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The chronic disease management of rheumatoid arthritis has been popularized and applied in China. This article will review the application and research progress of different chronic disease management models, including chronic care mode, chronic disease self-management, transitional care mode, community-based chronic disease management, and "internet + chronic disease management" in rheumatoid arthritis patients in China, and compare the advantages and disadvantages of different intervention models, in order to provide a theoretical basis for exploring the chronic management of rheumatoid arthritis under different regional medical resources.
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Objective:Explore the efficacy of pulmonary wedge resection in the treatment of non-small cell lung cancer (NSCLC) and risk factors for postoperative recurrence, and construct a risk prediction model.Methods:A retrospective analysis of the clinical data of 126 NSCLC patients were admitted to Mianyang Central Hospital from June 2018 to June 2020. According to different surgical methods, the patients were divided into pulmonary wedge resection group ( n=88) and lobectomy Group ( n=38). Compare the metastasis rate, recurrence rate, and fatality rate at 1 year after the two kinds of operations; according to the recurrence of the lung wedge resection group, the patients are divided into recurrence group ( n=15) and non-recurrence group ( n=73). The general data and preoperative laboratory examination indexes of the two groups of patients were compared; multivariate Logistic analysis of factors affecting postoperative recurrence of patients; a risk scoring model was constructed and its predictive value was evaluated. Enumeration data was expressed by the number of cases and percentage (%), and the comparison between groups was performed by chi-square test. Multivariate Logisitic regression analysis of factors affecting the recurrence of NSCLC patients at 1 year after pulmonary wedge resection; a risk scoring model was constructed according to risk factors, and X-tile software was used to obtain the cutoff value of the score; a calibration curve was used to evaluate the accuracy of the risk prediction model prediction The clinical decision curve evaluates the effectiveness of model predictions. Results:The surgical margin metastasis rate and mortality of patients in the pulmonary wedge resection group were 0 and 6.82%, and the lobectomy group were 13.16% and 21.05%, respectively. The differences between the two groups were statistically significant ( P<0.05); The proportion of patients with smoking history, vascular thrombus cancer, lymph node dissection ≤ 15, carcinoembryonic antigen >5 ng/mL, neutrophil to lymphocyte ratio>2.5, soluble CD105>4 ng/mL, vascular endothelial growth factor >9 ng/mL and matrix metalloproteinase 9 (MMP-9) > 300 μg/L in recurrent group were significantly higher than those in non-recurrent group. All of them were risk factors for recurrence after wedge pneumonectomy ( P<0.05); the above risk factors were incorporated into the risk scoring model, and weights of 22, 38, 25, 33, 20, 27, 36, and 30 were assigned respectively, and patients were classified as medium according to the cut-off value. Risk patients (≤78 points), high-risk patients (>78 points and ≤162 points), and extremely high-risk patients (>162 points). Conclusions:The effect of thoracoscopic wedge resection in the treatment of NSCLC is significantly better than that of thoracoscopic lobectomy. The construction of a risk scoring model for predicting postoperative recurrence of patients is beneficial to early identification of high-risk groups in clinical practice, and to guide medical staff to adopt personalized treatment and nursing care measures.
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Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.
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@#Objective To determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy. Methods From November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared. Results On postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05). Conclusion Multimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.