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Objective To standardize an expert consensus on pulmonary rehabilitation nursing of chronic respiratory diseases. Methods On the basis of literature review, 5 experts were interviewed and 19 experts were consulted to establish the primary and secondary themes. 10 nursing experts in this field were invited to conduct peer review on the draft consensus to modify and improve the consensus content. Results After expert consultations，14 first-level themes and 40 second-level themes were established. The value of Ca (judgment coefficient),Cs (familiarity coefficient) and Cr (authority coefficient) were 0.895,0.839 and 0.867 ,which indicated the expert consultation have high authority and credibility. The Kendall coefficients of first-round expert consultation were 0.121 and 0.151, and they were 0.205 and 0.149 in the second round (P<0.05).In the first-round expert consultation, the coefficients of variation of the first and second themes were 0.197 and 0.200,and in the second round ,they were 0.202 and 0.237. They were all less than 0.25 , indicating that the expert's judgment results were relatively consistent. Conclusion As this consensus was developed based on 19 clinical nursing professionals from across the country, it is scientific and authoritative. This consensus can not only benefit to clinical nursing practice, but also lay the foundation for the development of guideline, and it still needs further theoretical and empirical research verification.
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OBJECTIVE Construct and validate the EGFR-CART (Epidermal growth factor receptor-chimeric antigen receptor T) cells targeting the Fadu cell line of hypopharyngeal squamous cell carcinoma, and provide the preclinical basis for the application of CART cell technology in hypopharyngeal squamous cell carcinoma. METHODS EGFR-CART cells and CART-control cells were constructed by lentivirus transfection. The expression of EGFR antibody in CART cells was detected by FACS fluorescence detection, and the expression of EGFR in Fadu cell line and HCT-116 cell line was verified. RESULTS EGFR-CART cells and CART-control cells were successfully constructed, the infection efficiency was about 67％, and there was no significant difference between the two groups in the distribution of cell subsets. HCT-116 is selected as the non target cells of EGFR-CART, Fadu as target cell. CONCLUSION In this study, we successfully prepared and validated the EGFR-CART cells targeting the Fadu cell line of hypopharyngeal squamous cell carcinoma, and laid the foundation for the application of CART technique in the treatment of hypopharyngeal carcinoma.
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Objective To explore the clinical features,diagnosis and treatment of ectopic thyroid lesions.Methods Retrospectively reviewed the clinical data of 15 patients with ectopic thyroid tissue from Oct.2002 to Jun 2017 in Beijing Tongren Hospital,Capital Medical University and Beijing Anzhen Hospital,Capital Medical University,and figured out the clinical features,therapy and prognosis.Among the 15 patients,there were 2 males and 13 females.There were 8 cases of lingual ectopic thyroid,3 cases of endotracheal ectopic thyroid,3 cases of thyroglossal duct ectopic thyroid,and 1 case of retropharyngeal ectopic thyroid.Follow-up were conducted during outpatient review or by telephone.Results Twelve patients received surgical treatment and the lesions were pathologically confirmed as ectopic thyroid tissue,including 2 cases of papillary thyroid carcinoma.These patients were followed up for 1 to 6 years.Their main symptoms were alleviated and the malignant patients had no recurrence or metastasis.Three patients with lingual ectopic thyroid selected observation and follow-up without any treatment and no progress was observed.Conclusions The incidence of ectopic thyroid is low and the forms are diverse.The clinician should take the possibility of ectopic thyroid and its associated pathological changes into account to avoid the complete removal of the only functional thyroid tissue without preparation.
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OBJECTIVE To study the effect of the free anterolateral thigh myocutaneous flap on the appearance and functions after maxillectomy.METHODS The clinical data of 5 patients with malignant maxillary tumors from June,2016 to June 2017 were analyzed retrospectively.The 5 cases were T3-4N0M0 lesions.All of them received the maxillectomy and then were reconstructed with the free anterolateral thigh myocutaneous flap,and the flap was about 1.25 times of the defect in volume.RESULTS The needed volumes for the reconstruction were from 165 ml to 225 ml and the operation time of reconstruction were between 80-95 minutes.All the free flaps survived after operation.Although the reconstructed side looked swelling obviously in the first month after surgery,the appearance became good and symmetrical after the radiotherapy.No diplopia occurred and the functions of breathing,swallowing and speaking were normal.No movement disorders happened caused by the donor of thigh flap.CONCLUSION The free anterolateral thigh myocutaneous flap as the reconstructive tissue has many merits.The volume is adequate and can be regulated according to the defect.The forward appearance is better than the free anterolateral thigh flap without muscles.So the reconstruction of free anterolateral thigh myocutaneous flap is an ideal material for reconstruction because of the good functions and being easy to operate.
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OBJECTIVE To evaluate the survival and functional outcomes of advanced laryngeal squamous cell carcinoma after modified supracricoid partial laryngectomy(SCPL).METHODS We selected 65 laryngeal cancer patients treated with modified supracricoid partial laryngectomy from 2002 to 2015 in our hospital.Among them,62 cases were males,3 cases were females with an age ranged from 35 to 80 years(median age 58 years)There were 26 cases with T2 stage,32 cases with T3 stage and 7 cases with T4 stage.We selected 120 laryngeal cancer patients treated with vertical partial laryngectomy at the same period as control.Then we evaluated the functional outcomes of modified supracricoid partial laryngectomy group compared with vertical partial hemilaryngectomy group.RESULTS The 5-year cumulative survival rate and decannulation rate were 82.3％ and 98.3％ for supracricoid laryngectomy group respectively.Decannulation ratewas 86.1％ for vertical partial hemilaryngectomy group(P＜0.05).However,there was no significant difference between supracricoid partial laryngectomy group and vertical partial laryngectomy group in pronunciation evaluation and abnormal deglutition.CONCLUSION Modified supracricoid partial laryngectomy is a good choice for local advanced laryngeal squamous cell carcinoma.
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Objective To acknowledge the quality of life (QOL) in patients after lung transplantation and to explore related factors. Methods A cross- sectional study design and a convenience sampling were performed in this research. Totally 30 patients after lung transplantation were investigated. The questionnaires which used to explore the quality of life were Short Form 36 Health Survey Questionnaires (SF-36) and Revised Airways Questionnaires 20 (AQ20-R). Related state were surveyed by questionnaires consisted of demographic questionnaires, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Medical Coping Mode Questionnaires (MCMQ). Statistical analysis was performed by SPSS 20.0 software. Correlation analysis and multivariate analysis were performed using Pearson linear correlation analysis and multi-linear regression. Results The scores among the 8 dimensions of SF-36 were(34.48±16.73)-( 71.63±22.83), lower than those of norms(Z=-9.684--2.817, P<0.05 or 0.01). Somatic pain scored the highest (71.63±22.83), while physiological function scored the lowest (34.48±16.73). The mean score of AQ20-R was 7.93±5.21. The major two problems that manifested QOL were: uncomfortable feeling of lung caused by strong scent, smog or perfume, exhausted feeling after having a cold. The mean scores of SAS and SDS were 44.33±9.33,48.05±9.80, higher than those of norms, which were 33.80 ± 5.90, 41.88 ± 10.57 (t=6.1833, 3.4458, P < 0.01). The scores among the 3 dimensions of MCMQ were 8.93 ± 2.08, 16.10 ± 2.28, 3.63 ± 1.33 and the differences were significant in 3 dimensions compared with those norms, which were 19.48±3.81, 14.44±2.97, 8.81±3.17(t=-27.7281, 3.9885,-21.3878, P<0.01). Conclusions In SF-36, role-physical of patients after lung transplantation was the worst dimension, while bodily pain was the best dimension of QOL. The QOL of patients after lung transplantation were almost worse than normal people. The related factors of QOL in patients after lung transplantation maybe:anxiety, depression and medical coping style.
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OBJECTIVE To explore t he significance of reducing the incidence rate of airway burn of CO2 laser laryngeal surgery by spreading the idea of grading prevention st rateg y. M ETHODS We retrospectively reviewed the data of laryngeal lesions treated by the endoscopic CO2 laser surgery from Feburary 1992 to December 2016. The period was divided into two stages, the first one is from Feburary 1992 to December 2008, and the second one is from January 2009 to December 2016. We will distinguish the difference of airway burn between the two stages. RESULTS Four cases of airway burn were found in the first stage including 3 cases of glottic cancer and 1 case of vocal cord polyp with Reink's edema. But no airway burn happened in the second stage. Two cases of endotracheal intubation cuff broken by laser were found promptly, but with FiO2 decreasing from 70% to 30%, wet gauze filling subglottic region and the endotracheal tube reserved, the laser surgery proceeded till airway burn happened. The endotracheal intubation cuffs of the remaining two cases kept intact intraoperatively, the FiO2 was 70% when airway burn happened. One case had the cervical tracheal stenosis with long-term tracheotomy, The other 3 cases had no postoperative complications. CONCLUSION The grading prevention strategy is helpful for reducing airway burn during the CO2 laser surgery of larynx.
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OBJECTIVE To explore the strategy of diagnosis and therapy of lingual ectopic thyroid(LET). METHODS We retrospectively reviewed the clinical data of6 cases of LET, and figured out the clinical features, imaging characteristics, therapy and prognosis.RESULTS 6 lingual ectopic thyroids were diagnosed by the Tc-99m thyroid static imaging; 3 cases accepted surgery, one only took oral levothyroxine, and one selected watch and see. 3 cases of lingual ectopic thyroid accepted the ectopic thyroid transposition and took oral levothyroxine postoperatively. Pharynx foreign body sensation and sleep snoring disappeared one month later. The lingual ectopic thyroid carcinoma resection was performed by direct laryngoscope in one case which was lost to follow up.CONCLUSION The thyroid static imaging is specific to the diagnosis of the LET. The indications of the surgery were obvious symptoms such as airway obstruction, snoring and pharyngeal foreign body sensation, and mass hemorrhage, cystic degeneration and carcinogenesis. The principle of therapy is to retain thyroid function as far as possible and comprehensive use of surgery, thyroid hormone replacement and iodine radiotherapy to improve symptoms, prevention and treatment of hypothyroidism.
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[ABSTRACT]OBJECTIVETo explore the efficacy and safety of localization for parathyroid glands with intravenous low dosage of methylene blue in thyroidectomy. METHODSWe retrospectively reviewed the clinical data of 41 patients who suffered from thyroid papillary carcinoma between Aug, 2014 and Jan, 2015 (9 males and 32 females, with a median age of 46 years). Thirty eight patients underwent primary thyroidectomy and 3 patients underwent second operation. A variety of thyroidectomy was performed in all patients, and who also underwent intravenous (3-4) mg/kg methylene blue in operation. RESULTSEighty four parathyroid glands were stained. Among 39 patients who's parathyroid glands were stained, the mean dyeing time was (31.27±9.41) min. Dyeing rates and dyeing time were not significantly different between 3 mg/kg group and 4 mg/kg group (t=0.24 and 0.20, all P>0.05). None of patients had the hypoparathyroidism problem such as peri-oral numbness, tingling, muscle aches and spasms. According to postoperative monitoring of parathyroid hormone, all of patients had no permanent hypofunction of the parathyroid gland. Neurotoxic effects and other serious side effects were not observed in all patients. CONCLUSIONIntravenous low-dose methylene blue in thyroidectomy is a safe, easy, and effective technique that facilitates rapid identification of parathyroid gland.
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[ABSTRACT]OBJECTIVETo observe the short term effects and adverse effects of induction chemotherapy with Paclitaxel,Cisplatin and Fluorouracil(TPF) in locally advanced squamous cell cancer of hypopharynx. METHODS78 cases locally advanced squamous-cell cancer of hypopharynx form jan 2011 to oct 2013 for the first time treated by TPF scheme,after 2 cycles,to recheck CT scan and evaluate therapeutic effective.RESULTSAll 78 cases patients achieved 156 cycles chemotherapy,CR was 4 cases (5.1%),PR 55 cases (70.5%),SD 17 cases (21.8%), PD 2 cases (2.6%). Total effective rate (CR+PR) was 75.6%,and with low incidence ofⅢ/Ⅳ grade side effect. Logistic regression analysis shows that there is a significant correlation between effective rate and low differentiation cancer.CONCLUSIONFor locally advanced squamous-cell cancer of hypopharynx patients,the TPF chemotherapy scheme showed good therapeutic effective and safety,could be a choice for the induction chemotherapy treatment in locally advanced squamouscell cancer of hypopharynx. The patients with low differentiation cancer may have benefit from the induction chemotherapy.
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OBJECTIVE To investigate the expression and clinical significance of epidermal growth factor receptor (EGFR), the mutations of gene EGFR, KRAS and BRAF in sinonasal intestinal-type adenocarcinomas. METHODS We investigated the EGFR protein expression by immunohistochemistry method with antibodies targeting the extracellular domain, the intracellular domain, and the phosphorylated isoform in a series of 11sinonasal intestinal-type adenocarcinomas tissues. EGFR, KRAS, and BRAF mutational status were detected by DNA direct sequencing and Melt curve method.RESULTS The findings were analyzed with respect to clinical data, histological typing, and outcome of the patients. EGFR was expressed in 72.7% tumors with a focal distribution with both extracellular domain and intracellular domain, which showed a significantly correlation. p-EGFR was expressed in 9.1% tumors. 9.1% tumors had the mutation of EGFR gene in exon 19, 9.1% tumors had the mutation in exon 2 and exon 15 of gene KRAS and BRAF respectively. There was no association between these molecular features and the survival period of the patients. CONCLUSION The current study revealed various EGFR expression patterns in sinonasal intestinal-type adenocarcinomas, that indicated the tumor heterogeneity. Sinonasal intestinal-type adenocarcinomas share common alterations of the EGFR pathway as the mutation of EGFR, KRAS and BRAF genes, but with a lower frequency.
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<p><b>OBJECTIVE</b>To explore the feasibility and effect of CO2 laser surgery for early glottic carcinoma with anterior commissure involvement.</p><p><b>METHODS</b>Twenty-seven patients with T1b glottic squamous cell carcinoma who underwent transoral CO2 laser surgery as the primary modality of treatment from January 2008 to August 2013 were reviewed. All patients were males and the age ranged from 46 to 81 years old. The patients did not receive any other treatments. Preoperative enhanced CT scan was performed to assess the status of the tumors and the lamina of thyroid cartilage. All the patients without the lamina of thyroid cartilage involved underwent transoral CO2 laser surgery.</p><p><b>RESULTS</b>Among 27 cases, aside from 1 patient converted to open operation due to inadequate exposure, 26 patients were successfully implemented operation. All the patients were followed-up for 12 to 60 months (median 26 months) and no recurrence. Granulation occurred four to six weeks after operation in all patients. Among them, granulation disappeared automatically three to six months in 22 patients and was resected with local anesthesia in other 4 patients, which the pathological results were inflammatory lesion. All patients did not undergo tracheotomy and nasogastric feeding, with an average stay of three days in hospital after surgery, and had different degree of vocal cord adhesion 6 months later.</p><p><b>CONCLUSIONS</b>Transoral CO2 laser surgery is an ideal procedure for early glottic carcinoma with anterior commissure involvement. Better preoperative evaluation, endoscopic technique and satisfied exposure are keys to the success of operation.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Carcinoma, Squamous Cell , Therapeutics , Endoscopy , Glottis , Head and Neck Neoplasms , Therapeutics , Laryngeal Neoplasms , Therapeutics , Laser Therapy , Neoplasm Recurrence, Local , Thyroid Cartilage , Vocal CordsABSTRACT
Objective To comprehensively analyze of risk factors for the incidence of pulmonary embolism,and provide the basis for the prevention of clinical decision-making.Methods Using Meta-analysis to find out the domestic risk factors of pulmonary embolism with a comprehensive analysis of the quantitative method,and RevMan 5.2 and Stata 12.0 software were used for statistical analysis.Results A total of 11 research literature was included,with a total sample size of 1 459 cases,including DVT,cancer,operation history within 6 weeks,long-term bedridden ≥ 7 d and COPD which were associated with pulmonary embolism,the pooled odd rate (95％ CI) were 10.41 (4.54,23.87),6.79 (2.37,19.43),2.63 (1.12,6.19),3.48 (1.15,10.58),2.36 (1.45,3.84).It could not be certain that past history of thrombosis and smoking history were related to pulmonary embolism,their pooled OR (95％ CI) were 2.06 (0.80,5.33),1.57 (0.87,2.82).Conclusions Bedridden ≥ 7 d,cancer,DVT,operation history within 6 weeks and COPD are major risk factors for incidence of pulmonary embolism.Pulmonary embolism in high-risk groups should be dealt with early intervention.
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OBJECTIVE@#To study the definition, etiology, diagnosis, treatment and prognosis in patients with multiple primary malignant tumor of upper aerodigestive tract cancer and thyroid cancer.@*METHOD@#Retrospectively analyze the events of 7 cases with multiple primary malignant tumors of upper aerodigestive tract cancer and thyroid cancer.@*RESULT@#Lesions of upper aerodigestive tract cancer and thyroid cancer located on the same side. After 4 to 8 years of follow-up, 2 cases of hypopharyngeal cancer and thyroid cancer got poor prognosis, prognosis of other patients with early stage laryngeal cancer and thyroid cancer is better.@*CONCLUSION@#The prognosis of multiple primary malignant tumors in patients with upper aerodigestive tract cancer and thyroid cancer depends on the biological behavior of aerodigestive tract cancer.
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Aged , Female , Humans , Male , Middle Aged , Follow-Up Studies , Neoplasms, Multiple Primary , Prognosis , Retrospective Studies , Thyroid NeoplasmsABSTRACT
Objective To investigate the possibility of chest approach gasless endoscopic surgery for the parathy-roid tumor. Methods Through a 2 cm incision on the surface of chest bone, a gasless procedure was developed to management of parathyroid tumor in our department. There were 2 cases of the parathyroid cyst-adenoma were dis-sected. Results 2 cases were successfully performed, and there were no paralyze of the revers laryngeal nerve and hypofunction of parathyroid could be observed. The cosmic and mini-invasive results were obtained. Conclusion Chest approach gasless endoscopic surgery for parathyroid tumor is a safe, mini-invasive, and cosmic procedure for selected patients.
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OBJECTIVE To study the application of transcervical approach for benign parapharyngeal space tumors.METHODS The clinical data of 19 patients(20 operations) with benign parapharyngeal space tumors were analyzed retrospectively.RESULTS The 19 patients with benign parapharyngeal tumors were operated on in Tongren Hospital from July 2004 to July 2007.All patients were operated on through trans-cervical approach under general anesthesia.They were followed up from 6 to 36 months.Recurrence was found in a girl 15 months after operation,and was reoperated on by the same approach.No complications occurred.CONCLUSION The patients with parapharyngeal space tumors must be carefully studied by CT or/and MRI scan.If a clear tumor capsule is identified,the tumor can be removed through transcervical approach.Transcervical approach is a useful approach with least damage,and nearly all benign tumors of parapharyngeal space can be removed through it.
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OBJECTIVE To understand the function of MMP-2 and TIMP-2 and the relationship among expression of MMP-2, TIMP-2 and microvessel density in laryngeal carcinomas. METHODS The expression of MMP-2, TIMP-2 and CD34 in 37 laryngeal carcinomas patients were studied with immunohistochemical staining. The staining results were studied morphometrically with computer image analysis. RESULTS The mean values of MMP-2 expression and microvessel density (MVD) in squamous cell carcinoma group with lymph node metastasis were significantly higher than that without lymph node metastasis (P
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OBJECTIVE To investigate the diagnostic and prognostic value of molecular biological detection of DTC in peripheral blood. METHODS 32 cases of laryngeal or laryngopharyngeal carcinoma were investigated. DTC in peripheral blood was detected by nested reverse transcription polymerase chain reaction,using CK19mRNA as the marker. RESULTS In the RT-PCR study,15 of 32 cases (46.9 %) showed a positive result. Ten of the 25 cases (40 %) of laryngeal carcinoma were positive. Fix of the remaining 7 cases (71.4 %) of laryngopharyngeal carcinoma were positive. All controls were negative. Of the 20 cases without lymph node metastasis,6 were positive; of the 12 cases with lymph node metastasis,9 were positive. The positive rate of the group with lymph node metastasis was higher than that of the group without lymph node involvement(P