative deaths.The operation time was 32 to 83 min,and average time was 34.5 min.The time of extubation was 4 to 15 d,and average time was 5.6 d.Among 24 patients with pleurodesis underwent regularly postoperative CT scan and follow-up,one case died of a brain metastasis after five months later,the other patients were survive more than six months.Conclusions Pleurodesis with single utility port video-assisted thoracoscopic surgery in the treatment of malignant pleural effusion is a minimally invasive,effective and practical method.
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To improve the part of the hardware about Xin Hua SL-IC model X-ray radiotherapy simulative position finder, using CR and PACS, so that located-picture shooting for the simulative position finder have been realized digital upgrade.
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Electronic Data Processing , Radiographic Image Enhancement , Radiotherapy , Methods , Tomography, Spiral Computed , MethodsABSTRACT
Objective To summarize the experience of clinical diagnosis and treatment for recurrence and progress of relieved myastbenia gravis after thymectomy. Methods 22 recurrent and progressive after relieved pa-tients with myasthenia gravis who underwent thymectomy were retrospectively analyzed. The remission therapy was conducted with combined glucocorticoid and anticholinesterase and its effectiveness was estimated. Results It was 1,17,4 as better Osserman scale Ⅰ , Ⅱ , Ⅲ respectively before operation but 15,6,1 as better Osserman scale Ⅱ , Ⅲ, Ⅳ respectively in recurrence and progress of relieved myasthenia gravis after thymectomy besides 6 with myas-thenic crisis. Complete remission and partial remission were gained in 9 patients and 12 patients respectively. There was 1 hospital-death. Conclusions Recurrence and progress can occur in any patient of relieved myasthenia gravis after thymectomy. Bulbar myasthenia gravis is usually presented as dysphagia. Reasonable administration of glucocor-tieoid could improve majority of recurrence and progress of relieved myasthenia gravis after thymectomy but responses poorly to the anticholinesterases.
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Objective To study the effects of rehabilitation training on the expression of Nogo-A around the area of cerebral infraction using rats. Methods A total of 60 Wistar rats were randomly divided into a reha- bilitation group and a control group after an experimental cerebral infarction had been established in them. The ani- mals in the rehabilitation group were given exercise with a rotating bar, a balance beam and a rolling cage for one hour daily, while those in the control group were caged without any abnormal exercise. Nogo-A expression in the ar- ea surrounding the infarcts was detected by imunohistochemical techniques at the 3rd, 7th, 14th, 21st and 28th day after infarction. Meanwhile, neurobehavioral evaluations were also conducted. Results The animals in the rehabilitation group scored much lower than the controls in the behavioral evaluations at the 14th, 21st and 28th day. The expression of Nogo-A in tissues around the infracted area increased by the 7th day and peaked at the 21st day in both groups, but the expression of Nogo-A was significantly stronger in the rehabilitation group at the 14th, 21st and 28th days. Conclusion Rehabilitation training decreased the expression of Nogo-A in the brain of rats after infarction. This may have important implications for the functional recovery of the central nervous system.