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@#Objective To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. Results Totally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P<0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1± 2 542.0 steps, P<0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.
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OBJECTIVE To investigate the effects of renally inappropriate medication （RIM） on the frailty of elderly patients with diabetes. METHODS The data of elderly patients with diabetes mellitus admitted to a third-grade class A hospital in Yunnan province from January to December 2022 were collected， and Beers criteria （2019 edition） and Chinese version of FRAIL scale were used to evaluate RIM and the frailty of the patients； the patients were divided into the trial group （with RIM） and the control group （without RIM） according to whether there was RIM. The propensity score matching was used to balance confounding factors between two groups， and the influence of RIM on the frailty of elderly diabetic patients was analyzed by the Logistic regression model. RESULTS Among the 367 patients， 80 patients （21.80%） had RIM， the drugs involved RIM were spironolactone （82.56%）， rivaroxaban （13.95%） and gabapentin （3.49%）. After reaching the balance between groups using the propensity score matching method， the incidence of frailty was 77.94% in trial group and 27.94% in control group （P＜0.001）； the difference was not statistically significant in other confounding factors between the two groups （P＞0.05）. Results of Logistic regression analysis showed that the risk of frailty in the experimental group was 3.118 times that of the control group （odds ratio was 3.118，95% confidence interval was 1.758-5.530， P＜0.001）. CONCLUSIONS RIM is a risk factor for the frailty of elderly patients with diabetes， which can be considered as an indicator for early identification and screening of the frailty of elderly diabetes patients.
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ObjectiveTo explore the safety and efficacy of robot-assisted minimally invasive esophagectomy （robot-assisted minimally invasive esophagectomy， RAMIE） and thoracic laparoscopy combined with minimally invasive esophageal resection （minimal invasive esophagectomy， MIE）. MethodsThe data of 188 patients treated with Da Vinci robot assisted minimally invasive esophageal resection （RAMIE） from April 2021 to December 2022 were analyzed. In the RAMIE group， 69 patients， 49 males and 20 female， age （67.2 ± 7.2）； 119 in the MIME group， respectively， 89 males and 30 female， age （69.1 ± 7.0）. At 1 ∶ 1， including 58 patients in the RAMIE group and 58 patients in the MIE group. The t-test， Wilcoxon rank-sum test， χ2 test， and so on. ResultsAfter PSM treatment， the clinical data between the two groups. There was no significant difference in operation time， postoperative tube days， and total number of lymph node dissection between the RAMIE and MIE groups （P <0.05）； the RAMIE group was better in terms of intraoperative bleeding and the MIE group， statistically significant （P <0.05）； the MIE group was better in drainage flow and lymph node dissection for three days （P <0.05）. In terms of postoperative complications， there was no statistical difference between RAMIE and MIE groups （P>0.05）. ConclusionThe recent efficacy of robot-assisted minimally invasive esophagectomy is comparable to that of thoracic laparoscopy and minimally invasive Mckeown esophagectomy； robotic-assisted minimally invasive esophagectomy can reduce intraoperative bleeding and have more advantages in left recurrent laryngeal nerve lymph node dissection.
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OBJECTIVE To evaluate the efficacy， safety and cost-effectiveness of generic drugs and original drugs of voriconazole. METHODS The information of patients who used voriconazole generic drugs selected in National Centralized Drug Procurement （generic drug group） or non-selected original drugs （original drug group） in the treatment of fungal infection was collected from the our hospital. The propensity score matching was carried out to eliminate bias. The comprehensive efficacy was evaluated according to clinical efficacy， image findings and microbiological test， and stratified analysis of different populations was conducted based on fungal species， underlying diseases， etc.， the efficacy of different stratifications was evaluated. Evaluation of safety was performed by using the incidence of adverse reactions. The total cost， defined daily doses （DDDs） and defined daily dose cost （DDDc） were used to evaluate the cost-effectiveness. RESULTS A total of 436 patients were included， and there were 190 patients in each group after matching. In terms of efficacy， the effective rates of voriconazole generic drugs and original drugs were 62.63% and 59.47% （P＝0.528）； in terms of safety， the incidence of adverse reactions caused by generic drugs and original drugs of voriconazole was 13.68% and 7.89%， respectively（P＝0.069）. In terms of cost-effectiveness， the average total cost of generic drugs was 4 636.26 yuan， and that of original drugs was 8 613.20 yuan （P＜0.001）. After the implementation of National Centralized Drug Procurement， replacement rate of generic drugs increased to 87.30%， and DDDc decreased by 59.08%. CONCLUSIONS The efficacy and safety of voriconazole generic drugs are similar to those of original drugs in the treatment of fungal infection， and it is more cost-effective in terms of treatment cost.
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Organ transplantation is the optimal treatment for end-stage organ failure. Nevertheless, organ shortage is a global problem, which limits further development of organ transplantation. Recent research shows that genetically modified pig may become a realistic alternative source of clinical organ transplantation donor. Xenotransplantation may serve as one of the effective measures to resolve the problem of organ shortage. Since 2021, 2 cases of living xenotransplantation and 6 cases of xenotransplantation in brain death recipients have been performed worldwide, and phase Ⅰ clinical trial of xenotransplantation has been launched, and the results have exceeded expectations. Therefore, in this article, recent clinical trial results of xenotransplantation in living and brain death recipients were retrospectively analyzed, and scientific, technical and ethical issues related to clinical research of xenotransplantation were illustrated, hoping to provide reference for clinical research of xenotransplantation in China and promote the development of xenotransplantation in clinical practice.
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RESUMEN Antecedentes : las ventajas de la hepatectomía videolaparoscópica (HVL) hicieron que gane cada vez más campo para el tratamiento de los tumores hepáticos benignos (THB). Objetivo : comparar los resultados perioperatorios de pacientes sometidos a HVL con los de los operados con hepatectomía abierta (HA) por THB, emparejados con propensity score matching (PSM). Material y métodos : estudio descriptivo, retrospectivo y comparativo de HA y HVL por THB entre agosto de 2010 y junio de 2021. Se analizaron variables demográficas, preoperatorias, intraoperatorias y posoperatorias. Para evitar sesgos de las distintas covariables entre los grupos se realizó un PSM 1:1. Resultados : de 403 hepatectomías, se analizaron 82 por THB. De ellas 36 (44%) fueron HA y 46 (56%) HVL. Edad media 45 ±14 años, 65% mujeres. Tras realizar el PSM, quedaron dos grupos de 28 pacientes cada uno. En HA, 5 (18%) pacientes requirieron transfusiones y ninguno en HVL (p = 0,01). Las complicaciones mayores se presentaron en 4 (14%) pacientes en HA, y ninguna en HVL (p = 0,03). Se reoperaron 4 (14%) pacientes con HA y ningún paciente con HVL (p = 0,03). La estadía hospitalaria total fue significativamente mayor en las HA (p = 0,04). No se registraron muertes a los 90 días en ninguno de los dos grupos. Conclusión : la HVL por THB es una técnica segura y eficaz, ya que los pacientes presentaron menor requerimiento transfusional, número de reoperaciones, de complicaciones mayores y de estadía hospitalaria que con HA. Por las ventajas encontradas, la HVL podría ser considerada la técnica de elección en cirugía por THB.
ABSTRACT Background : The advantages of laparoscopic liver resection (LLR) have increased its use for the treatment of benign liver tumors (BLTs). Objective : The aim of this study was to compare the perioperative outcomes of patients undergoing LLR with those operated on with open liver resection (OLR) for BLTs using propensity score matching (PSM). Material and methods : We conducted a descriptive and retrospective study comparing OLRs with LLRs performed between August 2010 and June 2021. The demographic, perioperative, intraoperative and postoperative variables were analyzed. We used PSM with 1:1 matching to avoid biases of the different covariates between the groups. Results : Of 303 liver resections, 82 corresponded to BLTs and were included in the analysis; 36 (44%) were OLRs and 46 (56%) were LLRs. Mean age was 45 ±14 years and 65% were women. After PSM, two groups of 28 patients each were constituted. Five patients (18%) in the OLR group and none in the LLR required transfusions (p = 0.01). Major complications, occurred in 4 (14%) patients in the OLR group and in no cases in the LLR group (p = 0.03). Four (14%) undergoing OLR required reoperation versus no patients with LLR (p = 0.03). Total length of hospital stay was significantly longer in OLR (p = 0.04). There were no deaths in any of the groups within 90 days. Conclusion : LLR for BLTs is a safe and effective technique, with lower requirement for transfusions, fewer reoperations and major complications and shorter length of hospital stay than OLR, Therefore, LLR could be considered the surgical technique of choice for BLTs.
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Abstract Objective The role of Primary Tumor Volume (PTV) in Nasopharyngeal Carcinoma (NPC) treated with Volumetric Modulated Arc Therapy (VMAT) is still unclear. The aim of this study was to access the effect of PTV in prognosis prediction of nasopharyngeal carcinoma in era of VMAT. Methods Between January 20 and November 2011, 498 consecutive NPC patients with stage I-IVA disease who received VMAT at a single center were retrospectively analyzed. Receiver Operating Characteristic (ROC) was performed to access the cut-off point of PTV. Univariate Kaplan-Meier and multivariate Cox regression analyses were used to evaluate prognostic value for PTV. The Propensity Score Matching (PSM) was used to adjust baseline potential confounders. Results The 5-year Locol-Regional Failure-Free (L-FFR), Distant Failure-Free Survival (D-FFR), Disease-Free Survival (DFS) and Overall Survival (OS) were 90.6%, 83.7%, 71.5% and 79.3%, respectively. Before PSM, the 5-year L-FFR, D-FFR, DFS, OS rates for NPC patients with PTV ≤ 38 mL vs. PTV > 38 mL were 94.1% vs. 90.4% (p= 0.063), 87.9% vs. 76.3% (p< 0.001), 78.5% vs. 58.5% (p< 0.001) and 86.3% vs. 66.7% (p< 0.001) respectively. Multivariate analysis showed PTV was an independent prognostic factor for D-FFS (p= 0.034), DFS (p= 0.002) and OS (p= 0.001). PTV classified was still an independent prognostic factor for OS after PSM (HR = 2.034, p= 0.025. Conclusions PTV had a substantial impact on the prognosis of NPC patients treated with VMAT before and after PSM simultaneously. PTV > 38 mL may be considered as an indicator of the clinical stage of nasopharyngeal carcinoma. Level of evidence III.
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Purpose: Recently, the proportion of patients with high myopia has shown a continuous growing trend, more toward the younger age groups. This study aimed to predict the changes in spherical equivalent refraction (SER) and axial length (AL) in children using machine learning methods. Methods: This study is a retrospective study. The cooperative ophthalmology hospital of this study collected data on 179 sets of childhood myopia examinations. The data collected included AL and SER from grades 1 to 6. This study used the six machine learning models to predict AL and SER based on the data. Six evaluation indicators were used to evaluate the prediction results of the models. Results: For predicting SER in grade 6, grade 5, grade 4, grade 3, and grade 2, the best results were obtained through the multilayer perceptron (MLP) algorithm, MLP algorithm, orthogonal matching pursuit (OMP) algorithm, OMP algorithm, and OMP algorithm, respectively. The R2 of the five models were 0.8997, 0.7839, 0.7177, 0.5118, and 0.1758, respectively. For predicting AL in grade 6, grade 5, grade 4, grade 3, and grade 2, the best results were obtained through the Extra Tree (ET) algorithm, MLP algorithm, kernel ridge (KR) algorithm, KR algorithm, and MLP algorithm, respectively. The R2 of the five models were 0.7546, 0.5456, 0.8755, 0.9072, and 0.8534, respectively. Conclusion: Therefore, in predicting SER, the OMP model performed better than the other models in most experiments. In predicting AL, the KR and MLP models were better than the other models in most experiments.
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@#Objective To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P>0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P>0.05). Conclusion Reasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.
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@#Objective To compare and analyze the occurrence of acute and chronic pain after subxiphoid and transcostal thoracoscopic extended thymectomy. Methods A retrospective analysis was performed on 150 patients who underwent thoracoscopic extended thymectomy in our hospital from July 2020 to June 2022, among whome 30 patients received subxiphoid video-assisted thoracic surgery, and 120 patients received transcostal video-assisted thoracic surgery. The patients were matched by the propensity score matching method. Postoperative pain was evaluated by numeric rating scale (NRS). The intraoperative conditions and postoperative pain incidence were compared between the two groups. Results After matching, 60 patients were enrolled, 30 in each group, including 30 males and 30 females with an average age of 50.78±12.13 years. There was no difference in the general clinical data between the two groups (P>0.05), and no perioperative death. There were statistical differences in the intraoperative blood loss, postoperative drainage volume, postoperative catheter duration, postoperative hospital stay, postoperative pain on 1 d, 2 d, 3 d, 7 d, 3 months and 6 months after the surgery (P<0.05), but there was no statistical difference in the operation time or the postoperative 14 d NRS score (P>0.05). Further univariate and multivariate analyses for postoperative chronic pain showed that surgical method and postoperative 14 d NRS score were risk factors for chronic pain at the 3 months and 6 months after the surgery (P<0.05). Conclusion The subxiphoid thoracoscopic extended thymectomy has advantages over transcostal thoracoscopic surgery in the postoperative acute and chronic pain.
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Objective:To analyze the effect of the implementation of diagnosis-intervention packet (DIP) on the doctors′ diagnosis and treatment behavior of chronic diseases, so as to provide reference for further improving medical insurance payment related policies.Methods:The first page information of chronic disease patients admitted to hospitals with diabetes, hypertension and coronary atherosclerotic heart disease as the main conditions in 103 hospitals at all levels and township health centers in a city from 2016 to 2020 was collected, and the patients were divided into non-DIP group and DIP group according to the implementation time of DIP. After 1∶1 propensity score matching to balance the general conditions of the 2 groups, the diagnosis and treatment behaviors were analyzed from two dimensions: diagnostic behavior and treatment behavior. The grade A rate of medical record writing, admission and discharge diagnosis coincidence rate, and the average length of stay were used to evaluate the diagnostic behavior; the proportion of drugs and the degree of change in the cost structure were used as the evaluation indicators of treatment behavior.Results:After matching, 41 050 patients were included in both the non-DIP group and the DIP group.From the perspective of diagnostic behavior, the grade A rate of medical record writing in the non-DIP group and the DIP group was 99.40% and 99.83%, the coincidence rate of admission and discharge diagnosis was 58.42% and 61.79%, the average hospital stay was 8.03 days and 7.04 days respectively, and the difference between the groups was significant ( P<0.05). From the view of treatment behavior, the proportion of drugs decreased from 33.00% in the non-DIP group to 27.59% in the DIP group, with a significant difference ( P<0.05); the drug cost represented by Western medicine changed negatively, while the diagnostic cost showed a positive change. Conclusions:DIP has played a certain role in regulating doctors′ diagnosis and treatment behavior for chronic diseases. Among them, doctors have significantly improved their diagnostic behavior for chronic diseases, and the proportion of drugs in treatment behavior has been well controlled.
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Objective:To report the use of right internal mammary artery (RIMA) in coronary artery bypass grafting (CABG) in our center, summarize the purpose and configuration of RIMA graft in CABG.Methods:All clinical data of coronary artery bypass grafting patients in our center performed in the past 6 years were collected and analyzed retrospectively. Those patients were divided into RIMA group and non-RIMA group according to the use of RIMA. Propensity score matching had been performed before these data was compared. Surgical technique of use of RIMA was summarized.Results:1 537 CABG had been performed from January 1st, 2016 to October 31st, 2021 in our center. Of which, 128 cases were allocated to RIMA group. After propensity score matching having been performed, there was no difference in baseline data between the RIMA group and the non-RIMA group (128 cases), and the RIMA group had more grafts and arterial grafts than the non-RIMA group. The postoperative drainage volume in the RIMA group was more than that of the non-RIMA group. However, there was no statistical significance in difference of transfusion between two groups. Also, there was no difference in postoperative mechanical ventilation time, ICU time and length of stay postoperatively. The postoperative complications were similar between two groups. Postoperative patency rate of the RIMA graft was as high as 95.2%. The target vessels of RIMA included left anterior descending branch (45 cases), diagonal branch (19 cases), intermediate branch (12 cases). obtuse marginal or circumflex branch (16 cases), posterior descending branch (5 cases) and right coronary trunk (18 cases). 41 RIMA used as free grafts, 87 used as in situ grafts, of which 19 RIMA need lengthened by other graft vessels.Conclusion:The patency rate of RIMA graft is high and the application of RIMA do not increase the surgical risk significantly. However, there are versatile contour of RIMA grafts. It can be used as artery graft in selected patients.
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Objective:To explore the early and medium-long term outcomes of steatosis donor liver transplantation(LT)for an optimal clinical application.Methods:From January 2015 to December 2020, this retrospective cohort study was conducted jointly at Shulan (Hangzhou) Hospital, First Affiliated Hospital of Zhejiang University and First Hospital of Jilin University. The relevant clinicopathological and follow-up data were collected from 1535 LT recipients. For comparison, propensity score was utilized for case-control matching of steatosis and non-steatosis donor livers. According to presence or absence of liver steatosis, the recipients were divided into two groups of steatosis donor liver (n=243) and non-steatosis donor liver (n=1292). And 1∶1 propensity score matching was made for two groups. Then early and medium-long term outcomes of two groups were examined. Counts were described as absolute numbers. Kaplan-Meier method was employed for calculating survival time and plotting survival curve and Log-rank test for survival analysis. COX regression model was utilized for univariate and multivariate analyses. Based on basic metabolic disease pre-LT, steatosis donor liver recipients were divided into three subgroups: BMI ≥25 kg/m 2 with hypertension or diabetes (n=21), BMI<25 kg/m 2 and no hypertension or diabetes (n=130) and other recipients (n=92). A comparative study was performed for determining the prognosis of subgroups according to the different characteristics of recipient and donor liver. Results:No significant inter-group difference existed in 2-year survival post-LT ( P=0.174). However, significant inter-group difference in survival existed after 2 years post-LT ( P=0.004). And 3/5-year survival rate of steatosis donor liver was 66.4% and 44.2% respectively. Both were significantly lower than those of non-steatosis donor liver. Multivariate Cox regression analysis indicated that steatosis donor liver and male recipients were independent risk factors for prognosis >2 years survival post-LT( P=0.008, P=0.004). Subgroup analysis of steatosis liver donors showed that the prognosis of patients with BMI ≥25 kg/m 2 with hypertension or diabetes was significantly worse than other subgroups (BMI <25 kg/m 2 with no hypertension or diabetes and other recipients) <2 years survival post-LT ( P=0.029, P=0.043). Conclusions:Steatosis donor liver does not affect early survival of recipients, yet reduces medium-long term survival rate of recipients notably. In steatosis donor liver recipients, early survival rate declines markedly in recipients with preoperative BMI ≥25 kg/m 2 with hypertension or diabetes as compared with BMI <25 kg/m 2 with no hypertension or diabetes group.
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Objective:To investigate the risk factors of urethrovesical anastomotic leakage after laparoscopic radical prostatectomy.Methods:The clinical data of 292 patients who underwent laparoscopic radical prostatectomy in the Tenth People's Hospital Affiliated to Tongji University from January to December 2021 were retrospectively analyzed. According to whether there was anastomotic leakage, the patients were divided into leakage group (27 cases) and non-leakage group (265 cases). There were no significant differences in age [(71.5±6.5) years vs. (70.2±6.4) years], body mass index [(24.5±3.6) kg/m 2 vs. (24.2±3.0) kg/m 2], prostate volume[40(27.3, 63.2)ml vs. 38(28.1, 56.2)ml], Gleason score, clinical stage, and risk classification between the leakage group and the non-leakage group ( P>0.05), but the total prostate-specific antigen in the leakage group was significantly higher than that in the non-leakage group[20.0 (9.6, 79.0) ng/ml vs. 13.7 (8.5, 25.0) ng/ml, P=0.049]. Propensity score matching (PSM) was used to match the above indicators between the leakage group and the non-leakage group as 1∶1, so that the baseline of the two groups was balanced. The perioperative indicators of the matched two groups of patients were compared and analyzed. Statistically significant indicators were selected and included in univariate and multivariate logistic regression to analyze the risk factors of anastomotic leakage after radical prostatectomy. Finally, the receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated. The accuracy of each factor in predicting urine leakage was obtained. Results:After PSM, 24 cases were successfully matched. The leakage group had shorter membranous urethral length (MUL) [(15.5±2.2)mm vs. (17.5±1.5)mm, P<0.001], thinner membranous urethral wall thickness (UWT) [(9.5±1.9)mm vs. (10.6±1.5)mm, P=0.024], longer anastomotic time of urethrovesical neck[(21.6±4.1)min vs. (16.9±2.9)min, P<0.001] and higher failure rate of water injection test [16.7% (4/24) vs. 4.2% (1/24), P=0.045] than the non-leakage group. There was no significant difference in other indicators between the two groups. The results of multivariate logistic regression analysis showed that short MUL ( OR=0.544, 95% CI 0.335-0.884, P=0.014), narrow UWT ( OR=0.538, 95% CI 0.313-0.924, P=0.025) and long anastomotic time of urethrovesical neck ( OR=1.519, 95% CI 1.122-2.110, P=0.009) were independent risk factors for anastomotic urine leakage. ROC curve analysis showed that the AUC of MUL, UWT, and anastomotic time were 0.789 (95% CI 0.651-0.927), 0.715 (95% CI 0.562-0.868), and 0.842 (95% CI 0.731-0.953), respectively. Conclusions:Narrow and short membranous urethra and long anastomosis time in patients with laparoscopic radical prostatectomy may be independent risk factors for postoperative anastomotic leakage, which may predict the occurrence of anastomotic leakage.
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Objective:To compare the clinical efficacy and toxicity of intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in radical radiotherapy for cervical cancer.Methods:Clinical data of 1002 patients with cervical cancer treated with radical radiotherapy at Zhejiang Cancer Hospital from September 2013 to December 2016 were retrospectively analyzed. All patients were divided into the IMRT group and 3D-CRT group according to the technology of external beam radiation therapy (EBRT). After 1∶1 propensity score matching (PSM), clinical prognosis of patients receiving IMRT or 3D-CRT was compared. Continuous data were expressed as Mean ± SD or median . Categorical data were described by case number (percentage). Quantitative data were compared by t-test. Qualitative data were compared by chi-square test or Fisher's exact test. Survival rates in two groups were calculated by Kaplan-Meier method and log-rank test. Results:The percentage of patients who received pelvic and para-aortic radiotherapy in the IMRT group was significantly higher than that in the 3D-CRT group (14.9% vs. 1.2%, P<0.001). The percentage of patients whose positive lymph nodes dose reached 55 Gy or more in the IMRT group was significantly higher than that in the 3D-CRT group (26.6% vs. 15.5%, P=0.002). In the IMRT group, the 5-year disease-free survival (DFS) rate (74.6% vs. 68.9%, P=0.084) and overall survival (OS) rate (79.4% vs. 74.9%, P=0.270) were slightly higher than those in the 3D-CRT group, but there were no significant differences between two groups. In the IMRT group, the local recurrence (3.0% vs. 6.9%, P=0.020) and distant lymph node metastasis rates (4.2% vs. 9.0%, P=0.013) were significantly lower compared with those in the 3D-CRT group. In terms of acute radiotherapy toxicities, grade 3-4 leukopenia (46.3% vs. 37.9%, P=0.028) and anemia (18.8% vs. 14.0%, P<0.001) occurred significantly more frequently in the IMRT group than in the 3D-CRT group. Conclusions:Both IMRT and 3D-CRT could achieve good therapeutic outcomes in radical radiotherapy of cervical cancer. IMRT can boost the radiation dose of metastatic lymph nodes and has significant advantages in reducing local recurrence and distant lymph node metastasis.
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Objective:To investigate the correlation between the tortuosity of the internal carotid artery and the formation of internal carotid aneurysms.Methods:The clinical data of patients with suspected cerebrovascular disease admitted to the Jinling Hospital from July 2009 to March 2017 were retrospectively collected. All patients underwent head CT angiography and digital subtraction angiography. Patients with single internal carotid artery aneurysm were classified as the aneurysm group, and patients without obvious abnormal vascular disease were classified as the control group. The demographic information of the patients, including age, gender, history of hypertension and diabetes, were collected. The size of the aneurysm and the tortuosity parameters of the internal carotid artery were measured, including the classification of the tortuosity of internal carotid artery, anterior genu angle (A angle), posterior genu angle (P angle), sum of the angles of A angle and P angle (AP angle) and height difference of anterior genu and posterior genu (D value). SPSS software was used for propensity score matching (PSM). Independent sample t test, Mann-Whitney U test or χ 2 test, Fisher exact test were used to compare the differences of each parameter between the two groups. Spearman analysis was used to analyze the correlation between the tortuosity and aneurysm size. A multivariate logistic regression was used to analyze the independent risk factors of aneurysm formation and to predict the formation of internal carotid aneurysm. The receiver operating characteristic curve and the area under the curve were used for model performance. Results:After PSM, 108 patients were included in each group. The proportion of tortuous internal carotid artery in the aneurysm group was lower than that in the control group [19.4% (21/108) vs. 32.4% (35/108), χ 2=4.72, P=0.030]. A, P and AP angles in the aneurysm group were significantly larger than those in the control group ( U=7 105.50, P=0.006; U=7 139.00, P=0.004; t=-3.14, P=0.002). Multivariate logistic regression analysis showed that AP angle (OR=1.010, 95%CI 1.003-1.016, P=0.002) was an independent risk factor for aneurysm formation. The area under the curves of logistic regression model based on AP angle was 0.624 (95%CI 0.549-0.699). There was a weak correlation between the size of internal carotid artery aneurysm and AP angle ( r=0.210, P=0.002). Conclusions:The tortuosity of the internal carotid artery is associated with the formation of internal carotid artery aneurysms, and the AP angle is an independent risk factor for the formation of internal carotid artery aneurysms, and a weak positive correlation with the size of the aneurysm is observed. It provides a new idea for understanding the formation of internal carotid artery aneurysms from the morphological characteristics of the parent artery.
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Objective:To investigate the prevalence of thyroid nodules (TN) among people undergoing physical examination in Taiyuan City, and evaluate the impact of hyperuricemia (HUA) on the risk of TN.Methods:Using a prospective design, a total of 42 966 people who underwent routine physical examination at Shanxi Shangning Health Examination Center from October 2020 to October 2021 were selected as subjects and divided into the HUA group ( n = 7 235) and the non-HUA group ( n = 35 731) based on the serum uric acid levels. The propensity score matching (PSM) method was used to balance the confounding factors between groups, and logistic regression was used to analyze the impact of HUA on the risk of TN. Results:The total detection rate of TN in the physical examination population was 55.6% (23 907/42 966). The detection rate of TN in females [61.0% (15 011/24 618)] was higher than that in males [48.5% (8 896/18 348)], and the difference was statistically significant (χ 2 = 664.55, P < 0.001). A total of 2 438 pairs of matching data were obtained after PSM, and the distribution of confounding factors in HUA and non-HUA groups reached equilibrium (the absolute values of standardized differences < 0.10). Logistic regression analysis before PSM showed that HUA was a protective factor for the incidence of TN in general population and males [odds ratio ( OR) = 0.696, 0.817, 95% confidence interval ( CI): 0.661 - 0.732, 0.768 - 0.868], while HUA was a risk factor for the incidence of TN in females ( OR = 1.370, 95% CI: 1.192 - 1.574). After PSM, HUA was not a influencing factor for the incidence of TN in general population and males ( P > 0.05), but it was still a risk factor in females for the onset of TN ( OR = 1.373, 95% CI: 1.014 - 1.858). Conclusion:In the physical examination population in Taiyuan City, HUA is an independent risk factor for TN in females.
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Objective:To analyze the application effect of nano-carbon lymphatic tracer technology in laparoscopic colon cancer (CC) radical resection based on propensity matching.Methods:Retrospective case-control study was performed in this study. From January 2016 to April 2021, 714 cases of CC patients who underwent laparoscopic CC radical resection in Kunshan Second People′s Hospital were divided into groups according to whether or not the nano-carbon lymphatic tracing technique was applied. Seventy-eight cases in group A were applied with nano-carbon lymphatic tracing technique, while 636 cases in group B were not applied with nano-carbon lymphatic tracing technique. The initial data were matched 1∶3 by the propensity score matching method, and finally group A (73 cases) and group B (219 cases) were obtained. The detection of lymph nodes in the two groups after propensity score matching was compared.Results:By comparing the baseline data of the two groups after propensity score matching, it was found that there were no significant differences in gender, height, weight, body mass index, tumor T stage, tumor N stage, tumor TNM stage, preoperative chemotherapy, or tumor location ( P>0.05). The total number of lymph nodes in group A was higher than that in group B: (22.24 ± 7.08) pieces vs. (19.03 ± 6.29) pieces, and the difference was statistically significant ( t = 3.66, P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis in group A were not significantly different from those in group B ( P>0.05). Tumor T stage T 3, tumor N stage N 0, tumor TNM stage Ⅱ, and preoperative chemotherapy, the total number of lymph nodes in group A was higher than that in group B: 23 (6, 60) pieces vs. 19 (4, 54) pieces , 20 (3, 62) pieces vs. 18 (3, 75) pieces, 23 (6, 59) pieces vs. 20 (7, 54) pieces, 22 (5, 45) pieces vs. 14 (4, 46) pieces, and the difference was statistically significant ( Z = 2.43, 2.70, 2.64 and 3.32; P<0.05); the number of positive lymph nodes and the degree of lymph node metastasis of tumor N stage N 2 in group A were lower than those in group B: 4 (4, 9) pieces vs. 6 (4, 25) pieces , 16 (10, 42) pieces vs. 32 (19, 100) pieces, and the difference between groups was statistically significant ( Z = -2.53 and -2.87, P<0.05). Followed up to April 2022, among the 292 patients, 5 were lost to follow-up, the 3-year disease-free survival rates of 72 patients in group A and 215 patients in group B were 83.33% (60/72) and 91.16% (196/215) respectively, there was no significant difference between two groups ( P>0.05). Conclusions:The number of lymph nodes detected in laparoscopic CC radical resection increases after the application of nano-carbon lymphatic tracing technology.
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Objective:To evaluate the protective effect of foam dressing in preventing intraoperative acquired pressure injury (IAPI), and to provide reference basis for prevention and treatment of IAPI during clinical operation.Methods:The clinical data of 455 surgical patients admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University from October 2020 to January 2021 were retrospectively collected. According to whether foam dressing was used at the compression site during operation, the patients were divided into dressing group (101 cases) and control group (354 cases). The two groups were matched with age, body mass index, preoperative Braden and cerebrovascular disease as covariates, and were finally divided into 89 patients in the dressing group and 162 patients in the control group. Logistic regression analysis and stratified analysis were used to comprehensively evaluate the actual effect of foam dressing on the occurrence of IAPI in the surgical patients.Results:Among the 251 patients, there were 14 (15.7%) cases with IAPI in the dressing group and 13 (8.0%) cases in the control group, and the difference was not statistically significant ( χ2=3.41, P>0.05). Among the patients in the prone position, compared to the control group, the dressing group can effectively reduce the risk of IAPI in surgical patients by 77% ( OR=0.23, 95% CI 0.05-0.98, P<0.05). There was no interaction between foam dressing and intraoperative surgical characteristics ( P>0.05). Conclusions:Foam dressing plays a protective role in preventing the occurrence of IAPI in patients undergoing surgery in the prone position. There was no significant protective effect of intraoperative foam dressing in patients with other surgical characteristics.
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OBJECTIVE@#To investigate the effect of dexmedetomidine (DEX) on renal function after laparoscopic radical nephrectomy.@*METHODS@#We reviewed the clinical data of 282 patients with renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy (LRN) in the Department of Urology, Third Medical Center of PLA General Hospital from November, 2020 and June, 2022.According to whether DEX was used during the operation, the patients were divided into DEX group and control group, and after propensity score matching, 99 patients were finally enrolled in each group.The incidence of acute kidney injuries were compared between the two groups.Serum creatinine (sCr) data within 3 months to 1 year after the operation were available in 51 patients, including 26 in DEX group and 25 in the control group, and the incidence of chronic kidney disease (CKD) was compared between the two groups.@*RESULTS@#After propensity score matching and adjustment for significant covariates, there were no significant differences in postoperative levels of sCr, cystatin C (CysC), β2-microglobulin (β2-MG), hemoglobin (Hb), or C-reactive protein (CRP), extubation time, incidence of AKI, or length of hospital stay between the two groups (P>0.05).The intraoperative urine volume was significantly higher in DEX group than in the control group (P < 0.05).A significant correlation between AKI and CKD was noted in the patients (P < 0.05).The incidence of CKD did not differ significantly between the two groups (P>0.05).@*CONCLUSION@#DEX can not reduce the incidence of AKI or CKD after LRN.