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Objective:To investigate the prevalence of malnutrition in elderly patients with neurological diseases and the of nutrition, and to explore their association with clinical outcomes.Methods:A retrospective study was conducted to analyze 566 elderly patients with neurological diseases in the database of the "National Multicenter Survey on the Dynamic Changes of Nutritional Status of Hospitalized Patients" by using the Global leadership Initiative on Malnutrition(GLIM)criteria and subjective global assessment(SGA). The two diagnostic tools for malnutrition were compared to explore the correlation between malnutrition and clinical outcomes.Results:Based on the GLIM criteria, 83 cases were diagnosed with malnutrition and the incidence of malnutrition was 14.66%(83/566), with 14.72%(48/326)in men and 14.58%(35/240)in women.Patients with moderate malnutrition accounted for 8.30%(47/566)and patients with severe malnutrition accounted for 6.36%(36/566). According to the SGA, the incidence of moderate malnutrition(SGA Grade B)was 15.55%(88/566), the incidence of severe malnutrition(SGA Grade C)was 1.94%(11/566), and all cases of malnutrition(SGA Grade B+ C)accounted for 17.49% of the participants(99/566). The total length of hospital stay was(15.46±6.49)days in the malnutrition group and(13.55±5.09)days in the non-malnutrition group, with a statistical difference between the two groups( t=-3.02, P<0.01). The body weight of the malnutrition group was significantly lower than non-malnutrition group[(52.0±8.5)kg vs.(65.2±9.6)kg, t=12.92, P<0.01]. There were also statistically significant differences in BMI(19.1±2.7 kg/m 2vs.23.9±2.6 kg/m 2, t=15.48, P<0.01), upper arm circumference[(22.3±2.5)cm vs.(28.3±3.9)cm, t=7.01, P<0.01], and lower leg circumference[(28.9±3.4)cm vs.(32.5±3.3)cm, t=6.81, P<0.01]between the two groups.Laboratory tests showed that there were significant differences in lymphocytes[(5.0±8.5)×10 9/L vs.(9.4±11.8)×10 9/L, t=3.61, P<0.01]and albumin[(38.5±4.4)g/L vs.(40.7±5.1)g/L, t=3.18, P<0.01]between the malnutrition group and the non-malnutrition group.The correlation between GLIM and SGA was good, and the consistency was reasonable(AUC=0.711). Conclusions:The incidence of malnutrition in elderly patients with neurological diseases is relatively high; The GLIM criteria are suitable for the diagnosis of malnutrition in elderly patients with neurological diseases, and the diagnostic results have a good correlation with those of SGA.Malnutrition is associated with anthropometric measurements, laboratory indicators, and clinical outcomes.
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Objective:To study the association of frailty status with nutritional risk and the effect on clinical outcomes among elderly surgical inpatients.Methods:Elderly inpatients from the surgery department of Beijing Hospital were enrolled from January to June 2021. Frail scale and nutritional risk screening 2002 (NRS 2002) were used for frailty evaluation and nutrition risk screening. The influence of frailty and associated nutrition risk in elderly surgical inpatients was analyzed.Results:487 elderly surgical patients were included, of whom 131 cases were in the non-frailty group, 279 cases were in the pre-frailty group and 77 cases were in the frailty group, according to the Frail scale score. 146 cases were at nutritional risk, of whom 8 (6.1% of 131) were in the non-frailty group, 87 (31.2% of 279) in the pre-frailty group and 51 (66.2% of 77) were in the frailty group. According to univariate/multivariate logistic regression analysis of frailty in elderly surgical patients, a higher NRS 2002 score, older age, and the presence of multiple concurrent diseases (≥ 5) were significantly associated with frailty ( P < 0.001). The Frail scale score was positively correlated with NRS 2002 score ( r = 0.448, P < 0.01). Multiple comparisons showed that frailty had statistically significant effects on hospital stay and medical costs in elderly surgical patients ( P < 0.05). Conclusions:The prevalence of frailty is higher in elderly surgical patients, and the prevalence of nutritional risk increases with the progression of frailty. Frailty can lead to prolonged hospital stays and increased hospital costs in elderly surgical patients.
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Most hospitalized patients infected with coronavirus disease 2019 (COVID-19) are in severe or critical condition, and malnutrition is a key factor contributing to adverse outcomes. The basic principles of medical nutrition therapy have been determined in the recently released tenth edition of the National Diagnosis and Treatment Protocol. The principles have promoted nutritional risk assessment, emphasized the preferred method of enteral nutrition, and recommended the daily intake of calories at 25 to 30 kcal/kg and protein at > 1.2g/kg. Parenteral nutrition should be also added when necessary. Based on the above principles, Beijing Hospital has refined the medical nutrition therapy measures to facilitate the implementation in clinical practice, in order to improve healthcare quality and decrease the mortality in COVID-19 patients.
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Objective:To investigate the prevalence of malnutrition in hospitalized patients with lung cancer in China using the global leadership initiative on malnutrition (GLIM) criteria.Methods:A retrospective analysis was performed with 623 lung cancer patients selected from the national multi-center prospective investigation database in 2014. The diagnosis of malnutrition was according to GLIM criteria with muscle mass reduction not included. The prevalence of malnutrition in patients with lung cancer was investigated and the correlation between malnutrition diagnosis per GLIM criteria and anthropometry as well as laboratory indexes was explored.Results:Among the 623 lung cancer patients, 33.5% (209) were at nutritional risk as per Nutritional Risk Screening 2002, 17.8% (111) were malnourished as per GLIM criteria. There were significant differences in age, body weight, body mass index, arm circumference, leg circumference, grip strength, hemoglobin, albumin, total protein and prealbumin between malnutrition and non-malnutrition groups as diagnosed with GLIM criteria ( P<0.05). Conclusions:The nutritional risk and malnutrition prevalence in lung cancer patients are relatively high. The nutritional risk screening of lung cancer patients should be standardized and the GLIM criteria can be used for the diagnosis of malnutrition.
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Objective:To summarize the surgical treatment experience of extended thymectomy for myasthenia gravis(MG), and to explore the surgical treatment of MG.Methods:Retrospectively analyzed the clinical data of 527 MG patients undergoing extended thymectomy in our hospital from June 1996 to October 2017, including 242 males and 285 females, aged 5 to 77 years, with a mean age of(52.6±13.7) years old. The course of illness was 12 days to 18 years. There were 22 cases of hyperthyroidism, 7 cases of pure red blood cell aplastic anemia, 1 case each of hypothyroidism, irritable bowel disease, rheumatoid arthritis, ankylosing spondylitis and thrombocytopenia syndrome. There were 272 cases of MG in Osserman Ⅰ, 72 cases inⅡa, 78 cases inⅡb, 81 cases in Ⅲ, and 24 cases in Ⅳ, respectively. The muscle fatigue test and neostigmine test of all patients were positive, and the diagnosis was confirmed by chest CT examination. Meanwhile, summarize the perioperative data and postoperative follow-up.Results:3 cases died during the postoperative period, all of which were thymoma with MG, including 2 cases of Osserman Ⅲ MG and 1 case of Ⅳ MG; 15 cases of postoperative myasthenia crisis, including 2 OssermanⅡb cases, 11 Osserman Ⅲ cases and 2 Osserman Ⅳ cases, also including 7 cases of tracheotomy; 70 cases of plasma exchange, of whom 2 cases of hypotonic syndrome and 2 cases of lower extremity venous thrombosis. The postoperative pathological types were followed by thymic hyperplasia 293 cases(55.60%), thymoma 207 cases(39.28%), thymic cyst 24 cases(4.55%) and thymic atrophy 3 cases(0.57%) in descending order. 378 cases were followed up with an average follow-up of(85.9±58.5)months; MG with complete remission, partial remission, no change and deterioration accounted for 135(35.71%), 192(50.79%), 41(10.85%) and 10(2.65%)cases, respectively. Complete remission rate ranked as Osserman typeⅠ>Ⅱa>Ⅳ>Ⅱb>Ⅲ, the deterioration rate from high to low was Osserman type Ⅲ>Ⅳ>Ⅰ. 18 OssermanⅠcases showed no effects, whose preoperative course of disease> 5-10 years; 1 OssermanⅠcase was worsening who initially was diagnosed with ophthalmic MG and underwent video-assisted thoracoscopic thymectomy. The left thymus lobe was left unresected and developed 6 years later. Another operation was performed to remove the left lobe thymus, confirming the compensatory hypertrophy of the left lobe thymus. Among the worsening patients, 6 died, all of them were thymoma with MG, including 5 cases of type Ⅲ and one case of type Ⅳ. The cause of death was omyasthenia crisis(3 cases), sudden respiratory arrest after 3 months of rapid stopping of brompistigmine(2 cases)and cholinergic crisis(1 case).Conclusion:Standardized extended thymectomy is an effective method for the treatment of MG. Earlier surgery for ocular muscle type MG can effectively reduce the risk of generalization. MG with Osserman Ⅱb or higher is prone to myasthenia crisis. Comprehensive treatments should be taken to reduce MG-related risks. Myasthenia crisis can occur repeatedly in severe patients in the long term after surgery, requiring regular medication and comprehensive MG treatments.
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Objective:To analyze the correlation among nutritional status, sarcopenia and frailty in elderly inpatients with chronic cardiovascular disease.Methods:A cross-sectional study was conducted in a total of 147 patients aged 65-88 years old who were hospitalized for chronic cardiovascular disease between September 2018 and February 2019. Nutritional status was assessed by mini nutritional assessment short form (MNA-SF), frailty by FRAIL scale and sarcopenia by criteria from Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. The prevalence and overlapping prevalence of nutritional status, frailty and sarcopenia were analyzed, as well as the influence of nutritional status on frailty and sarcopenia.Results:The mean age was 74.45 (range: 65-88). The prevalence was 25.9% (38/147) for risk of malnutrition, 1.4% (2/147) for malnutrition, 37.4% (55/147) for risk of sarcopenia, 6.8% (10/147) for sarcopenia, 55.8% (82/147) for pre-frailty and 10.2% (15/147) for frailty. When stratified by disease, the subgroup with chronic heart failure showed the highest prevalence of malnutrition risk, sarcopenia risk, sarcopenia and frailty (66.7%, 50%, 16.7% and 50.0%, respectively). The prevalence of sarcopenia risk and sarcopenia increased with age. Age was negatively correlated with calf circumference ( r = -0.219, P = 0.008), grip strength ( r = -0.307, P < 0.01) and walking speed ( r = -0.390, P < 0.01) and was positively correlated with the five times sit-to-stand test time ( r = 0.406, P < 0.01). The prevalence of frailty also increased with age and age was positively correlated with the FRAIL score ( r = 0.232, P = 0.005). As for stratification based on BMI, the majority (63.9%) patients were overweight or obese (BMI ≥ 24.0) and the prevalence of malnutrition risk in this subgroup was 20.2% (19/94). The prevalence of malnutrition risk in patients with normal BMI was 32.0% (16/50). The subgroup with BMI < 18.5 were either at malnutrition risk or with malnutrition. MNA-SF score was positively correlated with BMI ( r = 0.334, P < 0.01). The prevalence of sarcopenia risk and sarcopenia in patients with BMI ≥ 24.0 kg/m 2 was 23.4% (22/94) and 2.1% (2/94), that in normal BMI subgroup was 62.0% (31/50) and 14.0% (7/50), and that in BMI < 18.5 subgroup was 66.7% (2/3) and 33.3% (1/3). BMI was positively correlated with calf circumference ( r = 0.659, P < 0.01) and ASMI ( r = 0.367, P < 0.01). The overlapping prevalence of sarcopenia risk/sarcopenia and malnutrition risk/malnutrition was 13.6% (20/147), that of pre-frailty/frailty and malnutrition risk/malnutrition was 21.8% (32/147), and that of sarcopenia risk/sarcopenia and pre-frailty/frailty was 26.5% (39/147). The overlapping prevalence of sarcopenia risk/sarcopenia, malnutrition risk/malnutrition and pre-frailty/frailty was 10.9% (16/147). MNA-SF score was negatively correlated with FRAIL score ( r = -0.316, P < 0.01). The prevalence of pre-frailty/frailty in the malnutrition risk/malnutrition group was higher than that in the subgroup with normal nutritional status (80.0% vs. 60.7%, χ 2 = 4.808, P = 0.028). The prevalence of sarcopenia risk/sarcopenia in the malnutrition risk/malnutrition group tended to be higher than that in the subgroup with normal nutritional status (50.0% vs. 33.6%, χ 2 = 3.302, P = 0.069). Logistic regression analysis showed that the risk of pre-frailty/frailty was 2.585 (95% CI: 1.087 to 6.147) times higher in the malnutrition risk/malnutrition group. Conclusions:The prevalence and overlapping prevalence of malnutrition risk, pre-frailty and sarcopenia risk was high in the elderly inpatients hospitalized for chronic cardiovascular disease. Patients with malnutrition risk/malnutrition had a higher incidence of pre-frailty/frailty and required close attention.
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Objective:To retrospectively investigate the incidence of malnutrition in patients with gastric cancer in China, and to explore the applicability of Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria.Methods:Data were extracted from National Multi-center Investigation and Study on Dynamic Changes of Nutritional Status of Inpatients database led by Geriatric Nutrition Support Group of the Chinese Society of Parenteral and Enteral Nutrition. A retrospective analysis in patients with gastric cancer was conducted. Involuntary weight loss, low body mass index (BMI) and muscle mass loss were adopted as phenotypic indicators in GLIM criteria for malnutrition diagnosis and the application of GLIM criteria for malnutrition diagnosis in patients with gastric cancer was evaluated.Results:In a total of 563 gastric cancer patients, 203 cases were diagnosed with malnutrition per GLIM criteria and 193 cases without malnutrition were identified as control using 1:1 propensity score matching. There were significant differences in body weight, BMI, right calf circumference, right hand grip strength, total cholesterol, hemoglobin, albumin and total protein between malnutrition group and non-malnutrition group ( P < 0.05). After muscle mass loss was removed from the phenotype indicators in GLIM criteria, the hospitalization duration in patients with malnutrition was (16.15±7.04) days compared with (14.28±6.70) days in patients without malnutrition, demonstrating statistically significant difference ( χ2= 0.442, P = 0.007). Conclusions:Gastric cancer patients showed high incidence of malnutrition. The cut-off value of calf circumference reported in foreign populations may be unsuitable to apply in Chinese population. Further clinical researches are needed to determine the optimal cut-off calf circumference value for Chinese individuals.
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Intestinal barrier function impairment can lead to bacterial and toxin translocation in critically ill patients and is an important factor in gut-derived infections and even multiple organ failure. Early enteral nutrition (EEN) can nourish the intestine, prevent bacterial translocation, effectively maintain intestinal barrier function and immune function and provide metabolic substrates for the body, bringing clinical benefits. For critically ill patients such as those with severe acute pancreatitis, severe burns and severe traumatic brain injury and those after major abdominal surgery, there is evidence-based proof supporting EEN while in patients with uncontrolled shock and severe hypoxemia and acidosis, the initiation of EEN should be delayed. EEN in critically ill patients can be applied orally or through nasogastric tube. Dietary fiber-free intact protein preparations are recommended at initiation and administration via continuous pumping can improve EEN gastrointestinal tolerability.
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Objective:To analyze the relationship between nutritional status and frailty among elderly inpatients from cardiology department.Methods:A cross-sectional study was conducted in a total of 519 patients aged 65-92 years old who were admitted to cardiology department between September 2018 and February 2019. Mini nutritional assessment short form (MNA-SF) was used to assess the nutritional status. Fried phenotype was used to assess frailty status. The nutritional status and frailty in patients with different diseases, age and body mass index were analyzed, as well as the nutritional status of patients in different frailty strata.Results:The mean age was 75.12 years (range: 65-92 years). The prevalence of malnutrition risk was 28.9% (150/519), malnutrition 3.3% (17/519) and frailty 23.5% (122/519). When stratified by disease, the subgroup with chronic heart failure showed the highest prevalence of malnutrition and frailty (63.6% and 50.0%, respectively). The prevalence of malnutrition risk (22.8%, 35.5%), malnutrition (3.0%, 3.6%) and frailty (15.3%, 32.3%) were higher in patients ≥ 75 years compared with those aged 65 years - 75 years. MNA-SF score was negatively correlated with age( r = -0.134, P = 0.002). Fried phenotype score was positively correlated with age ( r = 0.319, P < 0.01). As for stratification based on BMI, the majority (62.6%) patients were overweight or obese (BMI ≥ 24.0 kg/m 2) and the prevalence of malnutrition risk in this subgroup was 21.2% (69/325). The prevalence of malnutrition risk in patients with normal BMI was 38.7% (70/181). The subgroup with BMI<18.5 were either at malnutrition risk or with malnutrition. MNA-SF score was positively correlated with BMI ( r = 0.353, P < 0.01). There was no significant difference in the prevalence of pre-frailty and frailty among different BMI groups. The prevalence of malnutrition was the highest in the frailty group (8.2%), followed by the pre-frailty group (2.0%). Fried phenotype score was negatively correlated with MNA-SF score( r = -0.291, P < 0.01). Logistic regression analysis showed that frailty was an independent risk factor for malnutrition, and the risk of malnutrition in frailty patients was 4.818 (95% CI:1.701～13.644) times higher than that in non-frailty patients. Conclusions:The prevalence of malnutrition risk and frailty was high in the elderly inpatients from cardiology department. Frailty patients had a higher incidence of malnutrition and required more attention.
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Objective:To investigate the prevalence of malnutrition in hospitalized elderly patients with cancer in China using the Global Leadership Initiative on Malnutrition (GLIM) criteria.Methods:The data of 854 elderly cancer patients were extracted from the database of multi-center investigation and research on the dynamic changes of nutritional status of hospitalized patients in China led by the Geriatric Nutritional Support Group of Chinese Society of Parenteral and Enteral Nutrition. Changes in anthropometrics, nutritional risk and malnutrition prevalence from admission were collected at discharge and were compared among patients with different cancer types.Results:The prevalence of nutritional risk (NRS 2002 score ≥ 3 points) and malnutrition diagnosed per GLIM criteria were 63.23% and 42.74% at admission, and 69.44% and 42.86% at discharge. When further graded, prevalence of moderate malnutrition decreased from 24.12% at admission to 10.07% at discharge, and that of severe malnutrition increased from 18.62% to 32.79%, both with statistical significance. There were significant differences in anthropometric and laboratory parameters between malnutrition and non-malnutrition groups diagnosed per GLIM criteria.Conclusions:The GLIM criteria is applicable for the diagnosis of malnutrition in elderly cancer patients. Elderly cancer patients should be screened for nutritional risk, and GLIM criteria can be used to diagnose malnutrition. The changes of nutritional status should be dynamically monitored during hospitalization
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The purpose of value-based healthcare is to effectively control medical costs on the basis of comprehensively improved healthcare quality, which is the key focus of medical system reform in China. Improving information system framework, establishing scientific evaluation methods and transforming medical insurance payment methods are the impetus for value-based healthcare practice in China. "Screening, assessment and intervention" is the critical step in standardized medical nutrition management. In line with the connotation of value-based healthcare, nutritional risk screening aims to improve clinical outcomes. The diagnosis of malnutrition per the Global Leadership Initiative on Malnutrition (GLIM) criteria enables the inclusion into Diagnosis Related Groups (DRGs). Oral nutritional supplement is the preferred medical nutrition treatment for patients at nutritional risk or with malnutrition and insufficient food intake. Standardized application can reduce weight loss, improve clinical outcomes, save medical costs and improve the health and survival of malnourished elderly patients at a lower cost, exemplifying the value-based healthcare model.
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In recent years, enteral and parenteral nutrition has seen vigorous development, and relevant diagnosis and treatment system in clinical nutrition has been further improved. The updates of nutrition guidelines and consensus for different disease categories and different populations are conducive to guiding the comprehensive development of clinical diagnosis and treatment. With the focus on "medical nutrition, standardization and innovation", here we presented the latest progress on clinical nutrition under diverse clinical settings, including neurology, hepatology, nephrology, geriatrics, surgery, oncology, pediatrics, pharmacy, etc., comprehensively covering the basic research, clinical research, the latest guideline consensus, treatment strategy, disease management and other perspectives.
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The clinical treatment of locally advanced thymic epithelial tumors still faces many challenges, a multidisciplinary treatment model based on surgery is the main treatment method. In recent years, the surgical treatment of locally advanced thymic epithelial tumors has progressed rapidly, especially in the field of minimally invasive treatment. But controversies still exist and there are concepts needed to be clarified and principles to abide by. This article focuses on current status and recent progress in diagnosis and treatments of locally advanced thymic epithelial tumors.
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Alanyl-glutamine dipeptide is an important component in parenteral nutrition, which can be decomposed into alanine and L-glutamine in vivo. It plays multiple functions including maintaining intestinal barrier, improving immunity, promoting protein synthesis, and regulating the production and release of inflammatory mediators. Substantial clinical evidences have demonstrated its favorable effectiveness and safety. Rational application of alanyl-glutamine dipeptide can reduce postoperative complications, shorten hospital stay and save medical costs. There are still controversies at home and abroad on the applicable population and dosage of alanyl-glutamine dipeptide. Chinese Society of Parenteral and Enteral Nutrition organized China's experts of related disciplines to compile international standards in accordance with the latest guidelines and consensus, so as to achieve the goal of standardized application and patient benefits.
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Objective@#To investigate the prevalence of witnessing domestic violence,and to explore the relationship between witness domestic violence in childhood and college students’ injury and violence behaviors.@*Methods@#In October 2018, self-made questionnaire on “Health and Risky Behaviors among University Students in Anhui Province” was conducted among 4 034 college students from 4 universities in Hefei. Multivariate Logistic regression models (control of confounding factors) were used to explore the impact of childhood witnessing domestic violence on college students’ injury and violence.@*Results@#Among 4 034 college students,the prevalence of witnessing domestic emotional violence,mild physical violence and severe physical violence in childhood was 27.6%,22.4%,10.7%,respectively. Univariate analysis showed that students with experiences of witness domestic emotional violence,mild physical violence and severe physical violence had higher rates of self-injury,physical,emotional,and sexual violence compared to those without domestic violence witness(P<0.05). Multivariate Logistic regression analysis showed that witnessing domestic severe physical violence,emotional violence in childhood associated positively with self-harm (OR=1.53,95%CI=1.05-2.23; OR=2.15,95%CI=1.51-3.04) and emotional violence (OR=1.65,95%CI=1.16-2.35; OR=2.57,95%CI=1.87-3.53). Witnessing domestic severe physical violence showed positive association with physical violence (OR=4.99,95%CI=2.58-9.62) and sexual violence (OR=8.68,95%CI=3.30-22.81) among college students (P<0.05).@*Conclusion@#The experiences of witness domestic violence can increases the risk of college student’s injury and violence behaviors,especially witness domestic severe physical violence.
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Objective@#To explore the effects of precollege peer bullying at different stages, on quality of life (QOL) among college students.@*Methods@#A stratified cluster sampling method was used to select participants in October, 2018. Cluster sampling method was adopted to recruit a sample of 4 034 college students from four universities in Hefei city, Anhui province. Relations between peer bullying at different stages before entering college, and the quality of life, were investigated. t test and analysis of variance were used to compare the differences of QOL in different groups. Multiple linear regression models were used to assess the associations between various types of peer bullying at different stages and the QOL at precollege days.@*Results@#Among all the 4 034 college students under study, mean scores of the 4 dimensions of QOL appeared as physical (12.61±2.02), psychological (14.09±2.62), social relationship (13.72±2.71) and environment (13.77±2.46), respectively. After adjusting the confounding factors, data from multiple linear regression showed that, factors as verbal bullying victimization during primary school (β=-0.21)/secondary school (β=-0.27)/or at both periods (β=-0.56), relational (β=-0.21) and physical (β=-0.38) bullying victimization in secondary school, and physical bullying victimization in both periods (β=-0.67) were negatively correlated with the physical dimension of QOL. Verbal bullying victimization in both periods (β=-0.41) and relational bullying victimization in secondary school (β=-0.42) were negatively correlated with psychological dimension of QOL. Factors as relational (β=-0.32) and physical (β=-0.51) bullying victimization in secondary school, physical/cyber bullying victimization in both periods (β=-0.57) were negatively correlated with the social dimension of QOL. Verbal bullying victimization during primary school (β=-0.20) and both periods (β=-0.46), relational bullying perpetration during primary school (β=-0.35) or at both periods (β=-0.90) were negatively correlated with the environmental dimension of QOL (All P<0.05). Index related to bullying victimization (β=-0.33, -0.36, -0.30, -0.33) and bullying perpetration β=-0.28, -0.31, -0.23, -0.28) were both negatively correlated to all the 4 dimensions (physical, psychological, social relationship and environment) of QOL (P<0.001).@*Conclusions@#Various forms of peer bullying experiences occurring before college, were associated with the decreased scores of QOL in different domains, among the university students. Programs on prevention and control of peer bullying in different stages before college days seemed important thus should be strengthened.
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To investigate the clinical efficacy of extended thymectomy by subxiphoid approach video-assisted thoracoscopic surgery(VATS) for myasthenia gravis. Methods We retrospectively analyzed the clinical date of 64 cases of myasthenia gravis treated by subxiphoid approach VATS in the same surgical team from September 2015 to April 2018. The patients were equally divided into 4 groups(A, B, C and D) according to the date of operation. Comparisons were made among the four groups in operation time, blood loss during operation, rate of conversion to thoracotomy, postoperative complications, postoperative hospital stay, duration and amount of postoperative chest tube drainage, frequenlly of surgery. The operative effect of different stage was analyzed. Results There were no intraoperative deaths. 1 patient(group A) was converted to thoracotomy. 3 patients(2 cases of group A; 1 case of group D) had lung infection. 1 patient(group B) developed myasthenia crisis after surgery, and the rest patients showed obvious improvement in postoperative myasthenia symptoms. No significant differences were found in postoperative complications, rate of conversion to thoracotomy, postoperative hospital stay, duration and amount of postoperative chest tube drainage among the 4 groups(P >0. 05). The operation time was significantly longer in group A(186. 25 ± 25. 79) min than the other 3 groups [B(128. 75 ± 16. 28) min, C(135. 00 ± 21. 29) min, D(128. 75 ± 19. 62)min], P <0. 05. The blood loss in surgery was significsntly more in group A(110. 00 ±38. 82)ml than that in the other 3 groups[B(63. 75 ±28. 26)ml, C(58. 13 ±27. 86)ml, D(58. 75 ±25. 00)ml], P <0. 05, while no statistical difference was found among group B, C and D. The frequency of surgery was increased from 1. 6 cases in group A to 2. 3, 2. 7 and 2. 7 cases one month in B, C and D, respectively. Conclusion The results of the present study have shown that subxiphoid approach VATS thymectomy is safe and feasible for the treatment of MG patients. For thoracic surgeons with certain experience in thoracoscopic technique, a plateau of the surgical skill of the subxiphoid opproach can be reached after learning curve procedures.
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Objective To develop a standard and procedural protocol for the perioperative management of thymectomy for myasthenia gravis(MG) patients and thus to reduce the incidence of MG crisis.Methods From June 1996 to March 2016,466 MG cases received thymectomy we continuously explored key technologies of surgical treatment for MG 466 patients,there were 209 male cases and 259 female cases,with age ranging from 5 to 77 years and chief complaint history ranging from 12 days to 18 years.Symptoms included drooping eyelids,double vision,weakness,shortness of breath,coughing,dysarthria,and difficulties in swallowing and chewing.According to the modified Osserman classification,there were 248 type Ⅰ MG cases,58 type Ⅱa MG cases,66 type Ⅱb MG cases,71 type Ⅲ MG cases,and 23 type Ⅳ MG cases respectively.116 cases received thymecotomy via full sternotomy,204 cases via J type semi-sternotomy,and 146 case via thoracoscopy (including 13 cases via sub-xiphoid approach).Results Perioperatively one case died of sudden death,another patient died of respiratory failure after the second operation for metastatic thymoma,with a mortality rate of 0.42％ (2/466);13 cases had M G crisis (13/466);Six cases underwent tracheotomy (6/466);2 cases had plasmapheresis hypotonic syndrome (accounting for 3.4％ in plasmapheresis cases) and were reoperated to stop bleeding.Postoperatively pathological diagnosis was made,including three thymic atrophy cases,272 thymic hyperplasia cases,178 thymoma cases,and 13 thymic cyst cases.Conclusion A standard and procedural protocol for the perioperative management of thymectomy for MG patients can be developed,which can reduce the morbidity of MG crisis and the incidence of tracheotomy.