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Objective:To evaluate the safety and clinical efficacy of the novel double disc-shaped gastrointestinal occluder (hereinafter referred to as occluder) in treatment of refractory tracheoesophageal fistula (TEF).Methods:From July 1, 2020 to January 31, 2021, 10 patients with refractory TEF treated with occluder at Department of Gastroenterology, the First Affiliated Hospital with Nanjing Medical University were collected. The patients′ clinical data such as gender, age, body mass index and fistula diameter were recorded. The success rate of operation, intraoperative and postoperative complications, operation time, postoperative hospital stay, efficacy of fistula closure and postoperative recovery were analyzed. The Karnofsky score and body mass index of patients 1 month and 3 months after operation were compared with those before operation for curative effect evaluation. Paired t test was used for statistical analysis. Results:Among the 10 TEF patients, there were 7 males and 3 females, the median age was 64.5 years old (ranged from 49.0 to 78.0 years old), the body mass index was (18.0±2.5) kg/m 2 and the diameter of the fistula was (1.2±0.6) cm. Occluder placement was successful in all patients. The operation time was (17.6±7.8) min (ranged from 7.0 to 30.0 min). Two cases had little bleeding during the operation, and there was no bleeding after the operation. The postoperative hospital stay was (5.9±4.0) d (ranged from 1.0 to 12.0 d). Among the 10 TEF patients, fistula of 5 patients were completely blocked, 4 cases were partially blocked and 1 case was ineffectively blocked, the effective rate of blocking was 9/10. One month follow-up after operation showed that the symptoms of choking and coughing during eating were significantly improved in 9 patients, and the symptoms of choking and coughing during eating were significantly improved in 1 patient after waist diameter of 12 mm occluder was replaced with the occluder of 15 mm. The 3-month follow-up after operation showed that the occluders were in the right place in 8 patients, the occluder was displaced in 1 patient and the occluder was removed and treated with enteral nutrition. One patient died due to the recurrence of esophageal cancer. The Karnofsky score of TEF patients 3 months after operation and the body mass index of TEF patients 1 month and 3 months after operation were higher than those before operation (70.0±34.0 vs. 46.0±10.7, (19.32±2.59) and (19.73±2.92) kg/m 2 vs. (18.03±2.50) kg/m 2), and the differences were statistically significant ( t=-3.09, -2.37 and -2.82, all P<0.05). Conclusions:Gastrointestinal occluder is safe and effective in the treatment of refractory TEF.
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Objective:To evaluate the long-term efficacy of double-tunnel peroral endoscopic myotomy (POEM) and traditional POEM in the treatment of achalasia cardia.Methods:A randomized controlled trial was performed on the data of 30 patients with achalasia cardia, who underwent POEM in the First Affiliated Hospital of Nanjing Medical University from June 2018 to June 2019. The 30 consecutive patients were randomly assigned to double-tunnel POEM group (15 cases, a second tunnel was established opposite to the traditional one) and traditional POEM group (15 cases). Intraoperative information was recorded, and patients were followed up regularly to compare the efficacy and complications between the two groups.Results:Double-tunnel POEM and traditional POEM were all completed with technical success. There were no significant differences in the intraoperative complications (5/15 VS 4/15, P=1.000), hospitalization time or cost between the two groups. The follow-up time was 17.20±4.83 months and 15.33±4.67 months in the traditional POEM group and the double-tunnel POEM group, respectively. The Eckardt scores after surgery between the two groups had no significant difference [1.53 (2.00) VS 1.60 (3.00), Z=-0.363, P=0.744]. The symptom relief cases were both 14 in the two groups. The postoperative 4-second integrated relaxation pressure (4 s IRP) of the double-tunnel group (11.27±3.14 mmHg) was significantly lower than that of the traditional group (15.05±4.21 mmHg, t=2.794, P=0.009). There was no significant difference in postoperative gastroesophageal reflux disease questionnaire scores between the two groups (4.40±1.64 VS 4.20±1.42, t=0.357, P=0.724). Conclusion:Double-tunnel POEM has almost the same efficacy as the traditional POEM except for a lower post-POEM 4 sIRP.
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Objective:To evaluate the safety and efficacy of combination of submucosal tunneling endoscopic septum division (STESD) and peroral endoscopic myotomy (POEM) for the treatment of esophageal epiphrenic diverticulum with esophagogastric junction (EGJ) outflow tract disorder.Methods:From October 2017 to August 2021, 6 patients with esophageal epiphrenic diverticulum complicated with EGJ outflow tract disorder receiving combination of STESD and POEM in the Endoscopic Center of the First Affiliated Hospital of Nanjing Medical University were enrolled. The clinical characteristics of the patients were retrospectively analyzed, which included the ratio of male to female, age, course of disease, length of diverticula, location, whether with multiple diverticula, type of EGJ outflow tract disorders, whether the endoscopic technique was successful (the completion of all steps under endoscopy, including tunnel establishment and diverticulum cristae, lower esophageal sphincter and cardia muscularis propria incision); operation time, changes in the severity of clinical symptoms before and after operation (including weight loss, dysphagia, retrosternal pain, and reflux assessed using the Eckardt score), intraoperative and postoperative complications, and follow-up, including whether achieved clinical success (complete or nearly complete improvement of dysphagia, vomiting after eating, retrosternal pain, regurgitation, weight loss, no need for repeat endoscopic intervention during follow-up) and adverse events. Descriptive methods were used for statistical analysis.Results:The male to female ratio of the 6 patients was 3 to 3, the median age was 69.2 years old, and the median disease course was 92.3 months. The median length of the diverticula was 47.5 mm. Diverticulum was located in the right wall of esophagus in 4 cases and in the left wall of esophagus in 2 cases, of which 1 patient was multiple diverticulum of esophagus. Achalasia was found in 5 cases, and EGJ outflow obstruction was found in 1 case. All the 6 patients successfully completed combination of STESD and POEM, and all achieved successful edoscopic technique. The operation time (range) was 55 min (40 to 70 min). Clinical symptom Eckardt score (range) before and after operation was 9.0 (7.0 to 11.0) and 1.3 (1.0 to 2.0), respectively. After operation the clinical symptom improved compared with that before operation. There were no delayed bleeding, perforation, infection, subcutaneous emphysema and other complications and severe adverse events. Six patients were all cured and discharged. Follow-up period was 1 to 50 months. The symptoms of dysphagia, vomiting after eating, retrosternal pain, regurgitation and weight loss were all significantly improved compared with those before operation. There were no severe adverse events and all achieved clinical success.Conclusions:Combination of STESD and POEM is safe and effective in the treatment of esophageal epiphrenic diverticulum with EGJ outflow tract disorder, and has good short-term and long-term effects.
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To evaluate the therapeutic effectiveness and safety of a novel gastrointestinal occluder device for gastrobronchial fistula. Data of 5 patients diagnosed as having gastrobronchial fistula who received treatment by a novel gastrointestinal occluder device at the First Affiliated Hospital of Nanjing Medical University from July to August 2020 were retrospectively analyzed. The total operation time, occluding time, intraoperative and postoperative complications, postoperative hospital stay and patients′ satisfaction were reviewed. Regular follow-up was conducted, and the short-term curative effect of occluding was evaluated 1 month after operation.All patients were males with age of 58-69 years. The course of fistula ranged 3-16 months and the diameter ranged 0.3-1.0 cm. All 5 patients achieved technical success with operation time of 38-88 minutes and occluding time of 8-24 minutes. The postoperative hospital stay ranged 3-5 days and the patients′ satisfaction score was 10. No severe complications occurred during or after operation. One month after endoscopic therapy, fistula was completely occluded in 4 patients. One patient died due to severe pulmonary infection and multiple organ failure although the bucking symptom after drinking and eating recovered before. Endoscopic closure of gastrointestinal fistula by means of the novel gastrointestinal occluder device is safe and effective.
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Objective:To explore the relationship between anxiety and mental resilience of caregivers for community-dwelling dementia patients.Methods:Patients in four communities who met the diagnostic criteria for Alzheimer's disease(AD)were randomly selected and their caregivers served as study subjects.General characteristics, anxiety and resilience of caregivers(n=592)were investigated with a questionnaire developed by ourselves, the Generalized Anxiety Disorder-7 Scale(GAD-7), and the Conner-Davidson Resilience Scale(CDRISC).Results:There were 592 subjects in the study, with 185 cases(31.3%)having anxiety.Differences in manifestations of anxiety existed between caregivers for AD patients in different age groups( P<0.01). Anxiety levels were also influenced by AD patient caregivers' gender, educational level and blood relationship to the patient( P<0.05). The differences were reflected in tenacity( F=72.58), strength( F=82.19), optimism( F=12.57)and the total elasticity score( F=162.88). The Spearman correlation was used to analyze the association of caregiver anxiety with caregivers' general characteristics and domains of psychological resilience.The results showed that anxiety was negatively correlated with gender( r=-0.09, P<0.05), education level( r=-0.112, P<0.01), blood relationship( r=-0.122, P<0.01), psychoelasticity and three other domains( r=-0.457, -0.495, -0.208, -0.60, all P<0.01), but was positively correlated with age( r=0.127, P<0.01). Logistic regression analysis showed that psychoelasticity was a protective factor for anxiety in caregivers for community-dwelling AD patients( β=-0.323, P<0.05). Conclusions:While treating Alzheimer's patients, clinicians can consider psychotherapy measures to improve the psychological resilience of their caregivers.
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Objective:To prepare 68Ga-2-(4, 7-bis(carboxymethyl)-1, 4, 7-triazonan-1-yl)pentanedioic acid (NODAGA)-YHWYGYTPQNVI (GE11) and evaluate its feasibility of PET imaging for pancreatic cancer. Methods:GE11 peptide was conjugated with NODAGA and then labeled with 68Ga. The labeling yield, radiochemical purity, hydrophilicity, stability and specificity in vitro were determined. Human pancreatic cancer BxPC3 nude mice models ( n=9) were established. MicroPET imaging was then obtained after 30 and 90 min, and mice were sacrificed at 90 min to acquire the radioactivity distribution of main organs and tumors. Pair t test was used to analyze the data. Results:The labeling yield was (73.5±5.4)% and radiochemical purity was more than 98%. After incubation 120 min in mouse serum at 37 ℃, radiochemical purity was more than 92%. The uptake was specific in BxPC3 cell lines. MicroPET images showed that 68Ga-NODAGA-GE11 could accumulate quickly in tumor. Value of tumor uptake was significantly higher than that of normal pancreas at 90 min ((1.38±0.25) vs (0.49±0.07) %ID/g; t=12.67, P<0.05), and the radio-uptake of blood, muscle and bone was lower than that of tumor. Conclusions:68Ga-NODAGA-GE11 is easy to be prepared with high radiochemical purity and good stability, and can specifically target BxPC3 xenograft tumor. However, due to the high uptake in the kidneys and liver, the value of 68Ga-NODAGA-GE11 in PET imaging for pancreatic tumor needs further study.
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Objective To study the clinical effects of continuous blood purification (CBP) in the treatment of newborns with severe sepsis and multiple organ dysfunction syndrome (MODS). Method From May 2013 to November 2018, the clinical data of infants with severe sepsis and MODS receiving CBP in the neonatal department of our hospital were retrospectively analysed. Changes of blood pressure, arterial partial pressure of oxygen/inhaled oxygen concentration (PaO2/FiO2), pH, serum potassium, sodium, urea nitrogen, creatinine, urine volume and maintenance dose of adrenaline at different time points before and after CBP were analysed. Result According to the inclusion and exclusion criteria, a total of 8 newborns with sepsis and MODS were enrolled in the study. One patient had the complication of perforated colon, and the other one had acute renal failure. The number of affected organs in these infants was 3～5. Six cases began CBP treatment within 1～5 days after admission, and the other two cases began CBP treatment on the 38th and 47th days after admission. The average treatment duration was (58.6±25.9) h. The effective rate of CBP in the treatment of severe sepsis with MODS was 75.0％(6/8). Blood pressure was increased at 6 h, 12 h, 24 h and 48 h after treatment and at the end of treatment. PaO2/FiO2 and blood pH were increased. The urine volume was increased at 24 h and 48 h after treatment and at the end of treatment (P<0.05). Serum potassium, urea nitrogen and creatinine were significantly decreased (P<0.05). The maintenance dose of adrenaline was also decreased significantly at 12 h after CBP (P<0.05), and withdrawn at 48 h after treatment. Only one case experienced membrane blockage during CBP. Dialysis was continued after the replacement of filtration membrane. No other complications existed. Conclusion CBP is effective in the treatment of neonatal severe sepsis with MODS. It can improve the circulation and renal function.
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Objective To investigate the risk factors of lymph node metastasis (LNM) in patients with superficial esophageal cancer (SEC) and to evaluate its clinical application.Methods From January 2010 to December 2016,769 SEC patients,who received surgery in the First Affiliated Hospital of Nanjing Medical University,were enrolled,and their clinical data were retrospectively analyzed.Chisquare test and logistic regression analysis were performed for statistical analysis.The sensitivity,specificity,and overall positive accuracy of pathological type and depth of invasion before operation were evaluated.Results The rate of LNM in patients with SEC was 15.34％ (118/769).There were significant differences in alcohol consumption,maximum tumor diameter,histological type,differentiation degree,depth of invasion and vascular invasion between patients with LNM (118 cases) and patients withoutLNM (651 cases) (x2=5.66,13.71,40.65,20.04,36.70 and 61.51;all P＜0.05).The results of multivariate analysis showed that maximum tumor diameter＞2 cm(odd ratio (OR) 1.76,95％ confidence interval (CI) 1.12 to 2.77),poor differentiation(OR 1.92,95％CI 1.23 to 3.01),submucosal invasion(OR 2.67,95％CI 1.28 to 5.56) and vascular invasion (OR 5.28,95％CI 2.75 to 10.13) were independent risk factors of LNM in patients with SEC.The tumor location was significantly correlated with the site of LNM (x2=107.05,P＜0.01).The sensitivity and specificity of preoperative assessment of LNM were 58 ％ (51/88) and 59 ％ (301/510),respectively.The overall positive accuracy of histological type before operation was 66.7％ (440/660).The overall positive accuracy of depth of invasion evaluated by endoscopic ultrasound before operation was 27.9％ (19/68).Conclusion Endoscopic treatment is recommended for SEC patients with maximum tumor diameter ≤ 2 cm,high ormoderate degree of differentiation,tumor confined to the mucosal layer and without vascular metastasis for the relatively low risk of LNM.
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@#Objective To establish theoretical framework, content, and standard of disability data using International Classification of Functioning, Disability and Health (ICF). Methods The structure and content of the Disability Survey Project Form by Washington Group on Disability Statistics, World Health Organization Disability Assessment Schedule 2.0, Model Disability Survey developed by World Health Organization and ICF Core Set (General) were analyzed with ICF categories and coding. Results The sturcture and contents of disability measurements has been developed and analysed using ICF.Conclusion The framework, content and data standard had been developed.
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Objective To evaluate the sensitizations of Hydroxyethyl Starch 40 Sodium Chloride Injection . Methods Active systemic anaphylaxis ( ASA) test, internal sensitive index ' s determination and screening and Passive Cutaneous Anaphylaxis ( PCA) test are carried out .Observe the allergy safety of the samples .Results We use guinea pigs to carry on ASA test and PCA test with Hydroxyethyl Starch 40 Sodium Chloride Injection from 45 batches of 3 companies and no changes have occurred .Measuring and comparing the sensitive index of HIS ,IgG, IgM and IgE in plasma, IgM and IgE are not obvious variation;HIS and IgG positive group and negative group and sample groups are different .Conclusions It is suggestion that Hydroxyethyl Starch 40 Sodium Chloride Injection safety evaluation should include allergic reactions , HIS and IgG sensitive index monitoring in clinical application of hydroxyethyl starch .
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Objective To observe the effect of core stability training on the associated reaction of upper limbs in stroke patients with hemiplegia. Methods From November, 2014 to May, 2016, sixty stroke patients with hemiplegia were randomly divided into control group (n=30) and treatment group (n=30). Both groups accepted routine rehabilitation, while the treatment group received core stability training for 20 minutes during exercise. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Fugl-Meyer Assess-ment-Lower Extremities (FMA-LE), Berg Balance Scale (BBS) and Associated Reaction Rating Scale (ARRS) before and 6 weeks after treatment. Results The scores of FMA-UE, FMA-LE, BBS and ARRS improved significantly in both groups after treatment (t>12.158, P2.317, P<0.05). Conclusion Core stability training can re-lieve the associated reaction of upper limb in stroke patients with hemiplegia.
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Objective To investigate the invasion situation of cardinal ligaments(CL) in stage Ⅰ A2 - ⅡA2 cervical cancer and to find the high risk clinicopathological factors affecting its invasion .Methods The retrospective analysis was performed on the clinicopathological data in 2 982 patients with cervical cancer treated by operation extracted in 5 hospitals from January 2004 to De‐cember 2014 .Results (1) Totally 855 cases according with the research condition were included .The CL invasion was found in 20 cases(2 .3% ) .No CL invasion occurred in the stage ⅠA2 ,the CL invasion rate in the stage ⅠB1 was 1 .7% ,in the stage ⅠB2 was 1 .2% ,in the stage ⅡA1 was 5 .7% and in the stage ⅡA2 was 2 .9% .With the increase of FIGO staging ,the CL invasion rate had no significant increase(P=0 .269) .(2) The infiltration rate of left CL and right CL had no statistical difference among the stageⅠA2- ⅡA2(P=1 .000) .And the invasion rate of the left CL with different FIGO stages had no statistical difference(P=0 .286) , while the right one had statistical difference(P=0 .005) ,in which the highest was in the stage ⅡA1 (4 .3% ) .(3)The univariate a‐nalysis found that lymph‐vascular invasion ,cervical stroma infiltration depth ,pelvic lymph node metastasis ,uterus body infiltration and vaginal fornix infiltration were the risk factors of CL invasion(P<0 .01);the further multivariate analysis determined that the invasion of uterine body(OR=11 .858) ,pelvic lymph node metastasis(OR=6 .359 ,) ,vaginal fornix infiltration(OR=6 .012 ,) were the risk factors for CL invasion(P<0 .05) .Conclusion The invasion rate of CL invasion in early stage cervcial cancer is low .The invasion of uterine body ,pelvic lymph node metastasis and vaginal fornix filtration are the risk factors for CL invasion in the stageⅠA2- ⅡA2 cervical cancer .
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A simple and green method for the determination of trace bisphenol A( BPA) was established by coupling supported ionic liquid solid phase extraction to β-cyclodextrin modified ionic liquid carbon paste electrode-based electrochemical detection ( SILs-SPE-ED) . The synthesized imidazolium ionic liquid modified styrene type macroporous resin was used as adsorbent for SPE of BPA. The critical parameters that affect the extraction efficiency were optimized, including 0. 4 g of packing material quantity, 200 mL of sample solution at pH 7. 0, 5 mL of methanol as an eluent solvent, and 4. 5 mL/min of the SPE flow rate. Dynamic adsorption test showed that the maximum adsorption capacity of BPA on the SILs-SPE cartridge was 10. 1 mg/g, and the enrichment factor was 40 . The calibration curve showed a good linearity between the anodic current and the BPA concentration in the range of 1. 0×10-8-1. 0×10-6 mol/L (i. e. 2. 3-228μg/L). The detection limit was 4. 16×10-9 mol/L (equal to 0. 95 μg/L). The SILs-SPE-ED method was applied to the analysis of water and plastic samples and the results agreed well with HPLC method.
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Objective To explore the efficacy and safety of systemic mild hypothermia in management of neonates with moderate or severe hypoxic-ischemic encephalopathy (HIE).Methods A retrospective case-control study was conducted on 75 neonates with moderate or severe HIE,who were admitted to the Neonatal Intensive Care Unit of Teaching Hospital of Fujian Medical University (Quanzhou Children's Hospital) from January 1,2011 to May 31,2015.The 75 neonates were divided into two groups,the conventional treatment group (33 cases,control group) and the mild hypothermia treatment group (42 cases,hypothermia group).Sequential management protocol for all subjects was followed,including amplitude-integrated electroencephalogram (aEEG) before treatment,aEEG and brain MRI at one week after birth,neonatal behavioral neurological assessment (NBNA) on the 14th day after birth,and determination of mental and psychomotor development index with Bayley Scales of Infant and Toddler Developmental at 18 months old.Adverse reactions,serious disability cases and deaths during the study were also recorded.Two sample-t test and Chi-square test were as statistical methods.Results There were six death cases in the control group,but on one died in the hypothermia group.In the survivals,The maximum voltage and minimum voltage in the hypothermia group were higher at 7-day old than that before treatment [maximum voltage:(31.3 ±2.4) vs (18.1± 2.2) μ V;minimum voltage:(13.5±2.1) vs (6.1 ±1.5) μ V,t=8.591 and 5.314,both P ＜ 0.05],and also higher than that of control group [(25.2±3.1) and (9.3±3.1) μV,respectively,both P ≤ 0.05].Compared with the control group,there were more babies with normal head MRI [43％(18/42) vs 18％(6/33),x2=4.814,P ≤ 0.05] in the hypothermia group at 7-day old and less cases of severe disability [21％(9/42) vs 45％(15/33),x2=4.902,P ≤ 0.05] and deaths [0％(0/42) vs 18％(6/33),x2=6.098,P ≤ 0.05].Higher NBNA score at 14 day and Bayley developmental index at 18 months were shown in the hypothermia group than in the control (39.4±2.6 vs 35.3 ±2.4,t=3.316;mental development index:96.3± 13.2 vs 84.3 ± 10.6,t=7.893;psychomotor development index:98.2 ±16.8 vs 85.4±13.2,t=8.753,all P ≤ 0.05).The adverse effects of hypothermia treatment included electrolyte imbalance (n=12),abnormal blood glucose level (n=8),hepatic and renal dysfunction (n=7),infections (n=6) and bradycardiac (n=4),and no cold injury syndrome case was reported.However,none of the above had significant difference compared with the control group (P ＞ 0.05).Conclusions Systemic mild hypothermia treatment is effective in reducing mortality rate and major disability rate in neonates with moderate or severe HIE and improves the neuromotor development when babies grow up to 18-month-old.
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Objective To observe and investigate the influence degree of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation.Methods 76 patients with gastric and duodenal ulcer perforation were selected as study subjects,and they were divided into control group(conventional open operation group)and observation group(laparoscopic operation group)according to the random number table,38 cases in each group.The serum body stress hormones and antiinflammatory,proinflammatory related indexes of the two groups at first day before operation and at first,third,seventh day after operation were respectively detected and compared.Results The serum IL -2 levels of the observation group at first,third and seventh day after operation were (3.53 ±0.24)μg/mL,(3.25 ±0.22)μg/mL and (4.37 ±0.33)μg/mL,which were higher than those of the control group(F =5.876,P <0.05),while other serum body stress hormones and antiin-flammatory,proinflammatory related indexes were all obviously lower than those of the control group (all P <0.05), there were significant differences between those postoperative evaluation results of the two groups.Conclusion The influence of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation is relatively small,and it shows that the bad body stress degree caused by the operation is relatively smaller.
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Objective To explore the experience in nursing the patients with esophageal high-grade intraepithelial neoplasia lesions treated with endoscopic submucosal dissection. Method A retrospective analysis was carried out among the patients with esophageal high-grade intraepithelial neoplasia lesions to look into the nursing care to the patients. Results Thirty patients were successfully stripped, and no surgical complication occurred. After intensive care, they were cured and discharged. Conclusion Professional and meticulous care can effectively improve the success rate of endoscopic submucosal dissection and reduce the incidence of complications, and promote the rehabilitation of patients.
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@#The Comprehensive Rehabilitation on Combining Medical Treatments with Education (CRCMTE) has become hot in the field of special education and rehabilitation medicine. The research of CRCMTE is deepening, the formulation of CRCMTE was drawn on a special background, and the content of CRCMTE involves extensive range of service. The research in the future will focus on some fields, such as personnel training, establishing institution, the school-based rehabilitation, and the reform of children's hospital rehabilitation department (center).
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<p><b>OBJECTIVE</b>To investigate the risk factors for metastasis and clinical indications for dissection of lymph node posterior to right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC).</p><p><b>METHODS</b>A prospective analysis including 283 consecutive patients with PTC who underwent total thyroidectomy with routine central lymph node dissection (CLND) in our hospital from Jan. 2010 to Jan. 2012 was performed. The right paratracheal lymph nodes in the central compartment lymph nodes (CCLN) were divided into the anterior (level VIa) and posterior (level VIb) compartments by recurrent laryngeal nerve (RLN), and were removed respectively. The complications and recurrences were recorded with a follow-up of 3 months to 3 years.</p><p><b>RESULTS</b>CCLN metastases were present in 47.7% (135/283) of the patients, and level VIb metastases were present in 27.2% (77/283) of the patients. The incidence of level VIb metastasis was 20.5% (58/283) in level VIa-positive patients, while 6.7% (19/283) in level VIa-negative patients. Complications of level VIb dissection were found in 4.9% (14/283) of all patients. 2.1% (6/283) of all patients were diagnosed with regional recurrence during the 3-year follow-up. Univariate analysis revealed that level VIb metastasis was significantly associated with tumor size, number, extrathyroidal invasion, clinical nodal stage, level VIa and lateral lymph node metastases. Multivariate analysis revealed that tumor larger than 1 cm, multifocality, extrathyroidal invasion, level VIa and lateral lymph node metastases were independent risk factors for level VIb metastasis.</p><p><b>CONCLUSIONS</b>Lymph node posterior to right recurrent laryngeal nerve can be the only site of metastasis from PTC without other cervical compartment involvements. Therefore, routine intraoperative detection of these nodes may be necessary for patients with right PTC, and dissection should be considered when a right-side PTC tumor is larger than 1 cm, multifocality, with extrathyroidal invasion or cervical nodal metastases.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Carcinoma , Pathology , General Surgery , Carcinoma, Papillary , Follow-Up Studies , Lymphatic Metastasis , Neck Dissection , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Prospective Studies , Recurrent Laryngeal Nerve , Pathology , Risk Factors , Thyroid Neoplasms , Pathology , General Surgery , Thyroidectomy , Tumor BurdenABSTRACT
The Comprehensive Rehabilitation on Combining Medical Treatments with Education (CRCMTE) has become hot in the field of special education and rehabilitation medicine. The research of CRCMTE is deepening, the formulation of CRCMTE was drawn on a special background, and the content of CRCMTE involves extensive range of service. The research in the future will focus on some fields, such as personnel training, establishing institution, the school-based rehabilitation, and the reform of children's hospital rehabilitation depart-ment (center).
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Objective To summarize the anatomic variations of recurrent laryngeal nerve (RLN during thyroid surgery and to investigate the technical key points for identification and preservation of the nerve.Methods Clinical data of 1548 consecutive patients undergoing thyroid operation with intraoperative routine exposure of RLN from June 2010 to June 2012 was retrospectively analyzed.Results In this series,2620 RLNs at risk were clearly exposed and identified during a total of 1548 thyroid operations,wherein complete dissection was performed on 1886 nerves.Injury occurred in 11 of 2620 (0.42％) nerves.Through the analysis of all 2620 RLNs,conditional variations were found in 64 nerves.Of 1886 RLNs that were completely dissected,421 (22.3％)nerves presented with natural variations of six patterns,including morphological branching variation in 126 (6.68％) nerves,course and location variation in 124 (6.57％)nerves,variation in relationship with inferior thyroid artery (ITA)in 36 (1.91％)nerves,variation at the Berry ligament in 112 (5.94％) nerves,variation at the cricothyroid joint in 17 (0.80％) nerves,and 6 (0.32％)cases of non-recurrent laryngeal nerve (nRLN).Conclusions Variations in RLN found during thyroid surgery are of relatively high incidence,complex and diverse,which can be a potential reason of nerve injury due to visual misidentification.Thus,a thorough knowledge of the normal anatomy of RLN and its anatomic variations ensures a safe and effective thyroid surgery.