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@#Objective To explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC). Methods The clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. Results A total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557). Conclusion There is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.
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@#Objective To summarize our experience in the treatment of esophageal foreign bodies. Methods A retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out, including 75 (50.3%) females and 74 (49.7%) males with an average age of 57 (2-85) years. Results There were 146 patients confirmed by endoscopy, and 3 patients were not found foreign body. Among the confirmed patients, 127 patients were removed by gastroscope and 19 patients were treated by operation. Esophageal foreign bodies are mainly related to the types of food. Jujube seed is the most common food foreign body in the northwest China. The injury rate of mucosal was 47.54% within 48 hours. The complication rate of taking out the foreign body after 48 hours was 100.0%. The success rate by endoscopy decreased (P=0.005), if the foreign body combined perforation. There was no statistical difference between the neck and other parts when using ultra-fine gastroscope (P=0.157). Conclusion The sharper the foreign body is, the easier the perforation is. The earlier the foreign body is removed, the less complications are. The size of the foreign body determines the difficulty of endoscopic removal. Gastroscopy is the first choice for diagnosis and treatment, especially ultra-fine gastroscopy, and the foreign bodies that cannot be removed by endoscopy need surgical treatment.
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Objective:To explore the application prospect of "education cloud platform + dual track" teaching in continuing medical education of thoracic surgery.Methods:A total of 100 trainees who participated in continuing medical education in thoracic surgery department in Air Force Medical University were randomly divided into experimental group and control group, with 50 students in each group. The experimental group adopted "education cloud platform + dual-track" teaching, and the control group adopted dual-track teaching. At the end of the study, an examination of theoretical knowledge and practical operation would be conducted; at the same time, an anonymous questionnaire survey would be used to evaluate the satisfaction of the two teaching modes. SPSS 20.0 was used for t test and chi-square test. Results:There was no statistically significant difference between the two groups in basic theoretical performance. The professional theoretical performance [(28.6±3.7) points] and operational theory performance [(34.9±4.7) points] of the experimental group were higher than those of the control group, with significant differences ( P<0.05). The experimental group performed better than the control group in five practical operation assessments: basic operation of thoracoscopy, basic operation of opening and closing the chest, operation of vascular isolation and suture, operation of esophageal anastomosis and operation of tracheal anastomosis, with statistical differences ( P<0.05). The satisfaction with teaching of experimental group was significantly higher than that of the control group ( P<0.05). Conclusion:"Education cloud platform + dual track" teaching can effectively ensure the teaching progress of problem-based learning (PBL) and team-based learning (TBL), improve students' learning effect, and has high promotion and application value.
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@#Objective To investigate the safety and feasibility of laryngeal mask general anesthesia as a replacement of tracheal intubation general anesthesia in the "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch for thymoma patients without myasthenia. Methods From January 2018 to June 2019, clinical data of patients with thymoma who underwent the novel "three-port" operation in our institution were analyzed retrospectively. The patients were divided into two groups according to the anesthesia methods, including a tracheal intubation general anesthesia group and a laryngeal mask general anesthesia group. There were 70 patients in the tracheal intubation general anesthesia group, including 42 males and 28 females, with an average age of 45.83±15.89 years. There were 39 patients in the laryngeal mask general anesthesia group, including 26 males and 13 females, with an average age of 43.31±15.64 years. The clinical data of the two groups were compared. Results The baseline characteristics of the patients in the two groups were well balanced (P>0.05). No massive bleeding, conversion to thoracotomy, postoperative myasthenia or death occurred in those patients. No patient with laryngeal mask anesthesia had a conversion to tracheal intubation anesthesia during the operation. There was no significant difference in the operation time, intraoperative bleeding, intraoperative maximum partial pressure of CO2, lowest partial pressure of oxygen and anesthesia effect score between the two groups (P>0.05). There was also no statistical difference in postoperative aspiration, gastrointestinal discomfort, length of hospital stay, pain score and patient satisfaction degree between the two groups (P>0.05). However, the anesthesia time before operation and the time of awake after anesthesia in the laryngeal mask anesthesia group were significantly shorter than those in the tracheal intubation general anesthesia group (P<0.05), and the incidence of transient arrhythmia, laryngeal discomfort and hoarseness in the laryngeal mask general anesthesia group was significantly lower than that in the tracheal intubation general anesthesia group (P<0.05). Conclusion The "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch under laryngeal mask general anesthesia is safe and feasible in the treatment of thymoma without myasthenia, and can be recommended routinely.
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@#Objective To evaluate the clinical outcomes of larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical esophageal squamous cell carcinoma (ESCC) without tumor involvement of the larynx and hypopharynx compared with the upper thoracic ESCC. Methods Retrospective and comparative analysis of consecutive patients with cervical and upper thoracic ESCC who underwent R0 surgical resection from 2006 to 2011 in our center was performed. Kaplan-Meier method was used to calculate the patients’ survival. Results In total, 44 pairs of patients, including 71 males and 17 females with an average age of 60.66±8.49 years were enrolled in the study after propensity score matching. The baseline characteristics of the two groups of patients were well balanced. There was no statistical difference in the operation time (P=0.100), blood loss (P=0.685), mortality rate in 30 days (P=1.000), total complication rate (P=0.829), cervical anastomosis leakage (P=0.816), mechanical ventilation (P=1.000), normal oral diet within 15 days (P=0.822) and anastomosis recurrence rate (P=0.676) between the two groups. Survival analysis showed that there was no statistical difference in survival time between the cervical group [31.83 (95%CI 8.65-55.02) months] and upper thoracic group [37.73 (95%CI 25.29-50.18) months, P=0.533]. The 5-year survival rates were 32.6% and 42.1%, respectively. Conclusion Larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical ESCC without involvement of the larynx and hypopharynx may result in a similar clinical outcome to upper thoracic ESCC.
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Objective To investigate the level of knowledge, attitude and practice (KAP) of cardiopulmonary resuscitation (CPR) and analyze its related influencing factors in order to provide the basis for the construction of CPR training and management model and enhance the knowledge level and operational skills of CPR among community residents in Shacheng district of Wenzhou City. Methods From June 2015 to June 2016, a total of 560 community residents in Shacheng district of Wenzhou City were randomly selected as the subjects based on community house number using the random number table method, and they were investigated by general information questionnaire, CPR training questionnaire, and CPR KAP questionnaire. Univariate and multivariate linear regression analyses were used to analyze the influencing factors on KAP of CPR among community residents; the bivariate correlation analysis was used to analyze the correlations between KAP of CPR and the dimensions of KAP in the community residents. Results Of the 560 community residents, 33.39% knew CPR, only 15.89% had received CPR training and 12.14% knew how to handle cardiac arrest (CA), the average score of CPR KAP in community residents was (42.50±11.34) scores, which was positively correlated with knowledge, attitude and behavior dimensions (r = 0.56, 0.45, 0.49, all P ＜ 0.05). The average scores of CPR KAP of residents with various occupations were as follows: farmers, workers, students, teachers, company staff, medical workers, and other residents (respectively 37.24±9.34, 38.28±8.12, 43.12±8.45, 45.45±10.23, 44.89±9.89, 49.67±7.45, 40.00±10.45), the average scores of CPR KAP of residents with various educational levels were as follows: elementary school and below, junior high school, senior high school or secondary technical school, college education, bachelor degree or above (respectively 35.65±8.76, 37.67±10.65, 40.87±9.87, 44.56±10.78, 49.87±9.23), the average scores of CPR KAP were differed by whether they knew CPR or not (47.34±8.76 vs. 40.07±11.23), whether they had received CPR training or not (49.56±9.56 vs. 41.17±11.78), and whether they knew how to deal with CA or not (51.89±9.34 vs. 41.20±11.18), which were statistically significant (all P ＜ 0.05). Multiple linear regression analysis showed that the education level [95% confidence interval (95%CI) =1.12 - 2.24, P = 0.00), whether they knew the CPR or not (95%CI = 0.87 - 1.89, P = 0.00), and whether they had received CPR training or not (95%CI = 1.32 - 2.58, P = 0.00) and whether they knew how to deal with CA or not (95%CI =1.87 - 3.23, P = 0.00) were the factors affecting the residents' KAP of CPR. Conclusions The CPR KAP level of community residents in Shacheng district of Wenzhou city is low, and the level is influenced by many factors such as education level, etc. Local public health departments should actively carry out effective training of CPR knowledge and skills, and from the CPR knowledge, attitude and practice aspects, comprehensively enhance the residents' level of CPR KAP.
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Objective To investigate the effects of moving services on negative emotions and quality of life of the patients with leukemia.Methods A total of 128 patients with leukemia were chosen and divided into the control group(n =66)and the intervention group(n =62)according to admission date.The patients of the control group received conventional nursing mode,while the patients of the intervention group were given moving services including updates care philosophy,advocated behavior reflect personalized and multi -style health education.The self -rating depression scale(SDA),self -rating anxiety scale(SAS)before and after the intervention were used to assess changes in patients with negative emotion,while the quality of life scale QLQ -C30 core was used to estimate quality of life in patients before and after treatment.Results After intervention,QLQ -C30 functional scores including physical function, role function,cognitive function,emotional function and social function score were higher than the control group [(68.79 ±13.97)points vs (60.48 ±14.95)points,(53.49 ±15.82)points vs (31.03 ±20.68)points,(88.81 ± 16.46)points vs (73.33 ±16.50)points,(86.48 ±8.21 )points vs (70.30 ±16.43 )points,(31.03 ± 1.27)points vs (26.36 ±8.72)points],and the differences were statistically significant(t =3.094,3.606,3.265, 3.478,3.20,all P <0.05).QLQ -C30 symptom scores including fatigue,pain,nausea,vomiting,dyspnea,insomnia, appetite loss,constipation,diarrhea rating were lower than the control group[(41.81 ±14.25)points vs (52.85 ± 14.57)points,(16.89 ±10.14)points vs (24.43 ±19.05 )points,(17.41 ±13.56 )points vs (29.51 ± 13.64)points,(25.83 ±21.09 )points vs (36.56 ±21.50)points,(11.54 ±8.19 )points vs (25.76 ± 19.07)points,(40.93 ±18.30)points vs (55.87 ±20.05 )points,(15.02 ±10.24)points vs (21.54 ± 12.41)points,(8.66 ±2.41)points vs (15.47 ±9.16)points],and there were statistically significant differences (t =3.179,3.243,3.359,3.470,3.205,3.151,4.282,3.153,all P <0.05).After intervention,the scores of SAS and SDS of the intervention group and the control group were (34.96 ±10.24)points vs (48.24 ±11.71)points, (33.58 ±9.60)points vs (42.06 ±9.62)points,and the differences were statistically significant(t =6.320,5.806, all P <0.05 ).The passing rate of care satisfaction of the intervention group was higher than the control group (98.06% vs 73.08%),and the time of hospitalization of the intervention group was lower than the control group [(22.02 ±2.24)d vs (27.54 ±3.41)d],and the differences were statistically significant(χ2 =4.337,t =3.759,all P <0.05).Conclusion Moving services can improve the quality of life of patients,reduce the negative emotions of patients,improve the quality of nursing services.
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Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after esophagectomy.Methods In the randomized controlled trial,60 patients undergoing esophagectomy were divided into study group(n=30,received olive oil-based lipid emulsion)and control group [n=30,received medium-chain triglyceride/long-chain triglyceride(MCT/LCT)emulsion].The parenteral nutrition Was provided for 7-10 postoperative days.The nutritional formulas were equivalent in nitrogen,calorie,osmotic pressure,and fluid volume.Peripheral venous blood tests were performed before operation and on the first and eighth postoperative days.All the patients were evaluated by nutritional status(weight,body mass index,nutritional risk screening,etc.),safety profiles[full blood test,electrolytes,aspartate aminotransferase(AST),alanine amiotransferase(ALT),total bilirubin and direct bilirubin,blood urea nitrogen(BUN),creatinine,blood glucose,etc.],and efficacy indicators(hemoglobin,albumin,total protein,etc.).Results The albumin and total protein levels returned to the normal ranges in beth groups 8 days after operation,although both levels were significantly higher in study group(P=0.000).Also,the difference of total protein levels between the eighth and first postoperative days Was significantly higher in the study group(P=0.002).In addition,the AST and BUN readings returned to normal ranges 8 days after operation in the study group, which were significantly lower than those in control group (P = 0.025, P = 0.013).No serious adverse events were reported in both groups.Other nutritional parameters, renal and hepatic safety profiels, vital signs, and hematology showed no significant difference between two groups.Conclusions Olive oil-based lipid emulsion is a safe and efficient lipid emulsion for parenteral nutrition in patients undergoing esophagectomy.Compared with MCT/LCT, it has less effect on AST and BUN.
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Objective To build a bio-material artificial chest wall and discuss its feasibility and efficiency in reconstruction of huge bony defects of chest wall in mongrels in comparison with traditional "sandwich" procedure. Methods (1) The procine osteal and membranate tissues were treated with epoxy cross linking method and their surfaces were modified with amino acid solutions at various concen-trations and at different temperatures to obtain an artificial pleura and artificial ribs for construction of the artificial chest wall. (2) The huge bony defects (5 cm×5 cm) were created in chest wall of five Chinese mongrels. (3) Three mongrels in test group was repaired with artificial chest wall, while two mongrels in control group was repaired with traditional "sandwich" complex. A follow-up was carried out to observe reconstruction effect and rejection in both groups at 3,6 and 12 months after implantation. Results There was no death found during the perioperative period and at 12 month follow-up in test group, with abnormal contour of chest wall and good thoracic activity after reconstruction. In the meantime, there found no rejection, collapse in the repaired region or paradoxical respiration. The postoperative X-rays at 3,6,12 and 24 months showed a good integrity of the thorax, with no collapse, deformation or abnormal movement. Meanwhile, the follow-up of control group showed a normal contour but slight collapse, with no paradoxical respiration. The Chest X-ray examination revealed that the bone cement in" sandwich" complex was X ray opaque and showed mild abnormal movement with breathing. The common blood test and immune items showed no abnormal. Conclusions The bio-material artificial chest wall is a safe and effective reconstruction technique for bony defects of thoracic wall in mongrels, with no acute or chronic rejection.
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Objective To investigate the features of lymph node metastasis and its effects on the prognosis of patients after radical operation for thoracic esophageal squamous cell cancer, and investigate the reasonable postoperative adjuvant protocol. Methods Multivariate analysis of the clinical data of 204 patients was carried out by Spearman correlation analysis, Cox model and Kaplan-Meier method. Results The lymph node metastasis rate was 40.2% (82/204), and 166 out of 2193 dissected lymph nodes had metastasis with the rate of 7.57%. The analysis of related factors revealed that the invasion depth, tumor length and differentiation grade were significantly associated with the postoperative lymph node metastasis (χ2 = 17.466, 11.494, 6.767, P <0.05), while age, tumor site were not significantly correlated with the postoperative lymph node metastasis (χ2=1.086, 3.897, P > 0.05). Kaplan-Meier analysis showed that the 1-, 3-, 5-year survival rates of patients with < 4 lymph nodes metastasis were significantly higher than those with ≥4 lymph nodes metastasis (χ2=4.493, 4.494, 4.450, P < 0.05). The recurrence and metastasis were more often occurred in patients with lymph node metastasis compared with those without lymph node metastasis (r=-2.060, -4.296, P <0.05). Multivariate analysis confirmed that the pathological stage, tumor differentiation grade, and the postoperative adjuvant treatment were the independent prognostic factors. Conclusions The invasion depth, tumor length and differentiation grade are significantly associated with the postoperative lymph node metastasis. The lymph node metastasis state and the number of involved lymph nodes affect the prognosis of patients. Oral administration of 5-FU is benefit to the patients without lymph node metastasis.