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Objective:To explore the indications of lung transplantation for pulmonary interstitial fibrosis after COVID-19 and the precautionary measures of medical staff during operation.Methods:Lung transplantation was performed for three cases of COVID-19 from February 15, 2020 to March 1, 2020. The course of disease, mechanical ventilation time, extra-corporeal membrane oxygenation (ECMO) support time, surgical procedures and precautionary measures of medical staff during operation were analyzed.Results:The course of disease were 40, 7, 39 days, the mechanical ventilation time 26, 22, 27 days and ECMO support time 16, 7, 14 days. The postoperative pathological results of three cases indicated pulmonary interstitial fibrosis. One case died on the operative day and two survivors stayed currently in rehabilitation. Thirty-nine medical staff had no symptoms of COVID-19 after 14 days of isolation. The detection of 2019-nCoV nucleic acid was negative for both nasal and pharyngeal swabs.Conclusions:Patients with pulmonary interstitial fibrosis after COVID-19 show no improvement after 1 month of active medical treatment. And the 1-month risk of mortality was over 50% and nucleic acid of 2019-nCoV turned negative. Lung transplantation might be considered. The triple precautionary levels of medical staff during operation prevented the transmission of 2019-nCoV.
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Objective:To elucidate the factors influencing the differences in the survival rates of esophageal squamous cell carcinoma (ESCC) patients between the rural and urban regions in China. Methods:A total of 36,723 ESCC patients derived from the clinical data-bases containing 500,000 esophageal and gastric cardia carcinoma cases (1973-2015) of the Henan Key Laboratory for Esophageal Can-cer Research of the First Affiliated Hospital, Zhengzhou University, were analyzed. Of these patients, 33,625 were from the rural re-gions (91.6%), comprising 20,906 male patients with an average age of 58.98 ± 8.71 years and 12,719 females with an average age of 59.59 ± 8.53 years. The remaining 3,098 were from the urban regions and composed of 2,089 male patients with an average age of 60.84±9.10 years and 1,009 females with an average age of 62.46 ± 9.14 years. All the patients underwent radical esophagectomy, de-tailed histopathological diagnosis, and TNM staging. Chi square test, Kaplan-Meier, Log-rank, and Cox proportional hazards regression model were used to analyze the differences between ESCC patients from rural regions and those from urban regions and among the risk factors in prognosis. Results:Kaplan-Meier and Log-rank analysis results showed that the ESCC patients from the rural regions had significantly higher overall survival than the urban patients (χ2=12.971, P=0.000). Further analysis showed that rural patients≥50 years old and diagnosed with stage IIa and IIb (middle stage) ESCC had higher survival rates than urban patients in males and females (male:χ2=16.188, P0.05). The results of Cox proportional hazards regression model analysis showed that age, gender, and TNM stages were independent risk factors for rural and urban ESCC patients. When the rural and urban ESCC patients were both considered, the Cox proportional hazards regression model analysis results showed that male ESCC patients≥50 years old, urban residence, and TNM stages were independent risk factors. Conclusion:Rural ESCC patients have significantly high-er overall survival than urban patients. Male, age of≥50 years old, urban residence, and TNM stages were independent risk factors for ESCC patient survival.
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Objective To explore the effect of contract learning on rehabilitation training to patients with stroke . Methods According to the random number table, 120 stroke patients were randomly divided in equal number into control group and observation group. The patients in the control group were treated with conventional nursing during hospitalization and health guidance during follow-up. The patients in the observation group were given rehabilitation training according to contracted learning during the period of hospitalization and follow-up. The time was 6 months. The quality of life was compared between the two groups of patients before and after the intervention, 1 months after discharge, 6 months after discharge. Results After six months of intervention, the 7 dimensions of quality of life, including daily life ability, hand function, mobility, strength, emotion, communication and participation in the intervention group were significantly better than those of the control group (P<0.001). The 6 dimensions of quality of life, including daily life ability, hand function, mobility, strength, emotion, and communication of the control group were significantly better than before the intervention (P<0.001). Conclusion For stroke patients, the rehabilitation training under the learning contract can improve the effect of rehabilitation training so as to improve the quality of life and the prognosis.
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Objective:To characterize the clinical and epidemiological changes, treatments, and prognoses of primary esophageal small cell carcinoma (PESC). Methods:A retrospective analysis was conducted using the clinical epidemiology data of 529 PESC patients se-lected from the clinical databases of 500,000 esophageal and gastric cardiac carcinomas of the Henan Key Laboratory for Esophageal Cancer Research (1992-2015). Among these patients, 241 cases were included in the survival analysis. The five-year survival rate was calculated using Kaplan-Meier analysis, and the differences in survival rates were compared using the Log-rank analysis model. Re-sults:All 529 PESC cases were analyzed, which accounted for 0.2%of esophageal cancers diagnosed in the same period. The incidence of PESC increased annually (R2=0.574). The survival rates for 1-, 2-, 3-, and 5-year of 241 PESC patients were 55%, 40%, 29%, and 9%, respectively, and the median survival time was 21.9 months. On the basis of the VALSG criteria of lung small cell carcinoma, a statisti-cal difference was observed in the overall survival rates for limited and extensive diseases (P=0.003), with the median survival time of 24.3 and 17.5 months, respectively. Furthermore, significant differences were observed on survival with various treatment modalities (P=0.004). The median survival time of PESC patients treated with combined surgery and radiochemotherapies (28.8 months) was lon-ger than those with either chemotherapy (17.8 months, P=0.015) or chemoradiotherapy (14.5 months, P=0.004). In limited disease pa-tients, the median survival time was longer in patients treated with surgery (27.7 months) than in those without surgery (16.2 months, P=0.007). Notably, the biopsy diagnosis before surgery for PESC was only 40.8%. Conclusion:PESC is a rare malignant carcinoma with increasing incidence. PESC presents poor prognosis, and the survival rate can be improved through combined therapies based on sur-gery. A high misdiagnosis rate for PESC is observed before surgery with biopsy.
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Objective To investigate the effect of electroacupuncture on the expressions of in-terleukin(IL)-33 and ST2 in spinal cord and dorsal root ganglion in rats with neuropathic pain. Methods Forty adult female SD rats were randomly divided into sham operation group (group Sham),model group (group MC),ipsilateral electroacupuncture group (group SE)and contralateral electroacupuncture group (group VE).Each group had 10.The sciatic nerve injury models were es-tablished.The rats in group SE and group VE were respectively accepted electrical acupuncture treat-ment in Yanglingquan and Zusanli in the right and left limbs.Respectively,before treatment (T0 ), treated for 7 d (T1 ),3 d (T2 )and 7 d (T3 )after treatment,the MWT and TWL of rats in the four groups were measured.At T3 ,the expressions of IL-33 in spinal cord and dorsal root ganglion in rats were detected by using quantitative PCR.Results Compared with T0 ,MWT and TWL in group MC, group SE and group VE at T1-T3 were decreased significantly (P < 0.05).Compared with sham group,MWT in group SE and group VE,TWL in group MC,group SE and group VE at T1-T3 were decreased significantly (P <0.05).Compared with group MC,MWT and TWL in group SE and group VE at T2 ,T3 were increased significantly (P <0.05).Compared with sham group,the relative expression levels of IL-33 mRNA and ST2 mRNA in spinal cord and dorsal root ganglion in the group MC,group SE and group VE were elevated,the differences were statistically significant (P <0.05). Compared with group MC,the relative expression levels of IL-33 mRNA and ST2 mRNA in spinal cord and dorsal root ganglion group SE and group VE were decreased,the differences were statistical-ly significant (P <0.05).Conclusion The electroacupuncture treatment could significantly reduce the pain symptoms of neuropathic pain in rats,possibly via inhibiting the expressions of IL-33 and ST2 in spinal cord and dorsal root ganglion and blocking the IL-33/ST2 mediated inflammatory to play role.
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Objective:To investigate the clinicopathological characteristics, treatments, and survival of patients with esophageal adeno-squamous carcinoma (EASC). Methods:A total of 494 patients with EASC were selected from the clinical information databases of 500, 000 cases with esophageal and gastric cardiac carcinomas in the Henan Key Laboratory for Esophageal Cancer Research. Among the 494 EASC cases, 361 were males with an average age of 61.47 ± 8.32 years, and 133 were females with an average age of 65.56 ± 8.06 years. SPSS 21.0 software was applied to determine the statistical differences among the different groups. A life-table method was also used to calculate the five-year survival rate. A linear regression model was used to analyze the correlation of changes at different peri-ods. Results:The incidence of EASC in our database was 0.196%(494/251707). EASC occurred predominantly in male patients (male:female=2.71:1.00). The peak age was within 60-69 years in both males and females (39.6%vs. 40.6%). Notably, the incidence of male patients showed a downward trend (R2=0.063), whereas that of female patients showed an upward trend (R2=0.004). The prevalence of EASC was obviously higher in low-incidence areas for esophageal cancer than in high-incidence areas (53.1%vs. 46.9%, P<0.001). Ac-cording to the TNM staging criteria for esophageal cancer, phases II and III patients comprised the majority of cases, which accounted for 40.8%(173/424). The positive lymph node metastasis rate was 47.0%(206/438), and the number of positive lymph node metasta-ses ranged within 1-2 (48.5%, 100/206). In addition, preoperative biopsy was performed in 467 cases, and more than half of the pa-tients (53.96%, 252/467) were diagnosed before the operation. Surgical resection was the predominant treatment method for EASC (88.8%, 419/472). Only 1.9%patients (9/472) underwent radiotherapy and chemotherapy. The five-year survival rate of male patients who were neither smoking nor drinking of alcohol was higher than that of male smokers (26.5%vs. 12.1%). In patients with stagesⅠ,Ⅱ, andⅢ+Ⅳcarcinomas with surgery as lone treatment, the three-year survival rates were 64.7%, 50.9%, and 48.5%, respectively. Correspondingly, these rates were 51.7%, 47.8%, and 33.1%after adjuvant radiotherapy and chemotherapy. Conclusion:EASC is a rare type of esophageal malignant tumor. The preoperative biopsy pathological diagnosis has high misdiagnosis rate. Smoking and drinking of alcohol can influence the prognosis of patients. In EASC patients, lymph node metastasis easily occurs, and a simple surgery is bet-ter than other cancer treatments.
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Objective:To analyze the clinicopathological characterization of primary esophageal benign tumor (EBT). Methods:A total of 1,058 EBTs were enrolled from 500,000 cases in an esophageal and cardiac tumor biological sample and clinical information data-base of Henan Key Laboratory for Esophageal Cancer Research (1973-2015) in the First Affiliated Hospital of Zhengzhou University. SPSS 21.0 software was applied for data analysis. Results:In this database, 1,058 cases with primary EBTs among the 249,246 esopha-geal tumor patients with detailed clinical and pathological information were identified with an incidence of 0.42%(1,058/249,246). A total of 544 patients were male with an average age of 50±11 years old, whereas 514 patients were female, with an average age of 52± 11 years old. Among the 10 types of EBTs, leiomyoma was the most common type (84.50%, 894/1,058), followed by papilloma (6.90%, 73/1058). Adenoma (0.38%, 4/1,058) was the rarest type. Leiomyoma, gastrointestinal stromal tumor, and neurofibroma mainly oc-curred in male patients. By contrast, lipoma, granulosa cell tumor, schwannoma, and hemangioma mainly occurred in female patients.All five cases of hamartoma occurred only in female patients. Given the incidence of≥50%as the common standard, the common EBT in sequence in young male patients was leiomyoma and gastrointestinal stromal tumor, whereas that in young female patients was granulosa cell tumor and lipoma. The common EBT in sequence in older male patients was papilloma, gastrointestinal stromal tumor, and leiomyoma, whereas that in older female patients was schwannoma, papilloma, leiomyoma, gastrointestinal stromal tumor, and hamartoma. Additionally, lipoma, hemangioma, neurofibroma, and adenoma in male patients and neurofibroma in female patients oc-curred in older patients. The different ages of patients with EBTs (P=0.034) and leiomyoma (P=0.004) had a statistical significance. In these EBTs, leiomyoma, papilloma, gastrointestinal stromal tumor, and schwannoma mainly occurred in the middle esophagus, where-as lipoma mainly occurred in the lower esophagus. The major treatment for EBT in the present study was surgery (57.54%, 492/855), which was followed by endoscopic resection (38.01%, 325/855) and others (4.45%, 38/855). Conclusion:The incidence of EBT is low, with a couple of different histological types. Gender, age, and predilection sites are different depending on the histological types of EBTs. Surgery and endoscopic resection are the major treatment methods.
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Objective To investigate the relationship between inflammatory response and depth of propofol sedation during cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty patients undergoing cardiac valve replacement with CPB were randomly divided into low Bispectral index (BIS)group(30≤BIS<45)and high BIS group(45≤BIS≤60).Each group had 25 cases.The induction of anesthesia in the two groups was in the same way.Anesthesia was maintained in the fol‐lowing way :low BIS group and high BIS group received intravenous infusion of 7 mg/(kg · h) and 3 mg/(kg · h) propofol ,re‐spectively.In operation ,the propofol infusion rate was adjusted to maintain each group in the corresponding BIS value range.Before induction of anesthesia(T0 ) ,at the end of the CPB(T1 ) ,the end of operation(T2 )and 1 h after operation(T3 ) ,re‐spectively ,6 mL of jugular vein blood samples were collected.The concentrations of IL‐6 ,TNF‐αand S100βprotein in the serum were detected by ELISA method.At T0 ,T1 and T2 ,respectively ,arterial blood was collected ,the pH of blood and the concentra‐tions of blood glucose and lactate were determined.Results At T1 ,T2 and T3 ,the concentrations of IL‐6 and TNF‐αin serum in low BIS group were all lower than those in the high BIS group(all P<0.05).At T2 and T3 ,the S100βprotein concentrations in serum in the low BIS group were all lower than those in the high BIS group (both P< 0.05).Compared with the high BIS group ,the concentrations of blood glucose and lactate in low group at T 1 and T2 were all lower(all P<0.05).Conclusion Ap‐propriately enhancing the depth of sedation could help relieve the inflammatory reaction of patients during cardiac valve replace‐ment with CPB.It can help protect brain tissue and reduce the incidence of brain injury.
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Objective To investigate the effectiveness of 360-degree assessment method in clinical teaching for nursing students.Methods Forty-six nursing interns in our hospital from May 2012 to March 2013 were assigned as the observation group,and another 44 from May 2011 to March 2012 as the control group. The observation group was assessed in respect of nursing theory,nursing techniques,examinations,nursing ethics using the 360-degree assessment,while the interns in the control group in the traditional methods.The quality of comprehensive clinical evaluation over the interns in the two groups was compared.Result The nursing interns in the experiment group were significantly better than those in the control group in terms of nursing theory,nursing techniques, examinations,evaluation of nursing students on teaching quality of department and the satisfaction degree of patients,teachers and students with their nursing work (allP<0.05).Conclusions 360-degree assessment method can reflect the information of clinical nursing students from different prospective. It helps improve the ability of the nursing trainees in clinical comprehensive career ability and build up their correct professional attitude of “patient-centered”.