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A mixed drug self-delivery system(DSDS)with high drug content(＞50％)was developed to regulate pH-triggered drug release,based on two doxorubicin(DOX)-DOX dimmers:D-DOXADH and D-DOXcar con-jugated with acid-labile dynamic covalent bonds(hydrazone and carbamate,respectively)and stabilized with PEGylated D-DOXADH(D-DOXADH-PEG).Owing to the different stability of the dynamic covalent bonds in the two dimers and the noncovalent interaction between them,pH-triggered drug release could be easily regulated by adjusting the feeding ratios of the two DOX-DOX dimers in the mixed DSDS.Similar in vitro cellular toxicity was achieved with the mixed DSDS nanoparticles prepared with different feeding ratios.The mixed DSDS nanoparticles had a similar DOX content and diameter but different drug releasing rates.The MTT assays revealed that a high anti-tumor efficacy could be achieved with the slow-release mixed DSDS nanoparticles.
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Objective@#To analyze the causes and correlative factors of high perioperative blood transfusion demand in patients with lung tumor, and to discuss the influence of high blood transfusion demand on patients’ postoperative recovery and its predictive factors.@*Methods@#From November 2007 to October 2017, clinical data of patients who had underwent surgery for lung tumors in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences were collected. A total of 83 cases with perioperative transfusion of red blood cells ≥5U were classified as high transfusion demand group. Another 83 cases were selected from the rest of the patients with transfusion of red blood cells <5U as normal transfusion demand group. Related clinical and transfusion data were summarized to analyze the causes of high blood transfusion demand and its effect on postoperative recovery, univariate and multivariate logistic regressions were used to analyse correlative factors.@*Results@#From November 2007 to October 2017, 23 898 patients with lung tumor underwent surgery in our department and the high blood transfusion demand rate was 0.35%. In the last 10 years, the ratio of high transfusion demand was 0.61%(46/7 503) in the first 5 years versus 0.23%(37/16 395) in the later 5 years(P<0.01). By contrasting high transfusion demand group and normal transfusion demand group, the ratio of thoracoscopic surgery was 42.17%(35/83) vs. 26.51%(22/83)(P<0.05), the ratio of postoperative blood transfusion was 39.76%(33/83) vs. 22.90%(19/83)(P<0.05) and the ratio of left upper lung surgery was 24.10%(20/83) vs. 12.05%(10/83)(P<0.05). The ratio of patients with preoperative comorbidities was 21.69%(18/83) in the high transfusion demand group versus 8.43%(7/83) in the normal transfusion demand group(P<0.05), and the ratio of patients with anemia was 57.83%(48/83) vs. 52.63%(30/83)(P<0.05). The incidence of complications was 39.76%(33/83) in the high transfusion demand group versus 18.07%(15/83) in the normal transfusion demand group(P<0.01), and the incidence of Infection-related complication were 25.30%(21/83) vs. 8.43%(7/83)(P<0.01).@*Conclusion@#For perioperative high blood transfusion demand in lung tumors, there were significant differences between different operation approaches, site of operation and phase of blood transfusion. The perioperative high blood transfusion demand may also increase the risk of postoperative complications, comorbidities or anemia were its predictive factors.
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Objective To analyze the causes and correlative factors of high perioperative blood transfusion demand in pa-tients with lung tumor, and to discuss the influence of high blood transfusion demand on patients' postoperative recovery and its predictive factors. Methods From November 2007 to October 2017, clinical data of patients who had underwent surgery for lung tumors in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences were collected. A total of 83 cases with perioperative transfusion of red blood cells≥5U were classified as high transfusion demand group. Anoth-er 83 cases were selected from the rest of the patients with transfusion of red blood cells <5U as normal transfusion demand group. Related clinical and transfusion data were summarized to analyze the causes of high blood transfusion demand and its effect on postoperative recovery, univariate and multivariate logistic regressions were used to analyse correlative factors. Results From November 2007 to October 2017, 23898 patients with lung tumor underwent surgery in our department and the high blood transfusion demand rate was 0. 35％. In the last 10 years, the ratio of high transfusion demand was 0. 61％(46/7503) in the first 5 years versus 0. 23％(37/16395) in the later 5 years(P<0. 01). By contrasting high transfusion demand group and normal transfusion demand group, the ratio of thoracoscopic surgery was 42. 17％(35/83) vs. 26. 51％(22/83)(P<0.05),theratioofpostoperativebloodtransfusionwas39.76％(33/83) vs. 22.90％(19/83)(P<0.05) andtheratioof left upper lung surgery was 24. 10％(20/83) vs. 12. 05％(10/83)(P<0. 05). The ratio of patients with preoperative comor-bidities was 21. 69％(18/83) in the high transfusion demand group versus 8. 43％(7/83) in the normal transfusion demand group(P<0.05),andtheratioofpatientswithanemiawas57.83％(48/83) vs. 52.63％(30/83)(P<0.05). Theinci-dence of complications was 39. 76％(33/83) in the high transfusion demand group versus 18. 07％(15/83) in the normal transfusion demand group(P<0. 01), and the incidence of Infection-related complication were 25. 30％(21/83) vs. 8. 43％(7/83)(P <0. 01). Conclusion For perioperative high blood transfusion demand in lung tumors, there were significant differences between different operation approaches, site of operation and phase of blood transfusion. The perioperative high blood transfusion demand may also increase the risk of postoperative complications, comorbidities or anemia were its predictive factors.
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Objective@#To study the impact of the advance of the times and technological progress on the surgical treatment of lung cancer.@*Methods@#The data of patients with non-small cell lung cancer treated by thoracic surgery at Cancer Hospital of Chinese Academy of Medical Sciences from 2005 to 2015 were retrospectively analyzed. The population distribution, operation methods and treatment results were analyzed retrospectively.@*Results@#510 patients (in 2005) and 1 235 (in 2015) non-small cell lung cancer patients were included in this study. The proportions of male patients (79.0% vs. 55.8%), smoking (52.9% vs. 30.1%), squamous cell carcinoma (50.2% vs. 22.4%) and video-assisted thoracoscopic surgery (VATS) (0 vs. 61.1%), stage Ⅰ (15.2% vs. 36.8%), the number of lymph node dissection (21.8 vs. 16.6), intraoperative blood transfusion rate (9.6% vs. 1.9%), palliative resection rate (7.5% vs. 2.0%), the average length of stay (10.8 d vs. 7.6 d) were significantly changed. There was no significant difference in the average age of patients and operation time.@*Conclusion@#There was a significant change in the distribution of population and surgical techniques in patients undergoing lung cancer surgery in last ten years.
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BACKGROUND@#Surgeons are the direct decision-makers and performers in the surgical treatment of patients with lung cancer. Whether the differences among doctors affect the survival of patients is unclear. This study analyzed the five-year survival rates of different thoracic surgeries in patients undergoing surgery to assess the physician's impact and impact.@*METHODS@#A retrospective analysis of five years between 2002-2007 in the Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, for surgical treatment of lung cancer patients. According to different surgeons grouping doctors to compare the basic information of patients, surgical methods, short-term results and long-term survival differences.@*RESULTS@#A total of 712 patients treated by 11 experienced thoracic surgeons were included in this study. The patients have nosignificant difference with gender, age, smoking, pathological type between groups. There were significant differences in clinical staging, surgery type, operation time, blood transfusion rate, number of lymph node dissection, palliative resection rate, postoperative complications and perioperative mortality. There was a significant difference in five-year survival rates among patients treated by different doctors. This difference can be seen in all clinical stage analyzes with consistency. In the multivariate analysis, it was suggested that surgeon was an independent factor influencing the prognosis of patients.@*CONCLUSIONS@#Thoracic surgeon has a significant effect on the therapeutic effect of lung cancer patients.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Lung Neoplasms , General Surgery , Multivariate Analysis , Postoperative Complications , Retrospective Studies , Surgeons , Survival Analysis , Thoracic Surgery , Thoracic Surgical ProceduresABSTRACT
Objective To explore the clinical effect of neoadjuvant chemo-radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy for esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 111 esophageal cancer patients who underwent neoadjuvant chemo-radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2010 and December 2016 were collected.Among 111 patients,68 with interval time between neoadjuvant chemo-radiation and thoracoscopic and laparoscopic three-incision esophagectomy ＜ 8 weeks were allocated into the ＜ 8 weeks group and 43 with interval time between neoadjuvant chemo-radiation and thoracoscopic and laparoscopic three-incision esophagectomy ≥8 weeks were allocated into the ≥8 weeks group.Patients underwent preoperative radiotherapy and chemotherapy with TP regimen,and then underwent selective thoracoscopic and laparoscopic three-incision esophagectomy.Observation indicators:(1) neoadjuvant chemo-radiation situations;(2) surgical and postoperative situations;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Count data were analyzed using the chi-square test or Fisher exact probability.Comparison of ranked data was done by the nonparametric test.Results (1) Neoadjuvant chemo-radiation situations:all the patients underwent neoadjuvant chemo-radiation,without severe adverse reaction.Number of patients with complete remission based on oncopathology were 34 in the ＜8 weeks group and 15 in the ≥ 8 weeks group,with no statistically significant difference between the 2 groups (x2=2.441,P＞0.05).(2) Surgical and postoperative situations:all the patients underwent successful thoracoscopic and laparoscopic three-incision esophagectomy,with negative surgical margins.Operation time,volume of intraoperative blood loss,number of lymph node dissected,time of postoperative intrathoracic drainagetube removal,time of postoperative neck drainage-tube removal,hoarseness,upper gastrointestinal hemorrhage,anastomotic fistula,respiratory complication,pleural effusion and empyema,cardiovascular complication,incision abnormal healing,death within postoperative 30 days and duration of hospital stay were (354±103)minutes,(400± 76)mL,19±4,(11±4)days,(4.9±1.6)days,5,1,12,3,6,5,8,0,(19± 17) days in the ＜ 8 weeks group and (343±92) minutes,(392±51)mL,19±3,(12±6)days,(4.5±1.0)days,2,0,7,5,3,4,3,2,(18± 11) days in the ≥ 8 weeks group,respectively,with no statistically significant difference between the 2 groups (t =1.080,0.569,0.326,1.223,1.286,x2=0.029,0.035,1.114,0.000,0.000,0.246,t=0.315,P＞ 0.05).(3) Follow-up:90 of 111 patients were followed up for 3-82 months,with a median time of 25 months,including 55 in the ＜8 weeks group and 35 in the ≥8 weeks group.During follow-up,death and tumor recurrence were detected in 9,11 patients in the ＜8 weeks group and 6,11 patients in the ≥ 8 weeks group,respectively.Conclusion Neoadjuvant chemo-radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy is safe and effective,and it doesn't increase the perioperative risks based on preoperative 8-week interval time.
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Objective To evaluate the clinical effect of ultrasound - guided sclerosing agent lauromacrogol injection in treating lymph leakage. Methods A total of 31 patients with postoperative lymph leakage were selected for this study. Of the 31 patients, successful conservative oppression treatment was accomplished in 16, and lauromacrogol injection had to be carried out in 15 as conservative oppression treatment failed. The patients were followed up and the results were analyzed. Results In 15 patients receiving lauromacrogol injection treatment, complete cure of lymph leak was obtained in 14 with a success rate of 93.33%. Among the 14 cases, the second lauromacrogol injection was employed in 3 at one week after the first injection. Infection occurred in another case one day after the injection , which was cured after dressing change for 15 days. Conclusion For the treatment of lymph leakage, ultrasound-guided sclerosing agent lauromacrogol injection is effective and safe.
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Objective To observe the efficacy of endoscopic resection with thyroid benign tumor. Methods 60 cases of thyroid benign tumor were randomly divided into the endoscopic group and the traditional group, 30 cases in each group. The operation time, blood loss ,drainage volume, postoperative hospital stay, postoperative complications and hospitalization expenses in two groups were compared. Results There was no significant difference ( P >0. 05) between the two groups of postoperative hospital stay; endoscopic group blood loss (25.3 ± 15.6) ml significantly less than the traditional group (57. 2 ± 33. 8) ml, the difference was statistically significant ( P < 0. 05); endoscopic postoperative drainage volume ( 85.6 ± 53.2) ml significantly more than the traditional group ( 23. 5 ±37.2) ml (P < 0. 05); endoscopic operative time of ( 105.3 ± 23. 5) min, while the traditional group ( 80. 4 ±25. 3 ) min, the difference was significant ( P < 0. 05 ); hospitalization costs were significantly higher than conventional endoscopy group ( P < 0. 05). Both groups were not have obvious complications postoperation. Conclusion Compared with traditional open surgery, endoscopic surgery for benign thyroid tumors has advantages of superior cosmetic results and less bleeding,it is a good choice for the treatment of the disease.